PROMOTING CHANGE/ PROMOTING CHANGE/ PREVENTING DISEASEPREVENTING DISEASE

Tracy GarlandTracy GarlandWashington Dental Service FoundationWashington Dental Service Foundation

May 20, 2004May 20, 2004Grantmakers In HealthGrantmakers In Health

Washington, DCWashington, DC

CITIZENS’ WATCH FOR ORAL HEALTHCITIZENS’ WATCH FOR ORAL HEALTH

THROUGH POLICYTHROUGH POLICY

POLICY CAMPAIGNS: Focus shifts:POLICY CAMPAIGNS: Focus shifts:

From

Problem defined at individual level

Short term focus on programs

Treating people as consumers

Using mass media to change health habits

To

Blend of individual and societal responsibility

Long term focus on policy

Treating people as citizens

Using mass media to influence policy

POLICY CAMPAIGNSPOLICY CAMPAIGNS

You can’t have a media strategy You can’t have a media strategy without an overall strategywithout an overall strategy

POLICY CAMPAIGNS: Strategy POLICY CAMPAIGNS: Strategy DevelopmentDevelopment

What is the problem?What is the problem? What is the solution or policy?What is the solution or policy? Who has the power to make the Who has the power to make the

necessary change?necessary change? Who must be mobilized to apply the Who must be mobilized to apply the

necessary pressure?necessary pressure? What do the targets need to hear?What do the targets need to hear?

POLICY CAMPAIGNS: Problem IDPOLICY CAMPAIGNS: Problem ID

““A public problem doesn’t exist until A public problem doesn’t exist until enough people with enough clout in the enough people with enough clout in the society say it does.”society say it does.”

POLICY CAMPAIGNS: Theory of ChangePOLICY CAMPAIGNS: Theory of Change

Public officials look to media as a Public officials look to media as a proxy for public opinionproxy for public opinion

Media set the public agendaMedia set the public agenda Use media to frame our issueUse media to frame our issue Public officialsPublic officials

– Feel it is safe to move the issueFeel it is safe to move the issue

– Believe that people will understand Believe that people will understand why he/she is doing thiswhy he/she is doing this

POLICY CAMPAIGNS: Communications POLICY CAMPAIGNS: Communications ResearchResearch

Media creates a framework of expectation Media creates a framework of expectation about an issue (dominant frame)about an issue (dominant frame)

Must understand how ordinary people thinkMust understand how ordinary people think– Frame trumps factsFrame trumps facts

To change opinion, must shift the frameTo change opinion, must shift the frame– Search for metaphors, messengers, images to Search for metaphors, messengers, images to

support new framesupport new frame

Oral Health in America:Oral Health in America:A Report of theA Report of the

Surgeon GeneralSurgeon GeneralEXECUTIVE SUMMARYEXECUTIVE SUMMARY

Department of Health and Human ServicesDepartment of Health and Human ServicesJune 2000June 2000

Q. How to give legs and longevity to the Q. How to give legs and longevity to the Surgeon Generals report on oral Surgeon Generals report on oral health?health?

A. Citizens’ Watch for Kids Oral A. Citizens’ Watch for Kids Oral HealthHealth

ORAL HEALTH POLICY CAMPAIGNORAL HEALTH POLICY CAMPAIGN

Issue is unknown; no salienceIssue is unknown; no salience Issue is undervalued; connects to toothbrushes, junk food, Issue is undervalued; connects to toothbrushes, junk food,

smiles, self-esteemsmiles, self-esteem Issue is framed solely as personal responsibility (habits, Issue is framed solely as personal responsibility (habits,

discipline)discipline) For children, likely frame is parent responsibilityFor children, likely frame is parent responsibility No consequences, no connection to overall healthNo consequences, no connection to overall health No opportunity for public/private partnershipsNo opportunity for public/private partnerships Dental visits an expendable luxuryDental visits an expendable luxury Dentists seen as self-interested, not credibleDentists seen as self-interested, not credible

Research FindingsResearch Findings

The Good News in the Research The Good News in the Research FindingsFindings

When prompted, adults believe that oral When prompted, adults believe that oral health is part of overall health and well-health is part of overall health and well-being.being.

