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Media Advocacy and the Public Health Professional


I Introduction
II The power of the media to support social change
III Media Advocacy and Community Engagement
IV Planning for Media Advocacy
V The Media Advocacy Plan
VI Framing For Access and Content
VII Conclusion

--Submitted by Jason Chapman, Media and Communications Coordinator (Tobacco Control), Media Network / PTCC, Tara Maher, Media and Communications Coordinator (Healthy Eating, Active Living), Media Network / PTCC, and Steven Savvaidis, Manager, PTCC

I Introduction

The physical and social environment is a key determinant of health and the development of healthy public policies is a key strategy for achieving health supportive environments as reflected in the Ottawa Charter for Health Promotion and other health promotion policy statements (World Health Organization, 1986). The Ontario Public Health Standards and accompanying guidance documents also specify the important role that Ontario public health departments play in helping to support healthy public policy (Government of Ontario, 2008). This role involves working with and building the capacity of community coalitions to inform and influence decision-makers to make the policy changes that are needed. Media advocacy is an important, but often underutilized policy development tool. Public health practitioners should increase their knowledge and capacity to work with community groups and utilize media advocacy in pursuit of healthy public policy. This article will describe the key steps that are involved in conducting effective media advocacy campaigns and the relationship to other important activities such as coalition building and strategic planning.

II The power of the media to support social change

Media advocacy is defined as “…the strategic use of mass media as a resource for advancing a social or public policy initiative” (U.S. Department of Health and Human Services, 1989). When engaged in media advocacy, the media is the primary target due to its influence in shaping public opinion and the policy agenda. The media often cover issues from an individualistic perspective neglecting socio-environmental factors and causes. Public attitudes and understanding of issues are in turn influenced by media coverage. It is the job of media advocates to position public health issues as societal issues with policy solutions.  When done effectively, media advocacy ultimately changes the way that issues are portrayed, understood, and acted upon. It shifts the focus away from changing the individual to holding government decision-makers and industry responsible for making environmental changes that support healthy behaviour and protect public health.

In developing media advocacy strategies, we are typically trying to garner earned media rather than paid media exposure. The reason for focusing on earned media is two-fold. First, public health departments and community groups rarely have the resources to directly compete with the large paid advertising budgets of the tobacco, alcohol and other industries. Second, earned media, including news coverage, editorials and letters to the editor, tend to be viewed by the public as more credible sources of information than paid advertising. Often community concerns receive limited coverage in the media. By building the capacity of community groups to access the media, public health practitioners can help to redress power gaps and support health equity. Media advocacy enables community groups to point towards the environmental root causes of health conditions in a public way which can challenge the way in which resources are distributed in society, and influence decision-makers to create policies that are more equitable and health promoting.

III Media Advocacy and Community Engagement

Media advocacy is a participatory approach which directly engages the community. Community engagement is therefore an essential step for effective media advocacy. This can take place by working with existing coalitions or supporting the development of new coalitions or community groups. A sustained coalition can provide the long-term attention that is needed to change public attitudes and achieve policy goals. A diverse group of community members around an issue is also valuable as it brings people to the table with a variety of skills and resources that can help contribute to the project’s goals and objectives. From a practical perspective, coalitions also have a stronger voice and more clout than any single individual or group. When engaging community members or groups, always remember that your goal is not only to inform, but to also build capacity for action.

As employees of government funded agencies, public health practitioners may be reluctant to directly participate in media advocacy campaigns due to the conflict between different interest groups that is often at play in any advocacy situation. Also, government decision-makers are often the target of media advocacy efforts. While these risks are real, there are nonetheless a variety of important roles that public health practitioners can play to support media advocacy for healthy public policy. This is often achieved by supporting the work of community coalitions. This capacity building role may include serving as a public health expert to a coalition, facilitating planning processes, providing access to local data (e.g., community health status report, public opinion data) and other evidence-based information that the coalition can use to identify its policy objectives and rationale (Kuhn, Doucet, & Edwards, 1999).  The public health practitioner may also be able to help the coalition access training opportunities such as media interviewing skills training. Public health practitioners may also be willing to be interviewed by the media as public health experts.

