Health communication - health promotion by another name?

Hi Pradeep,

Many thanks for your considered and comprehensive response. I would not correct you at all. My feeling is that this is a 'can of worms' or the opening of a 'Pandoras Box' (please excuse the metaphors). I agree that what potentially differentiates it is more of a 'micro' communications aspect - but all these still cluster under a broader health promotion/health education umbrella.

Dean

Pradeep Paul George

Thanks Dean for your kind words. I agree with your views. There are a lot of the newer disciplines emerging every now and then in healthcare without clearly distinguished roles. These, I guess are the culmination of man's quest (sometimes greed) for professional recognition.

James A Green

This confusion is most manifest in two journals from the same publisher: Health Communication and Journal of Health Communication, each of which takes one of those perspectives.

Usually, in a public health perspective, health promotion is the goal, communication is the tool to reach the goal. I generally use for health campaign evalutation the health promotion indicators like outcome parameters, the communication indicators like process parameters.

Hi all,

Many thanks for the feedback so far. James - what you suggest certainly makes sense. Very interesting that two target journals use the same term for different purposes. I certainly will check them out. Guiseppe - I take your point as a valid one. However, most expansive health promotion programmes, especially if they use certain methodologies like action research, will incorporate both process and outcome evaluation - even if they don't use the types of communication processes that have been highlighted.

Communication is like a label on a a big box of meanings. We have to get so critical in the word.

I got experienced in commercial marketing, and I saw that profit companies invest a lot in communication campaign. They evaluate them by communication parameters, but the investment is evaluated by economic parameters. Winning campaigns are such because they increase business, at the end. I've seen that epidemiologic reasoning is effective also in business world.

Now I'm applying my competences in public health, non profit, area. My main concern is to see that there is often confusion between general and sectoral strategy, actions and tactics, instruments and actors, process objectives and general goals.

To evaluate it's necessary to choose a unique and strong rational perspective. So it's necessary to choose a general strategy, defining long term goals and actions. Actions must be rationally functional to general goals and sinergic. Actions must be evaluated, the sinergic effects must be evaluated, long term goals must be monitored.

During last 10 years I worked in different projects that use the action research methodologies (the most famous is the "mamma beve bimbo beve" - mum drinks, baby drinks - project). I'm strongly convinced that action research is an effective professional methodology to reach cultural, community and individual changes.

Hi Giuseppe - many thanks for sharing your further thoughts. Your past and current activities sound very interesting. I am a big fan of action research as well - and view it as one of the more 'complementary' methodologies for health promotion programmes. I've added a link here to an article of mine that I co-wrote with some colleagues a little while ago which states this particular case.

https://www.researchgate.net/profile/Dean_Whitehead/publications/2?sorting=published&pubType=article

Mary I. Bresnahan

Health communication focuses on the interaction between health givers and health receivers about options for improved health that derive from these interpersonal interactions. For example, HC might examine how physician talk to patients and how what they say either enhances or detracts from patient compliance, e.g. a loss message, a gain message, a fear message, a hope message, a guilt message). Some ways of talking to patients depending on patient traits (e.g., persuadability of the message recipient or acquiescence to authority) might be more effective than others. HC might follow how people seek health information on social media and online health support groups and how they are empowered or discouraged in their own health care, e.g. HIV/ADIS stigma in online communities, cyberbullying about weight). More specifically, HC studies how people with health conditions seek and obtain support and what types of support are most effective. What messages are most effective in promoting positive health outcomes and why messages work or fail. Some physicians have told me that they are distressed when a patient comes in with a handful of printouts from health internet sites but perhaps physician and patient should work together rather than seeing health information seeking as adversarial.

For example, I have studied the social norm of smoking among Chinese males. Offering, accepting and smoking a cigarette or cigarettes continues as a form of male bonding in China. This is a very difficult norm to overturn but there is evidence that injunctive norm messages about social disapproval of smoking and the harm that smoking causes to people you care about seem to have an impact on young adults. This is part of the terrain of HC as James Green said earlier focusing on the interactive process of message exchange between people.

