Meeting Report
STRENGTHS, WEAKNESSES, OPPORTUNITIES and OBSTACLES
11-12 January 2005
Summary Abstract
This meeting was convened to explore what role, if any, professional journals, as principal communication resources of many national medical, nursing, and pharmacy associations, could play in a global/local campaign aimed at enhancing patient health competencies. To this end a range of national medical, nursing and pharmacist journal editors from twelve European countries was gathered in Helsinki on the occasion of the WHO European Ministerial Conference on Mental Health. Journal strengths identified included perceived trustworthiness, editorial independence, and reliability as an evidence-based source. Weaknesses noted included proprietary nature of some journals, inaccessible technical language, intra-professional focus, healthcare rather than health focus, and the lack of input from patient users. Many opportunities for enhancing journal involvement were discussed including reframing ways of reporting on different illnesses (eg combating stigma related to mental health), creating platforms for patient voices, developing professional media advocacy capacities, networking, and opportunistic action.
Based upon these discussions, participants expressed interest in further exploring the development of an inter-professional journal editors' network. This report, with its requests for case study and/or comments from different participants, is a first step towards the development of such a network.
Background – Rationale for Meeting[1]
On the occasion of the first World Health Professional Alliance (WHPA)[2] global symposium on the future of healthcare held in Geneva in May 2004, a focus group, consisting of leaders from nursing, medicine, pharmacy and patient associations, was convened to discuss issues related to "the health competent patient."[3] The group affirmed the fact that the future of health and healthcare was indeed in the hands of "patients" and that in fact a key determinant and measure of effective health system performance relates to the ability to generate health competencies in their users. Acknowledging current global health communication trends (see box 1), the WHPA has been working with World Health Communication Associates (WHCA) on identifying ways to support health competency development. This process has led to the elaboration of a global Ask? & Act! It's your health! campaign concept and strategy. This campaign concept focuses on enhancing demand for reliable, accessible and timely health information, and the capacity of health professionals and systems to respond effectively.
This meeting was convened to explore what role, if any, professional journals, as principal communication resources of many national medical, nursing, and pharmacy associations, could play in such a campaign. To this end a range of national medical, nursing and pharmacist journal editors from twelve European countries was gathered in Helsinki on the occasion of the WHO European Ministerial Conference on Mental Health.[4]
- The growing importance of communication as a determinant of health;
- Increasingly competitive health information marketplaces, often dominated by hazard merchants;
- Weakening presence of independent, evidence-based, ethical health information; and
- Widening information gaps between and within countries with inequities in information/communication access closely paralleling and reinforcing social gradient differentials in disease and mortality patterns.
The ground rules
The group adopted Chatham House rules, a UK convention, which state that everything discussed can be made public but nothing can be attributed without permission. Secondly, the meeting acknowledged that the agenda was exploratory and that more questions than answers were likely to emerge. Order would come from this chaos as discussions would inform a longer process which would continue "virtually", after this first meeting, with internet-based communications. Thirdly, it was also noted that several people would be coming in and out of the meeting during the course of the two days, because their involvement in the WHO Ministerial Conference meant they could only come into the Journal Editors' Workshop for a limited period of time. Finally, acknowledging the need for continuous connectivity in communications, mobile phones were put to silent but not turned off.
Medical, nursing and pharmacy editors were represented, together with a couple of health journals whose target audience was the general public. Participants had come to their current work as medical editors through a variety of routes. Some considered themselves to be primarily journalists, others primarily health professionals. The readership of the journals varied greatly - some had very large readership, others more restricted; some journals were aimed exclusively at professional members of organisations and were by subscription only, with the focus entirely on scientific research; others tried to achieve a balance between science and health issues and were more widely read - it was pointed out that although the main readership of one journal was nurses, the journals were frequently passed on to other family members, who were not health professionals, and it was also read by politicians as a source of information. They therefore felt they were part of public discussion.
Several of the participants were already members of wider networks (European Nursing Editors organisation, Nordic network, Vancouver Group – network of medical journalists, World Association of Medical Editors - supporting medical editors) and those participants said they greatly appreciated the sharing of ideas and experiences that belonging to such networks brought.
