Health Communication: A double-edged sword for vulnerable communities

Radio broadcasts contributing to genocide speak volumes about the power of communication! The Rwandan genocide of 1994 marked one of the darkest periods of human history; it lasted for 100 days beginning from April 6, 1994. Approximately 500,000 members of Tutsi and moderate Hutu tribes were killed by armed forces and militia, dominated by Hutu extremists. This act of barbarity, with its roots in colonization by Belgium, was led by the Hutu tribe that constituted the majority of the population in Rwanda. The extremists within them launched and supported a radio station, Radio Television Libre des Mille Collines (RLTM), in 1993 that conveyed hatred and demonized the minority community (Tutsi tribe). Political slogans and songs compared Tutsi tribe to “cockroaches”/ “snakes” and encouraged people to “cut down the tall trees”, about Tutsis. The station broadcasted details about the people including their names and locations, that deserved to be exterminated. The entire process appealed to the Youth and mobilized them against the minority community. These youth movements became pivotal in executing the genocide. The conflict could only be stopped on June 18, 1994. This is not the only incident where communication as a determinant of deaths stands out. A lot has been written about different communication strategies, including cinema, utilized by the Nazi regime to fuel hatred against the Jews that led to their subsequent massacre. The same trend could be observed in the Indian context where the current political regime has been organizing hate campaigns to villainize a minority community (Muslims). On many occasions, these strategies have resulted in mob violence. These few examples, while being extreme, reflect how communication could act as a powerful tool in determining people’s chance of survival, especially those who are at the margins.

 But history is also replete with examples where communication has contributed significantly in ensuring the health and well-being of vulnerable communities during public health emergencies such as epidemics/pandemics. However, in the process, it othered them and subsequently portrayed them as a threat to the larger society. This paradox could be best illustrated through the HIV/AIDS epidemic that killed thousands of people across the globe in the 1980s. Interestingly, fear, stigma, and ignorance defined HIV in those days. It was reported to be mostly prevalent among people of color and non-gender confirming groups. Certain kinds of messaging through various media platforms such as TV shows, posters, and newspaper articles stereotyped people with HIV/AIDS as a danger to the so-called general community.

A New York Times Magazine in the 1980s described non-homosexual victims of AIDS as ‘innocent bystanders’/true sufferers caught in the path of a new disease whereas the gay community was labeled as ‘liable’. The same was equally propagated by TV shows as well. In 1983, a TV broadcast titled “60 Minutes” (Australia), “The AIDS Mystery” created a sense that people affected with HIV, were frightening, to the general community. These messages reeked of racism as well as homophobia. On the hand other hand, in the absence of any effective treatment back then, the power of communication was harnessed towards the prevention of the disease. Posters emerged as a key to connecting with the people. A poster titled “Always the last to know!!! And what you don’t know can kill you!!!” presented compelling statistics describing the distribution of HIV/AIDS among people of color. Further, it emphasized that “Education is the only answer” so it is important for people to know more about the disease to prevent it. As stigma and discrimination against those with the disease were major roadblocks in prevention efforts, posters were specifically designed to allay the same. One of the posters lucidly put it “We are not afraid of Uncle George, he has AIDS, and we love him”. This poster was a reminder to the African American communities that hugging and loving people with AIDS was alright, and safe. Posters also emphasized educating non-gender confirming communities about safe sex practices. For instance, one among them stated “Men of the 90’s, top, bottom, both do the same thing”.

It was observed that with such efforts by the 1990s, AIDS organizations could communicate to gay audiences, without much fear of censorship. These posters developed to alleviate myths and fears associated with people with AIDS, were outcomes of a participatory research work. Simultaneously, a popular medical drama of the time – St. Elsewhere – dedicated one of its episodes to discussing facts and challenging misconceptions through on-screen medical professionals. In the episode, a successful politician (white man) with AIDS comes to the hospital, which the script suggests he contracted from cheating on his wife with other women. This could make people perceive the disease can impact someone they might know, or whom they might even vote for. “If you have AIDS, you’re sick, you need help,” one doctor ultimately says in the episode. “And that’s all that matters. And that’s why we’re here.” Concurrently, advocacy, another communication strategy, gained prominence leading to the formation of various groups such as the Treatment Action Campaign, and Global Network of People Living with HIV, to name a few. They contributed/continue to contribute significantly to mobilizing and engaging communities, health providers, and policymakers, to address HIV-related challenges.

