Health Communication Health Communication - from individual behaviour change to civil society - from individual behaviour change to civil society

development and participatory governancedevelopment and participatory governance

ByByThomas Tufte, Ph.D, ProfessorThomas Tufte, Ph.D, ProfessorRoskilde University, DenmarkRoskilde University, Denmark

ttufte@ruc.dkttufte@ruc.dk

Presentation given at seminar in Copenhagen 4 May 2010: Presentation given at seminar in Copenhagen 4 May 2010: Communication for Social Change – lessons learnt from public healthCommunication for Social Change – lessons learnt from public health

ADRA/AIDSNET/ENRECA Health/Glocal NOMADADRA/AIDSNET/ENRECA Health/Glocal NOMAD

IntroductionIntroduction

3 key questions framing the discussion3 key questions framing the discussion

3 hypotheses related to public health, 3 hypotheses related to public health, globalisation and health and the globalisation and health and the discipline of health communicationdiscipline of health communication

Example: Femina HIP in TanzaniaExample: Femina HIP in Tanzania

Question 1Question 1

What role does communication play What role does communication play in the configuration of health in the configuration of health citizenships?citizenships?

Three levels of analysis:Three levels of analysis:• The level of health policies (long trad. for broad The level of health policies (long trad. for broad

definitions + notion of comm??)definitions + notion of comm??)• The level of the sciences or disciplines (health + The level of the sciences or disciplines (health +

comm)comm)• The level of health and the health communication The level of health and the health communication

practice (emerging experiences..)practice (emerging experiences..)

Question 2Question 2

What dimensions of globalization What dimensions of globalization are influencing the politics, are influencing the politics, disciplines and practices of disciplines and practices of health communication?health communication?

• The relation between globalisation and The relation between globalisation and modernity: Arjun Appaduraimodernity: Arjun Appadurai• Mass migrationMass migration• The electronic mediation of everyday lifeThe electronic mediation of everyday life• The articulation of an ontological The articulation of an ontological ininsecuritysecurity

Question 3Question 3

What are the key challenges that What are the key challenges that health communication face today health communication face today – in terms of policies, theories – in terms of policies, theories and practices?and practices?

• A discipline and a practice in crisis and in A discipline and a practice in crisis and in profound transformationprofound transformation

• There exists a strong current of rethinking the There exists a strong current of rethinking the discipline and the practicediscipline and the practice

Hypothesis IHypothesis I

The centre of public health lies The centre of public health lies outside of the public health outside of the public health systemsystem

• Public health problems relate to broader Public health problems relate to broader questions: citizenship, empowerment, socio-questions: citizenship, empowerment, socio-economic conditions, culture, power relations and economic conditions, culture, power relations and political prioritiespolitical priorities

Hypothesis 2Hypothesis 2

The forces of globalisation are at The forces of globalisation are at the centre of the challenges we the centre of the challenges we must understand and relate to in must understand and relate to in order to achieve the construction order to achieve the construction of a ’healthy’ societyof a ’healthy’ society

• ’’Glocalized’ lives that we need to Glocalized’ lives that we need to reconstruct and understand better in order reconstruct and understand better in order to respond accordingly and betterto respond accordingly and better

Hypothesis 3Hypothesis 3

Health communication is a discipline Health communication is a discipline in crisis and in transformation. There in crisis and in transformation. There is a strong need for a more solid is a strong need for a more solid philosophical and epistemological philosophical and epistemological basis which parts from a broad notion basis which parts from a broad notion of health and which connects the of health and which connects the health related challenges more health related challenges more strongly with the other key strongly with the other key challenges within development and challenges within development and social changesocial change

Towards health citizenshipsTowards health citizenships

Alma Alta 1978Alma Alta 1978 Ottawa Charter 1986Ottawa Charter 1986 UNFPA Conference, Cairo 1994UNFPA Conference, Cairo 1994 Round-table on Communication for Round-table on Communication for

Development, Managua 2001 (and Development, Managua 2001 (and subsequent ones in Rome, Addis and subsequent ones in Rome, Addis and Washington)Washington)

7 challenges emerging from 7 challenges emerging from globalizationglobalization

Epidemics travel (HIV, SARS, Bird Flu, etc)Epidemics travel (HIV, SARS, Bird Flu, etc) Media development – expanding and diversifying Media development – expanding and diversifying

symbolic worldssymbolic worlds Transnational agency and advocacyTransnational agency and advocacy New Economy – mainstreaming of principles of New Economy – mainstreaming of principles of

market liberatiion and deregulation of the mediamarket liberatiion and deregulation of the media Changing public sphere (transnational + Changing public sphere (transnational +

diasporic)diasporic) Risk societyRisk society Migration, marginalisation and social exclusionMigration, marginalisation and social exclusion

Challenges for health commChallenges for health comm

Scope, size and interconnectedness of Scope, size and interconnectedness of issues – national policy frameworks + issues – national policy frameworks + glocal dimensions..glocal dimensions..

