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Breaking Down the Strategy Silos



by Brian Hyndman



A. The "Strategy Silo" Barrier in Health Promotion Practice



One of the key messages emanating from health care reform initiatives (too numerous to mention here) is the need to overcome the "silo mentality," the tendency of health-related sectors to keep to themselves, thereby avoiding the potential opportunities and reduced duplication arising from collaboration with other disciplines. The silo mentality is also alive and well within disciplines. I refer here to the tendency of many health promotion practitioners to segment the strategies at their disposal. The false dichotomy between health communication, the process of promoting health through the exchange and sharing of information, and community mobilization, the process of working with communities to take action on health-related priorities, is one such example.



For the purposes of health promotion programming, health communication and community mobilization are often regarded as mutually exclusive. This perception is understandable when one considers the features of health communication at its worst: pedantic, top down, victim-blaming campaigns that treat the "target audience" as passive recipients of information aimed at correcting their bad habits. Such initiatives -- of which there are all too many examples -- are justifiably viewed as incompatible with the capacity-building objectives of community mobilization.



Yet, in many ways, health communication and community mobilization strategies are complementary. Each approach can strengthen the impact of the other.


B. The Case for Combination



Health communication methods enhance community mobilization in two key respects:



1) Communication methods can mobilize communities to take action by increasing awareness of their shared health concerns.



Community organization projects utilize communication channels, the means by which messages are sent (e.g., newspapers, radio), to raise community awareness of health-related priorities, such as inadequate housing or unsafe drinking water. Communication channels are especially important for mobilizing communities of interest, geographically dispersed groups of individuals whose sense of "community" arises from shared characteristics or a common sense of purpose (e.g., AIDS advocacy groups).



2) Communication methods enhance the skills and capacities of community groups, thereby increasing their ability to act on issues affecting their health.



The development of community capacity, the collective problem-solving ability of a community, is crucial for the successful resolution of shared health problems by community members. Effective communication skills, such as media relations, is a key element for building community capacity. Training in health communication techniques equips community members with the knowledge and skills needed to take part in effective mobilization efforts.



Conversely, the concepts and principles underlying community mobilization can be used to strengthen the impact of health communication campaigns.



1) Community mobilization activities can strengthen the impact of media-based communication initiatives.



In many instances, health communication campaigns rely solely on media appeals to achieve their objectives. However, evaluation research has consistently found that "media-alone" initiatives have little or no impact on the attitudes and behaviours of the intended audience.More significant outcomes have occurred when community mobilization activities were utilized in combination with media appeals. Community mobilization, or any organized group activity, may also help to bridge the "knowledge gap," the tendency of communication campaigns to have a greater impact on individuals with higher levels of income and education, who are better prepared to interpret and act on the information.



2) Community mobilization enables marginalized groups to secure access to communication channels.



By raising public awareness of new ideas and practices, communication channels can play a key role in health promotion programming. But the print and broadcast media tends to offer a limited perspective on health-related issues, emphasizing "lifestyle" factors at the expense of the social, economic and political barriers to health. As a result, the health priorities of marginalized groups are not always reflected in our mass communication channels. Community mobilization enables marginalized community group members to increase support for their health issues by gaining access to key gatekeepers of the media and other communication channels.



3) Community mobilization enhances the effectiveness of health communication efforts by defining and framing health problems as the communities of interest perceive them.



All too often, communication campaigns reflect the priorities of the sponsor rather than the recipient ("you can deal with your workplace stress by lowering your cholesterol level"). As a result, many campaigns have little or no impact because they fail to address the perceived health needs of the priority group. This limitation can be addressed through use of community mobilization methods to actively involve priority group members in developing messages that better reflect their interests and concerns.



Together, the principles of health communication and community mobilization can guide the planning and implementation of effective health promotion initiatives. So what does this look like in practice? The following project provides an apt illustration.



C. Health Communication and Community Mobilization in the Media Arts Program



The Media Arts Program is an ongoing skill-building initiative for young people living in Regent Park, a low-income community in the east end of Toronto. Sponsored by the Regent Park Focus Community Coalition, the program provides a range of learning experiences for young people in the media arts field (e.g., video production). Participants apply their skills to develop communication materials focusing on substance abuse and related problems in the community. The objectives of the program are "to provide youth and young adults with a forum to interactively learn about substance abuse; to teach youth to teach others about substance abuse; and to use print, media and video presentations to present strategies that individuals, families and communities can use to prevent substance abuse and promote health."



A needs assessment conducted by the local community health centre inspired the development of the program. Informal discussions with young people in Regent Park revealed a lack of knowledge about the consequences of substance abuse. All of the youth interviewed identified television and videos as a source of drug-related information, a finding that led to the identification of the Media Arts Program as a means of engaging their interest.



The program also emerged from the work of a local youth centre coordinator, who observed that many of the young people he was trying to attract to after-school activities were hanging out in bars, video arcades and pool halls. Time spent in these settings inevitably brought the young people in contact with drug use and negative role models. The Media Arts program was conceived as a way of dissuading young people from spending time in high-risk settings that increased their vulnerability to drug and alcohol-related problems.



Components of the program include media awareness training, media skills training (including an annual media arts camp project), and the development of communication materials (videos, newspapers, etc.) by participants. In addition, the Media Arts Program offers a peer education program for youth, weekend and after-school employment opportunities and ongoing promotion and outreach to the community.



To date, program participants have developed a number of videos addressing substance abuse as well as other community health problems, such as racism. In general, teachers, students, public health workers, parents and local residents who have viewed the videos feel they are highly effective, culturally appropriate vehicles for communicating information about the health concerns of young people in the community.



Participants in the Media Arts Program report increased levels of skill and knowledge related to accessing drug education resources and information. Participants also report increased awareness of the consequences of drug and alcohol use, which places them in a better position to make healthy choices. Moreover, the activities offered through the program provide the participants with healthy recreational alternatives to drug use, as well as marketable skills that can open doors to future educational or career opportunities.



In summary, the Media Arts Program is an innovative example of the way in which the principles and concepts underlying health communication and community mobilization can be combined in programming efforts. All effective community mobilization efforts need communication methods to engage participants, build public support and achieve their objectives; all effective communication campaigns require mobilization efforts to actively involve priority group members in the development of messages that reflect their shared concerns. You can't have one without the other!



D. So What's Really New?



You don't have to look very hard to find examples of health promotion programs that have successfully combined health communication with community mobilization. I'm not under any illusions about discovering the health promotion equivalent of Reese's Peanut Butter Cup T ("you've got social marketing in my community development!"). Nor am I putting forward an argument for the total abandonment of the strategy silos. Given the realities in which we operate, health communication campaigns and community mobilization efforts will continue to be pursued for quite different purposes.



My intent is to point out that the use of two fundamental health promotion strategies, which are sometimes regarded as incompatible, provides a powerful combination for promoting health at the local level. Health communication strategies enhance the impact of community mobilization efforts by enabling participants to express their health priorities. Community mobilization, by contrast, complements health communication efforts by enabling participants to secure access to communication channels and enhancing the credibility of campaign messages by defining and framing health issues in accordance with community values and perceptions



So what have you got to lose? Break out of the strategy silo!


** For a more detailed discussion of the ways in which health communication can be used in conjunction with community mobilization, please refer to:



Hyndman, B. Health Communication and Community Mobilization: Complementary Strategies for Health Promotion Toronto: The Health Communication Unit at the Centre for Health Promotion, 1995.



Copies of this resource are available on the THCU website:

http://www.thcu.ca