Not all the participants were medical editors - there were also representatives of NGOs and the WHO Healthy Cities network, whose input was related to the specific issue of what role the media could play in the context of the issue of Mental Health, and several of whom shared stories of their own successful experiences of working with the media which could serve as ideas and models of good practice.
In an effort to avoid the "serial death" too often associated with many meeting proceedings, and to stimulate discussion, this report has elected to collect comments and organise them under a SWOT format.
Strengths
Trustworthiness of source It was widely agreed that the main strength of the journals was the fact that they were considered a "trustworthy" source of information. Public opinion polls repeatedly show that scientists and NGOs are considered more trustworthy than government and industry sources. This trustworthiness stems from editorial independence (free from political and economic influence) and evidence-based reporting.
Independence Most of the participants had, and cherished, complete editorial independence and several stated openly that they felt their allegiance lay with their readership rather than the organisations they represented. Different journals had different ways of achieving and maintaining their independence, including legal registration of the journal as an independent entity, multiple ownership to avoid any one party having a greater influence, having members on the editorial board who have no links with the organisation, maintaining financial independence (by subscription, other activities, etc), having a separate department to deal with advertising, peer review of potential articles, etc. This independence allowed the journals to avoid becoming merely a mouthpiece for an organisation and was also reflected in the statement of several participants that they felt their journal was a "platform" for their readers - to allow them to debate issues that they felt were relevant, print both sides of an argument, and raise issues of concern.
Evidence-based The point was also made that whereas the daily newspapers have short deadlines and often have little time to check out all the facts and information for an article, the journals, with their longer peer reviewed "pipelines", do have the time to establish the reliability of their facts. In fact, it was felt that it was a "duty", or "responsibility", of the journals to maintain a high standard of reliability, and this in turn enhanced their importance as sources for others.
Reliable source Because of the nature of "scientific" writing, which aims to be evidence-based or knowledge-based rather than opinion, the journals are well-placed to act as reliable source material for professionals and the lay press and can play a leading role in replacing some of the pervasive myths about an issue with facts. One of the best ways for this to be carried out is through press releases, and one editor actually stated that he only accepted articles for publishing if they could be turned into a press release. Other journals made copies of their articles available on their website. While some examples were given of topics that had been covered by journals which were later covered in daily newspapers, this was identified as a major area of opportunity (see discussion below). This depended to some extent on the journals, and their readers, taking responsibility for taking their messages forward. Journals as reliable sources of information for decision-makers could help shape political agendas (see Case Study/Comments 1, for example).
This journal is regularly read by politicians as a source of information, as well as by other lay persons - relatives and friends of the nurses for whom the journal is produced. This journal had published a piece of research that showed strong links between poverty and poor health, which it felt deserved wider attention. It therefore produced a news item for the national media, hence putting the question of the link between poverty and health into the public arena. The topic was eventually debated in Parliament.
Intra-professional communication platforms The professional journals have well-defined target audiences, usually the members of their host associations. These readers tend to have long-term relationships with the journals, often over the life span of their professional careers. Readers may well depend on journals to keep them current and be a "one-stop-shop" for relevant professional information. Journals also serve as important intra-professional communication platforms through letters to editors, opinion editorials, job advertisements, conference and events announcements and book launches.
Opinion research Another strength of the journals identified was their ability to gauge the reaction and opinions of their readers. Several of the journals carried out regular surveys amongst their readers and allowed the feedback from these surveys to inform future editions.
The Association of Finnish Pharmacies produces two journals - Apteekkari is aimed at the Association's members, and they also produce a journal which is distributed free of charge to customers in pharmacies (at the point of sale, as it were). This latter has a distribution of just under a million copies, and receives thousands of letters and emails a week by way of feedback from its readers (who are members of the general public). This feedback is then incorporated into the next issue. This constant feedback enables the journal to monitor the views of the general public, and tailor its contents accordingly.
Every journal for itself! Journals too often reflect the "silo" mentality of their parent associations, with little inter-professional or cross-border cooperation, alliance building or networking. Some participants were members of wider networks and appreciated the opportunities to share ideas and experiences. However, there was also some concern expressed about giving too much away to "the competition" within cooperative ventures.
