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Communicating the Social Determinants of Health GUIDELINES FOR COMMON MESSAGING October 23, 2013 Canadian Council on Social Determinants of Health
Communicating the Social Determinants of Health Guidelines for Common Messaging Également disponible en français sous le titre : Communiquer les déterminants sociaux de la santé: guide pour la création de message communs To obtain additional copies, please contact: Canadian Council on Social Determinants of Health E-mail: CCSDH.Correspondence@phac-aspc.gc.ca This publication can be made available in alternative formats upon request. ISBN: 978-0-9937151-0-5
Preface
This document is based on research The CCSDH fulfills its mandate through various
commissioned by the Canadian Council activities, including support for the creation
on Social Determinants of Health (CCSDH), or adaptation of tools to leverage action on
previously known as the Canadian Reference social determinants of health. Communicating
Group on Social Determinants of Health (CRG). the Social Determinants of Health: Guidelines
for Common Messaging is one such tool. In
The CCSDH is a collaborative multi-sectoral
creating the guidelines, the aim of the CCSDH
stakeholder group established to:
is to provide individuals and organizations
• Provide the Public Health Agency of with the knowledge to create effective, targeted
Canada (PHAC) with advice on matters messages on the factors that shape health.
relating to the implementation of the
The development of this tool was guided
Rio Political Declaration on Social
by the Communications Expert Group,
Determinants of Health, including planning,
which was comprised of members of the
monitoring, and reporting; and
CCSDH Communications Subcommittee
• Facilitate and leverage action on the social
and communications advisors from various
determinants of health through member
CCSDH organizations. The guidelines
networks and targeted, intersectoral initiatives.
were conceived as part of a wider strategy
The CCSDH brings together organizations from to raise awareness and understanding
a wide array of sectors that have a role to play of the social determinants of health. As such,
in addressing the factors that shape health. The it is the hope of the CCSDH that they
CCSDH also includes individuals selected on will be widely shared and used to facilitate
the basis of their knowledge and experience an expanded conversation about health
regarding policy, research or intersectoral in Canada.
action on the social determinants of health.
COMMUNICATING THE SOCIAL DETERMINANTS OF HEALTH: GUIDELINES FOR COMMON MESSAGING iTHE CANADIAN COUNCIL ON
SOCIAL DETERMINANTS OF HEALTH
KRISTA OUTHWAITE, JEFFREY CYR BEN HENDERSON
CO-CHAIR Executive Director, Representative, Federation
Associate Deputy Minister, National Association of of Canadian Municipalities
Public Health Agency Friendship Centres and City Councillor,
of Canada City of Edmonton
ERICA DI RUGGIERO
PEGGY TAILLON, CO-CHAIR Associate Director, Canadian RÉAL LACOMBE
President and CEO, Institutes of Health Research, Director of Public Health and
Canadian Council on Institute of Population Medical Affairs, Agence de la
Social Development and Public Health santé et des services sociaux
de l’Abitibi-Témiscamingue
KIMBERLY ELMSLIE JOEY EDWARDH
(EX OFFICIO) Director, Community KATHY LANGLOIS
Acting Assistant Deputy Development Halton Director General, Strategic
Minister, Public Health Agency Policy, Planning & Information,
of Canada GERRY GALLAGHER First Nation and Inuit Health
Acting Executive Director, Branch, Health Canada
MICHAEL BLOOM Social Determinants and
Vice-President, Organizational Science Integration CORY NEUDORF
Effectiveness and Learning, Directorate, Public Health Chief Medical Officer
Conference Board of Canada Agency of Canada of Health, Saskatoon
Health Region
PAUL BORN MARGO GREENWOOD
President and CEO, Academic Leader, National HILARY PEARSON
Tamarak Institute for Collaborating Centre for President, Philanthropic
Community Engagement Aboriginal Health Foundations Canada
ED BULLER TREVOR HANCOCK LOUISE POTVIN
Elder Professor and Senior Scholar, Scientific Director, Centre
School of Public Health Léa-Roback sur les inégalités
BARBARA BYERS
and Social Policy, University sociales de Montréal
Executive Vice-President,
of Victoria
Canadian Labour Congress ANDREW SACRET
JEAN HARVEY Director of Policy
CONNIE CLEMENT
Director, Canadian and Public Affairs,
Scientific Director, National
Population Health Initiative, Canadian Institute of Planners
Collaborating Centre for
Canadian Institute
Determinants of Health
for Health Information
IAN CULBERT
Executive Director, Canadian
Public Health Association
ii COMMUNICATING THE SOCIAL DETERMINANTS OF HEALTH: GUIDELINES FOR COMMON MESSAGINGCommunications Expert Group
COMMUNICATIONS SUBCOMMITTEE EXTERNAL ADVISORS
DEBORAH LYNKOWSKI (LEAD) LYNE CANTIN
Former CEO, Former Analyst,
Canadian Public Health Association Canadian Public Health Association
BARBARA BYERS JIM CHAUVIN
Executive Vice-President, Former Director of Policy,
Canadian Labour Congress Canadian Public Health Association
ANDREA GABOR IAN CULBERT
Former President, Former Communications Director,
Canadian Institute of Planners Current Executive Director,
Canadian Public Health Association
PEGGY TAILLON
President and CEO, DENIS GRUENDING
Canadian Council on Social Development Communications, Canadian Labour Congress
CHERYL SMITH
Communications Executive,
Canadian Public Health Association
CARL VENDETTE
Senior Manager, Executive Networks,
Conference Board of Canada
Acknowledgements
This document is based on work completed The CCSDH would also like to thank the
in 2011–12 for the Canadian Council on Social members of the Communications Expert
Determinants of Health (CCSDH) by Provoke, Group, who provided guidance on the
a communications firm in Calgary, Alberta. The development of the messaging guidelines.
