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Preventing Chronic Disease

Launching a Media Advocacy Campaign

Local health departments have a tradition of working with individuals, communities and policy makers, but less so with the media. Sometimes public health professionals and advocates use news or advertising to promote changes in personal behavior, but far less often to advance public policy. Newspapers, radio and television offer a terrific, largely untapped opportunity to depict the many influences on chronic disease and to issue a call to action. Professionals and advocates use news or advertising to promote changes in personal behavior, but far less often to advance public policy.

This chapter describes ways public health professionals can use the media to promote chronic disease prevention. Local health departments will vary in their ability to pursue media advocacy, but any health department can do so to some degree. At a minimum, the department may watch for opportunities to respond to emerging stories with a well-prepared message about chronic disease prevention by writing a simple letter to the editor. In other cases, a department may decide to dedicate significant resources to a media campaign, taking the initiative to plan activities that will generate coverage.

The Chronic Disease Prevention Organizing Project (CDPOP) engaged itself at both ends of the spectrum. Initially the project used simple tactics, such as writing letters to the editor. The letters responded to newspaper stories that cited a chronic disease or related risk factor. Each letter recast the story, changing the focus from individual behavior to the need for collective community action to reduce a range of risk factors. Readers were directed to the project to receive more information or to arrange for a presentation in their community. A number of community leaders contacted the staff in response.

Later CDPOP pursued more elaborate measures. The project worked with a local cable television station to produce a video showcasing local communities that had organized to prevent chronic disease. The award-winning film, "Together We Can Make a Change," aired more than two dozen times on the county's cable station, which serves 285,000 homes. We produced an accompanying facilitator's guide and incorporated the film into presentations to local community groups interested in working on these issues in their neighborhoods.

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Other Resources (13k PDF, 2pp.) - obtain a copy of the video or facilitator's guide

Following are steps you can take to plan media coverage of your public health efforts.

Step One: Determine your objectives

When developing the objectives of media advocacy, ask the following questions:

  • How will the media strategy contribute to the program's overall goals?
  • What resources do we have? Are there natural opportunities to influence the media?
  • What educational objectives might be addressed through the media?
  • What action-oriented and policy objectives could be addressed?

Step Two: Develop the message

Frame the issue

When it comes to publicity, the challenge is not just to get a topic into the news but also to frame the issue in keeping with the program's objectives. The frame is the perspective from which the story is told. When the media cover disease, they tend to focus on one illness, such as cancer, or one risk factor, such as smoking. Your task is to shift the focus from a single problem to a convergence of risk factors. In proposing solutions, you have the opportunity to shift the focus from individual behavior to broader social policy.

Most people understand that smoking is bad for your health. They know that lack of exercise and poor nutrition also lead to health problems. They also have learned that pollution and stress are dangerous. But few have seen how all of these problems together lead to a group of diseases that cause the majority of deaths in a community. And even fewer may recognize that these deaths can be prevented by a comprehensive attack on numerous risk factors.

The importance of framing the story cannot be overstated. It largely defines the boundaries of public discussion about an issue. Elements in the frame are perceived as legitimate; those outside the frame are marginalized.

A media campaign must frame for both access and content:

Framing for access means shaping the story to get the attention of journalists. Often it means staging an event or offering an alternative perspective on current news.

Framing for content means describing the story in terms of the policy issues. Ideally, you want to develop a story that concludes naturally with the proposal you seek to advance.

When it comes to access, look for opportunities to make a dramatic statement. For example, the Contra Costa Breast Cancer Partnership had little success getting coverage for routine breast cancer awareness efforts until the local cable station pulled a breast self-exam video off the air because of concerns about nudity. The Partnership used the opportunity to make the point that educating women about the importance of breast exams saves lives.

When it comes to content, take care in identifying an opponent. For example, groups in Contra Costa criticized tobacco companies for paying merchants to display cigarettes openly, rather than behind the check-out counter. Critics refrained from blaming store owners because health officials need to cooperate with merchants on other programs. The Contra Costa Tobacco Prevention Coalition and a group called TIGHT (Tobacco Industry Gets Hammered by Teens) underscored their desire to work with local merchants and avoided casting them as the villains.

Ultimately, there is a delicate balance between framing for access and framing for content. Sometimes the slant that is most likely to draw media attention is not the one that the health department would prefer to take. For instance, the media often are attracted to news stories that focus on the victim. Keep in mind that your objective is to shift from the perspective of the individual, which is most likely to draw attention, to the perspective of social accountability, which seeks the root causes of a problem and leads to a policy solution.

Identify your audience

Any media campaign must target a particular audience. Depending on your objectives, you may want to reach the general public, or to tailor your message to policy makers, individuals, health providers or community leaders. Each group is in its own position to respond. For example:

  • Policy makers can enact restrictions on toxic industries or require that healthy food choices be available in schools.
  • Individuals can change their own eating and exercise habits.
  • Providers can change standard education and treatment practices.
  • Communities can organize to plant gardens or lobby for better lighting in local parks.

