**Author details**

behavioral economics has been able to shed new light on human behavior and what shapes behavioral choice. The BE practitioners have been rewarded not only with popular acceptance but have also been awarded the Nobel Prize in economics three times between 1992 and 2017. BE's contributions to SBC are relatively recent, so another of our key challenges will be to fully

For the past 60 years or more, social causes and public health programs have adopted all manners of media to inform and persuade, often to good effect, especially when media channels were combined and paired with interpersonal means of community engagement. Disease outbreaks in recent years have offered an opportunity to examine the role that various forms of communication play as communities and outside experts work and struggle to negotiate local solutions. The West African Ebola outbreak 2014–2015 clearly showed that media was able to quickly and broadly convey information about the risk to audiences near and far. However, suspicion and rumors could also spread quickly through social media and social networks and just as quickly lead to detrimental results. We also saw that medical solutions could be stalled or ineffective without community dialog and effective, negotiated community engagement [9]. Disease outbreaks such as Ebola have clearly shown that communities need to be engaged from the outset, and, if their concerns are ignored, they can mobilize to thwart the efforts of public health workers. In outbreak situations, decisions must be made quickly, so it is not uncommon to find a small village besieged by technical experts from the outside—whether from the district, the capital, or other countries. It should not be surprising that communities that have become accustomed to receiving few services from the outside may be suspicious of the sudden attention, and it is not unusual for rumors to spring up questioning the motives of the outsiders. "Community engagement" has become the broadly accepted term to describe the strategy for creating dialog with communities to gain or regain their trust and cooperation in the face of an outbreak or other unusual health event. An important aspect of community engagement is the recognition that behaviors are not determined solely by individuals. The "social" in social and behavior change is important because individual choice has its limits and behaviors often involve social norms, traditions, and taboos. In order to successfully influence individuals to make better choices, we need to engage social networks effectively, for example, by building on the important roles played by respected leaders in the community and elders within the family [10]. For example, during the Ebola crisis, traditional burial practices and customs were found to be a major conduit of disease transmission. However, the solution was not to end traditional practices. Community leaders and technical experts worked with experts in SBC, including anthropologists, to find out ways to accommodate traditional beliefs and practices in behaviors that were also effective in stopping transmission.

The field of SBC has come so far from its origins in the middle of the last century. Over the years, it has built a strong evidence base, demonstrating the link between health outcomes and key

document how significant its contributions can be.

**1.4. Negotiate behavior change**

6 Selected Issues in Global Health Communications

**2. Looking forward**

Anton Schneider1 \* and Muhiuddin Haider<sup>2</sup>

\*Address all correspondence to: aschneider@usaid.gov

1 USAID, Bureau of Global Health, Office of Infectious Disease, GHSI-III—CAMRIS International, Inc., Washington, DC, USA

2 Global Health, University of Maryland, College Park, MD, USA