Council thanks Provoke for their contribution The important contribution of Andrea Long,
to this project. Policy Analyst, Social Determinants and Science
Integration Directorate, Public Health Agency
of Canada, who authored the guidelines, is also
much appreciated.
COMMUNICATING THE SOCIAL DETERMINANTS OF HEALTH: GUIDELINES FOR COMMON MESSAGING iiiTable of Contents
Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii
1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
2. Understanding the Context for SDH Messaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
2.1 Views about health and social determinants of health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
2.2 Values and metaphors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
2.3 Implications for SDH messaging. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
3. Crafting SDH Messages. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
3.1 Expressing concepts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
3.2 Using facts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
3.3 Selecting words. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
3.4 Best practices for communicators. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
4. Conveying SDH Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
4.1 Selecting the right tool. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
4.2 Priming the audience. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
4.3 Audience segments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
5. Key SDH Messaging Guidelines. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
6. Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
COMMUNICATING THE SOCIAL DETERMINANTS OF HEALTH: GUIDELINES FOR COMMON MESSAGING vExecutive Summary
Our health is influenced by diverse factors— ‘social determinants of health’ which may not
not only by medical care and our health care be widely understood and may not engage
system, but also by our work, our level of audiences. The abstract concepts that underlie
education and income, where we live and SDH must be made tangible with concrete
many other things that are together referred analogies or examples and the judicious use
to as social determinants of health (SDH). of facts. Messages that evoke images or
emotion tend to be more memorable, as
Canadians’ knowledge about SDH and their
are messages shared through stories to which
impact on health is limited. As a result, it
audiences can relate.
can be challenging to raise awareness about
the importance of economic, social and Understanding the audience is an important
environmental policies for building a healthier key to effective messaging. This involves
population. As part of its mandate to facilitate assessing the values or metaphors that inform
action on SDH, the Canadian Council on Social the way in which people perceive health
Determinants of Health (CCSDH) supported and its social determinants. A message that
research to assist member agencies as well as is consistent with personal values tends to
other individuals and organizations to build be more convincing than a message that
the knowledge and tools needed to develop does not align with one’s worldview. Preparing
effective SDH messages. the audience by using a fact, image or story that
they already believe—or that aligns with
The guidelines for common messaging examine
their values and interests—can also help make
factors that influence audience receptivity to
messages more compelling. The way in which
SDH messages, the ingredients of effective
a message is conveyed should be appropriate
messages and considerations for tailoring them
for both the audience and the context, such
for priority audiences. Findings emphasize that
as a short provocative statement, a story
effective messaging requires clear and plain
or a powerful image.
language rather than abstract phrases such as
COMMUNICATING THE SOCIAL DETERMINANTS OF HEALTH: GUIDELINES FOR COMMON MESSAGING viiThe following table summarizes the key guidelines for effectively communicating SDH:
WHAT TO DO WHAT TO AVOID
ü Use clear, plain language û Technical language or jargon
ü Make issues tangible with analogies û Abstract concepts or terms
and stories
ü Break down and round numbers; û Complex numbers, or large numbers
place numbers in context without any context
ü Challenge conventional wisdom û Exhaustive documentation
with one unexpected fact
ü Use inclusive language (we, our, us) û Creating distance between groups
(them, they)
ü Identify people by shared experiences û Labeling people by group membership
ü Prime your audience with a fact, image û Facts, images or stories that audiences
or story they are likely to believe, based may find too contentious or extreme
on their values, interests and needs to be believable (even if they are true)
ü Leave the audience with a memorable û Being forgettable
story or fact that can be easily repeated
ü Use a conversational and familiar tone û A clinical or academic tone
ü Take the time to understand your û Assuming the same message will work
audience—this includes customizing your for all audiences
message by selecting appropriate tools,
approaches and information
ü Prepare your message content and û Speaking off the cuff
presentation
ü Focus on communicating one thing at û Trying to do too many things at once
a time
viii COMMUNICATING THE SOCIAL DETERMINANTS OF HEALTH: GUIDELINES FOR COMMON MESSAGING1. Introduction
Our health is influenced by many diverse In Canada, many individuals and organizations
factors. These include the work we do, our are working to raise knowledge and awareness
level of education, our income, where we about how SDH factors influence health. This
live, the quality of our experiences when we tool was developed to help guide them in
are children and the physical environment their efforts.
