I spent one summer of medical school in a community clinic where most families spoke Spanish at home. The clinic kept a stack of glossy diabetes pamphlets on the counter—every single one in English, every photo of people who looked nothing like the patients I saw each morning. The advice was sensible enough: eat more vegetables, walk thirty minutes a day, check your blood sugar. But it was written for a phantom patient. Someone with a flexible schedule, a reliable car, a grocery store around the corner, and a kitchen set up for cooking from scratch. The people I met lived worlds away from that assumption. That summer taught me something no lecture hall ever did: public health messaging that treats everyone the same ends up failing exactly the people it claims to serve.
The Myth of the Average Person
Most public health campaigns start with a tidy idea—craft a clear, evidence-based message and broadcast it far and wide. The logic feels unassailable. If the science is solid, the message should land the same way for everyone who hears it. Except people don’t hear messages in a vacuum. They hear them through the filter of their own lives. Language, culture, income, housing, education, and a thousand small realities that shape what feels doable.
Take a campaign urging people to eat more fresh produce. For a middle-class family with a car and a supermarket nearby, that’s a fine suggestion. For a single mother working two jobs, living where the closest thing to fresh fruit is a bodega banana, that same message can land like a slap. It’s not that she doesn’t want to feed her children well. The path to doing it is simply blocked by structures she didn’t build. When we ignore that, we aren’t just being sloppy—we’re reinforcing the same inequalities that make some people sicker to begin with.
One Size Fits None: A Few Real Stories
Let me give you a handful of examples, pulled from research and from my own clinical work.
The Sodium Warning That Backfired
Back in the early 2000s, a large city rolled out a campaign to cut sodium intake in neighborhoods with sky-high hypertension rates. Billboards showed a salt shaker inside a red circle with a slash through it. The message was blunt: cut the salt. But in a lot of those neighborhoods, cooking from scratch was a luxury. People leaned on processed foods, canned goods, and takeout—not because they didn’t care, but because time and money were stretched to the breaking point. The campaign raised awareness, sure. Behavior barely budged. Worse, a chunk of residents felt blamed for something they couldn’t easily control. A later evaluation found sodium intake had scarcely moved. What would have helped? Practical, culturally grounded advice on reducing sodium inside the constraints of a tight budget and a cramped kitchen.
Exercise Guidelines That Leave People in the Dust
Standard physical-activity guidelines tell us to get at least 150 minutes of moderate exercise a week. The evidence behind that number is strong. But for someone who works a physically punishing job—say, a warehouse worker on her feet for ten hours—the last thing her body needs is more “moderate activity.” It needs rest, not a brisk after-dinner walk. For a parent in an unsafe neighborhood, an evening stroll isn’t a health choice; it’s a risk calculation. The guideline, as written, makes perfect sense for a desk worker with a gym membership. For just about everyone else, it can feel irrelevant or quietly guilt-inducing. Tailoring the message to different realities isn’t about lowering the bar. It’s about admitting the same bar looks completely different depending on where you’re standing.
Why We Keep Getting This Wrong
If the problem is this obvious, why does it stick around? Part of the answer sits inside how public health agencies are built. Campaigns are usually designed by teams of well-educated professionals who—however well-meaning—share fairly similar backgrounds. They test messages on focus groups that may not reflect the full spread of the population. Deadlines and budgets push toward simplicity. A single, universal message is easier to produce, easier to approve, and easier to measure than a dozen tailored ones. But easy and effective are not the same thing.
There’s also a deeper, more awkward reason: the stubborn belief that health is mainly a matter of individual choice. That assumption runs through a staggering amount of public health messaging. Choose to eat better. Choose to exercise. Choose to quit smoking. Of course personal decisions matter. But they’re shaped—often decisively—by the environments where we live, work, and play. When we tune out those environments, we end up preaching to people as if they were free-floating agents, unbound by circumstance. The result is messaging that sounds rational on paper and tone-deaf in real life.
