Making the case for prevention: Basic messages for health departments

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March 11, 2011

At BMSG, we work to help advocates make the case for systems and structures that will improve health. This document is designed to help health departments better explain their goals and rationale for prevention. It's a starting point to use for tailoring messages for the media, policy makers and community leaders. First, a few guidelines. Messages in general have moving parts depending on the outcome you seek, the audience, and who delivers the message. The only hard and fast rules are:

  1. pay attention to order, which means prompting the environmental perspective first;
  2. state your values; and
  3. be sure the solution gets at least as much attention -- or more -- than the problem.

Some messages here do all these things at once, which can be a bit awkward. Not every sentence in a speech or op-ed must contain all three items. But as a unit, the speech or op-ed should start by prompting the environment, incorporate values, and state the solution clearly.

The message rules apply to all audiences, but the audience will dictate how you apply them. So, for example, if your audience is business leaders the value you emphasize might be ingenuity and can-do spirit. If the audience is residents you might emphasize health, fairness or community cohesion. You know your audience -- and your own values -- best, so you should choose the emphasis. Messages should be true and consistent but tailored so people, no matter where they live or what they do, can find themselves in your vision of health.

Lastly, and this may be surprising, avoid using "choice" since it points to the person and away from the environment. Many people are talking about "making the healthy choice the easy choice" as a way of bridging the individual and the environment. Fair enough. But unless we can make the environment visible, the bridge won't take us all the way. Most people don't need to be prompted to see the person but do need to be prompted to see the settings and circumstances around people. Without that direct connection, the term will reinforce the idea that people make choices, not that environments shape choices. Especially if you say choice, be explicit and describe the role of the environment.

The messages

Localize these messages and the answers to questions that follow by naming your key partners, inserting images from the region that everyone will recognize, and editing them to reflect your policy and environmental change priorities. We've left a blank [_____] or an asterisk [*] in the spots where the statement could be easily localized.

  1. Our health is affected by our communities -- where we live, work, learn and play. People breathe easier and are healthier when the air is free from tobacco smoke and when children cannot obtain tobacco products. We eat better when healthy food is more available than junk food and sugary beverages. We move more when we have inviting places nearby to be active. We live longer, healthier lives in these communities.
     
  2. Unfortunately, in some of our neighborhoods* healthy food isn't readily available, and soda is more available than milk; even taking a walk is a challenge for people who live where sidewalks don't exist or are in ill-repair; there are few parks or other places for children and families to be safely active. More people smoke or are exposed to secondhand smoke. The result is higher rates of heart disease, diabetes, and lung disease. This is a tragedy for the families who suffer directly, and it's also a loss for the rest of the county. For our residents and region to thrive, we need all our county* residents to be healthy.
     
  3. The good news is we can fix many of the health problems we face, and prevent other problems from starting. When we work together -- our public health department, cities, schools, businesses, and community-based organizations -- we can overcome even the most tenacious problems. We have skilled, creative and dedicated people who can make our region* the best it can be.
     
  4. [If you are highlighting a new program or special focus] Our agency* and partners* were recently awarded a highly competitive grant that gives our county the resources to bring talented people together to put their dedication to work. Through this new program, our health department, together with our partners*, will transform systems and environments to create neighborhoods that foster health. These changes will make it easier for everyone to be healthier.
     
  5. Our health is affected by the decisions our community makes every day -- and the public health department and its local partners* can create opportunities to make it easier to be healthier, not harder. Not every neighborhood can have a ______ [insert a positive local example here of an environmental feature that benefits health]. But every neighborhood* can have a thriving market with fresh produce and safe, clean, interesting places to walk. Every neighborhood can be protected from tobacco smoke and make tobacco products less accessible to young people. That's what we're working toward.
     
  6. Change takes time and it won't be easy, but together we have the creativity, dedication, and know-how to build a healthier region*. We strive for a county with neighborhoods where it's safe to walk or bike, where fresh, affordable and culturally appropriate food is easily available, where schools and childcare settings provide healthy food and drinks and plenty of physical activity, and where we all can breathe smoke-free air. Through the collective work of all CPPW partners everyone here* -- all ______ million residents* -- will benefit.

Answers to questions about prevention

Why is the government spending taxpayer money on prevention?

In our county we are faced with a huge problem to solve: every year thousands of our residents get sick, and some die, from preventable chronic illness. At the health department it is our mission to do everything we can so every neighborhood fosters health, not illness -- and we take that responsibility seriously. We know from experience and research that whether our county is healthy is dependent in large part on its infrastructure -- whether neighborhoods have markets with fresh produce, inviting places for families to walk and play, and air free from tobacco smoke. We know the local situation and we're working with more than ______ local partners*. Together we have the commitment, the know-how and the responsibility to create healthier communities for our county's ______ million residents*. Our health department is local government at its best, doing everything it can to help residents thrive.

Since public health and other departments are cutting programs, is prevention a responsible use of taxpayer dollars?

Absolutely. At the health department we take our responsibility seriously. We know from experience and from research that the environments where people live, learn, work and play affect their health. To prevent disease we have to improve those environments. And that's a sound investment. With our funding we are creating neighborhoods in our county* that promote health and safety for everyone.

[Policy example using joint use]: Children are healthier when they have safe places to play and be active. When schoolyards are closed after hours, children who live in neighborhoods where there are no places to play can't get the exercise they need to be healthy. One of the smartest things we can do is unlock the schoolyard gates. The health department can bring residents and school officials together to do just that. With our resources, residents and schools are working together to ensure children and families have safe, inviting places to be active.

