August 11, 2022

The pandemic has shone a clear light on the importance of community risk factors in shaping health outcomes. Even still, popular understanding maintains that health is primarily a product of health care, and that remaining differences are merely a result of personal choice. The piece that is often missing from that narrative is the understanding that those choices are limited due to place-based constraints that often play out over the course of a lifetime. 

To better understand public perception of these issues and possible communications opportunities to raise the profile of place-based determinants of health, the Nova Institute for Health commissioned a series of focus groups conducted by the Center on Society and Health at Virginia Commonwealth University, with recruitment support from the Millbank Memorial Fund. These groups consisted of participants with varying levels of political involvement (including active and former state legislators), differing ideologies, and widespread geographies, and helped us uncover some important takeaways as we continue to think about drawing attention to the importance of addressing certain place-based differences in a post-COVID world.  

The main themes we took away from this work are as follows.

  1. Right now, it is too early to use COVID-19 as a “themed talking point.” The issue and the experiences are too polarized. But a time is coming when the stories and takeaways can be used as a vehicle for underscoring important themes, and it will be important to seize that opportunity when it comes. The challenge is timing, as the pandemic will lose its poignancy when the memory is no longer fresh.
  2. Terms like “social determinants of health” and “public health” mean different things to different people. Breaking the habit of using familiar or more academic terms can be challenging, but speaking in plain language and avoiding potentially loaded terms can help reach and persuade new audiences. We found the phrase “community health” to be more relatable and well-received than “public health” or “population health.”
  3. Trust will need to be rebuilt—in leaders, public health, and science itself. The pandemic showed us the hazards of inconsistent messaging, especially by leaders, and it also taught us the need to respond deftly to changing science in ways that maintain public confidence.
  4. Mandates can be used creatively to protect health and safety, but with caution to not trample on personal freedom. Changing the “environment” to facilitate desired behaviors is often a more effective and subtler alternative.
  5. Appeal to both civic responsibility and personal responsibility. While health is certainly shaped by individual choices, it is important to support our communities and ensure the choices that support health and wellbeing are truly accessible to everyone. 
  6. Public health needs far more developed “story-campaigns,” which grab attention in evocative ways that statistics and epidemiology cannot.
  7. Accurate information is not enough—and is often readily available.Communicators should pay more attention to the way their audiences communicate, the channels and sources they use, and where the messages land.
  8. As our society has become more polarized, the tendency to use stereotypes has increased, but it is unhelpful. Audiences are not a monolith and are easily put off by messages that assume they are.

“We” may not be the most effective messengers. We, as researchers or public health professionals, national leaders, or politicians, are less compelling than trusted leaders from within a community.