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vi CONTENTS
Part Four: Case Studies and Lessons from the Field 441
Glossary 523
References 539
Tables
1.1 Health Communication Definitions 8
1.2 Key Characteristics of Health Communication 11
1.3 What Health Communication Can and Cannot Do 30
3.1 A Comparative Overview of Ideas of Health and Illness 92
3.2 Examples of Disease-Specific Ideas of Illness 95
4.1 Comparing Cultural Norms and Values 106
4.2 Barriers to Effective Provider-Patient Communication:
Patient Factors 122
5.1 Internet and New Media Penetration 136
5.2 Health Communication in the Media Age: What Has
Changed and What Should Not Change 137
5.3 Public Relations Functions in Public Health and Health Care 140
5.4 Characteristics of Psychological Types Relevant to Public
Relations 141
5.5 Key Characteristics of Ethical Public Relations Programs 146
5.6 Dos and Don’ts of Media Relations 154
5.7 Mass Media Channels and Related Public Relations Tools 158
5.8 Most Common Uses of the Internet and New Media by
Health Organizations 159
5.9 Sample Factors in Public Perception and Use of New
Media–Specific Tools 161
7.1 Key Audiences of Professional Clinical Communications 221
7.2 Key Obstacles to Clinician Change 228
7.3 Communication Approaches and Tools and Their Effects:
Analysis of Thirty-Six Systematic Reviews 232
7.4 Key Communication Tools and Channels in Professional
Communications 236
8.1 Guidelines for Establishing and Preserving Long-Term
Relationships 249
8.2 Potential Drawbacks of Partnerships 253
8.3 Sample Partnership Success Factors 257
9.1 Key Elements of a Policy Brief 270
x TABLES, FIGURES, EXHIBITS, AND NUMBERED BOXES
Figures
1.1 The Health Communication Environment 22
1.2 The Health Communication Cycle 28
2.1 Health Communication Theory Is Influenced by Different
Fields and Families of Theories 35
2.2 Attributes of the Audience 37
2.3 Ideation Theory 47
2.4 Logic Model and Evaluation Design for a National Pro-
gram for Infant Mortality Prevention by the Office of
Minority Health, Department of Health and Human Services 65
3.1 Comparing Culture to an Iceberg 84
3.2 Health Outcomes as a Complex and Multidimensional
Construct 87
4.1 The Potential Impact of Interpersonal Communication
on Behavior: A Practical Example 110
6.1 Number of WPV Cases by Year in Nigeria 185
6.2 Proportion of Actual Noncompliance, High-Risk States,
May 2012 186
6.3 Preliminary Data, Sokoto VCMs 187
6.4 Main Reasons for Noncompliance 187
6.5 Moving from the Pre-During-Post Scenario to the
Preparedness-Readiness Response-Evaluation Constant
Cycle (PRRECC) 214
9.1 Sample Key Questions for Media Advocacy Planning 274
10.1 Health Communication Cycle 288
10.2 Key Steps of Health Communication Planning 290
TABLES, FIGURES, EXHIBITS, AND NUMBERED BOXES xi
Exhibits
10.1 Examples of Outcome Objectives for a Program on Pedi-
atric Asthma 302
11.1 Audience Segmentation Example 321
11.2 SWOT Analysis for the Caribbean Cervical Cancer Pre-
vention and Control Project 334
12.1 Sample Communication Objectives: Understanding the
Connection with Other Program Elements 359
Numbered Boxes
2.1 Diffusion of Innovation Theory: A Practical Example 38
2.2 The Added-Value of Theoretical Models in Evaluating
Mass Media Campaigns 41
2.3 Raising Awareness of Infant Mortality Disparities in San
Francisco 55
4.1 Personal Selling and Counseling Case Study 113
4.2 The Impact of Effective Provider-Patient Communica-
tions on Patient Outcomes: A Pediatric Nurse Practi-
tioner’s Perspective 117
4.3 Impact of Physician Attitudes on Patient Behavior:
A True Story 119
5.1 Johnson & Johnson’s Campaign for Nursing’s Future
Initiative 144
5.2 Using the Internet as a Key Public Relations Channel: The
Schepens Eye Research Institute 147
5.3 Sports for Health Equity: A Multifaceted National Program 162
5.4 Street Fighters of Public Health: Using Online Tools to
Create Networking Opportunities in Public Health 165
xii TABLES, FIGURES, EXHIBITS, AND NUMBERED BOXES
A s for all projects that are in the making for a long time, this second
edition is inspired by many people and is the fruit of years of thinking
and work for which I am indebted to many colleagues. First and foremost,
my heartfelt thanks go to my editors, Andy Pasternack and Seth Schwartz
of Jossey-Bass, for their invaluable help and expert guidance with the many
questions related to this project, as well as for their great support, cheers,
and much-appreciated commitment to seeing things through. I could not
have made it without them!
