Stamps for health education
BMJ 2001; 323 doi: https://doi.org/10.1136/bmj.323.7319.966 (Published 27 October 2001) Cite this as: BMJ 2001;323:966Data supplement
- Stamps for health education
The postage stamp: carrying the mail and carrying the message Robert A Greenwald
Postage stamps are miniature art prints that circulate to millions of people. Over time, stamps illustrate the cultural development of the nations that issue them (library.utmb.edu/Blocker/stamps.asp). Governments use stamps to carry messages, celebrating and publicising special events, campaigns, and achievements. And often that message is about health: a quick search on the web yields stamps with clear health education messages from as long ago as the 1920s. For instance, New Zealand issued a pair of stamps in 1929, each bearing a picture of a nurse and the message "Help stamp out tuberculosis"
In this week’s theme issue of the BMJ we have reproduced (on pp 966 and 969) 15 stamps issued to raise awareness of chronic diseases in Austria, Belgium, Congo, Cyprus, Grenada, India, Japan, the Maldives, Mexico, Pakistan, Poland, Uganda, and the US (see details below).
All these stamps were kindly supplied by a medical philatelist in New York, Dr Robert Greenwald, whom we invited to contribute the essay that appears below on the history of postage stamps and medical philately. It is based on a similar essay he wrote for the June 1992 issue of Tobacco Control (1992;1:87-8) which devoted the covers of its first six issues to anti-tobacco postage stamps.
Ron Davis, North American editor, BMJ rdavis1{at}hfhs.org
Trish Groves, assistant editor, BMJ (tgroves{at}bmj.com)
Further reading
Greenwald RA. The philatelic rheumatologist. J Rheumatol 1992;19:1458-61.
Shafrir E. History and perspective of diabetes illustrated by postage stamps. London: FreundPublishing House Ltd, 1999.
Lutschg JH. Smoking research of the 1950s could be celebrated in UK and US stamps. BMJ 2000;321:378.
Woloshin S, Schwartz LM. The U.S. Postal Service and cancer screening – stamps of approval? N Engl J Med 1999;340:884-7.
Scalpel & Tongs: American Journal of Medical Philately (ISSN No 0048-9255). Edited and published by Dr RanP s Chakravorty, Salem, Virginia, USA (rchakrav{at}vt.edu).
The Ugandan (p966) and Mexican and Pakistani stamps (p 969) illustrate sphygmomanometers and a blood pressure chart, espousing the theme of the World Health Organization’s World Health Day in 1978: "Down With High Blood Pressure."
The Indian stamp (p 966) was issued to announce the 10th International Epilepsy Conference held in conjunction with a World Congress of Neurology. The stamp from Belgium (p 966) is also devoted to epilepsy.
Heart disease was the theme of the WHO’s World Health Day in 1972, and several countries issued stamps on that theme, including Poland and Cyprus (p 966).
The Austrian stamp showing retinal blood vessels (p 966) was also issued for a scientific congress, this time on diabetes. The US also issued a diabetes stamp in 2001, following closely on the heels of the breast cancer and prostate cancer awareness stamps of the recent past.
The WHO declared 1977 as World Rheumatism Year, and many countries issued stamps to commemorate the campaign. The Republic of Maldives issued a set of four stamps, including the one shown on p 969.
The Japanese stamp (p 969) shows a total hip prosthesis, acknowledging that even the best treatment for chronic arthritis often fails to prevent the need for implant surgery.
Chronic depression and mental health awareness were themes of stamps issued by Mexico (p 966) and Austria (p 969); the latter was issued in conjunction with a congress on suicide prevention.
The stamp from the US, "Know more about diabetes" (p 969), was issued in March 2001. Illustrated by James Steinberg and designed by Richard Sheaff, the stamp has a microscope to represent research and a test tube to show the importance of early detection and testing for diabetes (www.diabetesmonitor.com/stamp.htm).
The stamp from the Republic of Congo publicises the campaign to "Stop polio!" (p 969). The stamp from Grenada features lung transplantation (p 969), a treatment for chronic lung disease that is probably unavailable to most of the residents of that small country.
The postage stamp: carrying the mail and carrying the message
Robert A Greenwald
One might engage in an endless, albeit silly, debate, as to what invention of the past 200 years has had the most beneficial effect on mankind. Nominees might include the internal combustion engine, the telephone, and the computer. (My own choice would be air conditioning.) But if cost of production and size were taken into consideration, it would be safe to say that the postage stamp must surely rival all other inventions, even the silicon chip.
Postal systems have existed for several thousand years. The ancient kings of Persia had a mail system, and mail systems flourished in the Middle Ages. These were usually the province of the king for use in communicating with the nobility, as well as making exorbitant profit. It was not until 1490 that the middle classes and merchants were allowed to use the postal systems in Western Europe.
Everything changed on 6 May 1840. Prior to that date, it was the recipient, not the sender, who paid the postage for a piece of mail. Secondly, the rate tables were extraordinarily complex, and postal clerks spent a great deal of time calculating the proper amount to charge for a non-routine letter, especially if it contained more than one sheet, was heavier than normal, or needed to traverse political boundaries. Finally, the rates were exorbitant, and many mailers went to great lengths to avoid paying anything at all, sometimes by writing secret codes on the outside of the wrapper which the recipient could look at before rejecting the missive, or by using a system of free franking privileges.
In North America today it takes about two minutes for an employee making $10/hour to earn enough to mail a letter. In 1830 it would have taken the average worker 40 minutes to garner the equivalent amount. Imagine how you would feel if you were notified that there was a letter waiting for you at the post office, and you waited in line for the right to pay perhaps a half-day’s wages, only to find notification that you might be a winner in Ye Olde Publishers’ Sweepstakes!