Reclaiming agency – TANsReclaiming agency – TANs Questioning economic and ideological Questioning economic and ideological

logic informing management, org. logic informing management, org. Dev, policies. Are there alternatives?Dev, policies. Are there alternatives?

Changing public sphere Changing public sphere

Communication for social changeCommunication for social change

Rethinking subject, culture and social Rethinking subject, culture and social change results in CFSC…change results in CFSC…

Interaction between popular culture, Interaction between popular culture, communication practices and communication practices and construction of meaningconstruction of meaning

Confront the structural challenges, Confront the structural challenges, linked to questions of inequity and linked to questions of inequity and social injusticesocial injustice

Introducing Femina HIPIntroducing Femina HIP Tanzanian NGO, 1999-Tanzanian NGO, 1999- Focuses on SRHR and Focuses on SRHR and

HIV/AIDSHIV/AIDS Many donors on board, but Many donors on board, but

is a ’homegrown’ is a ’homegrown’ organisationorganisation

EE through real life storiesEE through real life stories Media outlets include: Two Media outlets include: Two

large magazines, tv talk large magazines, tv talk show, radio drama, show, radio drama, interactive websiteinteractive website

Femina clubsFemina clubs

Femina HIP ObjectivesFemina HIP Objectives

To build supportive To build supportive environments in Tanzania environments in Tanzania where:where:

Young people in their Young people in their communities enjoy their communities enjoy their right to access information right to access information & services and are & services and are empowered to make empowered to make positive informed choices positive informed choices around sexuality and lead around sexuality and lead healthy lifestyles in order healthy lifestyles in order to reduce the negative to reduce the negative impact of HIV/AIDS.impact of HIV/AIDS.

Today: Femina HIPs 2nd ObjectiveToday: Femina HIPs 2nd Objective

To build supportive To build supportive environments in environments in Tanzania where:Tanzania where:

Communities exercise Communities exercise their right to express their right to express themselves, themselves, participate in public participate in public debate & engage in debate & engage in civil society. (Femina civil society. (Femina HIP Logical HIP Logical Framework, 2007)Framework, 2007)

FEMAFEMA

FEMA. A glossy FEMA. A glossy magazine, 64 pages, magazine, 64 pages, 170.000 copies 170.000 copies Published 4 x year. Published 4 x year. Targets youth aged Targets youth aged 15-24 especially 15-24 especially secondary school secondary school students in every students in every region of the countryregion of the country

SiMchezoSiMchezo

Si Mchezo! 32 Si Mchezo! 32 pages, 175.000 pages, 175.000 copies. copies.

6 x year. Targets 6 x year. Targets out of school youth out of school youth and their and their communities communities particularly in rural particularly in rural areas. areas.

Is expanding to Is expanding to 250.000 250.000

Results (1)Results (1)

- All secondary schools in the country - All secondary schools in the country have Fema magazines, read in Fema-have Fema magazines, read in Fema-clubs and used in classclubs and used in class

– Widespread Fema-club structureWidespread Fema-club structure– Increased youth talk about the subjectsIncreased youth talk about the subjects– Changed authorities: collaboration with Changed authorities: collaboration with

MOE, also on ZanzibarMOE, also on Zanzibar– Political cloutPolitical clout

Tanzanian ContextTanzanian Context Still low – but now Still low – but now

growing- levels of growing- levels of participation in public participation in public life and decision-life and decision-makingmaking

Changing and growing Changing and growing civil societycivil society

Much more diverse Much more diverse media infrastructure – media infrastructure – new media emergingnew media emerging

Comparative Comparative advantage: Femina advantage: Femina HIP became a visible HIP became a visible NGO early onNGO early on

Other Media OutletsOther Media Outlets

Pilika PilikaPilika Pilika. A radio soap opera. Carries messages from . A radio soap opera. Carries messages from Femina as well as two other organisations. Airs on national Femina as well as two other organisations. Airs on national radio 4 times a week.radio 4 times a week.

