F
or a few tense moments, the scenario staged in classroom 505 of the Harvard School of Public Health last May seemed all too real:

Mustering everything he'd learned at HSPH about crisis communications that semester, Paulraj Samuel now faced the first real test of his leadership as the new U.S. Secretary of Health and Human Services. A mysterious white powder--anthrax?--had been found in the lobby of the School's Kresge Building, and Samuel was on the hot seat, fielding tough questions from the national media.

Who's in charge here?

You're a pretty new guy, Mr. Secretary, and this situation is unprecedented. What can we expect at a time like this?

The governor is concerned that this is going to spread like wildfire and cause thousands of deaths. Do you agree?

As a video camera rolled, Samuel stepped to the mike. "We have gathered the sample and we'll be testing it, making sure the public knows exactly what's going on every step of the way," he replied calmly. "I am taking charge of the situation, and I'm privileged and honored to work with a tremendous number of people who are experienced in this field. ... We're working tirelessly to keep people safe," he continued, deftly parrying one reporter's blunt thrusts to drive home the message that public safety was paramount and an investigation was under way.

Suddenly Samuel's interrogator broke into a grin and led the room in a round of applause. "Hey! You're goooood, Mr. Secretary. Fantastic job!"

In reality, this was no press conference--just another Monday meeting of HSPH course ID 284: The Media and Health Communication: Practical Skills. The U.S. Secretary was an MPH candidate, and his interrogator was Professor Howard Koh, one of the course's three teachers and the former commissioner of public health for Massachusetts, passing on what he'd learned during his experience of the real-life U.S. anthrax crisis in the fall of 2001.

Real-world skills
For Samuel and his classmates, the exercise illustrated the value of what Koh and others have referred to as a "single overriding health communications objective," or SOHCO ("sock-o"). "Pretend your SOHCO is a horse, and you're riding it. Stay on message," Koh advised.

Mixing role play and real-world experience is par for the "Practical Skills" course, introduced last year to demystify the news media and help future public health leaders reach millions of people. Through homework assignments, workshops, and field trips, students learn how to use newspapers, radio, television, and the web to relay health messages, influence public opinion and policy--and ultimately, transform attitudes and behaviors through what's known as "social marketing."

How do news editors decide which stories to cover? How can public health advocates generate headlines? What's the protocol for handling reporters, especially in times of emergency and crisis? In a long-term mass-media campaign, how do you target your audience, test your message, enlist key media, and determine whether your strategy is working?

Students learn by doing--writing news releases and opinion articles, weathering adversarial interviews, and staging mock press conferences. Finally, they design a mass-media campaign to raise awareness of a major issue of their choosing--the rise of drug-resistant infections in Boston schoolchildren, say, or underuse by the poor in Ghana of a new health insurance system.

"How do you get from public health theory to practice? That's what this 'Practical Skills' course is about," says HSPH Dean Barry Bloom. "You can do research, but to change policy and human behavior, you need to reach the public through the media."

That's why Bloom added communications to the School's teaching and research missions. While Harvard offers a range of courses in the evolving discipline of health communications, "Practical Skills" is "terrific," Bloom says, because it draws on the seven-plus decades of practical experience of its three instructors:

Jay Winsten, the course's lead instructor, an associate dean at HSPH who directs the School's Center for Health Communication, is a social marketing expert who harnesses the media and entertainment industries to transform social norms. Winsten popularized the "designated driver" concept in the U.S., for example, which contributed to a dramatic decline in drunk-driving-related fatalities in the 1990s. Today, with major support from the MetLife Foundation, Winsten oversees a national effort to promote the mentoring of America's youth, particularly by retiring baby boomers.

Robin Herman, who as HSPH's director of communications is the School's chief spokesperson, spent 25 years as a reporter for the New York Times and for the Washington Post's health section. Her office handles hundreds of reporters' calls each year, facilitating coverage of School-sponsored activities and research. In 2004, the School was cited in nearly 1,000 print articles and broadcasts.

Howard Koh, the associate dean for public health practice and Harvey V. Fineberg Professor of the Practice of Public Health, is a physician who served from 1997 to 2003 as Massachusetts' public health commissioner, a post that placed him squarely in the media spotlight. Koh led the state's successful and award-winning anti-tobacco campaign, Make Smoking History, and guided an anxious public through the aftermath of 9/11, serving as the face of public health for the Commonwealth.

