Project’s Project
The research project aims to understand the communication of health public policies in Portugal. Given the scarce studies found on the subject, the project, based on the literature review conducted, undertakes to answer the research questions: How is the Portuguese governmental communication message of health public policies characterized?; How do the media communicate health public policies in Portugal?; How do governments and journalists relate to communicate health policies in Portugal?
In this sense, the project adopts the mixed method, including content analysis and rhetorical analysis to the message of governmental communication of health public policies, content and discourse analysis to news about these subjects, and qualitative, semi-structured and in-depth interview to the actors involved. The cases under analysis are the governments of Pedro Passos Coelho (2011-2015) and António Costa (2015-2022).
Several authors recommend that the governments should assume a more active role in the meaning making of the policy. Knowing how to communicate policies is essential because citizens need to understand decision-making – the pillar of democracy – and to access, understand, and use health content for their benefit. The literature shows the relation between communication and effectiveness of public policy. Communication, when used competently, can save lives.
It is trusted that the proposed project will have a high scientific and applied contribution, and may be of value to various stakeholders. It is a project that aims to improve the communication of health public policies, having this macro rather than micro potential, going beyond the improvement of a health measure.
Project’ social impact
This project seeks to respond to challenges and needs identified in the literature. For example, it considers: a) the Healthy People 2030 commitment, which focuses on keeping people safe and healthy through policies. To optimize this scope of public health policies, communication must have qualities that make them accessible, understandable and useful for citizens; b) the finding of several authors, who recommend that governments strive to assure key communities that their concerns and information needs are understood, adapting recommendations and messages to address the audiences they represent (Tangcharoensathien et al., 2020); c) the results of the study of Jo and You (2019), which suggests that the government should assume a more active role in the meaning making of the policy.
The need to communicate health competently is more pressing given that 61% of the Portuguese population surveyed in the European Health Literacy Survey (HLS-EU-PT) has a problematic or inadequate level of general health literacy (Pedro et al., 2016), meaning that more than half of the Portuguese people reveal difficulties in accessing, understanding and using health resources. Low health literacy has been associated with riskier health choices, non-adherence to medical therapies and treatment plans, poor patient self-care, high health care costs, increased risk of hospitalization and mortality and the reinforcement of social inequalities.
Linking the present research proposal and the sustainable development goals (SDG) 2030 agenda, it can be said that the results of the proposed project can contribute to:
Goal 3 - good health and well-being: The literature and human experience confirm that "the first wealth is health" (Emerson, 1860), since without health all other components of quality of life have little value (Stiglitz et al., 2009, pp. 156-157) and "good health is the foundation on which to build - a life, a community, an economy" (Hayden, 2014, para. 2). The proposed project, by focusing on the study of communication of health public policies and noting a tendency in the literature to emphasize communication as a catalyst for results (e.g., Quy & Ha, 2018), is assumed as a contribution to improving the health and well-being of citizens. Expressions such as "healthy thanks to communication" (Belim & Vaz de Almeida, 2018), "open the door of communication for better health outcomes" (Vaz de Almeida & Belim, 2019), "the key to a healthier tomorrow" (Ratzan, 1994, p. 202) are examples that reflect the value of communication for health. Ratzan (1994) emphasises that effective communication between participants, advocates and publics becomes the currency to achieve optimal health (p. 202). Citizens, by fully understanding the substance and information of the public policies decided and communicated, will be able to better translate the usefulness of these public policies into their health literacy and their health.
Goal 10 - reduce inequalities: By betting on better government communication on health public policies and having most citizens understand these public policies transmitted, inequalities between those who have more and less information and knowledge are reduced and, therefore, between those who have more and less power at this level. It is known that information and knowledge are power (Bacon, 1597), being an important capital for making informed and enlightened decisions. In contextual terms, it is noted that the pandemic of covid-19 worsened health inequalities in access to health, leaving the poorest more unprotected (Santinha & Perelman, 2022, p. 10). Also a study based on the sixth National Health Interview Survey - 2019 showed that the prevalence of several diseases was substantially lower among individuals with higher levels of education compared to lower levels, adjusting for age (Perelman, 2022). For example, compared with men with the lowest level of education, a lower risk was measured for men with tertiary education for cardiovascular disease (-90%), chronic bronchitis (-75%), stroke (-70%), diabetes (-62%), hypertension (-41%) and obesity (-43%) (Perelman, 2022, pp. 443, 445). Given this scenario, by investing in a more effective communication with qualities that allow it to be more accessible and better understood regardless of educational qualifications, social inequalities can be mitigated and combated by providing individuals with health literacy, which, as we know, saves lives (Walensky, 2022, para. 2).
Goal 16 - peace, justice and strong institutions: The proposed project contributes specifically to fulfil "target 16.6 - Develop effective, accountable and transparent institutions": the project aims to identify ways, through communication, to provide the government and the entities that disseminate health public policies with greater strength and confidence. For example, Kim and Kim (2020) shows that there are structural relationships between government communication and public acceptance through the mediation of components of actionable core drivers of public trust (responsiveness, reliability, integrity, openness, and fairness) and that the public may accept certain government policies through complex cognitive processes from their perception of government communication that affects their trust on the government rather than just from their preference or rational choice on policies; "target 16.7" - Ensure responsive and inclusive decision-making" that considers different needs and characteristics of citizens, who, by accessing and better understanding the information of communicated health public policies, are able to use that information to benefit their health and that of their communities and make informed and reasoned health decisions (health literacy); "target 16.4" - Ensure public access to information": through the promotion of public discussion and the sharing of a set of results, and thus knowledge, and good practices that this project intends to gather, it will be possible to help institutions to reflect on practices of informing the citizen about health and contribute to optimize public access to health information, useful for decision making and that can save lives.
Various stakeholders and groups of individuals, such as government and governmental institutions (e.g., Ministry of Health, Serviço Nacional de Saúde, Direção-Geral da Saúde), health associations, hospitals, health centres, citizens in general can benefit from the proposed project through public and free access to its results, available in various outputs (e.g., e-book, good practice guide, videos, scientific articles, webinar, conferences). The health public policy sender will have at his/her disposal results and knowledge that can help him/her communicate competently and effectively with the citizen(s). Citizens, given the process and effects of communication, will benefit from accessible, understandable and useful health communication, among other qualities, which will translate into their health literacy and their health. Academia will also benefit, as, with this study, an attempt is made to fill a research gap on health public policy communication in Portugal and to strengthen and tighten the relationship between Academia and society. And as Azamfirei (2016) refers: "scientific knowledge is shared through publications that not only inform, but have the capacity to influence decision making" (p. 65).
