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Advocacy - Connecting With the PublicBob Crittenden, MD, MPH The Herndon Alliance November 19, 2010
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Communications and Community Prevention
• Why Communications Essential?
• What Connects with the Public?
• Example: Prevention
• Strategies That Work
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Task Ahead
• Expand Number of People Supporting Community Prevention • Need about 60%
• People Need to Understand What Policy Proposals Mean and How They Affect Them• Everything is personal
• Community Prevention Needs Support for Resources
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Need to Connect to Public• Beliefs trump facts• Base rarely the group need to convince• Public will listen if you start where they are
– Then move them to next step– Frame is long term, issue is short term (Healthy Kids vs.
better food) – Everything is personal
• Multiple spokespeople/perspectives– Same frame – provides echo effect
• Listen to trusted source• Inside/Outside
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Underlying Values
• Lens is Personal
• Values change over years
• Issue translated thru values
• Personal Responsibility
• Future of children
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Challenging EnvironmentPublic disappointed, anxious by current direction and partisanship of country—not trusting.
Public focused on economy and jobs.
Voters are concerned about rising health care costs
Love prevention – Not primary health issue
Straightforward ‘policy’ explanations don’t move opinions.
Many don’t believe changes will help the economy.
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Prevention
80% Support – But
Supporters divide between community (44%) and personal responsibility (36%) initially when taxes are mentioned.
So: 1. Interviews – Business, PH and local officials 2. Seven Focus Groups – Involved voters 3. Poll 950 likely voters plus 100 Latino
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Public can be moved from initial skepticism and will support community action IF we approach in ways that
they support
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Interviews:
1.Doing Poorly in Community Prevention2.Lack of Coherent Shared Message3.Invisibility of Successes4.Change from Top Down and Bottom Up5.Who’s in Charge? – No One Claiming Responsibility6. Investments Needed / Savings Possible7. National Coordination Needed8. Public Engagement – PR Not Enough
7%
36%
57%
28%
17%
Support Oppose Don't know
8%
19%
72%
38%
9%
Support Oppose Don't know
10Darker color indicates intensitySometimes in a survey like this, people change their minds. Would you support or oppose investing more money and resources in community prevention efforts to make it easier for people to maintain their health and make healthier choices, [even if it means increasing your taxes by $100 dollars a year]? Would you say you support or oppose this strongly or not so strongly?
No taxes*
Overall support for investing in prevention remains solid at the end of the survey, with little movement in either direction in part because support was already large.
Final Vote: Investing in Prevention
With taxes*
*split sampled question
+53 points
+21 points
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• The public moves significantly toward the community view of responsibility as a result of information and messages.
• Moving people on this dimension should be a key goal of public campaigns on this issue.
• The people who move most towards a community view of responsibility include
• Northeast women (32%),
• Northeast whites (30%),
• non-college educated older women (28%),
• weak Republicans (27%), and
• West men (26%).
We Can Move The Public To Greater Support for Community View of Prevention
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32%
21%
46%
34%
Now, here are two statements about health and prevention. Please read each carefully and rate which statement comes closer to your point of view, even if it isn’t exactly right.
Community vs. Individual Responsibility
+11 points
Initially, a plurality of the public agrees that the community has a role in prevention efforts. However, support and intensity drop when taxes are mentioned.
*split sampled question
27%
24% 36%
44%
+8 points
Some people say that while staying healthy is up to each individual, there are things that communities can do to make healthy
choices easier for individuals and families. We are all in this together, and we all have
a lot to gain from making it easier to eat better, exercise more, and ultimately live
longer, [even if it means increasing taxes].
Other people say that a person’s health is due to their individual choices, and that becoming healthier is each individual’s
responsibility. Instead of spending money on community programs, it will be more effective to leave it to individuals to take control and make healthier lifestyle
choices.
Without taxes* With taxes*
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37%
14% 22%
Now, here are two statements about health and prevention. Please read each carefully and rate which statement comes closer to your point of view, even if it isn’t exactly right.
Final Vote: Community vs. Individual Responsibility
+33 points
Real movement is seen on the responsibility dimension. Support for community responsibility increases in the version that doesn’t mention taxes from +11 to +33, and for the version that does mention taxes, the lead nearly doubles from +8 to +15.
