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 Media Advocacy:
A Strategyfor Empowering
Peopleand Communities

LAWRENCE WALLACK

If you don'texist in the media,for all practicalpurposes,you don'texist.

DanielSchorr
News Correspondent
INTRODUCTION

yawa<; N eighth-gradegirl in Pojoaque, New Mexico, a fam-

A ily physician in Davis, California, and a network of
IX
1\ 2tobacco control advocates around the country all
share a strong belief in the power of the media to
promote public health goals. They took on power-
ful "manufacturersof illness" (i) and, with creative
use of mass media, were-able to achieve their objectives. In Pojoaque,
a school substance-abuse project turned into a battle to remove alco-
hol billboards from the immediate area of the school. The combina-
tion of community organizing and the power of the press made a
young girl into a giant-killer and brought the billboards down. In
Davis, a physician concerned about children inadvertently killing
other children with easily available handguns that often were mis-
taken for toy guns, combined scientific research with a topic the
media could not resist, to focus attention on the need for policy
change. One short-term outcome is the difficulty of finding certain
kinds of toy guns in California stores. Tobacco control advocates suc-
cessfully developed a media strategy to counter the Philip Morris
"Bill of Rights Tour." The cigarette maker's public relations dream
turned into a nightmare when advocates successfully reframed the
issue in the media and made it a health story.
The experience of these people is part of the foundation of a cre-
ative and innovative approach to use mass media as an advocacy
420
WALLACK * STRATEGY FOR EMPOWERING PEOPLE 421

tool. What they learned,and what people are learningin communi-

ties acrossthe country,is that the power of the presscan be claimed
by advocacygroupsand used to promotechangesin the social envi-
ronment.In breakingfrom traditionalpublic educationcampaigns
that conveyhealthmessages,they developeda "voice"to wieldpower.
Media advocacycan be a significantforce for influencingpublic de-
bate, speakingdirectlyto those with influence,and puttingpressure
on decisionmakers.Mediaadvocacyis a tacticfor communitygroups
to communicatetheirown storyin theirown wordsto promotesocial
change.It is a hybridtool combiningadvocacyapproacheswith the
strategicand innovativeuse of mediato betterpressure decisionmak-
ers to supportchangesfor healthypublicpolicies.
Historically,the massmediahavetendedto presenthealthissuesin
medicaltermswith a focus on personalhealth habits, medicalmira-
cles, physicianheroicsor technologicalbreakthroughs(2-6). High-
tech curative treatment and low-tech preventive behavior-change
have beenthe primaryfocus. Social,economic,and politicaldetermi-
nantsof healthhavebeenlargelyignoredby the most pervasivemedia.
Media advocacytries to change this by emphasizingthe social and
economic,ratherthanindividualand behavioral,rootsof the problem.
The researchbase in public health stronglysuggeststhat while a
balanceof initiativesis necessary,policy changeis a key factorin pro-
moting public health goals. Currentresearchin public health and
mass communicationclearlyindicatesthat it is time to shift the bal-
ance of our effortsin usingthe massmediafromindividualchangeto
social change, from promoting health information to promoting
health policies, from giving people a message about their personal
healthto givingcommunitiesa voice in definingand actingon public
health issues. Certainlythe provision of clear,accurateinformation
about risk factors and personalbehaviorchange throughpublic in-
formationcampaignsmust be a constantpart of the media environ-
ment. However,the researchindicatesthat it is appropriateand nec-
essary for public health to move from the public affairsdesk to the
news and opinion desks.
Healthadvocatesare attractingnews attentionmore and morefre-
quentlyon issues such as violence,alcohol, tobacco, and HIV infec-
tion (4). Publichealth issues are newsworthybecausethey can link
personalstorieswith broadersocial and politicalconcerns.Commu-
nity initiativeshave provided solid evidence that local groups can
422 JOURNAL OF PUBLIC HEALTH POLICY * WINTER 1994

