The Covid-19 pandemic has necessitated intense scrutiny on the process of communication in relation to matters of public health. The challenge has been for public health authorities and governments to propagate and disseminate mass-media messages at a national level and on a large-scale. These messages have been expected to engender widespread awareness, acceptance and actions across the whole UK population, as they relate to the drivers of viral transmission and infection. However, many of the communications methods that have been deployed in the UK have been ineffective, particularly when social inequalities and cultural differences are factored into the challenges of public engagement. Too often communication has been top-down, assuming that all members of our communities share the same common framework of reference, while also assuming that everyone has the same access to mainstream communications channels. The belief is that everyone can respond equally to the governments instructions because they are presumed to have the same economic and social capacity that enables them to make vital changes to their behaviour.
Leicester has been particularly hard hit by the pandemic, enduring one of the longest ongoing lockdowns in Europe, with consistent and stubbornly high rates of transmission and infection. Similarly, the roll-out of the Covid-19 vaccines are lower in many Leicester communities than in others. The pandemic has brought to the fore the many layers of deeply rooted social inequality that structurally exclude and marginalise many people, including the pervasiveness of low-skilled employment, multiple occupancy of housing, low levels of English language skills, and a lack of access to communications platforms and networks. As Sir Michael Marmot argues, these are all indicators of the failure to recognise the ‘causes of the causes’ of the structural racism that many in our communities must overcome, particularly people from black and ethnic minority backgrounds.
The Covid-19 pandemic situation therefore raises several strategic questions related to public healthcare. Have the public health communications activities been effective in reaching the residents and communities that are often easily ignored? Has there been enough focus on grass-roots forms of community communications development and engagement, particularly the kind that can engender individual and collective trust during the pandemic? Has the communications process supported communities and individuals who are most at risk because not enough has been done to foster and facilitate sufficient awareness of their civic entitlement? Do public health communications professionals do enough to account for and mitigate the inequality of needs and risk that many in minority ethnic communities face? Is the public health communications process sustainable and resilient enough to address the disadvantages that many must overcome to achieve health access parity and health outcome parity?
Working with the development team associated with the A Germ’s Journey project, led by Professor Sarah Younie and Dr Katie Laird of De Montfort University, I’m producing a series of podcasts that will discuss and examine the challenges of public health communications in Leicester. A Germ’s Journey links people across three continents to promote the message that handwashing is an essential part of our personal and public health responsibilities. A Germ’s Journey supports people in developing communities to make and share their own trusted and engaging media content about public health and hygiene. Underpinning Germ’s Journey is the idea that public health information is more effective if co-produced by people who share an affinity and common life-experiences. This means making media that reflects what it is like to live in a specific place and community. Germ’s Journey aims to support public health focussed communications that fits with local social and cultural priorities, that meets the expectations and priorities of people acting for themselves to make home-grown improvements in their health and wellbeing.
Over a series of three one-hour podcasts a group of activists and advocates of community-focussed communication will be brought together to discuss the challenge of supporting public health communication and information in Leicester. The discussion will explore how Leicester-based community health and communication practitioners, researchers and public policy reform campaigners, make use of different media platforms and formats that support underrepresented communities, offering guidance and information that challenges misinformation, raises awareness of the public health, and leads to effective community learning that meets the challenges of the Covid-19 public health crisis.
These discussions will reflect on what alternative forms of media are demonstrating that they make a difference, and what local approaches are being used that are distinct from the ‘assumption-driven’ national mass-media communications approach. The discussions will consider examples of local innovation in community-focussed communications in practice, and are an opportunity for practitioners to share their experiences and insight about what they have learnt during the pandemic, and what has made a difference, at a grassroots and neighbourhood level in Leicester.
Running through all three podcasts are some general questions:
- Are we doing enough to foster community trust, awareness and comprehension at a time of challenging public health need?
- What are the lessons that we can take forward and apply in effective public health communications in the future?
The first podcast will frame this question in relation to the mainstream approach to communications that has been taken by many public bodies and government advisors. Namely the behaviourist model that seeks to ‘nudge’ people into acting in specific and approved ways. In the behaviourist approach the focus is often placed on instructions and mechanical assumptions of behaviour, which some regard as superficial. If a falling infection rate was the goal of the Covid-19 behavioural communications, then in Leicester very little was achieved. This discussion will ask, then, to what extent the mass-communications approach, which uses mainstream media platforms and networks to distribute messages in a systematic way, is failing to address the complex and diverse needs, experiences and cultural differences of all members of our communities in Leicester. Especially those that do not readily fit with the assumptions made by mainstream communications professionals.
The second podcast will seek to understand the causes of media marginalisation, and the way that some people are ignored and overlooked in the mainstream communications approaches that have been offered in relation to healthcare communications. The discussion will seek to understand the extent to which this marginalisation is systematic, for example in relation to access to platforms; or to what extent this is cultural, and can be regarded as evidence of biased cultural assumptions that fail to recognise the diverse communications outlooks and needs of people from different social backgrounds, such as ethnicity, class, cultural background, faith, gender, sexual orientation, disability, or other relevant social characteristics. The discussion will ask if communications practitioners are doing enough to understand and address the concerns of people from groups that are easily overlooked, and will ask what can be done to change the dynamic of healthcare communications in Leicester.
The third podcast will seek to explore how the sharing of community-focussed stories, associated with public healthcare, can become a sustainable route for integrated approaches to public wellbeing based on community acknowledgement, empowerment and inclusion. The discussion will consider how tacit and local social experience and knowledge can be adapted to support a framework of healthcare information that is capable of addressing practical wellbeing needs. This discussion will ask what we need to do to counter misinformation, and thereby facilitate better access to healthcare and wellbeing services. The discussion will illustrate how stories can be shared and facilitated in an accountable and mutually supportive manner, that enhances the credibility and trust of public engagement between both residents of Leicester and the healthcare service providers who support wellbeing in the city.