Harris County Public Health
"Blueprint for an in-house creative agency"
Harris County Public Health (HCPH) is the health department for Harris County and provides comprehensive public health services to the community with an annual budget of $102 million and a workforce of approximately 650 public health professionals all dedicated to improving the health and well-being of Harris County residents in communities where they live, learn, work, worship and play. The HCPH jurisdiction includes approximately 2.5 million people living in unincorporated areas and over 30 other municipalities in Harris County. According to a 2017 LA Times article, Harris County is one of the most diverse counties in the nation.
Public health communications is acknowledged as an essential component of any local health department, but it often does not receive the investment of funds appropriate for its importance. The 2016 NACCHO Profile of Local Health Departments (LHD) indicates only 20% of LHDs have public information professionals. Surprisingly, 24% of LHDs that serve over 1 million people did not have a public information professional. The Profile indicates there are only 540 FTEs with the occupation of Public Information Professional in all sampled (n = 1611 1808) local health departments. HCPH set out to redress this in 2015 with the creation of the Office of Communications, Education, & Engagement (OCEE). We have 10 FTE's many of whom are either fully or partially funded by local tax revenue.
The mission of OCEE is to tell the Harris County Public Health storyâ€”a diverse narrative involving the people, places, and experiences that define Harris County. We educate, engage and empower all the residents within our rapidly expanding county by providing practical, relevant information for well-informed health decisions. We use a comprehensive, innovative approach to support and advance the goals and overall mission of HCPH: to build and sustain a healthy, safe community for residents and their loved ones.
Clear communication is a vital part of health literacy. We work closely with all our partners to ensure the communication initiatives, public health campaigns, educational materials and all forms of media we create are readily available, easily understood and culturally sensitive.
OCEE gives HCPH industry grade marketing for a public sector price tag. In the 2 years that the Office has been around, we have created a unified brand with a new logo & website, generated over $100 million in free publicity for the agency, and built up public trust during our Zika response that allowed us to be more effective for our Hurricane Harvey response.
HCPH also has an enhanced relationship with traditional media due to OCEE's efforts. Our team, some of whom have traditional media as part of their background, believes that the media is a positive partner for the agency. When there is an event being held, such as a door-to-door survey (CASPER) of residents to inquire about their post-Harvey situation, OCEE works to ensure that the media is present to amplify the effects of our engagement.
In the aftermath of Hurricane Harvey, over a dozen 1-minute YouTube videos were made. These videos provide tidbits of information, either about HCPH recovery related activities or education on how people can protect themselves or their property. We made the videos 1-minute long because longer-format videos are rarely watched by the public and we needed to disseminate information quickly and succinctly. One minute videos are especially effective on social media platforms such as Twitter and Facebook and allow for sharing of information through channels that we know individuals are using.
HCPH's approach to communications, social media, and traditional media is a creative, professional, and highly effective use of a practice that exists in virtually all local health departments. In the absence of a highly effective communications strategy & team, HCPH's voice would get lost in all the competing messaging that occurs in our community. Harris County is home to 2 local health departments (the City of Houston has its own health department), the Texas Department of State Health Services 6/5S regional office, the Texas Medical Center â€“the world's largest medical center- and countless non-profits that serve various segments of our community of 4.5 million people. Each agency is vying for the public's attention. To be successful, HCPH needed to modernize its communications operations and build a comprehensive strategy.
Adding to the complexity of getting HCPH's messaging is the fact that Harris County is an incredibly diverse locale and so all messaging needs to be adapted for several different cultural groups. Harris County is 42% Latino, 31% White, 19% Black, 7% Asian, and 1% Native American/Pacific Islander. Harris County has over 1 million residents who were born in another country; much of the county is urban, yet some areas are very rural. Messaging produced by OCEE is regularly translated into Spanish and other languages primarily spoken in the region.
Historically, messaging at HCPH has been supported only to the level of â€˜good enough' or individual perspective. Messaging and education was crafted to make sure all the â€˜boxes' were checked, and not crafted to make sure it was consumed. With professional marketers on staff, we understand the importance of quantitatively and objectively measuring performance; we use tools to align our work with good public health practice, such as checking language through plain language software, more imagery, fewer words, and we regularly use impression data and market impact data to guide and improve our work.
