|Training Manual in Combatting Childhood Communicable Diseases Part I (Peace Corps, 1985, 579 pages)|
|Module 4: Health education|
|Session 25: Health education through mass media|
More than a medium, more than a message, communication is the total process whereby people understand each other, and each other's environment and aspirations. Too often it is seen by the "haves" merely as a way of passing on instructions and ideas to the "have-nots". Correcting this misperception, and placing real communication at the centre of development programmes, can help overcome the obstacles that stand in the way of social change. By SALIM LONE.
Salim Lone is a Kenyan journalist, until recently Editor of the monthly magazine Viva, currently an information consultant with UNICEF in New York.
In discussing ways to improve his country's economic performance, Mozambique's Minister of Information was recently quoted in a New York Times article as saying that what was needed was a return to the methods the ruling Frelimo party used during the liberation struggle against the Portuguese colonies.
"Then the people in the liberated areas would debate and find solutions to their problems", said the Minister, Luis Cobaco. "Now there is a tendency to call in the engineer to solve the problem, without discussing in with the people who are experiencing the difficulty".
The minister's words reflected the growing realization in the international community that a major shortcoming of many development efforts of the past tow decades has been the absence of close communication between all those - planners, professionals and the population - involved in development programmes.
Not that awareness of the importance of communication wasn't there. But just as the process of development was seen primarily as the as the provision of goods and services to the people, communication was conceived as a static, one-way flow of information from the "professionals" to the masses. Enormous amounts of energy and resources were spent on developing a technology which would make "communication" as instantaneous and far-reaching as possible and the whole exercise was predicated on the notion that those providing this technology were also the ones to provide the ideas and the solutions for those at the listening - receiving - end. As Juan E. Bordenava said at a recent UNICEF workshop, this communication paradigm "fitted the requirements of the international and national patterns of domination of the peripheral by the central countries, and of the less privileged majorities by the social elites".
The sophisticated new systems - new generations of satellites being launched, submarine cables being laid, optical fibres and lasers being harnessed for information transport - actually emphasize the technological mastery of one group and heighten the fear of scientific incompetence of the others. They have even sometimes become the instruments for hindering the very participation and interaction that communication is meant to promote. In the words of Armando Vargas, the former President of the Centre for Third World Communications and now Costa Rica's Minister of Information, the telecommunications revolution is "playing perhaps an even more important role than the steam engine in the industrial revolution. But it is asserting increasing control of our economies, ways of life and social values... and this control is in the hands of powerful organizations whose principal objectives are increased private profits and an enlarged market share".
It is from the development arena that some of the strongest challenges to the established communication structures are emerging. One element of the challenge comes from those struggling to place communication between the deprived communities and those providing them expertise, at the centre of development planning. Contending that human communication is the pivot on which balances the success or failure not only of individual programmes but of the whole process of development, these protagonists argue that traditional societies are socially literate. Over generations, they establish their own norms and technologies, which were dynamic and constantly propelled the societies to higher stages of production. Not to understand this, and to perceive third world communities as helpless bystanders who are too backward to understand the interventions that are being organized on their behalf, is a sure recipe for failure.
The argument would seem painfully obvious were it not for the fact that even to this day, the vast majority of development programmes are conceived and executed without a serious communication component. David Mason and Ramzan Azhar describe in an article on pages 14-16 how a scheme to provide much-needed iodinated salt to a region in Pakistan suffering from an extremely high incidence of goitre foundered badly because the entire promotional campaign was devised without even a rudimentary understanding of the people's sensitivities. In a deeply conservative, Muslim population, the salt was promoted with photographs of a smiling, unveiled young woman, to which the bulk of the population reacted with hostility. It was only after the unsold salt packets began piling up on store shelves that UNICEF's communications staff in Islamabad were asked to come in and do some quick rescue work.
Communications personnel are rankled by this "plan first, communicate only after initial failure" syndrome. But as more and more of those after-the-fact appeals are heard, it is becoming clear to planners that communication is not merely another hardware component consisting of posters, radio messages, and so on, but a central and decisive factor of any programme. Whether it is an effort to reduce the death rate from water-borne diseases in West Africa or an attempt to increase the rice yields in Asia, the communication of the ideas involved does not take place automatically. On the contrary: not only is their value far from self-evident to programme recipients, but their displacement of an existing set of strongly-held ideas is a complex undertaking.