*split sampled question
25%
21% 32%
47%
+15 points
Some people say that while staying healthy is up to each individual, there are things that communities can do to make healthy
choices easier for individuals and families. We are all in this together, and we all have
a lot to gain from making it easier to eat better, exercise more, and ultimately live
longer, [even if it means increasing taxes].
Other people say that a person’s health is due to their individual choices, and that becoming healthier is each individual’s
responsibility. Instead of spending money on community programs, it will be more effective to leave it to individuals to take control and make healthier lifestyle
choices.
Without taxes* With taxes*
55%
14
18%
30%
47%
31%
Thinking about the community prevention actions like the ones you just rated, here are two different statements about spending money on these actions. Please read each carefully and rate which statement comes closer to your point of view, even if it isn’t exactly right.
Funding for Community Prevention
+16 points
Some people say that spending money on community prevention is a good
investment because it results in better health, and it saves money in the long run
by reducing the cost of expensive treatment for chronic diseases.
Other people say that these may be nice things to have in a community, but times are tough and we just can’t afford to be
spending more money on these prevention activities when governments
are running deficits already.
In an engaged debate, a plurality of the public agrees that spending money on community prevention is a good investment, even when challenged on the cost of the investment in these tough times.
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• Women 55% – but with taxes 43%
• Democrats 58%
• African Americans – 59%
• Latinos – 53%
When Challenged with ‘Can’t Afford’
• Women 50%
• Democrats 57%
• African Americans 59%
• Latinos 53%
• Independents 49%
Support for Funding of Prevention
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Strategies:
28%
28%
43%
44%
79%
79%
89%
86%
Two For One - Science Project*
Two For One*
Healthy Schools Healthy Kids -Everyday
Healthy Schools, Healthy Kids -3 Days
10 8 or 9 6 or 7
17Policy Proposals – Top TierNow, here are some strategies that have been suggested as ways to make our communities healthier. Please read and rate
each one on how effective you think this will be in making your community healthier, where ten means you think this would be extremely effective, and zero means you think this would not be at all effective in making your community healthier, and you can choose any number in between.
All of the community prevention strategies we tested were popular, the best testing proposal by far focuses on kids and schools, while the next best proposal addresses how we can get “2 for 1” with smart, efficient investments.
*split sampled question
Mean
8.4
8.5
7.6
7.6
• [HEALTHY SCHOOLS, HEALTHY KIDS – 3 DAYS] - Too many schools have become unhealthy, offering snacks and soda from vending machines as well as unhealthy school lunches to kids. We should limit junk food in schools and make the school lunch menu more nutritious. We should also have physical education classes at least 3 days a week, not cut them, so kids can be active, which helps them be healthier and learn better.
• [HEALTHY SCHOOLS, HEALTHY KIDS – EVERYDAY] Too many schools have become unhealthy, offering snacks and soda from vending machines as well as unhealthy school lunches to kids. We should limit junk food in schools and make the school lunch menu more nutritious. We should also have physical education classes every day, not cut them, so kids can be active, which helps them be healthier and learn better.
• [TWO FOR ONE]- In these tough times, we have to do more with less, and find ways to promote prevention while we do other things. Where possible, every school should have a community garden. We should use our school facilities after work for exercise programs. When we repair parks and streets, let’s build playgrounds and bike paths where it makes sense. For minimal cost and effort we can get multiple benefits.
• [TWO FOR ONE – SCIENCE PROJECT] In these tough times, we have to do more with less, and find ways to promote prevention while we do other things. Where possible, every school should have a science project community garden. We should use our school facilities after work for exercise programs. When we repair parks and streets, let’s build playgrounds and bike paths where it makes sense. For minimal cost and effort we can get multiple benefits.
Text of top tier policy proposals
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Disparities:
20
14%
27%
60%
24%
10%
Support Oppose Don't know
Darker color indicates intensityNow, thinking about community prevention, would you support or oppose efforts to target people in certain neighborhoods [ethnic and racial minorities or people who have lower incomes] who may have a harder time accessing and choosing healthy lifestyles? Would you say you support or oppose that strongly or not so strongly?
Target in Certain Neighborhoods*
Targeting is marginally more supported when referred to as “certain neighborhoods.”