IV Planning for Media Advocacy

Media advocacy is not a standalone strategy or activity, but rather an important component of a broader policy development or advocacy strategy (Wallack, Woodruff, Dorfman & Diaz, 1999). A key first planning step for any public health strategy is to complete a situational assessment to help understand the nature of the problem and its root causes.  A root cause analysis is particularly important in order to determine the agents responsible for the problem and to identify the policy solution(s) that are needed. For example, a root cause analysis of the problem of childhood obesity within a particular community would move beyond understanding whether parents’ are aware of the importance of healthy eating and physical activity, to assessing the local food environment including the availability of healthy and nutritious foods, income disparities, and the marketing practices of the food industry. The availability of safe and accessible recreational activities in the community might also be identified as an important contributor to low levels of physical activity. This root cause analysis is essential in helping to determine what policy options will become the focus of your media advocacy efforts.  

In addition to the above, it is important to learn who the policy-makers are and have a firm understanding of the policy-making process. It is also important to understand the public’s and decision-makers’ attitudes and beliefs around an issue so that your messaging can be tailored. Two questions that can assist with this process are: Do decision-makers, their constituents and/or the public at large understand the issue? Do they support or oppose a policy solution? Monitoring how the media are currently covering your issue is also an important preliminary planning step, and can be an indicator of how issues are viewed by decision-makers and the community at large. Media monitoring should be part of any situational assessment and continuous media monitoring is important throughout your campaign. Monitoring the media is further discussed in the ensuing paragraphs.

V The Media Advocacy Plan

Influencing the quantity and quality of coverage is critical to advancing healthy public policy.  Your media advocacy plan will specify how you will achieve this end. The specific components of a media advocacy plan include, policy objectives (e.g., policy adoption/revision), audiences (who has power to enable change or take action), messages (what needs to be communicated), and strategy and tactics (nuts and bolts of what you plan to do).  A good plan must have short and long-term objectives and also include evaluation mechanisms so that progress can be measured and adjustments to the plan can be made.

The media advocacy plan will also specify the media relations tactics that you will utilize to ensure your message is heard. A variety of media relations tools can be used both proactively and reactively. Proactive engagement includes tactics such as distributing press releases, media advisories, hosting news conferences, setting up editorial meetings, pitching stories ad hoc and submitting opinion editorials.

From a reactive standpoint, monitoring newswires and local media outlets are effective strategies. These efforts will provide you with an opportunity to piggyback on opposition media activities to ensure the public health, community voice and policy perspective is included. This can be done by calling a journalist when you see an opposition press release distributed over the newswire or by submitting letters to the editor when a story lacking the public health and policy perspective appears in your local paper. In today’s online world, you can also respond to coverage by posting comments that support policy change to web-based news stories, blogs or through social media platforms like Twitter. The Program Training and Consultation Centre’s Media Network project provides members with a daily summary of relevant media coverage for tobacco control and healthy eating and active living issues that can serve as a useful support for your media monitoring efforts.
To support all media relations activities, a solid grouping of key messages should be developed that emphasize the points you wish to address and counter opposition messaging. It is paramount that these messages be delivered clearly and consistently. They should be memorable and be designed to resonate with the audiences you are looking to influence. Whenever engaging the media, whether it be proactively or reactively, the stories you pitch need to be newsworthy and above all else, framed properly.

VI Framing For Access and Content

In media advocacy framing is critical. Frames define problems, diagnose causes, make moral judgments and suggest remedies (Entman, 1993). Framing is traditionally broken down into two components, framing for access and framing for content. For public health professionals engaging in media advocacy, the frame you will most often work with around policy initiatives will typically fit into the following construct (although the words used will be different):

X policy is required for issue X as people “…cannot be healthy in an unhealthy environment” (Wallack & Dorfman, 1996).  

