Opinion: Communication is essential to achieving WHO’s new strategy

The new draft 13th General Programme of Work for 2019-2023, adopted at this year’s World Health Assembly, articulates the World Health Organization’s vision to “promote health, keep the world safe, serve the vulnerable.” At the same time, this bold and exciting vision aligns with the United Nation’s Sustainable Development Goals, particularly SDG 3 on ensuring healthy lives and promoting well-being for all, at all ages. It also describes strategic and organizational shifts focusing on three priority areas: Healthier populations, health emergencies, and universal health coverage.

However, without creative and innovative ways of addressing these priorities — and in particular, leveraging the capabilities and capacities of the private sector through public-private partnerships — the progress that has been achieved over the past 25 years will continue to plateau.

A common thread that runs through each of the priority areas, and one that will strengthen their successful outcomes is the implementation of effective, evidence-based, creative health communications — a model the private sector has used successfully to fuel the multitrillion-dollar brand market.

Effective health communications, which are often under-appreciated and under-funded in the public sector, must be based on strong evidence that shines a light on the life of the “health consumer,” who is often a woman and mother. To engage this consumer, we must understand the culture that surrounds her, who and what her influences are, what competitive forces dictate her decision-making, and where she gets the information that she perceives as trustworthy. We must be dedicated to the relentless pursuit of truth in all of its forms to generate life-changing ideas that improve the health of humanity.

Health communications with these underpinnings can persuade a mother of the value of childhood vaccines and provide the motivation she needs to bring her child to the clinic, despite logistical and financial barriers. And, it is one of the most important ways to change long-standing cultural beliefs and alter unhealthy behaviors such as tobacco use and poor nutrition, or to encourage preventive measures in the case of asymptomatic conditions such as hypertension and diabetes.

First priority area: Healthier populations

The challenges to promoting healthier populations include noncommunicable diseases, conditions — such as obesity, hypertension, cardiovascular disease, diabetes, chronic obstructive pulmonary disease, cancer, and mental health disorders — which are on the rise, particularly in low- and middle-income countries.  

WHO intends to work with countries to improve human capital, prevent NCDs, promote mental health, and address both high-impact diseases — such as malaria — tackle antimicrobial resistance, and the health effects of climate change.

However, tackling NCDs — which are often the result of lifestyle choices and lack of preventive services due to environmental conditions — requires changing deeply entrenched habits and practices, overcoming social norms to influence behavior, and improving uptake of existing preventive services. As many NCDs are characterized by long periods of asymptomatic disease progression, the challenges to altering lifestyle behaviors in the absence of acute symptomatic episodes are great. The vast differences in culture within and between regions also means that one size does not fit all, and the strategies needed to address the barriers to behavior change must be well-founded in a deep understanding of local and regional cultures, traditions, and habits.  

Second priority area: Health emergencies

The recent Ebola outbreak in West Africa and the current outbreak in the Democratic Republic of the Congo provide an opportunity to revisit the importance of communications strategy preplanning.

Even though WHO has committed to building and sustaining resilient capacities to ensure that populations have access to health products and services during outbreaks, a report on lessons learned in Sierra Leone during the 2014 Ebola outbreak concluded the messages initially provided by health officials were unclear and inconsistent, and social media amplified and spread misconceptions and misinformation. Although health-related messages were widely disseminated through radio and were effective in providing widespread awareness of Ebola, these messages did little to change the behaviors and practices that directly contributed to its spread.

In June 2014, four months after cases began to spike, and 11 months after the initial case was reported in late December 2013, the communications strategy shifted from awareness campaigns to behavior change campaigns. A social mobilization action consortium was established to deliver evidence-based communications activities through radio, by training religious leaders, engaging with on-the-ground community mobilizers, and through Ebola survivors. The report suggests the new strategy likely contributed to the decline in cases over the ensuing months.  

It is clear that resources for communications were not prioritized and strategies that could have been implemented rapidly were not in place. An effective, evidence-based communications strategy that targeted changing behaviors, rather than raising awareness, happened far too late to alter the course of the disease for many. Strategies to address similar outbreaks, such as the current Ebola outbreak in DRC, as well as future pandemics would likely benefit from the preplanned development of a robust health communications strategy tailored regionally, which can be deployed within days of an outbreak, rather than months.  

Third priority area: UHC

The ultimate impact of UHC will not be realized unless people actually take up the products and services provided to them. Often, long-standing cultural beliefs are a significant barrier that can dramatically limit the perceived value of important components of the health system, despite their availability.  

For instance, mothers will choose to pay for the services of traditional birth attendants for antenatal and delivery services, rather than attend free government clinics, based on their beliefs. A mother may also give a baby diluted animal milk rather than breastfeed based on belief systems held by their elders, and myths and misperceptions about contraceptives and the prevalence of gender inequalities may impede or prevent women from accessing birth control.  

The General Programme of Work encourages countries to improve service delivery; strengthen the health workforce; ensure provision of essential medicines, vaccines and health products; and strengthen governance, financial, and informational systems.

However, the “build it and they will come” model does not take into account the myriad of pressures, cultural influences, and forces that individuals face when prioritizing how they pursue health and wellness decisions. More needs to be done to understand these pressures and barriers, develop effective and creative communications that harness these beliefs, and reach individuals where they live as empowered health consumers rather than passive recipients of health services.  

Across each of the three key priority areas, the development of effective health communications based on evidence that takes into account the most effective channels of communication, that are targeted at key populations, that are creative and meaningful to the audience, and that can be measured for impact, will be essential to achieving the health outcomes described in the General Programme of Work.

We cannot continue to solely provide health education and awareness and expect to overcome deep-seated cultural beliefs. Effective public health communications must be based on a strategy that is informed by well-formulated qualitative and quantitative market research. The strategy must systematically take into account insights into the health consumer; environmental, cultural, and societal factors that influence that consumer decision-making; the most effective channels of communications; other competitor products and services; an understanding of where the health intervention sits within its product category; and perceptions among consumers about the organization providing the intervention.

To effectively measure the effectiveness of these communications strategies, metrics must focus on outcomes, not outputs; changes in behavior, or product or service uptake, and not numbers of people reached. An effective communications strategy is more than a slogan or tagline, and when a brand is developed, the brand must be actively managed to ensure it stays relevant to its intended audience. So, while countries and development agencies work toward realizing the goal of ensuring healthy lives and promoting well-being, it should be incumbent upon them to also ensure that the often under-resourced and under-appreciated component of effective health communications, is not overlooked.

For more coverage of NCDs, visit the Taking the Pulse series here.