FEMA Tv Talk Show.FEMA Tv Talk Show. Half ½ hour talk show. Broadcasts Half ½ hour talk show. Broadcasts on national TV 4 times a week. Mobile phones are used for on national TV 4 times a week. Mobile phones are used for feedback and voting, particularly around the TV.feedback and voting, particularly around the TV.

ChezaSalama ChezaSalama (‘play safe’). Interactive website with a (‘play safe’). Interactive website with a series of activities and information in English and Swahili. series of activities and information in English and Swahili. First of its kind in Tanzania.First of its kind in Tanzania.

Individual Publications:Individual Publications: Range of specialist publications Range of specialist publications produced on for example HIV-testing, Treatment (500.000 produced on for example HIV-testing, Treatment (500.000 copies distributed to all CTC clinics), youth empowerment copies distributed to all CTC clinics), youth empowerment (Watata Bomba, for children/youth was produced in (Watata Bomba, for children/youth was produced in 90.000).90.000).

10 years down the line…10 years down the line…

FEMINA HIP today: reaching 25% of the FEMINA HIP today: reaching 25% of the population!population!

Conceptual sharpeningConceptual sharpening– Participatory Communication/CFSCParticipatory Communication/CFSC– Exploring citizenship and governance Exploring citizenship and governance

perspectives on an HIV/AIDS communication perspectives on an HIV/AIDS communication initiative initiative

– Exploring CFSC-oriented process indicators Exploring CFSC-oriented process indicators (ownership, leadership, particpation, social (ownership, leadership, particpation, social norms, etc)norms, etc)

Improving M&EImproving M&E

Re-examining resultsRe-examining results KAP:KAP: Increased knowledge, changing attitudes Increased knowledge, changing attitudes

and practiceand practice

Voice:Voice: Established and growing ’discursive Established and growing ’discursive spaces’spaces’

Media:Media: Strong media vehicle for any Strong media vehicle for any subject/developed media infrastructuresubject/developed media infrastructure

Organisation:Organisation: Grown NGO with huge network of Grown NGO with huge network of stakeholdersstakeholders

Embryonic civil societyEmbryonic civil society at community level at community level

CFSC IndicatorsCFSC Indicators FEMINA HIPFEMINA HIPLeadership Emerging amongst Emerging amongst

youthyouth

Degree and Equity of Participation

Broader Broader participationparticipation

Information Equity Voice of all groupsVoice of all groups

Collective Self-Efficacy

Open talkOpen talk

Sense of Ownership

Growing Growing engagement engagement (letters)(letters)

Social CohesionSocial Cohesion Long term changeLong term change

Social NormsSocial Norms Democratic Democratic values..and others values..and others (gender, (gender, entrepreneurship, entrepreneurship, etc)etc)

The driving forces of The driving forces of communication for social changecommunication for social change

CFSC is CFSC is horizontal and strengthens community bondshorizontal and strengthens community bonds by amplifying the voices by amplifying the voices of the people who are poorestof the people who are poorest

peoplepeople within poor communities within poor communities must be the protagonistsmust be the protagonists for their own change for their own change and manage their own communication toolsand manage their own communication tools

rather than focusing on persuasion and information dissemination, CFSCpromotes rather than focusing on persuasion and information dissemination, CFSCpromotes dialogue among equal voices, and debatedialogue among equal voices, and debate and negotiations within communities and negotiations within communities

the results of the CFSC process go the results of the CFSC process go beyond individual behaviourbeyond individual behaviour and consider the and consider the influence of social norms, values, current policies, culture and the overall influence of social norms, values, current policies, culture and the overall development contextdevelopment context

CFSC strives to strengthen cultural identity, trust, commitment, voice, ownership, CFSC strives to strengthen cultural identity, trust, commitment, voice, ownership, community engagement and empowermentcommunity engagement and empowerment

CFSC rejects the linear model of information transmission from a central sender CFSC rejects the linear model of information transmission from a central sender to an individual receiver, and to an individual receiver, and relies instead on a cyclical process of interactionsrelies instead on a cyclical process of interactions focused on shared knowledge and collective action focused on shared knowledge and collective action

Thanks!Thanks!