Reluctance to share information Although the professional journals have access to a lot of information, critical review processes, evidence-based and ethical materials, it was felt this was greatly under-utilised. Some of the journals produced press releases when they felt information should be distributed to a wider audience but at least one editor stated that he had little faith in the process. His experience had been that pre-publication articles that his journal had made available on their website had often been utilised by other journalists without the journal being credited as the source. This unethical behaviour, it was noted, undermines the trustworthiness of the information. Without this information being made available, however, news reports may well be based on less reliable information.
Inaccessible technical language Written for their own professional technical audiences, much of the reporting is largely incomprehensible to the lay reader (which includes politicians and other decision-makers, and members of the non-professional press). Additionally, non-professional journalists may misunderstand the scientific articles and convey the wrong message to the general public.
Focus on healthcare, not health Another weakness identified was the healthcare focus of many of the journals, and the fact that few of the readers are willing (or have the competencies) to take forward public health "messages" (eg to urge politicians to take action). It was felt that there was limited effort to engage readers in public health advocacy initiatives.
Minimal patient voice A general criticism of all media (including professional journals) was the absence of representation from those affected by the issues (both users of the healthcare system and their relatives and carers).
Reactive not proactive Some editors felt that their agenda was driven by what articles were sent in for consideration for inclusion in the journal, which was itself dependent upon what people wanted to write about. There was an element of "putting the journal together" from other people's material rather than proactively setting the agenda for what to publish.
A wide variety of proactive campaign, networking, and advocacy opportunities for editors and their journals were identified. Several examples of effective media actions were described by participants. Although the examples used came from the sphere of Mental Health, most of them would be equally applicable to other public health issues.
Research over the past ten years has shown that "health competent" people are more independent, better able to co-manage their health and healthcare, cost less to health systems and are more likely to actively engage in shaping effective health policies. Ask? & Act! - It's your health! is a global/local campaign aimed at improving people's health competencies and health system performance through the strengthening of health information delivery and utilization. To accomplish this, the campaign aims to promote the value of public "engagement" for Health, stimulate a broad demand for health information and support the capacity of health information mediators, eg health professionals, media, policy spokespeople, NGO advocates, and private sector advertisers, to respond effectively. (See Annex 1)
Combating stigma One of the main priorities for action within the sphere of Mental Health is combating stigma. This applied equally to members of the health professions as well as the wider arena, as a nurse with mental health problems was just as likely to encounter discrimination and stigma at work as anyone else. Balanced reporting, substituting facts for opinion, and inclusion of the voice of people who had experienced mental health problems were regarded as the main ways in which the media (of all sorts) could help to counter stigma and discrimination. The journals could play a leading role here by providing a platform for professionals to discuss their own experiences of stigma and discrimination, and also recovery. A general criticism of all media was the absence of representation from those affected by the issues (both users of the healthcare system and their relatives and carers) - the professional journals could address this issue amongst their readers perhaps more easily than other media could.
The Scottish SeeMe campaign to reduce stigma around mental health issues is being organised by a coalition of five organisations, so that the messages are not seen as coming from "the Government", although it is funded by the Scottish Executive and forms part of a larger political initiative to improve mental health and wellbeing by setting an inclusive agenda around mental health issues and to improve the quality of life of those affected by mental illness.
Although the main target of the SeeMe campaign is the general public, the media was the chosen means of getting the message over, through a proactive strategy to improve how the media report mental health issues and to stop them linking mental illness and violence. Action/activities include a "Mind Your Language" box to discourage the use of certain terminology, a media watch group to monitor media reporting, the production of a set of guidelines for journalists on reporting mental health issues, and building up a resource bank of people who are willing to talk to the media about their experiences of stigma. Surveys of public attitudes towards people with mental health problems are carried out every two years and show a dramatic fall in the percentage of people who think people suffering from mental illness are dangerous since the start of the campaign.