When prompted, adults can understand that When prompted, adults can understand that children’s oral health is a community children’s oral health is a community responsibility.responsibility.

ORAL HEALTH POLICY CAMPAIGNORAL HEALTH POLICY CAMPAIGN

How Do We Shift the Frame?How Do We Shift the Frame?

Emphasize prevalence of problemEmphasize prevalence of problem

Explain severity of problemExplain severity of problem

Identify consequences of problemIdentify consequences of problem

Underscore the efficacy of prevention in Underscore the efficacy of prevention in

solving the problemsolving the problem

Mainstream the issueMainstream the issue

ORAL HEALTH POLICY CAMPAIGNORAL HEALTH POLICY CAMPAIGN

““Tooth decay is the most common chronic Tooth decay is the most common chronic childhood disease in America. It affects childhood disease in America. It affects half of all first graders and 80% of half of all first graders and 80% of seventeen-year-olds. In Washington State, seventeen-year-olds. In Washington State, one in seven low-income children has one in seven low-income children has unmet dental needs, and many more unmet dental needs, and many more families struggle to pay for dental care. families struggle to pay for dental care. Oral disease keeps kids out of school and Oral disease keeps kids out of school and later out of work…”later out of work…”

ORAL HEALTH CAMPAIGN: MessageORAL HEALTH CAMPAIGN: Message

ORAL HEALTH CAMPAIGN: SolutionORAL HEALTH CAMPAIGN: Solution

““It doesn’t have to be this way. When It doesn’t have to be this way. When communities make prevention and early communities make prevention and early treatment a priority, kids can get regular treatment a priority, kids can get regular check-ups, sealants, and fluoride. So let’s check-ups, sealants, and fluoride. So let’s watch our mouths and use them to speak up watch our mouths and use them to speak up for the children of Washington State. for the children of Washington State. Because if our mouths aren’t healthy, Because if our mouths aren’t healthy, neither are our bodies.”neither are our bodies.”

ORAL HEALTH CAMPAIGN: ToolsORAL HEALTH CAMPAIGN: Tools

COALITIONCOALITION MEDIAMEDIA

– PAIDPAID– EARNEDEARNED

POLICYPOLICY– Phase IPhase I Political advance workPolitical advance work– Phase IIPhase II awareness awareness solutions solutions

ORAL HEALTH CAMPAIGN: CoalitionORAL HEALTH CAMPAIGN: Coalition

Citizens’ Watch for Kids Oral HealthCitizens’ Watch for Kids Oral Health• Business Business

• LaborLabor

• MedicalMedical

The AskThe Ask- Embed this in your policy agendaEmbed this in your policy agenda

- Open your communication channelOpen your communication channel

- Sign Op-EdsSign Op-Eds

- TestifyTestify

• Dental

• Education

• Public Health

ORAL HEALTH CAMPAIGN: ResultsORAL HEALTH CAMPAIGN: Results Issue reframed, with new identityIssue reframed, with new identity Success broadening constituencySuccess broadening constituency Policy “wins”Policy “wins”

– Defeat anti fluoridation attackDefeat anti fluoridation attack– Oral health references in model Oral health references in model

nutrition legislationnutrition legislation– WSMA policy: responsibility of md’s to WSMA policy: responsibility of md’s to

identify, treat and refer oral diseaseidentify, treat and refer oral disease WDS Foundation seen as “moral authority” WDS Foundation seen as “moral authority”

in state capitalin state capital

ORAL HEALTH CAMPAIGN: SummaryORAL HEALTH CAMPAIGN: Summary

Improved health status will come about as a Improved health status will come about as a result ofresult of

• Individuals getting more knowledge about Individuals getting more knowledge about personal health behaviorspersonal health behaviors

• Groups getting more power to change social Groups getting more power to change social and economic conditionsand economic conditions