This article is both a reflection and a condensed version of dissertation research I completed at the University of Stirling between 2024 and 2025. It brings together questions that I am still seeking answers to, ideas that continue to challenge me and opportunities I believe strategic communication professionals should be paying closer attention to.
Grab a coffee, your notebook and a pen and allow me to take you on a journey.
Setting the scene
The balance of strategic communication and ethical advocacy in the pharmaceutical industry is far from a simple tension between speaking up and staying silent. For communication professionals working in regulated, scientific or institutionally sensitive environments, it is quite a bit more complicated than that. It’s the art of knowing when to speak, what to say and how to say it. A delicate yet powerful balance and a task that should be treated with an unwavering understanding that your words, timing and delivery have a grand impact.
Communication is rarely just about message clarity and I mean that for any industry. It is about permission, legitimacy, timing, audience tolerance, legal interpretation, institutional confidence and the very real consequences of saying something in a way that shuts down the conversation you are trying to open.
That is the professional challenge my dissertation research explored through the case of pharmaceutical pollution. Two of my deepest interests, the art of communication and the impact of our actions on future generations.
For context, pharmaceutical pollution is a public health and environmental issue, but it is also a communication problem. The science is complex, the routes of pollution are varied and responsibility is distributed across manufacturing, prescribing, consumption, disposal, wastewater systems, procurement and regulation. The issue does not offer the communicative simplicity of an oil spill, a plastic filled beach or a visible act of corporate harm, which even then is far from simple.
It is slow, cumulative and difficult to narrate.
Pharmaceutical residues have been detected across global water systems, with research showing that concentrations exceeded safe ecological thresholds for at least one pharmaceutical at more than a quarter of the river sampling sites analysed in a large-scale global study (Wilkinson et al., 2022). Despite growing scientific understanding, the issue remains relatively underdeveloped in mainstream public and professional discourse.
That makes pharmaceutical pollution an important case for a wealth of people, in fact, everyone, but in this instance, communication professionals, particularly those of us working across strategic communication, as we are forced to look at one of the least comfortable parts of our work…what happens when an issue matters, but the conditions for speaking about it are constrained.
Why this is a strategic communication question, not a sector critique
I want to be clear about that from the outset, I have worked across pharma, health, medical for well over a decade and I owe so many of my accomplishments and experiences to the pharmaceutical companies that actively work towards a more ethical, accessible and sustainable future.
This is not an argument that the pharmaceutical industry is uniquely silent, uniquely resistant or uniquely responsible for the communication challenges surrounding complex environmental health issues. Pharmaceutical innovation remains fundamental to contemporary healthcare and the medicines developed, prescribed and used across society have transformed lives in ways that are not ethically incidental to this discussion.
That is precisely why the communication challenge is so so very difficult. Medicines sit in a complicated ethical position. They are associated with care, treatment, prevention, survival and progress, while also being part of systems that have environmental externalities, supply chain implications, waste considerations and regulatory gaps. Communicating about those tensions requires more than a campaign message or a sustainability statement, because the issue does not sit neatly inside a single organisational function, public narrative or policy owner. It sits across all of them.
For communication professionals, this is the more useful terrain to examine. Not whether one sector should be praised or blamed, but how strategic communication operates when science, ethics, regulation, reputation and public interest overlap.
Beginning not with a molecule, but with a campaign
In my dissertation research, I examined Health Care Without Harm Europe’s (HCWHE) 2016 to 2020 Safer Pharma campaign , a civil society campaign that sought to increase the visibility of pharmaceutical pollution within European policy contexts (Health Care Without Harm Europe, 2025; Swanser, 2025).
HCWHE advanced a communication strategy aimed at reframing pharmaceutical residues as indicators of misalignment between environmental protection, public health and regulatory design. Working at the overlap between healthcare, sustainability and environmental justice, the campaign offered a practical example of how civil society attempts to engage publics, institutions and policymakers through strategically framed discourse. This analysis therefore begins not with a molecule, but with a campaign.
That distinction matters because communication professionals are often brought into complex issues once the evidence exists, the risk is known, the policy context is moving, and the organisational sensitivity is already present. But the work of communication is not simply to translate complexity after the fact. It helps shape how that complexity is understood, how responsibility is distributed, which audiences are invited into the issue and what forms of response become possible.
Strategic communication, rooted in public relations theory and historically attentive to institutional dynamics, has developed into a critical tool for advancing advocacy and public interest agendas within complex policy environments. BUT in a regulated sector such as pharmaceuticals, that tool must be handled with unusual care. Therefore, strategic communication in this context is not only about persuasion, profile or public awareness, it is also about admissibility.
