Press Release

Messaging research: Effective public health communication strategies for divisive political climate

August 2023

Graphic that reads "Public Health: Changing the Narrative" with BCHC logo and stylized tree in background
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Polling and focus groups in 35 big cities showed that public health officials can more effectively reach key audiences by (1) emphasizing how they address key health-related issues such as crime, homelessness, and affordable housing; (2) describing racial inequity as a human-made problem that we can solve; and (3) framing public health’s work as empowering healthier choices.

Overview

Between March and May 2023, the Big Cities Health Coalition polled key audiences in its member jurisdictions (35 big cities). The goal was to better understand how individuals who are skeptical of public health interventions could be moved to better support the important role governmental public health departments and leaders play in their communities.

Continue reading for our top-level findings and messaging recommendations. Download the messaging guide to save these recommendations in a convenient one-pager. Download the full slide deck to review more detailed findings from our research.

Download PDF 122.5KB

Messaging guide

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Download PDF 3.4MB

Full slide deck

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Project details

In collaboration with Hart Research, we conducted two focus groups with 8 white centrists and 8 Black residents in Philadelphia; then QualBoards with 20 white center-right and 19 Black and Hispanic residents; and finally an online survey of 1,006 similar “policy influencers” in 35 BCHC jurisdictions with an oversample of Black and Hispanic residents.

The project was primarily supported by the CDC Foundation.

map showing BCHC's 35 member cities
Map showing BCHC’s 35 member cities, whose residents were the focus of this study
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Research-supported strategies

Our messaging research supports the following communication strategies.
  • Explain the direct connections between public health and health issues people care about most. Respondents ranked reducing crime, addressing homelessness, improving education, and increasing access to affordable housing and quality medical care as even higher priorities in their city than public health. (See Graph 1 below.)
GRAPH 1. Respondents consider public health important – but rank other city needs as having a higher priority.

Percent who answered yes to “This issue should be a top priority for the city I live in to address.”

Bar graph showing that 58% of respondents said that ensuring residents and communities are healthy should be a top priority for the city they live in to address. But 5 other issues ranked higher in their priorities.
  • Illustrate how health departments fight for policies that make it easier for all people to live their healthiest lives: livable wages, safe and affordable housing, healthy food.
  • When relevant, account for regional and political variation: respondents in western states and conservative residents were the most concerned about homelessness and substance use disorder, while respondents in southern states (incl. Texas) prioritized obesity and diabetes instead. Concern about mental health issues was highest in the northeast and the midwest and among Black residents.
  • Describe how meaningful investments in public health save money by preventing disease and supporting a better quality of life for all communities (see Persuasive Messages section below).
  • Show how your city supports opportunities for health and empowers residents to make healthy choices. In our study, using empowerment and opportunity language aligned with respondents’ values and made them more likely to see their local health department as a valued community partner. (See Graph 2 below.)
GRAPH 2. Respondents support city government giving residents opportunities to be healthy.
Bar graph showing that an additional 6% of respondents were supportive when we asked if city government should provide opportunities to be healthy (instead of saying city government should help residents be healthy). Liberal Democrats, Independents, Black residents, and women supported this opportunity language even more strongly.

Graph shows subgroups who showed the most significant preference for the empowerment/opportunity framing.
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  • Emphasize that people have the power to address and even solve their community’s challenges. Respondents often resisted explicit language about racial justice, but most (57%) supported this framing: “Racial health inequities are a result of social and economic systems that have been made by people, and therefore can be changed by people as well. Addressing racial health inequities will require examining and addressing the root causes of these disparities, including unequal access to healthcare and distribution of resources. But by acknowledging that these inequities are manmade and fixable, we can begin to take the necessary steps to create a more fair and just society.” (See Graph 3 below.)
GRAPH 3. Discussions of racial inequity gain more traction when framed as a human-made problem we can fix.

Percent of respondents who said messaging about racial health inequities being human-made and thus fixable was a major reason for their city to focus on the health of Black and Hispanic residents.

Bar graph showing that 57% of respondents said messaging about racial health inequities being human-made and thus fixable was a major reason for their city to focus on the health of Black and Hispanic residents. Support was even stronger among Democrats, Black residents, people under 50, and those with a college or postgrad education.

Persuasive messages

The audiences we polled found these to be the most convincing messages about why city leaders should invest in public health:

Fiscal responsibility & prevention

One reason the United States spends so much on healthcare is that we spend so little on preventing health problems before they start. We have one of the lowest life expectancies in the world and huge disparities across race, ethnicity, and income. We can reduce healthcare costs by investing in things like livable wages, healthy food access, and other things that will help prevent many health problems from occurring in the first place.

Quality of life

Everyone wants their city to be a healthy, thriving city. We don’t want to have to choose between clean air, good education, affordable housing, and access to quality food and we shouldn’t have to choose. We need all these things in order to have the best possible quality of life for our families and our neighbors, and everyone in the city needs and deserves them. The city must make investments to ensure we have them.

Further resources

Watch our presentation of this study at NACCHO360

Download PDF 122.5KB

Messaging guide

Download now Messaging guide

Download PDF 3.4MB

Full slide deck

Download now Full slide deck
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