Creating platforms for patient voices One of the main reasons given by the media for not including the opinions and viewpoints of those affected by an issue was that they could not find anyone who wanted to talk to journalists. Similarly, the main reason those affected did not talk to journalists was that they did not know who to contact, although there was also concern about being misrepresented or dealt with insensitively by the media. The issue of access to individuals who were prepared to tell their stories, and issues of publishing photographs, privacy, consent, and respect, were discussed at great length. Most of the NGOs had mechanisms in place for putting the media into contact with people who could tell their own personal stories, and some of the NGOs also acted as a forum for representing the patients.
The Geneva Initiative on Psychiatry is involved in advocacy work on behalf of people with mental health problems, as well as training, anti-stigma campaigns, etc. It produces a journal on mental health reforms aimed mainly at mental health professionals and users' collectives in the countries of the former USSR.
GIP in Sofia has been running a project in collaboration with journalists in Bulgaria - "Media for Mental Health". The aim of the project is to create a positive attitude towards mentally ill people in Bulgaria by attracting journalists as allies for the mental health "cause". Based on the hypothesis that an effective way of achieving this aim would be the use of personal experience to build relationships with mental health service users themselves, the project consisted of several interactive educational modules during which all participants visited a mental health service/institution. This gave journalists the opportunity to talk to mental health service users and professionals, to touch upon a concrete human story and learn about the difficulties and problems of both service users and providers. As a result, the journalists became more competent to write about mental health issues and also became useful advocates for reform.
One outcome of the project has been that the mental health theme has become "fashionable" and almost all media have included it in their programs. More importantly, the journalists trained during the project have remained reliable partners ever since.
Develop professional advocacy capacity It was also felt that the journals could support professionals - the phrase used was "empowering" professionals - amongst other things by reporting good practice and providing a forum for the sharing of ideas and experience, so that they did not feel that they were the only person using a particular approach, for example. Several of the nursing editors also stated that their journals had included booklets and diagnostic tests which their readers could actually use as tools, which had been very successful with their readers, and the provision of tools that professionals could use is one of the most basic ways in which journals could assist a public health campaign (eg for early detection of people who are at risk of committing suicide). NGOs often produce resources for professionals as well as patients, and journals could play a part in letting their readership know what materials are available.
The Global Alliance of Mental Illness Advocacy Networks - Europe brings together national patient organizations from all over Europe and covers the whole spectrum of mental health problems. The main foci to its work are: combating stigma and discrimination; an information initiative; "grass-roots" research; representation of patients' perspectives; and shifting the focus to mental health rather than mental illness.
GAMIAN already has links with the Standing Committees of health professionals and urged greater links and cooperation between all the various sectors, including the media. The view was expressed that the media had a key role to play in balanced and sensitive reporting of mental health issues to help combat stigma and discrimination; provision of information to health professionals about training and resources available (GAMIAN itself produces a wealth of resources for patients (and their carers and relatives) and professionals); the provision of education and knowledge around mental health issues, including the publication of the sort of research data produced by GAMIAN, which was not covered elsewhere; allowing the voices of patients to be heard; and promoting good health as a resource in which to invest.
Media advocacy We have already seen that the provision of reliable, ethical and evidence-based information is a key function of the professional journals, but that it is not always taken forward as strongly as it could be. However, when it is given the high profile it deserves and taken to a wider audience, it can have a big impact because of the high standing that the professional journals have as a source. Nevertheless, the criticism was made that sometimes academic research is too far removed from "real patients", as well as the possibility that a "technical" article for a professional journal may not be accessible to non-professional readers.
One way to resolve such dilemmas is training and there were good examples of training schemes involving or run by the media given at the meeting. The first example was that of the Croatian Medical Journal which had been involved in training and education from its inception (see Case Study/Comments 7). Another example involved a NGO agreeing to give money to journals for them to train Mental Health service users to act as advocates. Other NGOs also provide training courses (including working with the media) and materials for member organisations, and provide training for journalists to work more closely with service users and their representatives. The provision of and/or involvement in training (of all descriptions) is an area of great possibility.