Disparity Questions
13%
30%
56%
27%
13%
Support Oppose Don't know
Target Ethnic and Racial Minorities Or Low Income*
*split sampled question
60% 59%66%
42%
21%
30%
Caucasians AfricanAmericans
Latinos
50%
85%
61%
61%
19%
44%
Caucasians AfricanAmericans
Latinos
21Darker color indicates intensityNow, thinking about community prevention, would you support or oppose efforts to target people in certain neighborhoods [ethnic and racial minorities or people who have lower incomes] who may have a harder time accessing and choosing healthy lifestyles? Would you say you support or oppose that strongly or not so strongly?
Target in Certain Neighborhoods*
Certain demographic groups support targeted messages more.
Disparity Questions by Race
Target Ethnic and Racial Minorities Or Low Income*
*split sampled question
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Messages:
77%
77%
73%
73%
42%
40%
38%
35%
Kids-gain*
Michelle
Individualresponsibility*
Like other cities
Total Convincing Very Convincing
23Positive Community Prevention MessagesNow, here are a series of statements people have made in support of community prevention. Please read and rate whether
each is a very convincing, somewhat convincing, not very convincing or not at all convincing reason to support community prevention.
The most effective messages for community prevention focus on helping children grow up healthy, and highlight the health problems we face as a country.
*split sampled question
Kids-gain is a popular message among all adults, followed closely by Michelle. Individual responsibility does well among tougher audiences, including Republicans and men, and Like other cities resonates well among our base and could be used for consolidation.
• [KIDS-GAIN] - Kids are our future, and to have a healthy future, we must help our children grow up healthy. We need to focus on improving nutrition at schools including getting rid of the junk food, make sure healthy fresh food is available at home, and that there are clean and safe parks in every neighborhood where kids can play. It’s the least we can do for our kids to grow up healthy.
• [MICHELLE] - It’s important to get preventive care, like checkups, vaccinations, and mammograms—but we need to do more. We need to change the way we eat, move, and interact so that health and prevention become priorities every day and not just when we get sick. This will help us combat diabetes, heart disease, and obesity, especially for children. These chronic diseases contribute to seven in ten deaths in the U.S. right now, and 75 percent of our current national health care costs. We owe it to ourselves to change this.
• [INDIVIDUAL RESPONSIBILITY]- It’s time we step up to the plate and take control over our own lives. By making healthier choices like buying fruits and vegetables, cooking instead of going through the drive-through, and playing outdoors with our kids instead of watching television, we will have more energy and fewer health problems. It is up to us to act, but we need government and businesses to work with us, not get in the way. We need information about nutrition, healthier choices on the menu at school and work, and safe places to exercise, so we are able to make good choices.
• [LIKE OTHER CITIES]- Community prevention can make a real difference—like it has in Oklahoma City. People there were among the most obese in the nation, and it was impacting their local economy since employers don’t want an unhealthy workforce who miss too many days of work and cost too much. They invested in prevention by making the city more pedestrian friendly, getting local businesses involved, and encouraging residents to exercise more. Oklahoma City lost half a million pounds and attracted new employers. so now they are not only healthier, but their economy is stronger too.
Text of positive messages
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Negative Community Prevention Messages
Now here are a series of statements people have made against investing more in community prevention. Please read and rate whether each statement raises serious doubts, some doubts, minor doubts, or no real doubts in your own mind about investing more in community prevention.
Oppositional messages following positive messages lack intensity and reach in persuading the public against investing in community prevention efforts.
39%
38%
40%
19%
17%
14%
Government Overreach
Individual lifestyles
Economic
Total Doubts Serious Doubts
• [GOVERNMENT OVERREACH] - This is yet another example of government overreaching, telling us how to live our lives. It is unbelievable that government feels like they can tell us what to eat and how to exercise, and now, how to raise our kids. Government officials have no business telling us what we can eat for dinner or how we should pack our kids’ school lunches.
• [INDIVIDUAL LIFESTYLES] - Lifestyles are all about individual choices and personal responsibility, and there’s no need for government and employers to get involved. What we eat for dinner and what we do with our time and money is our business. Community prevention programs are just an excuse for government and big business to invade our privacy and interfere with our personal lives.
