Richard Besser’s insights from a career talking public health to the public
After an eclectic and acclaimed career in public health—from field epidemiologist to acting director of the U.S. Centers for Disease Control and Prevention (CDC) to chief health and medical editor for ABC News— Richard Besser took over this year as president and chief executive officer of the Robert Wood Johnson Foundation. In a recent interview with Madeline Drexler, editor of Harvard Public Health, Besser—a Distinguished Visiting Fellow at the Harvard T.H. Chan School of Public Health—reflected on what he has learned about communicating the public health message.
- Speak from the heart
I started out as an epidemiologist at CDC. And in epidemiology, you’re taught the value and the importance of data—that well-crafted studies will reveal powerful scientific truths. But what I learned as a communicator is that you have to connect at the level of the heart before you get into the numbers, because for a lot of people, that heart connection is what will drive their understanding and behavior.
For instance, during the swine flu pandemic in 2009, before talking about the number of flu cases and the expected mortality rate, you needed to acknowledge that these are scary times and that there’s a lot of uncertainty. When there’s uncertainty around health, people are worried and they want to know what they can do to protect themselves. That’s a normal, rational feeling: to be afraid. Once you connect at that level, then you can talk about the situation and what people can do to protect and promote their health.
- Look for teachable moments
In public health communication, you want to catch people when they’re interested in what you want to talk about. That usually means when the issue has been raised to the level of news or public conversation. We can’t let those opportunities go by.
For example, hurricanes, cyclones, heat waves: When it happens in your community, it’s like, whoa, we didn’t see that coming. But if you look back over the past 20 years, every state in America has had a declared public health emergency for a weather-related event—and if you live in a coastal area in the South, you’ve seen a lot more. These are teachable moments—a great time to talk to people in a community about overall preparedness, so that they know what to do, the value of a communications plan, steps they should take in the event of an emergency in their area.
It is also a time when you could slip in messages such as: A lot of scientists believe, and there’s a lot of evidence to support them, that a changing climate is making these weather events stronger and more frequent.
- Channel emotions into action
Once you grab people’s attention, shift it into an action step: Here’s the problem, this is really concerning, and thankfully there’s something that you can do. It’s a way to channel people’s emotions, whether it’s concern or fear or helplessness, into the realization that there are things that they can do and that they can demand that others do.
I have a friend who’s a public health leader, and he was a master at creating the doomsday scenario. Whenever I would invite him to address a group, I would say, “I’m not going to let you speak unless you spend at least a third of your talk telling people what they can do with the scenario that you’ve laid out.” It’s easy to craft scenarios that are all doom and gloom, but it’s not empowering. It doesn’t lead to change. It doesn’t bring people to healthier solutions.
- Know your audience’s world view
If you don’t understand where someone’s coming from, it’s hard to think about how to effect change. There’s a terrific book, Strangers in Their Own Land, by the Berkeley sociologist Arlie Hochschild. She went down to Louisiana to try to understand why some of the people who might benefit most from government programs were the most opposed to those programs. If you don’t try to understand those issues, you’re never going to effect change; you’re just going to be talking past each other.
Crediting the conceptual framework in Jonathan Haidt’s book The Righteous Mind, Hochschild found that, on the political left, the motivation was primarily around issues of caring and around justice. On the right, people were also concerned about caring and justice—but in addition, they were concerned about loyalty, sanctity, authority, and about oppression and the government telling them what to do. If you don’t understand that those ideas come into play and all you talk about is how the government is going to take care of those most in need, you’re going to rub some people the wrong way.
On the other hand, whether they’re on the right or the left, most people want children to have the opportunity to grow up healthy and to have opportunities for health and economic success. That’s an area where there’s a lot of agreement.
- Go retail
Should experts get out of their ivory towers? I have strong feelings about that: I think public health should go retail. By that, I mean public health should be talking directly to the public and not just to policymakers or the health and medical communities. On many issues, public health has bipartisan support. The public health community can and should be a trusted voice in the broader community for health issues.
There are lots of different ways to go retail. If you’re the local public health officer in a community, you can go to your PTA meeting and speak out for why it’s so important to have healthy lunches and physical activity in your school. You’ll be viewed as an expert and could have sway over a school board or a principal or a program. Or if there’s a big storm headed for your community and the local news asks what people can do to protect themselves, you can make sure that you know how to give out targeted messages.
Anyone who is embarking on a career in public health where they may be involved in communication should get training in communication. It takes practice to learn how to communicate effectively to different audiences. Too often, it’s just an afterthought—or not a thought at all. That represents a missed opportunity to improve the health of our communities.
