The world’s population continues to grow, primarily in developing countries, despite increasing awareness of the negative consequences of this tremendous population increase. Snowden (2008) states, “Population has soared above all in the poorest and most vulnerable regions of the world with the global urban population growing at four times the rate of the rural” (p. 16). As a result, urbanization is becoming a global social challenge.

The pace of urbanization has increased in recent decades. It took two centuries to create the urban industrial societies in developed countries; it is taking just a few decades to bring rapid urbanization to developing countries (UNFPA 2007). The United Nations (UN) declared in 2008 that half of the world’s population lives in urban areas (Haub 2009); the UN predicts that in the next decade almost all urbanization will take place in developing countries. For example, in 1975, the urban population was estimated to be 813 million in less developed countries compared to 704 million in more developed countries. Yet 30 years later, in 2005, the urban population grew to 2,266 million in less developed countries versus only 344 million in more developed countries (UN Habitat 2006). This rapid urbanization occurred in the most dramatic way in less developed Asian nations. In 1975, four Asian cities were ranked as one of the top ten megacities in the world: Tokyo and Osaka in Japan, and Shanghai and Beijing in China . In 2013, the first seven of the top 10 megacities are in Asia: Tokyo, Japan; Jakarta, Indonesia; Seoul, South Korea; Delhi, India ; Shanghai, China ; Manila, Philippines; and Karachi, Pakistan. (Cox 2013).

Although urbanization in developing countries is making a significant contribution to those nations’ economies, it is also producing serious public health problems among the urban poor. These problems arise due to overcrowded living conditions and lack of proper housing and sanitation. For instance, in the Indian megacity of Delhi, an estimated population of over 22 million lives within a land area of 750 square miles with a density of 30,400 as compared to Tokyo with its population of over 37 million living on a land area of 3,300 square miles and a density of 11,300 (Cox 2013). Additionally, the continued migration of people to the already crowded urban areas compounds the problem. This chapter provides an overview of global urbanization and examines the potential of theory-based strategic health communication in addressing urban public health issues in India .

Global Urbanization

Urbanization occurs for two major reasons: (1) increase in the population and (2) migration of people to urban areas for employment opportunities and for improved living conditions. In fact, the World Health Organization (2013) reports that approximately one billion of the three billion people who live in urban settings live in slums . People migrate to urban areas as economies develop; they come for better jobs and more income.

Despite the economic growth and the innovation that occur in cities, problems abound in the urbanized parts of the developing world. The growth is chaotic and the cities are not prepared for it. The rapid increase in population creates a strain in areas such as sanitation, water, and power (UNFPA 2007). Unplanned urbanization results in “escalating poverty, widening social inequality , the birth of megacities and the spawning of teeming peri-urban slums without sanitary, educational and other infrastructure.” (Snowden 2008, p. 20). Child mortality in the slums of cities in Nairobi, where approximately 60 % of the city’s population lives, is 2.5 times greater than in other areas of the city (World Health Organization 2013). This massive population growth in urban areas puts an enormous burden on the resources of the region and of the nation. For instance, the intensive use of resources in these urban areas results in environmental challenges including waste disposal, noise, air, and water pollution, soil erosion, and deforestation among others (Jakarta Post 2009).

Overcrowding in urban areas, particularly in slums , also makes the population vulnerable to infectious diseases. Indeed, the city is the microcosm of the nation; its citizens are biologically connected: no individual is immune to infection. In such an environment, epidemic diseases easily occur and reoccur and that happens because of the continuous movement of large numbers of products and people from place to place. Migration is a key factor affecting “the balance between microbes and man” (Snowden 2008, p. 16).

Urbanization in the Indian Context

India is no exception to urbanization’s travails and triumphs. Its three large cities, Mumbai, Delhi, and Calcutta (Kolkata), with their enormous populations, present both the economic rewards and unique challenges of urbanization . Delhi has an estimated population of over 20 million, Mumbai over 17 million, and Kolkata over 15 million (Cox 2013). In India, urban is defined as, “specified towns with governments and places with 5,000 or more and at least three-fourths of the male labor force not in agriculture” (Haub 2009, p. 1). Other factors not specified in the definition include population density and specific urban characteristics (Haub 2009). While less than a third of India’s population lives in urban areas, these population-dense spaces create more than two-thirds of the nation’s gross domestic product (GDP) and generate 90 % of government revenues (World Bank 2009). Gender equality is also a driving force behind economic prosperity. Women are a vital part of India’s growing work force. For instance, those states with greater gender equality are “also the fastest growing and have greater anti-poverty effectiveness of growth” (Besley et al. 2004, p. 3). However, the increased migration of people to the megacities spawns gargantuan slums where the migrant laborers create homes for themselves. In Mumbai, slum dwellers who were one in six in 1971, are now the majority. When a plane descends in the Mumbai airport, the sprawling Dharavi slum with blue roof tops is clearly visible from the air. Slums in Mumbai, unlike those in other cities, are located close to places of work. Mumbai is also home to Bollywood, which includes India’s wealthiest movie moghuls and stars. This lively business center has a thriving business community, a sizeable middle class, and slum dwellers.