[Policy example using secondhand smoke]: Almost every day new research confirms that ridding the air of tobacco smoke saves lives and saves money. Researchers in Arizona recently reported that clean indoor air laws are saving lives now, not some time in the future. In hospital costs alone the state saved millions. Our focus on prevention will help us get the same benefits for our county*. [citation is http://ajph.aphapublications.org/cgi/content/abstract/AJPH.2009.179572v1]

Why doesn't the health department redirect its prevention funds for health care services?

The point of prevention is to keep people out of the doctor's office in the first place. We can do that if we ensure the environments where people live promote health instead of disease. When people eat more fruits and vegetables and don't inhale smoke, they live longer and their children are healthier. When Arizona reduced exposure to secondhand smoke, there were so many fewer hospitalizations the state saved $16.8 million the first year the policy was in place. We want to do that in our county* too. With a focus on prevention, we have a fighting chance. We are grateful that our funders recognized the commitment and know-how of our health department staff to put prevention to work. We will make good use of those prevention dollars, and the whole region will benefit, because healthier residents are more productive residents. Part of the reason we were awarded these resources is because in our county* we have entire neighborhoods where it is hard to be healthy. We have a plan to fix that so everyone here lives in communities where fresh food is available, air is smoke-free and there are places to be active. When we put prevention to work we will help our residents avoid the doctor's office.

Why is government doing this work?

At the health department it's our job to be sure every neighborhood fosters health, not disease. When people have regular physical activity, they live longer, healthier, more productive lives. But physical activity as a part of daily life is limited in areas like ______* and ______*, where sidewalks and bicycle lanes are virtually nonexistent. Exposure to secondhand smoke is more prevalent in places where smoke drifts into homes*, as in some apartment buildings. We can change that. When we do, whole families will breathe easier -- and be healthier. It's also our job -- the health department's job -- to do everything we can so that all our* residents have a fair chance for health. The prevention resources coming to our county will help us create neighborhoods where it easier to walk or bike, where every corner store sells fresh fruits and vegetables, where school lunch menus offer healthy food and drinks, and where all our residents can breathe smoke-free air.

[Policy example using joint use and the value "ingenuity"]: Research shows that children are healthier when they have safe places to play with well-maintained playgrounds. There's a smart way to make this happen right now: open schoolyards before and after school. That's how we can take advantage of the resources we already have available and be sure children can have safe places to play. The health department's prevention program is bringing school administrators and community residents together so we can make agreements for joint use. With those agreements in place, children and their families have safe places to be active.

[Policy example using joint use and the value "equity"]: Research shows that children are healthier when they have safe places to play with well-maintained playgrounds. It's not fair that some children in our city have this while others don't. If we keep schoolyards open after hours, all children can have safe places to play. The health department's prevention program is bringing school administrators and community residents together so we can make agreements for joint use. With those agreements in place, children and their families have safe places to be active.

Why is government interfering in my personal choices?

Our health department*, like all health departments, is responsible for protecting the public's health. People can't make healthy choices in an unhealthy environment. For example, some county* residents aren't able to find produce at their local store, which makes it difficult for them to eat well even when they want to. No one knows like the people who live here what our problems are, and what should be done. At the health department, we support our local communities in deciding how to address the problems in our neighborhoods around tobacco, food and physical activity; our health department* is proud to support these efforts because we want to be sure all neighborhood residents can find healthy food at their local neighborhood stores and be sure there are places for children and families to play and be active.

[Policy example using access to healthy food and the value "ingenuity"]: When our county residents without vehicles live farther than one mile away from a grocery store, that makes it too hard to get healthy food on the table every night. With prevention funds, we can work with neighborhood stores to help them find ways to offer fresh, affordable, healthy food. No one knows these issues like the people who live and work here. Partnering with local businesses and residents we can solve this problem.

[Policy example using reducing sugary beverage consumption and the value "equity"]: In some places in our county, it's cheaper to buy soda than milk or even water. That's not right, and it's especially not fair to the families who have the fewest resources. Parents don't decide which beverages are on the store shelves or what the prices will be.

Is government going to take away my choice to smoke?

Most smokers want to quit. It's a struggle. The good news is that while having tobacco-free environments will definitely protect non-smokers, it will also help protect smokers because they will smoke less. In some of our neighborhoods tobacco use is higher, as is exposure to tobacco smoke. At the health department, we're working to be sure every neighborhood is as healthy as it can be. That's why we need to make sure that public areas aren't filled with smoke. When we know as much as we do about a health hazard like secondhand smoke, we have an obligation to do everything we can to keep people away from it. The most recent Surgeon General's report confirmed that there is no safe amount of secondhand smoke. Our prevention program is going to protect people from breathing the deadly poisons in smoke-filled air. Every county resident wants to breathe clean air. We want to be sure they can, no matter where they live, work, learn or play. Secondhand smoke kills people. In the near term it causes asthma; in the long term it causes lung cancer and heart disease. Our prevention program will help us protect children and adults from secondhand smoke, reduce disease, and save lives and money at the same time. It's as simple as that.

Why is government trying to dictate what I eat and drink?

At the health department it is our responsibility to do everything we can to be sure healthy food and drink is within reach of everyone. After all, when we know how to prevent heart disease, cancer, and premature death, we have a duty to share that knowledge with everyone. It's a responsibility we take seriously. It means we are supporting programs to be sure every family in every neighborhood has access to healthy food. And we are supporting programs to minimize unhealthy food and drink so we can all be at our best. If we do our job well, no matter where you live in our county, healthy, affordable food and drinks will be available.

For more examples of how to frame messages to emphasize prevention, see What Surrounds Us Shapes Us: Making the Case for Environmental Change.

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