The target audience influences not only the message but also the channels you choose to convey it. For example, the general public is more likely to read the style section of a newspaper than the editorial page. On the other hand, community leaders who shape public policy tend to follow editorials closely. Similarly, commercial broadcasters draw the largest audiences, while public television and radio tend to appeal to a smaller audience of active residents.

Craft an Effective Message

The overarching message is that public health problems are socially generated and involve institutional actors--such as government, industry and the media--who shape the context for individual behavior. In Contra Costa, the health department wanted to help communities and local policy makers understand the risk factor concept and see how they could work together to reduce these risks.

Crafting the particular message is an art. The specifics will depend upon the objectives you have outlined. Ideally, the health department and the community leaders will work together to develop the message. Resident leaders in Contra Costa County, for example, were adamant that they did not want to portray their communities as needy and full of problems. Rather, they wanted to convey a positive message emphasizing the community's assets and the accomplishments of people working together.


Create sound bites to support it

A full-length story on the evening news averages about 90 seconds. So no matter how complex the issue at hand, you have to be able to get your message across quickly. For better or worse, the media rely heavily on "sound bites," those pithy, memorable quotes that get right to the point. Learn to create them.

Sound bites must relate to your media objectives. Each one should convey one message, simply and succinctly. Imagine the slogan on a billboard. Try writing one on the back of your business card; if it won't fit, it is probably too long. Work to frame the issue as a social problem in which the public has a stake.

For a series of sound bites, keep the following guidelines in mind:

  • State your conclusion up front.
  • Support your statement briefly with evidence or explanation.
  • Call for a specific response.

For example, let's say the objective is to alert the public about risk factors for chronic disease and encourage communities to respond. Here are some possible sound bites:

Conclusion: "We can reduce the risk of chronic disease, such as cancer or heart disease."
Support: "If we don't act, two out of every three local residents will die from chronic disease."
Response: "Communities can do something to address the six most important factors influencing chronic disease: tobacco, stress, nutrition, exercise, the environment and socioeconomic status."

It's not easy to define the qualities that make a successful media bite. As Supreme Court Justice Potter Stewart said about pornography in 1964, "I know it when I see it." Nonetheless, here are some tips:

  • Use fresh, lively images.
  • Avoid preaching.
  • Be creative. Try literary devices such as alliteration, rhyme or puns.
  • Be authoritative. Prepare to back up statements with specific facts from credible sources.
  • Use humor and irony where appropriate. Witty statements are often quoted. Biting humor can also be an effective way to convey outrage. A well-conceived quip can instantly deflate your opponent's message. Experiment with ironic rephrasing of industry statements or popular maxims.
  • At the same time, be cautious with humor. If you're too cute or frivolous, you may under mine the gravity of your own message.

Finally, remember that sound bites can come in the form of pictures as well as words. For a powerful indictment of alcohol marketing to youth, you can't do better than a photograph of Anheuser-Busch's Budman-a costumed super-hero-shaking the hand of a four-year-old child at a public event. Likewise, to bolster its anti-tobacco campaign, Contra Costa's TIGHT project used photographs of markets that displayed cigarettes right next to candy. The group showed the pictures to local officials when asking for an ordinance reducing youth access to tobacco.

Step Three: Analyze media markets

Many local health departments keep a press list, either with a public relations officer or sometimes within individual programs. Build on what already exists to develop a complete, up-to-date list of all newspapers and broadcasters that cover the department's service area. Be sure to include ethnic media markets and outlets in your list.

Every city, town and county falls into some media market. Large metropolitan areas constitute their own markets, while rural markets may cover a vast geographic area. The market for the San Francisco Bay Area, for example, includes San Francisco and its environs-parts of the Peninsula to the south, Marin County to the north, and the East Bay. Contra Costa County, which lies further east, is usually considered a separate market.

Media markets are usually served by more than one broadcast station or "news feed." Small broadcasters rarely have enough staff to cover stories beyond the local area, so they contract with wire services, such as the Associated Press, for regional and national stories. A large newspaper chain, such as Knight Ridder, will share stories among its member papers and also rely on wire services.

When seeking press coverage, identify news outlets appropriate to your story. Don't send a strictly local story to a national paper, for instance. If the story has potential appeal beyond your locality, don't hesitate to try to shape it accordingly and pitch it to relatively large papers. In general, don't limit yourself to the daily papers. Though they have the largest readership, their attention may be hard to capture. Look to weekly and monthly community papers, public access television and newsletters.

Keep two press lists-one for mailings and one for phone calls. Sort each list by type of outlet: for example, local, regional and national press; trade publications or other periodicals with a specialized audience; local radio; local television; network news; and so forth. When it comes to radio, consider call-in shows as well as news programs.