- Can the message enter the room?
- Can it be heard without triggering defensiveness?
- Can it sustain trust while still naming risk?
- Can it create momentum without overstepping legal, ethical or reputational boundaries?
- Can it engage publics without simplifying the issue to the point of distortion?
These are not theoretical questions, they actually sit at the centre of communication practice in healthcare, science, sustainability, public affairs, corporate affairs, internal communication and change.
Framing is not cosmetic
One of the strongest reflections the dissertation research gave me was that framing is not a cosmetic layer added to strategy once the important decisions have already been made.
Framing constitutes a discursive architecture through which meaning is ordered, boundaries are drawn, and public sensibilities are shaped. It governs the selection, emphasis and omission of narrative elements, choreographing what is noticed, what is normalised and what is rendered peripheral. Within advocacy, this structuring logic becomes a site of political intervention, determining not only how a message is conveyed, but what forms of response are made possible or precluded. Put more simply, framing does not just describe the issue, it also decides what the issue can become.
Entman’s (1993) work on framing remains useful here. Particularly the idea that framing involves selecting and making salient certain aspects of reality to define a problem, diagnose causes, make moral judgements and suggest remedies. For communication professionals, that means our work carries consequence far beyond wording. The frames we choose shape whether audiences see a problem as urgent or peripheral, technical or moral, individual or systemic, solvable or simply too complex to touch.
In the case of pharmaceutical pollution, framing affects whether the issue is understood as a wastewater problem, a prescribing issue, a manufacturing concern, a procurement challenge, a healthcare sustainability issue, a public health risk, an environmental justice concern, or some uncomfortable combination of all of those things.
That is why strategic communication matters, the work is not simply to make an issue louder, but instead to make it legible in a way that does not strip out its complexity and does not leave it trapped inside technical opacity.
What the Safer Pharma campaign showed
What stood out in the Safer Pharma campaign was not a lack of strategy, in fact it was actually quite the opposite.
The campaign was highly controlled, consistent and institutionally fluent, beautifully so. It aligned pharmaceutical pollution with antimicrobial resistance, used the language of shared responsibility and positioned the issue within existing policy conversations rather than trying to force an entirely new public narrative. From a communication perspective, that is worth taking seriously.
It shows the value of understanding the room you are trying to enter. The campaign appeared to prioritise policy access, credibility and institutional continuity over public confrontation. It avoided sensational imagery, emotive storytelling and direct attribution of blame. It spoke in a language that regulators, policymakers and healthcare audiences could recognise.
Undoubtedly strong and immaculately disciplined communication, but as we all know, discipline always has a cost.
The more an issue is translated into the language of institutional acceptability, the more certain forms of meaning can fall away. Public experience becomes harder to see. Emotional urgency becomes softened. Ethical tension becomes procedural. The issue becomes easier to discuss in policy spaces, but harder to recognise as something that touches people, communities and environmental futures.
This is where the dissertation research became most interesting for me.
Pharmaceutical pollution, as the research argued, cannot be understood solely as an environmental or regulatory failure. It constitutes a problem of visibility, attribution and narrative coherence, within a governance system that often prefers procedural discretion over communicative confrontation. The Safer Pharma campaign, positioned within this complex terrain, presents a communicative strategy situated in the institutional and ethical strictures through which civil society operates in transnational pharmaceutical contexts.
Rather than examining the campaign as a sequence of outputs, my dissertation research interpreted it as a case of strategic navigation across overlapping pressures of credibility, legitimacy and rhetorical containment.
That phrase has really been at the forefront of my mind for quite some time now as it deeply interests me. Rhetorical containment.
It captures something that many communication professionals will recognise, even outside the pharmaceutical industry. The careful narrowing of language so that a message remains acceptable. The avoidance of sharper attribution so that relationships remain intact. The decision to work within a system’s codes rather than confront them directly, because access, however imperfect, may still be more useful than exclusion.
That is the reality of much strategic communication work, particularly when the issues are ethically live, politically sensitive and reputationally exposed.
The ethics of restraint
Ethical advocacy is often imagined as the courage to say more…and I mean, sometimes it is.
But in practice, particularly in regulated sectors, it can also involve the judgement to understand how much can be said before the opportunity for influence is lost altogether. In such contexts, ethical speech is not always about maximal transparency or expressive freedom. Sometimes it is about sustaining the capacity to speak at all.