Please see the Journal of Health Communication, Qualitative Health Research, and Health Communication for examples of how this approach is distinctive.

Hi Mary - many thanks for your excellent response - much appreciated. There is obviously a distinct social and online media slant to health communication - but I still think that the waters are a little 'murky' that explicitly distinguish it from health promotion and health education. Your work with Chinese males and cigarette consumption sounds interesting. It mirrors, perhaps, to a certain extent - some of my work with studying adolescents and the 'norm' health decisions that they make; what I refer to as the 'pleasure principle' related to their 'health journey'. Below is a link, as an example, of this very point. However, what I refer to is firmly located with behavioural health education programmes and, indeed, the article is published in the journal Health Education.

Then you say that this is 'part of the terrain' of HC. That's still the dilemma to me and I will do more reading around it in the suggested journals to try and 'pin it down' and work out what makes it distinctive - but, currently, I'm not sure that it is easy to do so. To me, there still seems to be direct links. If health communication presents itself as a 'distinct' discipline - that's a bit of a 'double-edged sword'. A large critique of health promotion (and to a lesser extent health education) has been its difficulty in defining exactly what it is and, subsequently, the difficulty in measuring and evaluating it. Health communication, if it fits a tighter definition, could be potentially very useful. On the other hand, if it's health promotion dressed up to look different - then it could be viewed as a 'smokescreen'. That said, my initial instincts are that it is 'health promotion dressed up to look current'.

Article In pursuit of pleasure: Health education as a means of facil...

Mary I. Bresnahan

Thanks and I am eager to read your article. I agree there is ambiguity. At MSU in East Lansing where I teach we have MA programs in Health Communication, Public Health, Health Sociology and Health Anthropology. All do slightly different things but there is overlap. Health Com is about the effects of health message framing looking at message strength, one and two sided message arguments, compliance gaining strategies and other features of messages. However Health Com students takes courses in epidemiology, health sociology, health anthropology and those students take our classes on focus groups and health communication.

Mary I. Bresnahan

You might also contact Dr. Sandi Smith email: [email protected] who is the Director of the Communication Health and Risk Center on this topic.

Many thanks again Mary. It's definitely getting clearer and better defined in my head. Definitely good to have this discussion. Similarly, I've worked in several Faculties - where there is a lot of cross-over between public health, health policy, community/population health and individual health papers/programmes. They tend to be conveniently clustered under either a health promotion or primary health care umbrella. I have to admit that your Health Com students do seem to have quite a broad and 'rich' mix of subject areas that I wouldn't always naturally put together. It will intersting, for me, (relating back to my original quesion) to see what mix comes out in the health communication programme that we end up developing. Oh - and many thnaks as well for Sandi's contact!!

One other wee point that I meant to say in my last reply - for anyone who might read my added 'health journey' article. It was written and published a decade ago. Had I written it more recently (especially as it is targeted at adolescents), I no-doubt would have incorporated the use of mass and social media to influence health events. That, in turn, may have made it even more about health communication.

Nimmathota Arlappa

Health communication is often used synonymously with Health Education,which itself suggests " outward and downward" communication of knowledge (WHO TRS 690 p1983). Health communication cater following needs-1.Information 2.Education 3.Motivation 4.Persuation 5.Counselling 6.Raising morals 7. Health development and 8.Organization.

Whereas, Health promotion is " the process of enabling people to increase control over, and to improve health". The well-known intervention are-1.Health Education 2.Specific protection 3.Early diagnosis and Treatment 4.Disabilty limitation and 5.Rehabilitation. Thus, though, these two terms appears to be similar, but in actual sense they are different.