Thanks to Joshua Bernstein, Erin Driver, Rachel Gonzales, John Kowal-
czyk, Doris J. Laird, and C. J. Schumaker for their comments and feedback
on the second edition revision plan and David Anderson, Ellen Bonaguro,
Kathy Miller, and Mario Nacinovich for the invaluable suggestions that
have considerably contributed to the significance of this second edition.
Their helpful feedback was provided via Jossey-Bass’s peer review pro-
cess. My appreciation also goes to all professional friends and colleagues
who provided suggestions on early drafts of the first and this second
edition, or helped secure relevant case studies and interviews that are
published here. Among them are Doug Arbesfeld, Susan Blake, Joe Casey,
Lenore Cooney, Amanda Crowe, Gustavo Cruz, Chris Elias, Everold Hosein,
Marina Komarecki, Destin Laine, Rafael Obregon, Sherry Michelstein, Elil
Renganathan, and Lisa Weiss. Thank you also to the many authors of the
case studies published in this book for their generosity, time, and willingness
to contribute to this project. I am very grateful to Radhika Ramesh, a grad-
uate of the New York University master’s program in media, culture, and
communication, as well as a former student and a colleague, who worked as
a research and editorial assistant for this second edition, for her dedication
and attention to detail. Also, my thanks go to Ohemaa Boahemaa who
helped with the graphic design of many of the figures included in this book
and managed to fit this in her busy schedule. Thanks to Prarthana Shukla
who was a research assistant for the first edition and to other former public
health students who have contributed feedback, most notably Lawrence
Fung and Ellen Sowala, as well as other students and colleagues who used
the book’s first edition and provided suggestions for changes.
xviii ACKNOWLEDGMENTS
Thank you to colleagues from New York University and the CUNY
School of Public Health at Hunter College, to whom I owe my academic and
teaching experience: Marilyn Auerbach, Jo Ivey Boufford, Jessie Daniels,
Nicholas Freudenberg, Sally Guttmacher, Susan Klitzman, James Macinko,
and Kenneth Olden. Thanks also to the many other colleagues from either
of these two institutions, with whom I have had many conversations on
society, health, and communication or worked closely on different projects.
Most noticeably, May May Leung, for her professionalism, graciousness,
and sense of humor; Marcia Thomas and Lorna Thorpe, for our periodic
lunch meetings and their professional friendship; and Jack Caravanos, Paula
Gardner, Judith Gilbride, Barbara Glickstein, Lydia Isaac, Heidi Jones, Diana
Mason, Khursheed Navder, Stacey Plitcha, Lynn Roberts, Diana Romero,
Yumari Ruiz, Arlene Spark, and Christina Zarcadoolas. And a special
thank-you to Sally Guttmacher, who encouraged me to write this book at
the time of its first edition. I also want to acknowledge colleagues from
Columbia University, James Colgrove, Leah Hopper, Lisa Melsch, and
Marita Murrman, for the opportunity to start teaching in fall 2013 at the
Mailman School of Public Health and their support as I get started. I look
forward to our partnership.
