Health Promotion - the community dimension
We must and perhaps we can achieve Health for All. If so, how to go about it and what should be the essential ingredients in our health promotion efforts towards achieving the goal? The National Health Policy, 1982 had rightly observed "the various health programmes have, by and large, failed to involve individuals and families in establishing a self-reliant community. Also over the years, the planning process has become oblivious of the fact that the ultimate goal of achieving a satisfactory health status for all our people can not be secured without involving the community in the identification of their health needs and priorities as well as in implementation and management of various health related programmes. In short, we can say that the present pathetic scenario of health can only be improved by way of departing from the popular approach of institution-based health care to an alternative community-centred model of health care which hinges critically on building individual and community self-reliance and developing people’s competences to become full partners in preventive, promotional and curative health".

Communication in Health Promotion
It has been a global experience that any move towards community reformation or transformation had to begin from awareness. Awareness, as we know, is the outcome of education. When we talk of education we are basically talking of communication. Therefore, health education, which is considered to be the key factor in achieving holistic health, is quite often used inter-changeably as health communication like the Madhya Pradesh Vigyan Sabha which has designated its health volunteers as "Health Communicators".
As summarized by WHO committee on "primary health" the objective of health education and communication is to encourage people to want to be healthy, to know how to maintain health, to do what they can individually and collectively and to seek help when needed. In 1981 Ramesh Thapar, B.G. Varghese and colleagues brought out "An Agenda for India", a plan of action to steer India through the 1980’s and beyond. Underling the importance of communication, they wrote "as the greatest force in India probably being inertia, ignorance, dead-habits and superstitions, the change we seek calls for awareness, mobilization, organization and participation. Among the prime instruments for this purpose is communication".

Communication is a very important component in health promotion activities. In its simplest sense, it is perceived as the process of sharing meaning by understanding others and by being understood by others.

Communication in health can be looked at from different levels. The first, and perhaps, the most important level is ‘interpersonal communications’. In a recent VHAI publication "Reaching Out To The Poor" the authors have collectively agreed that interpersonal communication or face to face communication, is the single most important means of effective dissemination of development messages in rural areas. The village school teacher, health guide, health volunteers and the ANM play crucial roles in such health communication efforts.
Although, interpersonal communication is recognized as the most important of all development communication strategies including health promotion, it is also the most neglected one in our planning. We have to realize that we are in the game of life and death. A wrong message or a wrong interpretation due to "senders" limitation can cause serious damage. Therefore, adequate emphasis has to be given to at least two aspects of interpersonal communication namely, speech and listening. In my experience with the health promotion activities, I have noticed that most of our health workers - the so-called health communicators - supervisors and even health trainers are unskilled speakers. It does not mean that a health worker should be an orator. What is expected is clarity in speech and awareness about the needs of the audience and the ability to adapt the messages to the level of the receiver or beneficiary, use of proper intonation etc. Communication of all sorts is basically meant to express than impress. A skilled speaker is able to express as well as impress the other person. Hence we need to really provide useful tips and exercises on speech communication to our health workers in all our training programmes so that they become effective health promoters in their respective areas of operation.
The second and equally ignored aspect of communication is listening. Normally an individual spends all his communication time in reading, writing, listening and speaking. Of all the four, one would be surprised to find that we spend the maximum time, i.e. 45% to listening alone. Despite this proven fact, most of us are very poor listeners. In our training programmes too, we spend hardly any time on improving listening skills. All of us, unknowingly, hear all the time but don’t listen. Meaningful and attentive hearing is listening.
Hearing is more a biological process whereas listening is a mental process. Late Mother Theresa, perhaps the patron of all of us in the field of health promotion, had mastered the skill of listening. She could listen to anything from anybody with lot of compassion and empathy. By mastering the skill of listening she became the mother of the nation. There are other aspects of interpersonal communication but I wish to confine myself to only speech and listening.

Power of the Group Media
The next level of health communication is small group. This type of communication is popularly known as ‘small media’ or ‘group media’. In a campaign, be it health or literacy, group media is considered to be a very powerful tool for communicating and interpreting messages. Everyone has heard of mass media and mass communication, but few by comparison speak of small or group media. Group media could be very simply understood as the traditional folk media and the modern electronic media scaled down to the size of a group.
Myron J. Pereira in his popular book "Our Second Skin" states "Education does not only mean coming to grips with the electronic media environment, but it also requires mobilizations, organization and participation". And here perhaps the traditional forms are more within the resources of India’s masses and therefore more likely to be effective. However, referring to a number of studies in the field of folk media conducted by the World Association for Christian Communications (WACC), he cautions, that the traditional forms of communication do not, by themselves, effect social change. In fact they tend to reinforce inequalities at the village level. However, coupled with a developed social consciousness, traditional forms can be put to dynamic use. Folk media such as puppetry, kirtan, tamasha, bhavai, nacha, maach, jatra, pandvani and street theatre are more than mere styles of entertainment. They are based on community participation and collective action. They remind us of a time when we did not have to reckon with the alienation, or anonymity or mass consumerism of the mass media. Today even the mass media has started recognizing its impact. In the post independence period, traditional and folk media have given a tough fight to the mass media. The positive impact created by these forms of small media are known worldwide.
The modern electronic media is also used in smaller productions like slide shows and videos which are not broadcast on TV. There are also materials like pamphlets, newsletters and posters which are not mass circulated like news papers. Small-scale productions in audio cassettes also are used for health promotion even though they are not presented before large audience like in a theatre. These group media may borrow their style from modern mass media, yet they are different. Their technology may be electronic but is cheaper and more accessible to individuals and small organisations. The programme content is narrower and more specific on issues which are closer to the lives of the people. The oral and visual codes of folk culture find electronic expressions in the small media. Structure used by the group media evoke reflection, awareness and actions. These group media are "halfway" bridges between the modern mass media and the traditional folk media. In a nutshell, we can say that the small or group media are within the financial, technical and intellectual reach of people/group. It is a media which is culturally contextual, unifying and emancipatory rather than repressive (meaning, it encourages new possibilities). They don’t excite and titillate, but educate and develop. Therefore, it would be only appropriate that every health communicator should get trained in the production and effective use of group media in their health promotion activities.

A responsive Mass Media
Finally a reflection on the role of mass media and mass communication in health promotion. Mass communication through mass media in its purest sense is only a diffusion of information and not communication. All mass media are unidirectional, momentary and lack viewers participation. Nonetheless, we have to reckon with the fact that as consumers of mass media, from sunrise to bed time, we are intensively influenced by them. We know from several studies that mass media also have a tremendous capacity to misguide and mislead people. With the implementation of the "Prasar Bharati" the mass media in India will totally go to the private sector. Only time will tell whether it will do good or bad to the masses of India. As health promoters through education and communications we need to become pro-active and critical consumers of the media. We have a crucial role to play in interpreting the mass media for the welfare of the masses we have committed to serve.
"The object of education is the freedom of the mind, which can only be achieved through the path of freedom - though freedom has its risks and responsibility as life itself has".

– Tagore

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