that surrounds us.1, 2 Together, these factors
The guidelines for common messaging examine
are referred to as social determinants of
factors that influence audience receptivity to
health (SDH).
SDH messages, the ingredients of effective
Even though research has proven the messages and considerations for tailoring them
importance of SDH, public knowledge and for priority audiences. They will be useful to
understanding about them remains limited. those who work in health and public health, and
Canadians are more likely to believe their those working outside the health sector on
health is shaped by the individual decisions issues related to SDH such as early childhood
they make about smoking or diet and physical development, employment, literacy and income.
activity, rather than societal factors such as
The guidelines build on earlier research
their level of income or education.3,4 This belief
completed for the Public Health Agency
is often reinforced by media coverage that
of Canada by Wellspring Strategies.5 They are
focus on individual health and health care issues,
also informed by research undertaken by
medically-oriented messages and public
the Robert Wood Johnson Foundation (RWJF)
awareness campaigns that emphasize personal
to develop and test new approaches in
health behaviours.5
communicating the SDH.6
COMMUNICATING THE SOCIAL DETERMINANTS OF HEALTH: GUIDELINES FOR COMMON MESSAGING 12. Understanding the Context
for SDH Messaging
The following section briefly reviews households with income less than $30,000
perspectives on health and what makes people were more likely to identify income as having a
healthy. It also examines some of the values strong impact on their health).4 Environmental
and cultural beliefs that underlie these views. conditions such as air and water quality were
This contextual information will help to inform considered by a majority of Canadians to
an effective SDH communications approach. significantly impact their health.3
2.1 VIEWS ABOUT HEALTH AND
SOCIAL DETERMINANTS OF HEALTH In Canada, individuals who recognize
Canadians place great value on their publicly the structural causes of ill health are more
funded health care system and view it as likely to support policies to address the
a cornerstone of Canada’s social policy resulting health inequalities. This means
landscape.7,.8, 9 Health and health care that increased awareness of SDH through
consistently feature as top priorities identified effective messaging has the potential to
in public opinion polls.10 contribute to subsequent action.14
Most Canadians also believe they have good
or excellent knowledge of health issues3, 4
Commonly held cultural beliefs also influence
and often identify factors such as disease and
how health information messages are received.
illness (e.g. cancer, diabetes) and health care
Independence and personal autonomy tend
infrastructure (e.g. access to doctors, wait
to be valued within the North American cultural
times) as key health policy issues.3, 4, 11
context. Consistent with this, health is often
There is evidence that Canadians are generally viewed as a personal responsibility and as
uninformed about SDH.3, 12, 13 They are more something that individuals can control.6, 15
likely to believe their health is influenced by In general, people also tend to underestimate
individual factors such as smoking, diet and the role of external factors and circumstances
exercise, and their access to health care in explaining behaviours, and overemphasize
rather than by social and economic factors the importance of personal motives or abilities.15,16
such as adequate income, education level, A moral dimension is often overlaid on claims
employment or social connections.3, 4 When about health outcomes, implying that healthier
asked specifically about social conditions individuals have made the “right” choices while
and community characteristics, only one in those who are less healthy have made the
three Canadians responded that these factors “wrong” choices.
impacted their health3 (although members of
2 COMMUNICATING THE SOCIAL DETERMINANTS OF HEALTH: GUIDELINES FOR COMMON MESSAGING2.2 VALUES AND METAPHORS It is not one single factor that contributes to
poor health, but rather a constellation of factors
By their very nature, beliefs about SDH are
such as housing, food, employment, and health
connected to individual and societal values.