There are many people to whom I owe my practical experience in health
communication and related fields. These include the colleagues, partners,
and clients with whom I have had the privilege to work over the years. I spent
endless days (and nights) with many of them brainstorming and learned a
great deal from all of them. The task of naming them all is quite daunting, so
please forgive me if I do not mention someone who greatly contributed to
my work or thinking over the years. A short list of colleagues with whom I
have had the pleasure to work just in the last decade includes Upal Basu Roy,
Ohemaa Bohaemaa, Patricia Buckley, Joe Casey, Paula Claycomb, Lenore
Cooney, Samantha Cranko, Blake Crawford, Amanda Crowe, Gustavo
Cruz, Isabel Estrada-Portales, Rina Gill, Matilde Gonzalez-Flores, Elena
Hoeppner, Everold Hosein, Neha Kapil, Scott Kennedy, John London,
Alka Mansukhani, LaJoy Mosby, Asiya Odugleh-Kolev, Lene Odum Jensen,
Denisse Ormaza, Radhika Ramesh, Akiko Sakaedani Petrovic, Barbara
Shapiro, Glenn Silver, Teresa (Tess) Stuart, Kate Tulenko, Marie-Noelle
Vieu, Beth Waters, Jennifer Weiss, Lisa Weiss, and Sabriya Williams. And
a special thank-you to past colleagues Daniel Berman and Frances Beves
for their friendship of many years, and our many brainstorms.
I also want to acknowledge colleagues from Cases in Public Health
Communication and Marketing, Journal of Communication in Healthcare,
and The Nation’s Health: Lorien Abroms, Samantha Ashton, Susan Blake,
ACKNOWLEDGMENTS xix
For many generations the gift of oratory has been in the blood of
the Phillips family. The founder of the family in America, the Rev.
George Phillips, first minister of Watertown, Mass., is noted in New
England annals for his eloquence. “The irrefragable doctor” he was
called by his hearers, we learn from the pedantic Mather, so able
was he in dispute, and such readiness had he on all occasions to
stand to his guns and to maintain any statement he had once made.
But there must have been another strain of blood in Wendell Phillips,
added to that in the veins of his ancestor George, for Mather goes
on to say that the earlier Puritan was “very averse unto disputation
until delivered thereto by extreme necessity.”
The son of George Phillips, of Watertown, was the Rev. Samuel
Phillips, first minister of Rowley, so distinguished a preacher that it
was said of his father: “He would have been beyond compare, if he
had not been the father of Samuel.” This is Mather’s epitaph on the
Rev. George Phillips.
The grandson of the first Phillips was another George, a minister
like his father and grandfather, who lived at Brookhaven, Long
Island. “A good man,” was the second Rev. George, but “thought to
be too much addicted to facetiousness and wit;” more dangerous
qualities in those Puritan times than nowadays, and suggesting,
again, the Phillips of our day.
The great-grandson of the first George Phillips, nephew to the
second, was Samuel Phillips, for sixty years minister of Andover, and
the father of John and Samuel Phillips, the founders of the Andover
and Exeter academies. Strictly orthodox was the Rev. Samuel
Phillips, as one may see from his sermons; and the religious tone
that he gave to the village of Andover has lasted to this day. His
many printed sermons are proof of the popularity of his public
speech, and the election sermon, at least, shows that he was not
afraid to deal with the living problems of the day.
His sons founded the two Phillips academies, John that at Exeter,
and the two together the academy at Andover. Samuel was as well a
liberal benefactor to the theological seminary at Andover. It would be
fair to say, that with one single exception, where there was perhaps
insanity, the family has been distinguished for public spirit, as well as
for eloquence. Two of the grandsons of the Rev. Samuel, Samuel
and William, were chosen lieutenant-governors of the
commonwealth of Massachusetts. Their second cousin, John Phillips,
was the first mayor of Boston. Their grandfathers had been brothers,
the one Samuel, the Andover minister, and the other John, a Boston
merchant. The mother of this second John was Margaret Wendell.
She was Wendell Phillips’s grandmother, and from her he had his
Christian name. His mother was of another Puritan family. Her
maiden name was Walley.
John Phillips, father of Wendell, graduated at Harvard College in
1788, and became a lawyer. He was afterward one of the trustees of
the college, and in 1809 was appointed a judge of common pleas. In
1822 Boston was made a city, and John Phillips was chosen the first
mayor. He died in the next year of a trouble of the heart. His sudden
death took place when Wendell and his brother George were both
scholars in the Boston Latin School—the oldest school in America. At
that time this school had recently been revived, and set in new
order, with great local reputation, under Mr. Benjamin Apthorp
Gould. It is said that the mayor, John Phillips, once came into the
school to examine it, and, almost of course, had offered to him the
seat of most dignity on the platform. This his little boys thought a
mistake in etiquette, considering that no one could be of rank as
high as the master. They did not hesitate then, more than in later
days, to express their disapprobation, and when their father met
them at table, told him they had been mortified to see him in that
chair. “Ah,” he said, “you were not more ashamed of me than I was
of you.”