India’s slum population, which was 41 million in 2001, is estimated to become 69 million in 2017 while the urban population is expected to rise to 500 million (World Bank 2009). The Millennium Development Goals Report 2009 (MDG 2009) notes that in 2005 about 35 % of the urban population was living in slums. Slums can be described as neighborhoods that are “lacking in at least one of four basic amenities: clean water, improved sanitation, durable housing, and adequate living space” (MDG 2009, p. 47). The harsh living conditions in the slums highlight the urgent need to focus attention on the health needs of the urban poor. While the poor living in slums might have a harder time than the poor living elsewhere in the city, this is not applicable for all cities and, in some cases, there is no noticeable difference. The greater gap, however, is between the urban poor and the nonpoor. The disparity is in both living and health conditions. Programs that assist those in the slums would be a definite benefit, but focusing only on slum dwellers would not help the pressing needs of the large number of poor not dwelling in the slums (Gupta et al. 2009).

Urban Health Disparities

While there are huge health disparities between the urban poor and the urban rich, there are also enormous differences in the population between cities and among different groups of the population in the same city. The urban poor are overwhelmingly impacted by new public health challenges in communicable, maternal, perinatal, and nutritional conditions (Blas and Kurup 2010). For example, the under-five mortality rate was substantially higher for the urban poor in the state of Madhya Pradesh (132) than for urban areas of Madhya Pradesh as a whole (83). Among the urban poor in India, only 25 % of pregnant mothers receive complete antenatal care (ANC), which includes at least three ANC visits, iron, and folic acid tablets for at least 3 months, and at least two tetanus toxoid injections. Among the urban poor, about “three-quarters of babies are delivered at home” (Gupta et al. 2009, p. 10).

The health status of migrant populations in urban contexts is also affected by social issues like child marriage and its attendant problems of negative maternal-child health outcomes. Research shows that girls in rural areas are more likely to marry a year and a half earlier than those in urban areas (Westoff 2003) and that those who marry early are more likely to be associated with early childbirth. Additionally, one-third of women in developing countries give birth before they reached 20 years of age (Save the Children 2004). The maternal health consequences of early marriage include higher rates of maternal mortality (CDC 2002), obstetric fistula (Murray and Lopez 1998), and increased risk of contracting HIV/AIDS (Clark 2004). In every urban area, poor women and men as compared to nonpoor women and men are more likely to be “abnormally thin, and undernourished. At least four in ten women are anemic in both slum and non-slum areas in every city” (Gupta et al. 2009, p. 44). Despite India’s impressive economic growth, it has more maternal deaths (56,000 per year) than any other country in the world (Save the Children 2013).

Given these challenging health circumstances, it is imperative that any meaningful and effective health communication strategy considers these uniquely urban circumstances.

Strategic Health Communication

Broadly understood, strategic health communication frameworks examine evidence of key communication problems to bring about planned and targeted behavioral change in specific audiences. From their roots in early models of community organization and social change (for example, the knowledge gap hypothesis, Mosteller and Moynihan 1972; Tichenor et al. 1970) to more tailored community-based interventions (Rimer et al. 2001), the foci of these frameworks range from communicating vision, shared sense making, soliciting feedback, establishing legitimacy, to communicating goal achievements (Lewis 2000). Increasing evidence supports the need for communication interventions to be strategic and evidence-based, to adopt culturally sensitive communication practices and to incorporate multiple stakeholders such as active community participants in designing the communication strategy (Kreps and Sparks 2008).