care. From a system perspective, disparities in
For example, the extent to which a person
health outcomes are a sign of imbalance which
believes their health outcomes are connected
needs to be corrected so that equality can
to their income or education may be related to
be achieved.6
their views on social justice, equality, personal
responsibility and so on. Since people are more The journey metaphor views the pursuit of good
likely to dismiss or resist messages that are not health as journey. Just as life itself, journeys can
aligned with their values, it is often challenging be “fraught with challenge” or “smooth sailing”;
to develop broadly compelling messages.17 some journeys will be “unpredictable” while
others “focus on a series of steps that, if
Although there is limited Canadian research
followed, will take you to a predetermined
about the values that influence our view of
goal”.6 Poor health is framed in terms of a failure
health and SDH, studies by the Robert Wood
to provide individuals with “a road map of how
Johnson Foundation (RWJF) in the United
to achieve good health”.6 There is a recognition
States can inform our efforts to develop
that people must have the opportunity to make
effective SDH messaging in Canada. RWJF
healthy choices, but also, that they will choose
research explored values related to health
their own path, which may or may not
and SDH using the concept of deep metaphors.
contribute to good health. These “divergent
Deep metaphors “reflect the basic structures
paths” and the resulting imbalances in health
in our minds that organize our perceptions and
outcomes are natural. In that sense, expecting
shape the sense we make of them and how we
that everyone can achieve the same health level
react. The feelings around these metaphors are
is both unrealistic and misguided. The primary
unconscious—an automatic viewing lens that is
concern is that overall progress is achieved.6
seldom explicitly acknowledged”.18 In other
words, deep metaphors act as a filter, shaping In Canada, the system metaphor may resonate
the way we understand and make sense of with those familiar with the complexity of
our world. health and social support systems, such as
public health practitioners or social / health
The RWJF found that health is often understood
policy organizations. The journey metaphor may
through one of two “deep metaphors”, a system
better resonate with those who value personal
metaphor or a journey metaphor. The system
responsibility or those who are less likely to look
metaphor connects disparate elements into a
to public policy to address problems. If only
single structure of interdependent parts. Within
one metaphor can be used to frame messages,
this perspective, all individuals, from the poorest
the RWJF research suggests that the journey
to the wealthiest, are interdependent. If certain
metaphor is a better choice because it is less
communities are experiencing poor health,
likely to offend or distance those who subscribe
then the whole system is affected. Furthermore,
to a system view.
poor health is understood to be the result of
a “complex and interrelated system of social,
cultural, economic, and biological factors”.6
COMMUNICATING THE SOCIAL DETERMINANTS OF HEALTH: GUIDELINES FOR COMMON MESSAGING 32.3 IMPLICATIONS • Validate the role of individual choices for
FOR SDH MESSAGING health and draw attention to broader social
Understanding how Canadians view health and economic factors.
and SDH as well as the values that help shape • Affirm the value of individual responsibility,
these views can inform SDH messaging. while also drawing attention to the ways
The above discussion on values and metaphors members of a society are interdependent.
suggests that SDH messaging may be made • Avoid creating distance between groups.
more effective if we: Do not single out marginalized or vulnerable
• Build on Canadians’ interest in health populations. Use pronouns such as we or
and health care to ‘prime’ how they our instead of they or them.
receive messages about other factors • Refer to situations or circumstances, rather
that influence health. than labeling individuals, e.g. use terms such
• Frame messages in a manner that is as people living in poverty, people without a
consistent with audience values. home, people with disabilities.
• Frame messages in non partisan language. • Draw attention to current circumstances that
Avoid relying on words or phrases likely to are unfair or not equitable.
be associated with particular political parties • Identify the problem and at the same time,
or ideologies. affirm alternatives and solutions. Emphasize
• Consider the relevance of deep metaphors. the idea of creating conditions for people
and society to progress.
4 COMMUNICATING THE SOCIAL DETERMINANTS OF HEALTH: GUIDELINES FOR COMMON MESSAGING3. Crafting SDH Messages
The following section provides tips on how Provide factual context. How and when a fact
to create effective messages about SDH. is presented is critical, especially when it may
It stresses the importance of making abstract challenge an existing belief. Placing facts in the
concepts tangible and the appropriate use appropriate context can help make contentious
of facts and language to engage audiences. information easier to accept.
3.1 EXPRESSING CONCEPTS
One of the challenges of delivering SDH A message could state that:
messages is how to translate theoretical Half of parents in poor neighbourhoods don’t
language and abstract concepts into tangible feel safe letting their children play outside.
and easily understood concepts. This challenge
Or it could create an image of the situation:
can be addressed by using plain language and
illustrating abstract ideas through stories or Many parents feel they are not providing their
analogies. For example, an abstract concept children with the most basic opportunities to
such as ‘food insecurity’ can be explained by play outside, but are unable to move because
using concrete indicators and illustrating their of their job or income.6
implications, as in, “When we don’t have
enough of the right food, it holds us back”.
