Introduction by Croakey: As we anxiously watch unfolding news on the latest COVID outbreak in Victoria, it becomes ever-more urgent to address the widely canvassed failings of the national vaccination rollout, in particular the lack of an effective communications strategy and campaign.
It is hard to fathom why this has not been forthcoming.
Back in November last year, public health experts released a detailed document to guide the design and implementation of a COVID-19 vaccine program, with specific recommendations for broad and tailored communications campaigns, as per below.
The report also noted that the provision of well-crafted messages is not enough in itself as vaccination behaviours are shaped by many factors, including access, cultural beliefs, community, a person’s identity and their norms, education, and socioeconomic status, as well as by philosophical beliefs.
Meanwhile, an analysis of Croakey’s early coverage of the pandemic and public health communications makes clear that concerns about the quality of pandemic communications are not new, identifying five key themes to help improve them.
The article below is based upon a presentation to the recent Preventive Health Conference 2021, which was prepared by Dr Melissa Sweet, Dr Summer May Finlay and Associate Professor Megan Williams, with input from other members of Croakey Health Media. (See here for a Twitter wrap of other #Prevention2021 presentations).
Melissa Sweet, Summer May Finlay and Megan Williams write:
We begin by acknowledging the Country from where this presentation was developed, and where it has been viewed. We pay our respects to other Aboriginal and Torres Strait Islander nations, to Elders past, present and emerging, and to Aboriginal and Torres Strait Islander colleagues, including those whose work has helped to inform this analysis.
In this paper, we present a preliminary analysis of the first 100 articles that Croakey published on the pandemic that discuss public health communications.
They were published between 28 January 2020 and 18 September 2020 – accounting for 30 percent of the 332 articles on the pandemic that we published over that period.
The 100 articles in our sample included:
- News articles by journalists
- Opeds by academics, NGOs, health professionals, and others
- Cross posts from The Conversation and other publications, including blogs
- Some articles were published via the Croakey Conference News Service – notably our coverage of VicHealth’s Health Reimagined webinar series
- One article included in the analysis was sponsored content from the Australian Commission on Safety and Quality in Health Care.
The tweet above, which was included in the first article Croakey published on the pandemic, on 28 January 2020, is a reminder of how significant Twitter has been during the pandemic. Most of our articles included embedded tweets or links to Twitter threads.
The methods for the solutions-focused thematic analysis included:
- critical reflection on key documents, including ACCC Digital Platforms Inquiry, the News Media Bargaining Code, and The United Nations Declaration on the Rights of Indigenous Peoples
- discussion among team members
- selection of core high-level themes
- selection of quotes and other items to exemplify the five themes identified.
1. Challenging communications environment
The COVID-19 pandemic has occurred in a uniquely challenging communications environment.
It is challenging for governments and other actors to deliver clear messages in rapidly evolving situations where there is a high degree of uncertainty and an overwhelming volume of scientific, medical and health literature, both reviewed and unreviewed.
The complexity of the Australian health system, and the division of responsibilities between jurisdictions and longstanding politicisation of health also add to the challenges.
The task is even more difficult in a toxic, poorly regulated information environment distinguished by contested, polarised and fragmented public spheres, and an “infodemic” of misinformation and disinformation.
Decades of neoliberalism has weakened wider civil society, undermined the public service, and reduced the capacity of many public agencies and the community sector to deliver services, including communications services.
During the pandemic, political and business leaders, mainstream media and digital platforms have spread misinformation and disinformation.
The pandemic has also shown the need to improve health literacy.
As Associate Professor Lesley Russell wrote on 6 July 2020, in The Health Wrap:
The coronavirus infodemic has highlighted that poor health literacy is an underestimated public health problem globally – both for individuals and also for organisational health literacy.”
Other authors wrote that millions of Australians do not have sufficient health literacy to understand complex COVID-19 communications, and this problem is exacerbated by the failure of governments to enact best practice in communications – they gave the Federal Health Department website as an example of this.
Rarely has it been more important for communities to have trusted, reliable news sources.
Yet the COVID-19 pandemic has threatening the viability of many media organisations, leading to closures and journalism job losses. Hardest hit have been rural, remote and regional communities, whose needs are not always well reflected by metropolitan-based media outlets.
At the same time as partisan corporate media has spread distrust, racism and division, the ABC been slashing staff, services and programs, while globally, the decline of press freedom has been documented in many countries.
Another key theme identified in our analysis are wide-ranging concerns about governments’ pandemic communications.
2. Concerns about public health messaging
Concerns about government communications, to both the general public and health sector, were raised repeatedly and can be summarised as:
- Lack of transparency
- Inconsistent, contradictory and confusing messaging – between and within governments
- Delays in messaging
- Information gaps
- Politicisation of communications.
