London School of Hygiene and Tropical Medicine.

Talk for the London School of Hygiene and Tropical Medicine. 9th May 2011

George McBean

Visual Literacy and Health Communication.

(Visuals prepared in Power Point.)

One thing to keep in mind throughout this presentation, when you hear me speak of differing Art forms as Communication… remember that each person brings their own meaning to whatever they see or hear. ie an audience’s point of view is greatly influenced by their cultural background, exposure to education and the media that surrounds them. (There are also many other personal capacity issues such as health; circumstance; mood and season.)

Artists engaged in development communicators should never take for granted that the message they hope to covey with their work will be understood as they intended. They can however engage and display their art with the public they want to reach… and use as much research and observation as they need to modify and refine opportunities to communicate more effectively.

My personal start in the Communication business.

As a Scottish illustrator and animator in the 1970’s my first job overseas was in East Africa with UNICEF. I was asked to work in an environment where there were little or no illustrative arts circulating in the community. There were skills in many crafts but images on pieces of paper were rare. Working in refugee camps in Somalia or with pastoral nomadic groups of Rendile, Samburu and Turkana in Kenya I discovered that people who saw images in 2D for the first time had some difficulty interpreting what these visuals meant. Even after the advent of Polaroid cameras when people in remote rural villages were shown images of themselves for the first time… they would stare for long periods of time trying to assess what they were looking at… before recognising the image. In refugee camps in Somalia there was often repulsion among people at the sight of a hygiene poster with hands washing under a tap. To the viewer the image of severed hands in a poster reminded them of criminals who were caught stealing and had their hands amputated! There were other mis-interpretations of posters and flipcharts mostly because they were imported images from over-seas; scenes that people were completely unfamiliar with. An African-American mother; shown in a poster under a bathroom shower, was used by aid groups in a fairly desperate attempt to improve camp hygiene, this held little interest to people who washed from a cup. We began to draw the people themselves doing the things that we wanted them to do with regards to protecting their children… and there was immediate interest in my drawings. On nearly every occasion when they looked at these drawing and recognised who was in the illustration this realisation was followed by a response of laughter. (Making my job all the more rewarding and enjoyable.)

However trying to communicate important health messages about children’s health and nutrition to young nomadic non-literate mothers became more of a challenge. They were the most endangered and most at threat from the complications and lack of service and knowledge among the regions mothers.

(Show Power point slides of Refugee camps in Somalia and rural nomads in Northern Kenya and Sudan.)

By the end of the eighties we became quite experienced at producing effective teaching aids for the variety of different ethnic groups in East Africa and I began to teach other local artists how to draw more informed Illustrations for Development. I also began to take an interest in what was called Visual Literacy Research and enrolled in a full summer course at Stanford University in the USA to learn of other Visual Research studies and share some of my own experiences.

In 1982 I was transferred to Nepal and took up the challenge of developing a visual communication strategy for UNICEF to promote the use of Oral Rehydration Solution, since most deaths of children in the country were caused by diarrhoea related dehydration.

Show: Changing Vision is a film about a study in Visual Literacy in Nepal and shows some of the challenges that exist for health communicators using visual aids who are working in rural areas of the world’s poorest countries. In Nepal in the mid-eighties 90% of the population lived in rural areas where only 18% of women were literate… yet these women were (and still are) the backbone of the family and the economy. This film shows why you should begin to analyze the audience you are trying to reach in order to understand what you are attempting to communicate. This type of study into visual literacy represents the starting point for the design of any communication strategy.

Discuss VIDEO

As you might guess by now… the quality of the artwork plays an important part in the communication process. For those who profess to know about art and artists it is not enough just to choose an artist because they are local or famous… it is necessary to find out if an artist’s work is capable of any ‘communication value’ for the people you are trying to reach.

Here we are not talking about the avant-garde Art influence on society where Art becomes attractive because it is not clear what the artist means. Picasso’s work communicates best with those who care to take the time to learn his language… the language he expresses in his work. In order to distinguish this from the sort of challenge for artists working in development communication... we began to talk of their work being Ergonomic… in the same way as a designer makes a chair more comfortable for the office worker… the development artist changes lines here and there… taking into account the viewer’s capacity to ‘read’ meaning into it. If a development artist does not make understanding easier for the viewer… they have failed the most fundamental challenge. (For example… it’s like a valuable piece of literature written with bad handwriting , then blaming the reader for not understanding. An illustration should by definition…. Illustrate. It’s hopeless if its illegible.)

Another point from the film to note is the speed at which people with no education can grasp information from visuals, once they are familiar and exposed to the learning process. Good illustration is the gateway to literacy in children… it is no different for adults. Keeping pace with a community’s development is also essential to prolong interest in learning social or health information. Once involved in the world of visuals, people with the economic means to change their lives do so by imitation… everything from their clothes, and fashion to kitchens and bathrooms can be inspired by seeing visual images.

When designing a communication strategy for health, there are several ways that people go about this task. One approach is to put together a list of different types of materials and methods to carry your messages. Many Agencies and Ministries of health still do this today. You’ll hear them ask for samples from what has worked elsewhere… and simply copy these for their own programmes. When they do this they often create an assortment of posters and brochure, videos etc. that look impressive at meetings but are ineffectual in the field. These days the list of things that have worked elsewhere can be endless… from old fashioned posters; flip-charts and extension workers, we have progressed to include drama groups; comedians; faith healers; retired soldiers; school teachers; puppets; politicians; musicians; entertainers; media celebs; religious leaders, trade unions artists and employers as well as an assortment of new media such as comics, matchboxes, T shirts badges, concerts, flash cards, animation and do it yourself explanations. We even have examples of camels in Chad carrying solar panels and TV sets. There are health workers in Nepal carrying umbrellas with ORS messages.

