Advocating Intersectoral Action for Health Equity and Well-Being: The Importance of Adapting Communication to Concept and Audience

"...we are very aware of the importance of transforming evidence into meaningful information for different audiences, whether they are politicians, practitioners, or the public."

The Regional Office for Europe of the World Health Organization (WHO) contends that, to improve health and well-being and tackle inequities effectively, many stakeholders and non-health sectors of government need to be involved in the response. Communicating health information in ways appropriate for both context and intended audience is particularly important in advocating, and translating data for, intersectoral action for equity and well-being. In order to facilitate an exchange of experience in the translation and communication of health information and data for different audiences, the WHO Regional Office for Europe and the Centre for Health and Development Murska Sobota, Slovenia, hosted a summer school in Ljubljana, Slovenia, from July 6-7 2016. This publication offers a detailed report of the contents and topics covered during the 2-day meeting, providing a perspective on the specific role of intersectoral solutions in improving public health and developing better conditions for population health.

As the report reveals, there were many opportunities during the event to remind the participants (senior civil servants and public health experts from across the WHO European Region) that the receptivity of key stakeholders to evidence and data provided forms the basis of transformative change at all levels: international, national, and regional. This means that how we communicate public health messages plays a pivotal role in the progress we make in implementing guiding policies such as Health 2020 and the United Nations 2030 Agenda and in reaching the Sustainable Development Goals (SDGs). In dealing with health risk, disease prevention, and health promotion, strategic communication can thus act as a game changer on the one hand, and as a formative element for the public on the other.

The different sections of the report draw on presentations at the summer school (listed in Annex 1) and other relevant material to give the reader an insight into experience gained across the European Region and beyond, as well as lessons learnt, in engaging with different audiences on intersectoral action for health and well-being. These presentations address: translating evidence into policy effectively; the role of evidence in policymaking, including examples from WHO Member States; the communication of health data and information to different audiences, with a focus on data profiling and social marketing campaigns; and the communication of health risks to different audiences.

Participants in the summer school explored a population approach - that is, focusing on improving the health of a population or subpopulation, as opposed to trying to reach the the individual. The idea is that this approach "not only has a wider-reaching impact but also greater benefits, such as a sustainable and integrated health system, increased national growth and productivity, and stronger social cohesion and citizen engagement. To obtain a comprehensive picture of a population's health, data from other sectors are also necessary."

A key theme to emerge from the discussions is that context specificity is crucial to the communication and presentation of data. Factors that play a key role in policy decision-making are, among others: evidence; experience and expertise; political context; public opinion; values and judgements; culture and traditions; available resources (human and physical); budgetary constraints; policy narratives; and non-health stakeholders (for example, pressure groups, lobbyists, industry, and civil society). In the same way, the characteristics of the intended audience (for example, age, gender, ideology, and role) and whether it is in the public or private sector or is a political party/affiliation, must be taken into consideration in determining the communication approach and data to be used.

In a similar vein, the severity of risk perception depends on the intended audience. Risk perception comprises two key elements: hazard and outrage. The level of outrage drives perception, not the hazard. Key factors of risk communication include:

• Framing and method of communication appropriate to the intended audience - For example, if certain data are destined for a specific audience, it is important to make them accessible to that audience through media outlets they actually use (newspapers and magazines' online sites), as opposed to simply publishing the data in scientific journals.
• Quality of information, transparency, simplicity, coherence, and timing of message - Consider all these elements and ensure that the communication reflects receptivity to public concerns.
• Multisectoral and multistakeholder involvement in a joint communication strategy, led by a single figurehead.
• A clear methodology, which should be participatory and integrate social and traditional methods of communication, and impartiality in integrating robust evidence with public norms and values.
• Advantages of new communication vehicles - When used correctly, social media promote a sharing aspect that creates a sense of active communication. Social media have a larger outreach than traditional media, and make it possible to communicate quickly and broadly; however, the speed of communication can also cause a rapid spread of false information.
• Effect of outrage on risk perception - It is usually the level of outrage - as opposed to the level of hazard - that determines political action, if any.
• Importance of embedding risk communication in scientific evidence, even if initially presented in a more accessible form (for example, as infographics).
• Need for capacity-building in the area of risk communication - It is a specialised task, requiring particular skills. The emergence of new types of social media also reiterates the fact that professionals working in the communication area must adapt to and be receptive of a changing world.
• Monitoring as a component of risk management and communication - Monitoring activities (such as, the real-time measurement of air quality in a city or region) are important components of risk management and communication and increase the effectiveness of both by allowing for evidence-based responses and promoting the credibility of the message.