gain accessto media,reframeissuesto focus on policy,and advance

communityinitiativesfor policychange.
THE INFORMATION GAP VERSUS THE POWER GAP

Traditionalformsof massmediainterventionsemphasizethe "infor-

mationgap"whichsuggestshealthproblemsare causedby a lack of
informationin individualswith the problemor at risk for the prob-
lem. Publiceducationcampaignsprovideinformationto fillthatgap.
Media advocacy,on the other hand, focuses on the "powergap,"
where healthproblemsare viewed as a lack of power to definethe
problemandcreatesocialchange.Thetargetof mediaadvocacyis the
power gap. It attemptsto motivate broad social and political in-
volvementratherthanchangesin personalhealthbehavior.
Themassmediaregularlyreinforcethe viewthathealthmattersare
personalproblemsratherthan social or communityconcerns(7,8).
The definitionof the problemat the personallevel leadsto solutions
designedfor and directedto the individual.In this "informationgap"
model the personis seen as lackingsome key information,and it is
this lack of informationwhich is the problem.Whenpeoplehavethe
informationand "knowthe facts,"it is assumedtheywill thenact ac-
cordinglyand the problemwill be solved.If everyindividualgets the
rightinformationandmakesthe rightdecision,thenthe community's
problemwill be eliminated.The role of the media is to deliverthe
solution(knowledge)to the millionsof individualswho need it.
The informationgap modelsees the contextin whichthe problem
exists only as a placeto delivera message.It accountsfor the pres-
suresanddemandsof dailylife only in determininghow to deliverthe
message. It assumespeople have adequateavailableresourcesfor
meetingthose demands.Family,school, community,and social vari-
ablesare seen as less importantthan havingthe "rightinformation."
A classicexampleof usingthe mediato fill the informationgap is
the Partnershipfor a Drug FreeAmerica.This programis basedon
the idea that "if only peoplereallyknew how bad and uncool drugs
weretheywouldn'tuse them."Manyof theseads arememorable,but
their strong statementsgenerallydo not take a public health ap-
proach.Instead,they focusalmostexclusivelyon individualbehavior
andpersonalresponsibility. The Partnershipads insistthat:"thedrug
problemis your problem,not the government's.The ads neverques-
tion budgetallocationsor the administration's emphasisof [law]en-
WALLACK * STRATEGY FOR EMPOWERING PEOPLE 423
forcementover treatment... If thereare mitigatingreasonsfor drug
use-poverty, familyturmoil,self-medication,curiosity-you'd never
know it fromthe Partnershipads" (9, pp. 3 1-4). The Partnershipads
laud volunteerism,self-discipline,and individualism(IO, p. 34), pre-
cisely the values that resonatewith the Americanpeople. And the
Partnershipstrategiesmeetwith littlepoliticalresistancebecausethey
areconsistentwith a victim-blamingorientationtowardpublichealth
(I I).
The Partnershipcampaigns,like virtuallyall publicinformationef-
forts, assumethat informationis the magic bullet which inoculates
people againstdrugs. Social conditionsthat form the context of the
problemsuch as alienation,poor housing, poor education,and lack
of economic opportunity are ignored. Because the context of the
problemis part of the problem,any solution that does not take the
context into account inevitablywill be inadequate.In fact the Part-
nership'spublic service advertisements,despite their intent to im-
provethe public'shealth,ultimatelymay do moreharmthan good by
underminingsupportfor moreeffectivehealthpromotioneffortsthat
focus upstreamon powerrelationshipsand socialconditions.The ads
occupyvaluablemediatime with compellingmessagesthat reinforce
a downstream,victim-blamingapproach.
Media advocacyemphasizesthe power gap by highlightingalter-
native definitionsof problems and policy level approachesto ad-
dressing these problems. In the tradition of sociologist C. Wright
Mills (I z), media advocacytakes personalproblemsand translates
them into social issues. A primarystrategyof media advocacyis to
work with individualsand groups to claim power of the media to
changethe context or environmentin which the problemoccurs.
The focus on policyaddressesdeterminantsof healthwhich areex-
ternal to the individual.These determinantsinclude variablessuch
as basic housing, employment,education,health care, and personal
security,and might be consideredunderthe generalrubricof social
justiceissues. A second set of determinantsfocuses more closely on
immediatemarketingvariablesassociatedwith health-compromising
productssuch as alcohol, tobacco, high fat foods, and other danger-
ous products.Thesemarketingvariablesincludeadvertisingand pro-
motion, pricing,productdevelopment,and productavailability.For
example, alcohol activistsare concernedabout advertisingand pro-
motion of alcohol at eventsor in mediawhich attractlargeyouth au-
424 JOURNAL OF PUBLIC HEALTH POLICY * WINTER 1994