Using numbers. Explain large numbers so
3.2 USING FACTS they can be understood. Large numbers
can lose their meaning in the absence of
Facts are an essential ingredient of effective SDH
adequate context. If possible, numbers should
messages. They provide critical information to
be rounded to make them more memorable
inform stories and can lend credibility to claims
(e.g. 23.6% could be expressed as ‘almost
and assertions. It is important to remember
one-quarter’ or ‘almost 25%’).
however, that facts must be used carefully if
they are to engage key audiences. A number represents a value, but it can also
express our values.6 For example, stating that a
How many facts? Research shows that one
program or intervention costs $10 million over
strong and compelling fact can be more
five years may be of interest to policy-makers,
powerful than a series of facts, particularly when
but stating that it costs $2 a day for all Canadians
the fact is an unexpected or surprising point
may be more appropriate to the general public.
that arouses interest, attention and emotion.
What kind of facts? Information must be
believable to the audience. Even if a fact is
correct, it may be doubted if appears too
extreme. It may also lead to perceptions of
‘cherry picking’ data that best supports the
conclusion, which could cause your audience
to doubt the message.
COMMUNICATING THE SOCIAL DETERMINANTS OF HEALTH: GUIDELINES FOR COMMON MESSAGING 5SAMPLE FACTS • Living in unsafe, unaffordable or insecure
Here are some good examples of how numerical housing increases the risk of many health
facts can be incorporated into SDH messaging problems.22
in Canada: • Education is a strong predictor of long-term
health and quality of life.23
• The poorest 20% of Canadians have more
than double the chance of having two or more • There is growing evidence that investing in
chronic health conditions like heart disease education is a highly effective step we can take
and diabetes than the richest 20%.19 to improve health outcomes. One study
estimates that having quality education
• People living in Canada’s highest income
available to all could save eight times as
urban neighbourhoods live about three years
many lives as medical advances.24
longer than those in the lowest income
neighbourhoods.19 • Warm and supportive parenting can help
protect children from the negative impacts
• First Nations youth are over 4 times as likely
of poverty, including poor health.25
to commit suicide compared to other
Canadian youth. The suicide rate for Inuit • Being unemployed or having a low-paying
is almost 12 times higher.19 stressful job can bring on illness and injury.
A good job can promote better health,
• The likelihood of being obese is influenced
self-esteem and social contacts. With a
by our income, education and jobs. Young
good job, we feel we belong.26
people from more affluent families have
more opportunities to be physically active
3.3 SELECTING WORDS
and to consume healthier food.20
Research from the United States has shown that
• Bullying can have a serious impact on mental
abstract phrases such as ‘social determinants of
health. Studies suggest that 36% of students
health’ do not engage audiences.6 Nevertheless,
in grades 6 to 10 may be victims of bullying.20
the concepts that underlie these phrases are
• More than one in four lower income actually broadly supported, particularly when
Canadians have skipped meals as a result they are expressed in concrete terms. These
of financial concerns.4 findings can also inform how we communicate
• 25% of lower income Canadians say they have SDH messages in Canada.
delayed or stopped buying some prescription
Using plain, values-driven and emotionally
drugs because of the economic downturn.
compelling statements can help craft effective
Only 3% of Canadians earning more than
SDH messages. For example, we should
$60,000 have taken similar action.4
avoid using labels and refer instead to the
• Canadians living in the most deprived circumstances that people experience when
neighbourhoods had mortality rates that they belong to a certain group. Below are
were 28% higher than those living in the some examples of how to use alternate
least deprived neighbourhoods.21 language to describe abstract concepts and
groups adapted from the RWJF.6
6 COMMUNICATING THE SOCIAL DETERMINANTS OF HEALTH: GUIDELINES FOR COMMON MESSAGINGWHEN TALKING ABOUT ABSTRACT TRY USING SIMPLE, VALUES-DRIVEN AND EMOTIONALLY
CONCEPTS OR GROUPS… COMPELLING STATEMENTS.
Social determinants • Our opportunities for better health begin where we live,
learn, work and play.
• Where we live, learn, work and play can have a greater
impact on how long and well we live than medical care.
• All people should have the opportunity to make the choices
that allow them to live a long, healthy life, regardless of their
income, education, or ethnic background.
Health inequalities • Giving everyone a fair chance to live a healthy life.
Vulnerable groups • Too many people don’t have the same opportunities to be
as healthy as others.
• People whose circumstances have made them vulnerable to
poor health.
Poverty • Families who can’t afford the basics in life.
Low-income workers • People who work for a living and still can’t cover basic costs.
