Science and Art in Public Health: The Struggle to Turn Sows’ Ears into Silk Purses

1. Science and Art in Public Health:The Struggle to Turn Sows’ Ears into Silk Purses R. Elliott Churchill, MS, MACenters for Disease Control and Prevention Source: Teutsch SM, Churchill RE. Principles and Practice of Public Health Surveillance. New York: Oxford U Press, 1999.

2. Reporting unit of science: the fact Reporting unit of communications: the message

3. Where is the wisdom we have lost in knowledge? Where is the knowledge we have lost in information? T. S. Eliot Where is the information we have lost in data? CDC Editors

4. Data: The smallest units of description—may be words, numbers or other symbols Information: Data that have been interpreted to provide meaning and contest Message: Information conveyed in such a way as to instruct the intended audience of its importance or relevance to them

5. DATA INFORMATION MESSAGE 1,000 casesof measles 1,000 cases of measles (50% more than last year) Have all infants vaccinated for measles before their first birthday

6. DATA INFORMATION MESSAGE 1,000 casesof measles 1,000 cases of measles (50% more than last year) For every dollarspent on vaccines, $21 are saved in health-care costs

7. Communications is a process— not a product.

8. The Communications Loop **B acts on the basis of the message received A conveys information to B A and B agree on the message sent and received B receives A's information sendermessagereceiverchannelimpactevaluation B analyzes A's information B conveys to A the meaning and intent of A's information __________________________ ** Sometimes included in loop.

9. Communications • REACTIVE in a control setting • PROACTIVE in a prevention setting

10. Steps in a Successful Public HealthCommunications Campaign 1. We must develop rapport with our public.

11. Steps in a Successful Public HealthCommunications Campaign • We must develop rapport with our public. 2. We must be patient and persistent.

12. Steps in a Successful Public HealthCommunications Campaign • We must develop rapport with our public. • We must be patient and persistent. 3. We must repeat, modify, and update.

13. Steps in a Successful Public HealthCommunications Campaign • We must develop rapport with our public. • We must be patient and persistent. • We must repeat, modify, and update. • We must use all appropriate avenues.

14. Steps in a Successful Public HealthCommunications Campaign • We must develop rapport with our public. • We must be patient and persistent. • We must repeat, modify, and update. • We must use all appropriate avenues. • We must ultimately speak person-to-person.

15. 80000 70000 60000 50000 Calls to HIV/AIDS Hotline 40000 30000 20000 10000 0 1989 1990 1991 1992 Years Pattern of Use of CDC'sHIV/AIDS Telephone Hotline

16. 50,000,000 45,000,000 40,000,000 35,000,000 30,000,000 Calls to HIV/AIDS Hotline 25,000,000 20,000,000 15,000,000 10,000,000 5,000,000 0 1989 1990 1991 1992 1993 1994 Years Pattern of Use of CDC'sHIV/AIDS Telephone Hotline

17. Communications messages must • Reach people • Persuade them of the validity of the information • Convince them to take appropriate action

18. Public Health News 1. Information describing or confirming a new discovery 2. Information revising (or contradicting) an earlierhypothesis 3. Information connecting, for the first time, two or more already-available pieces of information 4. Any (or all) of #1-#3 above, crafted to providethe information to an audience not previouslyaddressed or one identified as now havingbeen reached in previous efforts

19. Planning a Communications Program 1. What do I want to say? (MESSAGE) 2. To whom do I want to say it? (AUDIENCE) 3. Through what means can I convey it most effectively? (CHANNEL) 4. When will it have the most advantageous effect? (TIMING) 5. What do I want to have happen as a result of my message?(IMPACT) 6. How will I assess the effect of my message? (EVALUATION) 7. How will I improve the message for its next presentation?(MODIFICATION)

20. Marketing Public Health Information • Use graphic displays • Focus message into one basic statement • Highlight and package the information • Release the information in a timely manner

21. FIGURE I. Notifiable disease report, comparison of 4-week totals ending Novem-ber 4, 1995, with historical data — United States CASES CURRENT4 WEEKS DISEASE DECREASE INCREASE 2,167 Hepatitis A 632 Hepatitis B Hepatitis, C/Non-A, Non-B 207 Legionellosis 44 107 Malaria 9 Measles, Total* Meningococcal Infections 194 Mumps 47 Pertussis 370 378 Rabies, Animal 6 Rubella 0.03125 0.0625 0.125 0.25 0.5 1 2 4 † Ratio (Log Scale) Beyond Historical Limits

22. SOCOSingle Overriding Communications Objective • What is new? • What works best? • Who is affected?

23. Checklist for Authors of Publications and Presentations,Centers for Disease Control and Prevention In one brief paragraph, please state the key point or objective of your submission for publication or presentation. This statement should resemblewhat you, the writer (speaker), would like to see as the lead paragraph ina newspaper story or in a broadcast news report about your submission. What are the three facts or statistics you would like the public to rememberas a result of reading or hearing about your report? 1.2.3. What audience or population segment would you like this report to reach? Primary Secondary What is the one message the audience needs to receive from this report? Who in your office will be available to answer questions posed by mediarepresentatives or by members of the reading/listening audience? Name _______________________ Telephone number _____________Date and times available __________________________

24. Channels of Communicationsfor Large Audiences • Publications • Electronic Applications • Broadcast and Print Media • Public Forums

25. Report Oral Written Inform Persuade Inform Persuade Audience Within the Health Care System Outside the Health Care System Friendly Neutral Hostile Friendly Neutral Hostile Form Purpose Direction Attitude

26. If the purpose is to inform,the standard formula for the scientific report is IMMRAD

27. If the purpose is to persuade,the standard formula for the scientific report is SOCO!! SOCO First Middle Last Most important things first . . . move to details

28. SOCOSingle Overriding Communication Objective SOCO Supporting Evidence SOCO Citation of Authority SOCO Elements of Persuasion SOCO

29. Figure 1. Architecture of Scientific Presentations To Inform To Persuade SOCO Intro-duction Supporting Evidence Audience’s Attention Span SOCO Case Studies M&M SOCO Etc. Results SOCO Discussion IMRAD SOCO Introduction, Materials and Methods, Results and Discussion Single Over-Riding Communication Objective

30. Where is the wisdom we have lost in knowledge? Where is the knowledge we have lost in information? T. S. Eliot Where is the information we have lost in data? CDC Editors