Can reframing public health advocacy create positive change?

Man pretending to 'hold up' a large boulder on a desert-like plain.

Shelby Craig, former PHAA intern

With key public health issues such as gambling and climate change regularly making the headlines, it’s worth critically reflecting on how messaging around these topics is framed.

Frames are mental structures that shape the way we see the world, including perceptions of who or what is responsible for an issue. This is important in the health sector, particularly when the media play a significant role in framing of health issues evident in often sensationalised stories of “problems” that need to be “fixed”.

This ‘deficit discourse’ represents and frames people or groups by deficiency – absence, lack or failure, and is especially pervasive in relation to First Nations peoples and other marginalised groups. Deficit-based language can often appear innocuous, framing a problem around the result of inadequate or poor diet, obesity, or unhealthy lifestyle.

This language serves to emphasise individual problems and responsibility without acknowledging the larger socio-economic, political, and environmental structures that may act as barriers to health.

While these deficit-based approaches may intend to create positive change, this type of framing perpetuates stigmatisation, power imbalances and disempowerment. In contrast, a strengths-based approach:

  • Doesn’t diminish a problem;
  • Offers an alternative language and set of solutions;
  • Shifts the focus from risk factors to protective and health promoting factors;
  • Recognises that strengths within individuals and communities can be built on;
  • Focuses on assets and capacities;
  • Identifies barriers and how existing resources may be built upon;
  • Creates space for conversations and exploration of community-based solutions; and
  • Provides opportunities to strengthen partnerships and facilitate collaboration.


Junk food advertising and children

One of the resounding messages emphasised during my Masters of Public Health was that of a strengths-based approach to health. With that message firmly embedded, I was curious about the use of language at a roundtable on junk food advertising and children. Framing often focused on negative consequences of not taking action, and the negative impacts on industry, as opposed to the positive outcomes that may result.

Some considered that, within policy, disparities and negative outcomes are more ‘newsworthy’ and ‘attention grabbing’ than positive stories, thus it may be beneficial to adopt a deficit frame to define a policy target area.

While significant discussion surrounded the negative consequences of inaction, which aids in clarifying challenges and potential costs, this proposed bill is a step towards a strength-based policy that considers the wider environment on food choices.


Measuring What Matters

The Australian Government’s proposed ‘Measuring What Matters’ framework is one example of moving towards strengths-based framing. While the framework still includes some deficit markers, it incorporates holistic and strengths-based views of the community’s well-being.

PHAA has advocated for the government to expand their proposed framework to include additional strengths-based or positively framed indicators and measures. Ideally, government would embed these into ongoing policy-making and budget-setting procedures across departments.

PHAA’s proposed measures have been derived from established wellbeing frameworks in Canada (Quality of Life Framework), New Zealand (Living Standards Framework), Scotland (National Performance Framework) and Iceland (Well-being in Iceland). They include the ability to express identity, Aboriginal and Torres Strait Islander connection to culture, sense of belonging, satisfaction with personal relationships, life satisfaction, work life balance, and sense of meaning and purpose. These indicators are important in facilitating a more informed and inclusive policy dialogue.


Engaging in a strengths-based approach

Hill (2008) further outlines ways social policy could better engage in a strengths-based approach:

  • start with a goal statement, and redefine the problem as a barrier(s) to achieving a goal;
  • be open and inclusive of the target populations of the policy;
  • begin with the “strengths, competencies and resources needed for preventing or dealing with adversities rather than the deficits, pathologies and deviance that can result from them”; and
  • focus on long-term approaches and responses.

There is growing evidence to suggest that employing strengths-based approaches and focusing on health assets can counter negative social and economic determinants of health. But it’s also important to recognise that, in some circumstances, deficit language may be a powerful tool to influence change, especially within health policy. However, this must be done consciously and carefully to ensure the values of dignity and respect are upheld, and the systemic factors are highlighted and held accountable.


Image: Vicky Sim/Unsplash


Note: Article updated 05/04/2023 to include third heading.

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