Director's Blog
Health Marketing Musings
from Jay M. Bernhardt, PhD, MPH
It is my pleasure to welcome our first "guest blogger" to health marketing musings. The following remarks are from my colleague Dan Rutz, MPH, the Associate Director of Communication Science from the CDC National Center for Preparedness, Detection, and Control of Infectious Diseases (NCPDCID). He shares interesting and important observations about the frailty of our human experience and our communication science, and he calls for strengthening both. As always, reader comments are welcome and encouraged.
In describing the sensitivities around new terminology in public health communications Jay gives example to the natural tension between "hard" science and empirical practice. Practicing clinicians often refer to the "art and science" of medicine in acknowledging that there is more to healing than the evidence base. And comforting as it is to rely on data alone to influence care and treatment decisions, the state of knowledge precludes it as the sole, automatically binding consideration. We simply don't know enough about individual responses to prescribed interventions or the mind/body connection. Most disturbingly, even where data rules (as it has to, mind you) we are constantly reminded of the limitations of applying population-based solutions to individual cases. For example, just last week a previously healthy and very physically fit 47 year old CNN videographer died of acute complications of chemotherapy that had been prescribed for a leukemia diagnosed just two weeks earlier. On paper, he was an ideal candidate for aggressive treatment; too, the "gold standard" for treatment for his tumor type clearly showed it offered the best prospects for cure. And yet, the treatment—not the disease—brought about a catastrophic event that claimed his life. While the approach to this case was fully and appropriately science based, what consolation can that afford a new widow and their young son? The numbers suggested the treatment should work; the reality was it failed miserably. Clinicians attending to the immediate needs of individual patients must apply the evidence base, and must deal with the recurring patient question, "What does this mean to me?"
Such is our lot in public health; we are charged with considering population-based problems, and measuring our success through analysis of population-based data. But as communicators, our message falls on the ears of individuals who want to know what it means to them. How we craft our response reflects on our credibility as well as our effectiveness in encouraging desired behaviors. Both of these attributes are on the line every time, and depending on how candid we are, they may also both be somewhat at odds with one another. Do we, for example, emphasize the "common good" argument and admit to an uncertain personal benefit in support of credibility but at risk of discouraging compliance, or do we fudge in favor of selling "personal benefit" and threaten our credibility by implying more than the evidence-base might allow?
In practice, both the clinician and public health communicator learn to strike a balance; but doing so usually requires something more than scientific considerations alone. And it all gets even more complicated with we consider the science governing our field of communications. If the clinician must forsake the "sure-thing" science of the engineer who can trust her designs to observe the laws of physics without exception, e.g., 100 bridges built exactly the same way will support the same weight while a far lesser percentage of patients will respond the same way to a given treatment, we are forced even further out on the limb, since so much of our data are qualitative and our target is the intangible mind.
In this context it is, I think, very appropriate to expand the range of health marketing. Purists should be ever mindful of the limitations of biological science and beyond that the more glaring limitations of communication science. While we have come a long way from just "winging it" our field remains much dependent upon subjective analysis, fraught with vague measurements and inconsistent outcomes.
And yet, we know we must communicate to achieve our public health goals. We must because we know communication is vital to the successful public health response. And in a world of emerging threats, infectious by nature or human intent; of aging populations threatened by chronic, often behavior-driven conditions; of sad economic and social inequity; of violence and cruel exploitation; the need for messaging will often exceed both the science that ideally would fully inform its content, and the science by which such messaging is crafted and dispensed.
A bit of humility in considering how strong a foundation we stand on should, I think, help reconcile tension over which communication discipline is or should be dominant. We shouldn't let the science of communication lull us into a sense of self assurance. The point is, the science just isn't good enough, and until it is we are forced to experiment in our actual communication practice. It is most appropriate for CDC to recognize this and, through our National Center for Health Marketing stretch the envelope, and thereby advance the field.
Posted by: Dan Rutz at 2:10 PM on Friday, September 8, 2006
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Hello Jay,
This comment is sparked by two of Jay's entries: "This blog can save your life!" and "Health Communication: Science and Art."
Dr. Jay Bernhardt wrote: "New media efforts to engage and galvanize the public like FluWiki, Green Hammer, and the Slidell Hurricane Damage Blog are critical to CDC's ability to prepare for and respond to an influenza pandemic and to other possible public health emergencies"
Here we are—a bunch of talented people (and I explicitly include the FluWiki and other blog participants, alongside those of us who are communicators by profession)—struggling to prepare for problems of potentially unprecedented magnitude and completely unknown near-term likelihood, like a flu pandemic. And we are communicating with each other, and noticing that it helps in our planning.
There is real two-way risk communication going on between government officials at CDC, private consultants, international agency advisors, and citizens from a broad swath of backgrounds. Input from "unofficial sources" is hitting our radar screens (more than that, we are seeking it out), and it is mostly being received with respect and gratitude.
And the participant-citizens are—just maybe—starting to see some of "us" agency types or agency advisors as human, even though we are representatives of our agencies.
I am heartened by the launch of Jay's blog, and his reaching out to the participant-citizens.On a broader scale, I am heartened, grateful, and full of admiration for HHS' welcoming response to all the outside input it has received since its August 2004 draft pandemic plan. Some of the input it received was scathing—I know, because I submitted some of the most scathing—but HHS was open to it all, and used it to improve its risk communication.
That is the encouraging news, reflected in Jay Bernhardt's blog and in the work of his agency.
But as Dan Rutz commented:
"the need for messaging will often exceed both the science that ideally would fully inform its content, and the science by which such messaging is crafted and dispensed.
"A bit of humility in considering how strong a foundation we stand on should, I think, help reconcile tension over which communication discipline is or should be dominant. We shouldn't let the science of communication lull us into a sense of self assurance. The point is, the science just isn't good enough, and until it is we are forced to experiment in our actual communication practice. It is most appropriate for CDC to recognize this and, through our National Center for Health Marketing stretch the envelope, and thereby advance the field."
Dan and I have argued hard over the years, in ways that nevertheless cemented our friendship, about all the unknowns and uncertainties about various risk communication strategies. But we have never pretended that we were sure we were right. Although it isn't quite as dark as it used to be, we still know that we are working in the dark. The field still isn't fully the "science-based" field that some practitioners portray it as. We have to humbly own that, and be ready to notice when our recommendations are not working, or when other people come up with better ideas to try.
Congratulations on opening up this blog, Jay. And it is particularly fitting that Dan Rutz, who has for so long been corresponding on these issues with an unusually open mind—and insisting that others keep their minds open—is your first guest-blogger.
(My comments here represent my own views, and are not made as a representative of the World Health Organization.)
Warm regards,
Jody
Jody Lanard M.D.
Short-term consultant in risk communication (until November 1),
Emergency and Humanitarian Action unit,
Western Pacific Regional Office of the World Health Organization
Manila, Philippines
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