Experiences of handling the COVID-19 pandemic illustrate yet another instance where communication acted as a double-edged sword. While the previous case was discussed in the global context, I am confining the discussion on COVID-19 to India as being trained in public health I was closely following India’s containment strategies. Being a new disease, scientists across the globe struggled to characterize it. In a short time, it emerged as one of the worst public health crises of the century. In the absence of any significant understanding of the disease, preventing it through existing means was the only way out. Amid the panic created by the disease, it was important for the Indian state to communicate with its citizens. The head of the state, the Prime Minister, did ‘communicate’ by announcing one of the world’s strictest lockdowns within a short time without consulting any experts. Much has been written about the deadly consequences of the lockdown, especially for marginalized groups including migrant workers, and minority communities. Along with facing livelihood challenges, these groups also become scapegoats. Again, this is nothing new. We have seen the same during the HIV/AIDS epidemic. Public health officials across the globe warned against stigmatizing minority groups during the pandemic. However, the opposite happened in India. One needs to situate this in the political scenario of India that has fueled Islamophobia in the past decade with communication playing a significant role. Indian social media ‘communicated’ Islamophobic content incessantly and tried hard to attribute the spread of the pandemic to the Muslim minority.  They held a religious gathering responsible.

One of the news channels outcried “In the battle against Corona, Jamaat has dealt a bloody blow”, another one demanded “Save the country from Corona jihad” and “Act strongly against Corona jihad”, and yet another claimed, “In the name of religion, they have put our lives at risk”. Hashtags such as #CoronaJihad was rampantly circulated on the Twitter. The same was communicated even by the Ministry of Health and Family Welfare through a press briefing. It claimed that 30% of cases in India in the initial days of the pandemic were related to religious gatherings. Subsequently, cases were filed against the members of the congregation. The cases could not stand in the court in the absence of any evidence. The framing of minority community as a ‘vector’ of the disease did irreparable damage resulting in their socio-economic boycott and threatening their very survival. One of the posters outrightly communicated it. It banned the entry of Muslim traders in a central Indian village.

While on the one hand, certain forms of communication exacerbated the existing marginalities of the Muslim communities by correlating the spread of the virus to the religion, and in the process labeled them as ‘threatening characters’, alternative forms of communication conveyed timely and accurate information, minimized stigma and discrimination, and reduced fear among other marginalized groups in India. Many groups were formed at multiple levels to design and implement COVID-specific messages.  For instance, a puppet show titled “Tara Hai Tayyar” in Uttar Pradesh conveyed the story of a spunky girl who, along with her father practised healthy COVID-19-specific behaviors, such as handwashing and wearing a mask. Many posters were designed in local languages to ensure maximum reach to the community. In another instance, helplines were set up in Jharkhand for migrants returning home to ease their return to homes while ensuring preventive behavior. Similarly, community radios were leveraged extensively in many parts of rural India to disseminate COVID-appropriate information. Youths were extensively mobilized to reach out to the public through digital platforms. In addition, the political leadership of a few Indian states ‘communicated’ with their people, especially marginalized groups, to assure them of their safety and wellbeing. The Chief Minister of Kerala stood out in this regard. He held daily press conferences to connect to his people by providing them with updates about the measures the state was taking to contain the pandemic. This act of communication ensured a sense of trust between the community and the state that became instrumental in Kerala’s efforts to mitigate the effects of the pandemic.

Thus, the role of communication goes much beyond delivering a message: rather it constitutes a social process. However, it is important to understand that it cannot be extricated from the larger socio-economic, cultural, and political context. It is this context that shapes what should be communicated, how communication should occur, and who is entitled to know what is communicated. Within this context, it then emerges as a tool that can either mitigate or exaggerate health inequity.

Sapna Mishra is a faculty member at the Department of Sociology and Anthropology, Easwari School of Liberal Arts, SRM University, Andhra Pradesh.

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