Almost every aspect of our lives influences our health – our jobs, homes, access to education and whether we experience poverty or racism. These factors – the wider determinants of health – are often left out of public debate around improving health or are poorly understood.
To address health inequalities, we need to change the way that we communicate about the wider determinants of health to increase public understanding and build space for policy change to improve health.
Six practical recommendations
A few years ago, the Health Foundation commissioned the FrameWorks Institute to examine how people think about health. In March, we published findings from the second and final phase of the research.
This report provides practical recommendations for public health communicators to increase understanding and build greater support for action on the wider determinants of health. These are summarised below:
1. Show why the wider determinants of health matter
To increase support for policies and action on wider determinants of health we need to start by showing why people should care.
Lead by stating what’s at stake – this is a matter of life or death. Right now, in the poorest parts of the UK, people are dying years earlier than people in wealthier areas.
Connect this with the need to address the social and economic conditions that are harming health and cutting lives short, and give one or two examples of how wider determinants of health shape life expectancy.
2. Harness the power of explanation
Most people fail to understand why and how the world around us shapes our health. Our research shows that explanation is a powerful way to shift public thinking, and that builds support for change.
There are two ways people working and communicating in public health can increase understanding of the wider determinants of health through explanation:
- A ‘building blocks of health’ metaphor: compare the process of building a healthy society with that of constructing a sturdy building. We need strong building blocks such as good working conditions, housing and transport.
- ‘Deep-dive’ explanations: Use jobs or housing to explain how wider determinants shape health, as the public are most familiar with these. The example of chronic stress can also be used to explain how hardship or discrimination impact health.
3. Show change is possible
When communicating about issues as broad and complex as the wider determinants of health, people can feel the topic is too big and difficult to tackle. To mitigate this, we can:
- Pair explanations of the issue with solutions to help people to see that change is possible
When people are fatalistic about the possibility of change in the wider determinants of health, they are less likely to support the action needed to address inequalities in life expectancy. To overcome this, pair explanations of how the wider determinants of health shape health outcomes with a message that we can fix it. Be explicit about the fact that change is possible. Give concrete examples of how but avoid giving a long list of policy solutions. Instead focus on one or two examples of the types of solutions needed to improve health outcomes.
- Build public support for specific policies by talking about the solution early on and explaining how it improves health and life expectancy
Explain the specific ways in which support for a specific policy will improve health and life expectancy – and embed your explanation within a broader argument about life expectancy and health. Lead with the fact that people in the UK are dying earlier than they should, then move onto why the specific policy you want to build support for can create change. Focussing your explanation on the policy’s expected impact will also help people connect the dots between the need for the wider determinants of health to be a governmental priority and specific policies they might not have instinctively associated with health.
4. Talking about the NHS
In the research, messages that focused on the NHS as a way to talk about the importance of wider determinants of health were unpersuasive and, sometimes, backfired. Where possible, avoid centring the NHS in communications about the wider determinants of health:
- Remind people that the NHS was never meant to go it alone and it should be part of a broader system of support addressing jobs, housing, education, and public transport.
- You don’t have to talk about the NHS as part of all your communications about the wider determinants of health. But if you need to, explicitly mention people’s attachment to the NHS. Talk about ‘the NHS we all value and rely on’, but avoid making the NHS a central part of your messaging.
5. Talking about racism and discrimination
People mainly understand racism as abuse committed by one individual towards another. More systemic or subtle forms of racism are not on most people’s minds, which makes them quick to push back against messages asking them to engage with structural racism.
Public health communicators should not shy away from talking about the important ways racism shapes health outcomes. But these efforts should happen in concert with organisations whose work centres on racism, to build understanding of what structural racism is and how it works.
When bringing racism and discrimination into the conversation, always explain what data about racial inequality means. Don’t assume it will speak for itself.
Embed your explanation within the broader story of the wider determinants of health. When we position racism and discrimination as amplifiers of wider issues, people become more receptive to the message.
Use chronic stress as a pathway to build understanding of how racism shapes health and life expectancy. When we explain some of the ways in which chronic stress due to racism and discrimination shapes health, we help counter assumptions about what shapes inequalities in health outcomes.
6. Talking about the pandemic
The COVID-19 pandemic has resulted in people being more aware that society is unequal, but they often remain unsure of why such inequalities exist. The public continues to think about health in individualistic ways.
The research suggests that future communications should only mention COVID-19 when it is truly relevant to the argument being made. Putting the pandemic front and centre in discussions of the wider determinants of health might lead some people to tune out, at best, and make arguments sound opportunistic and disingenuous at worst.
Working together to tell a bigger story
It is crucial for public health advocates to work with other sectors. This means actively partnering with groups focused on issues of housing, education, or the environment to encourage them to talk about the issues they cover as health issues and create consistency in how different sectors communicate and frame their work.
Find out more
- Reframing the conversation on the social determinants of health (phase one)
- A matter of life and death: Explaining the wider determinants of health in the UK (phase two)
This content originally featured in our email newsletter, which explores perspectives and expert opinion on a different health or health care topic each month.