Harris County Public Health employs a wide array of KPI's to purposefully measure the general effectiveness of our marketing campaigns and messages. One of the most useful tools in our arsenal is analytics, particularly Google analytics for our website and Facebook and Twitter analytics for our social media outlets. When using Google analytics, to measure user engagement on our website, HCPH focuses on three primary measurement categories:
Page views - The total number of pages viewed
Unique Page views - The number of sessions during which the specified page was viewed at least once
Average Time on Page - amount of time users spent viewing a specified page or screen, or set of pages or screens
When analyzing KPI's for social media, HCPH uses a few different categories for measurement.
For Twitter HPCH focuses on:
Tweet impressions - Tweets sent that generate interaction or replies from others
Profile visits -The total number of users who visit HCPH twitter profile
Mentions - A mentions occurs when a user includes the HCPH handle in his or her message
For Facebook HPCH focuses on:
Reach - the number of unique people who saw your content
Engagements - post clicks, likes, shares and comments
Post shares - When a user shares your Facebook post with his or her Facebook friends
For media, we use a monitoring service such as that lets us know when our name gets mentioned via radio, broadcast or printed media, whether the story was positive or negative, how many people read/saw the story, and it helps expand our reach to media outlets that we traditionally would not have access to.
OCEE invested in modern tools for its staff. Adobe InDesign was purchased for all design staff. InDesign is a sophisticated software tool that is comparable to Microsoft's Publisher. It is the tool of choice for most professional design professionals that create printable media. Additionally, professional grade cameras were purchased to ensure video quality is high definition and high quality resolution.
OCEE's innovative approach to community engagement started with Zika. Harris County has a very high risk of importing and sustaining local transmission of Zika due to our large, mobile Latino population and the hot, humid climate that is able to support Aedes aegypti mosquitoes year round. When the first fatal case of Zika occurred in the county, we decided to proactively engage the media directly. Our executive director, Dr Umair Shah, spoke at a press conference to discuss the problem and discuss how HCPH was addressing it. This helped propel Dr Shah as the face of public health in the county. OCEE set him up with several interviews, media appearances, and blog posts to discuss the many ways we approached Zika to build community resilience. One of the biggest highlights was securing a visit by US Senator John Cornyn to visit HCPH and tour our agency's Mosquito & Vector Control Division. Senator Cornyn was a major supporter of securing Zika related funds for local jurisdictions.
According to Pew Research, around seven-in-ten Americans use social media to connect with one another, engage with news content, share information, and entertain themselves. Over the past decade there has been increased use and consumption across the social media landscape. On average, Pew Research states that individuals in the U.S. spend approximately two hours on social media sites each day.
CDC has long identified and recommended the use of visuals, such as pictures, drawings, charts, graphs and diagrams. These are effective tools for communicating health information, especially for individuals who have low health literacy levels. Visuals such as videography can present complex information that is easier to comprehend, more attractive, and can reinforce written or spoken health messages. Visual communications can benefit all audiences. For example, prior to our CASPER survey we worked with a local media affiliates to help explain the benefits and purpose to the survey. Since we were surveying in a high immigrant community, there were natural fears to complete the survey due to apprehension of government in general. Understanding that cultural complexity, we invited media before and during the CASPER. As a result, individuals stated they had seen the media outlets and were more likely to complete the survey.
Direct video messaging uses a story format to explain public health information with little room for misinterpretation, and it can be easily shared. The high quality videos we created highlighted important public health work and helped individuals understand public health's role during and after a disaster.
OCEE engages all of Harris County's communities to ensure they are educated about the services HCPH has to offer and are aware of the public health threats in the community. OCEE regularly partners with traditional media, community leaders, and the public at-large. HCPH understands that we are not going to draw the public's attention in most instances, so we often partner up with a high-profile celebrity to capture the public's attention.
OCEE uses media to foster trust and build resilience in the community. The community did not understand what HCPH was, so we decided to upgrade our logo to be less â€˜government' and more welcoming. The new logo has a modern design and much more color than our previous logo, which was just our acronym. Once our rebranding was complete, we set out to engage and educate our community through social media. We established Twitter, Facebook, Instagram, and YouTube accounts. We regularly update these accounts and directly engage with the public.
