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18 Disease Eradication as a Springboard for Broader Public Health Communication Jeffrey Bates, Sherine Guirguis, Thomas Moran, and Lieven Desomer Abstract In the initial stages of a public health campaign, the mass media is usually very effective in communicating with the majority of the public. Thereafter, focused and intensive engagement is required to reach the underserved, politically, and economically marginalized sectors of society: people who have little social capital, who avoid risks that could destroy the fragile security systems they possess, or those who simply do not have access to the information and services provided to the rest of society. Here is where the final battles against disease are fought. Local initiatives—those which identify the most marginalized segments of society and encourage ownership and participation through intensive interpersonal communication and modifications in service delivery—are necessary to ensure the success of large-scale public health efforts. For all major public health initiatives, the underserved or late adopters are the hardest to reach, yet because an eradication effort must achieve nearly 100% coverage, they hold the key to success or failure. Identifying these groups and understanding the segmentation required even within these minority groups represent critical elements in program design. Strategies and results from the Global Polio Eradication Initiative in India and Nigeria are discussed and applied to the design of future public health and disease eradication initiatives. Introduction Health communication has evolved greatly over the past fifty years. Better linkages between social and communication theory, research, and practice have yielded strong evidence for what works best in the field. When communication began to emerge as an area of study, it was guided by claims from the realms of psychology and the social sciences that the mass media could exact 256 J. Bates et al. immediate and powerful effects. This basic tenet of mass effect informed early health communication efforts and still persists today in many health communication programs. Along with the supposition that mass media could have a dramatic influence on public behavior, the medical establishment widely believed that people, as rational actors, would naturally embrace a behavior that would help them or their loved ones achieve a longer, healthier life. These assumptions proved wrong. Simple yet obviously beneficial actions (e.g., wearing a safety belt when driving or putting out the cigarette forever) have yet to be universally adopted despite the near universal understanding that such actions are good things to do. Public health officials and communication professionals came to understand that health promotion is very difficult when it involves a lot of people doing something different from what they and their community usually do. Gradually, it was recognized that social identity, cultural norms, and political dynamics all play important roles in whether a person adopts a required behavior, and it is through these social and personal channels that behaviors can be best promoted. Fortunately for disease control and eradication, most health interventions do not require drastic behavior changes. Social behaviors around health are usually positive, with the majority of the public demanding better and more impactful preventative and curative services. However, people do not always make healthy choices even if they are well aware of the risk and dangers of continuing behavior or not changing their ways. Thus the role of health communication is to interact with communities by providing information and assisting in service delivery so that people can be persuaded to participate in specific health actions. In the process of adoption, the most difficult phases are the introduction of an innovation, when only risk takers or people with special interests pick up the behavior, and the final stages, when late adopters persistently remain difficult to reach. Late adopters—those who adhere to old practices, take an oppositional perspective to new ways, or are simply out of reach of the health system—pose one of the most significant threats to an eradication initiative, which by definition needs to reach everyone. Whether the public health objective is to get the public to hold out their arm for a single vaccination prick, use a mosquito bed net, or accept multiple doses of oral polio vaccine (OPV) for their children beyond the prescribed immunization schedule, late adopters hold the key to the ultimate success or failure of any eradication effort. In the initial stages of a public health campaign, mass media is usually very effective at reaching the majority of the public who are the first to adopt an...

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