Tim Sly

Interesting thread. Dean, if I may offer an additional couple of considerations..... Health promotion of course involves many aspects of communication, so there is an undeniable overlap. But I consider 'health communication' to be a health-oriented version of 'risk communication'. In this sense, the communication is a dialogue, and not just in name only. The effectiveness of risk assessment has not traditionally been matched by the effectiveness of communications about those risks. People will make their own mind up about what they are prepared to act upon or make decisions about. And to do this they (we all do) use a complex basketful of heuristics, or rules-of-thumb, that tend to depart from the 'pure' science. Successfuul communication of health-related information and understanding is dependent upon really coming to grips with this process, and designing communications that take these heuristics into account. I would suggest becoming familiar with Peter Sandman's extensive volume of work, also Paul Slovic, Granger Morgan, Baruch Fishhoff, and they will lead to many others. This is especially relevant today when public confidence and trust in traditional sources of health-related information has never been lower! Myth and misunderstanding travels far faster and is more pervasive than conventional wisdom. Just look to see how public decisions about vaccination have taken their bizarre downturn, and how pasteurization is now being disregarded by a growing cadre of celebrity chefs, movie starlets, and organic commandos.

Best of success! ....................................../Tim Sly

Nimmathota and Tim - many thanks for your recent reponses - both appreciated.

Nimmathota - I have to say though that I'm not a fan of the WHO health promotion definition. To me - it's a 'catch all' and can mean almost anything related to health is health promotion.and part of the reason that I started this question thread. I wouldn't want the same fate to occur with health communication if it is something distinct - as it is, to a certain degree, starting to appear.

Tim - I like the notion of 'risk communication' coming in. Acknowledging effect heuristics in interpersonal health communication - and looking to enforce or counter - is an important aspect of behavioural-change programmes. Aligned to heuristics and risk - I've written several articles whereby I've posited the 4 R's - resistance, reactance, rationality and risk. There are, of course, other complex theories that apply. However, it's back 'full circle' then for me. I relate these concepts back to social cognitive theory - and if we then bring that back to health - I'm immediately drawn to health belief/change models/theories - and then I'm squarely back to 'health education'.

Thanks for the author suggestions - getting some interesting bed-time reading through this thread - and I fully agree about public confidence and health messages

Barbara Docherty

Hi Dean and others

I have recently completed my Master of Nursing in this field- in particular where it relates to communication,patient engagement and notably the type of langauge we use in primary health care (particularly general practice settings) to coerce people into changing unhealthy behaviours. (Seen as health promotion).The action and qualitative research we utilised over a lengthy period ( I have spent 15 years training health professionals in communicatin and behavioural health) identified that health promotion used by primary health care professionals was based on public health policy e.g. immunisation, cervical/ breast/ screening, risk assessments for cardiovascular disease etc. --a medical model focusing on the identification and treatment of only high-risk individuals. The way we speak to people about changing unhealthy behaviours is key to health promotion I believe but opportunities to promote health and wellness (prevention of the disease before any signs and symptoms appear) are continuously overlooked in favour of assessing risk for disease and then focusing on treatment of the disease itself. Words often used interchangeably - lifestyle disease, health promotion, primary prevention, preventative health, preventative medicine, preventive treatment and behavioural medicine - all suggest an emphasis on illness and disease models of prevention and health promotion. Our communication habits of a lifetime usually in the guise of the need to give advice to fix people is not health promotion and patients are suffering as a consequence. That's my take on this interesting discussion.

Shreekant Manohar Sapatnekar

Hi Barbara - good to hear from someone in this part of the world!! You may already be aware of my 'critique' of nursing and its more 'natural' orientation towards medicalised approaches to health promotion and health education. On the other hand, it is encouraging that many nurses, like yourself, are 'in the know' and seeking to reorientate the situation. As much as we can align changes like this to evolving concepts, such as health communication, the better for all I believe.