3.4 BEST PRACTICES A good communicator should clearly
FOR COMMUNICATORS understand the motivations, needs, values
The messenger will always be a key element and background knowledge of their audience.
in the communications equation. It is essential This will help them tell a story or message
that the communicator appears open and that the audience will understand, remember
eager and uses a familiar and conversational and retell. A good communicator prepares
tone. If the communicator feels emotion about message content in advance and pays attention
stories and messages it is more likely that this to delivery (e.g. gestures, body language),
emotion will be conveyed to the audience in a structure (e.g. duration, anticipated responses)
compelling and memorable way. and approach (e.g. words, visuals).
COMMUNICATING THE SOCIAL DETERMINANTS OF HEALTH: GUIDELINES FOR COMMON MESSAGING 74. Conveying SDH Messages
The following section reviews ways to design The Robert Wood Johnson Foundation
and deliver messages so that they align with the (RWJF) used a sophisticated research and
specific contexts and circumstances in which testing process to develop a set of SDH sound
they will be delivered. It illustrates how to select bites. Some of these messages have been
appropriate tools and engage an audience by slightly adapted to the Canadian context:
understanding their needs and interests.
• Health starts—long before illness—in our
4.1 SELECTING THE RIGHT TOOL homes, schools and jobs .
Messages about SDH can be conveyed in many • All of us should have a fair opportunity to
different ways to suit various contexts. Three make the choices that allow us to live a long,
basic types of tools are outlined below: sound healthy life, regardless of income, education
bites, stories, and visuals. These tools can be or ethnic background .
used independently or combined together. • Our neighbourhood or job shouldn’t be
hazardous to our health .
SOUND BITES • Our opportunity for health starts long before
Sound bites are 10–20 second short statements we need medical care .
or tag lines. They can be used on their own or • Health begins where we live, learn, work
to introduce longer stories. Sound bites should and play .
convey one key idea in a clear and evocative
• The opportunity for health begins in our
manner. They should be easy for the audience
homes, neighbourhoods, schools and jobs .
to remember and repeat.
STORIES VISUALS
Audiences understand and recall stories more Images are an important element of effective
easily than facts and figures. If an audience can SDH messages and can include pictures,
relate to a character or a set of circumstances diagrams, maps or other visual aids. Images
they are more likely to change their view about should illustrate or reinforce the SDH message
an issue.5 A good story can inspire audiences and help create a “mind’s eye view” by
and convince them that action is both describing a situation or fact in a manner
important and possible.27 that reinforces the point.
SDH stories should be clear and compelling Images can create a conscious or unconscious
and if possible, based on real facts. True stories emotional response. Messages that create
or analogies can help to make the information strong imagery can be powerful, but be
more tangible and authentic. cautious about negative images that may
distance the audience.
8 COMMUNICATING THE SOCIAL DETERMINANTS OF HEALTH: GUIDELINES FOR COMMON MESSAGING4.3 AUDIENCE SEGMENTS
Although medical care is essential for There are many potential audiences for SDH
relieving suffering and curing illness, 75% messaging. CCSDH members selected the
of the things that can help make us healthy following four priority audiences:
are not part of the health care system.16
• Youth: Of the general public, Canadian
When we think about health, it’s easy youth are the prime target because it is
to assume that it just means eating the important to influence their understanding
right food and being active. Health is a lot of health early to influence behaviour and
more than that. Did you know that your outcomes across the life course. Parents are
education, job, relationships, and where also targeted as having an important influence
you live account for up to 60% of your on youth.
total health? 27 • Professionals: Educators need an understanding
of SDH because they have the capacity to
influence youth. Health and public health
4.2 PRIMING THE AUDIENCE practitioners are important because they work
It is important to prepare, or “prime” the at the frontline of the health system.
audiences to receive SDH messages. Audiences • Sectoral leaders: Business leaders are
may be more likely to believe a message if it invested in creating and maintaining a
begins with facts or images they already believe healthy and productive workforce and the
or support. For example, Canadians place great workplace policies they adopt can strongly
value on their health care system. As a result, impact SDH. Public sector leaders are in a
they may be more likely to understand and position to propose and/or influence public
act upon SDH messages that incorporate the policies and programs that impact SDH.
importance of access to quality medical care. Many non-governmental organizations
Messages that resonate with existing beliefs are concerned with issues relevant to SDH,
about personal responsibility and control over and tend to be oriented towards opportunities
health may help prime audiences to consider to create change.
other factors that influence health, such as • Media: Members of the media need an
SDH. See the box below for examples. enhanced understanding of the non-medical
Prior to delivering an SDH message, it is factors that influence health because they
important to assess the level of an audience’s have the potential to share information
knowledge about SDH, and/or health. Do they widely and to inform public opinion.
believe in myths or common misconceptions? The following tables draw upon available
A well-informed audience may be better knowledge about SDH in Canada and list the
able to engage with a complex SDH message. important “hooks”, “primes” and considerations
Audiences with little knowledge of SDH will for framing SDH messages for each target
require more compelling and repetitive audience segment.
messaging, as well as information that
challenges their misconceptions.