HCPH has an enhanced relationship with traditional media due to OCEE's efforts. Our team, some of whom have traditional media as part of their background, believes that the media is a positive partner for the agency. When there is an event being held, such as our door-to-door surveying (CASPER) of residents to inquire about their post-Harvey situation, OCEE ensures that the media is present to amplify the effects of our engagement.
CASPER is a CDC developed tool to understand the needs and status of residents after an emergency. It is a scientifically rigorous survey methodology that is most effective when the public understands its purpose and opts to engage with public health. If citizens are untrusting they are less likely to respond to a knock on the door from government officials. This is especially true in portions of Harris County with a significant Latino community who may be concerned about issues around deportation.
Because OCEE has a strong partnership with the media, they proactively engaged a local news station to publicize the CASPER on the morning news. They agreed to publicize it; they also sent a camera crew to the CASPER event that evening to provide a live broadcast. Several citizens who participated in the CASPER reported they had heard about the event earlier on the local news, this made them feel much more comfortable and willing to engage with our teams that were going door-to-door.
OCEE recognizes HCPH has made a significant investment in our Office. As good stewards of taxpayer dollars we need to show our impact for the agency and community. We regularly track and assess our impact in traditional and social media through measuring publicity value and public engagement through quantitative measurable such as like, retweets, shares, comments, and impressions.
The primary measurable of performance for traditional print & televised media is publicity value. Publicity value is a standard marking-industry metric to quantify the value in dollars of a particular advertisement or public relations piece. While there is certainly a lot of debate out its merits within that industry, it is a much underutilized tool by local health departments. In 2017, HCPH media coverage is calculated at approximately $100 million dollars in publicity value. Hurricane Harvey related coverage accounts for $20 million of that. Another $2 million can be attributed to media promotion & adoption promotion of our Veterinary Public Health (VPH) services.
From March through December 2017 we were cited in 1,274 media pieces related to VPH. That accounted for a publicity value of $1.7 million. We had an average of 56,000 Facebook post engagements (i.e., likes, shares, comments). This led to adoption rates being up for the year. In one instance 59 puppies were dropped off at the VPH shelter. Our media engagement led to a public response where 200 animals were adopted within a few days.
To improve public awareness of our health clinics we set up a Google ad words campaign. The ad word campaign targeted 90,000 individuals. Of these, 10% â€˜clicked' the ad; the industry average click rate is 2%. At least 900 people were found to have called directly from the ad on their smartphones.
Our social media presence continues to grow. In 2017 we had over 175 YouTube videos produced, which led to over 16,000 views and over 41,000 minutes of watch time.
The post-Harvey CASPER gave us an opportunity to evaluate the overall public health messaging efforts around storm clean up, water safety, mosquitoes, and mental health. Survey respondents were asked if they had heard information on these topics related to Harvey. CASPER data indicated that most public health messaging was successful in reaching 50% - 70% of the population. Mental health information was only heard by 38% of the respondents. However, of the 22% that responded needing mental health services, 68% reported having knowledge of mental health resources.
HCPH's Office of Communications, Education, and Engagement gives HCPH an industry-grade communications team at a public sector price tag. Every jurisdiction will need to scale their communications team according to their population size and resource availability, but we believe that having a more than modest budget pays dividends in an agency's ability to engage and educate the public. The funding should be stable and performance should be tied to quantitative metrics.
For OCEE to be successful, and therefore continue to be sustained, it must be perceived as a benefit to the whole agency. As such, OCEE needs to be plugged into the activities of all areas of HCPH. And each area should find ways to measure the impact of improved marketing on their programmatic impact. For example, VPH should continue to measure and understand the relationship of improved, targeted advertising and adoption rates. Only then can the true value of a well-funded communications team be understood. Because of OCEE's positive impact on adoption rates, VPH sees OCEE as an extension of its own mission, and not a fraternal rival for general fund dollars.
OCEE also needs to show its value to elected officials. Elected officials (or a board of health in some jurisdictions) are the arbiters of taxpayer dollars. Communications teams can be seen as an unnecessary luxury, so having a good relationship with elected officials is important to be able to regularly demonstrate and communicate value.
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