Baird's CMC -- Blog

Thanks to the BBC we may know a bit about the Republican game plan for dealing with the fall-out from New Orleans. Shawn Steel, past president of the California Republican Party and a trusted Bush operative, was on Radio Five Live last night. He probably laid out more of the response than domestic Republican spokespeople are doing at the moment. As an exercise in communications, it was bold but predictable. Here are the key points.

• The victims are to blame. Nearly all had access to cars but they took a calculated risk and decided to stay. There’s nothing wrong with taking risks, he seemed to say, but people shouldn’t start crying when their risk-taking goes wrong.
• New Orleans is to blame. “The murder rate is ten times higher than the average for US cities” so a uniquely awful criminal underclass was ready to take advantage of the disaster in ways which would be unthinkable elsewhere. Besides which, the City Council is legendary for corruption. They chose not to reinforce the flood defences. There was no direct criticism of the mayor but many suggestions that he headed a deeply corrupt organisation.
• Alabama and Mississippi were also hard hit but did a much better job of recovering, illustrating that the state governments there (run by Republicans) coped better than that in Louisiana (with a Democratic governor)
• The Federalist system of the US meant that the US Government could not step in until the Governor asked and in Louisiana she never did.

Don’t expect to see the full force of these arguments in the US while there are pictures on TV of the corpses of dead old ladies still in their wheelchairs: effective propagandists know that it is much easier to change recollections of history than perceptions of the present, especially when those perceptions have taken such a strong hold. In a month or so this will, though, undoubtedly be the approved White House version of what happened during and after the hurricane.

It seems unlikely that the White House will get away with this but who would ever have imagined they could escape so lightly from the analyses of what happened in the run-up to the attack on Iraq?

“It doesn’t feel like my country anymore” one participant told me after a recent meeting in California. It’s a common sentiment amongst the liberal élite on the East and West coasts. So many enquired about Canadian citizenship after the last presidential election that one Canadian government website crashed. Even Republicans in New York and California are worried that it’s not just about lower taxes and a more pro-corporate foreign policy any longer. The élite think by shouting louder or producing a bit more data in the opinion-leading press that the rest of the country will come back to its senses. In fact, America is probably entering one of those periods where populist opinion dominates. Many of those who love democracy in the abstract may be a bit less keen on this manifestation of it.

When I was at university in Alabama almost thirty years ago (before you ask, it’s a long story about how a British 20 year-old ended up with a degree from Troy, Alabama), the crowd would erupt at the local discotheque every time they played the Charlie Daniels Band singing “be proud you’re a rebel, the South’s gonna do it again”. It seemed unlikely then. Jimmy Carter was in the White House but he was there despite being a Southerner not because he was one: he was one of the few white politicians who had not been tainted by collaboration with the segregationists. Southern Republicans were still a rare breed (the very odd Jeremiah Denton was only allowed to run for the US Senate from Alabama because he seemed so unlikely to win; when he actually did, one state Republican leader turned to a colleague and asked “my God, what have we done”). George Wallace was still the governor (and would be – on and off – for another decade) but the Dixiecrat wave looked like the end of something rather than a start.

Today the values of the South have become the values of most of the Red States (those that the TV networks colour red every time the Republicans carry them). Almost half of Americans say they accept the Biblical account of creation but only about a third accept evolution. Many more Americans describe themselves as “conservative” than anything else. The levels of church membership and attendance nationwide are higher than they were in the last century.