diences.In addition,the pricingof alcohol so that it is competitive

with soft drinks,coupledwith its easy availability,contributesto an
environmentthat is conduciveto problematicuse of the product.
Store owners who indiscriminatelysell malt liquor to children,or
companiesthatdevelopnew productssuchas winecoolerswhichtar-
get youth,furthercontributeto the seductiveenvironment.Theseare
all potentialfocal points for mediaadvocates.
THE PRACTICE OF MEDIA ADVOCACY

Media advocacyis the strategicuse of mass mediato advancea so-

cial or publicpolicy initiative(13). It uses a rangeof mediaand ad-
vocacy strategiesto definethe problemand stimulatebroad-based
coverage.Mediaadvocacyattemptsto reframeand shapepublicdis-
cussionto increasesupportfor and advancehealthypublicpolicies.
Fundamentalto media advocacyis knowingwhat policy goals you
want to accomplish.Thus, the first step is to establishwhat your
group'spolicygoal is -what do you wantto happen?The secondstep
is to decidewho yourtargetis-to whomdo you wantto speak?Does
this person, group, or organizationhave the power to make the
changeyou want to see happen?The thirdstep is to frameyour issue
and constructyour message.The fourthstep is to constructan over-
all media advocacyplan for deliveringyour messageand creating
pressurefor change.Finally,you want to evaluatehow well you have
done what you set out to do.
To illustratethe planningprocess,considera coalitionthat is seek-
ing to reduce deadly violence among youth. They decide on three
local policygoals:limithandgunavailability;limitalcoholavailabil-
ity; and increaseemploymentopportunitiesfor youth. They decide
their primaryaudienceis the city council,with communityopinion
leadersas a secondaryaudience.The generalmessagethey decideto
use is that violenceis a publichealthissue,is predictable,and can be
prevented.Theyframetheirmessageto emphasizethe socialandeco-
nomicaspectsof violenceamongyouth.Theydevelopa mediastrat-
egy to reachtheir audiencewith the messageand to promotetheir
policy initiatives.In their mediastrategythey considermethodsfor
creatingnews, takingadvantageof existingnews opportunities(e.g.
localizinga national story), and buying media time and space to
speakdirectlyto theiraudience.All throughthe processtheyinstitute
feedbackmechanismsto get a senseof how they are doing.
WALLACK * STRATEGY FOR EMPOWERING PEOPLE 4Z5

The processand successof mediaadvocacy,however,are linkedto

how well the advocacyis rooted in the community.Localmediaout-
lets feel a legaland civic responsibilityto theircommunities.They are
concernedabout what the communitywants. The more supportand
participationat the local level for media initiatives,the more likely
journalistswill definethe issueas relevantand newsworthy.As Tuch-
man notes, ... . the more members,the more legitimatetheirspokes-
person"(14, p. 9z). Mediaadvocacy,then,reallycombinesthesepa-
rate functionsof mass communicationwith communityadvocacy.
Traditionalpublic healthcommunicationstrategiestend to see in-
dividualsand groupsas partof an audienceto be addressedin a one-
way communication.At best, if the "audience"is included in the
planning, it is after major boundariesof the issue have been set.
Media advocacytreatsthe individualor groupas potentialadvocates
who can use theirenergy,skills,and otherresourcesto influencewhat
issue is addressedand what solutionsare put forth.Whiletraditional
campaignsseek to convinceindividualsto changetheirhealthhabits,
mediaadvocacyinitiativescreatepressureto changethe environment
which, in largepart, determinesthese habits.
THE FUNCTIONS OF MEDIA ADVOCACY

