A public examination and discourse about public policy occurs across numerous venues. This is often the case when the public's interest has been heightened; perhaps through outrage at some particular event or a perceived threat to individual or group self-interest.

The public examination of policy may be enlivened and improved through the use of media that can create interest, immediacy, and the knowledge necessary to capture the interest of policymakers. The key is to be strategic so public policy truly becomes the solution to a public problem. For example, the other evening I was at a reception listening to a small group of individuals debating a potential piece of legislation that had major regulatory implications. One member of the group stated in frustration, "We shouldn't be making policy to address a non-problem!" His point was that policy developed to resolve a poorly developed idea or issue that doesn't require a legislative solution is poor public policy. I wondered whether we apply this sound logic in public health. I thought about all of the important public health issues that don't get the public's attention or are poorly understood by the public juxtaposed against public health issues that do receive the attention of the public and the policymakers but end up with insufficient public policy solutions. Most important are the public health issues that had been so poorly developed or understood by policymakers that the legislative response entirely missed the problem.

Examining the Public Policy Process

At least part of the problem of ineffective or unnecessary public health policy arises from a lack of knowledge and understanding on the part of the public and policy-makers about the nature, importance, and threat of many public health issues. Threats to the public's health such as ground water contamination generally do not develop overnight. Their solutions do not occur overnight either. Solving problems that contribute to a reduction in the health status of a community and population require system level methods with long term goals for improvement. The quick fix is rarely effective in public health. Long term strategy can be frustrating to the public and policymakers who want immediate outcomes. Our standard for public health policy needs to include clear parameters for both immediate "relief" and long term improvement and ultimately, resolution and prevention. Most models for the process of policy development begin with a clear definition and analysis of the problem or issue. We diagnose what currently exists relative to the issue and analyze what current views of the issue prevail.

Would a challenge to the current thinking about the problem be accepted or rejected? Do we need to construct a better idea about solutions to address the issue? Can the complexity of the issue be reduced so that its elements are readily understood? This includes not only getting at the origin of the issue and the data that estimate its scope and size, but also determining what solution or intervention is best. At the very beginning of the policy process we must ask the question, "Does this require a policy solution, and if so, what type of policy?" For example, we could be looking at a statute change or new legislation, a new rule or regulation, economic or budgetary policy, a judicial decision, or perhaps a transformation in macro, system-level policy or institutional or organizational policy.

Public Discourse Is a Valuable Policy Tool

If some of our public health issues are poorly understood or supported, it is at this juncture we should engage in a dialogue with the public. One method for starting the dialogue and getting the public's attention is through the use of the media. At the root of building advocacy is translating the issue to others; the media can be an excellent source of assistance for the translation. Naturally, there are risks to this method of increasing public awareness and advocacy. Calling the public's attention to the many threats to health associated with environmental hazards and personal behavior such as tobacco and drug use requires us to be clear in our language, precise in our science, and sensitive to the interests of communities, business, and culture at the same time. This challenge requires a well-developed communication and media plan that contains strategies for managing controversial and high-risk issues. A successful process demands intensive effort during the planning, communication, and evaluation phases. An example of this approach to public discourse is the Turning Point media campaign linked to the release of the film "A Civil Action".

Turning Point's Civil Action Campaign

The major Hollywood motion picture, "A Civil Action", provided Turning Point with a unique opportunity to build on the attention directed at one of our major public health issues, groundwater contamination. The movie tells the story of a town in Massachusetts devastated by the deaths of a number of children from leukemia. The townspeople related the deaths to groundwater pollution whose source was thought to be the result of industrial waste. The movie focuses on the courtroom drama that ensues when the families of the victims sue the corporations accused of being responsible for the contamination. Although the movie is primarily a legal thriller and does not feature public health directly, its potential to raise the awareness of the public about public health was evident.

Media Campaign Goals and Objectives

The first step in any media campaign is developing goals and objectives—what it is you aim to accomplish and how.

The goals of the Turning Point "A Civil Action" media campaign were:

• Use the release of "A Civil Action" to build additional public interest in strengthening and improving our public health system.
• Provide Turning Point partners with practical, hands on advocacy tools for making the case on behalf of public health.
• Ensure that the needs of the public health system are adequately addressed by federal, state, and local policymakers.

The objectives of the Turning Point "A Civil Action" media campaign were:
Expand public health awareness within the media, the general public, and local opinion leaders by using the following materials and strategies:

• Placement of opinion editorials and newspaper advertisements in major daily newspapers.
• Soliciting radio, television and newspaper coverage of local "Public Health Heroes" working to protect the public's health every day.
• Distribution of public health statistics and state-specific public health stories.

Four Turning Point states contributed significantly to the campaign by developing case studies of four major public health issues. Illinois described an outbreak of food borne salmonella agona. Oklahoma's case study of Hepatitis A demonstrated an alarming rise in reported cases during a two year period and the aggressive epidemiology and action that followed. Louisiana related the story of a new strain of drug-resistant tuberculosis. Virginia's case study highlighted the outbreak of E.coli in a never before reported source. All four case studies emphasized the need for a time intensive scientific process of investigation, analysis, intervention, outbreak control, and ultimately strategies for prevention. In addition, these case studies documented the expertise of public health professionals and the value of investing in a strong public health system.

Evaluating Our Success and Risks

The evaluation of the Turning Point "A Civil Action" media campaign is currently underway. The evaluation will help us determine the impact of the campaign on the media's interest in public health issues. The evaluation will also help us understand the current capacity of public health to take advantage of unique media opportunities. The capacity required includes the ability to organize a local or state-wide public relations campaign, individuals skilled in public relations and communication, support of public officials to engage in a media campaign, and a network established with professionals in the media so action can occur quickly.

A campaign of this nature also requires public health to take the risks associated with calling the public's attention to our issues. We must be prepared to engage our constituents, elected officials, advocates, industry representatives and others in a dialogue and potentially a debate about the issues, the ideas behind the issues, the potential solutions, and public policy. The media is an important method for engaging the public in an examination of public health ideas and issues. Alone, it will not bring us all the data and information we need to determine whether public policy is required to prevent or resolve a public health problem. However, it is a powerful tool that public health professionals and our multiple partners can and should use to build the public's awareness of the value and importance of strengthening the infrastructure and capacity necessary to protect and promote the public's health.