The art of making a massive health impact.

Posted on August 9, 2023 by sunoor

public health communication multi-stakeholder engagement singapore

A call to active lifestyle by Singapore health authorities.

How can a small island nation with a multi-ethnic and multilingual citizenry and four official languages become a global champion in health communication? The answer is to use scientific evidence effectively, to be proactive in responding to evolving trends, to employ many communication channels, and to tailor messages to diverse audiences. And the country with this extraordinary feat will be 58 on August 9, 2023. It’s #Singapore!

Singapore’s demographics are rapidly shifting, posing significant challenges for the country’s health systems. The population is ageing, with the median age anticipated to reach 49 by 2030, as is the proportion of people suffering from chronic diseases. While many chronic diseases can be avoided or delayed, they are expensive to treat when they do develop. Singapore has a higher suicide rate than many other countries, and mental illness is stigmatized. Similarly, the prevalence of obesity rates in Singapore is rising, especially among children and adolescents. And Singapore is addressing all these head-on.

During my visits to Singapore, I can’t help but see behaviour change signals everywhere, some subtle and some direct. Singapore’s health authorities appear to be working on a war footing to confront emerging health concerns by investing in exceptional health communication.

As a strategy and leadership communication professional, I consider Singapore’s approach to be an accurate implementation of “Health is a Human Right” and “Health in All Policies.”

When I decipher Singapore’s magical public health communication formula, I discover the following precious principles:

One, Audience: Understanding your audience is essential to any public health communication strategy. Who are you targeting? What are their concerns? What drives them? After knowing your audience, you may personalize your message. However, this requires leaving your cosy offices and connecting with people in their homes or workplaces. Public health authorities must likewise give up the idea that they know what’s best for people.

Two, Relevance: your message should address your audience’s worries. They should care about it and recognize how it affects them. In contrast to Singapore, which determines its agenda with limited foreign intervention, low-income countries frequently follow the priorities of their international donors.

Third, Credibility: your message should be founded on solid evidence and originate from a reliable source. As in Singapore, this is made possible by multi-sectoral collaboration. Four, Engagement: your message should be engaging and thought-provoking to captivate your audience. It should inspire curiosity and action. Five, Simple messaging: Your message should be easy to understand and avoid jargon and technical terminology.

Singapore’s health communication formula also includes using a variety of mediums to engage people, such as print, television, radio, social media, and public events. Use humour and storytelling to connect with your audience. Track your public health communication campaign’s performance to see what works and what doesn’t, as this helps campaigns improve over time.

Feedback on health messaging is critical to improve campaigns.

Collecting feedback from audiences on health messaging is critical to improving campaigns.

Singapore has many public health successes. Singaporeans’ rising Type Two Diabetes rate prompted the 2016 “War on Diabetes” campaign. The 2015 “National Steps Challenge” to promote physical activity saw fivefold participation by 2018. The government has created an extensive initiative to support firms of all sizes in obesity prevention and management, chronic illness management, mental health, and smoking cessation.

Singapore’s health initiatives’ interconnectedness is their beauty. The government works with the urban planning sector to design localities that encourage physical activity; with the transportation sector to promote public transportation and make it easier for people to walk, cycle, and use active modes of transportation; with the education sector to promote health education in schools and create a healthy school environment; and with the workplace sector to encourage healthy workplaces.

By linking its public health programs with other vital sectors, Singapore has created a more holistic approach to health promotion that benefits the entire population.

Understanding that communication is a means to an end is critical to Singapore’s health communication success. Singapore’s health communication programmes are proactive, evidence-based and serve measurable health objectives—infrastructural investments back health campaigns. To give Singaporeans a place to exercise, relax, and mingle this “Planned City” features government-built 59 regional and 271 community parks. They usually have running, cycling, and inline skating paths that link to nearby parks. Parks have many outdoor workout stations. The government also provides healthcare subsidies. This guarantees quality health care for all.

Leadership by example is also a part of Singapore’s health communication strategy. It sends a strong message to the public that healthy living is essential when Singaporean leaders and top civil servants follow what they preach. This encourages better choices. Singapore’s leadership communication strategy frequently includes health and lifestyle messages, demonstrating their importance as a national priority.

What also helps is that Singapore has traditionally had stable governments with enough majority to expedite health-related legislation. The other significant and rare advantages that Singapore enjoys are – one, Singapore has a long history of electing highly educated and trained science political officials, due in part to the country’s emphasis on education and its commitment to developing a knowledge-based economy and two, the presence of an impressive number of self-made female professionals in high-decision making roles. This is recognized to lead to better representation of women’s interests, more diversity of thought, and more decisive leadership.