The strategic health communication perspective can be employed to further define two major and closely related target groups: publics and stakeholders. A public is defined as a group of people who relate to the issue or organization, who demonstrate varying degrees of activity or passivity, and who might or might not interact with others concerning their relationship (Aldoory 2001; Hallahan 1999). Stakeholders, on the other hand, are those publics who have an active stake or interest in the issue or the organization. Strategic communication can be understood as a purposeful and deliberative communicative activity with a goal of interpreting the source (e.g., an organization’s) vision, values, mission, or message to key publics (see also Steyn 2007). However, strategic communication is not merely a linear, one-way, controlled process. To be meaningfully successful, it should privilege multiple perspectives of those affected, and productively integrate alternatives that are culturally sensitive to the contexts of the stakeholders and publics within which they will be enacted.

Therefore, a strategic health communication framework approach examines planned programmatic behavior change from three perspectives: (a) the source/goal, (b) the key stakeholders, and (c) the target publics. In other words, strategic health communication can be defined as an informational or persuasive activity involving relationship-building between both stakeholders and publics that encompasses “intentional communication undertaken by an [organization or group] with a purpose and a plan, in which alternatives are considered and decisions are justified” in order to bring about a desired health-related planned behavioral change (Smith 2009, p. 4). Thus although strategic health communication is goal-oriented, as a public relations function it productively integrates programmatic elements of health communication intervention design, channel, and message selection with the involvement of all key stakeholder groups and affected publics.

Public relations theory can usefully inform the conception, design, and implementation of strategic health communication interventions to address public health issues in India (see also Toth 2006). Thus, within the strategic health communication perspective , we now provide an overview of two key theoretical frameworks: (a) the stakeholder theoretical perspective, and (b) the situational theory of publics that can be used to involve publics and stakeholders in the process of planned change implementation.

Stakeholder Theoretical Perspective

In essence, stakeholder analyses help researchers identify project stakeholders, conduct needs assessments, and find ways in which their interests affect the program’s implementation. Research is an important part of the public relations practitioner’s goal in this endeavor (Macleod and Michaelson 2007). Some of the ways in which stakeholder analyses examine the intersection of stakeholders and program implementers are by incorporating research that: (a) identifies ways of harnessing the support of target publics in favor of the intervention, (b) effectively addresses the risks posed by stakeholders who oppose the intervention, and (c) identifies the specific role that a particular stakeholder can play to achieve the intervention’s objectives. In this manner, stakeholder analyses provide a useful framework for implementing planned communication activities involving stakeholders and publics, and thus make an important contribution to strategic health communication .

Therefore, stakeholder theory examines the role of communicative processes in managing relationship-building strategies with stakeholders in the community implementation of health initiatives. Because stakeholder theory integrates processes to meaningfully negotiate the voices of implementers, target publics, and stakeholders within a community-based context, it has been applied in the implementation of public health programs like HIV/AIDS interventions in India . This is particularly useful because stakeholder analyses combine relationship-building with the community during the information gathering stage and contributes to the partnership of stakeholders, affected publics, and the community opinion leaders in program implementation.

For example, for HIV/AIDS interventions targeted toward migrant populations, the primary stakeholders and the target publics include: (a) the migrant workers who interact with high-risk sexual networks, (b) the spouses and sexual partners of migrants, and (c) the migrants living with or who are affected by HIV and AIDS. Multifaceted strategies have been employed to increase involvement of stakeholders and target publics. These strategies include: (a) targeting the prioritized workplaces and areas around them such as canteens and roadside cafés (dhabas), as well as residential areas (slums, temporary shelters); (b) targeting influential stakeholders such as owners of village square informal wrestling game (kabbadi) shops, tea stalls, and cigarette shops; (c) targeting private medical practitioners providing services within the migrant neighborhoods, or areas where sex worker operations are concentrated: cinema halls, and union offices such as rickshaw (a hand-driven bike with an open seat at the back for passengers) pullers unions, auto drivers associations, and traders associations in informal vegetable markets (sabzi mandis). In some cases, programs have been designed to obtain the support of law enforcement so that they would not be an obstacle to HIV prevention and treatment (UNAIDS 2012a, b).

In involving important stakeholders within the programmatic planned change, the stakeholder theory allows researchers and practitioners to give all participants a voice in achieving program goals.

Situational Theory of Publics

While the focus of stakeholder analyses is on communicating program goals to the key stakeholders in order to obtain their involvement, the situational theory of publics foregrounds an analysis of the key publics and thus makes an important contribution to the strategic health communication perspective in implementing community-based health behavior change initiatives. By emphasizing effective message design in interventions keeping public segmentation in mind, this public relations theory has been successfully utilized in persuasive communication (Parrott 2004; Pfau and Wan 2006). Essentially, this perspective envisages the public as an entity having something in common: members of the public could be affected by the same problem or issue, or adopt a similar behavior toward the problem (Grunig and Hunt 1984). The situational theory of publics predicts communication behavior according to three factors: (a) problem recognition, (b) constraint recognition, and (c) level of involvement (Grunig and Hunt 1984). These factors affect the extent to which individuals engage in either passive forms of information processing or more active forms of information seeking behaviors. In the case of information processing, publics do not seek information, but they will pay attention to it, which distinguishes processing from mere exposure to a message (Slater et al. 1992). Information seeking, on the other hand, is the active and deliberate search by the individual for information on a particular issue.

