The effectiveness of the public health workforce hinges on its ability to effectively communicate its key messages to the public. As the Department of Health undertakes yet another consultation on public health the question is: do we now need a public health media centre?
Public health has a long tradition of health promotion, and often seeks to implement change by communicating the risks and benefits of health behaviours to the public. It is odd, then, that engaging with the media has been such a low priority.
It is well documented that stories in the media can influence behaviour and attitudes toward health. This may be positive, such as increasing demand for cervical screening following the media coverage of Jade Goody’s death. Other stories have been detrimental for the health of the population. For example, the media coverage of Wakefield’s academic paper contributed to public mistrust of the MMR vaccine. This has contributed to multiple measles outbreaks in many parts of the UK.
Public health can offer expertise in promoting specific positive messages, but also in challenging misinformation, and placing risks in context. This must be done with a keen awareness that journalism and public health have very different priorities. The Kings’ Fund, for example, have found that UK media over-report relatively rare health scares, such as vCJD, and underreport more prevalent health threats, such as smoking and alcohol abuse. To an extent this is understandable: new threats present novel stories with sensational headlines which appeal to the tabloid press. Specific health advice stories can also be inaccurate and misleading. Dietary advice in national newspapers, for example, is commonly based on the weakest forms of evidence. Again, this may reflect journalists’ desire for novelty, certainty, and authority. But the absence of compelling stories on smoking, alcohol, and diet may also reflect the failure of the public health workforce to reinvent and communicate its key messages.
This is a challenging area, where positive action can sometimes have negative consequences. Some public health messages, for example, are perceived as anti-libertarian, such as banning smoking in public places. Where public health does make the news, the media can often fit these stories to established negative themes, such as the “Nanny State,” dictating what is permissible in the private lives of individuals.
Given this mismatch between the interests of the media and public health workforces (see table below) how well is the public health workforce engaging? The short answer is that, with a few exceptions, it isn’t.
This lack of engagement is not new. The Kings’ Fund produced a report in 2004 making it clear that channels of communication between public health and the media have room for improvement. The research found a hearty media appetite for public health stories, but a relative dearth of forthcoming information from public health professionals. Almost a decade later, this has not been well addressed.
The Faculty of Public Health are occasionally quoted, but it is commonplace to see media stories around the risks and benefits of health behaviours, or population interventions, with little input from qualified experts who could provide the broader context. Other initiatives and organisations have addressed some of these missed opportunities. “Behind the Headlines” from NHS Choices provides lay summaries of the published academic papers behind major health news stories on a daily basis, and the Science Media Centre help to steer scientists from all disciplines toward the media on specific stories. Similarly many bloggers try to reduce or correct public health misinformation. Public health practitioners, however, still have limited input.
The reasons for this limited input remain unclear. Some public health practitioners are unwilling to take what they perceive to be risks with the media, as a result of previous negative experiences where the wrong messages were communicated. Despite the importance of informing and engaging with a local or national population, working with the media is a low priority in public health training. This is unfortunate: relationships and reputation are forged over the course of decades, and by not forging stronger links, opportunities are missed.
In 2011 a group of public health registrars, with the support of a board of experts, decided to explore the idea of a public health media hub. The Science Media Centre has been successful in its mandate to improve communication between the science community and the media, but its remit is much broader than just health. An organisational model was considered, similar to the SMC where public health practitioners with relevant expertise, working with press officers, would engage directly with journalists to produce accurate health stories.
There was initial support for this initiative within the public health profession. Likewise, media colleagues were enthusiastic about the possibility of a bank of experts who would be available for reliable quotes and opinions, especially given the numerous stories with a public health angle. This initiative has remained in consultation stage in order to ensure that the appropriate platform can be found.
The current consultation on the public health workforce states its aim is to make the phrase “Public Health is everyone’s business” a reality, and that partnerships must be built with all those who contribute to the health of the population. A strategy to engage with the media would seem essential and yet it is not mentioned.
| What the media do | How public health gets it wrong | How this could be mitigated |
|---|---|---|
| Highlight sensational rare threats | Fails to communicate absolute risk effectively | Focus on clarity in risk explanation |
| Ignore common but important public health issues | Inability to reinvent communication on core issues | Develop more creative approaches to present existing issues |
| Portray public health professionals as anti-libertarian paternalists | Focussing on “banning legislation” at the expense of the risk/benefit narrative | Reframe the argument away from the “Nanny State” |
| Write articles of interest to readers | Dismissing issues as trivial despite high public interest | Match evidence for change with public’s needs and desires |
Having a public health central hub where media professionals can go for information and opinions on current stories is an exciting and tangible possibility. Public health has a skilled workforce, with people working behind the scenes both within and outwith the NHS to ensure that the overall health of the population is protected by producing, communicating, and implementing evidence. Like any profession it benefits from public awareness, but more than that, public engagement should be regarded as a core component of implementing its goals.
Media coverage can impact on both individual health behaviours, and on policy. Failing to deliver accurate information to the public, by working with the media, could be negligent, and suggestions of new ways in which the public health workforce can communicate more effectively with the media would be welcome. The consultation on the development of Public Health England presents an opportunity for real change: we should take it.
Rebecca Cooper – Public Health StR, Oxford Deanery.
Louise Hurst – Public Health StR, London Deanery.
Douglas Noble – Lecturer, Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry.
Felix Greaves – Public Health StR, Imperial College London.
Ben Goldacre – Wellcome Research Fellow in Epidemiology, London School of Hygiene and Tropical Medicine.
Acknowledgements: The authors would like to thank the other members of the media centre project: Kate Mandeville, Jenny Hall, and Gracia Fellmeth. Thanks also to our advisors: Sir Muir Gray, Ray Fitzpatrick, Alison Hill, and Sally Gainsbury, and all at the Science Media Centre, particularly Fiona Fox