Each entry on the mailing list should include the name of the media outlet, address, fax number and e-mail address. It should also include the names of personal contacts at that outlet. When you send out a press release, send it not only to the assignment desk but also to any reporter with whom you have an ongoing relationship. It's acceptable to send multiple releases to the same paper or station. One person might ignore the story, while another might follow up.

The phone list will be smaller than the mailing list. Call lists should include the outlet name, phone number, fax number and names of assignment desks. Also list names of reporters you know, the fields they cover, their direct phone numbers, and their home numbers, when available.

Update media lists regularly to keep up with staff changes or to add producers and reporters you contact through your work.

Step Four: Develop a campaign plan

Your media strategy should fit within your larger program goals. Design a campaign in concert with other activities. Try to include the voices of people who are personally affected by an issue or policy. As you pursue a range of strategies, make sure that all the participants in your initiative deliver a unified, consistent message to journalists as well as policy makers and the community. (See Planning a Media Campaign (8k PDF, 1p.).)

With goals, objectives and a clear message defined, you are ready to plan for action.

  1. Choose your outlets. These are the specific newspapers or broadcast shows you will target.
  2. Develop a news hook. In other words, frame for access. Perhaps you want to publicize an initiative to reduce chronic disease, or a new report showing an increase in deaths from chronic disease. Write a press release about the story. Look continually for new angles as the project continues-perhaps a new organization joins your network, or a community group reaches one of its goals.
  3. Fine-tune your message. In other words, frame for content. Each time you seek coverage, have one main theme in mind that you want to get across. Deliver it in simple, concise words.
  4. Appeal to your audience. Consider the language and tone that will capture the group you want to reach. Public radio listeners, for example, may be more receptive to scientific discourse than those who listen to call-in shows.
  5. Respond to current news. Write letters to the editor. For example, if you see an article on the relationship between diet and heart disease, seize the opportunity to talk about multiple risk factors that contribute to a range of illnesses. Suggest a comprehensive approach to chronic disease prevention and give the name of a person to contact at the health department for more information.

Step Five: Talk to the media

To reach the media, you must deliver a clear and compelling message. Health department staff can set the stage for the story, providing a comprehensive message about risk factors. They can also prepare representatives of the community to speak to the press, and can direct reporters to those speakers. Make sure that community partners are comfortable in their role as public and media spokespersons. All spokespeople should be thoroughly familiar with the objectives of the campaign and the messages that have been developed.

In Contra Costa County...

Health department staff trained members of its citizen advisory group to talk about CDPOP. The citizens made presentations to various groups using a slide show and discussion guide. They were also listed as spokespeople on press releases. But while volunteers were enthusiastic, they found the subject difficult to master. They gave few talks and tended not to be contacted by the media for interviews. In the end, paid staff proved more effective in this particular role.

Letters to the editor proved to be a more effective vehicle for making a community leaders aware of the project. As articles about chronic disease appeared in local papers, staff sent commentaries that put chronic disease in a broader context and described CDPOP. Numerous community requests for presentations resulted.

Talking to journalists can be intimidating, especially when you are speaking into a tape recorder, and even more so when you are on camera. Nonetheless, interviews are an invaluable opportunity to promote public awareness. The more you do them, the easier they get.

Interviews will go more smoothly if you are prepared. Always keep on hand the objectives of your campaign. Don't simply answer the reporter's questions. Instead, think ahead about the message you want to convey. Perhaps you want to emphasize the success of a program or the need for action. Remember that ultimately you should have one message in mind. Make it simple and succinct.

If a journalist calls to interview you and catches you off guard, see whether it's possible to buy a little time. Find out the reporter's deadline and ask if you can call back shortly. Take a few minutes to collect your thoughts and review your sound bites.

Often reporters have an agenda or angle that is different from your own. Feel free to touch on the reporter's question and then go on to emphasize your own message. Don't wait for the reporter to ask the perfect question. It probably won't happen.

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Tips for Talking to the Media (8k PDF, 1p.)

Step Six: Evaluate media activities

Evaluating a media advocacy effort is not easy; nonetheless, it can provide important information about how to focus future efforts. To find out which media outlets are most effective for informing people, you will need to document how people heard about your chronic disease prevention program. Develop a simple form for key staff, including support staff who are the initial contacts for the public. Have them ask callers how they heard about the program. Note periods of increased inquiries and assess whether they correlate to any intensive publicity activities.

It may be difficult to evaluate whether your efforts have led to a greater understanding of chronic disease prevention or to changes in policy. Staff can try tracking changes over time to see whether the media have begun to reframe the issues. A review of minutes from governing bodies or policy-making boards may reveal whether community leaders and decision-makers are viewing the issues in a new light or beginning to consider new policies. A more formal evaluation might include interviews with leaders you are trying to reach, to see whether their view or level of commitment to chronic disease prevention has changed.

[next section: A Participatory Evaluation Approach]

Content provided by the The Community Wellness & Prevention Program of Contra Costa Health Services.

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