Mass media are like the beam of a searchlightthat moves rest-

lesslyabout, bringingone episodeand then anotherout of dark-
ness into vision.
WalterLippmann,1922
The threefunctionsof mediaadvocacycan be thoughtof in termsof
Lippmann'sclassic image of the mass media. First, media advocacy
uses the media to place attentionon an issue by bringingit to light.
This is the process of agenda setting. Substantialevidence suggests
that the media agendadeterminesthe public agenda:what's on peo-
ple'smindsreflectswhat'sin the media(I 5-I7). Second,mediaad-
vocacy holds the spotlighton the issue and focusesin on "upstream"
causes. This is the processof framing.Recentresearchfrom the po-
litical sciencefield suggeststhat the way that social issuesare framed
in the news media is associatedwith who or what is seen as primar-
ily responsiblefor addressingthe problem(8). Third,mediaadvocacy
seeks to advancesocial or publicinitiativesas a primaryapproachto
the problem.Changesin the social environmentthroughthe devel-
426 JOURNAL OF PUBLIC HEALTH POLICY * WINTER I994

opment of healthypublic policiesare viewed as the means for im-

provingpublichealth.
Settingthe Agenda:Framingfor Access
A local news programin the SanFranciscoBay areaused billboards
and televisioncommercialsto tell people, "Ifit goes on here,it goes
on [Channel]4 at io." The implicationwas that if you do not see it
on the news, then an event has not happened.When AIDSwas not
coveredby the New YorkTimes,it did not make it on the nation's
policy agendaeither.If the pressdoes not cover your demonstration
to highlighta contradictionin healthpolicy,it mightas well havenot
takenplaceas far as the broadercommunity(and probablythe per-
son with the power to make the change you want) is concerned.
Daniel Schorr,National Public Radio commentatorand longtime
journalistsays, "Ifyou don'texist in the media,for all practicalpur-
poses, you don'texist" (i8, p. 7). Gainingaccessto the mediais the
firststep for mediaadvocateswho want to set the agenda.
Gainingaccessis importantfortwo reasons.First,thepublicagenda-
settingprocessis linkedto the level of mediacoverageand thus the
broad visibilityof an issue. The media alert people about what to
thinkabout,and the morecoveragea topic receivesin the media,the
morelikelyit is to be a concernof the generalpublic(I5,I6,I9,20).
Second, media are a vehicle for gaining access to specificopinion
leaders.Politicians,governmentregulators,communityleaders,and
corporateexecutivesare peopleyou mightwant to reachspecifically.
In successfulmediaadvocacyboth objectiveswill be met. Forexam-
ple, recenteffortsto removePowerMastermaltliquorfromthe mar-
ket were able to get the problemout in the mediawhich helpedto
make it a publicissue (4). At the same time, specificpoliticiansand
governmentregulatorsat the Bureau of Alcohol, Tobacco, and
Firearmswere exposed to mediareportswhich gave them a greater
sensitivityto the issue and a greaterexpectancythat others around
themwouldbe awareof the issue.Journaliststhemselvesput pressure
on bureaucratsjust by doing the story,apartfrom what mighthap-
pen with public opinion after the story is broadcast.With tape
rolling,officialshad to answerfor theiractions.Consequently,advo-
cates were able to musterenoughpublicand regulatorypressureto
preventthe productfromstayingon the market.
Newsworthiness.None of us is the Presidentof the UnitedStates
WALLACK * STRATEGY FOR EMPOWERING PEOPLE 427

