Transcript Document

Talking Public Health:
America’s Second Language and
What It Means for Public Health Nutrition Advocates
Guiding the Winds of Change in Public Health Nutrition
Association of State and Territorial
Public Health Nutrition Directors
Annual Meeting
June 15, 2009
Lawrence Wallack, DRPH
Dean and Professor of Public Health
College of Urban and Public Affairs
Portland State University
Special thanks to Liana Winett, DRPH for her assistance with this presentation.
Obesity Trends* Among U.S. Adults
BRFSS, 1990
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
Obesity Trends* Among U.S. Adults
BRFSS, 1992
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
Obesity Trends* Among U.S. Adults
BRFSS, 1994
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
Obesity Trends* Among U.S. Adults
BRFSS, 1996
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
Obesity Trends* Among U.S. Adults
BRFSS, 1998
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
≥20%
Obesity Trends* Among U.S. Adults
BRFSS, 2000
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
≥20%
Obesity Trends* Among U.S. Adults
BRFSS, 2002
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
20%–24%
≥25%
Obesity Trends* Among U.S. Adults
BRFSS, 2004
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
20%–24%
≥25%
Obesity Trends* Among U.S. Adults
BRFSS, 2007
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
20%–24%
25%–29%
≥30%
Obesity Trends Among U.S. Adults
BRFSS, 1990 vs. 2007
1990
2007
No Data
<10%
10%–14%
15%–19%
20%–24%
25%–29%
≥30%
Thanks to CCPHA for this cartoon
QuickTime™ and a
TIFF (LZW) decompressor
are needed to see this picture.
Following Shrek’s Advice
To burn off the calories in one bowl of
Shrek cereal, a 60-lb person would have
to perform 2100 jumping jacks!
Two Stories about diabetes:
what is the right balance?
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Who are the characters?
Who is at risk or harmed?
Who is inflicting harm?
What are the solutions?
Who can advance the solutions?
What are the underlying values?
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Some questionable beliefs
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The facts will set you free.
The data speak for themselves.
We need to educate everyone.
We just need a catchier message/slogan.
I understand it so everyone else should.
Those who don’t support us don’t make sense.
Basic Public Health Question
Will the public’s health improve primarily as a result of:
individuals getting more and better knowledge about personal risk
factors
OR
groups getting more skills and opportunities to participate in
changing public policies?
Land of controversy:
the upstream territory
• Distant from perceived immediate causes
• Perceived as minimizing individual responsibility
• Addresses issues of social or public policy
• Often confronts well financed corporate interests
• Few short term indicators of success
“…20 years from now people will look back and
say: ‘What were they thinking? They’re in the
middle of an epidemic and kids are watching
20,000 hours of commercials for junk food.’”
Dr. Thomas R. Frieden
NYC Health Commissioner
New York Times, 1/9/06
What are frames?
• Frames are mental structures that help people
understand the world, based on particular cues
from outside themselves that activate
assumptions and values they hold within
themselves.
Berkeley Media Studies Group
QRFSJTV
QRFSJTV
I JFAI TI IV FATJNC
I JFAI TI IV FATJNC
OBESITY and
HEALTHY EATING…
What do these mean?
Lakoff’s levels of analysis
Level 1: Big ideas and universal values like
fairness, family, community, equality, and justice
Level 2: Issue types such as housing, civil
rights, the environment, public health
Level 3: Specific issues such as rent subsidies,
beer taxes, toxic waste sites
Adapted from The Frameworks Institute
http://www.frameworksinstitute.org
Childhood Obesity Arguments
Personal, Individual
Social, Environmental
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 and related activities)
Victims of Excess
Local, state & federal policy issues
(farm, tax, advertising, zoning)
Framing tension
Social Justice
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Shared responsibility
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Interconnectedness
Dominant Values
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Self-determination/Self
discipline/Rugged individualism
Strong obligation to collective
good
Basic benefits should be assured
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Government involvement
necessary
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Benefits based solely on effort
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Limited obligation to collective
good
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Voluntary and moral nature of
behavior
Limited government intervention
Adapted from Beauchamp, 1976
The challenge to rebalance
Community, policy,
social, economic
understanding
Personal, behavioral,
Individual/family
understanding
Simplifying Model Challenge
Joe Grady and Axel Aubrun
Cultural Logic LLC
Take something that is familiar, easy to
understand, rooted in explicit values and use
it to explain your issue. It’s like ….
Childhood development
Kids are like sponges
Kids are like modeling clay
Nutrition
You are what you eat
What’s around us shapes us
How do you structure the
environmental approach?
“In many neighborhoods, there is little or no access to
affordable healthy foods, and the lack of infrastructure
and/or public safety issues make regular physical
activity difficult to achieve. It is not surprising that
people in these neighborhoods suffer from higher
rates of overweight and obesity. These problems go
beyond factors under the control of families and
individuals to include conditions in our social and
physical environments that encourage people to eat
and drink unhealthy foods and beverages and limit
their physical activity.”
Framing
 What is the broader social/community issue?
e.g. protection of children, ensuring high functioning communities
 What is the shared responsibility for change?
e.g. parents, school boards, government nutrition programs, large
grocery stores, restaurant chains
 What needs to be done in policy terms?)
e.g. Increase access to health food options, improve neighborhood
design, change composition of school lunches, broaden food
stamp eligibility
 What are the practical and value appeals?
e.g. Protect children, save lives, promote opportunity, protect the
community
 What elements can shape the story?
e.g. visuals, media bites, social math, authentic voices
Framing
 What is the broader social/community issue?
e.g. protection of children, support for families
 What is the shared responsibility for change?
e.g. parents, city council, non-profits, corporations
 What needs to be done in policy terms?
e.g. draw from menu physical activity and nutrition policies
 What are the practical and value appeals?
e.g. saves money/protects children, fairness for the community,
shared responsibility
 What story elements can shape the story?
e.g. visuals, media bites, social math, authentic voices
The After All Challenge
• Obesity rates have risen dramatically in the US over the
last 10 years. Of course people can avoid obesity and
improve their health and chances for living longer by
eating healthy food and exercising regularly. But personal
choices about diet and activity aren’t the only factor in the
rise of obesity. After all...
Message Development
• What’s wrong?
– We have disinvested in our children by not funding
physical education.
• Why does it matter?
– This endangers the health of the next generation.
– We have a responsibility to provide children a fair
chance to be strong and successful.
• What should be done?
1) Physical education must be part of a overall healthy
education.
2) The legislature must provide adequate funds for
complete education.
Message Development
• What’s wrong?
– We have left the food industry to determine the diet
and health of our children.
• Why does it matter?
– This endangers the health of the next generation.
– We have a responsibility to provide children a fair
chance to be strong and successful.
• What should be done?
1) Limit availability of fast food outlets.
2) Increase the availability of affordable, nutritious
foods.
Power of the default frame
Reframing Questions
• What stories are we telling?
• What cues are we giving?
• What values are we activating?
• What actions are we advocating?
Moving ahead
 Travel to the upstream territory
 Advance research-based policy for change
 Rebalance our stories to reflect policy issues
and the upstream terrain
 Root our stories in community and social
justice values
Conclusion
“If they can get you asking the wrong questions,
they don't have to worry about answers.”
Thomas Pynchon
Gravity’s Rainbow