The first factor in the theory, problem recognition, is that people do not really think about problematic situations unless they perceive that something needs to be done to improve the situation. Indeed problem recognition aids the likelihood of communication because once people recognize something as a problem, they are more likely to engage in information seeking and information processing. The second factor, constraint recognition, is defined as the extent to which individuals see their behaviors as limited by obstacles or barriers beyond their control. That is, perceived high constraints will tend to lead to reduced communication. The third factor in the theory, involvement, is a key concept for many theories and has been used in studies pertaining to health communication campaigns , persuasion, and public relations (Chaffee and Roser 1986; Grunig and Hunt 1984). Involvement is defined as the extent to which an issue is perceived as being personally relevant for the individual (Grunig and Hunt 1984). Clearly, if the particular issue or message is perceived as being of high relevance to the person, that person will be more likely to attend to and comprehend it. It stands to reason, therefore, that people with high involvement elaborate upon issues more deeply (Petty and Cacioppo 1996) and attain greater knowledge levels (Engelberg et al. 1995). In addition, highly involved publics will be more likely to seek information and communicate actively when they perceive an issue to be a problem or perceive that the issue involves them and believe they can do something about it (Grunig 1989). An active public will be involved enough to engage in information seeking from various avenues: the media, interpersonal contacts, and specialized channels, whereas a passive public is more likely to simply process information from mass media (Heath and Douglas 1991). The situational theory, therefore, has significant implications for designing messages in health communication campaigns . The theory is especially relevant for messages that are perceived to be of high relevance to the target audience who are then more likely to recognize the problem as well as seek out information on it.

Strategic Health Communication in Urban Contexts in India

In a developing country like India, strategic health communication provides a useful framework to design and examine the efficacy of strategies concerning the implementation of behavioral health initiatives among at-risk populations. By incorporating stakeholders and segmenting publics, organizations can envision message design as an inclusive, dynamic, and nonlinear process whereby behavior change is organically conceived rather than imposed (Fig. 13.1). For instance, female sex workers in India who are older, married, and practicing sex work for longer duration with a higher clientele are more likely to engage in risky sexual practices (Mahapatra et al. 2013). Therefore, the key challenges facing the urban marginalized lie in the area of assessing progress on social issues that have been traditionally intransigent to planned programmatic change. Some challenges include providing access to adolescent girls’ education, awareness initiatives in sexual and reproductive health , property and inheritance rights, and gender-based violence, among others. Social issues including violence against women are also associated with increased vulnerability to HIV. For example, married women in India who had experienced physical and sexual violence from intimate partners were three times more likely to be HIV-positive than those who had experienced no violence (UNAIDS 2012b). Data from the International Labor Organization (ILO) also show that gender wage gaps have risen in parts of the world, such as India and China that are most affected by globalization and labor market shifts (ILO 2007).

Fig. 13.1
figure 1

A stakeholder-publics theoretical approach model of strategic health communication

Full size image

Studies by several organizations such as the International Center for Research on Women (ICRW 2006) have found strategic health approaches can contribute in increasing implementation effectiveness, monitoring, and evaluation, especially in the realm of women’s public health issues in urban contexts. In particular, the framework of strategic health communication provides a useful focus to critique public health initiatives through the lens of public relations theory by foregrounding the stakeholders and key publics within health communication interventions (see also, Wise 2001). For example, one advantage of employing multistakeholder teams (MSTs) is that they can help in empowering marginalized women and in mobilizing community support for the planned implementations. Some of the ways MSTs can help are through influencing community members to participate in resolving tensions between members and staff. In this case, MSTs help achieve project goals by serving as a liaison between “key populations and groups within the community, such as ‘gate keepers’ for the key populations, influential representatives within the community, members of associations such as youth clubs, health watch committees and women’s groups” (ICRW 2006, p. 14). Such bridging across networks of influence is especially important for women in urban contexts particularly migrant women who struggle with the fragmentation of traditional social roles and communities.