That does not mean as communication professionals we should accept silence as inevitable or treat restraint as inherently virtuous. It means we need to become more precise about the different kinds of silence we are dealing with. As I said, it truly is a form of art.
Some silence is negligent; some silence is protective, some silence is strategic, some silence is imposed by regulation, governance or institutional fear and some silence keeps a conversation alive, while some silence prevents a conversation from ever becoming meaningful. The professional task, our obligation, our responsibility, is to tell the difference.
In the Safer Pharma case, restraint appears to have helped the campaign maintain legitimacy within European policy spaces. Yet that same restraint narrowed the communicative frame. Patients, communities and lived experience were largely absent. Pharmaceutical pollution was presented as a matter of systems, stewardship and regulatory improvement rather than as a human or environmental story with visible consequences. Now, that is not a simple failure by any means, it’s actually…a strategic and ethical trade off.
Mitchell, Agle and Wood’s stakeholder salience model helps illuminate part of this tension, because stakeholders with power, legitimacy and urgency are not always the same people, nor are they equally visible in strategic communication (Mitchell, Agle and Wood, 1997). In policy contexts, those with institutional authority often become the audiences most carefully addressed, while those with lived or experiential urgency may remain symbolically important but practically less visible.
For communicators, this raises a sharper question than whether the campaign should have been louder, but in my opinion, the better question is…what communication infrastructure would have allowed the campaign to be both credible and more inclusive?
And that is where the wider opportunity sits.
A pause for communication professionals
Before we rush to the language of lessons learned, I think this research asks us to sit with a few uncomfortable questions.
- When we choose restraint, what exactly are we protecting?
- Are we protecting accuracy, trust, access and the possibility of influence, or are we protecting institutional comfort?
- When we frame an issue in the language of systems and shared responsibility, are we helping audiences understand complexity, or are we making accountability harder to locate?
- When we avoid emotion, are we preventing manipulation, or are we removing the human meaning that makes an issue matter?
- When we prioritise credibility with decision makers, who becomes less visible in the story?
- When we say an issue is too complex for public communication, are we describing the issue honestly, or are we avoiding the professional difficulty of making it understandable without making it simplistic?
These are not questions with neat answers and that is precisely why they matter. I really do urge you to pause for a moment and consider these questions, play around with them, think about what they mean for you.
To me, strategic communication is not only tested when the message is easy, the audience is warm and the organisational position is clear, it is also tested when all of those things are contested.
Strategic communication as infrastructure
One of the strongest conclusions I took from the dissertation research is that communication professionals need to think beyond individual campaigns and towards the conditions that shape what campaigns are able to do.
A communicator can craft a better message, but if there is no shared agreement on what can be said, who can say it, how cross sector collaboration can happen responsibly and how different forms of evidence and experience can be included, then even the best message will remain constrained.
This is particularly important in pharmaceutical communication, where the boundaries between information, promotion, advocacy, reputation and public interest can become difficult to navigate. Companies may be cautious because they fear legal exposure or accusations of greenwashing. NGOs may be cautious because they need to preserve independence and access. Regulators may be cautious because their role is to maintain process and avoid politicised interpretation.
The result can be a communication vacuum where all parties recognise the issue, but few feel able to speak about it with sufficient clarity or collective force. That vacuum is where we as communication professionals have a role to play. Not as spin doctors, not as corporate defenders, or campaigners shouting from the margins. We are architects of the conditions that make responsible communication possible.
That means developing shared language, clearer governance, transparent partnership models, stronger stakeholder inclusion and better ways of balancing legal caution with ethical visibility. It means creating communication approaches that can hold complexity without becoming evasive. It means resisting the false choice between reputational safety and moral responsibility.
In my dissertation research, I proposed the idea of a Strategic Communications Agreement on Pharmaceutical Pollution, or SCAPP. The purpose of such an agreement would not be to solve pollution directly, nor to replace environmental regulation. It would be to address the communication barriers that prevent more coordinated, lawful and ethically credible advocacy. At its most practical, such an agreement could help establish a clearer reference point for how pharmaceutical pollution can be discussed across sectors, without collapsing into either accusation or avoidance. It could provide shared language, disclosure principles, collaboration templates and reporting expectations. It could help organisations communicate without turning every conversation into a reputational risk exercise.
The proposal is deliberately ambitious, but the principle behind it is practical. I chose to not fixate on the hurdles and barriers as the first point of call, but instead to look at the most ideal solution and to then adjust, edit and revise until the hurdles and barriers had been met, understood and recognised appropriately.