Other concerns have included:
- Failure to engage the community as partners in preparation and communications
- Failure to foster a collective response based on solidarity and reciprocity rather than individualism
- Messaging that has been impractical and out of touch with reality of many people’s lives and circumstances. As one author wrote: “No advice is provided for people who don’t have stable and safe housing, regular employment, a car, a mobile phone, internet access, the capacity to deal with a short-term lack of income, or the ability to purchase and store bulk foods.”
3. Leadership by the Aboriginal and Torres Strait Islander health sector
On a more positive note, a third theme identified in our analysis is the leadership of Aboriginal and Torres Strait Islander people and organisations.
The leadership shown by the Aboriginal and Torres Strait Islander health sector and community groups was a strong theme across many articles.
Key points relevant for communications included:
- The importance of self determination, including in governance and decision making. The Aboriginal and Torres Strait Islander Advisory Group on COVID-19, which informs national policy making, works on principles of shared decision-making, power-sharing, two-way communication, self-determination, leadership and empowerment.
- Articles highlighted the importance of responses centring Aboriginal and Torres Strait Islander perspectives and cultures and of ensuring cultural safety, equity and inclusion of Indigenous knowledges
- Innovation and flexibility in communications enabled messaging tailored to local context and languages, using multiple formats, including graphics, videos, Facebook, Instagram, TikTok, and other social media channels.
- The sector developed messaging that emphasises cultural strengths, solidarity and resilience, including respect and care for Elders.
One clear lesson from the COVID-19 pandemic is that the wider health system has much to learn from the successes of the Aboriginal Community Controlled Health Organisations sector and Indigenous health leadership.
The sector was also a strong advocate for communities, including when governments were slow to act or silent on critical issues.
A recurring theme across the articles has been about the deafening silence in government communications about key population groups, including:
- people with disabilities
- homeless people
- refugees, asylum seekers in detention, and people with limited English language skills
- women and children living in situations of domestic violence
- prisoners and their families.
This story featured above is a reminder that advocates and communities have sought to hold governments to account for the silences in their communications.
Government pandemic communications also failed to acknowledge and address the importance of the Black Lives Matter movement in the pandemic context, and to acknowledge and address the impacts of institutional racism.
Senior health policy makers have failed to use their authority to name and address the systemic racism that contributes to poorer healthcare, as it does to overincarceration.
Rather than seizing an opportunity to advocate for meaningful reform, their statements problematised the Black Lives Matter protests and the protesters, lending weight to mainstream media narratives that so often have concentrated on critiquing the protesters, rather than the reasons for protest.
In a joint statement, legal and human rights groups noted that instead of committing to systemic change to keep Aboriginal and Torres Strait Islander people out of prisons and end Black deaths in custody, the Prime Minister called for Black Lives Matter protesters to be arrested and charged – juxtaposed against an announcement that football stadiums with crowds of 10,000 would be reopening.
Meanwhile, on the theme of groups under-served by communications, one author also raised concerns about children’s needs for information and suggested COVID briefings for children.
5. Room for improvement
The articles in our sample identified many opportunities for improving health communications, as suggested by this extract:
Source: Doing better
In this concluding section on recommendations, we look at some of the upstream determinants for creating a safer and healthier communications environment.
Putting equity first in policies will help to ensure equity is also addressed in communications.
Policies and information campaigns should be targeted to the population groups most at risk. In addition to those groups already mentioned previously – migrant women were highlighted as a group disproportionately affected and yet under-served by information and support.
A number of authors stressed the importance of representation and diversity in governance – and ensuring this happens before epidemics occur.
The pandemic has shown the importance of trusted local community voices and organisations in communities, and thus the need to invest in strengthening communities, the community sector and wider civil society.
Primary healthcare infrastructure is the missing link in an effective communications ecosystem. The ACCHO sector has shown power of a holistic primary health care response for effective and community-focused communications.
Members of the Croakey team have some related suggestions, as per below.
Articles in our analysis also recommend ensuring that cultural safety and explicit anti-racism are part of communications.
And they encourage a shift to paradigms beyond neoliberalism…putting the needs of vulnerable populations, such as people in aged care, ahead of profits.
How, for example, can we improve health literacy without addressing inequity in education?
If you read Croakey regularly, you will be familiar with two hashtags that identify two important avenues for public health advocacy and interventions: engaging with regulation of the powerful digital platform monopolies, and with media policy to ensure sustainable public interest journalism.
These are critical for developing a safer and more empowering communications environment.
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Finally, we’d like to encourage you to use the Croakey archives as a valuable resource for informing research/policy/practice etc.
We also acknowledge and thank our funders, and everyone who engages with us – through writing opeds, contributing comments, providing feedback, sharing our articles.
See our archive of stories on health communications.
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