The term "Health Promotion" has a context & connotation. It is NOT Health Communication by another name. It was Leavell & Clark in 1958 that showed a continuum between prevention and cure. The background can be read on , particularly at page 99. It will demonstrate that Health Communication is a subset of Health Education, which is ONE OF THE WAYS of Health Promotion. For the sake of argument, one may say that Health Promotion can be attained in absence of Health Communication. (It will not be long lasting and effective. It may be resisted. But that is another issue).

It is unfortunate that a number of terms are usually used interchangeably (vide Barbara Docherty above). That shows either ignorance of the topic or else callous disregard for scientific terminology. One can forgive this for lay press. But in scientific communication, it amounts to a sin! e.g., "Preventive Health". Coining such a term makes "Curative Health" a corollary, sabotaging the very concept of "Health" which has promotive, preventive, curative and rehabilitative components. There is a universally accepted historical context for these terms. And therefore the standard glossary ought not to be subjected personal liberties.

Hi Shreekant - many thanks for the input. I agree with you on some levels - but not others - and it keeps the debate 'circular'. I agree that health communication, for me, is more aligned with health education than anything. Both health education and health communication are, again to me, then sub-sets of health promotion. Yes - you can have a health promotion programme that exists without both (just purely at the political and policy level) - but that is unlikely.

Where I don't agree is in the existence of 'a universally accepted historical context' - or that there exists a 'standard glossary'. If this was the case - there would be no need for this type of debate. There is no universal consensus around issues related to health promotion or 'health' per se. The WHO has attempted to define - but has probably clouded the issue more than clarified it. Take terms such as - 'community health', 'population health', 'public health', 'primary health care' etc; 'same thing or different' - everyone has their own spin on it!!

"We feel that the good is something individual and inalienable" (I, 4.26). "Welfare is not a common quality, which is expressed under a single idea" (I, 6.26), but varies depending on the population: "As regards the actions and what is worthwhile in life has nothing stable, as well as regarding health "(II, 2.a3-5). Unfortunately scientists as "aim at some good, and while seeking what is missing to get to them, they neglect their knowledge" (I, 6.a5-7).

"The Nicomachean Ethics" of Aristotle (384-322 BC)

Communication and promotion. For "product promoters", like Folletto sellers, there are no big trouble in distinguish the two domains. But it seems there are many troubles when we collocate the two words in health context. It's reasonable that the confusion is about the meaning of "health". Has "health" an universal sense? Aristotle said it's a cultural affected domain. If it's really so, "health promotion" and "health communication" are different concepts in different cultures. If it's so, I (a Latin one), Shreekant (I think he is Indian) and you (an Anglo-Saxon) may be are speaking about different things.

Simon Carroll

Hi Dean, great question and it has obviously been stimulative of a rich discussion. Having participated in some of the definitional debates around the term 'health promotion', i can agree that we still have great ambiguity of definition, although I would say less at the theoretical level (for most academics and researchers in the field, the Ottawa Charter definition is a consensus one) and more at the practical one. Most people practicing health promotion at the coal-face are still acting from a more technical life-style, behavioral change perspective; rather than the broader, more political level at which many of us advocate for. Recently Irv Rootman and Michel O'Neill have argued for a new use of language that would call the broader Ottawa Charter approach the 'promotion of health', leaving 'health promotion' to refer to the technical programming more aligned with health education and health communication and other lifestyle change endeavors.

Ironically, as Barbara alludes to, perhaps what health professionals need more of is the broader promotion of health approach, as too often health promotion as just a technical extension of preventive medicine can be dis-empowering for both patients and care providers.

For students of health promotion interested in some of these conceptual debates, the last two editions of Health Promotion in Canada offer a variety of takes, though I'd say much of the relevance of health communication has been subsumed under a broader concern with health literacy.

While it is true that the Charter definition has a 'catch-all' quality to it, it should be noted that its real purpose and affect is to change the discourse around health, and as Ilona Kickbusch has argued, it is here that health promotion has made the most progress. You can hardly 'reorient' health services without understanding the radical perspectival shift the Charter demands.

