Narrative Storytelling and Public Health Messaging.

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A few years ago, I was invited to visit the communication program at Jamia Millia Islamia University in New Delhi, India, one of that nation’s most prestigious universities, and to observe students preparing a community outreach project. The assignment was to come up with an entertaining way to inform the people in rural and desperately poor villages as to steps they could take to combat the public-health threat of disease-carrying mosquitoes.

Were a similar assignment given to my students in the College of Communication, I am confident that the project would entail several actors; sets constructed on a sound stage; several high-definition TV cameras; audio equipment capable of separating ambient sounds from spoken dialogue; and assiduously gathered audience research to inform the script produced by a writers’ team. All that work would be handed over to a post-production team that would edit the video, layer on a musical score, and package the resulting story for multi-media distribution.

Here’s what the students in India did: They put together a puppet show. This entailed stitching together some hand puppets and building a little theater for the performances. The students proudly pointed out that the entire operation could be transported anywhere in India, needed no electricity, and required only a script and the talents of a few puppeteers.

I am not relating this to draw a contrast between the voluminous assets available to BU students and the modest ones available to their counterparts at Jamia Millia Islamia. To the contrary. What impressed me greatly about the approach taken by these students is this: They recognized that their sole goal was to craft and deliver a story that motivated the villagers to effectively confront the mosquito problem.

They understood that in rural India a slickly produced, high-tech media program—no matter how clever and on multiple platforms—was simply irrelevant to their task. In those villages, you could forget distributing a message via TV. Forget using social media. Forget using anything that needed a plug or a battery. Forget even producing written pamphlets because few in these villages could read.

But a traveling puppet show would draw every child in every village, as well as most of their parents. Cleverly woven into the show’s script were messages that India’s health authorities wanted to get across. Regrettably, I don’t have any comparative results to report on the effectiveness of this campaign, but my hunch is that these shows were enormously successful if the story told by the puppets was indeed entertaining.

That hunch is informed by research on the power of narrative storytelling. We love stories, especially story narratives that entail an enticing beginning, a tension-building narrative arc, and a climax—the battle is won; the scullery maid marries the prince.

Now, thanks to neuroscience, we know that information delivered to us in story form is processed much more effectively by our brains than information lacking the narrative arc. Imagine being in that rural village when a bureaucrat arrives with a bullhorn, a podium, and a checklist of dos and don’ts, which is dutifully read in no particular order. Where would the children be? Who among the few listeners could recall even two or three items on that checklist?

But we’ll remember the stories for this reason: They stimulate our empathetic responses in ways that information alone cannot. Legend holds that Ernest Hemingway bet some friends over dinner that he could write a novel in just six words. When they took the bet, he scribbled these words on a napkin: “For sale: Baby shoes. Never worn.” The friends paid up.

True or not, that six-word “novel” exemplifies how our brains take off and run when ignited by even the tersest of narratives. Our imaginations immediately build on that short narrative: Why weren’t the shoes worn? Did a baby die? Were the shoes purchased anticipating the birth? Why are the parents selling the shoes? Are they very poor? The “novel” writes itself in the imagination of the reader and even has the elements of a beginning, middle, and climax. Straight information does none of that.

The point that was well-understood by the students at Jamia Millia Islamia is that the impact of the public-health message depended on the impact of the story in the puppet show. The more entertaining the story, the greater the impact, because the listeners would eagerly share it. Of course, modern media also can have great impact on audiences.

My COM colleague Traci Hong, who studies public health campaigns, told me of an episode of Grey’s Anatomy written with the express purpose of disseminating the little-known fact that, with proper treatment, babies born to HIV-stricken mothers have a 98 percent chance of being healthy. Prior to that episode, just 15 percent of the show’s regular viewers were aware of that fact. After the show, 61 percent were aware—more than 8 million people. Hollywood often traffics in stories touching on public health—usually disasters. In 1995, many moviegoers first learned of the deadly Ebola virus through the doomsday thriller Outbreak, starring Dustin Hoffman and Donald Sutherland. Who knew an infected monkey could be as dangerous—maybe more dangerous—than a nuclear warhead?

(On the flip side, stories in the entertainment media can carry messages contrary to public health. Anti-vaccine activist Andrew Wakefield’s film, Vaxxed, uses narrative to tell the fully discredited story that vaccination is linked to autism. He further alleges that this fact is being covered up by the public health profession, just as was done with the Tuskegee syphilis experiments. Sadly, millions of people have been taken in by Wakefield’s false narrative.)

On the bookcase in my office is a wooden sign that expresses the central purpose of the College of Communication. It reads: Your Story Matters. I believe that sign also would work well on a wall at SPH.

Tom Fiedler is the dean of the College of Communication.