True story. Over twenty years ago, two children in the village I live in Switzerland set out to buy a mouse, doting grandma in tow. She asked if they had sought parental permission before bringing the rodent home but the children were already running towards the computer shop. The grandma’s worries dropped only after she saw the mouse. What, you may ask, is the link between the preceding lines and Coronavirus? Plenty.
Truer story. I have been speaking to a wide range of people in the health sector in Europe for the past three weeks. Even the most knowledgeable are watching and waiting to see how and where the rate of infection spreads and what is the best way to communicate without raising panic. We are all talking about the same mouse across generations, socio-economic strata and understanding without knowing which way it will turn when, how and where. This virus, this thing virus, this thing, that thing is how it is being called depending upon who you are speaking to.
It is common knowledge for people who work in public health communications that language influences thinking and context influences policy. Before I address the problem of why health communications is critical in public health, let me say this. The new Coronavirus outbreak the world is witnessing is flu at best and death at worst and people with underlying conditions, the elderly and the infirm have to be especially careful. There’s an entire gamut of diagnoses in between and the seriousness can only be determined with immediate tracking and tracing the moment a person has symptoms that mimic a cold.
No one goes to a hospital for a cold. Given what this cold could mean if not traced and followed, no country in the world is prepared for the scale at which this can spread. India is not in a good position because our primary health care system is next to non-existent, most Indians pop a paracetamol or self medicate when they have a cold and poor people cannot afford to fall sick. Coping with this virus is a health systems and communications issue for governments as much as it is a curved ball for researchers and doctors. Most health ministries in the world including in India have to be on alert.
Calming down without panic is new vocabulary. People do not understand what medium and high alert means in countries like India where public health should be a daily emergency, not once declared internationally.
The world does not understand the language of public health because public health experts don’t speak to the world except when there’s a crisis and even then they use words few understand. They believe you have to be a medical doctor to work in public health. Public health advocacy is all about building trust on a regular basis and includes lawyers, media, economists and ethicists. Trust cannot be manufactured rushing to claim the conversation after the damage is done – as is happening with the virus – is perhaps the worst way to communicate. In this case the situation is compounded by the simple fact that sources I routinely check for health outbreaks from various perspectives contradict each other.
Even in Italy –where several cities in the north are under lockdowns, people do not understand what that means. If an entire building is locked down, what happens to people living in it who test negative? Where do they go? Similar questions across Switzerland where numbers are rising, mainly traced to Italy. The Swiss health system is wired to sound, health insurance is mandatory covering eventual hospitalisation and hotlines are ready. Is the United States (US) ready? In a deeply litigious country, who will take care for the some 26 million people who have no insurance?
Poor nations like India are in a double bind. An agricultural economy, ‘experts’ foisted the Fourth Industrial Revolution bus on us when most of us walk for miles to get to a bus picking up communicable and non-communicable diseases as we wait for food and water. What is the industrial nomenclature for the Coronavirus outbreak? It has to be trendy enough to invite money. Poor people are not trendy and this is where I find the response of international public health experts and their national champions leagues including in India deeply disturbing.
They above all know best that their parachuting ‘expertise’ is not feasible because poor countries do not have the capacity to absorb money and resources out of the blue. Cancer, malaria, diabetes, maternal and child diseases, heart attacks, tuberculosis – the list of what our system is failing to cope with is long. How can we wash hands frequently when most of us have to make do with a pot of water for a family for a whole day? How are we supposed to avoid close contact when most of us travel in crowded trains and busses to get to work? We see countries and donors pouring money for Coronavirus assistance – is someone keeping track of.
How much will go into administering this (international travel for ‘experts’) and how much will disappear in transition? Is money being made in the name of poor people, once again? These are questions I hope the media will raise because a sick country cannot be a developed country. We have to start telling evidence-based stories so that children and grandparents and people of all ages understand what is being said and feel reassured about the source. That kind of trust-building and sustaining is long and hard work, but there is no way around it and there are no quick fixes.
When the World Health Organisation (WHO) declared a Public Health Emergency of International Concern (PHEIC) praising China for all it was doing and pointing to weak health systems, antennas left little doubt India was on the radar. “The disease spreading to countries like India which are quite unprepared to contain a potential spread has certainly contributed to the WHO’s decision to declare a PHEIC,” wrote Oommen Kurian, Senior Fellow, Health Initiative at the Observer Research Foundation (ORF) who has been tracking this story diligently from the word go. Read him here and follow him @oommen.
Newsrooms around the world are under extreme pressure to follow the virus and the money. The two cannot co-exist. Much of the reporting in the international and Indian media is about damage to the economy. One report says $6trillion has vaporized in stock market wealth. Most Indians don’t belong to any markets that make a difference on the global level and public health brings up the rear when we manage to figure. I think this is the moment for newsrooms to develop their health desks, hire doctors, epidemiologists, lawyers and ethicists. The Indian media is following the money now but it must prepare to follow the virus.
Coronavirus: Public Health And Journalism Are Public Goods. Both Must Follow The Virus, Not Just The Money