For instance, in India and Nepal, HIV-positive women who use drugs work with local organizations as peer advocates promoting access to HIV prevention services as well as to sensitize police from violence toward sex workers using drugs (UNAIDS 2012a, b). The Avahan HIV/AIDS prevention program in India supported by the Bill and Melinda Gates Foundation contributes to the efforts of the National AIDS Control Program III (NACP III) government policy by seeking feedback from multiple stakeholders including key informants, staff of implementing partners, policy and decision-makers to suggest strategic channels for communication (Tran et al. 2013). The following section further discusses the applicability of strategic health communication interventions in the HIV/AIDS domain in India.

Strategic Health Communication in HIV/AIDS Interventions

The rapid mobilization of women in the migrant workforce has caused many public health issues , the more urgent perhaps being the growing HIV/AIDS epidemic . This target public of migrant women workers is particularly vulnerable. Research suggests that female sex workers in noncommercial, nonregular relationships report greater likelihood of being HIV positive, having syphilis, using condoms inconsistently with occasional clients, and having forced sex, as opposed to those in regular partnerships (Somanath et al. 2013). Although in urban areas HIV/AIDS is largely concentrated in traditional at-risk populations such as sex workers, injecting drug users, truck drivers, and men who have sex with men (MSM) , surveillance data suggest that increasingly the epidemic is moving into the larger population. This trend is a cause of increasing alarm because of its potential to influence traditional and larger, hitherto unaffected, populations. The lack of education for women, the difficulty women face in obtaining medications and resources, and the stigma associated with the epidemic are responsible for the particular vulnerability of migrant women. The shift in those affected by the epidemic suggests that awareness and campaigns for the empowerment of women and adolescent girls might be the best strategies for combating its spread.

For example, in the early stages of the HIV/AIDS epidemic , governments and donor agencies devoted most resources to technical interventions (TIs) with at-risk groups, such as sex workers, truckers, and migrant laborers. However, such targeted action often stigmatized People Living with HIV/AIDS (PLWH/A) and were considered counterproductive because they ultimately reinforced the denial of risk among the general population. To counter stigmatization, strategic communication initiatives using a planned combination of well-targeted mix of mass media and interpersonal channels, together with both social and community mobilization were utilized to increase public discourse and acceptance of the threat of HIV/AIDS . When incorporated productively, strategic health communication can help: (a) break the silence about HIV/AIDS in identifying the salient dimensions of stigma within the population (D’Silva et al. 2008) and the demographic and psychosocial correlates of these dimensions (Creel at al. 2008), and thus (b) move the discussion about HIV/AIDS from the personal-private to the public-policy sphere. Today, it is believed that this is the only feasible approach to HIV/AIDS prevention programs for large countries like India.

Some innovative behavioral change efforts have recently been initiated by both the Indian government and nongovernmental organizations (NGO) sector. A few Indian states, like Tamil Nadu, and several NGOs including FXB India Suraksha, have utilized Nai’s (a Hindi word for barbers) as local opinion leaders in a novel way to break the silence about HIV/AIDS. Traditionally Indian barbers have a key social status and play a central role as community healers, confidants, advisors, and matchmakers. A popular saying “To get the king’s ear, tell his barber” symbolizes this sentiment in popular culture well. Equally important, in rural areas, the barber’s wife is often a Dai, a traditional community health worker, functioning as the community midwife and birth attendant. In fact, barbers have the ear of all their clients, and barber shops are considered as a place in the neighborhood where clients can often speak openly and freely about intimate issues with the barber, including those topics that are otherwise taboo in the society. Involving this key group of local community leaders in an innovative program, Tamil Nadu has enrolled more than 5,000 barbers who, while cutting the hair of clients, also discuss issues related to safe sex, HIV/AIDS , and condoms. In fact, FXB India Suraksha still has a successful barber intervention program in many northern states. Barbers, in this instance, function as effective communicators transmitting appropriate messages in a comfortable, informal context.

Future Landscape of Strategic Health Communication in HIV/AIDS

Despite some successful interventions in India , communication scholars and community activists still face several challenges in the successful dissemination of HIV/AIDS programs . Public relations scholars and practitioners have the potential to make a vital contribution to the success of these interventions. This is especially critical in developing contexts such as India where the high-risk publics, stakeholders, and their sociocultural contexts are in a process of continuous change due to rapid urbanization. For example, increasing male migration provides the context for those who are infected with HIV to spread the epidemic from high-risk populations in high prevalence areas to populations in low prevalence areas (Saggurty et al. 2011). Thus changing economic imperatives coupled with changing demographic trends in migration are deeply linked with public health concerns such as the HIV/AIDS epidemic . Migrant males’ unprotected and high-risk sexual behaviors in their destination areas, in India , have been found to pose a risk of transmission from high-risk population groups to migrants, and in turn to their married and sexual partners in the places of origin (Saggurty et al. 2011). Thus these trends have to be taken into account through research incorporating all stakeholder and public voices to effect meaningful behavioral change.

