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The Role of Marketing and Communications in Shaping the Public Health Narrative

Health Literacy and Understanding Social Determinants of Health

Bigmouth is a human-centric agency, and we seek out a lot of clients in the public health sector. In the past five years alone, we’ve worked with the Chicago Department of Public Health to connect Chicagoans with newborn services; helped new parents ensure their babies sleep safely; and shared the stories of HIV advocates in a documentary series.

This work reaches different audiences with a wide variety of goals, but common themes arise every time we conduct background interviews, research a topic, choose imagery or craft messaging.

Public health functions in the background of our society, far from the minds of many Americans until they have an immediate need for its services (as we saw during the COVID-19 pandemic). As such, most people don’t understand the full breadth of public health—its responsibilities, abilities and role in their daily lives. Their image of public health is skewed and shifting, shaped by geography, politics, socioeconomic status and more.

These issues of understanding and perception are where public health communications—and Bigmouth—come in. It’s our job to meet people where they’re at with relevant messaging that (hopefully) inspires action toward longer, healthier, happier lives.

It’s our job to meet people where they’re at with relevant messaging that (hopefully) inspires action toward longer, healthier, happier lives.

In this two-part series, we’ll explore both of these issues from our experience and perspective. Our professional experience reflects one side of the public health conversation, so we sat down with two experts in the public health field—one on the health department side, another with experience in both public health and the agency world—to help us fill in the gaps. First up: health literacy and social determinants of health.
Dr. Megan Cunningham is a special advisor for implementation at the U.S. Environmental Protection Agency. She previously worked as managing deputy commissioner of the Chicago Department of Public Health, where she oversaw implementation of Healthy Chicago 2.0, the citywide health equity movement.
Ashlei Rodgers has over a decade of international and domestic public health and health equity experience, in addition to PR agency experience. She has worked on variety of public health initiatives, which include HIV/AIDS prevention/treatment, maternal and child health and housing and food insecurity.

The Root Issue: Public Health Literacy and Misperceptions of Social Determinants

Do you consider yourself to be health-literate? For example, do you know how to report all your symptoms to a doctor or understand your insurance benefit statements?

Just 12% of Americans are proficient in their health literacy, which the CDC defines as the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others. This includes social determinants of health, the conditions in our everyday environments that affect each person’s ability to live a long, healthy life.

The 5 Social Determinants of Health

Neighborhood and built environment
Economic stability
Healthcare access and quality
Education access and quality
Social and community context

Those categories are defined by the U.S. Dept. of Health and Human Services, and include factors like safe housing and neighborhoods; racism and discrimination; and polluted air and water.

Public health officials agree on this definition, and understand their responsibilities. The American public does not. An increasing number say they understand public health “very well” (42% in 2021, up from 25% in 1996).

But when asked which issues they consider to be the main responsibility of public health agencies, less than half identified these social determinants of health:

Reducing eviction and homelessness
Reducing racism
Preventing violence and death from guns
Reducing climate change

That lack of awareness plays out in real-time. “People seeking out direct services from [public health] view us as a safety net provider. Whether it’s healthcare or food, they know we’re a place they can go,” Dr. Megan Cunningham, former CDPH managing deputy commissioner, told us. “Even that knowledge is pretty limited.”

Cunningham collaborated with Bigmouth on a revived campaign for CDPH’s Healthy Chicago movement, which works to decrease the city’s racial life expectancy gap. (Healthy Chicago, which focuses on social determinants of health, was sidelined in 2020 by the COVID-19 pandemic; our work began in 2022.)

While Cunningham has an impressive healthcare background, she admitted that even she didn’t understand the extent of CDPH’s duties until she began working there. So it’s not shocking that the majority of the public is in the same boat.

But why does this lack of health literacy exist?

In part, it’s related to peoples’ ability (or willingness) to consider other peoples’ healthcare needs. Factors like politics, race, geography and socioeconomic status also play a role. We’ll cover both of these in Part 2 of our series.

In part, it’s because the American healthcare system is inherently set up to make money on illness, so it’s rife with confusing language and difficult to navigate. These frustrating barriers mean most people don’t become health literate until a devastating incident forces them to advocate for themselves or a loved one.

And in part, it’s because the public needs to hear the right message about public health in the right way. That’s where Bigmouth comes in.

Our Powers Combined: Creative Agencies and Public Health

Social determinants of health show us that public health is for everyone. We all have a right to healthy food, good doctors, a safe place to live and a vibrant neighborhood. Public health communications can’t just exist to inform people during a crisis like COVID-19 or Mpox. Like public health services, public health communications must be an always-on service to drive awareness and inspire action.

In a perfect world, this process would be simple: Public health departments and their smaller community partners provide services and education related to social determinants of health. Agencies help create awareness of services and education. Public uses services and education to improve their health. Repeat.

But here’s where things get (more) complicated, thanks in no small part to capitalism’s role in who gets funding, and the wonky American healthcare system that often leaves behind marginalized communities.

So, what’s holding us back?

Ashlei Rodgers, a health strategist and consultant, has worked in both public health and the big agency world. She says the power imbalance between community health organizations, corporate donors and creative agencies means the resulting creative work doesn’t reflect the community’s real needs.

“[Organizations] will bend over backwards and not necessarily speak their truth because they want to be in your good graces for funding the next time,” Rodgers says.

If the agencies crafting public health marketing—those who choose which messages to share and with whom—don’t reflect their audience, bias and ignorant assumptions can abound. Rodgers recalled one such instance, when she brought her data-driven perspective into a conversation with a pharma client.