or an editorfor the New YorkTimes,so how can we get accessto the

media? Media advocates gain access by interpretingtheir issue in
termsof newsworthiness.In a varietyof ways, mediaadvocatestake
advantageof how news is constructedand what its objectivesare.
Theirissuewill be coveredonly to the extentthat it is timely,relevant,
definedto be in the public'sinterestand/ormeets a numberof other
news criteria.Shoemakerand Mayfield(zi) presentan extensivelist
of factors that go into determiningnewsworthiness.Criteriafor se-
lectingnews "includesensation,conflict,mystery,celebrity,deviance,
tragedy,andproximity." TothatlistDearingandRogers(I7, p. 174)
add "the'breakingquality'of a news issue,how new informationcan
be moldedto recastold issues in a new way, and the degreeto which
new informationcan be fit into existingconstructs.""Humaninter-
est," which focuses on people overcomingdifficultodds, or helping
others,or unusualness,are also importantvariables.
Very few social problemsare new. Alcohol problems,teen preg-
nancy,drugs,and povertyhave been aroundfor a long time and are
periodicallyrediscovered.Gainingaccess for a particularissue may
depend on where it falls in a cyclic media attention span. Anthony
Downs (zz) has identifieda well ordered"issue-attentioncycle" for
many domesticproblems.His firststage is the pre-problemstage. At
this stage the problemfully exists and can be quite bad, but it is yet
to be discoveredand seenas a problemby the broadpublic.The April
I992. civil unrest in Los Angeles broughtto light basic problemsof
racism,povertyand alienationthat have long existedbut were below
the thresholdof mainstreampublic attention.The uprisingprovided
the basisfor the secondstageof the cycle:"alarmeddiscoveryand eu-
phoric enthusiasm"by the media and the mainstreampublic. Many
thought that racismwas no longera problemin our society;the up-
risingbroughthome the fact that conditionsremained,in fact, quite
bad. Fundamentalto the Americancharacteris a basicoptimismthat
even the most intractableproblemscan be solved.Soon the mediaen-
thusiasmmoved from the horrorsof the violent disturbancesto the
"roadto recovery,"highlightinghow volunteersfrommanydifferent
areaswere pitchingin to cleanup the devastation.The mediapictures
and descriptions,of people joining togetherto clean up, reinforced
the idea that through diversepeople working togetherthe problem
can be solved.
Downs' third stage involves a realizationof the cost of making
428 JOURNAL OF PUBLIC HEALTH POLICY * WINTER 1994

significantprogress. Most important here is the awarenessthat

changewill requiresacrificeand that better-offgroupsmay have to
beara burdento helpthosewho areless well-off.However,fromthis
stage it is a short trip to decline in public interestand pessimism
aboutwhetherchangecan takeplaceat all. Next is the post-problem
stagewhichis a kindof twilightwherethe problemcontinuesto exist
butgets littlepublicor mediaattention.The trailin LosAngelesfrom
Wattsof i965 to SouthCentralof I992 illustratestwo completecy-
cles of the mediaattentionprocess.
Whenthe mediaspotlightfades,attentionrecedesand oftenwe re-
turn to priorarrangementsand priorlevelsof concern.The shift of
the mediaaway froma problemis a curiousformof both causeand
effectof publicperceptions.It is a causeof attentionfading,because
without the media spotlightissues will graduallyfall out of public
discussionand will lose a sense of legitimacyas a problemand ur-
gency as a concern.It is an effect becausethe media will shift only
aftertheysensethatpeopleareboredwith the issueor thatsomenew,
more pressingproblemhas emerged.The media,afterall, are in the
businessof attractinglarge audiences,and if they bore or threaten
peoplebecausethe solutionsarecomplexor call for personalsacrifice,
they will lose their audienceand diminishtheir economicbase (i.e.
audiencefor advertisers).
Shapingthe Debate:Framingfor Content
Gainingaccessto the mediais an importantfirststep, but it is only a
firststepin influencingthe publicandpolicyagenda.Afteraccess,the
next barrierthat mediaadvocacyseeksto overcomeis the definition
of health issues in the media as primarilyindividualproblems.As
Henrik Blum, a well-knownhealth plannernotes, "Thereis little
doubtthat how a societyviewsmajorproblems. .. will be criticalin
how it acts on the problems"(23, p. 49). If we alterthe definitionof
problems,thenthe responsealso changes(24,25). Problemdefinition
is a battleto determinewhichgroup,andwhichperspective,will gain
primary"ownership"of the solutionto the problem.
The tendencyin the U.S. is to attemptto developclearand concise
definitionsof problemsto facilitate concrete,common-sensetype
solutions. This is a very pragmaticapproachwith strong appeal.
Oftentimes,however,problemsof health and social well-beingare
difficultto define,much less solve, and increasinglevels of problem
WALLACK * STRATEGY FOR EMPOWERING PEOPLE 429