Winsten speaks for the trio in saying that mass-media communication skills are essential for aspiring public health leaders. "What we try to accomplish in this course," he says, "is to prepare future leaders to handle a broad array of tasks that will be essential in their jobs--ranging from day-by-day interactions with the news media to long-term efforts to motivate behavioral changes in large populations.

"Robin, Howard, and I bring complementary perspectives on health communication, reflecting the different roles we've played," Winsten says. "We interact a lot in the classroom, sharing insights from our respective backgrounds, and I think this team approach greatly enriches the learning experience--not least for the three instructors. The three of us attend each class."

"It has been said that a public servant lives in a fishbowl made of magnifying glass," adds Koh. "Working with the media to deliver a succinct message is critical for public health practitioners. We hope our class can prepare students to begin to reach their full potential as communicators and leaders."

Fantastic and humiliating
"What students love about this course is that they apply what they learn," says teaching assistant Njoke Thomas. She says taking the class herself in its inaugural year prepared her for appearances on a local TV station as a spokesperson for the Family Planning Association of Trinidad and Tobago, a country where teen pregnancy rates are high.

In one assignment, Herman had students write a press release on an HSPH study led by Assistant Professor of Epidemiology Miguel Hernán. Scheduled for publication in the journal Brain, the study described a possible link between cigarette smoking and multiple sclerosis risk. Pronouncing student Amber Johnson's draft "beautifully done and of professional quality," Robin Herman posted it on EurekAlert, a news website for journalists.

The class also analyzed op-ed opinion articles, including one published by Koh in the Boston Globe on bioterrorism preparedness and the draft of another by HSPH Associate Professor of Epidemiology Marc Lipsitch on the nation's need to take precautions against a deadly flu pandemic like that of 1918. Then students put their own pens to paper. Paulraj Samuel urged voters in Austin, Texas, his hometown, to ban smoking in bars and restaurants in an upcoming referendum. Amitava Banerjee wrote in support of a clean-needle-exchange bill before the Massachusetts legislature.

Winsten, Koh, and Herman don't do all the teaching; students also hear from public officials, journalists, and guest faculty. After touring the Boston Globe, for instance, the students spent an hour with its Health/Science team. Editor Gideon Gil, reporter Steve Smith, and editorial writer Don McGillis explained how they decide what stories are headline-worthy and answered questions. In class, the Globe's Gareth Cook revealed how he developed a series of stories on embryonic stem-cell research that last April won a Pulitzer Prize for explanatory journalism.

The inside scoop on TV news this year came from David Ropeik, the former director of Risk Communications for HSPH's Harvard Center for Risk Analysis, who spent 22 years with Channel 5 in Boston. In videotaped lab sessions, Ropeik played reporter, grilling students who took on the roles of HSPH researchers. Together they reenacted the 2003 release of a controversial assessment of the risks to U.S. cattle posed by bovine spongiform encephalopathy, a.k.a. Mad Cow disease.

"That lab was fantastic--but also humiliating," says student Melissa Cole with a laugh. "Watching the tape, I could see that I'd been making all these weird hand gestures and obnoxious facial expressions."

'A privilege and a joy'
By the end of the semester, "Practical Skills" students roll everything they have learned into a mass-media campaign that puts an important public health issue of their choice before the public's eye. Having analyzed successful campaigns with Winsten, students draft a strategic plan, op-ed piece, and press release as their final assignment.

Ben Koh, a physician and health adviser from Singapore (no relation to Professor Koh), outlined a plan he wants to implement in his country to raise awareness of depression, which he says carries a stigma and is under-diagnosed. Alyson Burns mapped a way to curb the rise of drug-resistant bacteria and overuse of antibiotics among Boston schoolchildren. (Burns will soon be applying her skills at Ogilvy Public Relations in Washington, D.C., in a job she accepted after conferring with Winsten.)

On the last day, the three instructors offered some parting advice. "Working for an advocacy group, you'll be dependent on goodwill. Be helpful and useful to reporters," Winsten said.
Saying she was "impressed and personally gratified" by students' new level of sophistication, Herman said that she, Koh, and Winsten would always be willing to offer career advice. "Keep us in your Rolodex," she said.

"It's a privilege and a joy to represent public health before the press," said Koh. "You'll make mistakes, but that's part of the growth process. Tap into your passion and mission, and communicate that."

Karin Kiewra is editor of the Review and the associate director of development communications for HSPH.

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