From New York or San Francisco, it’s easy to caricature these views. Closer evaluation of what evangelicals and, even more, Catholics think shows a wide range of views. The Pew Forum recently invited Rick Warren, Senior Pastor and Founder of the Saddleback Church in Orange County, California to a forum for journalists. Saddleback is one of the 20,000 member mega churches that so terrify dinner parties from Baltimore to Seattle. Warren said, “There is a difference between ‘evangelicalism’ and ‘fundamentalism’ and ‘the religious right.” And people use them like they are synonyms. They are not – they are very, very different. I am an evangelical. I'm not a member of the religious right and I'm not a fundamentalist.” He also predicted a third great religious awakening in America (I really commend the whole talk to anyone interested in the influence of faith on American politics and life: http://pewforum.org/events/index.php?EventID=80). Jim Wallis and the Sojourners movement show what left-wing evangelicals sound like and many who are not so left wing have built on his ideas that evangelicals should care about issues such as il health and poverty. The very noisy evangelical anti-war movement recently upset a carefully staged speech by President Bush to the previously-conservative Calvin College.

Warren’s most astonishing comment was an acknowledgement of the class basis of the new American politics. “In fact, if I were building a political majority in this country, I'd start sort of where Gary Bauer is substantively. I'd take socially conservative and economically liberal, and I think that's a lower-middle-class majority in the making, which is the opposite of what you hear, that a party should be fiscally conservative and socially liberal. I think that's not the way to build a majority.” Of course, this was exactly what the Dixiecrats did – spend on the needs of poor whites whilst relying on fear of change to avoid the kind of real social and economic change which the progressives had threatened in the 1890s.

For those who think that this will all pass soon, Warren has a fascinating note on demographics, “one of my favorite statistics from this last election was that George Bush carried 22 of the 23 states with the highest white fertility rates and John Kerry carried the 17 states with the lowest fertility rates. And that's really not about fertility; that's about church attendance. People who attend church have more babies than people who don't.”

If this new majority is here to stay, all of us will have to think about how to influence them. A recent poll from a different arm of the multi-tentacled Pew centres suggests that very few conservatives believe anything they see on television or read in mainstream media (only 24% of conservatives even believe the very right-wing Fox News). The left-wing evangelicals are just as sceptical albeit for different reasons.

There are two keys to reaching the new majority. The first focuses on networks – traditional and new media. The influence of churches and affinity groups is enormous and amplified by new media opportunities from blogs and podcasts to, relatively, old-fashioned chatrooms. I’m not convinced that the new majority think that right-wing talkradio is any more reliable than Fox or CNN but they do believe people they have established relationships with whether in house groups or on electronic forums.

None of the “how to” matters if the vocabulary isn’t right. For many years, the language of policy has been the language of the coastal élites. To win over the new majority, it needs to be the language of church and community.

This may, of course, all be an elaborate justification for why I made the right decision by going to Troy University instead of taking up my place at Oxford but it might just be the Charlie Daniels prophecy coming true.

If you believe the opinion polls, George Bush is more unpopular than any president since polling started: he has a lower approval rating than John F. Kennedy just after the Bay of Pigs; lower than Lyndon Johnson at the nadir of the Vietnam war; lower than Jimmy Carter after a year of captivity for the US hostages in Iran; lower even than Richard Nixon on the eve of his resignation. Admittedly the others may have had great accomplishments that reinforced their positive ratings – JFK had Camelot, LBJ had the Civil Rights Act, Nixon had peace in Vietnam and the opening to China; Carter had his evident decency and honesty (and was the first Southerner to hold the White House since the Civil War which made a chunk of the Old South loathe to turn on him). Admittedly, Iraq has been a disaster and the half-truths which led to war are looking more and more like quarter-truths by the week. But is Bush really that disliked?

A part of the truth is probably that all of us have become more and more sophisticated about how we deal with market researchers of all kinds and especially about how we send messages through political pollsters. Even in the late 70s, when Carter was in the White House, people were much more naïve: if someone in a shopping mall (remember telephone samples were still seen as a bit unreliable) asked if you approved of the President’s performance, you were more inclined to weigh things and say whether on balance you really did or did not. Today, the respondents know what the headlines will look like. They know that only a 1,000 people are being questioned and that their answer will help send a message which will be on CNN and Fox News within 24 hours.

