Including Communities in Public Health Action: Harnessing Best Practices

The engagement and inclusion of people, and of their communities, is a vital element of any public health strategy. The willingness of professionals to prioritize engagement and inclusion, and to communicate in ways that reflect this priority, is a key determinant of the extent to which the strategy will succeed. This was evident to me during the 2014–2015 Ebola outbreak in West Africa. Subsequent reviews of the Ebola response, including the report of the High-Level Panel on the Global Response to Health Crises, have highlighted the need for responders at all levels to prioritize the engagement of communities, to do this effectively, and to reflect this emphasis in their communication practices.

The UN Global Health Crises Task Force was appointed by the UN Secretary-General in 2016 to catalyze action and monitor implementation in relation to the High-Level Panel’s recommendations. The Task Force members have taken a clear position that communities should be densely engaged in all health activities that relate to the identification and management of potentially serious events. The activities concerned include preparedness, detection, response, research, and prevention. Community engagement needs to be treated as an essential activity, ongoing and continuous, and not as something to be initiated when a crisis emerges and discontinued once it has been resolved. Responders of all kinds should seek to engage with, and involve, communities in ways that reflect best practice, paying attention to the sensitivities of communities about the ways in which external actors should behave when engaging with them.

The UN Global Health Crises Task Force has also underscored the importance of timely dissemination of accurate information during public health crises—even when the understanding of a sickness and its determinants is incomplete. Indeed, it is during times of uncertainty that the need for clear, coherent, and consistent risk communication is greatest. The Task Force members take the view that transparent sharing of information fosters trust and helps communities to take decisions that are based on available evidence rather than hearsay.

The articles in this special issue of the Journal of Health Communication: International Perspectives examine the role of communication, community engagement, and social mobilization during and after the Ebola response. The observations and recommendations conveyed in the articles will be of interest to a broad range of public health practitioners. They propose, for example, that communities be regarded as experts in their own culture and as sources of solutions and innovation. They maintain that communication is most effective when information is conveyed by individuals who are known and trusted by communities and when communication channels encourage participatory dialogue. They suggest that care is taken to appreciate the impact of social media and new communication technologies—and to use these means sensitively. They indicate the ways in which efforts to reach marginalized or out-of-reach communities (whether due to economic, political, geographic, or social factors) should take their literacy, language, and access to technology into account.

Many variables have the potential to influence the efficacy of health communication. There is an evolving body of best practice on how to engage and include communities in public health action. These articles demonstrate ways in which these practices can be harnessed to enable communities, nations, and regions to be better prepared for events that threaten the health of their people. They show what is known; they also highlight the need for additional research. Most of all, they remind us that the most important determinant of whether communities are engaged in health action is the willingness of professionals to make this a priority and to be accountable for ensuring it happens.