Why are so few Asian countries able to reproduce the basic recipe for effective health communication a la Singapore? Because corruption, nepotism, or political and bureaucratic greed come in the way.

Singapore’s public health ambassadors are chosen for their health advocacy, not political connections. Singapore’s health promotion platforms are not chosen for personal profit. Similarly, posters and brochures are printed in proportion to audience size instead of commission. Health authorities in many developing Asian nations have piles of obsolete printed material rotting in their warehouses.

Singapore’s performance suggests good governance and low corruption are necessary for effective health communication. Transparency International‘s Corruption Perceptions Index 2022 ranks Singapore fifth least corrupt country out of 180 nations. In 2023, the Chandler Institute of Governance ranked Singapore top in good governance, ahead of Switzerland, Finland, Denmark, Norway, Sweden, the Netherlands, Germany, the UK, and New Zealand.

International development and philanthropic health programmes in low-income countries need to learn from Singapore’s health communication excellence. In the absence of national-level good governance and the presence of high corruption perception among the population, investing in public health communications is bound to yield poor returns.

Donor funding for health communication is highly susceptible to corruption, causing anger over “failed” health promotion efforts and raising questions over donor credibility. So, unless international donor-development agencies want to mainly boost a country’s t-shirt, flex, and poster printing business or provide politicians with a health platform for self-promotion, the funding of health communication portfolios should be carefully reviewed.

Thank you, Singapore. Keep inspiring!

An abridged version of this article appears on page 4 in The Himalayan Times, Nepal, 9th August 2023.

Dr Sunoor Verma is a global health diplomat-practitioner specializing in strategic partnerships, high-level advocacy, and strategic leadership communication. He has supported the work of WHO, UNICEF, UNHCR, UNDP, ECMI and their leaders in building complex coalitions, communicating effectively and devising out-of-the-box solutions in development and humanitarian settings. He has also worked with Boston University, the University of Geneva and Cambridge University on programs that intertwine international relations, global health and conflict resolution.

Public Health debates we can ignore at our own peril

Posted on June 30, 2022 by sunoor

public health

Global lessons learnt are not as valuable as we might think!

Having lived and worked in low-, middle- and high-income countries, I do not like sweeping ‘global lessons learnt’. The situational, cultural, and operational contexts based on countries’ income levels vary hugely. Moreover, the reports and recommendations from global apex bodies are often drafted by people from primarily high-income country experiences. Many of them may have never actually worked at the country level. Often their lexica are so watered down in assessments of low-income countries that severe reprimand ends up sounding like applause by publication. Without a scorecard system where each country would know where they need to improve to achieve standards, it is difficult to get a reality check. We, the low-income countries, have a choice to make. We can believe that we are high performers or quench our vanity, critically examine our performance, and take corrective measures.

The glaring gaps in public health that COVID-19 exposed

COVID-19 has exposed critical societal gaps across the globe. In the case of high-income-developed democracies, this means adjustments and fine-tuning. In the case of low-income countries, this has meant seeing a horrid picture in the mirror and the need for transformational change. So a natural enquiry would be-what has been happening in the business of Health Systems Strengthening over the years and billions of donated dollars later? We would have thought that SARS, Ebola, MERS, and ZIKA emergencies would have better prepared our health systems, but here we are.

This pandemic has opened some chronic societal wounds, especially in low-income countries. The top issue that warrants an urgent societal debate is what services are essential and must remain in the public domain and how we regulate the private sector. Many proponents for the rapid privatisation of public services in low-income countries are foreign experts. Their countries have achieved an equilibrium between top-notch public services and effective private-sector regulation.

Public Health, Corruption & Transparency

Corruption, lack of transparency, power asymmetry, and invisibility of women in decision-making all contribute to the complexity of public versus private debate in low-income countries. When lawmakers overtly or by proxy own significant numbers of private hospitals, mainstream media, and educational institutions, it becomes difficult to have an objective national debate. The COVID-19 pandemic has allowed us to rethink and reboot societal contracts. The pandemic struck when public trust in institutions- governmental, civil society, private sector, media, academia, and the judiciary was at the lowest after years of steady decline globally.

Public sector- the saviour during COVID-19

Suppose we reflect on the past two years of the pandemic in low-income countries. In that case, we will note that we turned to either the public sector organisation or the defence forces whenever we needed a timely nationwide response. For example, when students needed to be brought back from abroad in India, the then-national carrier Air India stepped up. When stranded migrant workers needed to return home, it was the Indian Railways that rose to the occasion. When liquid oxygen had to be mobilised, the public sector was at work again. Working around the clock to secure scarce supplies from other countries and securing evacuation permissions were diplomats who are public servants. On the borders, facilitating the movement of people, supporting testing, quarantine etc., were members of the border police, armed forces, and the police. Similar was the case with many countries in South and Southeast Asia.