Bill Clinton was not the most popular president in recent history in the week where his adultery became common knowledge: it was just that, on balance, people did not want him to resign. Poll respondents were sophisticated enough to know that “approve” would mean a rejection of the calls for impeachment; “disapprove” would egg on Kenneth Starr and the Republicans in the Senate. George W. Bush is not the most unpopular president ever: the respondents know that “disapprove” ratches up the pressure for a quick end to the Iraqi adventure and discourages any other neo-con initiatives. It does not necessarily mean that most would even vote Democrat (as other polls show).

The same phenomenon is true in other countries. The Pew Research Center for People and the Press recently reported growing hostility towards America and growing approval ratings for Osama Bin Laden in some Moslem countries. Quite apart from serious methodological problems in the research, the analysis was misleading. The standardised polling questions did not ask about the invasion of Iraq or American threats to Iran. Even in Pakistan and the Middle East, respondents know that admitting to some admiration for Osama is a way of expressing opposition to the war in Iraq and to US policy in the Middle East.

In the commercial world, the analysis of market research data still ignores this inclination of respondents to use research to send messages. What ever I really think of mango-flavoured yoghourt, I may well claim to detest it if I think that admitting to be willing to try it will reduce the shelf space allocated to the flavours I like at the moment.

The 27th of July provided the starkest contrast imaginable between the French tradition of rationality and the Anglo Saxon one of putting together a few random bits of information and hoping a pattern emerges.

Le Monde carried a masterful editorial on Living With Terror. Ten closely-reasoned sub-points argued that “Islamic terrorism” (as I suppose we must get used to calling it) was:

• here to stay
• had no single cause
• could not be reduced to being the direct consequence of any single, long-standing regional conflict (although many fed volunteers to terrorist groups)

The editorial went on to say that:

• the US / British invasion of Iraq has, as many Europeans said it would, exacerbated tension and found limitless volunteers for radical groups
• Westerners do not hold all the keys to the solution: we desperately need progressive and reformist forces in the Islamic world to lead
• the struggle against Islamic terror is not a “war”: in wars, one side wins and there is a surrender or a negotiated cessation. That will not happen here: “Al Qaida” is more a brand than an organisation
• the hatred that drives the terrorism may be more of a European issue than an American one; it has been nurtured in communities in Europe where we have failed to make the ideas of Western democracy alive or appealing enough

Le Monde concluded with two suggestions:

• Pakistan is the epicentre of this terrorist movement. Overall American policy to Pakistan is inexplicable but its failure to target extremism there may be the most serious American foreign policy error.
• what the terrorists group want is for us to abandon our values and to resort to torture, internment and sanctioned state-killing. A first step to this “barbarisation” of our society would be abandoning habeus corpus and other traditional liberties.

I haven’t done justice to this exceptionally lucid and compelling piece of writing. Look at the original in the Le Monde archives for the 27th of July (http://www.lemonde.fr/web/recherche/0,13-0,1-0,0.html)

On the same day, the lead editorial in The International Herald Tribune, also published in Paris, was on Zimbabwe. Its leader writers had noticed that the UN report critical of slum clearance in Zimbabwe had been written by a woman. It showed, said the IHT, that she was “not one of the boys”. “Maybe that’s why she did not mince her words about the horrors ... that Africa’s male establishment seems so afraid to talk about.” This was it, the whole of the point. She was a woman; she had been critical; some men had not; ergo the problem in Africa is a male establishment sticking up for a male president. Presumably simple ignorance meant that the leader writers did not know that Mugabe’s designated successor (and an enthusiastic advocate of slum clearance) is a woman. Or maybe it was just a fact that didn’t support the conclusion. (See if I'm being unfair to them at www.iht.com)

You can see the common pattern in Anglo thinking. The people who blew up the World Trade Centre were Arabs who didn’t like America; Saddam Hussein is an Arab who doesn’t like America; ergo Saddam must be responsible for 9/11.

Maybe we should leave any serious thinking up to the French.