complexityare highlycorrelatedwith risingdegreesof disagreement

in definition.Our tendencyis to simplifythe problemby breakingit
down into basic elementswhich are easierto manage.In most cases
this is eithera biologicalunit and the solutionis medical,or an infor-
mation unit where the solution is education.
This misguidedpragmatismabout problem-solvingreducessoci-
ety'sdrugproblem,an enormouslycomplexissue that involvesevery
level of society,to an inabilityof the individualto "justsay no" and
resistthe temptationto take drugs.Generallydiseasesare reducedto
cognitive,behaviorial,or geneticelements.Publicand privateinstitu-
tions end up allocatingsignificantresourcesto identifyingthe gene
for alcoholismwhile leavingthe activitiesof the alcoholic beverage
industrylargelyunexamined.Even though 30 percentof all cancer
deathsand 87 percentof lungcancerdeathsare attributedto tobacco
use, the mainfocus of cancerresearchis not on the behaviorof the to-
baccoindustry,but on the biochemicalandgeneticinteractionsof cells.
The alternativeis to see problemsas part of a largercontext. To-
bacco use, for example,ratherthan beingseen as a badhabitor a stu-
pid thing to do, can be seen as a function of a corporateenterprise
which activelypromotesthe use of a health-compromising product.
Decisions at the individuallevel about whether to smoke could be
seen as inextricablylinked to decisionsof a relativelyfew people at
the corporatelevel regardingproduction,marketing,and widespread
promotion.Smoking,in this largercontext, is seen as a propertyof a
larger system in which a smoker or potential smoker is one part,
ratherthan simply as a propertyof individualdecisions.The same
could be appliedto automobilesafety,nutrition,alcohol, and other
issues. This type of analysistakes the problemdefinitionupstream.
The key for media advocatesis to frametheir issue in terms of up-
streamproblemdefinitions.
The environmental perspective. In public health a new environ-
mental perspectivehas evolved that directs attention to the role of
policy and community-levelfactors in health promotion.This envi-
ronmentalperspectiveincludesboth a physicaland a social element.
For example,policies and practicesthat supportproductavailability
and marketingof alcohol and tobacco, both of which help cultivate
positive social perceptionsabout these products,are primarytargets
for change. Thus, tobacco control advocateshave shifted the focus
from the behaviorof the smokerto the behaviorof the tobacco in-
430 JOURNAL OF PUBLIC HEALTH POLICY * WINTER 1994

dustryand to the policiesthat supportadvertisingand generalmar-

ketingactivitiescontributingto excess mortality.Limitingbillboard
advertising,vendingmachines,and tobaccocompanysponsorshipof
communityactivities,while also promotingclean indoor air legisla-
tion, are key targetsof the tobaccocontrolmovement.
The focus on the immediatemarketingand community-level envi-
ronmentis importantbut still fails to addressthe most significant
variable regardinghealth status. An extensive body of literature
clearlyindicatesthat social class is the singlemost importantdeter-
minantof health (z6). Virtuallyevery diseaseshows an association
with measuresof social class (27). This is not the resultof a simple
rich-poordichotomybut a gradedresponsethat can be seen even in
the upperquadrantof society(28-30). Recentwork suggeststhatthe
most importantfactor within the social class constructionmay be
level of education (3 i). Also, in cross-cultural comparisons, it ap-
pearsthata society'shealthstatusis not linkedsolelyto percapitain-
come, but to incomevariabilityand thereforethe extent of relative
deprivationand discrepancywithina society(3z). The UnitedStates,
for example,farespoorlyon a numberof key healthindicatorswhen
comparedto some countriesthat are less affluentbut also show less
variabilityin incomeacrosssocialstrata.Successfulhealthpromotion
thus reliesless on our abilityto disseminatehealthinformation,and
moreon our effortsto establisha fairerand morejust society.
Therearetwo importantreasonsfor emphasizingthe environment.
First,as the historyof publichealthamplydemonstrates,prevention
that is population-basedand focused on social conditionsis more
effectivethaneffortsaimedprimarilyat treatingindividuals(33-3 5).
It is the policiesthat definethe environmentin which people make
choicesabouthealththat appearto havethe greatestpotentialto im-
provehealth.Second,publichealthresearchpointsto the importance
of equalityand social justiceas the foundationfor action. Environ-
mentallyorientedsolutionstry to addressthe underlyingconditions
thatgiveriseto andsustaindiseaseandthuspromiselongtermchange.
Advancingthe Policy
The ultimategoal of mediaadvocacyis to createchangesin policies
that improvehealth chancesfor communities.This requiresclarity
about the policy being advanced,appropriateframingof the issue
and consistencyin the messagesabout the policy,and the abilityto
WALLACK * STRATEGY FOR EMPOWERING PEOPLE 431