Other selected main messages to emerge from the summer school:

• The principles of the Ottawa Charter are as relevant today as they were in 1986, but approaches must be adapted to fit their context (existing resource structures and power relationships within the environment) to ensure effective implementation. In striving to meet their commitments to Health 2020 and the SDGs, and through their participation in networks discussed in the publication, such as the WHO Regions for Health Network (RHN) and EVIPNet Europe, the countries are engaged in many activities in the spirit of the Ottawa Charter.
• The 2030 Agenda and its SDGs offer an opportunity for intersectoral collaboration and the formation of new transformative partnerships.
• Effective solutions require evidence-informed decisions, but there are a number of challenges related to use of the evidence base. EVIPNet Europe is working with countries to improve evidence-informed policymaking in the Region.
• Reducing health inequities requires reducing material and social inequities. It is important to ensure that policy action does not inadvertently contribute to increasing inequities through interventions that are not sensitive enough to equity. If action to tackle inequities is to be effective, it must be universal, and both the scale and intensity of the action must be proportionate to the level of disadvantage.
• A population-health approach is crucial to reducing health inequities and poverty. An analysis based only on health data does not give an overall picture of the health of a population.
• Data-sharing platforms are crucial in encouraging other sectors to become involved. Such platforms require the support of an intersectoral team.
• The different levels of the health system that use health equity data are unique audiences. These are the programme/department level, the system-planning/quality-improvement level, and the senior-management/strategy level. Engaging with any of them, either individually, or in conjunction with each other, requires a different approach and strategy.
• The type of data used in a communication approach is also dependent on the intended audience. This can be by level (data from the international, national, or subnational levels) or by timescale (elected politicians may be interested in data showing what can be done in an election-cycle, while others may require data for a longer period).
• Technology is key in communicating health information. It can help mitigate challenges, such as language barriers, issues of anonymity, unfamiliarity with the health system (for example, in the case of migrants), reluctance to engage with the health system for different reasons, and the inability to access the formal health system.
• Visuals can help in communicating data. Presenting data, using innovative visual technology, such as infographics, can have a stronger impact than simply showing statistics, depending on the audience.

Here is one of the examples from the publication that illustrates some of these messages in action: In Canada, the Saskatoon Health Region decided to alter its mode of communicating data. The policy had been to release a single, long-term report on health equity every four years and topical reports in between. They opted instead for a database-related approach that entailed regularly updating the core data and releasing various mini reports on micro topics throughout the year, as well as recommendations for policy- and decision-makers resulting from periodic reviews. They also expanded the indicators to include social determinants of health (SDH) and held follow-up consultations with stakeholders to assist them in interpreting, analysing, and disseminating the data, and to improve their uptake and ownership. This was combined with presentations, including infographics, and one-page briefings for relevant stakeholders, government committees, and the media to maximise the reach of the data and optimise their use. The Saskatoon model initiated a change in health-status reporting by introducing a web-based format, using the intersectoral website "CommunityView Collaboration". The website presents infographics and one-page documents, allowing users to click for more information, including a summary of recommendations for the health and other sectors on improving population health, and links to related work and research. The development of the website involved consultations with intended audiences to fine-tune format and content.