But this anecdote must only be taken to show that Wendell
Phillips at eleven years was not afraid of his father, and was not
averse to criticising what he thought mistaken. He took even
distinguished rank at school, and another school anecdote shows
how early boys can judge correctly of each other’s ability, for it is
remembered that when he first spoke before the assembled school,
on Saturday, the first class—who sat by themselves, and thought
well of their own opinion—were not displeased. Charles Chauncey
Emerson, who was a crack scholar, one of the very highest in repute,
turned to George Stillman Hillard and said, “That boy will make an
orator.” The name of Charles Emerson will not be familiar to all your
readers, for he died young. But here he is still remembered by the
men of his time as the young man of most promise, who, in those
days, left Harvard College. They will not admit that his brother
Waldo Emerson has won any renown in the world, or rendered any
service which would not have come in the life of Charles, had it been
spared to this earth.
From this school, with a distinguished reputation among his
fellows, Wendell Phillips entered Harvard College in 1827. The
college was not then what it is now. Neither law nor divinity school
was large, and these were the only graduate schools at Cambridge.
The college proper, or the “seminary,” as President Quincy used to
call it, numbered about two hundred students, of whom the greater
part were from Massachusetts. A few southern lads, from distant
plantation life, struggled up into what, in those days of no railroads
and of no coast lines of steamers, was a foreign country. They were
generally favorites; there was no such discussion of slavery as to
make their position in the least uncomfortable, and, indeed, the
general drift of sentiment among the people around them was not in
sympathy with Abolitionists or abolitionism. Both these words, if
spoken at all in those days in New England, were generally spoken
with scorn. After a genial and affectionate administration, Dr. John
Thornton Kirkland resigned the presidency of the college in the year
1828. Wendell Phillips was then a freshman. To succeed Dr. Kirkland,
Josiah Quincy was appointed. He had won his reputation by steady
work in Congress, first as a Federalist, and afterward as a watchful
maintainer of northern rights. More lately he had approved himself
an admirable administrative officer as Mayor of the city of Boston—
the second chosen under its city charter. John Phillips, the father of
Wendell Phillips, had been his immediate successor in that duty. The
older Ware was professor of Divinity, Levi Hedge of Logic and
Metaphysics, Dr. J. S. Popkin of Greek, Dr. Sidney Willard of Hebrew,
John Farrar of Mathematics, Edward T. Channing of Rhetoric and
Oratory, and George Ticknor of the Modern Languages. A few of
these names will be remembered by general readers, though “’tis
sixty years since” and more, and I record them because I wish all
biographers would tell more than they are apt to do of the
circumstances under which the mental powers of their heroes were
trained.
Several of Phillips’s classmates survive, and one of them, Mr.
Francis Gold Appleton, a gentleman whose wide American
sympathies and sterling public spirit have endeared him to the whole
community in which he lives, has kindly given to me some personal
reminiscences of the young fellow’s life there. Thirteen of his school
companions entered college with him. Other Boston boys came from
the Round Hill school, and Exeter, so that in a class of sixty there
were at least twenty Boston boys. In a sense, therefore, Phillips was
not lonely there. But his classmates saw, or fancied they saw, that at
one time he was moody, and suffering from what they called
religious depression. They knew, even then—for boys know almost
everything of the abilities of their companions—that Phillips had
remarkable power in elocution. They chose him into the Porcellian
Club—which takes its name from the traditional roasting of a little
pig (Porcellus)—and of this club he became president. In other days
the Porcellians were thought to be specially Southern in their
proclivities, and this club used to rally almost all the Southern
students. It is therefore rather a queer incident in its history that
Wendell Phillips stands as a popular president. His college reputation
was that of an amiable and bright young man, with an especial gift
for oratory. He took his first degree in 1831—studied at the Law
School, then under Professor Greenleaf, and Judge Story—and took
the degree of Bachelor of Laws in 1833. He then went into a
lawyer’s office in Boston and entered at the bar in 1834. He opened
his modest office and waited for clients. But in those days, perhaps
in these days, even such a young man waits long. For myself I think
that the old dons of money or of business would rather give such
scraps of formal business as they have to some young stranger from
the country, who has no relatives in Boston, and whom nobody
knows there, than to confide private affairs to somebody they have
known from childhood, whose father, or uncle, or brother-in-law they
meet at the Saturday Club or the Wednesday Club. But Phillips did
not flinch from doing what anybody wanted him to do. It has been
remembered that in the illness of his brother he did the almost
mechanical work of the clerk of the Municipal Court. This means that
he was brought into personal relation with every criminal who was
brought up there for trial and sentence.
