Dr subba rao

National Institute of Nutrition

Communication for Fluorosis Mitigation :

Some Challenges and Opportunities

Dr. G M Subba RaoScientist ‘C’


The harsh reality in India

• Pockets in 70-100% districts are affected in Andhra Pradesh, Gujarat and Rajasthan.

• 40-70% districts are affected in Bihar, National Capital Territory of Delhi, Haryana, Jharkhand, Karnataka, Maharashtra, Madhya Pradesh, Orrisa, Tamil Nadu and Uttar Pradesh

• 10-40% districts are affected in Assam, Jammu & Kashmir, Kerela, Chattisgarh and West Bengal.

• Throughout India fluorosis is essentially Hydrofluorosis except in parts of Gujarat and U.P. where industrial fluorosis is also seen (Momin, 2010).


The challenge that remains

• Lack of Safe Drinking Water to Many• High Malnutrition Levels • Problems in early diagnosis• Inadequate access to Health Care• Myths and Fads even in endemic areas• Lack of awareness among people


Expert advice…..

‘An expert is somebody who is more than 50 miles from home, has no responsibility for implementing the advice he gives, and shows slides’

Edwin Meese III


Creating awareness?

Awareness

Knowledge

Contemplation

IntentionAction

Maintenance


Should we talk education or communication?

Education• Top-down approach• Information dissemination• Awareness creation

Communication• It happens in a context• Audience are not passive

respondents• Feed forward is as

important as feedback


Fluorosis and Nutrition communication –

A challenge• People are usually not aware of symptoms in early

stages• People think they are immune to disease unless it

affects them• Nutrition messages don’t interest many• Make eating & living very complicated • Always talk about change in behaviour (unlike others)• Benefits are not immediate• The audience may feel it is not his/her cup of tea

• All are not decision makers• Limited powers and scope to change• Economies and infrastructure


Who will be our audience?• Young or old?• Adolescents or middle aged?• Researchers or Health professionals?• Policy makers or implementers?• Facilitators or opinion leaders?• Rich or poor?

Who will be prim

ary

audience?

Who will be secondary audience?

Who will be tertia

ry?


Young or Old?• Early detection is must • Good nutrition is important

– awareness should start early?

• Behaviour change is the idea – so catch them young?

• Reach the community – easy to reach through them?

• Introducing variety of foods rich in calcium and antioxidants becomes easier?

• Equip them to detect fluorosis early

• Good nutrition is important – it’s never too late?

• Behaviour change is the idea – so try if you can?

• Reach the community – increase social activity?


Adolescents or middle-aged?

• Youth or youth of old age?• Fluorosis – safe water as a right. Increasing public

demand• What can we do now?


Researchers or Health professionals?

• Qualitative data on KABP, perceptions of people on fluorisis, causative factors, nutrition and foms?

• Is there a need for multi-disciplinary approach?

• Role of social science researchers?

• Right kind of awareness?• Is it about making

information readily available to them?

• Or is it about equipping them by integrating in the curriculum?

• HRD?


Consumers or Manufacturers• Generating interest in

defluoridation• To make informed

choices of equipmet• What about

popularizing household techniques

• Popularizing and creating markets for equipment that can defluoridate water

• These as a source of revenue


Policy makers or implementers?

• Enabling environment for demanding and procuring safe drinking water?

• Eating a variety of foods… availability, accessibility and use?

• Policy interventions? Implementation?


Facilitators or opinion leaders?

• Take the message to the grassroot levels?

• Formulation of opinion?• Set agenda?• Manufacture consent ?


‘Multi’media approach• Nutrition and health communication have been

relying more on IPC – Fluorosis communication no different

• IPC can be made more effective if some more media are used

• No one medium is mass medium – so no umbrella solutions

• Combination of media is a must• Technological constraints and reach of the

medium


Multi-pronged approach?• Behaviour Change (communication)• Reinforcement (long spanning multi-media approach)• Change in social norms (social marketing)• Empowering people (Information dissemination) • Mustering support (Advocacy)

What first?• Who is to be tackled first?• What is to be conveyed first?• What do you want to achieve with IEC?• Change objectives according to KABP?


Never undermine

• Span of attention• Frame of reference

Also remember…

• Selective retention

• Selective

understanding

• Selective memoryMultiple uses of innovation

• Don’t just be happy with numbers• Get back to the audience in short

intervals


Thank you for your attention

Government & Nonprofit

Dr subba rao