Strategic Approaches to Public Health Communication

Getting people to wash their hands, wear masks during a pandemic, or quit smoking – these might sound simple, but changing health behaviour at scale is one of the toughest challenges in public health. That’s where public health communication strategies come in. These are structured, evidence-based approaches designed not just to inform people about health risks, but to actually motivate and sustain healthier behaviours across communities and populations. From grassroots campaigns to primetime TV dramas, the tools available today are diverse, creative, and increasingly effective. Let’s break down the major strategies that drive public health communication forward.

Social and behaviour change communication (SBCC) 🔗

Social and Behaviour Change Communication (SBCC) is one of the most widely used frameworks in public health today. It goes beyond simply telling people what to do. SBCC is a research-driven process that uses communication strategies grounded in behavioural science to influence knowledge, attitudes, social norms, and ultimately, behaviours among individuals and communities.

Previously known as Behaviour Change Communication (BCC), the “S” in SBCC was added to recognise the social and ecological context in which people make health decisions. A person doesn’t decide to get vaccinated or adopt family planning in a vacuum – their choices are shaped by family, community, religion, culture, and the broader policy environment.

How does SBCC work? 🔗

SBCC follows a systematic process. It begins with formative research – understanding the target audience’s needs, motivations, barriers, and media preferences. This is followed by behaviour analysis, communication planning, implementation, monitoring, and evaluation. Messages and materials are pre-tested with the intended audience, and campaigns are designed to operate at multiple levels: individual, community, institutional, and societal.

A core concept underlying SBCC is the Social-Ecological Model, which identifies four levels of influence on behaviour. At the individual level, factors like knowledge, attitudes, and self-efficacy matter. At the community level, social norms, peer influence, and local leadership play a role. At the service delivery level, the availability and quality of health services is key. And at the structural level, policies, cultural values, and economic conditions shape the broader environment. UNICEF’s SBC guidance notes that effective SBCC works across these levels using marketing, social mobilisation, mass media, interpersonal communication, and digital engagement to create an environment that supports positive change.

Where has SBCC been effective? 🔗

SBCC has demonstrated success across several health areas. It has helped increase the adoption of family planning methods, reduce the spread of infectious diseases like malaria and HIV/AIDS, and improve maternal and newborn health outcomes. During the 2014 Ebola outbreak in West Africa, a lack of strategic communication early in the response fuelled fear, panic, and the spread of misinformation – which further worsened the epidemic. This tragic example underscored SBCC’s critical role in emergency preparedness and pandemic response.

However, SBCC is not a magic bullet. As UNICEF has pointed out, SBCC alone is rarely sufficient when deep-rooted structural and social barriers exist. Challenges like child marriage or female genital mutilation have roots so deep that even the most robust communication campaign cannot overpower entrenched social norms without complementary structural interventions.

Health promotion, prevention, and education 🔗

While SBCC focuses on communication-driven behaviour change, the broader framework of health promotion, prevention, and education encompasses a wider set of actions that create the conditions for good health. These three concepts are closely related but distinct.

Health promotion 🔗

The World Health Organization (WHO) defines health promotion as the process of enabling people to increase control over, and to improve, their health. This definition was first articulated in the landmark Ottawa Charter for Health Promotion in 1986, which identified three basic strategies: advocating for health, enabling all people to achieve health equity, and mediating across sectors.

Health promotion is not limited to the health sector alone. It requires a whole-of-government and whole-of-society approach. Decisions made in education, urban planning, housing, transport, and employment directly affect population health. For instance, access to green spaces encourages physical activity, while unsafe working conditions increase the risk of injury and chronic disease. The WHO’s 9th Global Conference on Health Promotion in Shanghai (2016) further reinforced this by linking health promotion to the Sustainable Development Goals (SDGs).

Key focus areas in health promotion today include strengthening governance to make healthy choices accessible, improving health literacy so people can make informed decisions, creating healthy settings (like schools, workplaces, and cities), and facilitating community participation and empowerment. The Pan American Health Organization (PAHO) emphasises that participation itself generates health and is essential for the sustainability of any health promotion effort.

Disease prevention 🔗

Disease prevention focuses on specific interventions to reduce the burden of disease and associated risk factors. Primary prevention aims to stop disease before it starts – examples include vaccination, nutritional supplementation, and public awareness campaigns about risk behaviours. Secondary prevention involves early detection through screening programmes, such as cervical cancer screening or routine blood sugar checks. According to the WHO Regional Office for the Eastern Mediterranean, effective secondary prevention depends on the availability of health services that can promptly treat any detected abnormalities.

Health education 🔗

Health education has evolved significantly over the decades. It was once a top-down approach where professionals simply told people about health risks and how to live. Today, it is based on dialogue and active participation. Modern health education equips people with personal life skills – decision-making, assertiveness, and the ability to seek out reliable health information. A well-informed, health-literate population is better positioned to engage in community health action and hold governments accountable for health equity.

Media advocacy 🔗

Media advocacy takes a fundamentally different approach from traditional health communication. Instead of targeting individuals with messages about personal behaviour change, media advocacy uses mass media strategically to advance public health policy.

As defined by researchers at the University of California, Berkeley, media advocacy is the strategic use of mass media to support community organising and promote healthy public policies. It is rooted in community advocacy and shifts the focus from personal responsibility to the social, political, and environmental determinants of health.

How media advocacy differs from traditional health campaigns 🔗

Most health communication campaigns operate from the assumption that poor health outcomes result from a knowledge gap or a motivation gap among individuals. Media advocacy, on the other hand, focuses on the power gap – the idea that health problems often arise from people’s lack of power to change the broader systems and environments that shape their health.