But the skies were thickening, and there was not any danger that
a young man of spirit would long lack a chance if he chose to take it.
It was in October, 1835, that “a mob of gentlemen of property and
standing” broke up a meeting of the Women’s Anti-Slavery Society of
Boston. Phillips was an eye witness of the indignities with which Mr.
Garrison was then treated. He loyally threw in his fortunes with
those of the Abolitionists; and, as it proved, his chance came at a
public meeting called at Faneuil Hall.
At this meeting the small and unpopular set of Abolitionists was in
a measure reinforced by persons who had not been identified with
them; for it was a meeting in the interests of free speech. Lovejoy
had been killed by a mob in Illinois, and the people of Boston were
called to their historic Town Hall to remonstrate. The moderator
selected was Jonathan Phillips, a relative of Wendell’s, and a man
deservedly of leading position in Boston. He was rich, enterprising
and wise. He was a leader in philanthropic organization. He was a
great friend of Dr. William Ellery Channing, who said of him once, “I
have had much more from Mr. Phillips than he ever had from me;”
this from a friend who was saying that Phillips had derived great
profit from Dr. Channing’s preaching. Benjamin F. Hallett, a
distinguished anti-Masonic leader, moved the resolutions. Hillard, a
young lawyer, sustained them, and the event of the day—on the
program—was a speech from Dr. Channing, whose reputation as a
man of letters and a leader in religious opinion was at its height, and
who was senior pastor of the most fashionable and influential church
in Boston. But the meeting was held in Faneuil Hall, which, by a
clause in the city charter, must be given for the use of any fifty
citizens who asked for it for a public purpose. Of course, at such a
meeting any citizen might be present. On this occasion the enemies
of the Abolitionists were on hand in force. When the fit moment
came for them to reply, James T. Austin, one of the political leaders
of the State, of Democratic antecedents, but now Attorney General
of the State, under the rule of the newly named Whig party, took the
floor against the resolutions proposed. It was clear enough that the
hall was well filled with marketmen and truckmen, and other
laboring men, who, in those days, all supposed that a “nigger” was
the most despicable creature in the world, excepting that an
“Abolitionist” was worse. Austin never spared invective, and he used
it on this occasion to denounce Lovejoy and those who abetted him.
I doubt if Phillips knew he was going to speak when he went to
the meeting. Indeed, it is quite sure, that Austin secured for him the
attention of the unfriendly assembly. But he had not spoken long
before he was sure of their audience.
“I thought this floor would yawn open before the gentleman and
swallow him up. I thought the pictured forms behind me here would
step from their frames in horror at his words.” These are Phillips’s
phrases, which in one form or another those men repeat who heard
him.
The meeting was pitilessly opposed to him and his. After a
fashion a vote was obtained for all the resolutions of sympathy. But
nobody cared whether they passed or not. Nobody heard Phillips
that day who did not know that there was an orator in the town who
could do much what he would with any audience.
