Talking Public Health: Developing America’s Second Language

Lawrence Wallack, Dean, College of Urban & Public Affairs

Portland State University

1st Annual University of New Mexico National Health Disparities Conference

Albuquerque, NMMay 23, 2011

Thanks to CCPHA for this cartoon

Childhood Obesity Arguments

Personal, Individual, Behavioral

Social, Environmental, Political

Poor Parenting Massively promoted cheap, convenient, junk food

Bad Habits & Personal Choices Neighborhood connectivity & safety (e.g. recreation, transportation)

Overactive Thumbs, Underactive Legs Institutional policies (e.g. school lunches, phys ed classes)

Victims of Excess Local, state & federal policy issues (farm, tax, advertising, zoning)

Basic Question For Public Health

Will improved population health status come about primarily as a result of:

individuals getting more knowledge about personal health behaviors?

or

groups getting more power to change social and economic conditions?

Some things to consider

We are all reasonable people, aren’t we?

It seemed like a great story, didn’t it?

It’s about getting the right message, isn’t it?

YOYOs

WITTs

Jared BernsteinAll Together Now:

Common Sense for a Fair Economy

Frame basics

Frames are mental structures that help people understand the world. Frames are shortcuts for people that connect abstract ideas to familiar things (and do so very, very quickly).

BHPJ J G I IFAI TI I

BHPJ J G I IFAI TI I

“We've been talking about on how much we agree on different issues, but there really is a difference between us, and it's basically this: We don't think the government should be in control of all of this. We want people to be in control. And that, at the end of the day, is the big difference.”

-- Rep. PAUL RYAN (R, WI)February 25, 2010

http://www.whitehouse.gov/the-press-office/remarks-president-discussion-deficit-bipartisan-meeting-health-care-reform

HEALTH CARE REFORM, as a cue, what does it mean…?

To supporters To opponents To others1. 1. 1.2. 2. 2.3. 3. 3.4. 4. 4.

John Boehner on Health Care Reform(House Minority Leader on PBS NewsHour 11/5/09)

“This bill is the greatest threat to freedom that I have seen in the 19 years I have been here in Washington….It’s going to lead to a government takeover of our health care system, with tens of thousands of new bureaucrats right down the street, making these decisions [choose your doctor, buy your own health insurance] for you.”

No Blank slate

QPFSLTV

QPFSLTV

OBESITY, as a cue, what does it mean…?

To supporters To opponents To others1. 1. 1.2. 2. 2.3. 3. 3.4. 4. 4.5. 5. 5.

Lakoff’s three levels of analysis

Level 1: Big ideas and universal values like fairness, equality, justice, family, community

Level 2: Issue types such as housing, education, civil rights, the environment, public health

Level 3: Specific issues such as beer taxes, toxic waste sites, health care coverage

Adapted from The Frameworks Institutehttp://www.frameworksinstitute.org

It’s the values

“…economic policies are about values. If your policies undermine personal responsibility by separating the link between effort and reward, voters will punish you for it.”

David Brooks, “Faustus Makes a Deal,” New York Times, June 22, 2010.

Framing TensionSocial Justice Dominant (Market) Values

Shared responsibility Self-determination/Self discipline/Rugged individualism

Interconnectedness Benefits based solely on effort

Strong obligation to collective good Limited obligation to collective good

Basic benefits should be assured Voluntary and moral nature of behavior

Government involvement necessary Limited government intervention

Adapted from Beauchamp, 1976

Reframing Questions

• What stories are we telling?

• What cues are we giving?

• What values are we activating?

• What actions are we advocating?

Conclusion

• Understand the starting point of the discussion is not a blank slate

• Be clear about the social justice values and how to integrate these values into the story

• Move from values to policy/ program; don’t start at policy/program assuming values

• Think in terms of larger social narratives that guide public policy making