Where traditional campaigns target audiences as consumers of health messages, media advocacy targets policymakers and decision-making bodies. The “audience” for media advocacy is a city council, a legislative body, or a regulatory agency that has the authority to enact policy change. The Public Health Institute describes media advocacy as a practice that connects with newsmakers to narrate social policy issues through an engaging lens, broadening public debate beyond individual responsibility.

Key concepts in media advocacy 🔗

Two major theories inform media advocacy practice: agenda setting and framing. Agenda setting refers to the media’s power to determine which issues the public thinks about. Framing refers to how those issues are presented – and this matters enormously. News stories tend to frame health problems as individual failures (a “portrait” frame), but media advocates work to reframe them as systemic issues requiring policy solutions (a “landscape” frame).

For example, instead of framing obesity as a personal willpower issue, media advocates might highlight how food industry marketing practices, lack of access to affordable fresh produce in low-income neighbourhoods, or inadequate urban design for walking and cycling contribute to the problem. This kind of reframing shifts the public conversation from blame to accountability.

Media advocacy has been particularly visible in campaigns around tobacco control, alcohol regulation, and gun violence prevention. It emerged from a collaboration in the 1980s between public health groups working on tobacco and alcohol issues and consumer advocacy organisations, blending communication science with political strategy.

Entertainment-education (enter-educate) communication 🔗

Entertainment-Education (EE), also known as the enter-educate approach, is a communication strategy that embeds educational and health messages within popular entertainment formats. The idea is simple but powerful: people pay attention to stories that engage their emotions, and this engagement can be harnessed to promote positive health behaviours.

Origins of the approach 🔗

The modern EE strategy traces its roots to Mexican TV producer Miguel Sabido, who in the 1960s and 1970s pioneered the use of telenovelas (TV soap operas) for social change. His telenovela Ven Conmigo led to approximately one million people enrolling in Mexico’s adult education system. Subsequent Sabido-produced dramas on family planning themes contributed to a significant decline in Mexico’s fertility rate. Everett Rogers, a prominent communication scholar, later coined the term “Entertainment-Education” in 1979.

The approach has since been adopted globally. Organisations like PCI Media, BBC Media Action, and Sesame Workshop have produced entertainment-education programming on topics ranging from HIV/AIDS prevention and family planning to women’s rights and nutrition. As of today, EE programmes have reached over two billion people worldwide through more than 140 shows across multiple countries.

Why does EE work? 🔗

At the core of EE is Albert Bandura’s Social Learning Theory, which holds that people learn behaviours by observing role models. In EE programming, characters model both positive and negative behaviours – and audiences watch the consequences unfold within the story. A character who avoids testing for HIV may suffer devastating consequences, while another who seeks treatment early thrives. Viewers identify with these characters, and this emotional connection can lead to real-world behaviour change.

The enter-educate approach works because it is popular (entertainment is everywhere), personal (audiences identify with characters), participatory (audiences can engage with the development of the story), and persuasive (viewers imitate the role models they see). EE formats include soap operas, radio dramas, feature films, music, talk shows, theatre, comics, and even video games.

EE in the digital age 🔗

The rise of social media and digital platforms has created both challenges and opportunities for EE. Audiences have fragmented across channels and now create and share content themselves. Researchers have proposed the concept of “spreadable entertainment-education” – using social influence in online networks to amplify EE messages. This means working with social media influencers, content strategists, and data analysts to extend the reach of EE narratives beyond traditional broadcast media.

During the COVID-19 pandemic, EE organisations had to rapidly adapt – some redistributed existing content with updated messages, while others created entirely new programming under social distancing restrictions. These experiences demonstrated that EE initiatives benefit from starting with existing infrastructure to quickly build capacity, working with local partners for contextual relevance, and maintaining a focus on compelling storytelling.

Bringing it all together: an integrated approach 🔗

No single strategy works in isolation. The most effective public health communication efforts combine multiple approaches tailored to the specific context, audience, and health issue. SBCC provides the behavioural science framework and systematic process. Health promotion, prevention, and education address the broader determinants and create enabling environments. Media advocacy shifts policy and systemic conditions. And entertainment-education captures hearts and minds through the power of storytelling.

Together, these strategies aim to create what public health professionals call an enabling environment – a setting in which healthy choices are not only possible but encouraged, accessible, and supported. They promote health equity by addressing the socio-economic and environmental factors that shape health outcomes. And they contribute directly to global goals, including the Sustainable Development Goals’ vision of healthier, more equitable societies.

The key lesson across all four strategies is this: information alone does not change behaviour. Change happens when people have the knowledge, motivation, skills, social support, and structural conditions to act. Effective public health communication works at all these levels simultaneously – reaching individuals through education and stories, mobilising communities through participation, and transforming systems through advocacy and policy change.

What do you think? Which of these public health communication strategies do you believe has the most potential for impact in your community – and what barriers might prevent it from working effectively?

References

1. https://sbccimplementationkits.org/sbcc-in-emergencies/learn-about-sbcc-and-emergencies/what-is-social-and-behavior-change-communication/
2. https://www.sbcguidance.org/understand/social-and-behaviour-change-communication
3. https://pmc.ncbi.nlm.nih.gov/articles/PMC11505028/
4. https://www.who.int/health-topics/health-promotion
5. https://www.paho.org/en/topics/health-promotion
6. https://www.emro.who.int/about-who/public-health-functions/health-promotion-disease-prevention.html
7. https://pubmed.ncbi.nlm.nih.gov/7883943/
8. https://www.phi.org/our-work/expertise/media-advocacy-communications/
9. https://www.tandfonline.com/doi/full/10.1080/10410236.2020.1847451
10. https://pubmed.ncbi.nlm.nih.gov/12284960/
11. https://academic.oup.com/heapro/article/35/5/1241/5588513
12. https://pmc.ncbi.nlm.nih.gov/articles/PMC10749873/