Helping communications gain a more appropriate place in the development context has been enormously helped by recent evidence about its impact. We have seen, for example, the massive shift away from breastfeeding in just one generation. The aggressive use of marketing techniques and the mass media to convince mothers of the merits of formula feeds has contributed to the breastfeeding decline. In a Latin America study we have seen how two groups of children from identical, impoverished social classes show markedly different nutritional status, thanks in the main to the ownership of radios by the healthier families. And we have seen the yearning in many countries for expensive imported clothing inferior in quality to locally made garments, on the strength again of the myths and lifestyles promoted by their communication environment. We are now realizing that when we talk of communications in the context of social and behavioural change, we need to consider not only the "medium" and the "message" but also all those ideas, habits and aspirations acquired through social contact and interaction.
Means and ends
Amongst those who have been advocating a more careful study of communication for social development is Andreas Fugelsang, a development specialist who learned a great deal from the cultures in which he lived. Noting the tenuousness of traditional culture, which "is a carefully balanced man/environment interaction system, in which every detail has both technological function and spiritual significance and cannot be disrupted without drastic repercussions for the function of the whole", Fugelsang argues that the way new systems, processes and ideas are introduced into a way of life is as important as the benefits which those new systems and ideas hope to generate. To introduce what seems eminently logical to the outsider might in fact strain the recipient community's delicate fabric of socio-economic cohesion.
Fugelsang gives the example of an agriculture extension programmes in Ethiopia which introduced a new plough with a steel shave which was going to substantially enhance agricultural yield. But reception of the new plough was unenthusiastic: the plough was heavier, and the agricultural base could not support the better feeding of the oxen necessary to enable them to pull it.
To work in these traditional environments, Fugelsang argues insistently, requires sensitive and astute workers who can sympathetically comprehend the web of social relations of the group. Villages are not the collection of individuals that industrial, urban populations tend to be, and their attitude towards their leaders is different too. Modern societies allow professionals to lead them not necessarily for what they are intrinsically, but for their position in the system. But in the village, a professional will have credibility problems until he or she has proved his worth on a purely human basis. "Villagers live in communion", says Fugelsang, "and life there is characterized by intense communication and interaction". John Siceloff's experience in Peru and Tanzania described on pages 18-19 provide a concrete illustration of this point.
The distorted view of traditional societies that Fugelsang and others have in the last decade tried to correct was responsible for the hierarchical approach typical of so much development work. This approach is closely related to the paternalistic method of teaching described by Brazilian educator Paulo Freire as a "banking" system, where information is passed down from the active teacher to the passive recipient. In Freire's view, this "prescriptive teaching" diminishes the learner who is encouraged not to act upon his or her world, but to reflect back the ideas given by the teacher. Freire counters this whit the notion of "liberating education" which treats learners not as objects but as subjects who act upon their world to change it. The tenets of Freire's thought are that no-one can teach anyone else; no-one learns alone; people learn together, acting in and on their world.
Freire rejects conventional education as the tool ruling classes use to discourage the poor from learning and understanding the bases of their deprivations. The learning experience's primary purpose is to help change society, says Freire, particularly that aspect which has denied the illiterates an opportunity to participate in their own destiny.
The commercial communicator
Among those who must be classified as successful in fully investigating their target-group and understanding how to communicate with them are the commercial manufacturers. Their advertising campaigns have revolutionized consumption habits and lifestyles across the world. They have saturated the media with advertising carefully researched to gauge the concerns of their audience, and have succeeded far better in changing behaviour than have consciously-designed development programmes. In most third world countries, companies marketing agricultural products have reached remote farming communities with weed killers, fertilizers and insecticides. But try asking the same villagers if they know what is the best remedy for diarrhoea. And in many poor urban areas people will pay hard-earned cash for snacks and junk food, persuaded by commercial advertising that they are somehow "better" than vegetables from the backyard.
A growing number of voices, recognizing the impact of commercial advertising, are therefore advocating that their techniques be adopted in the promotion of social development. They argue that not to do so is to abdicate the print and air waves to those whose primary aim is profit and whose objectives are in direct conflict with the development propagandists. Richard Manoff is an experienced advertising man who has used his commercial skills to promote developmental messages in the third world. "Against the enormous power of the mass media to fashion food habits via advertising, the nutrition educator confined to traditional channels doesn't stand a chance", he asserts.
