Framing Public Health Issues

Aug 30, 2012, 11:30 AM, Posted by

This Q&A originally appeared on the RWJF New Public Health Blog.

Environmental issues are consistently a topic of hot debate. A new study reveals that how we talk about these issues could have a big impact on whether people feel compelled to act on them. According to new research led by two awardees of the Robert Wood Johnson Foundation Investigator Awards in Health Policy Research, Matthew C. Nisbet, PhD, MS, and Edward W. Maibach, PhD, MPH, talking about the environmental consequences of climate change may not convince the unconvinced—while talking about the public health consequences might have a better chance.

As the American University and George Mason University professors write in a newly published study in the journal Climatic Change Letters, “Results show that across audience segments, the public health focus was the most likely to elicit emotional reactions consistent with support for climate change mitigation and adaptation.”  The study was co-authored with Teresa Myers and Anthony Leiserowitz.

We caught up with Matthew Nisbet to get his take on the latest findings, and how the public health field can do a better job of framing issues in a way that motivates action.

New Public Health: What is message framing?

Matthew Nisbet: When you frame something as a communicator or as a journalist or as an expert, what you do is you emphasize one dimension of a complex issue over another, calling attention to certain considerations and certain arguments more so than other arguments. In the process, what you do is you communicate why an issue may or may not be a problem, who or what is responsible for that problem and then what should be done. One of the common misunderstandings about framing is that there can be something such as unframed information. Every act of communication, whether intentional or not, involves some type of framing.

New Public Health: Why is framing so important in communicating about public health issues?

Nisbet: Every public health challenge is incredibly complex and also has a lot of uncertainty about the causes and the best approaches to solutions. You can either communicate without really thinking purposely about how you’re going to frame that issue or you can actually turn to research to understand the best way to structure your communication around that problem.

When you use research to inform your communication, you need to think about who are the multiple stakeholders and publics involved, and what are their personal experiences? What are their political identities? What are the information sources that they draw upon in order to understand that complex issue? What kinds of frames of reference are going to enable those different publics to make effective judgments and decisions?

On an issue like climate change, the traditional framing of the issue has been that this is a major environmental problem that poses a range of environmental risks and if we take action, then we’ll be able to protect the environment and benefit the environment. But, of course, there are other ways to define the problem of climate change that will lead to different attributions and interpretations of relevance on the part of the public and others.

New Public Health: And what has your research found about the most effective way to frame environmental issues?

Nisbet: Well, the traditional frame of reference that has been most commonly found in media portrayals has been either that climate change is a looming environmental catastrophe and a major threat or—on the other side—that the science is uncertain and cannot yet justify action on the issue, especially in the face of potentially major economic costs.

So those are still the two dominant frames of reference. In that context, it’s difficult for people outside of the extremes of that spectrum to really view the issue of climate change as personally important or as a major political priority. What we’ve been looking at in our research is what happens when you change the frame of reference from being an environmental problem or an issue that’s really defined by uncertainty to being an issue that is really about public health. The public health frame focuses on the connections between climate change and things like fatalities and injuries from extreme weather events, the connections to increased incidence and severity of allergies and respiratory problems, the linkage to an increased incidence of infectious disease and vulnerability to things like extreme heat.

And when you do that, what you do is you start to shift the focus of the problem away from remote areas such as polar regions to local proximate areas such as cities and suburbs. You also change the focus of who or what climate change effects away from symbolic species like polar bears or penguins and start to put a human face on the issue by focusing on people like the elderly, those from low-income backgrounds and children, who are the most susceptible to the health risks of climate change.

New Public Health: How can we apply this research or some of the overall takeaways in how we communicate about different kinds of issues?

Nisbet: The research that we’re doing on climate change then adds to our understanding about how to effectively communicate about other major social problems. One of those major principles is that there’s no single “public”—on any complex problem there are a variety of publics that share common identities, information sources and different individuals or types of experts that they trust and look to for information. In trying to effectively communicate about complex problems, one of the first things you have to understand is how the relevant publics or audiences are likely to filter how they view that topic? And then based on that information you can come to understand what are the available frames of reference that are out there in public discourse and media coverage, and how do they resonate or in some cases conflict with the social identify or values of those different groups.

New Public Health: What’s another example of an issue that could use some reframing?