• [ECONOMIC]- During these tough economic times, we shouldn’t spend money we don’t have on community prevention efforts. Building recreational centers and biking paths while people are out of work, facing foreclosure, and struggling to make ends meet is not right. Now is not the time to focus on extras and parks—we need to focus on jobs and keeping taxes low.
Text of negative messages
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23%
11%
66%
25%
4%
More likely Less likely No difference/DK
Darker color indicates intensity
Now that you’ve read more about community prevention, would you be more or less likely to vote for a local elected official if he or she supported these efforts, or would it not make a difference to you? Is that much more or less likely, or somewhat more or less likely?
A point in advancing the community prevention agenda is that supporting such efforts would be beneficial to elected officials in winning votes.
Vote for Elected Official
80% of Democrats, 64% of independents, and 58% of Republicans say they are more likely to vote for an elected official who supports community prevention efforts. Only 5% of Democrats, 14% of independents, and 17% of Republicans say they are less likely.
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• There is wide gap between how high a priority they would like prevention to be, and how low a priority it is.
• Broadly and intensely support community prevention, described as investing more money to make it easier for people to maintain their health and make healthier choices (73% support, 43% strongly), even when taxes are mentioned explicitly (61% support, 32% strongly).
• Enthusiastic about a wide range of community prevention actions, including making school lunches healthier, better food labels, employer incentives, and many others.
• Support for various strategies focused on improving the health of the country. They especially love focusing on kids and schools and two-for-one programs.
• Two-thirds of the public would be more likely to support a local elected official if they supported community prevention efforts.
Findings to highlight to demonstrate public support for the community prevention agenda:
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Strategy
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Strategy - Prevention
1. Many Organizations Using Same Frame-Regular and Social Communications-Earned Media-Campaigns
2. National and Local
3. Unusual Organizations Health CareBusiness
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Strategy - LocalUse Communications Strategy Development as Organizing Focus
Build on Local Campaigns
Involve:-Business, Advocates, PH, Local Elected Officials-Local Issues-Develop Local Coordination
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Examples of Success
• Affordable Choice
• Cost of Doing Nothing
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Strategy - Reform• Overall Narrative – Where is Country Going?• Health Narrative
• Future Generation• Personal Responsibility
• National /Local Coordinated Offense / Defense
• Support State and Local Implementation• Policy and Communications• Proof is in the Pudding• Many proof points – one is prevention
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Implementing Health Reform -Large Overlap with Prevention
-Taps into Future Generation and Personal Responsibility
-Tired of Partisan Battles
-Have Absorbed Opposition Arguments
-Easy to instill fear
-Unaware of Content: info = support
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Use transition or bridge language to meet public where they are and relax their defenses.
“The law is a good start at helping many people. Now we’ll work to improve it.”
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Core provisions that the public values
Top tier: end discrimination based on:pre-existing conditions lifetime caps and dropping people when they get sick.
Second tier: small business tax credits to help secure coverage for their employees and Preventive care - requiring insurers to provide no-cost coverage.
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Address provider scarcity and cost concerns.
Big investment in the healthcare workforce
Yes, there are taxes , but only for those with incomes over $200,000/$250,000 annually
Repeal will cost the budget $455 Billon
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Avoid overheated political rhetoric.
Tap into individual responsibility to blunt opposition to the mandate
to have health insurance. “Those who choose not to have insurance and use the emergency room for routine care are increasing costs for the rest of us who have insurance.”
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Highlight – Members of Congress will participate in the same plan.
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Non-college educated women:Health care law passed.
What is in the law and how it will affect them.
They can keep the coverage they have now.
Latinos•Health care law passed•Congress will participate in the same plans, •Help for children and small businesses, •Lower income families will be helped through premiums based on a ‘sliding scale.’
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Don’t:• assume public knows the health reform law passed or
if they know it passed understand how it will affect them personally;
• list benefits outside of any personal context; • barrage voters with a long list of benefits—needs
context; • use complex language or insider jargon; • use heated political rhetoric or congratulatory
language;• begin the conversation by saying the law will reduce
deficit.
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Prevention to Health Reform
• Bridge Personal Responsibility to Community Action• Prevention
•Kids deserve fair start•Adults take personal responsibility
•Health Care – Converting ‘Undeserving’ to ‘Deserving’ – personal responsibility
•Take care of health• Pay what they can
