Developing world vision

The interdependency of health systems and policies which transcend national boundaries is becoming more apparent to European nations. In the Madrid Framework presented at the European Health Forum in Austria in 2004, more than one hundred health policy experts outlined principles for sustainable health policies and governance within Europe. The document also emphasised that we live in a globalised world, where local and national health policies can have an impact 'beyond their own borders'.

Much still remains to be done to tackle chronic diseases in the developing world. Of the USD 4.3bn loaned by the World Bank for healthcare between 1997 and 2001, just 2.5 per cent was used to address chronic diseases. However, governments, NGOs and industry are all starting to recognise that chronic disease, in particular diabetes, must be addressed urgently. In 2006, the United Nations General Assembly passed a landmark Resolution calling on all nations to develop national policies for the prevention, treatment and care of diabetes.

Complications arising from diabetes now kill as many people worldwide as HIV/AIDS, and a paper published in Diabetes Care in 2005 predicts this will equate to 3.8m deaths (or six per cent of world mortality) in 2007. The International Diabetes Federation states that there are now 246m people with diabetes, 80 per cent of whom live in developing countries. The federation estimates that if preventative measures are not taken, 380m people worldwide will have diabetes by 2050, with the greatest increase occurring in developing countries.

Rapid industrialisation and changing diets and lifestyles are all factors that will increase the incidence of diabetes. This will place an enormous socio-economic burden on healthcare systems already struggling to tackle poverty and communicable diseases. The developing world cannot tackle the diabetes epidemic alone and Europe must become involved and take responsibility for assisting them.

European healthcare communications can help
In terms of practical expertise and knowledge, European-based public relations agencies are well-equipped to work with global and national organisations in order to execute campaigns driving for political change in the developing world and initiate public health initiatives. At our London based PR agency Biosector 2 (B2) for example we are working with the World Diabetes Foundation (WDF), which is located in Denmark, but operates in the developing world to support prevention and treatment of diabetes.

Two campaigns in Vietnam in 2006 and ongoing collaboration in Kenya this year involved taking an integrated approach with global partners such as NGOs, the WHO, WDF, International Diabetes Federation, Ministries of Health, the World Bank, health insurers/payers, industry, charities, the scientific community, healthcare professionals and patient associations. We were working to address the diabetes epidemic and ensure action was being taken in terms of education, training, diagnosis and treatment and healthcare policy. In such campaigns, high-level media outlets from Europe, as well as Asia and Africa were invited to summits and to visit local diabetes projects to raise awareness of the issues in the regions to key European audiences encouraging action in Europe as well as Asia and Africa.

The challenges of communicating beyond the EU
One major challenge of these campaigns is that budgets can be limited, since charities and NGOs can usually offer only a fraction of the budget a corporation would have for the same activity. However, there is still an expectation for the same top-tier level of media to be attracted to the media events, especially when such high-profile international bodies are involved. Another challenge is that there are only a handful of pan-EU media covering policy topics, such as European Voice, E-sharp and The Economist. It can also be difficult to sell-in such stories to outlets throughout Europe as the angle is often perceived as a developing world story.

 Media approaches need to be very careful researched and tailored accordingly to demonstrate the European implications. Using this approach you can spark the interest of key media such as BBC World (TV and radio), The Times (UK), Les Echos, RF1 (TV) (France). In dealing with local media in developing countries, European-based agencies need to be prepared to deal with quite differing approaches to working with journalists. In Africa journalists rarely get an opportunity to travel to other countries and are more eager to travel abroad than journalists in Europe. It is therefore crucial to carefully research, identify and invite only the journalists whom you really wish to attend.

To achieve a successful outcome for such campaigns, it is vital to involve partners from all backgrounds and sectors, including industry. Current media scepticism of pharmaceutical-supported activities, means that the charity or NGO needs to remain independent in order to retain credibility. One way to do this is through openness, supported by the development of clear positioning highlighting the purpose of the campaign and the importance of the integrated, sustainable approach.

Tackling bureaucracy and coping with differing ideas about how campaigns should be implemented are other issues when dealing with third parties such as Ministries of Health and NGOs in developing countries. If the agencies are more accustomed to doing business with corporations in Europe where efficiency and tight deadlines are the norm, it can often be frustrating working with NGOs and similar organisations in developing countries. Cultural and language barriers and time zone differences can delay activities even further.

When working with such a large number of stakeholders across a variety of countries, the key is to factor in as much time as possible to allow for unexpected variations. Poor local infrastructure and technology can cause huge logistical complications for flights, travel and press events. Even top national newspapers in some African countries may not have reliable access to phones, email and the internet. PR agencies may try to overcome this by researching which countries have better infrastucture and transport prospects. This enables journalists to get there in the first place, visit local clinics and access more sophisticated technological systems to submit their stories to their editors. All of this is important to communicate the benefits of these pilot projects to other potential collaborators. A European-based PR agency implementing campaigns in developing countries needs to remember that anything can happen, so the most important qualities are to remain flexible and prepared to change plans at a moment's notice.

Benefits of the European perspective
European campaign knowledge, skills and experience are particularly welcomed in the NGO and charity sectors. Local project partners are very appreciative of the skills base made available to them and willing to take advice on campaign strategies. In return they are forthcoming with local knowledge, insight and information about how local healthcare systems operate. EU-based PR agencies are also able to use relationships they have built with media outlets in Europe to target their offices or correspondents in Asia or Africa. This can work particularly well with broadcast media such as the BBC World Service or French radio station RF1.

Broadcast media are key, as access to a radio can be more readily available than to printed media and makes it easier to get information across in areas where literacy levels are low. Another positive aspect of working with charities or NGOs to promote a cause or issue to European media outlets, is that journalists tend to be interested in this type of campaign where there is a drive or call for political change, rather than a straightforward 'product' campaign by a pharmaceutical company. From a local media perspective, journalists in developing countries are extremely eager and motivated to participate in press events outside their country.

For journalists, particularly in African countries, they may not often get the opportunity to travel to cover stories first-hand. Often, such journalists come from the top national newspapers, radio or TV stations and are a key means of transporting the political messages and driving change in their own country. They may operate locally on small budgets but for a relatively small cost to organisations based in Europe, local media in developing countries can play a significant part in delivering a successful communications campaign. NGOs and journalists in developing countries also have links and contacts on a local level with key government ministers, UN or WHO figures. In the crowded European marketplace, where corporations and charities alike have sophisticated marketing and policy departments, it can be a challenge to reach key political figures.

With modest assistance and funding, European agencies can use their expertise to advise local partners to unearth and exploit political infrastructures more effectively to bring about positive change. International organisations such as the UN and EU are encouraging governments and industry to think and act globally and adopt corporate social responsibility programmes. European corporations have a greater responsibility than ever to engage with the developing world in a responsible manner.

Organisations are looking to take an integrated approach and work with local bodies to effect change, and European-based PR agencies can play a vital role here. With increasing awareness of how our actions in Europe have an impact on our counterparts in developing world, such campaigns are a definite growth area. They can be hugely challenging but extremely rewarding.