Let’s break down framing into its two components.

1.    Framing for access

Framing for access deals with crafting a story in a manner to get a journalist’s attention so that your issue is reported as news. One of the keys to framing for access is ensuring that a story is newsworthy. The other is properly using media relations tools (like press releases) and knowing who, when and how to pitch a news story. All three pieces fit together like pieces to a puzzle. When combined together, it is like knowing a secret handshake that can help you gain access to the media. A story is perceived as being newsworthy by the media if it is:

  • New
  • Innovative
  • Timely
  • Local
  • Human interest
  • Controversial
  • A first
  • Includes a celebrity
  • National or international in scope

2.    Framing for content

Framing for content is part two of the framing process and deals with how your issue is covered by the media. This includes, defining what the problem is, who or what is causing the problem, what the solution is and who has the power to make it happen.

Framing for content essentially deals with ensuring a story is delivered from a policy perspective, specifically emphasizing the societal causes and responsibility of decision-makers for addressing the issue. “Ideally, the story should be framed so that the conclusion is the policy you seek to advance” (Wallack & Dorfman, 1996). The greatest challenge for advancing healthy public policy through media advocacy is that this process challenges commonly held assumptions, values and beliefs. The framing of news stories often reflects deeply rooted societal norms, belief systems about an individual or society and their roles and responsibilities.

Traditionally, the media present issues from the perspective that there is a lack of information, or to put it another way, that there is an information gap. This presumption unfortunately leads to a frame around the individual and can lead to victim blaming. The information/individual responsibility frame fails to address that there is a power gap and that people “…cannot be healthy in an unhealthy environment” (Wallack & Dorfman, 1996).  

For those engaged in media advocacy around a public health issue, this individual responsibility frame constantly needs to be challenged in the media, by highlighting the power gaps and environmental policy solutions required. Here is an example of how to shift an issue from an information/individual frame to a power gap/societal frame.

Information/Individual Responsibility Frame:  We need to run a social marketing campaign to educate athletes about the negative effects of tobacco use on performance.

Power Gap/Societal Responsibility Frame: We need a media advocacy campaign to push for tough, effective policy to keep tobacco industry products out of all sport and recreation activities in Ontario.

Changing established frames can be a long process. It is an uphill battle, meaning your messages need to precisely convey your position and be repeated regularly until they become part of the established discourse used to debate the issue. Whether it is framing for access to get your issue covered or framing for content to ensure your issue is being covered properly, always remember, that frames can determine what is and is not news, through what is included or excluded from a story. (Wallack et al.1999).  

VII Conclusion

Media advocacy is a powerful, but often underutilized tool for advancing healthy public policy. To effectively engage in media advocacy, one needs to understand the policy-making process, engage the community via coalitions and utilize media relations tools to highlight issues and apply pressure to decision-makers to make environmental changes. To achieve this end, the root causes of an issue need to be understood and firmly outlined as part of a comprehensive media advocacy plan.  

In all media advocacy efforts, framing is critical. From a public health perspective issues are framed as power gaps, meaning social responsibility and the need for healthy public policies, as opposed to information gaps, which reinforce a personal frame, individual responsibility and the need for public education.   

Through all healthy public policy endeavours, the information/individual frame needs to be challenged. Change is often incremental, but with sustained focus, policy goals can be achieved over time. Just think, less than 10 years ago, smoking in workplaces and restaurants was a societal norm. Today it is a different story, a story media advocacy helped bring about by reframing tobacco use from a personal right and responsibility to an issue of governments needing to protect the public’s health from second-hand smoke exposure.

The Media Network for a Smoke-Free Ontario and the Media Network for Healthy Eating, Active Living provide public health professionals across the province with a diverse set of media relations and media advocacy services to support the development and implementation of community-based healthy public policy, as well as to raise public awareness on key issues. To learn more visit:


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