capitalizeon opportunitiesin the mediato advancethe policy.Mass

media can be used to put pressureon policy makersand influential
persons,but the pressureis not automatic.The mediacoveragemust
be carefullycraftedand reflectbroad-basedsupport.Thereare many
examplesof how this can work, and a seriesof nine briefcase-stud-
ies have been presentedby Wallackand his colleagues(4).
In manycases mediaaccessis relativelyeasy,but shapingthe story
and focusingit on policy goals can be quite difficult.Considera typ-
ical, and tragic,examplefrom a majorcity in California.Earlyin the
evening, on her way home from work, a young woman was kid-
napped on the way to her car from public transportation.Her ab-
ductorsput her in the trunkof her own car,robbed,raped,and mur-
deredher.
The tragedyreceivedtremendouscoverageon televisionand in the
local papers. Communitymemberswere horrified,frightened,and
desperateto do somethingabout publicsafety.A local churchheld a
candlelight vigil for the woman, and more than 500 community
membersattendedher funeral.
Severalcommunity-basedorganizations(CBOs)were involved in
organizingthe vigil, which they anticipatedwould attractsignificant
media attention. It did. Nevertheless,membersof the CBOs were
frustratedwith the type of coveragethe woman'sdeath and the vigil
received.They blamedthe reportersfor focusingtoo much attention
on the dramaof the event,ratherthan on the issuesof importancefor
safety and well-beingin the community.
Indeed,news reportsthat discussedsafety emphasizedwhat indi-
vidualsshould do to protectthemselves.Articlesquotedmass transit
officialgiving advicesuch as:

-Observe all posted parking regulationsand park in designated

areas.
-Before leaving,check your headlights,lock your car, and do not
leave valuablesor packageswherethey can be seen.
-Carry your keys in your hands.
-When at stations at night, be aware of your surroundingsand
stand in the centerof the platform.If you need help, call station
police.
-If you do not feel safe walkingto your parkedcar,go backto the
station.
432 JOURNAL OF PUBLIC HEALTH POLICY * WINTER 1994

