The World Health Organisation (WHO) lists air pollution and climate change among the top public health threats facing the world today. For both, actions are needed at multiple levels — global, central, state and local governments and individuals. Effective public health efforts against these problems depend on being able to get them to work together. This is challenging as each stakeholder comes with its own priorities and there is a lack of common understanding.
How we frame the problem decides how people respond to it. Framing goes beyond mere education by linking the issue to a value that people hold dear. An issue can be viewed from a variety of perspectives and be construed as having implications for multiple values or considerations. By framing it in a particular way, we help people conceptualise the issue in that manner or reorient their thinking.
Framing a problem is an inherently political process and vested interests are involved. Politicians, governments, international organisations, civil society and advocacy groups – all try to frame an issue that serves their interests and gets more people behind them. It also simultaneously ruffles someone’s feathers.
Framing is at the core of any successful advertising campaign. For example, the “stop smoking if you love your daughter” campaign. Here, rather than adopting the “smoking kills” frame, the advertisement adopts a “love-your-daughter” theme – an emotive angle. While it is more likely to grab eyeballs, whether it causes a sustained change in behaviour is debatable. Messages aimed at changing behaviours can be framed to highlight either the benefits of engaging in a particular behaviour (gain frame) or the consequences of failing to engage in a particular behaviour (loss frame).
Three common frames are used extensively in public health — security, moral, and technical. In a security framing, the issue is presented as an existential threat to a person or society (HIV/AIDS is a good example). Moral framing pitches it as an ethical imperative or a larger societal good (water is precious). Technical framing as an evidence-based, rational investment (vaccination). While the technification frame appeals most to academic people, it is perhaps the least effective.
The use of the term “threat” by WHO for public health issues is indicative of its application of a “security” frame. While it is generally advised not to use “fear” in public health communication, evidence shows that it is effective, especially when combined with other efforts. Submerging of homes or villages in a flood is the “end-of-the-world” scenario often utilised in climate change campaigns. Many people may not identify with such doomsday scenarios as they believe that the probabilities of these occurring are low and in too distant future. Denial of the problem is also a framing. Evidence to show that such catastrophes are not that distant may appear to them as lacking credibility. Why should one bother to do something, if it is unlikely to occur in his or her lifetime? Even air pollution is seen as a short-term problem not need sustained change.
While air pollution and climate change have their roots outside it, the health sector bears the brunt of its consequences. If we frame these primarily as health problems, non-health sectors are not keen to be part of the solution. We have seen very little real participation from non-health sectors in addressing non-communicable diseases even though we have a well-intentioned multi-sectoral action plan. This is because of different sectoral priorities, lack of coordination, unclear expectations to and from stakeholders. Why should the results of climate change be any different?
Often, climate change conversations get caught up in the “development” debate. In international negotiations, India often takes the stand that developed countries are the main cause of the problem and till we catch up, we should be allowed to “pollute” – an equity or moral frame. While it may be appropriate from a global perspective, it encourages the same logic to be applied by states and individuals. In an analogous way, they can argue that no change is needed at their level. There always will be someone who pollutes more and questions about who should change first. This releases entities from their moral obligation to do anything.
Activists want to frame environmental problems as a “rights” issue – the right to clean air and water, which in a way shifts the responsibility onto the government. While experts and courts may call for bans on crackers during Diwali using a technical-logical frame, people may frame it as a moral issue, with hues of religious discrimination, denial of basic rights etc. The promotion of community fireworks during Diwali goes against societies’ individualist framing of the festival. The occasion has become synonymous with individual displays of wealth — bursting crackers for X amount gives one bragging rights.
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If these issues are framed as the community’s or everyone’s problem, then we run the risk that everyone thinks that someone will do it, and no one does. Why should one forgo convenience with no subsequent gain? Why change till one senses that a critical mass has been reached — circular logic that prevents the critical mass from being reached.
People may keep faith in science to find solutions before doomsday or may use it as an excuse to not change. Ultimately, depending on their understanding of the world and their own framing of the problem, people will provide legitimacy and motivations to their actions. As long as environmental issues continue to be seen from an “us versus them” lens, we are unlikely to make progress. We need to replace this multiple contradictory framing with a predominant win-win framing to make any progress, even as the doomsday clock keeps ticking.
The writer is professor at the Centre for Community Medicine at the All India Institute of Medical Sciences, New Delhi. Views expressed are personal
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