Building a Social Justice Narrative for Public Health.

Public health is the place where science, policy, politics, and activism converge. Each public health issue is a snapshot where we can see the unfolding of the collective processes that define who we are, what we believe, and what we value as a society. Our professional strength is our commitment to community and social justice values, but we are challenged to effectively communicate these values in an individualistic, market-dominated society. It is this language of community, and the values it represents, that must be the core of the narrative animating a more just and healthier society. A public health perspective characterized by social justice argues that public health problems are primarily socially generated and can be predicted based on the level of injustice and inequality in a society. Thus, the solutions to such problems must be through progressive social and public health policies and are best understood as a collective responsibility shared across the various levels of society. When we can develop a narrative that effectively communicates the social justice values that are the foundation of this perspective, ours will be a society that better understands the meaning of public health and responds more appropriately to its challenges. We will then be collectively more effective in better translating our values into caring, and more effective, public policy. This will not be easy, but it will be necessary.

Framing Federal School Nutrition Policy: The Healthy, Hunger-Free Kids Act in the Nation's News.

The 2010 Healthy, Hunger-Free Kids Act (HHFKA) represented a major and controversial overhaul of national nutrition standards for foods served in the United States' nearly 100,000 public schools. To unpack how debate over this far-reaching policy was presented to the public, we examined 152 national print; network, network affiliate, and cable television; and public radio news stories about the policy, all appearing during the window surrounding its scheduled reauthorization (9/1/14-1/31/16). We found that HHFKA opponents were more likely to argue from a smaller set of frames that comprised a concise, clear narrative they frequently repeated, while proponents drew from a broader range of frames, each used less frequently, to present their position. In addition, key voices expected to be prominent in a debate over child health-children and parents-were relatively deemphasized. Overall, the primary frames on either side of this debate argued past one another, leaving largely unanswered critical charges about the role of government in assuring the public's health. This debate reflects deeper arguments at the root of many public health policy decisions, and as such, is an illustrative case example for those planning how to enter and help shape national debate over public health policy.

A Framework to Address Challenges in Communicating the Developmental Origins of Health and Disease.

Findings from the field of Developmental Origins of Health and Disease (DOHaD) suggest that some of the most pressing public health problems facing communities today may begin much earlier than previously understood. In particular, this body of work provides evidence that social, physical, chemical, environmental, and behavioral influences in early life play a significant role in establishing vulnerabilities for chronic disease later in life. Further, because this work points to the importance of adverse environmental exposures that cluster in population groups, it suggests that existing opportunities to intervene at a population level may need to refocus their efforts "upstream" to sufficiently combat the fundamental causes of disease. To translate these findings into improved public health, however, the distance between scientific discovery and population application will need to be bridged by conversations across a breadth of disciplines and social roles. And importantly, those involved will likely begin without a shared vocabulary or conceptual starting point. The purpose of this paper is to support and inform the translation of DOHaD findings from the bench to population-level health promotion and disease prevention, by: (1) discussing the unique communication challenges inherent to translation of DOHaD for broad audiences, (2) introducing the First-hit/Second-hit Framework with an epidemiologic planning matrix as a model for conceptualizing and structuring communication around DOHaD, and (3) discussing the ways in which patterns of communicating DOHaD findings can expand the range of solutions considered and encourage discussion of population-level solutions in relation to one another, rather than in isolation.

Framing Strategies to Avoid Mother-Blame in Communicating the Origins of Chronic Disease.

Evolving research in epigenetics and the developmental origins of health and disease offers tremendous promise in explaining how the social environment, place, and resources available to us have enduring effects on our health. Troubling from a communications perspective, however, is the tendency in framing the science to hold mothers almost uniquely culpable for their offspring's later disease risk. The purpose of this article is to add to the conversation about avoiding this unintended outcome by (1) discussing the importance of cognitive processing and issue frames, (2) describing framing challenges associated with communicating about developmental origins of health and disease and offering principles to address them, and (3) providing examples of conceptual metaphors that may be helpful in telling this complex and contextual story for public health.

Developmental Origins, Epigenetics, and Equity: Moving Upstream.

The Developmental Origins of Health and Disease and the related science of epigenetics redefines the meaning of what constitutes upstream approaches to significant social and public health problems. An increasingly frequent concept being expressed is "When it comes to your health, your zip code may be more important than your genetic code". Epigenetics explains how the environment-our zip code-literally gets under our skin, creates biological changes that increase our vulnerability for disease, and even children's prospects for social success, over their life course and into future generations. This science requires us to rethink where disease comes from and the best way to promote health. It identifies the most fundamental social equity issue in our society: that initial social and biological disadvantage, established even prior to birth, and linked to the social experience of prior generations, is made worse by adverse environments throughout the life course. But at the same time, it provides hope because it tells us that a concerted focus on using public policy to improve our social, physical, and economic environments can ultimately change our biology and the trajectory of health and social success into future generations.