A good deal of my consultancy involves convincing governments, elites, the great and the good about the value of public health interventions in the developing world. Last week, I was working with a group of demographers at the International Union for the Scientific Study of Population meeting in Tours. One asked, very politely, if we were really sure that good communications had any impact on policy. I did have a moment of self-doubt. The world is full of press kits, dossiers, briefing notes and – heaven knows – resolutions. Do any of them make any difference?

Look at what happens when communications specialists don’t try to get science to policymakers and opinion formers. For example, for the last three or four years, it has become clear that many – maybe most – of the new HIV infections in sub-Saharan Africa are passed on during the first eight to twelve weeks of an individual being infected himself or herself. That’s to say that if a Kenyan man becomes infected tomorrow, half of the infections he causes in other people during his lifetime are likely to happen in the next two to three months. (Most of the rest, by the way, are likely to happen in eight to ten years time when the man is visibly ill with HIV).

It’s not actually that new a theory. Christopher Pilcher of UNC Chapel Hill outlined most of it in a very elegant paper in 2002 (http://www.natap.org/2002/9retro/day27.htm). In hindsight, it seems almost obvious. When a healthy individual is infected by HIV the virus runs wild producing tens of thousands of copies of itself in every millilitre of blood. It takes the immune system a few weeks to bring the HIV under control. Once the immune system kicks in, the number of copies of the virus circulating in the body drops dramatically (often by a factor of 10 or 100). The less virus there is, the fewer opportunities there are to pass it on in body fluids. After eight to ten years, the virus starts to wear down the immune system and the number of circulating copies increases again but, by this time, the person with AIDS is usually displaying clinical signs and symptoms.

Since 2002, Pilcher and others have gone about testing their thesis in very high-quality work in Africa. In one study, he looked at the viral load (the amount of virus) in semen in recently-infected men with HIV (tragically, the sober write-up fails to explain just how Pilcher and his colleagues were that persuasive). It then matched these findings to what we know about transmission from men with high and low viral loads (from a study of couples in which one is HIV positive and one is negative in the Rakai district of Kenya) and concluded that up to 60% of onward infections happened during this initial viral peak.

This work has caused quite a buzz in science circles and is part of the reason why the US National Institutes of Health have just invested another $350 million looking at issues related to this early viral peak.

But amongst policymakers, journalists and the chattering classes of the international health community, you hardly hear a mention of Pilcher and early viral peaks. Why? Well, it’s not a conspiracy but it’s not really in anyone’s interest to talk about it. Those who favours counselling and testing above all else (and aren’t too bothered about the niceties of it being voluntary) are clearly a bit unsettled: during this early peak of primary HIV infection (the few weeks after getting infected), a few people will have slight flu-like symptoms but most won’t feel anything and won’t test positive on the standard HIV antibody test kits used in testing programmes. So, if the theory, is right, testing will have no impact on stopping 60% of infections. Actually, it’s worse than that because most of the rest of the infections will happen when an individual is already showing signs of AIDS so testing will, at most, confirm something he probably suspects.

It doesn’t fit the neat myth of the abstinence crowd or the women-are-totally-blameless squad.

The vaccine and microbicide campaigners are, frankly, too lost in their own little world of failed monkey models to have registered the implication: only a vaccine – or a surprisingly- effective microbicide – can stop this epidemic. It’s particularly amazing that none of the vaccine advocacy groups has grasped it because they know that the first generation of AIDS vaccines is unlikely to prevent infection by HIV but may make the body better able to contain the disease if a person is vaccinated before he or she becomes infected (meaning that the initial viral peak would, potentially, be much lower in vaccinated individuals who subsequently became infected.)