The Croatian Medical Journal has been involved in training since its inception shortly after the cessation of the war with Serbia. A great deal of data on post-traumatic stress disorder and other mental health problems had been generated during and after the war, but no one really knew how to report the information. This was one of the deciding factors in the journal's focus on training in scientific reporting: it was responsible for the inclusion of a module on "scientific writing" in the national undergraduate curriculum for medical students. The journal sees itself as having a leading role in attempting to "bridge the gap" of communicating science to the wider public and it has hired a PR person to help to get the idea of evidence-based medicine over to the general public. The journal is currently actively engaged in training members of the non-professional press to understand scientific reporting, including concepts such as scientific methodology, evidence, etc, so that the journalists will be able to understand articles that have been written for a more technical scientific audience and distil the message accurately for the general public.
Networking Many of the NGOs had worked hard to develop strong links with journalists and felt that these "partnerships" had worked very well. Networks which brought together the media with other groups (patients and their representatives, health professionals, etc) also worked very well, and this is one of the most promising areas for improving communication capacities. All those participants who were engaged in a network appreciated the support and sharing and felt they benefited from being involved with others. It was also felt that collectively a network was more than just the sum of its parts. Additionally, it was felt that the media had a key role to play in any campaign on a public health issue.
Networking is an instrument to promote innovation, commitment to change, international cooperation, joint development, collective learning, capacity building, alliance building, experience sharing, information exchange or any combination of these. Effective links between local, regional and global networks can help public health advocates at all levels to track and address health trends, develop and disseminate common health messages and themes, whilst at the same time celebrating and nurturing cultural differences. The WHO Healthy Cities network is a good example of what can be achieved through successful networking (see Annex 2). Within the network, agreement has been reached on various key principles:
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Commitment to Health for All and Local Agenda 21
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Political decision-making
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Joint action between sectors
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Active community participation
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Innovation
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Healthy public policy
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International action and solidarity
The overall goals of the network include action to address the determinants of health and the principles of health for all; integrate and promote European and global public health priorities; put health on the social and political agendas of participating cities; and promote good governance and partnership-based planning for health. The Baltic Healthy Cities Collaborating Centre plays a key role in this process by supplying expert services, supporting the cities in their work, planning and implementing training, maintaining an information system, forming networks, coordinating projects and informing clients and media of activities and results. In order to gauge the success of any campaign, you have to have activities with measurable results and the Healthy Cities network engages in regular surveys to evaluate its projects, including the question of cost effectiveness.
Reframing Another key area of potential is that of "reframing" and the meeting heard examples of successful reframing around mental health issues by the Finnish Government (see Case Study/Comments 9). This included "reframing" the focus of discussion. When talking about "Mental Health", the actual emphasis is on the lack of mental health (ie "Mental Illness") rather than on mental health. The focus could be shifted onto strategies for avoiding mental health problems and actively promoting mental wellbeing, with journals including (for example) articles on lifestyle, or dealing with stress at work. As some of the organisations also have a role as Trades Union for their members, the promotion of stress reduction at work and changes in working conditions to promote optimum health would fall within their remit.
The Finnish Government has focused on changing people's perception of mental health, which has (as elsewhere) always had the connotation of mental illness. There were three main messages which the government was trying to promote. The first was the positive aspects of mental health - to remove the focus on mental illness and see mental health not just in terms of absence of illness, but also in terms of the positive attributes of mental wellbeing (including concepts such as "happiness"). This reframing was successful and Finland has seen a 30% reduction in suicides (although it still has a high suicide rate) - and even a decrease in illnesses such as Schizophrenia. There has also been an increase in the number of people visiting their doctor for help with mental health problems, which indicates that more people are seeking professional help.
The second message is that mental health is everyone's business, not just those people with mental health problems. This has included the wider social contexts of employment, housing, education, benefits, etc - sectors not traditionally seen as having a role to play in mental health. The message here is that everyone and every aspect of life has a role to play in the maintenance and improvement of mental health. Evening classes have also been set up to promote mental health "literacy" amongst the population, to break the association of mental illness and violence and provide "First Aid" for mental health problems.
The third message is "No Health Without Mental Health", which aims to include mental health within the description of normal "good health". The care of people with mental health problems is being integrated into "normal" hospitals, rather than kept apart in separate institutions: integrating mental healthcare into the primary healthcare system in this way helps to reduce stigma.