“I had a person who said, ‘Ashlei, we’re really looking for middle-class white people, because they’re the ones who can afford the drug,’” she told us.

Rodgers was the only Black person in the room, and says that experience taught her how to reframe public health interests for those holding the purse strings.

“Instead of being like, ‘This is the right thing to do, these are people who need it,’ it’s more like, ‘I’m sure the client won’t be happy if you’re leaving money on the table, because you could be reaching a larger market,’ ” she says. (We suspect social determinants of health aren’t high on this group’s list of priorities.)

Obviously there are vast differences between big pharma and public health marketing. But agency professionals bring lived experience and (conscious or unconscious) biases to the table. That’s why it’s absolutely critical to bring the people you’re trying to reach into the room. Rodgers offers these gut-check pieces of guidance for any agency:

While Bigmouth is an LGBTQ-owned and woman-led agency, we recognize our team’s diversity gaps. So we bring diverse partners to the table, including myWHY agency, to broaden the perspective. And we bring our audience to the table through stakeholder interviews, group discussions and surveying before we create a single mood board or content outline.

Working with creative agencies does offer a big benefit to public health departments stuck in an old-school marketing mindset: Agencies can make any topic sexier. Cunningham cited one such CDPH campaign about STIs, a decidedly unsexy topic. The “Save Yours” campaign used images of hot dogs, kittens and pickles, paired with cheeky headlines, to capture audiences’ attention and keep them reading.

“It did have an element of surprise that a city department was being cheeky and a little subversive,” she says. The program resonated both on a larger public level, and within a smaller target audience in Chicago neighborhoods with higher instances of STIs in teens.

Rodgers agrees with this approach. “We need to stop creating the driest after-school content,” she says. “Create something a little sexier for people to do and read.”

Defining Successful Public Health Marketing

You’ve accounted for your biases and worked to mitigate them; collaborated in lock-step with your public health client; and produced a campaign that (hopefully) will produce life-changing results for your community. How do you measure its effectiveness?

Funding for public health agencies and community organizations is often tied to data and results—the number of people who took action based on seeing a message. But for campaigns like Healthy Chicago, the direct effect of billboards or web ads is tough to measure, Dr. Cunningham says. “Maybe they never go to the [Healthy Chicago] website, but they carry that information back to a conversation at a church or community meeting,” she told us.

Tools like knowledge-based population surveys or focus groups can give CDPH a peek into the before and after of marketing efforts, if not a complete view. During the research phase of our Healthy Chicago work, the Bigmouth team invited community organizations and folks with grassroots knowledge of social determinants to share their understanding and knowledge gaps.

“Bigmouth did [focus grouping] really successfully in the Healthy Chicago space by having direct conversation with community organizations and people who better represent grassroots knowledge,” Dr. Cunningham says. “Some of those tools are a proxy for a representative survey.”

Another measurement of success relates to an audience we haven’t even touched on: Data scientists and policymakers. This group uses public health data and marketing outcomes as demonstrable proof of need to guide funding and introduce policy.

Again, Dr. Cunningham says, it’s impossible to draw a direct line between, say, public health messaging around safe housing (a social determinant of health) and city ordinances for more affordable housing. “But, as the city overall adopts health and racial equity promoting policies, is there a way we can make closer connections between the knowledge of public health and what is good for health and wellbeing, and then actually seeing city-level change?”

Taking a Socially-Relevant Approach to a Social Issue

That question summarizes the reason we’re writing this blog post, and the reason we keep working to get better at our jobs. The ultimate goal of public health marketing is a healthier public, even if we can’t directly attribute our successes. Like Dr. Cunningham says, “We have to be OK in our hearts that we can’t know when each of those things happen.”

But even if we can’t make these connections, agencies can follow our own advice and use tactics that prove anecdotally successful. When it comes to social determinants of health, we need to focus on the “social” aspect. This social issue requires socially-relevant visuals, vocabulary, storytelling, and physical presence to have even a chance at registering on the radar. And we need to communicate with our audiences first to ensure our social-focused work resonates and doesn’t just meet our lived assumptions.

Socially-relevant marketing also creates daily relevance for health literacy and health equity, even if we don’t use those exact phrases with our audiences (and we probably shouldn’t; they’re not exactly sexy). Perhaps a future edition of the Harvard study about health literacy will reflect the adoption of these marketing tactics?

Cunningham cited Bigmouth’s work on the Family Connects Chicago campaign, which offers free nurse visits to families with an infant, as another example of “intentional” work that reflects our city’s communities. And Rodgers wants to see tattoos, piercings, colored hair, Black women with shaved heads, hipster men with tattoos and beards.

“I just want us to get out of our own way and I think the next generation will push that,” Rodgers says.

Right now, it’s time for the current generation to step up. Creative public health work can’t get bogged down in old tactics or biased misconceptions of our audiences. It also can’t be sidelined by the current political climate, which has created a hostile environment for anyone who doesn’t fit in a very tiny box.

“I want us to get away from fear, because public health is so fearful of losing funding for pushing the envelope,” Rodgers says. “People are constantly fighting ideas of who has a right to have access to care. We all know public health-wise that we should be doing more for trans folks, but fear is factoring in. I wish we had the courage and were OK with fighting against the system.”

That’s a clear call to action for public health marketers. Be bold and authentic. Help everyone in your audience feel seen, heard, and supported. It’s our literal job.

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