Giuseppe - many thanks for the clarification. That makes sense to me now - and, yes, different things indeed. We talk about 'global health promotion', but taking different contexts and cultures etc into consideration, I wonder if there is such a thing - at least at a universal level? That point perhaps relates partly to my reponse (a bit later) to Simon's recent communication

Simon - a good response thanks - and a measured and balanced one. I like the determination of Rootman and O'Neill to offer and explore 'alternatives'. Is there something that I can access to evaluate? Until I see the context, I'm a little skeptical. It's back to my original question really. I do think that this thread has been useful in clarifying, if not conclusively, that health communication may be distinct from health promotion (or a sub-set of it). It could, at the same time, be seen as a 'new' attempt to make health promotion current or to 'distance' itself from the 'conceptual quagmire' that has followed health promotion and health education etc - for some time now. Rootman and Co, by introducing the 'promotion of health', may unwittingly be doing the same. Potentially, by adding too many interpretations to the mix, health promotion ends up 'chasing its tail'. I agree on your point of reorientation health services - but check out my invited HPI article on Ottawa 25-years on. It's premise is that we have to get the language right - before any radical change. It might be a bit simplistic for some - but it's been a constant in my clinical experience.

I note that you are based in Canada. Where it all started really - and thanks to Labonte etc. One of the main reasons that I came to New Zealand from the UK, was its comparable health policy to Canada (and health promotion) focus. A huge surge of governmental activity in the early 2000s appealed to me - but, despite significant funding over the last decade or so, the rhetoric has not necessarily equated to reality. Them's the breaks I suppose. The technical extension of preventative medicine, as you highlight, still looms large. I suppose that the influential US and Asian worldview of health promotion as 'health promotion behavior' exacerbates this. Going off at a bit of a tangent here, but influential journals such a s Health Promotion International, Global Health Promotion etc often publish behavioural health education studies. Journals, such as Health Education Research, Health Education, Health Education Journal etc, often publish expansive health promotion studies. To me - no wonder the debate goes on!!

Barbara Docherty

This has all been so very interesting to read and ponder on- thanks for broadening my thinking in many areas. I will have to make a comment on the behavioural health issue as that has been my passion for the past 15 years so sorry for throwing something else into the mix. Dean rightfully comments on the 'huge surge of government activity and funding' which has not equated to reality here in New Zealand and which takes us right back to the 'health promotion' that is public health becoming caught up in the 'health promotion' as viewed by those funding primary health care. (By the way here in New Zealand primary health care is not actually general practice settings- more primary medical care- but nevertheless large amounts of funding are given to general practices for health promotion activity largely delivered by nurses who have no training in this field). I was one of those practice nurses for 23 years, knowing little about health promotion but staggering through giving advice and instruction. This still occurs and the funding keeps coming. General practice will always want to get that big piece of the funding pie because it fits so nicely with our ground breaking document 'The Primary Health Care Strategy' which is an interesting (but confusing for some) mix of primary health care, primary medical care, health promotion, pieces of the Ottawa Charter public health policy, population health and individual care. No wonder there is no clear definition or understanding of health promotion and no wonder the funding is probably not getting to the heart of promoting health.

Barbara - many thanks again. We're getting off my original question a bit - but 'what the heck' - this is still, for me, stimulating debate. You've 'knocked it on the head'. You've obviously been someone on the ground experiencing and delivering the frailties of certain health policy and legislation for some time now - yet able to come out of the 'other side' and evaluate it for what it is. Easy enough for academics to say 'there's a problem here' - but much better when experienced and hard-working clinical practitioners confirm it. You get a vote from me!!