Communication professionals need better infrastructure for ethically complex issues, we really cannot keep relying on individual judgement alone when the issues we are dealing with are systemic, regulated and politically sensitive.
The deeper thought the research gave me
The deeper thought the dissertation research gave me is that strategic communication is often treated as the work of articulation, when in many contexts it is also the work of permission.
- Permission to name an issue.
- Permission to bring new voices into the frame.
- Permission to move a topic from technical containment into public meaning.
- Permission to hold institutional legitimacy without losing ethical force.
That is a more demanding view of communication than the version that sits neatly inside campaigns, channels and content plans. It asks us to think about what makes speech possible, what makes it risky and what makes it credible.
It also asks us to be honest about the fact that communication professionals are not neutral actors in these systems. We help build the frames through which issues are understood, we advise on what should be said and what should be withheld. We influence which audiences are prioritised and which are assumed to be too difficult, too risky or too far removed from the formal decision-making process. That influence carries responsibility.
Not a simplistic responsibility to say everything, all the time, as loudly as possible. That is not strategy, but a responsibility to notice when restraint has become default, when caution has hardened into avoidance and when legitimacy is being maintained at the expense of inclusion.
Questions that are still on my mind
The dissertation research answered some questions, but it also left me with further thoughts and areas to reflect on:
- How do communication professionals create space for affected voices without exposing them to tokenism, simplification or institutional discomfort?
- How do we hold complexity without making it inaccessible?
- How do we help organisations speak responsibly about harm when responsibility is distributed, contested or reputationally sensitive?
- And perhaps most importantly, how do we know when strategic silence is keeping a conversation alive and when it has become part of the problem?
Closing thoughts
The future of strategic communication will not be defined only by better campaigns, sharper narratives or more sophisticated channels. It will be defined by whether communication professionals can help organisations, institutions and civil society actors navigate complexity without retreating into safe language that says very little and without defaulting to performative boldness that burns trust faster than it builds action.
Pharmaceutical pollution shows us that some issues do not need louder messaging as much as they need better communicative conditions. They need shared language, credible participation, institutional courage, ethical restraint that does not become silence and strategic discipline that does not erase the people, places and futures at stake.
That is the true art of communication, not simply to speak but to make responsible, creative, ethically crafted speech possible.
With thanks
With thanks to Dr William Dinan, Dr Clare McKeown and Dr Alenka Jelen for their guidance, academic support and thoughtful challenge throughout the development of this research.
References
References
- Entman, R.M. (1993) ‘Framing: toward clarification of a fractured paradigm’, Journal of Communication, 43(4), pp. 51–58. doi:10.1111/j.1460-2466.1993.tb01304.x.
- Hallahan, K., Holtzhausen, D.R., van Ruler, B., Verčič, D. and Sriramesh, K. (2007) ‘Defining strategic communication’, International Journal of Strategic Communication, 1(1), pp. 3–35. doi:10.1080/15531180701285244.
- Health Care Without Harm (2018) ‘CleanMed 2018’, Health Care Without Harm Europe. Available at: https://2018.cleanmedeurope.org (Accessed: 01 June 2025) *Please be aware that the Safer Pharma campaign started as a singular campaign and has since become a wider movement.
- Mitchell, R.K., Agle, B.R. and Wood, D.J. (1997) ‘Toward a theory of stakeholder identification and salience: defining the principle of who and what really counts’, Academy of Management Review, 22(4), pp. 853–886. doi:10.2307/259247.
- Swanser, N. (2025) Strategic Communication and Ethical Advocacy in Transnational Pharmaceutical Pollution Campaigns: A Critical Analysis of Health Care Without Harm Europe’s ‘Safer Pharma’ Campaign. MSc dissertation. University of Stirling.
- Wilkinson, J.L. et al. (2022) ‘Pharmaceutical pollution of the world’s rivers’, Proceedings of the National Academy of Sciences 119(8), e2113947119. doi:10.1073/pnas.2113947119.
About the research
- Title: Strategic Communication and Ethical Advocacy in Transnational Pharmaceutical Pollution Campaigns: A Critical Analysis of Health Care Without Harm Europe’s ‘Safer Pharma’ Campaign.
- Review: Awarded distinction at postgraduate level and is a contribution towards Natalie’s time at University of Stirling, for which she was awarded the Sam Black Prize.
- Accessing the research paper: please reach out to Natalie directly via collaborate@nscommunicationsltd.com
