Thinking about the ethics and politics of public health campaigns

Over the past few years one of my research foci has been that of fat embodiment and obesity politics. This interest builds on my longstanding research on the sociocultural dimensions of health, medicine and public health, as well as the sociology of food and eating and the sociology of the body.

In July 2012 I wrote a piece for The Conversation critiquing a new Australian anti-obesity campaign, LiveLighter. The campaign included visual material and text that sought to evoke disgust (the ‘yuck factor’) about body fat in audiences. I argued in my piece that such strategies need to be examined for the ethical and moral issues they raise. Should health promotion campaigners be attempting to make people feel hatred and revulsion about their own bodies? To what extent are certain individuals and social groups identified by others as disgusting via such campaigns, and as a result subjected to social discrimination and stigma? How do such campaigns reproduce and exacerbate existing social disadvantage?

These questions have been addressed in several other publications of mine since then. In 2013 my book Fat appeared, in which I investigated the historical, social and cultural underpinnings of the disgust and revulsion that fat bodies tend to evoke in contemporary western culture. And I followed up my interest in public health campaigns and their use of strategies that attempt to arouse negative emotions such as disgust, shame and fear in two journal articles that were published recently.

One of these articles, published last week in Critical Public Health, builds on the piece I wrote for The Conversation by exploring the reasons why disgust is used in public health campaigns directed not only at obesity but also other issues, such as tobacco, excessive drinking and illicit drugs. It is entitled ‘The pedagogy of disgust: the ethical, moral and political implications of using disgust in public health campaigns’. Here is the abstract:

The developers of public health campaigns have often attempted to elicit disgust to persuade members of their target audiences to change their behaviour in the interests of their health. In this critical essay, I seek to problematise this taken-for-granted and unquestioned tactic. I assert that the pedagogy of disgust in public health campaigns has significant ethical, moral and political implications. In outlining my argument, the literature on the social, cultural and political elements of disgust is drawn upon. I also draw more specifically on scholarship demonstrating the ways in which disgust has operated in relation to health and medical issues to reinforce stigmatisation and discrimination against individuals and groups who are positioned as disgusting. It is concluded that advocates of using such tactics should be aware of the challenge they pose to human dignity and their perpetuation of the Self and Other binary opposition that reinforces negative attitudes towards already disadvantaged and marginalised individuals and social groups.

The other article was published last month in Fat Studies and is entitled ‘How do you measure up?’ Assumptions about ‘obesity’ and health-related behaviors and beliefs in two Australian ‘obesity’ prevention campaigns’. This article was based on research I undertook using documents reporting on the formative and evaluation research by market research companies that was undertaken for two other Australian anti-obesity campaigns: the ‘Measure Up’ and the ‘Swap It, Don’t Stop It’ campaigns. Analysing these types of documents provides an interesting insight into the mentalities and rationales that underpin their development on the part of public health authorities and the people they employ to develop the content and strategies of their social marketing efforts. This is the abstract:

This article presents an analysis of two related Australian government-sponsored ‘obesity’ prevention campaigns, including documents produced by commercial social research companies reporting the formative research and evaluation of these campaigns. This material is critically analyzed for its underlying assumptions about weight, ‘obesity’ and the public’s health-related behaviors and beliefs. These include the following: the concept of ‘good health’ has meaning and value that is universally shared; to be ‘overweight’ or ‘obese’ is to be physically unfit and at risk of higher levels of disease and early death; individuals are responsible for their own health status; individuals lack appropriate information about health risks and providing this information leads to behavior change; and information should be provided in a way that arouses concern and a belief that individuals should make a change. These assumptions are challenged from a critical sociological perspective.

Anyone who would like a copy of these articles can contact me on deborah.lupton@gmail.com.