Janet Elizabeth Roden

Hi Dean,

You may remember me - Janet Roden from Australia. I no longer work for academia but instead am getting into policyand some research with the New South Wales Nurses and Midwives Association. As we know definitions around health promotion, preventive health, health behaviour, and health education are problematic and often confused by others. However I must say that health communication must be closely aligned with health literacy .. something that I addressed recently in response to Health Literacy Consultation put out by the Australian Commission on Safety and Quality in Health Care. The concepts around health literacy also create complexities but it comes over very srtongly that communication is central to health literacy .. social media is important here as are strategies ie. video, or verbal narratives, even audio tape. However the term health literacy emerged in the 1970s, but did not gain momentum until the1990s when it began regularly appearing in academic literature. The term originated

from the field of public health where it developed in the context of health education,

health promotion and primary prevention. Perhaps my spin is fairly close to yours Dean- I do have reference material to support the last statement.

Nice to make contact again with you. I must try and get all my references acknowledged by Research Gate, something I have not worried about too much to date.

Hi Janet,

Good to hear from you - and, of course, I remember. I meant to add - many thanks for the citations in your recent Contemporary Nurse article - much appreciated. The change of job sounds interesting and I hope that it's been a good change.

Yes - there appears to be a 'distinct' theme to it. My question attempt was to really try to 'nail it on the head' (if it could be) and prevent it being hijacked - as say 'health promotion' has in nursing - as we both know. There is a potential for both health communication and health literacy to be 'diluted', in a similar, way by health professionals I.e. 'I try to make 'health' information that I give to my clients/families as easy as possible to understand' - therefore it then becomes loosely interpreted as health communication/health literacy' activity.

Yes - I'm quite new to ResearchGate - and it can be a little time- consuming at times - so relatively easy to lose thread every now and then. Worth it in the end though I think. Keep in touch!!

Dean

Diana Guzys

Hello Dean,

I have been pondering the concepts of health literacy, specifically critical health literacy, and the resonnance with health promotion for a while now. Having practiced as a community health nurse for a couple of decades (with an emphasis on health promotion rather than primary care provision) and entering into the world of academia later in life, I find the use and misuse of terms frustrating. Similar to professionals believing they are undertaking health promotion through providing health information, I feel that the health communication, health literacy and health promotion concepts are misunderstood. I would argue, (and frequently do), that health communication is a component of health literacy, as is functional health literacy, and that critical health literacy is achieved through health promotion. Put most simply, critical health literacy is the goal and result of health promotion practice.

The necessity of differentiating between functional health literacy and critical health literacy is reminiscent of differentiating between primary care and primary health care. This may seem trivial to some, but the need to differentiate demonstrates the lack of basic understanding which is frequently perpetuated in government policy and documents. Perhaps new terminology is required, however I suspect that this would just result in a new set of terms that will need to be be qualified and differentiated!

Cheers

Diana

Hi Diana,

Many thanks for your considered response. We are obviously from similar backgrounds and I share your frustrations - and have done for a long time. I don't know if you have checked my site generally - but much of my work sounds like it would resonate with your thoughts on this matter. Your specific narrowing down and definititon of terms is very useful. Many disciplines would appreciate that and perhaps adopt those definitions to help better define and guide practice. I don't think that this type of process is trivial at all - nor just merely semantics. I think that it is vital that all health professional disicplines are clear about what they are doing, how they are doing it, and why - and that is especially so for health promotion. However, like yourself, I do 'fear' that adding more 'layers' and terminology to reflect the multitude of evolving ways that health promotion and health education seeks to develop itself, will further 'muddy the waters' for many health professionals - especially those working in health service arenas. Despite that - I would still like to hear more about 'functional' versus 'critical' health literacy - and any other varitation - and how they relate to health communication. Funnily enough, I have a whole day with undergraduate nursing students next week - on health literacy - including a few hours with a guest-speaker from Translating NZ. One of their assignments has them developing a full health literacy resource. It would be nice to think that such input will manifest itself in practice in the not-to-distant future - but then I've been thinking that for a decade or more when it comes to health promotion generally!!

