In Part 1 of our series on public health marketing, we wrote about public health agencies as a whole — their day-to-day societal role, and how the public perceives (or misperceives) them. Our two public health experts — Dr. Megan Cunningham and Ashlei Rodgers — explained how our country’s pervasive lack of health literacy and ignorance of social determinants of health hold back our communities.
These roadblocks are on a constant simmer, creating day-to-day challenges for public health agencies and their community partners. In our work with public health professionals like the Chicago Department of Public Health, Bigmouth has helped connect Chicagoans with newborn services; supported new parents in ensuring their babies sleep safely; and shared the stories of HIV advocates in a documentary series. These services are among public health’s countless responsibilities — but they’re rarely the first to come to mind.
Public health communications is about creating awareness that inspires action toward the outcome of longer, healthier, happier lives. In a public health emergency like COVID-19, the urgency of these communications is paramount. Officials and medical professionals must quickly, effectively make decisions and communicate to inspire immediate, life-preserving action. But as we learned during the COVID-19 pandemic, that’s far easier said than done.
In a public health emergency like COVID-19, the urgency of public health communications is paramount.
The Root Issue: COVID-19 Was an Unprecedented Public Health Crisis in the 21st Century
To understand COVID-19 communications challenges, we have to remember that public health traditionally functions in the background of our society, far from the minds of many Americans until they need its services.
“The general perception of public health in a post-COVID world is really different,” Cunningham says. “Before 2020, most people didn’t know what it was, or only associated it with things like lead paint or immunizations.”
When COVID burst into headlines in early March 2020, public health became immediately, urgently relevant. While older generations lived through the beginning of the HIV/AIDS epidemic, COVID was the first global public health crisis Millennials and younger people experienced. It was the first time we had to rely on public health to save our lives.
Where It All Starts: Public Health Marketing Audiences
Direct users who need services. This group relies on public health from an individual or family standpoint. Urgency is very personal and immediate.
As of May 2021, a majority of the overall public (72%) believes public health agencies are extremely or very important to the nation’s health. But opinions on public health’s responsibilities did not align with the U.S. Dept. of Health and Human Services definition, particularly when it comes to social determinants of health.
To no one’s surprise, large gaps exist in public health perceptions when broken down by political parties. Another 2021 poll explored Americans’ opinions of health-focused agencies:
State Health Departments
The role of geography and politics in COVID responses was immediately clear. While liberal cities and suburbs turned into locked-down ghost towns, rural areas and red states were back to business as usual after a few weeks. In some places with low population density, it was as if COVID never happened.
It was an unfathomable response for those preaching and practicing caution as infection and mortality rates leapt off the charts. By June of 2020 — less than 3 months after lockdowns began — 100,000 Americans died of COVID. In May 2022, the death toll reached 1 million people, including Ashlei Rodgers’ father.
(In April 2020, Trump suggested scientists study bleach injections as a means of fighting the virus.)
Illinois and Chicago officials, including the Chicago Department of Public Health, took COVID very, very seriously. Coincidentally, the city served as the epicenter of a 2019 pandemic simulation known as Crimson Contagion. Details were eerily similar, and the exercise revealed the federal government lacked funds, coordination and capacities to implement an effective response to the hypothetical virus.
In 2020, CDPH was helmed by Dr. Allison Arwady, who now leads the CDC’s National Center for Injury Prevention & Control. Arwady was as equipped as anyone could possibly be to lead Chicago through a public health crisis; her experience included the CDC’s Epidemic Intelligence Service, Liberia’s ebola outbreak and infectious disease work throughout Illinois.
Cunningham was new in her role as a CDPH managing deputy commissioner but says she quickly realized “my job would be to listen to [CDPH’s] experts and figure out how to translate some of those messages to Chicagoans who were most vulnerable — the people who most needed to hear them.”
“You cannot have people panicking or worried about the wrong things or thinking you are not competent,” Arwady says. “You can lose the ball game right from the beginning.” Balancing these public perceptions with honesty and transparency set an incredibly high communications bar.
Arwady knew securing public trust meant literally showing up. She became the face of Chicago’s pandemic response, appearing almost daily at press conferences, briefings and on social media. Her Facebook Live segments, “The Doc Is In: Ask Dr. Arwady,” gave Chicagoans an avenue to ask questions and get answers in real time.
“We just started because we had to have a way to get the news out,” she says. But Facebook Live also turned into a tool for tailoring the city’s COVID communications. CDPH listened to residents’ questions, then used the anecdotal data to craft messages that better fit Chicagoans’ real needs.
In Part 1 of this series, we reflected on public health as a social issue that requires socially-relevant visuals, vocabulary, storytelling, and a physical presence. COVID was the ultimate moment for public health as a social issue. And as a white woman in government, Arwady understood she wasn’t the right person to deliver socially-relevant COVID communications to many Chicagoans.
Saving the most lives meant tight collaboration with healthcare providers; community and faith leaders; and other trusted faces, particularly in communities facing racial and health disparities.
“If people trust their healthcare provider, if people trust their pastor, if people trust their neighbor, building that network is as important as anything,” she says.
