Some suggestions for improving wider understanding of the work of population health

Published on
April 11, 2012

How can a wider audience be engaged in the broad-ranging and often complex issues of population health? Ben Harris-Roxas, a health impact assessment consultant, has some suggestions in the article below.

And at the bottom of his piece are some details of a new publication and a course for those with an interest in improving the health and wellbeing of locationally disadvantaged communities.


Some suggestions for engaging a wider audience in the work of population health

Ben Harris-Roxas writes:

If you follow health reporting on TV or in newspapers you could be forgiven for thinking that the only things that happen are scandals in clinical services or trials of new drugs.

But journalists and PR people aren't necessarily all to blame. As health professionals we often do a pretty bad job at explaining what we're doing.

I've been thinking about how we can do a better job of explaining the slightly more complex interventions that are required for a lot of the population health problems we face. New drugs and clinical stuff-ups fit into well understood tropes. We don't have to explain everything, the audience can take shortcuts because they understand what type of story it is.

When it comes to population health issues it's often not as easy because the issues are interdependent, and many of the interventions are unfamiliar to a mainstream audience.

A lot of my work is on health impact assessment, which involves developing evidence-informed recommendations to inform decision-making and implementation. When it's explained like that, it's no wonder journalists aren't interested. It sounds like a technocratic snooze-fest.

Instead, let's think about the demand for new housing in most Australian cities and the pressures to release new land on the fringe. Also think about how disastrous the design of some new suburbs has been for population health in the past by promoting car dependence, limiting walkability and increasing social isolation. The design of our suburbs matters.

Health impact assessment has been a practical way to get people to think about the health consequences of the way suburbs are designed and here's a few examples

Contrast that story with the bland description of health impact assessment in the earlier paragraph. It sounds a lot more engaging.

We often fail to describe this broader story in population health, not just when pitching stories but also when we communicate with other sectors (or even within the health sector).

Here are four ways I think we could get better at messaging.

1. Don't explain the solution, explain the problem

Or better yet, explain the causes of the problem. This piece from the Atlantic Cities is a good example. It describes the phenomenon of "ghost estates" in Ireland, which came about when 2,800 housing developments were abandoned as a result of the GFC. A community group has started planting trees on these sites to reintroduce some aspects of nature into these abandoned building sites. The piece works because rather than leaping into a description of the NAMA to Nature group, it first describes the problem as well as its causes. Too often we forget the broader context when describing what we're doing in population health.

2. Don't rely on the usual suspects

There's evidence that people are more willing to listen to arguments when they come from unexpected sources, at argued in this Ramp Up post. A good example recently is the conservative economist Judith Sloane's calls for an increase in the NewStart allowance. She could hardly be described as a usual suspect when discussing the rights of the unemployed. Different people paid attention to her comments as a result.

3. Avoid jargon and language that alienates people

The importance of this is emphasised in the Robert Wood Johnson Foundation report A New Way to Talk About the Social Determinants of Health. People switch off when things are described in stereotypical or politicised terms. As health professionals we often tend to fixate on the solutions and the jargon that surround them, partly because it's what occupies most of our time but also because we are already convinced about the importance of the problem.

4. Describe the human impact

This is often the hardest part for population health stories. Individual stories can illustrate broader population issues but they can also be misleading and seem glib. We often understandably resist this because we have an obligation to respect the dignity and privacy of the people we work with and we can't control how their experiences will be reported. Without the human dimension though it's difficult for not only journalists but also the audience to connect with the story. Human-scale narratives still matter, even with the most abstract ideas.

A good example of a media piece that embraces history, messiness, complexity and a population approach is Melissa Sweet's description of Miller for Inside Story. It's a story about the problems faced by a suburb in South West Sydney.

It's an almost impossible story to convey in usual journalistic form because it has a lot of history and people involved and doesn't have a neat narrative arc or resolution. Despite this, the piece manages to convey a lot of the complexity to the reader and provides a number of insights. The point is that it is still possible to tell even the most complicated stories in engaging ways.

We're confronting big social and population health challenges but we have some ideas about the solutions. We just need to make sure we don't bury the lede.

Ben Harris-Roxas is a health impact assessment consultant from Sydney and Health Section Co-Chair of the International Association for Impact Assessment. You can find him on Twitter @ben_hr


Working to improve health in disadvantaged communities

Further to Ben's mention of the Understanding Miller story, the Centre for Health Equity Training Research and Evaluation (CHETRE) recently launched a booklet telling the stories of the first eight projects that were part of its courses on working in locationally disadvantaged communities.

The booklet, "Real world stories: reflections on working in locationally disadvantaged communities", describes initiatives ranging from church-based health promotion for Pacific communities, to a project to improve health and educational outcomes for children in Airds and Bradbury, to a coffee club aiming to overcome social isolation in the Ashcroft area, to efforts to boost physical activity among Assyrian, Vietnamese and Cambodian communities. and a nitbusting project at a school where attendance was being affected by repeated infestations.

The booklet doesn't shy away from the difficulties that can arise, telling of the frustrations of delays with ethics approvals, and the difficulties of working with limited resources and of juggling community expectations.

Some of the comments from those involved with the projects included:

" to keep working with people rather than imposing something on them."

"We learnt about the important role that health and education play in disadvantaged communities and that health is not just a clinical presence. We became aware of the need to rethink the way we work in order to work within a social determinants model."

"This project grappled with a common issue for many health workers – the difficulty of recruiting to a project based around doing something that feels difficult – while recognising that people in disadvantaged communities often have other more pressing priorities than health."

CHETRE is now recruiting participants for its third course. Joan Silk, who edited the new booklet, says: "The course is an outcome of a research program that identified the skills needed to work in or with disadvantaged communities. Project teams in this course are trained and supported to learn more about effective strategies in addressing health disadvantage. The program comprises workshops, specialist mentoring, site visits and 12-month help desk support from the CHETRE project team. Participants plan, implement and evaluate projects based in disadvantaged communities."

(If you would like a copy of the booklet, please leave your details below).