Diana Guzys

Hi Dean,

I am familiar with several of your publications, and will have to learn how to properly engage in all the functions on Research gate to check out more of your work. I was trying to add an undergraduate text book that I have been involved in producing for Cambridge University Press to my publications list on this site, but it didn't fit into the categories available here, although I am sure that there must be a way. In some ways it feels like shameless self promotion, but I have been informed that is all part of networking.

Cheers

Diana

Hi again Diana,

Good to hear. I'm quite new to ResearchGate - so still learning myself. You can add a book. Go to 'add publication' on your home page (top right). Click on 'peer review', then 'manual entry' - then put in the book title and 'continue'. In the 'type' drop-box - you will see the book option. Click on that - and then pop in the detail. one other tip - when inputting to the Q&A, as here, look to see where you might vote others up (or sometimes down). Others tend to note when you acknowledge them - and that bodes well for you. It's not shameless to self-promote. it's putting yourself out there - so that you and others can benefit.

Dean

Dear Dean:

I think this article is interesting for this topic.

Timothy Edgar, PhD, Julie E. Volkman, PhD

Using Communication Theory for Health Promotion. Practical Guidance on Message Design and Strategy.

Health Promot Pract. September 2012 vol. 13 n° 5 587-590.

Sincerely.

Diana from Perú.

Hi Diana,

Good to know that several months on from threads RG members are still following them. That sounds a very useful article - the title seems very appropriate. I shall access, read and then feedback.

Many thanks,

Dean

Aniqa Ali

@Diana. This is a good article and is helpful in understanding the concept of health communication . It is basically health literacy and field of communication studies where media and communication practitioners bring their knowledge of communication with people to promote health quality.

Yogeswary Arumugam

Dear Diana,

In my opinion health communication and health promotion are very important in delivery care to our clients. I felt that without a proper skills in communication , we cant' promote health . Both need to be in line for healthcare providers.

Dear Aniqa:

I think the Medical Doctors must have skills in I.E.C (Information, Education and Communication.

Thank you.

Best wishes.

Diana from Perú.

Dear Dean:

This topic is very, very important in relation to Quality and Safety in Healthcare.

Best wishes.

Diana from Perú.

Correct Diana - it could well become the next level of intervention. It's all about 'layers' and dressing things up to be more appealing if they do not seem that palatable at first. There is a history of it with the WHO. Health promotion was supposed to replace behavioural health education and media-based health education, then came settings-based health promotion, then came a more global and ecological stance - now we may be revisiting issues with health communication and health literacy. It's all cyclical and anticipating the next trend. Quality and safety in health service settings (i.e. clinical governance) is very much a trend in today's context.

Johan De Rycker

Hi Dean,

Coming to this rather late, but especially your last post reminds me of 'framing', especially in terms of social movements. In communication theory, there's a raft of stuff on the one hand on framing in terms of 'phrasing' things on the one hand to capture attention and then set political agendas (framing as secondary agenda setting), and theory of the process itself of actually getting more people on board because of that 'phrasing' and whether it extends your movement or not (Benford & Snow). Entman probably kicked it all off, and from an operational point of view Matthes and Kohring made a good stab at coming up with a constructionist way of researching it. Faming - especially in Europe I feel seems to have moved towards 'Social Representation Theory' - but I guess we're really talking several traditions/disciplines claiming different solutions to similar aims. For example Bauer & Gaskell (LSE) in a way when dealing with the concept of biotechnology moved gradually from framing to social representation - in my opinion. Bauer also - part and parcel of 'Public Understanding of Science' identified quite astutely that we went historically from a period of 'lack of scientific literacy' through one of 'maybe scientists have to start understanding the public' to 'common sense'. All that simply to say that we're probably talking about either a gradual shift in framing - because the former frames were not working? - or society has moved on, and it then is a question of moving social representations to where you want to have them. Which begs the question of who's driving this, and why? But then we get into political theories...