As part of the campaign the Finnish Government provided mental health training for health professionals and a nationwide campaign for the prevention of suicide saw (for example) training in recognition of the warning symptoms that someone was at risk. The media played a prominent role in these campaigns.
The social costs of not taking mental health issues seriously, and not implementing measures to prevent mental illness developing, were also spelled out. The lesson of the tobacco campaign is that if an issue can be reframed to ask the right questions, people will sit up and take it seriously. Persuading the government that mental wellbeing has a positive social effect in areas such as unemployment, for example, may receive a more positive political response.
When opportunity knocks? Much of the success of communication campaigns relates to externalities (outside events) which provide "teachable moments": when, because of a crisis, public outcry, newsworthy or other external event, our issue moves onto the centre of the stage. These are moments not to miss. Be ready to respond with well packaged information on both the problem and solution and know how to advocate through the media!
The role of journals as reliable sources of information was particularly important at times of crisis. Example was given of the recent high-profile killings in Sweden by people suffering from psychoses. "Sensationalist" coverage of these slayings had the effect of giving a negative and unbalanced view of an issue. The medical journals are in a good position to provide more balanced and positive information about issues that are of importance, as opposed to "knee-jerk" reactions to big stories of the moment.
Various obstacles were identified, including conflict of interest, reluctance, balance, economic considerations, and lack of time.
Role definition Participants had come to their current work as medical editors through a variety of routes. Some considered themselves to be primarily journalists, others primarily health professionals, whilst a few felt they were somewhere between the two, or in neither category. It was felt that identity allegiance can cause conflicts and shape editorial behaviours.
Reporters or participants? For some journals, the prime function was the reporting of academic research and it was not clear how these journals could become actively engaged in campaigning. Others felt it was not their role to become actively engaged in campaigning, or that this decision was out of their hands. One journal felt that its agenda was largely set by the Association and although it could say it reported on a campaign, it could not say it was actively involved.
Conflict of interest It was suggested that sometimes a campaign might conflict with the interests of the members of the organisation (who are also the readers of the journals). Conflicts of interest could also arise around the issue of advertising and sponsorship. Most journals had had experience of people sending them "articles" for publication which were, in fact, propaganda. This was usually reliably dealt with through the critical review process, although one journal commissioned all articles itself and would not accept unsolicited material. Some journals actively separated the advertising department from the editorial process, to avoid any potential conflicts, and at least one had a clear written statement on conflict of interest. However, it was accepted that on occasions an article might have to be accepted from a commercial concern, where that concern was uniquely qualified to write about something. In those circumstances, it was up to the journal to make the right decision and also to make it clear to the readers that there was a conflict of interest, and explain why. In an effort to retain a "neutral" position of balance, some editors felt that if they carried an article promoting one viewpoint in a campaign, they would also feel obliged to offer the "right of reply" to the other side. It was also noted that some conflict of interest might be inevitable when so much medical research was funded by commercial enterprises and the opinion was expressed that it is difficult to find any specialists who are completely independent of any commercial enterprise.
Mental health has traditionally had a high profile in the Netherlands, but this is now under threat and the journal felt it had a responsibility to try to maintain the previous high profile of mental health issues, which it felt should not be marginalised. The journal cherished its editorial independence and felt its role was to provide balanced coverage of issues. Currently, there was a debate going in the country about the dominance of psychiatrists, which the psychiatrists were trying to reclaim, and the journal was offering a platform for both sides in the debate.
It had, however, recently taken a decision to publish an article about a new therapy from a commercial enterprise. The journal was aware there was a potential conflict of interest here, and had drawn this to the attention of its readers, but the topic was something which the journal felt would interest its readers and the commercial enterprise was uniquely qualified to write about the topic. It accepted that total independence of all commercial enterprise was difficult to obtain in practice: there was always likely to be some bias, because most research is funded by commercial enterprises.
Local/national interest The comment was made that a campaign instigated internationally was usually extremely "broad" and might not have much relevance to individual members. However, it was already common for an international "umbrella" organisation to set a theme for the year (for example) and provide a certain amount of information, to which national information and concerns were added, and it was felt that this was a useful approach.
