Shaping Narratives that Advance Health and Wellbeing

These steps can help create coherent, actionable narratives that unite and mobilize communities.

Editor’s note: This post is part of a three-part series that shares key insights from the RAND ALIGN Toolkit to support community leaders in advancing health equity. Other posts in the series explore measurement and aligning investments.

The Internet, social media, and now AI have transformed how people access and consume information, creating new opportunities and challenges for those of us working to advance health equity and wellbeing. Knowing how to shape and amplify narratives that reflect the realities of our lives is more important than ever.

Narratives start with what communities understand about their places and their people, and how those values and history then shape the path to health and wellbeing. They are not branding, messaging campaigns, or talking points. They go deeper, focusing on culture, history, and the values or frames at the heart of a community. Put simply, narratives provide a “North Star” to guide action. They offer the ability to:

• Mobilize a community toward a common aspiration or goal.
• Connect disparate efforts to align on a set of overarching messages and stories.
• Anchor a vision of health progress, both emotionally and practically.

Narratives have the power to advance—or impede—health equity, wellbeing, and justice. Traditional health communication strategies often start by emphasizing narrow aspects of health like disease prevention. But when leaders begin instead by focusing on broader community values (e.g., pride in place, commitment to the land, work ethic), they can create a more inclusive and compelling narrative that encourages collective action and drives progress to better health. This kind of approach can help bring people together and replace divisive narratives with unifying ones that offer a compelling vision for a healthier future for everyone.  

Advancing unifying narratives and shaping new ones that affirm a community’s values and experiences can inspire and mobilize citizens and leaders to pursue the changes they want. To support this, we created the RAND ALIGN for Health and Well-Being Toolkit with and for  communities. It offers guidance to community leaders for capturing local insights and developing practical solutions that promote health and wellbeing. It builds on other modules in the Toolkit to make this work seamless. Its Walking the Talk module focuses on shifting a community’s narrative toward a vision for positive health and wellbeing, providing four key steps for doing that work, and accompanying interactive exercises, some of which are described below.

Unpack frames that guide community values.

Frames are underlying values and beliefs.  A community’s history, the experiences of community members, culture, mindsets, and other factors all influence frames. Examples of frames are “Healthy people need healthy environments,” and “It’s time to address health equity and systemic racism.” Many communities have a dominant frame that informs their health actions.

To unpack a community’s frames, bring people together to examine its:

• Values, the principles or standards of behavior (e.g., the value of teamwork, self-reliance). How do those values relate to health?
• Experiences, the factors from the community’s history that influence how it addresses health issues. Consider a community’s recent experiences related to health that might shape beliefs, for example, a health initiative that did or did not work, economic choices, or political changes.
• Culture, the ancestries, traditions, and nationalities the community builds from, and how these cultures show up in how people view health or approach health challenges.

Examine how people frame health differences and their understanding of health equity.

Communities approach health equity in different ways. For some, the word “equity” might not be useful. Other terms that may resonate with them include “health opportunities,” “fairness in health,” and “health for all.” Ask community members to consider:

• Why they believe some people are unhealthy.
• How they think people in America view the topic of health equity.
• Whether the community focuses on disparities. Is it taking a broad approach to economic and/or educational opportunity with the aim of influencing health? Or is it focused on making systemic changes to address health inequities?

Then develop a set of messages and one compelling short story that illustrates why improving health equity matters to the community. Consider how those messages would resonate with audiences such as:

• A government agency focused on community needs other than health (such as public works).
• A for-profit business.
• A community-based organization focused on family economic opportunities.

Build stories that connect traditional health issues with collective wellbeing.

Ask community members to consider whether the term “wellbeing” works for the community. Alternatives might be “positive health” or “quality of life.” Whatever term is used, “wellbeing” should encompass a comprehensive view of health, including its multiple and holistic dimensions (e.g., social, emotional, physical, cultural, spiritual); and it should focus on not just the absence of disease but actions that help individuals and the community reach their potential.

Consider how the community talks about wellbeing and what community members hear others say gives them hope. Assign small groups to one of the following: mental or behavioral health; housing availability, stability, or homelessness; or healthy food access. Then ask each group to develop messages and a compelling short story that connects their assigned issue to collective community wellbeing. The goal is to shift the frame so that a sector can better understand why a typical health issue can and should be framed in the context of improving collective wellbeing.   Using a story helps achieve that shift.

Identify narrative influencers in the community.

Community influencers promote and advance narratives. Bring together community members to discuss who is shaping the community’s health narrative. Explore which narratives are dominant and why, and consider:

• Which community features will help maintain and sustain a narrative that promotes health equity and collective wellbeing.
• Who can advance this narrative?
• Who can help counter events or actions that might disrupt positive narratives about health equity and/or collective wellbeing.

Strong narratives drive change!

This work can be extensive and answers won’t come overnight. But developing a coherent, actionable narrative can serve as your community’s North Star on issues that build shared understanding and drive progress. It can advance health equity and collective wellbeing and bring us closer to the day when we can all realize our best health and lives.

About the Authors

Linnea Warren May is a policy researcher at RAND.

Leia Carey is program officer, Research-Evaluation-Learning, at the Robert Wood Johnson Foundation.