Further, the limited diversity of target-specific content and a lack of resources are tough issues that could be remedied by thoughtful planning and increased support from international and national agencies. One of the biggest obstacles, however, is the policies and actions of governments that hamper any work by HIV prevention activists. As in several places around the world, India stigmatizes prostitution. Although prostitution is legal, brothels and any form of organized prostitution are illegal. The law is often used to harass prostitutes (Debabrata 1998). Sex workers cannot legally solicit customers in public and are subjected to moral policing. For example, Goa’s state government demolished Baina’s red-light district and tried to move prostitutes into other work. NGOs working in the area found it quite impossible to reach the sex workers with prevention messages (Shahmanesh and Wayal 2004). A reexamination of the laws related to prostitution and human trafficking is needed. However, there is cause for optimism in the recent policy change abolishing the Indian law criminalizing homosexuality. Homosexual males are an at-risk population in the AIDS epidemic, and fear of being imprisoned has kept them from obtaining help in preventing the disease or treating it. A policy change like this one helps immensely in changing the future landscape of HIV/AIDS . Social media use has also seen a striking increase in the developing world and social media tools have a great potential to increase awareness, mobilize social action, and provide access for PLWHA (UNAIDS 2013). Its use in Africa , for example, has increased a whopping 2357 % between 2000 and 2010 and about 42 % of the total internet population worldwide is in Asia (UNAIDS 2013).

Conclusion

As the world’s population grows, so does the rate of urbanization . Especially among developing nations, urbanization has become a rapid yet unplanned process. This process typically produced several daunting problems in urban public health , such as HIV/AIDS and malnutrition. India is not an exception. In examining online websites of international nongovernmental organizations (INGOs) , Agarwal et al. (2013, p. 21) note that “political, socio-cultural, and economic conditions are imbued in the micro-practices of power and identity that define the communicative relationship building tactics” in cross-cultural stakeholder management thus encouraging INGOs working in HIV/AIDS to be constantly self-reflexive about the unintended implications of their actions. Ultimately, the urban health problems experienced in India are not unique to the country but rather shared by other developing nations. Therefore, this chapter used particular cases in India as examples of those common urban public health problems . Given the imperatives of designing implementations for advocacy geared toward spread of awareness and knowledge for behavior change, the strategic health communication framework provides a useful theoretical perspective for meaningful stakeholder management. It enables researchers, program implementers, and grassroots social workers to both assess the efficacy of health communication campaigns with respect to reach of programs and to conceive new initiatives.

The effectiveness of strategic health communication frameworks will depend on the campaign sensitivity and success in integrating the unique local and cultural elements of the campaign target publics. Indeed providing region- and target-specific content is a major communication challenge even within a single country further emphasizing the need for strategic health communication interventions . Due to the absence of effective vaccines or medications preventing/treating HIV/AIDS , the prevention depends largely on behavioral change through strategic health communication. Through illustrating the utility of two public relations theories in the HIV/AIDS context in India, this chapter emphasizes that to be effective in raising awareness, educating the target population and ultimately changing their behaviors, strategic health communication must be conducted within the particular cultural context of the stakeholders and target publics.

The deep-rooted nature of HIV/AIDS-related stigma in India was attested by the content analysis of newspaper articles in Indian media which primarily depicted ostracization due to HIV/AIDs as the dark belly of the Indian sociocultural landscape (D’Silva et al. 2011). Therefore, even though the cases in India provide valuable lessons, important challenges remain. How will these theory-based strategic urban health communication interventions work in different parts of the world? How will the factors in the theories be influenced by the uniqueness of different local or national cultures? The answers to those questions shall be obtained through continuous and sustained efforts made by both academics and practitioners.

Urbanization is an unavoidable step in the modernization process. This chapter contributes to the efforts of urban public health practitioners by providing an understanding of urbanization and its associated public health problems within the framework of two key public relations theories along with a consideration of their practical implications. Only through education, both researchers and practitioners can gain better understandings of the problems and solutions so eventually those living in marginalized urban areas will receive the benefit of urbanization without those negatives associated with urban public health.