Don’t tell us what to do! Some editors felt that "campaigning" was not really a role they should play. There was a reluctance to impose any more "shoulds" on a readership that was already under severe stress at work. It was also noted that readers did not want a magazine that made them miserable, although it was accepted that a balance had to be reached between reporting unpleasant issues and pretending everything was rosy. There was also a reluctance to be "pushed" into taking up an issue or campaign and the need for "differentiation" was felt.
This workshop identified some of the strengths, weaknesses, opportunities and obstacles to be considered by participants in exploring whether and how best health professional journals and their editors could enhance their engagement in efforts to raise public awareness and shape policies in their respective marketplaces. A wide variety of opportunities for promoting public health behaviours, perceptions and choices of both individuals and policy-makers was identified.
It is now up to each individual to find best fits into their journal's overall development plans. There appeared to be a strong consensus on the value of inter-professional journal networking, the convening of editors at newsworthy events, and the sharing of experience. Joint campaigning received a more cautious response. Some journals felt they already played a part in the political process (mainly the Scandinavian nursing journals), whereas others felt that campaigning was not part of their function. Campaign ideas to be customised to national and local markets seemed quite welcome.
This report, with its requests for case study and/or comments from different participants, is the next step in a network development process. Based on comments received, WHCA will report to the WHPA and plan follow-up events.
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Public participation The initiative will package, disseminate and promote relevant evidence on the beneficial effects of people actively engaging in shaping their own, their family's and the community's health and health policies.
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Capacity development While the initiative will select specific topics of focus in different information marketplaces, the primary aim is individual and system capacity development. All networking, training and information support tools will be developed in a "generic" way so as to go beyond single issues and to support broad health communication capacity.
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Adding value to existing events/days The initiative will not designate its own day(s) or events but will "add value" to existing days or events by stimulating demand for information related to the topic at hand (through participating in "ask about your health" networks and targeted media strategies) and supporting the capacity of health systems to respond.
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Networking networks The initiative will link health advocacy networks, including health professionals and their associations, through their common interest in enhancing communication capacities. The campaign's training and electronic support tools will be geared to the individual and collective needs of the networks involved. For example, electronic "news from the field" (highlighting and linking participants to good health communication practice examples) or media advocacy/campaigning training for leaders/trainers from nursing, medical, pharmacists associations, national networks of Healthy Cities, Hospital Federations, etc.
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Making "noise" in health information martketplaces In relation to selected topics and events, the campaign will demonstrate "real time" media advocacy action in selected marketplaces.
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Planning and evaluation panel Network participants can assist in the planning and evaluation of "adopted" days or events by testing "messages", tracking coverage and feedback on impact, eg policy change, etc.
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Branding the campaign The Ask? & Act! - It's your health! campaign will generate opportunities for participating associations and organisations to link their "brands" (eg logos) and local actions to a highly visible international activity. The overall campaign will have a recognizable logo applied to all information materials and campaign activities.
Structure of alliance: success also depends on whether the alliance structure fits its needs and goals. For example, if a loose alliance is needed to meet the alliance goals, the structure should be simple and flexible, rather than tightly integrated.
Balance between participation and effectiveness: successful alliances tend to encourage input from and consultation with all parties, without necessarily involving all in lengthy decision-making processes.
[2] The WHPA is an alliance of the International Council of Nurses (ICN), International Pharmaceutical Federation (FIP), and World Medical Association (WMA).
[3] "Patient" versus "people with ...". The group agreed that the term "patient" was not ideal, in that it could have a "dehumanising" implication. It was agreed, however, it was a useful and well-understood term that could be applied to anyone interfacing with the various aspects of health and healthcare systems including preventative, curative, rehabilitation and palliative services. On an individual level everyone is a person, on a systems level it was felt convenient and appropriate to talk about patients and patient competency.
[4] This meeting utilized a WHCA strategy called the "benevolent cuckoo model", whereby workshops are held in conjunction (in the nest, as it were) with newsworthy events so that journalist participants can not only explore and debate issues but go home with a story!
McKinsey et al 2002. Learning from success: objectives, structures, and systems of effective international health alliances. Bill and Melinda Gates Foundation report. http://www.eldis.org/static/DOC11504.htm