Media advocacy is the strategic use of mass media to support community organizing and to advance public policy that improves health. The purpose of media advocacy is to put pressure on policymakers by setting the agenda and shaping debate to include policy solutions in news coverage of health issues. Media advocacy equips people to become active in the political process of making change.
Media advocacy grew from a collaboration of public health groups working on tobacco and alcohol with public interest and consumer advocates in the 1980s. The public interest and consumer groups brought strategies and tactics that were more common in political campaigns than in public health efforts. The public health perspective provided a solid basis in science and theory for creating change. The result has been an approach that blends science, politics, and advocacy to advance public health goals.
Rather than intervene at the personal level to change behavior, media advocates practice at the political level to change policy. Media advocacy relies on theories and research from fields such as political science, social psychology, and mass communications, such as agenda setting and framing. This research is applied in the context of community organizing, coalition building, and policy advocacy.
Media advocacy campaigns progress through four layers of strategy. First is overall strategy, a plan for environmental change. Advocates develop the overall strategy by determining: What is the problem? What is the solution or policy? Who has the power to make the necessary change? Who can be mobilized to put pressure on the primary target(s)? The “target” for media advocacy will be a policymaker or a body (such as a city council) that has decision-making power. This is a different strategy than is used in most health communication campaigns, where the focus is on individual change.
Second, the media strategy uses mass media to direct attention to the policies that can reshape systems, institutions, and environments. Many public health communications campaigns are based on the idea that poor health outcomes result from a lack of information or motivation; media strategies are then devised to fill the “information gap” or “motivation gap”. Media advocacy focuses on the “power gap,” viewing health problems as arising from people’s lack of power to create change in the broader systems and environments that influence health. Media advocacy strategies are designed to increase community participation in the policy process.
Third, the message strategy links public health problems to inequities in social arrangements rather than to flaws in the individual. Media advocates refer to this as “framing for content” because they attempt to create news stories with content reflecting the importance of using policy to improve health environments. Framing for content is a formidable challenge for media advocates because research on the news suggests that public health issues are rarely portrayed in ways that illustrate the underlying causes of problems or their potential policy solutions. Health stories, like other news, often obscure factors outside of individual choice. This is in part because most news is framed episodically, like a portrait, focused on people or events, rather than as a landscape, focused on the context surrounding people and events. About 80 percent of television news and well over half of newspaper stories are framed this way. Consequently, the news usually reinforces values of individualism and personal responsibility rather than the core value of public health, collective obligation to the social good. This pattern in news is important to media advocates because it means that routinely they will have to reframe news stories from portraits to landscapes so public debate can focus on the policies and institutions that shape the circumstances determining people’s health.
Finally, the access strategy aims to garner news and editorial attention. Media advocates refer to this as “framing for access” since they emphasize what is newsworthy about their issue at the moment to attract reporters. Media advocacy uses media relations tactics that practitioners of other communications strategies use: news releases, pitching stories, piggybacking on breaking news, monitoring the media, and creating news. But these practices alone are not media advocacy. Media advocates also use paid advertising, as their issues are usually too controversial to rely on public service advertising.
Media advocacy continues to be used by tobacco control advocates, most recently in China. Children’s advocates used media advocacy to pressure national policymakers to prevent childhood lead poisoning. Disability rights advocates used media advocacy to fight for accessible public transportation. In New Zealand, alcohol control advocates used media advocacy to increase support for alcohol policies. In the US, affordable housing advocates used media advocacy to reframe technical policy discussions into stories that reflected their values and the values that resonated with policymakers. Violence prevention advocates used media advocacy to enact policies that reduced morbidity and mortality from firearms. Nutrition advocates have used media advocacy support laws that limit soda and “junk food” in schools. Common to all these media advocacy campaigns is a focus on policies that change the environment in which people live and make their health decisions.
Media advocacy has several limitations. Media advocacy requires a clear policy target. If the strategy is not clear and the target has not been well defined, the media advocacy effort will be diffused and ineffective. Since media advocacy is about raising community voices to demand change, it often focuses on policy advocacy, which can require lobbying that public agencies and some nonprofit organizations are prohibited from conducting. The political nature of media advocacy means that some practitioners will not be able to participate in all aspects of a media advocacy campaign. A final limitation is that the reach and promise of media attention – the idea that so many individuals can be reached at once with a single message – can be a distraction from the policy target. Media advocacy should be thought of as a tool in service to policy advocacy and community organizing, not as an approach that stands alone.
Media advocacy, used as a tool to accelerate and amplify community organizing and policy advocacy, directs public and policymaker attention to the policies that can reshape the social and physical environment so that it fosters health.
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