For the prevention industry, any finding that focuses attention on a small group is bad news. The big money comes from "awareness raising" campaigns with their glossy brochures, clever PR, long-running radio series and, above all, advertising. We have lots of evidence that small, community-based campaigns reduce AIDS transmission but almost none that the multi-media extravaganzas do any good. (For example, the World Bank's David Wilson noted that many of the most successful campaigns against HIV he had analysed were, "rapid, endogenous, inexpensive, and simple. They were based on the premise that communities, however disparate, have within themselves the resources and capital to reverse this epidemic. They preceded large scale exogenous assistance and occurred largely without the involvement of specialist agencies." BMJ 2004;328:848-849). It is the communities that have been ravaged by unprotected sex with multiple partners which have responded by measures which, unknowingly, reduced the numbers who would be infected by someone in this early, highly-infectious phase of HIV.

So, these findings about transmission during acute infection go largely ignored by policy makers.

What international public health really needs is a few more good spin doctors.

Sky News is so good that we often forget it is part of the same media family as Fox, The Sun and The New York Post. Friday was a good reminder that a struggle goes on between News International values and many of the journalists at Sky. A particularly inane poll was breathlessly reported. "46% [of British Moslems] said they thought of themselves as Muslim first and British second". How many blond-haired accountants think of themselves as blond first and accountants second? How many Big Mac-eating taxi drivers think of themselves as Big Mac eaters first and taxi drivers second? The questions are silly because there's no conflict between being a taxi driver and a Big Mac eater. If a polling organisation asked the question, you would expect about half to pick each answer. Surprise, surprise, about half of British Moslems picked one answer and half picked the other.

The question is based on very interesting market research work in the UK over the past few years which has tracked changes in the whether people think of themselves as "English, Scottish or Welsh" first and "British" second (or, for a depressingly small number of us, as "Europeans" first, "Welsh" second and "British" third -- but that's another story). These are all questions about nationality so you can ask people to make valid choices.

How would Christians answer if you asked if they thought of themselves as "Christian" or "British" first? Probably, with our traditional view of Anglicanism as a sort-of Shinto, you would get quite a few who would answer "British". It would be an odd view: "the Creator of the Universe has taken the trouble to personally communicate with me about timeless, unchanging ultimate truth but I think this is less important than being a citizen of a country that's existed for about 200 years and probably won't exist in another 100". Fortunately, no-one is about to commission the polling.

Still, Sky is positively responsible compared to The Times (of course, another News International outlet) which on the 12th of July reported, "stark divisions in attitudes between people living in London and the South East, and those in the rest of the country. The further away from London respondents lived, the stronger their support for tough new [security] measures." Read a bit further on and you will see that the biggest difference is actually about 11% ("While 95 per cent of Scots support security checks and baggage inspections at stations, 84 per cent in London and the South East back this measure.") In a survey with about a thousand respondents across the UK, margins of error in comparing regions and countries must be pretty broad. Maybe 11% is significant at some reasonable level but it is hardly "stark". Most of the "stark differences" were not remotely significant. How did Populus, the market research group commissioned by The Times, ever allow this copy?

A few weeks ago I was asked to take part in a meeting at the Hewlett Foundation on future directions in informing policy on reproductive health in the USA. I was asked particularly to look at the apparently growing influence of evangelicals on American thinking. (If you're interested, my presentation to the group is on the Hyderus Web site, www.hyderus.com)

What struck me is the demonisaton of the religious community by secularists. In the coffee breaks there were lots of horror stories about what faith-based groups were alleged to have done, especially in promoting abstinence in communities heavily affected by HIV. Sometimes when I go to Christain health meetings, I hear the same kinds of stories about leading non-religious groups -- they are trying to promote abortion and squash any discussion of the importance of sexual faithfulness.

I followed up on the things I'd heard and a friend at World Vision referred to me an excellent article that I'd missed in The Lancet (The Lancet 2004; 364:1913-1915). It's about the common ground on preventing sexual transmission of HIV and there is an awful lot of it. The article is signed by leading epidemiologists, researchers and leaders of faith-based organisations. We may all differ on 10% of what we need to do in the face of this epidemic but 90% of it is crystal clear. You'll need to register for The Lancet to read the whole article but it's free and well, well worth the time. Especially, if you've ever harboured the delusion that people of good will cannot work together on HIV prevention.