Manoff begins with a religious conviction that there is no idea that cannot be promoted as are commercial products. The way to get your message across, he says, is to create one which is short and confined to a single idea. "If you look through history, you will find that the great messages have been simple and short Moses only bad 10 commandments and they hardly add up to 60 words, and the 17 Rock Edicts of Ashoka are equally brief and to the point.
"Since we are not trying to make the rural mother a nutritionist or a doctor, I don't see why so many of you are writing books or pamphlets which few people except your colleagues are going to read", he says. "The development worker's approach is often too serious and academic and therefore less impactful. For example, when I was helping promote oral rehydration therapy in Nicaragua, we tried to make the message simple and catchy. We just said: "Make super lemonada at home - it will fight diarrhoea' The lemonade concept was one most mother related to immediately, and that is basically what anti-dehydration is: lemon, salt and sugar. And we didn't give it any formal name such as ORS, either. The reach of the message was enormous".
Participation and communication: two sides of one coin
While many educator and communicators do not accept Freire's ideological analysis, his emphasis on participation reflects what is probably the strongest new orientation in development work. The whole strength of primary health care initiatives around the world, as well as the efforts to elicit community participation, are indications of this recognition. The mere diffusion of innovations, it is being accepted, will at best have limited impact on the drive to increase the span, leave alone the quality of life. UNICEF'S current focus on, among other things, oral rehydration therapy and breastfeeding, is based on certain social, not technological, configurations.
The technology, of course needs to be available, and at low cost. But what really counts is how the technical intervention is integrated into the social structure of the target community. For example oral rehydration therapy has been technically available now for many years. But it has brought about no serious reduction in diarrhoea-related child mortality (over five million deaths a year) because of social perceptions about diarrhoea. Firstly, it is not regarded by most "target" people as life-threatening, since every child is frequently afflicated, but rarely dies from diarrhoea. Secondly, most mothers think that the way to stop the loss of fluid that characterizes diarrhoea is by ceasing to feed the child completely.
Clearly, therefore, any intervention aimed at the rehydration of imperiled children must first understand and address the community's view of the illness - and that is what communication for social development is all about. As Revy Tulubungwa, chief of UNICEF's Project Support Communications Section stresses: "Communication is the process through which human beings share social and cultural interactions, information, knowledge, experience, ideas, skills, motivations and aspirations". In other words, communication is decidedly not the diffusion of information and instruction alone.
Clearly, neither commercial advertising techniques, or a comprehensive communication strategy, is going to solve the most fundamental problem facing humanity, which is to eradicate poverty But correct communication will play its role. For decades now the mass media and other have promoted development as a process of "modernity", with technology providing the answers to human deprivations. Tractors will replace oxploughs, earth homes will give way to structures of stone and steel, with refrigerators area cookers inside, and milk will be available in cartons. So people started insisting on having the latest, most modern, most technologically "superior" products: injections from the doctor, instead of a tonic, for example; formula foods instead of breastmilk; a car instead of an ox-cart; a video receiver instead of a school textbook.
A more wholesome message
It is now not uncommon for communications practitioners to preach more modest more wholesome and more attainable goals. The emphasis is on social cohesion, the strength and wholeness of all cultures, the use of appropriate technology, and raising living standards not through material acquisition but through improved nutrition, health, and other essentials. We don't want to transform our environment overnight but to make it more productive and liveable, and share more equitably the fruits of human labour.
Such a message will not eradicate poverty. The causes of poverty are structural, and these structures, basically exclusionary and exploitative, will ensure that the communication process remains in the control of the privileged. But despite this major constraint a comprehensive communication strategy can help awaken the people to unchain their energies in the service of development. This dynamism is difficult to trigger, because in every social system, regardless of its insufficiencies, routine and tradition provide deep security. A culture is a collective identity and cultural change, even when it is generated by the people themselves, can be disorienting and fearsome.
The last frontier in development is also the largest. Knowledge is a language with an infinite vocabulary. It is also the only resource in the world which actually grows with use and which cannot be depleted To communicate effectively what we know will be for all of us to learn that much more.
(From: Lone, Salim, Communications: A Potent Force for Change. UNICEF News. 1982/4, p. 3-5)