From fatalism to mitigation: A conceptual framework for mitigating fetal programming of chronic disease by maternal obesity.

Prenatal development is recognized as a critical period in the etiology of obesity and cardiometabolic disease. Potential strategies to reduce maternal obesity-induced risk later in life have been largely overlooked. In this paper, we first propose a conceptual framework for the role of public health and preventive medicine in mitigating the effects of fetal programming. Second, we review a small but growing body of research (through August 2015) that examines interactive effects of maternal obesity and two public health foci - diet and physical activity - in the offspring. Results of the review support the hypothesis that diet and physical activity after early life can attenuate disease susceptibility induced by maternal obesity, but human evidence is scant. Based on the review, we identify major gaps relevant for prevention research, such as characterizing the type and dose response of dietary and physical activity exposures that modify the adverse effects of maternal obesity in the offspring. Third, we discuss potential implications of interactions between maternal obesity and postnatal dietary and physical activity exposures for interventions to mitigate maternal obesity-induced risk among children. Our conceptual framework, evidence review, and future research directions offer a platform to develop, test, and implement fetal programming mitigation strategies for the current and future generations of children.

Moving nutrition upstream: the case for reframing obesity.

Currently, nutrition is described primarily as a matter of individual responsibility, which results in a focus on limited strategies that are unlikely to be successful. Public health advocates need to change the terms of debate or "reframe" the issue so that the context around individuals-the social, economic, and political context--comes into view. This paper uses obesity as an example of the need for reframing in nutrition. The authors also offer some suggestions on reframing based on lessons learned from other public health issues.

Successful public policy change in California: firearms and youth resources.

The California Wellness Foundation's Violence Prevention Initiative (VPI) was a 70 million dollars, 10-year effort to reduce violence among California youth. The Policy and Public Education Program of the initiative advanced two broad policy goals: (1) limiting the availability of handguns to youth, (2) increasing the state's investment in youth resources. Roughly 110 communities passed more than 300 ordinances to limit gun availability or promote gun safety. In addition, California legislators passed 24 statewide gun laws. Funding for youth programs increased to more that 368 million dollars in 2002-03, from about 100 million dollars in 1996-97. Using a framework adapted from the social movements and political communications literature the importance of four key elements was apparent in the VPI: articulating clear policy goals, strategic issue framing, capitalizing on political opportunity, and effectively mobilizing resources. The impact of new gun policies, increased funding for youth programs, and a diverse network of policy professionals and issue advocates interested in social change to decrease violence remain to be fully understood.

More than a message: framing public health advocacy to change corporate practices.

Framing battles in public health illustrate the tension in our society between individual freedom and collective responsibility. This article describes how two frames, market justice and social justice, first articulated in a public health context by Dan Beauchamp, influence public dialogue on the health consequences of corporate practices. The authors argue that public health advocates must articulate the social justice values motivating the changes they seek in specific policy battles that will be debated in the context of news coverage. The authors conclude with lessons for health education practitioners who need to frame public health issues in contentious and controversial policy contexts. Specific lessons include the importance of understanding the existing values and beliefs motivating the public health change being sought, the benefits of articulating core messages that correspond to shared values, and the necessity of developing media skills to compete effectively with adversaries in public debate.

Talking about public health: developing America's "second language".

The mission of public health--improving the health of populations--is difficult to advance in public discourse because a language to express the values animating that mission has not been adequately developed. Following on the work of Robert Bellah, Dan Beauchamp, and others, we argue that the first "language" of American culture is individualism. A second American language of community--rooted in egalitarianism, humanitarianism, and human interconnection--serves as the first language of public health. These values resonate with many Americans but are not easily articulated. Consequently, reductionist, individualistic understandings of public health problems prevail. Advancing the public health approach to the nation's health challenges requires invigorating America's second language by recognizing the human interconnection underlying the core social justice values of public health.

Evaluating a campaign to detect early stage breast tumors in the United States.

Growing concern over failure to detect early stage breast cancer has led communities across the United States to participate in the Breast Cancer Awareness Month program. This program mobilizes local public and private institutions, particularly the media, to reach a large audience each October with information on salutary behaviors, including screening, and on resources that can assist newly motivated audiences to adopt the behaviors. Although the scholarly literature includes no assessments of the effect of the program on the actual detection of early stage breast tumors, similar programs targeting other illnesses (e.g., AIDS) are quickly emerging. We attempt such an assessment by applying time-series designs to 92 quarters (beginning January, 1975) of data obtained from cancer registries in the Atlanta and Detroit metropolitan areas as well as in the San Francisco Bay Area. We find that the detection of in situ and local breast tumors increased in all three communities during the quarters that included Breast Cancer Awareness Month. We conclude that community mobilization may have its intended benefit but suggest that community organizers not ignore unintended costs including the emotional and physical sequelae of false positives.