Correct Johan - you say it better than i could, but 'framing' then to me becomes either 'recycling' or 're-dressing'. For instance, in my field, there is often the 'next' or the 'new' public health movement or policy initiative i.e. 'The Health of the Nation' re-cycled as some thing new - but just really Health of the Nation - Part 2,3,4 etc. The bits that didn't work or were not implemented or the public didn't 'go for it' first time are re-vamped and we try again. The re-dressing route is similar. Again, in my field, clinical research-based practice did not evolve - so it was re-dressed as evidence-based practice; same thing (or at least the way EBP is actually implemented) - different term to try and make it look like something different and revolutionary.

Good to hear Chinedu that people are consulting you about differences between terms and disciplines in the field. It at least demonstrates that some are thinking about it - and feel that it is important to differentiate and clarify terms.

Douglas Storey

My perspective on this issue is shaped by academic training in educational psychology, journalism and communication, a longtime faculty appointment in a school of public health and thirty years of experience in international health, environmental and development communication. There is certainly overlap between health promotion, health education and health communication, but the differences are more than tactical. Health communication is a subset of a much larger communication science discipline (see Berger & Chaffee, 1987, Handbook of Communication Science) that dates back to at least the 1920s and has been informed by specific streams of research in psychology, sociology, cybernetics, information science, political science, anthropology and more recently neuroscience. Those who consider their field to be health communication invoke those theoretical origins in research and practice and tend to regard communication as THE fundamental human process that shapes perception, informs choices, enables or constrains social relationships, makes organizational structures possible and both creates and sustains cultural norms and values . My sense is that those who consider their field to be health education or health promotion tend to see communication in a narrower tactical sense, as a tool to achieve educational or public health goals. Communication can be and should be used as a tool for social good, but it is much more than that and -- I would argue -- can be used more effectively as a tool if it is studied and understood in its broader sociocultural context.

Tim Sly

Despite the iconic WHO definition of "health" at Alma Ata, we can still usefully (for this thread at least) include many types of 'risk-avoidance' advisories when considering the communication of "health". In this context, Douglas Storey makes an excellent distinction, and in my opinion is absolutely correct in situating all of these activities along a broader spectrum. There is much enlightenment to be shared in this regard from a large body of work by Mary Douglas, Starr, Tversky, Khanneman, Slovic, Fischhoff, vonWinterfeldt, Sandman, Freschette, and many others.

Hi Douglas and Tim,

Very good responses and, Douglas, yours is a comprehensive and insightful response based on extensive experience. I fully agree - health educationalists and health promoters (I would like to think that I am both) do tend to use it within a narrower (often clinical and/or public health context) framework. That's not necessarily a bad thing - unless say the 'essence' of the intervention is based around something like a social media campaign.

Dear Chinedu Okafor:

I think this document is very interesting too.

"Promoting effective communication among healthcare professionals to improve patient safety and quality of care".

http://www.health.vic.gov.au/qualitycouncil

This guide was prepared as part of the Victorian Quality Council´s project on improving communication healthcare professionals.

And published by the Hospital and Health Service Performance Division, Victorian government.

Department of health Melbourne , Victoria July 2010.

Sincerely.

Diana from Perú.

Glenn Laverack

Hello Dean

Bit late on picking up this thread - but health communication is a widely used term in development. It was most popular in the 1980s in for example FP projects. Health communication is a key strategy to inform the public about health concerns and to maintain important health issues on the public agenda. The purpose of health communication is to improve the health status of individuals and populations. The use of the mass and multi-media and other technological innovations to disseminate health information to the public, increases awareness of specific aspects of individual and collective health. Health communication, like IEC, encompasses several areas including edutainment or enter-education, health journalism, interpersonal communication, media advocacy, organizational communication, risk communication and social marketing. It can also take many forms from mass and multi-media communications to traditional and culture-specific communication such as story-telling, puppet shows and songs (Communication, Education and Participation, 1996). See a to z of HP page 104 for full description.