The city also formed The Racial Equity Rapid Response Team (RERRT), a data-driven, community- based and -driven mitigation of COVID-19 illness and death in Black and Brown neighborhoods. Officials partnered with three anchor community organizations — Greater Auburn Gresham Development Corporation, Austin Coming Together and South Shore Works — to develop hyperlocal, data-informed strategies. Their goals: Slow the spread of COVID-19 and improve health outcomes among communities most heavily impacted.
“It was a moment of really learning and understanding the need for support for public health,” Cunningham says. “It was a moment of reckoning around racial justice and how does this country respond to a legacy of oppression?”
Over time, our national divide only grew. At times, it was tough to tell whether COVID response was a medical issue or a political one. By November 2020, data showed more than a 20% gap between Democrats and Republicans who masked and practiced social distancing.
The first COVID vaccine was administered Dec. 14, 2020, and by October 2021, 72% of American adults had been vaccinated. Yet again, messaging by political party played a role in vaccination rates: 90% of Democrats had been vaccinated, compared with 68% of Independents and just 58% of Republicans.
“As time went on in this country, we saw a fraying of messaging and a fraying of trust at different levels, in different points with government,” Arwady says. “It’s really hard to hold people for a long time.”
From the onset, CDPH’s immediate communications goal was clear: Minimize morbidity and mortality. But as time passed, Arwady says, the department added the equally important goal of building and maintaining trust in the city’s COVID response. They didn’t just want Chicagoans to act — they wanted us to believe.
The city’s vaccine program was a massive opportunity to build and maintain trust by putting health equity into action. In January 2021, officials used census data to build the Chicago COVID-19 Vulnerability Index, which identified communities both disproportionately affected by COVID-19 and facing barriers to vaccination.
Officials now knew which residents would get priority access to the valuable vaccine. And data scientists and policymakers gained a wealth of information to fuel their short- and long-term COVID work.
Community partnerships and networks built earlier in the pandemic were crucial to gaining trust in the vaccine and encouraging participation. Volunteers went door to door, block by block, to educate their neighbors. Healthcare workers vaccinated vulnerable residents in their homes. Sports teams and celebrities got the message out. Mass vaccination sites opened across the city, initially reserved for high-risk Chicagoans.
Once again, a socially relevant approach to a social issue worked. More than 70% of Chicagoans completed the primary series of COVID vaccines, including 82% of residents ages 65 and up. Arwardy says CDPH and its partners spent “an incredible amount of time at the neighborhood level,” analyzing populations that fell behind to regroup and reach the most people.
“You can’t say it’s a successful response … when you have inequitable outcomes and inequitable vaccination rates,” Arwady says.
As we write in August 2024, a summer virus surge is wriggling its way through the country. COVID-19 has not “disappeared,” as Trump once predicted. But public health messaging has mostly petered off, as have masking and social distancing.
Annual COVID boosters are available; in December 2023, just 29% of Americans had received that year’s shot. One expert at a 2023 CDC meeting, Dr. Camille Kotton of Harvard Medical School, called the numbers “abysmal”, and urged stepped-up public education efforts.
Our Chicago public health experts expressed surprise and dismay over the lack of ongoing COVID mitigation messaging and public engagement. But they also recognize professional biases skew their expectations.
“I do think public health people have a rosy view of ‘We’re all in this together’ and ‘Rally the troops and everyone will do it!’ Cunningham says.”
“We have to design campaigns in a way that recognizes that a lot of decisions come down to self interest. How do you connect self interest to the public good in a really clear way?”
Communicating stories of individual tragedy creates moments of stark realization: This could happen to me.
COVID was a global disaster. It’s also a once-in-a-generation opportunity for those in public health marketing and communications to carry crucial lessons into our regular work.
Among all audiences, we must work in partnership with our public health clients to produce compelling brands, micro-brands and marketing campaigns. Day-to-day public health marketing can’t fade into the background; it should stand out as boldly as a Nike or Apple campaign.
Bigmouth faced such a challenge during our work on CDPH’s Healthy Chicago movement. We re-energized this micro-brand with bright colors, imagery that captured Chicago’s diversity and clear, direct messaging in multiple languages.
The complexity of campaigns like Healthy Chicago means “it’s important to think about marketing from a multilayered perspective,” Cunningham says, “including stats for the policymakers to demonstrate need.” Revitalizing Healthy Chicago’s marketing required a multi-pronged approach:
Among our audience of direct users, we must create continuous relevance beyond a safety-net option. This means improving health literacy at a universal level so people understand social determinants of health and the need for health equity, and take actions like getting a COVID booster.
Among our audience of community health providers, we must maintain relationships that fuel lifesaving communications pathways and connections. This means working together to consistently, effectively share relevant messages.
Among our audience of data scientists and policymakers, we must communicate how we’re connecting the dots between data, action and results. Measurable outcomes of the Chicago COVID-19 Vulnerability Index and the city’s Healthy Chicago movement are two fantastic examples of this approach in both a crisis and our daily lives.
No matter how hard public health communications try, politics and patently false messaging will continue to shape minds and actions. That doesn’t mean public health isn’t a fight worth fighting — in fact it makes our work even more crucial.
“Before COVID, I had not so fully appreciated the ways in which humanity is all in this together,” Cunningham says. “Our fates are so deeply intertwined, and unless we as a society decide to focus on the ways we lift everyone up, we will suffer the consequences.”