‘All for Health’ is one of UNICEF’s pioneering books that contains a list of this sort of variation in ways to communicate Health messages.

The creative list goes on. Finally there are those who try and reach large audiences from a distance… mass media such as print radio TV which are shown in a variety of formats such as News Current events, documentary soap opera, reality TV entertainment and games shows (The list goes on further to new media like cell phones; web-based visual media for the latest gadget… among the Google anything, anywhere, anytime generation.)

However when choosing to design a communication strategy from a list of media and formats you loose sight of one of the most important factors in successful communication… knowledge of the audience and their capacity (and even their interest) to take in new information. Each preventative health issue is unique with each audience you try and reach and if you can spot that uniqueness you may well boost your campaign to new levels of success. After accessing the audiences inclination for change in the subject you hope to help them with…you really have to begin by scoring off the most inappropriate methods and media (knowing what to leave out is a important as listing enormous amounts of materials, effort and expenses across all media frontiers.)

Identifying points of opportunity… with the use of some innovation in the design of appropriate material… is what gives your strategy a better chance of success.

When we talk about Art and Artists we are actually talking about a very small part of the process of communication and development. Good Art can help us to motivate all the parts of the process of development… from conducting surveys gathering information to delivery and evaluation. But Art rarely delivers improvement or development alone. Science and Engineering; Medicine and Economic growth are also important parts of the solution that contributes to development and they are much the same from country to country. These are the global elements that do not change, set in the multi-cultural world we live in. They contain factual and understood formulas. (ie Salt dissolves the same way in Egypt as it does in Essex… what changes is the way we explain it.) Water boils at the same temperature. The engineering of roads and bridges and latrines is much the same everywhere… but it is the motivation to build and use and maintain these facilities and structures in a language that people understand which requires communication skills.

UNICEF’s approach to childhood development has always stressed that we can succeed in the provision of basic services… despite poverty. In the future its important to add that we can also succeed … despite illiteracy. As we struggle to eradicate both poverty and illiteracy, we must not forget we already have enough knowledge and technology to succeed in improving health, despite high drop out rates in education and the challenges of remote rural locations.

This brings us back to the visual arts and the use of film animation. As the world has embraced TV and its outreach to remote rural areas, a similar problem exists for educators using moving visual images as once did for those using print media. How appropriate is the visual image for the audience it is being shown to. Although most people in the western world believe there is now a universal interest in visuals… in remote parts of the world the novelty and fascination of seeing oneself on screen still adds a new level of interest and attraction to the viewer. Animation has become the natural successor of good illustration. It has an increased capacity to simplify information and makes it available to people from differing cultures who may have low literacy skills. Because it is a manufactured moving image it is capable of removing the superfluous visual and verbal information of live action… to simplifies messages. It is clear from the use of animation in adverts for commercial medicines and product how persuasive a tool animation it can be. ( ie a fireman in your stomach can hose down the pain with a milky soothing substance… and you believe it.) It is also clear from the use of instructional animation that it has a long shelf life when used on long term issues in education and health. Film animation prepared to help children understand the letters of the alphabet for the TV programme Sesame Street were created in 1969 and although the presenters and puppets have changed over the years… these short spots of animation are still used in syndicated shows today.

(Note. Animation was once too expensive a medium for people in Government or Development Agencies to use for public information…but now it is clear that what they spend on print materials that are only used once for a meeting or a campaign or for their own internal ongoing administrative purposes is more prohibitive)

Show samples of animation… from the Jam, Cartoons for Children’s Rights and the maintenance of the India Mark 2 water pump



As the world’s population is in the process of doubling for the very last time… in the next sixty years we will have to come to terms with the largest number of humans who have ever existed on our planet. We will grow from the 6 billion mark to somewhere between 10 and 12 billion.

(Show the illustration of two ducks in the Pond… as a sample of a graphic used to explain the increase in Terai village populations in Nepal.)

As you can see on the first day there are two ducks in the pond. The next day there are four ducks in the pond, next day eight , next day sixteen, next day thirty two, next day sixty four, next day one hundred and twelve… etc etc .

The question is then asked … when is the pond full? The answer… the day after it is half full!

Things look ok when the pond is half full… that’s where we are just now. There still seems enough room to move around. In one day however things will change. This one day … is the next 60 years of human growth.

What to remember is not what countries this new and massive generation will appear in, or what cultures they will be born into, or what this growth in humans will be demanding… what we must remember first and foremost is that … they will be children. They will need to be talked to and provided for as CHILDREN. How we do this… and the subjects we provide knowledge in are crucial decisions because this generation will have limited capacity to take all things in and we have limited capacity to cover the whole of human history in a way that will help us all live together in peace. (History may even seem irrelevant in the face of the scale of youthful enthusiasm for change. )Like the emergency that renders everyone’s cell-phone useless because the demand is too much all at the same time… this generation of young people will struggle unless we act now to help them while they are in the world’s largest ‘nursery’. Reaching out to them from an aging, wizened, controlling Older-aged world will become one of the most important challenges of this century.

Lastly… we need to accept that this new generation (most of whom are not yet born) have such potential… they will live among the greatest collection of creative minds ever assembled. To meet their aspirations and challenges they need the best head start we are capable of providing. This means our existing knowledge of research and evaluation should help guide us through some of the predicted pitfalls; the lack of health and education opportunities for many of the poorest should not stand in the way if technologies and the media can combine creatively… almost in an emergency educational effort. Education materials that are prepared will do their work outside of schools as well as inside. They will provide education in poor areas of the world where education is seen as a very valuable asset. They should be good enough to be pirated. When they are of such demand they are copied and circulated by people outside of development projects… it is an indication of their popular effectiveness.

George McBean

May 2011

George McBean 2012