What Better Messaging Actually Looks Like
So how do we do better? The answer isn’t to ditch broad campaigns entirely—there’s still value in spreading basic health knowledge—but to supplement them with what researchers call “audience segmentation.” That means shaping messages for specific groups based on their actual constraints, cultural contexts, and communication habits. It takes more work. It also works better.
Start with Listening, Not Telling
The most effective campaigns I’ve seen didn’t start with a message. They started with a question: What does health mean to you? In one project I consulted on, a team working in a rural community spent weeks just talking to people—in kitchens, at church gatherings, in dollar store parking lots. They learned that for many women in that community, health was inseparable from family well-being. Exercise wasn’t about treadmills; it was about playing with grandchildren without getting winded. Eating well wasn’t about kale salads; it was about making the same beloved dishes with small, affordable tweaks. The campaign that grew out of those conversations looked nothing like the original plan. It used local faces, familiar language, and focused on incremental changes that fit inside existing routines. Participation rates shot up.
Design for Constraints
Good design doesn’t pretend constraints don’t exist. It works inside them. Instead of telling a low-income parent to “shop the perimeter of the grocery store”—advice that assumes a large supermarket is nearby—we can offer specific strategies for improving nutrition at corner stores. Instead of recommending daily outdoor walks to someone in a high-crime area, we can suggest indoor exercises that need no equipment and very little space. This isn’t about lowering standards. It’s about meeting people where they actually stand.
Use Trusted Messengers
Who delivers the message matters at least as much as the message itself. A glossy flyer from a government agency often carries less weight than a word from a trusted neighbor, a community health worker, or a local pastor. I’ve seen this play out repeatedly in immunization campaigns. When the messenger shares the community’s language, culture, and lived experience, skepticism softens. Trust isn’t a commodity you can mass-produce. It’s built through relationships. Effective public health messaging invests in those relationships instead of bypassing them.
Frequently Asked Questions
Why can’t we just give everyone the same health advice? Isn’t the science solid?
The science behind health recommendations is usually solid, but science tells us what works under controlled conditions. It doesn’t automatically account for the messy realities of people’s lives—income, housing, language, or access to resources. Good public health messaging translates the evidence into guidance that makes sense in real-world contexts. That often requires tailoring the message so it’s practical and actionable for different groups.
Doesn’t tailoring messages mean we’re lowering expectations for some communities?
Not at all. Tailoring is about building realistic pathways to the same health goals. It’s like giving different directions to the same destination depending on where someone is starting from. A person without a car needs bus directions; a person with a car needs driving directions. The destination—better health—stays the same. Tailored messaging respects the obstacles people face and helps them navigate around them, rather than pretending the obstacles don’t exist.
How can I tell if a public health message is designed with equity in mind?
Look for a few signs: Does the message use images and language that reflect diverse communities? Does it acknowledge common constraints like time, money, or safety? Does it offer flexible options rather than a single, rigid prescription? Messages designed with equity in mind often feel more like a conversation than a lecture—they invite people in rather than talking down to them. When in doubt, ask: Could someone with a very different life from mine act on this advice? If the answer is no, the message may need rethinking.
The Bottom Line
Public health has an ambitious mission: to help whole populations live longer, healthier lives. That mission can’t be fulfilled by talking to an imaginary average person. It demands that we see people as they actually are—complex, constrained, resilient, and wonderfully varied. When we tailor our messages to that reality, we don’t dilute the science. We honor it by making it usable. And we honor the people we serve by acknowledging that their lives matter not just as data points but as the very ground on which health is built.
I still think about that stack of pamphlets from my student days. Somewhere there’s probably a newer version by now, maybe with better pictures. But pictures alone won’t fix this. The real shift happens when we stop asking “What message do we want to send?” and start asking “What message can people actually use?” That’s the difference between public health that informs and public health that transforms.
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