Creating a healthy society requires greater action on the wider determinants of health. However, in the public debate about how to improve health in the UK, health inequalities and the wider determinants are often left out or misunderstood.
The Health Foundation has been working with FrameWorks over the last few years to try to help people think differently about health. We spoke to their Director of Impact, Maria Castellina, to find out more about the work and why framing an issue differently is so important.
What is framing and why does it matter?
Framing refers to the choices we make about what we say and how we say it: how we explain an issue, what we emphasise and the things we leave unsaid. Using a particular frame is essentially choosing to tell a different story – one that will improve understanding and build support for the changes we want to see. And that matters, because it can lead to radical changes in how people think, feel and act.
How has this approach helped to bring about changes in public thinking and policy?
I’ll give you a couple of examples. The first is work we did with a new youth-led organisation called Bite Back 2030. We developed framing recommendations to use in their campaigning work to improve child health.
When people think about child obesity, they tend to blame parents for making bad choices about diet. But the world around us shapes how healthy we can be. Are there shops nearby selling healthy food, or is the neighbourhood flooded with junk food?
Consistently telling a different story about child health over the last couple of years is starting to translate into policy support. Their recent #SpillTheBeans campaign led to a commitment from government for better monitoring and regulation of food standards in schools.
Another example of framing in action is the smoking ban. Smoking used to be seen as an issue of personal choice. When people saw smoking in that way, it was much harder to get them to support any big picture action. But when the conversation shifted to how it was unfair that second hand smoke was killing people, particularly employees having to put up with unhealthy working conditions, that really changed how people viewed the issue.
Over time that focus on the need to protect people ultimately led to the smoking ban. And now there's a completely different attitude towards smoking in this country than there was back in the 1990s.
Tell us about your work with the Health Foundation to help people think differently about health
Almost every aspect of our lives shapes our health. Whether that's our jobs, homes, access to education or whether we're experiencing poverty. It all influences our opportunities to be healthy. The trouble is that those wider determinants of health are often completely missing from any public and political debate. Instead, we tend to focus on health care, and on the choices we make as individuals. This is a problem. It creates a mismatch between what gets talked about, and the real action needed to create a healthier UK.
The Health Foundation commissioned FrameWorks to work on this challenge with them. We used both in-depth qualitative and large-scale quantitative surveys as part of the research process, to understand how people think about health. We then developed a strategy for what frames we can use to shift that thinking.
One of our main findings was that applying the metaphor of the ‘building blocks of health’ can be a particularly powerful way of increasing people’s understanding of the wider determinants of health using simple language.
How are you helping professionals make use of the new framing recommendations?
We’ve just published a new practical toolkit to help people use this framing in their communications. It shows how to apply the framing strategy, but also gives tips and suggestions drawn from framing best practice. For example, thinking about the order in which you say things (because normally what you start with is remembered most). And how you want to take people on a journey in their understanding of an issue, leaving them with a solution at the end.
The toolkit sets out how you can use those approaches, whether it’s in a 240-character tweet or a detailed report. It will be helpful for anyone working in health and care, but particularly public health practitioners and those campaigning around these issues.
What difference do you hope this will make?
We want people to take this knowledge and use it to help shift the conversation to one that will lead to improvements in health in the UK.
It’s a good time to be doing this. One of the knock-on effects of the pandemic is that it really demonstrated the impact of inequalities on health and helped build a bit more public awareness that health differences aren’t just down to individual choices. There’s an opportunity for us to build on that increased understanding even further now.
It’s also encouraging that there seems to be a huge appetite for this work from health professionals, particularly those working in public health. Many already understand the evidence. They know we need to tell a new story, and they welcome any help to do that. Our hope is that if we can upskill people, we really can start to change the way health is talked about – in the press, by the public and by politicians. That will lead to real policy and practice change because there will be clear demand from the public for more action on all the wider determinants of health.
This content originally featured in our email newsletter, which explores perspectives and expert opinion on a different health or health care topic each month.