Nisbet: A good parallel issue to think about is the issue of poverty which, like climate change, has multiple societal causes.  In addition, action requires us to rethink government, societal priorities, and even the organization of our economy and what it means in terms of individual responsibility. For a long time, effectively communicating about poverty has been hindered by racial biases and racial stereotypes and also deep American values that prioritize individualism.

Though well intentioned, advocates and journalists have not necessarily helped break through these perceptual barriers.  In fact, traditional portrayals may serve to reinforce these stereotypes. The focus in a lot of media portrayals has been on the plight of a single individual or family struggling economically. But when you frame poverty in terms of an episodic story about individuals or families, you then emphasize that responsibility for the rests with the individual.

Compounding the problem, the face of poverty in the media is disproportionately black, skewing audiences’ statistical sense of the racial make up of the working reports.  Whites watching the news may interpret the problem of poverty as an individual problem that has to do with an unstable family background or laziness, stereotypes associated with race. Based on that interpretation of the cause, the solutions would be “welfare to work” government programs that focus on individual incentives to work, rather than correcting systematic problems in our economy or changing the practices of employers.

On the other hand, if you tell stories about poverty that focus on more systemic causes—the way we organize our economy, the history of government programs, the role of corporations and other businesses within a state or a region and their own responsibility in offering people quality paying jobs and benefits—then when people reach judgments and attributions about what is to blame for poverty and what should be done, they focus on systemic solutions.

In sum, it’s very easy to overlook poverty as a problem if all of your focus and all of your attributions are on individual causes and not on institutional causes or community level factors, but until recently even advocates and well meaning journalists have promoted this focus.

New Public Health: Something we hear often from those who communicate about public health is a struggle to find the face of public health or to tell it as a compelling story like you’re talking about with poverty. It’s interesting to hear that that kind of individual story-telling can maybe skew the frame in a way that wouldn’t be helpful to the cause because the solutions are not at the individual level, the solutions are bigger than that.

Nisbet: Right. So I think one of the important things for these types of public health type challenges is to effectively communicate about moral responsibility and particularly the responsibility to those who are most vulnerable. We need to talk about why that type of moral responsibility is in line with community values and the need to live and work in a strong community. In other words, by protecting those who are most vulnerable, the entire community benefits.

Across the political spectrum, we stopped focusing on effective ways to communicate about the value of community and what a strong community means and the role that policy and different types of policy approaches can play in building and protecting prosperous communities.

Framing is also often wrongly interpreted and applied as one-way persuasion and communication process. What we actually have to do is we have to invest in new structures where people can come together from diverse backgrounds and communicate about an issue within a context or frame of reference where people recognize their shared common interests and goals. We need to think about new forms of public meetings, new forms of dialogue and new forms of media, especially at the regional or community level.

It used to be that newspapers played this role where everyone in the community read the same newspaper and they had a common starting point for understanding the problems within a community with new organizations providing an independent source of accountability and explanatory journalism. We’re missing those things now.

Crafting, testing, and implementing effective public health messages is only a small part of the puzzle, and it is easy to focus on this challenge, rather than the big picture.  In tandem with designing campaigns, we need to rebuild America’s civic, media, and communication infrastructure, especially at the regional and local level.  The weakness of our current infrastructure erodes our capacity to solve these public health challenges.

If we fail to rebuild our civic infrastructure, then no matter how effectively we might frame an issue or how many resources we put into it, people are not going to be able to come together to cooperate around common goals.

New Public Health: Do you think there are other areas where this idea of bringing the public health frame to an issue that people might not think of as public health? Do you think that might be effective in other areas?

Nisbet: Yes, and a great example is on the issue of gun control. For any frame, there are frame devices. These are catch phrases, metaphors that instantly trigger an underlying train of thought about the issue. When we refer to gun control as gun control, immediately what you trigger is that you’re defining it as an issue about individual rights. Should the government have the ability to control an individual’s ownership of guns? But if you shift that issue as the Clinton administration did in the ‘90s to not talking about gun control but talking about gun safety, immediately what you’re communicating is not an issue about personal rights but rather an issue about public health. It’s about protecting and defending innocent individuals in communities and making communities safer. You start to shift the issue from this mental box of rights to this new mental box about public health and protecting the innocent.

Read a related article on framing peak petroleum issues.

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.