COMMUNICATING THE SOCIAL DETERMINANTS OF HEALTH: GUIDELINES FOR COMMON MESSAGING 9• Hooks are facts or circumstances that may • Primes are ideas that may help to increase
serve as entry points to SDH messaging given audience receptivity to messaging.
what is known about the knowledge and • Considerations include other factors that
beliefs of the target audience. may influence the way in which audiences
are engaged.
CANADIAN PUBLIC: YOUTH
SDH Hooks Primes Considerations
Knowledge
Low • Connecting with • Health is about • Long term health or
others is an important making responsible other outcomes may
part of being healthy. choices—but it is also not be motivating.
• The health of the about what options • SDH are linked to
natural environment you have. other life experiences
is part of what shapes • Without health, (e.g. cost of
your health. opportunities for education, social
life experience inclusion, (un)
are limited. employment, etc).
CANADIAN PUBLIC: PARENTS
SDH Hooks Primes Considerations
Knowledge
Low • We want our family • We teach our kids • Connect SDH
to be healthy. how to be healthy to the health and
• Family health is and to take care of life outcomes
about more than themselves. Now of children.
the health of each we need to make • Parents shape the
family member. sure they know social conditions in
The circumstances how factors such which their children
and environments as school, jobs live. Be cautious
in which we live and friends affect about making them
together shape their health. feel they may not be
our health. • Without health, providing an optimal
opportunities for environment.
life experience
are limited.
10 COMMUNICATING THE SOCIAL DETERMINANTS OF HEALTH: GUIDELINES FOR COMMON MESSAGINGPROFESSIONALS: EDUCATORS
SDH Hooks Primes Considerations
Knowledge
Low to • In the classroom you • Education influences • Educators already
moderate . are on the front line . how healthy we are have many
Perceived Students who come throughout our lives . commitments
knowledge of to school hungry, • Children know they must meet
health issues without having that their doctor in the classroom .
may be higher . enough sleep or the will help them when It is important to
right clothes aren’t they are sick . They support them with
ready to learn . also need to realize easy-to-use tools
• Educators have an that there are other and messages .
opportunity to help professionals who
build a healthy and can help them avoid
productive next ill health .
generation .
PROFESSIONALS: HEALTH PRACTITIONERS
SDH Hooks Primes Considerations
Knowledge
Moderate, • Existing pressures • Patient care is • Supportive of SDH
but focus in service delivery critical to a healthy concepts, but unclear
tends to be and the challenges population, but it is on actions to take .
on individual they create for not enough . We also • Recognize there are
health/medical practitioners need to address the problems in frontline
care and patients . root causes of illness . service delivery, but
• Contribution to • Enable/empower systemic change is
creating a healthier patients to make difficult to imagine .
population—one healthy choices
patient at a time . by creating the
circumstances in
which these choices
are available .
COMMUNICATING THE SOCIAL DETERMINANTS OF HEALTH: GUIDELINES FOR COMMON MESSAGING 11SECTORAL LEADERS: PRIVATE SECTOR LEADERS
SDH Hooks Primes Considerations
Knowledge
Low, but • Ill health has a • You are invested • Illustrate the costs of
significant business cost—it in the health of your inaction, e .g . human
health results in workplace employees—it is capital development,
investments via absences and important that this cost of treating
benefit plans, diminished investment covers all instead of preventing
sick leave, etc . productivity . aspects of health . illness .
• Health is a • Preventing illness • Potential for long-
good investment . keeps employees term benefits in
Ill health is costly: at work . workforce health,
economically, • Your employment absenteeism, and
socially and and occupation can productivity .
personally . influence your health .
• Possible links to
corporate social
responsibility
agendas .
SECTORAL LEADERS: PUBLIC SECTOR LEADERS
SDH Hooks Primes Considerations
Knowledge
Varies by area . • Sustainability of the • The costs of ill • Awareness of
High among health care system, health are high . political timetables,
health leaders; growing cost We need to which can
moderate pressures . keep people from complicate
among social • Demographic getting sick by prioritizing longer
policy leaders . change—aging focusing on term outcomes .
May be low population and prevention . • General support
among others . connection to health • Enable/empower for the concept
care provision . people to make of cross-sector/
• Economic costs of healthy choices department work,
ill health and health by creating the but need help to
inequality, the cost circumstances in see opportunities
of inaction . which these choices for specific actions .
are available . • Jurisdictional
• Increasing prevalence
of chronic disease • Health is a divisions—clarity on
and the long-term consistent priority federal vs . provincial/
impacts on well- in Canadian public territorial/ regional
being, productivity, opinion polling . roles and policy
etc . levers is important .
