Message design strategies to raise public awareness of social determinants of health and population health disparities

Milbank Q. 2008 Sep;86(3):481-513. doi: 10.1111/j.1468-0009.2008.00530.x.


Context: Raising public awareness of the importance of social determinants of health (SDH) and health disparities presents formidable communication challenges.

Methods: This article reviews three message strategies that could be used to raise awareness of SDH and health disparities: message framing, narratives, and visual imagery.

Findings: Although few studies have directly tested message strategies for raising awareness of SDH and health disparities, the accumulated evidence from other domains suggests that population health advocates should frame messages to acknowledge a role for individual decisions about behavior but emphasize SDH. These messages might use narratives to provide examples of individuals facing structural barriers (unsafe working conditions, neighborhood safety concerns, lack of civic opportunities) in efforts to avoid poverty, unemployment, racial discrimination, and other social determinants. Evocative visual images that invite generalizations, suggest causal interpretations, highlight contrasts, and create analogies could accompany these narratives. These narratives and images should not distract attention from SDH and population health disparities, activate negative stereotypes, or provoke counterproductive emotional responses directed at the source of the message.

Conclusions: The field of communication science offers valuable insights into ways that population health advocates and researchers might develop better messages to shape public opinion and debate about the social conditions that shape the health and well-being of populations. The time has arrived to begin thinking systematically about issues in communicating about SDH and health disparities. This article offers a broad framework for these efforts and concludes with an agenda for future research to refine message strategies to raise awareness of SDH and health disparities.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Communication
  • Community Health Services / organization & administration*
  • Community-Institutional Relations
  • Health Promotion / organization & administration*
  • Health Services Accessibility / organization & administration
  • Health Status Disparities*
  • Humans
  • Medically Underserved Area*
  • Minority Groups / statistics & numerical data*
  • Primary Health Care / organization & administration*
  • Social Marketing*
  • Socioeconomic Factors
  • United States / epidemiology