Other rich countries, such as Germany and South Korea, responded robustly. Attribution to the ability of their governments to manage private-sector activity and essentially public ownership of critical health system elements. Their impressive testing capacity was thanks to public laboratories and the presence of industries that could supply the required safety equipment and chemicals.

The South and Southeast Asia neighbourhood

Some governments in Southeast Asia have managed to build public health systems that learn. So, lessons from SARS and Tsunami have fed into their preparedness systems, allowing them to respond efficiently and effectively. The city-state of Singapore has traditionally shown a proactive approach based on solid scenario planning and proactive public health communication. Within India, the response of the southern state of Kerala has stood out. Over the decades, Kerala has invested in health, education, and women’s empowerment. It has consistently adopted an evidence-based approach to decision-making on health matters. Theirs is a learning system that drew heavily on lessons from the NIPAH virus emergency not too long ago. Kerala has also avoided the black-and-white notion of Public or Private and established a successful public-private partnership model. The government of Vietnam efficiently diagnosed the regional situation and closed its borders. Similarly, they were swift in developing low-cost test kits.

Public Health and the private vs public discourse- an axis of national security too

The considerations that need to be at the centre of this post-COVID-19 public-private discourse are:

Re-evaluate and reign in the privatisation spree of health-related assets and services. Nurture back to health underperforming units through quick and transparent reform.
Two, Reboot and relaunch sensible and practical national health policies that serve the objective of achieving universal health coverage. These should not be a copy-paste of what middle- or high-income countries are doing but should be rooted in the realities of poverty, patriarchy, and emerging democracy.
Three, While the issue may appear to be of health, the scope of solution searching is well beyond the expertise or experience of health actors. The complexity of this matter warrants the leadership of the Ministries of Finance, Law, Commerce and Home. For example, supply chains, the rule of law during the lockdown, transportation of people, and labour issues related to health workers have solutions outside of health agencies’ remit.
Four, Governments must take the lead and regulate the private sector more effectively and transparently. While governing the somewhat more streamlined public sector may be more satisfying, the rapidly and wildly growing private sector needs aggressive regulation. In many low-income countries, this means enforcing the existing fantastic on-paper rules and not drafting new ones. Moreover, the hopelessness of data collection from private sector health providers, whether on testing, bed occupancy, oxygen availability, or mortality during COVID-19, has hampered many low-income countries’ effective and timely response.

Refocusing on the Health for All agenda

This public discourse requires us to open our eyes to what we witnessed in the last two years and set aside our ambition and vanity. Let us acknowledge the actual situation in our countries and not artificially push ourselves into a higher boxing category for mere prestige. Organic, home-grown solutions are needed now, not a collage of random international best practices. Instead of drawing lessons from countries in the region, we need to study states and provinces with similar challenges and partner with them. Cross-border areas should be of interest in standard solution searching.

Many glorious careers are built worldwide in the name of Health Systems Strengthening. However, COVID-19 has shown that not much strengthening may have happened. WHO’s “Health for All” agenda ought to remain our focus. However, the tools, processes and commitment need to be indigenous. Countries must bring their sharpest, most independent, and most fearless minds to this debate.

Let us not forget that health, education, and security are nation-building tools. Taxpayers will have little incentive to contribute their fair share if all these continue being disproportionately privatised. One can only imagine the threat to democracy this will pose.

About the Author

Dr Sunoor Verma is a global health practitioner. He has advised WHO, UNICEF, UNHCR, HUG-Geneva and Cambridge University on Strategy, Leadership Communication, Advocacy and Resource Mobilization. He is credited with setting up WHO’s communication portfolio from scratch in Nepal in the midst of COVID-19. He has set up and led the country and regional operations for the European Centre for Minority Issues in the Balkans. He has supported track two peace processes in Macedonia, Kosovo and Sri Lanka and emergency response to the Tsunami, Avian Influenza and COVID-19. He has taught Global Health at Boston University. He has curated partnership initiatives with Macedonia, Kosovo, Germany, Switzerland, Australia, and Nepal parliamentarians. He divides his time between the foothills of the Jura Mountains in France and Buddhanilkantha in Nepal.

Published in Nepal’s national daily Kantipur on 30 June 2022 in Nepali language. This is a translation with some additional text.