COVID-19 Communication: Fuel for Social Distrust
If you watch closely from within the society you can see the world is in an utter state of confusion and disarray.
Volatility, disbelief and fear are the three essentials that are ravaging our society. That is, if you are a part of the suffering society.
However, if you are a bureaucrat, your experiential landscape is completely different. Governed by the diktats of donors (and/or political leaders ) the pressure on bureaucracy is to produce quantifiable results!!!!
The Need for Effective Communication
The world witnessed HIV and AIDS. In 1981 first case was reported in USA and then over decades spread to several countries. Severe Acute Respiratory Syndrome (SARS, 2002-2003) originated in China and spread to nearly 29 countries, Swine Flu (2009-2010) appeared in Mexico and then spread to atleast 30 countries and Ebola (2013-2014) appeared in Africa and spread to at least 10 countries. It was the geographical spread of the virus which earned them the title of a pandemic. People affected by these viruses did not reach the proportion of either HIV or the current COVID-19.
In the absence of a vaccine, communication with focus on risk communication forms an integral part of non-pharmaceutical interventions (NPIs). In 2005 the International Health Regulations underscored the importance of risk communication as a health intervention. Later on, risk communication became central to WHO’s Pandemic Influenza Preparedness Framework.
The Learning from Previous Pandemics
1. HIV demanded the shift in discourse to risk communication;
2. SARS taught us the need to address mental health issues of people in isolation and healthcare workers.
3. MERS, Ebola highlighted the importance of real time monitoring of health data, importance of usage of advanced technology in healthcare.
How WHO (World Health Organization) Handled the Communication During COVID-19?
A dedicated webpage was designed on COVID-19 to tell the world on how to tackle the pandemic to reduce risk of getting infected. Graphic designers got in the game. They actively participated in spreading COVID19 awareness
In fact, there are quite a few similarities between HIV and COVID-19:
1. Both started with no vaccine for cure.
2. Both the pandemics have created social and moral panic.
3. HIV was slow onslaught and took nearly four decades to cause disruptions but similar to COVID-19, HIV had unprecedented impact on public health, human development and individual lives.
4. HIV made it evident that individual-centered risk reduction strategies have limited success since they discuss risk in a social vacuum.
HIV encouraged bottom-up approach in health communication.
The emphasis was on the need for communication for social change - ‘process where “community dialogue” and “collective action” work together to produce social change’.
In reality, the perception of risk is intertwined with the social context of the individual. Hence, health communication should understand and address the lived realities of individuals.
Driving COVID-19 Awareness Becomes A Bureaucratic Tool of Control
Ministry of Health and Family Welfare (MoHFW) in India developed officially a plethora of Information, Education and Communication (IEC) materials related to COVID-19. Along with print and electronic media; social media was used extensively to connect with the people. There was a dedicated webpage on COVID-19 on the website of Ministry of Health and Family Welfare (MoHFW).
The Ministry of Health ensured greater stakeholder engagement in risk communication by networking with different departments such as department of telecommunication, postal services etc.
The IEC materials addressed various issues - health risks, mental health, empathy, care and support, stigma and discrimination. There are messages such as ‘Do not stigmatise patients and family members’, ‘Do not stigmatise Covid-19 survivors’, ‘Standing together against Covid-19 stigma’. A psycho-social toll-free helpline has been created for better community engagement. For the first time, there is a series of communication materials talking about the contribution of the front line workers, their need for protection and the responsibility of the society to be respectful towards them.
A FEAR MONGERING POSTER!!!
Glaring Blind spots in COVID-19 Communication
Communication 'materials' with no community connect. Notwithstanding the positive endeavour of MoHFW, several challenges still remain.
Bridging Gaps or Deepening Inequalities?
By upholding the globally coined language of 'social distancing' but not WHO health advisory of 'physical distancing' as key to risk reduction communication existing inequities in the pre-COVID society in India is only deepening . Social discrimination, stigmatization of social classes, COVID positive patients are becoming ground realities of extremely added pain in the state of utter confusion in the economically shattering society. The Indian caste system thrives on the idea of "social distancing" !! . The practice of purity and pollution is through the exercise of social distancing between castes. The upper caste maintains its purity by socially distancing themselves from the impure, lower caste. As history shows the concept of socially distancing is inherently divisive. So, for such a society insensitive communication material is deepening the crisis to the extreme.
Globally coined "Social distancing" also implies people have the requisite resources and the enabling environment to adopt such preventive strategies. As yourself, can a daily wage earner, migrant labourer and countless homeless; who jostle for space, living in urban slums afford to practice social distancing when they need to depend on larger society for their livelihood by providing domestic help and running errands, selling what little skills they have?
No Bureaucratic IEC materials address the vulnerability of groups such as migrant labourers, homeless people, sex workers and others. As if it was to protect only urban rich.
STAY HOME, STAY SAFE WORKS ONLY IF YOU HAVE A PLACE TO LIVE IN
The approach remains top-down, 'control and convey', rather than being bottom-up. Moreover, given the socioeconomic realities of millions of people in India, as they try to navigate through survival, hunger and health; do you think it is possible for them to actually practice such elaborate norms of hand wash, sanitization practices and social and physical distancing.
In reality, COVID-19 communication highlighted a human society that has been blind to the basic needs of clean water and clean living spaces. The biggest cause of concern in the Indian context has been the uncritical acceptance of the global framework of "social distancing" risk communication.
1. Governed by the diktats of donors the pressure on bureaucracy is to produce quantifiable results.
2. Official reports are on headcounts.
3. National achievements are shown in Counting numbers of IEC materials produced, new media used, number of NGOs supported in communication materials preparation, people to whom these have been told.
If we observe the pattern of risk communication in India, it becomes apparent that the exercise is an attempt to respond to the bureaucratic targets of preparing information book, reports rather than to uplifting the lives of people. Failure to connect to societal dire needs is the recipe for social distrust with very long term negative impact on sustainable progress.
HIV had clearly shown that health communication is effective only when social norms and cultures are honored. National strategy can be stronger if it is NOT donor driven. Community practices, socio-cultural wisdom can enrich risk communication. Health communication will be inclusive, empowering and sustainable only when there is greater community involvement, articulation of local knowledge in health messages, existing power structures and inequalities are challenged. Sustainability depends on a hyphenated relation between global and local; we cannot let one overpower the other.
Take home messages from Covid-19 for way forward ?
a. Customize locally appropriate health messages
b. Local words, visuals and faces from the community should find a space in health-related materials.
c. Decentralize the process of health promotion
d. Health sector experts, workers to take lead rather than the standard bureaucracy
e. People need to be proactive even when this Pandemic is over and prepare dos and don'ts.
f. Investment and Wider engagement on a continuous scale in community health promotion and training.
g. Health and hygiene provision and training at all scales as basic human right
h. Local institutions to be engaged in documentation and dissemination of local/traditional practices of good health.
i. Information, communication and Education (IEC) materials need to be continuously taught to the society.
i. IEC should consciously highlight the healthy practices already in place and practiced by diverse communities.
j. Health exhibits at the community level in the local language to sensitize people.
We should not forget that in India, despite vaccines, every year seasonal measles attack is an annual phenomena. Family level Quarantine of the patient is a common family practice. The individual remains in self-isolation for three weeks. Such practices neither arouse stigma nor do they create any panic in the society. Instead of blindly following the global hype, we need to dip into our cultural intelligence and our sub-conscious wisdom. In doing so, we need to resort to messaging that uses local art forms to connect with community better.
Sreerupa Sengupta, works in the space of gender, media, public policy and human rights