He spared nobody and no thing in his attack. He never did till the
last hour of his life. And it is right to say, that the people he
opposed, denounced and satirized, replied with the sneer so often
lavished on such men, “He has a devil and is mad, why do you hear
him?” “Phillips’s crazy talk” is the phrase you constantly find as you
turn over private or published letters of those times. None the less
did people go to hear him, and, as I said, he could do with an
audience, friendly or unfriendly, much what he would. He seemed to
be—I think he was—quite careless about preparation. If he was
asked to speak for the cause, he spoke. He thus had, very soon, the
best possible training for his business. If I am right, it is the only
training worth much—namely, constant practice. I have never, in
forty years, varied from the opinion I expressed the night I first
heard him, that he was the best public speaker we had in New
England, as he was the best I had heard anywhere. He had the
double gift of language and of easy familiar gesture. He was
absolutely at his ease. He talked with his audience, played with
them, joked with them, reasoned with them, scolded them, ridiculed
them, soothed them, flattered them and compelled them, just as he
chose. He knew his audience through and through. He knew what
speech to make to them. He was never guilty of that ghastly folly
which insists on addressing to the audience of to-day the speech
which pleased some other audience a week ago.
I have no intention of writing his biography or an abridged history
of the time in which he was so active. I think he did not long remain
at the bar. I think it was as early as 1838 that he refused to take the
attorney’s oath of allegiance to the United States, without which he
could not practice in any United States Court. For the theory of the
extreme Abolitionists was that they must break up the Constitution
of the United States. But in practice very few of their adherents
followed them fully here, and many a man who cordially supported
their newspapers and their meetings, voted as he chose at the next
election, or when the time came went loyally into battle for the old
flag. Nay, of Phillips himself I remember this: I met him on the
Sunday before Fort Sumter was fired upon, and we walked half a
mile together. He had brought up town the last news from the
bulletin about the preparations of the South Carolina batteries. I had
been on the spot, on Sullivan’s Island, and pointed out some
inconsistency in the narrative, saying, what I thought then, that I
believed the whole thing would turn out to be mere Carolina bluster.
To which he replied with great cordiality, “I am sure I hope so;” and
from that moment to the end of the war I think no one enjoyed the
national successes more thoroughly than he.
Side by side with the Anti-Slavery excitement, which every one
connects with his name, was the growth of what may fairly enough
be called the “Lyceum Movement.” In the beginning this was thought
as pure a piece of philanthropy as the other. Almost every public
spirited man considered it his duty to have one or more “Lectures”
which he should deliver at the call of his neighbors when they had a
“Lyceum.” I have no doubt that Phillips’s early lecturing was a bit of
philanthropic effort of this sort. But as things went on, enterprising
committees began to raise the price of their tickets, to send for
distant lecturers and to pay them enough to make it worth their
while to come. Even college societies and the providers for
Commencement entertainments found it wise to pay a handsome
honorarium to their speakers, and I am afraid that the element of
philanthropy has long since disappeared from what is called the
“Lecture Platform.” Phillips had an ingenious way of uniting the
functions of a literary and of a political lecturer. No one was in more
demand than he for the regular work of the winter Lyceums. But it
would often happen that the timidity of a committee made them
pause before they would listen to his radicalism in a lecture. For
such agents he was quite ready. If people had scruples they must
pay for them. His program was: “For a literary lecture without
politics, $100 and my expenses.” “For a political lecture, nothing, and
I pay my fares.”
He used to tell a story of his arrival at a western city where the
committee were divided, four to four, on the question whether they
would hear his lecture on the “Lost Arts” or a political speech.
Perhaps he would determine between them.
“Let us have both,” said Phillips. To which they eagerly assented.
So he delivered the “Lost Arts” first, innocent as a new rosebud of
any political bias. Then a recess was given to the audience, and all
who wished to go might go. But of course, after that beginning, no
one went. And so Phillips had another hour, and an audience for as
many heresies as he chose to utter.
It ought to be remembered that as soon as he had any leisure
from his work as an Anti-Slavery agitator, he gave his time and
power, in the same open-handed way, to the temperance cause. In
all these late years the friends of temperance reform have had no
public man more ready to take up their work for them than he.
The country has shown that it can duly honor such an agitator,
whose own conscience was always clear, even though no man could
agree with him in what he called opinions. The truth is, they were as
often impulses as convictions. But in the matter of slavery, of
temperance, and of charity, he had settled convictions, and lived on
them without flinching. He was utterly without thought of self.
The public has never known nor said enough of Mr. Phillips’s
private charities, and I can not wonder at it. It is impossible for any
one to speak fitly of them this side of the recording angel.
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