12 COMMUNICATING THE SOCIAL DETERMINANTS OF HEALTH: GUIDELINES FOR COMMON MESSAGINGSECTORAL LEADERS: NON-GOVERNMENT ORGANIZATIONS OUTSIDE OF THE HEALTH SECTOR
SDH Hooks Primes Considerations
Knowledge
Varied. • Health, social, • Action on SDH can • Motivated by desire
It is likely that environmental and help to address to act and a sense of
many NGOs will other issues are inequality (or other social responsibility.
have high levels inter-connected. issues as appropriate). • Many NGOs already
of SDH-related There are common • A healthier recognize the value
knowledge, but elements between population can help of change and may
the language of these issues us to achieve other be oriented towards
SDH may not and SDH. societal goals. achieving it.
be consistently • Poor health and • It is a collective • Need to be equipped
used. health inequalities responsibility to with tools given
impact other create the conditions limited financial and
areas of life, such in which people human resources.
as employment, can succeed. • Consider the
child care, This includes language and
volunteering, etc. conditions that priorities of other
• Health inequalities support good health. sectors—problems
are costly— and solutions cannot
economically, be framed only in
socially and health terms.
personally.
SECTORAL LEADERS: NON-GOVERNMENT ORGANIZATIONS IN THE HEALTH SECTOR
SDH Hooks Primes Considerations
Knowledge
Moderate • Existing health • Medical care is • Medical care tends to
to high. system pressures critical, but not be the focus of
Some NGOs and the challenges enough to make health dialogue.
are likely to they create for people healthy. Health organizations
have a stronger governments, We also need to may need tools and
focus on practitioners and address the root support to extend
medical care patients. cause of ill health. this dialogue to
than SDH. • Public interest • Preventing people include SDH.
in health and from becoming sick
health care is is an important part
consistently high. of supporting health.
COMMUNICATING THE SOCIAL DETERMINANTS OF HEALTH: GUIDELINES FOR COMMON MESSAGING 13MEDIA
SDH Hooks Primes Considerations
Knowledge
Low to • Sustainability of the • Connection between • Timeliness is critical—
moderate . health care system, individual health and stories need to be
Primary focus growing cost the circumstances ‘newsworthy’ .
tends to be pressures . that create (or • Need to make
medical care, • Demographic undermine) it . SDH tangible—
stories about change—aging • Connections create a human face
individual health . population and between health for the story .
connection to health system pressures
care provision . and overall
• Economic costs of population health—
ill health and health build a healthier
inequality, the cost population by acting
of inaction . on SDH .
• New research or data
on health conditions
or treatments .
14 COMMUNICATING THE SOCIAL DETERMINANTS OF HEALTH: GUIDELINES FOR COMMON MESSAGING5. Key SDH Messaging Guidelines
WHAT TO DO WHAT TO AVOID
ü Use clear, plain language û Technical language or jargon
ü Make issues tangible with analogies û Abstract concepts or terms
and stories
ü Break down and round numbers; û Complex numbers, or large numbers
place numbers in context without any context
ü Challenge conventional wisdom with û Exhaustive documentation
one unexpected fact
ü Use inclusive language (we, our, us) û Creating distance between groups
(them, they)
ü Identify people by shared experiences û Labeling people by group membership
ü Prime your audience with a fact, image or û Facts, images or stories that audiences
story they are likely to believe, based on may find too contentious or extreme to
their values, interests and needs be believable (even if they are true)
ü Leave the audience with a memorable û Being forgettable
story or fact that can be easily repeated
ü Use a conversational and familiar tone û A clinical or academic tone
ü Take the time to understand your û Assuming the same message will work
audience—this includes customizing your for all audiences
message by selecting appropriate tools,
approaches and information
ü Prepare your message content and û Speaking off the cuff
presentation
ü Focus on communicating one thing û Trying to do too many things at once
at a time
COMMUNICATING THE SOCIAL DETERMINANTS OF HEALTH: GUIDELINES FOR COMMON MESSAGING 156. Conclusion
The guidelines for common messaging provide The CCSDH commissioned this document to
guidance on how to effectively communicate help foster national dialogue on the broad
messages about social determinants of range of factors that contribute to people’s
health (SDH). They are intended to serve as health. It is the hope of the CCSDH that by
a tool to help Canadian Council on Social equipping individuals and organizations with the
Determinants of Health (CCSDH) members knowledge to create effective SDH messages
and other individuals and organizations to we can build a broader understanding of health
build, use and share their own SDH messages. in Canada among diverse audiences. Further
research exploring Canadian views about SDH
and the values, metaphors and language that
provide the foundation for compelling messages
would also contribute to this goal.
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