6 thoughts on “Thinking about the ethics and politics of public health campaigns

  1. Hi Deborah, curious how you feel about the “disgusting” Cancer Institute NSW ads that show animated melanoma cancer cells in metatastatic progression? These are pretty graphic, and perhaps they might make people who chase a tan feel stigmatised as being vapid, stupid etc. Poor darlings. Do you feel that the promotional apparatus of popular culture in venerating tans over the decades while in the process, making pallid skinned people feel unattractive is also disgusting? I personally think the ads are a brave and important step in trying to put a tiny bit of balance into all that. You? Google “advanced melanoma” and click “images” and you’ll see what the ads are trying to prevent. People living with that disease tend to not get out much. Curious if you think there is ever any virtue in showing people images of spoiled identity that might evoke disgust, when the dominant culture keeps most people from ever reflecting on what tanning, smoking, drinking too much etc can cause.

    • Hi Simon

      I think we are going to disagree for perpetuity on this issue!

      I’m not sure if you’ve read both of the articles that I refer to in full, but my major argument is that linking disgust with certain social groups and doing so in a way that focuses on individual choice rather than the social determinants of health and illness tends to perpetuate stigmatisation and marginalisation of already disadvantaged people. When you examine the discourse of ‘educating’ people about health risks that is found in such documents as those produced by the market researchers who carry out formative research for campaigns (as I do in one of these articles), the language that is used represents many members of the public as ignorant and apathetic simply because they have not changed their behaviour to the extent considered appropriate by the health promotion professionals. Groups such as indigenous Australians were simply discounted as too hard to reach because of their social disadvantage, and therefore ignored. The general approach is both patronising and paternalistic. What’s more, there is a substantial literature suggesting that if people are repulsed by the images they see in public health campaigns, they tend to discount them and look away. I do not argue that people shouldn’t be educated about health risks – of course they should – but rather that tactics such as disgust are not necessarily the most appropriate or effective, for the reasons outlined above and in the two articles, and that public health professionals need to consider the ethical implications and unintended effects of what are often well-intended efforts to help people stay well.

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  3. Many people are ignorant and apathetic about health consequences, which suits various interest groups very well. Understanding of what emphysema, peripheral vascular disease etc are, what they look like, what daily life is like if you have these health problems is very low and rudimentary. Call me patronising or paternalistic if you like, but I think agencies like the Cancer Institute who think it’s a good idea to rudely interrupt the dominant narrative that tanning is wonderful, healthy and attractive ought to have all our thanks. I think a parallel case could be made about efforts to keep such information & understanding away from people. Campaigns which are ineffective deserve criticism for being wasteful, but those that do influence people to change deserve to be acknowledged for what they have achieved. I have never seen a study examining motivations for quitting smoking that did not put personal concern about health consequences WAY ahead of any other factor in accounts given by ex-smokers about why they quit. Where does such concern come from? How does it get into people’s heads? Anodyne “education” is a strategy promoted by big tobacco, coca cola etc. There is a huge amount of effort going into Indigenous tobacco control – -been that way for quote a few years. It’s a very difficult area. I think critics of these campaigns need to anticipate possible unintended effects of their criticism too. There is a regime in power now who are busy dismantling public health work, much to the delight of the junk food, drink, and alcohol industries. Is this what you have in mind?

  4. Of course I don’t want to promote dismantling public health work, merely to engage in some constructive debate about how best this work should be carried out. It’s a very interesting issue about how people become concerned about health risks and then take action about it. Public health campaigns are only one aspect; so is personal experience of others’ ill health and coverage of health risks in the news media, which is how most people learnt about issues such as HIV/AIDS in the first instance.

    I wonder what people who already have melanoma or lung cancer think about the campaigns that depict their bodies as disgusting? Has any evaluation included these types of audience members?

  5. Not sure I understand the ethical difference between giving people graphic, disturbing. motivating information via news media vs via a campaign. No one with any decency wants to see people who are suffering from hideous diseases suffer more than they already are. So policies & programs encouraging acceptance, empathy etc for people living with spoiled identities are very important. If most people have absolutely no idea what (eg) melanoma can do to you, to purposefully shield people from a better understanding out of sensitivity to those who have the disease seems perverse & likely to perpetuate the incidence of such suffering in others. I’m certain many drink drivers who have killed or badly injured others feel terrible about what they’ve done & that efforts to increase intolerance of drinking & driving makes them feel even worse. But what’s more important here?

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