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Dr subba rao
1. National Institute of Nutrition
Communication for Fluorosis Mitigation :
Some Challenges and Opportunities
Dr. G M Subba Rao
Scientist ‘C’
2. National Institute of Nutrition
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).
3. National Institute of Nutrition
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
4. National Institute of Nutrition
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
5. National Institute of Nutrition
Creating awareness?
Awareness
Knowledge
Contemplation
Intention
Action
Maintenance
6. National Institute of Nutrition
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
7. National Institute of Nutrition
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
8. National Institute of Nutrition
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?
W
ho will be primary audience?
Who will be secondary audience?
Who will be tertiary?
9. National Institute of Nutrition
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?
10. National Institute of Nutrition
Adolescents or middle-aged?
• Youth or youth of old age?
• Fluorosis – safe water as a right. Increasing public
demand
• What can we do now?
11. National Institute of Nutrition
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?
12. National Institute of Nutrition
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
13. National Institute of Nutrition
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?
14. National Institute of Nutrition
Facilitators or opinion leaders?
• Take the message to the grassroot levels?
• Formulation of opinion?
• Set agenda?
• Manufacture consent ?
15. National Institute of Nutrition
‘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
16. National Institute of Nutrition
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?
17. National Institute of Nutrition
Never undermine
• Span of attention
• Frame of reference
Also remember…
• Selective retention
• Selective understanding
• Selective memory
Multiple uses of innovation
• Don’t just be happy with numbers
• Get back to the audience in short intervals