While all of this is good advice,it placesalmosttotal responsibility

for safetyon the rider.This is important.However,who is askingthe
question, "Whatwould it take to make the environmentsafe, re-
gardlessof what variousindividualpassengersdo?"The storiesdid
not focus on environmentalfactors such as lightingin the station
area,cutbacksin stationsecuritypersonnel,or the muchlargerissue
of violenceagainstwomen.
The responsibilityfor newscoveragedoes not restsolelywith jour-
nalists.Whilemembersof the CBOswere unsatisfiedwith the cover-
age, theyalso had not clearlyarticulatedthe solutionsthey desiredin
termsthe mediacould easilyuse. Access,in this case, was abundant.
The work, from the mediaadvocacyperspective,neededto be done
to framefor content in orderto articulatethe solution and move a
policyforward.
One of the key goals of mediaadvocacyis to advancea policy or
approachto addressthe problem.Gettingthe media'sattentionand
havingstoriesair or appearin printis often the easy partof the job.
The difficultpartoccurswhen advocateshaveto put theirissuesand
approachesin the mediaandin frontof the peopletheywantto reach.
The importantwork of mediaadvocacyis reallydone in the plan-
ning stage before calling the media. Advocatesneed to know how
theywill advancetheirapproach,whatsymbolsto use, what issuesto
link it with, what voicesto provide,andwhat messagesto communi-
cate. The issue can be re-exploredin termsof mediaopportunities.
Strategiescan then be developedto framefor access and framefor
content.Framingfor accessand framingfor contentforceadvocates
to thinkin termsof the mediaand its needs.
In reality,most CBOsdo not have the resourcesor trainingto use
mass mediaeffectively.In this example,the CBOswere in a reactive
position.Communitygroupscananticipatesimilarsituationsandpre-
paretheirpolicysolutions,andhow theywant themframedin media
coverage.Articulatingthisvisionis the hardworkof mediaadvocacy.
Media advocacycan then effectivelybe used to help communities
claimthe powerandconfidencetheyneedthe betterto tell theirstory.
CONCLUSION

For advocates,the pressis a grandpiano waiting for a player.

Strikethe chordsthrougha news story,a guest column, or an
editorialand thousandswill hear.Workingin concert,unbiased
WALLACK * STRATEGY FOR EMPOWERING PEOPLE 433
reportersand smartadvocatescan make musictogether.
Susan Wilson,New JerseyNetwork for FamilyLife
Sincethe late I980s mediaadvocacyhas becomean increasinglypop-
ular approachto using mass media to promote public health goals.
This approachseeks to enhancethe visibility,legitimacy,and power
of communitygroups. Media advocacyrepresentsmore than just a
differentway of using mass media to promote health. It is an effort
to fundamentallyshift power back to the communityby cultivating
skillsthat can enhanceand amplifythe community'svoice. Insteadof
giving individiualsa message about personal health behaviors, it
gives groups the ability to broadly present approachesto healthy
public policy. It is based on the premisethat real improvementsin
healthstatuswill not come so muchfromincreasesin personalhealth
knowledgeas fromimprovementsin socialconditions.It is the power
gap ratherthan the knowledge gap which is the primaryfocus of
media advocacy.
Media advocacyreflectsa public health approachthat explicitly
recognizesthe importanceof the social andpoliticalenvironmentand
defineshealth problemsas mattersof public policy,not just individ-
ual behavior.Media advocacy attempts to help individualsclaim
power by providingknowledge and skills to better enable them to
participatein efforts to change the social and political factors that
contributeto the health status of all. The health of the community,
not necessarilythe individual,is the primaryfocus. Activeparticipa-
tion in the politicalprocessis the mechanismfor healthpromotion.
Social and healthprogramsgenerallytend to focus on givingpeo-
ple skills to beat the odds to overcomethe structuralbarriersto suc-
cessfulandhealthylives.Inthe long runit makesmoresenseto change
the odds so that morepeople have a wider and more accessiblerange
of healthychoices (36). Media advocacyhelps to emphasizethe im-
portanceof changingsocial conditionsto improvethe odds. Media
advocacycan be instrumentalin escapinga traditional,limitedfocus
on diseaseinformation,and, instead,promotea greaterunderstanding
of the conditionsthat will supportand improvethe public'shealth.
434 JOURNAL OF PUBLIC HEALTH POLICY * WINTER 1994

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ABSTRACT
Media advocacy is a new strategy that is emerging in the public health com-
munity. It has been particularly visible in communities of color. Media ad-
vocacy is defined as the strategic use of mass media to advance public policy
initiatives. Media advocacy is rooted in community advocacy and has as its
goal the promotion of healthy public policies. It can be differentiated from
traditional mass media strategies in a number of ways. Media advocacy
shifts the focus from the personal to the social, from the individual to the po-
litical, from the behavior or practice to the policy or environment. While
traditional media approaches try to fill the "knowledge gap," media advo-
cacy addresses the "power gap." Improvementsin health status are believed
to come about primarily from gaining more power over the policy environ-
ment rather than simply gaining more knowledge about health behaviors.