The complexity of social mobilization in health communication: top-down and bottom-up experiences in polio eradication.

The Polio Eradication Initiative (PEI) has been one of the most ambitious global health efforts in recent times. Social mobilization (SM) has been a strategic component of the PEI. Yet, a close-up analysis of SM dynamics seems to be lacking in the health communication literature. We examine critical aspects of the PEI experience in an attempt to move from dominant informational perspectives to a focus on emerging challenges in polio eradication efforts and new levels of complexity to SM. We examine available literature on communication and public health, available data on SM experiences that support polio eradication in Africa and Asia, and field work conducted by the authors where polio eradication efforts are ongoing. Our analysis suggests that (1) SM should not be casually approached as a top-down informational strategy to advance pre-established health goals; (2) centralized strategies hardly amount to SM; and (3) hybrid options that combine both activist and pragmatic SM are concrete possibilities for global health initiatives. In the context of renewed global democratization and persistent conflicts rooted in ethnicity, religion, and economics, it cannot be assumed that communities will either diligently espouse global goals or necessarily oppose them. Communication and SM strategies should rely on a clear understanding of the motives and agendas of involved actors. Resistance or opposition are important analytical dimensions as they may uncover new opportunities for effective health interventions. Further studies using these perspectives should be a priority for global health programs, including studies of the trust level, or lack thereof, among social actors.