Tag Archives: public health communication

Engaging the public on global health

This post originally appeared here.

A simple Google AdWords search of Ebola keyword searches in the past twelve months in the U.S. shows a general disinterest in Ebola all through the summer when cases were raging in West Africa and a sudden spike to 24 million searches in October 2014 just when cases were coming to the U.S. Similarly, average search volumes of “Ebola in Africa” are around 8,100 per month, while “Ebola in the U.S.” gets about 74,000 searches per month. Clearly, something is not right.

Yet the problem may not be exactly what we think it is. It is certainly not the case that people simply don’t care about global health and only become concerned when a disease encroaches on their own borders. In a Kaiser Family Foundation survey from 2012, 52% of people said that the media pays too little attention to health issues in developing countries. 50% of people said they paid at least some attention to global health issues in the news, 18% said they paid a lot of attention, and only 6% said they paid no attention at all. Lest we think people are merely self-interested, when asked why the U.S. should spend money on global health, 51% of people said it was because “it is the right thing to do”. Charitable giving statistics lend a bit more meat to this argument. In 2013, individual donation to health organizations in the U.S. amounted to a total of $31.86 billion, up 6% from 2012. Naturally, many of these health organizations have domestic missions. However, it does show concern about health in particular.

From these surveys and statistics, it would be difficult to argue that the American public has absolutely no interest in global health and international development. But there does seem to be a barrier to getting more involved in these issues: the way the information is presented. But the American public seems interested in knowing more about global health outside of these crises.

At the same time, it will be important to provide some more perspective on what the most pressing global health issues truly are. The same Kaiser survey found that when given a list of health issues in developing countries and asked to rank priorities, the public had a difficult time choosing, and about 1/3 of people claimed that all 12 named issues should be “one of the top” priorities. This finding suggests that although people want to engage more with global health, they feel overwhelmed by the number of issues that plague developing countries and have no reliable regular source of information to help them understand it all.

Engaging people on a regular basis in global health news and issues, as well as offering some perspective on what drives health crises in developing countries, might go a long way in mobilizing a group of people who want to help in some way but don’t know how. But whose responsibility is it to provide this kind of engagement, and how should it be done? Some possibilities include encouraging the media to make use of health crises in developing countries, such as Ebola, to more thoroughly explore and report on the contexts in which these crises arise. In a similar manner, these journalists should be engaging more extensively with local communities, and, perhaps more importantly, with local journalists, whose voices are very often absent from our news sources.

One interesting example of a current concerted effort to engage the public in dialogue about global health is the Wellcome Collection. The Wellcome Collection opened in 2007 and is described as a “free visitor destination for the incurably curious”. The Collection offers a wide range of information and exhibits related to science and medicine in general, but since the Wellcome Trust is such a major funder of global health, the collection also provides the public with a great deal of information on global health issues such as malaria, epidemics, and infant mortality.

In addition, health care companies and major foundations such as the Gates Foundation could make a more concerted effort to engage the general public in global health issues, especially during times of crisis when they already have an audience. This kind of engagement should go beyond statistics about various diseases and requests for funding to really making people aware of the entire political, social, economic, and healthcare context in which these epidemics arise. Perhaps this kind of regular engagement in global health issues might prevent the kind of needless and sometimes dangerous hysteria we witnessed with the Ebola epidemic and also target people’s attention and concern to where it would be most helpful.

Leave a comment

Filed under Publication

Does fear-based messaging help public health campaigns?

This post was originally published here.

A recent, well-publicized paper in Pediatrics cast considerable doubt on a tool public health practitioners value highly: informational messaging campaigns. The paper, based on a randomized-controlled trial, showed that neither information on the safety of vaccines nor details about the diseases being prevented by vaccination increased parental intent to vaccinate their children. In a surprising twist, graphic images of children suffering from vaccine-preventable childhood diseases, such as measles and pertussis, actually increased parental belief in an association between vaccines and autism and dramatic narratives about unvaccinated children who became ill increased parental belief in serious vaccine side effects.

The results of this study are decidedly disappointing to public health practitioners who strongly champion the utility of informational campaigns in producing better health outcomes and increasing rates of preventive behaviors. The study makes clear that much more research is needed on the particular effects of pro-vaccine messaging and that many public health campaign messages should be tested before being rolled out, not only to measure effectiveness but also to protect against any unforeseen negative effects. Testing for unintended consequences of health messaging is something that is often ignored in public health informational campaigns but may be just as important as testing for efficacy. Yet this study evokes an even wider question about public health campaign strategy: does fear-based messaging help or harm the cause? Does scaring people result in better health outcomes and increased uptake of preventive medical care or is it possible that this kind of messaging is actually associated with increased denial, psychological reactance, and increased distrust of the health and medical establishments?

Fear messaging in public health as well as in other related fields has a long history. In the past, public health authorities have tended to believe that fear messaging has the capacity to backfire. Yet recently, some health authorities such as the New York City Department of Health have begun to rely more heavily on fear appeals. For example, the city has launched a series of subway ads as well as television commercials featuring the terrifying consequences of lifetime smoking and graphic photos on the subway of amputated limbs due to diabetes from consuming too many sugary drinks. Widespread fear about an increasing tendency for parents to refrain from vaccinating their children and reports of several troubling measles and pertussis outbreaks in pockets of the country with low vaccination rates have led public health authorities to consider extending the fear appeal method to convince parents of the absolute necessity of vaccination. But is this the best way forward? If the method has a high likelihood of backfiring, as the evidence from the Pediatrics study seems to indicate, great care must be taken to vet and test all messages before they are disseminated to the public.

Several guidelines about constructing useful fear appeals do exist. In order to increase effectiveness, fear appeals must emphasize the severity of the threat as well as the intended population’s susceptibility. Without these factors, any fear-based campaign will inevitably be disregarded and fail. But these prerogatives do not justify simply flooding the public with gruesome images and messages about their inevitable susceptibility to the threat. Perhaps most importantly, fear-based messages should always be accompanied by strong efficacy messages. That is, the barriers that the intended population may face in preventing the dreaded health outcome must be carefully weighed and comprehensively addressed in any fear-based messaging campaign. Without reassuring people about their ability to prevent the feared outcome, strong fear appeals have a very high likelihood of backfiring. Public health practitioners must therefore walk the line between creating strong, efficacious messages about real, severe health threats and reassuring intended audiences that they do have the means and resources to prevent these threats. In addition, common counterproductive psychological responses, including denial and reactance, must always be taken into account when designing these types of messaging campaigns. The delicate balance between inventing efficacious fear-based messages and providing the public with hope for escaping these threatening outcomes is a large part of the reason why it is so important to test any fear-based messaging campaign before it is launched. Most importantly, if people are made aware of threatening health effects for which no practical solution seems accessible, fear-based messaging may result in precisely the reverse of the intended effect, including increased risk-taking behavior, denial, and hopelessness. It is the prerogative of public health officials to insure that messaging campaigns are not only effective but also, and perhaps even more importantly, not harmful.

Leave a comment

Filed under Publication