By Thomas Tufte , Ph.D , Professor Roskilde University , Denmark ttufte@ruc.dk

1. Health Communication- from individualbehaviourchange to civil society development and participatorygovernance By Thomas Tufte, Ph.D, Professor Roskilde University, Denmark ttufte@ruc.dk Presentation given at seminar in Copenhagen 4 May 2010: Communication for Social Change – lessonslearnt from public health ADRA/AIDSNET/ENRECA Health/Glocal NOMAD

2. Introduction • 3 keyquestionsframing the discussion • 3 hypothesesrelated to public health, globalisation and health and the discipline of healthcommunication • Example: Femina HIP in Tanzania

3. Question 1 • Whatroledoescommunicationplay in the configuration of healthcitizenships? Threelevels of analysis: • The level of healthpolicies (long trad. for broad definitions + notion of comm??) • The level of the sciencesordisciplines (health + comm) • The level of health and the healthcommunicationpractice (emergingexperiences..)

4. Question 2 • What dimensions of globalizationareinfluencing the politics, disciplines and practices of healthcommunication? • The relation betweenglobalisation and modernity: ArjunAppadurai • Mass migration • The electronicmediation of everydaylife • The articulation of an ontologicalinsecurity

5. Question 3 • Whatare the keychallengesthathealthcommunicationfacetoday – in terms of policies, theories and practices? • A discipline and a practice in crisis and in profound transformation • Thereexists a strongcurrent of rethinking the discipline and the practice

6. Hypothesis I • The centre of public healthliesoutside of the public health system • Public health problems relate to broaderquestions: citizenship, empowerment, socio-economicconditions, culture, power relations and politicalpriorities

7. Hypothesis 2 • The forces of globalisationare at the centre of the challengeswe must understand and relate to in order to achieve the construction of a ’healthy’ society • ’Glocalized’ lives thatweneed to reconstruct and understand better in order to respondaccordingly and better

8. Hypothesis 3 • Health communication is a discipline in crisis and in transformation. There is a strongneed for a more solid philosophical and epistemological basis which parts from a broadnotion of health and whichconnects the healthrelatedchallenges more stronglywith the otherkeychallengeswithindevelopment and social change

9. Towardshealthcitizenships • Alma Alta 1978 • Ottawa Charter 1986 • UNFPA Conference, Cairo 1994 • Round-tableonCommunication for Development, Managua 2001 (and subsequentones in Rome, Addis and Washington)

10. 7 challengesemerging from globalization • Epidemicstravel (HIV, SARS, BirdFlu, etc) • Media development – expanding and diversifyingsymbolicworlds • Transnational agency and advocacy • New Economy – mainstreaming of principles of marketliberatiion and deregulation of the media • Changing public sphere (transnational + diasporic) • Risk society • Migration, marginalisation and social exclusion

11. Challenges for healthcomm Scope, size and interconnectedness of issues – national policy frameworks + glocal dimensions.. Reclaimingagency – TANs Questioningeconomic and ideologicallogicinforming management, org. Dev, policies. Arethere alternatives? Changing public sphere

12. Communication for social change • Rethinkingsubject, culture and social changeresults in CFSC… • Interactionbetweenpopularculture, communicationpractices and construction of meaning • Confront the structuralchallenges, linked to questions of inequity and social injustice

13. Introducing Femina HIP • Tanzanian NGO, 1999- • FocusesonSRHR and HIV/AIDS • Many donors onboard, but is a ’homegrown’ organisation • EE through real lifestories • Media outletsinclude: Two large magazines, tv talk show, radio drama, interactive website • Feminaclubs

14. Femina HIP Objectives To build supportive environments in Tanzania where: • Young people in their communities enjoy their right to access information & services and are empowered to make positive informed choices around sexuality and lead healthy lifestyles in order to reduce the negative impact of HIV/AIDS.

15. Today: Femina HIPs 2nd Objective To build supportive environments in Tanzania where: • Communities exercise their right to express themselves, participate in public debate & engage in civil society. (Femina HIP Logical Framework, 2007)

16. FEMA • FEMA. A glossy magazine, 64 pages, 170.000 copies Published 4 x year. Targets youth aged 15-24 especially secondary school students in every region of the country

17. SiMchezo • Si Mchezo! 32 pages, 175.000 copies. • 6 x year. Targets out of school youth and their communities particularly in rural areas. • Is expanding to 250.000

18. Results (1) - All secondary schools in the country have Fema magazines, read in Fema-clubs and used in class • Widespread Fema-club structure • Increased youth talk about the subjects • Changed authorities: collaboration with MOE, also on Zanzibar • Political clout

19. Tanzanian Context • Still low – but now growing- levels of participation in public life and decision-making • Changing and growing civil society • Much more diverse media infrastructure – new media emerging • Comparative advantage: Femina HIP became a visible NGO early on

20. Other Media Outlets • Pilika Pilika. A radio soap opera. Carries messages from Femina as well as two other organisations. Airs on national radio 4 times a week. • FEMA Tv Talk Show. Half ½ hour talk show. Broadcasts on national TV 4 times a week. Mobile phones are used for feedback and voting, particularly around the TV. • ChezaSalama (‘play safe’). Interactive website with a series of activities and information in English and Swahili. First of its kind in Tanzania. • Individual Publications: Range of specialist publications produced on for example HIV-testing, Treatment (500.000 copies distributed to all CTC clinics), youth empowerment (Watata Bomba, for children/youth was produced in 90.000).

21. 10 years down the line… • FEMINA HIP today: reaching 25% of the population! • Conceptualsharpening • ParticipatoryCommunication/CFSC • Exploringcitizenship and governanceperspectiveson an HIV/AIDS communicationinitiative • ExploringCFSC-orientedprocessindicators (ownership, leadership, particpation, social norms, etc) • Improving M&E

22. Re-examining results • KAP:Increasedknowledge, changing attitudes and practice • Voice:Established and growing ’discursivespaces’ • Media:Strong media vehicle for anysubject/developed media infrastructure • Organisation:Grown NGO withhugenetwork of stakeholders • Embryonic civil society at communitylevel

24. The driving forces of communication for social change • CFSC is horizontal and strengthens community bonds by amplifying the voices of the people who are poorest • people within poor communities must be the protagonists for their own change and manage their own communication tools • rather than focusing on persuasion and information dissemination, CFSCpromotes dialogue among equal voices, and debate and negotiations within communities • the results of the CFSC process go beyond individual behaviour and consider the influence of social norms, values, current policies, culture and the overall development context • CFSC strives to strengthen cultural identity, trust, commitment, voice, ownership, community engagement and empowerment • CFSC rejects the linear model of information transmission from a central sender to an individual receiver, and relies instead on a cyclical process of interactions focused on shared knowledge and collective action

25. Thanks!