It was obvious to many Englishmen in the 1830s that the postal system needed urgent reform. An educator named Rowland Hill was asked to chair a postal reform commission. It eventually recommended a uniform penny postage rate for a single weight local letter, the cost to be prepaid by the sender. They suggested that the loss of revenue per letter would be more than offset by increased usage and efficiency, and by the benefits to society that would accrue. They were quite right. Mail volume in England went from 77 million letters in 1840 to 640 million a few decades later.
Hill’s commission suggested three possible means of prepayment: the mailer could pay cash to the postal clerk, the mailer could buy prestamped letter sheets or envelopes, or gummed stamps could be provided. Prestamped envelopes and letter sheets did indeed come into use, but the initial designs (called Mulreadys) were overly elaborate and were ridiculed by the public. So it was the "pregummed stamp" which carried the day.
Thus was born the postage stamp, officially put into use on 6 May 1840. The invention of the postage stamp was a reflection of the times: the extension of a government service to the masses was part of the general spirit of reform that prevailed in that age. The presses rolled out 500,000 stamps per day and still could not meet the demand. The people cheered in the streets to celebrate their access to the post. More than 68 million penny blacks (the first stamp) were eventually used, and they are not rare today. In recognition of the stamp’s birthplace in England, the Universal Postal Union, an organisation formed many years later to regulate mail flow between countries, has allowed Great Britain to be the only country in the world that does not need to print the name of the issuing country on its postage stamps: a cameo of the ruling monarch is sufficient without the words Great Britain. Brazil was the second country in the world (1843) to issue postage stamps. The United States did not do so until 1847.
It probably wasn’t long after the invention of the postage stamp that someone decided that it might be interesting to collect these tiny, colourful bits of paper from all around the world. We know that organised stamp collecting was flourishing by the 1870s. Philately has since grown to be one of the world’s most popular hobbies.
Stamp collecting takes many forms. The traditional collector selects a country or geographic area and tries to get one of everything. However, a very popular branch of philately is called topical, or thematic, collecting, in which it is the subject matter or illustration on the stamp that entices the collector’s interest. Topics that can be collected range from the mundane, such as cats or trains, to the esoteric, such as people who have been beheaded, or pineapples on stamps. Medicine and health is certainly one of the most popular topics. Topical philately has a great advantage over traditional collecting: it is usually much cheaper. Most of the stamps illustrated within this issue of the BMJ cost less than a dollar.
Topics for stamp issues are chosen by postal administrations for many reasons. Those countries of the world that are generally regarded as having conservative stamp issuing policies generally select people and themes relevant to their own country and culture. Heads of state, other prominent personages, important cultural institutions, customs and folkways, objects from the arts and sciences, etc, are all popular subjects.
In both theory and practice, the postage stamp is a tiny billboard that can readily be disseminated to the general public. Stamps are widely distributed and cross borders easily. Stamps are often used to promote political themes—for example, boundary disputes—or to raise funds for charities. In literate countries where most of the populace uses the post, a message can be transmitted on the stamp that will be seen by millions at rather low cost. (The US Postal Service, for example, pays only about $3 per thousand for the stamps it resells at $0.34 each.)
Thus it is not surprising that stamps have often been used to publicise health themes such as alcoholism, smoking, drug abuse, family planning, etc. Prostate and breast cancer were the subject of two recent—and controversial—US stamp issues. The prostate cancer stamp seemed to urge screening by prostate specific antigen (PSA), and some authorities objected on the grounds that the PSA test is unproved as a screening device. The breast cancer stamp was a "semi-postal," meaning a stamp sold at a surcharge, with the base rate going for postage and the balance to support charity. Many nations, but not hitherto the US, had issued semi-postals. Now there is talk of a semi-postal stamp to raise relief funds for the tragedies of 11 September.
For four decades, the World Health Organization has mounted campaigns of coordinated effort among many countries, all of whom agree to issue a stamp on the same theme on World Health Day (generally 7 April). Themes from the past include malaria control (1962), tuberculosis (1964), cancer (1970), heart disease (1972), river blindness (onchocerciasis and trachoma, 1976), World Rheumatism Year (1977), hypertension (1978), and tobacco control (1980). Many such stamps espouse a uniform theme, such as "Your Heart is Your Health" or "Foresight Prevents Blindness." The most successful WHO campaign, of course, was the eradication of smallpox; many countries issued stamps for this accomplishment in 1978.
Creating suitable artwork for a postage stamp is a very difficult process. The image area is very small, the choice of colours is limited, and the technicalities of printing must be taken into consideration. The artist must balance all of this with the desire to make the stamp both attractive and attention getting. David Gentleman, designer of more than 100 British postage stamps, has stated, "In designing a stamp … one has to translate a complicated, hazily defined and verbal subject into visual terms which will finally be concentrated, interesting, and self-explanatory.…" Drama certainly plays a part in stamp design. A famous anti-smoking stamp showed two cigarettes angled at 90 degrees to form a burial cross; another showed a black cloud over the lungs of a skeleton.
One of the ironies is that the people who most need to see these messages are the least likely to get them. In the industrial nations, patrons of the postal system are exposed to these messages, but they also receive them from many other sources. The people most in need of public health advice about chronic diseases are often the hardest to reach. Although the postage stamp is cheap and easily distributed, alas, many of the countries that issue thematic stamps have populations that are 98% illiterate, and some in fact are even uninhabited. Many Third World countries exploit stamp collectors by choosing subjects likely to have broad appeal to collectors. The stamps are often printed in Europe and shipped directly to dealers without even entering the putative country of origin. When a Third World country with one telephone per thousand persons issues stamps commemorating satellites, space stations, and heart transplants, the message is clearly not intended for the home audience. Many of the stamps advising attention to high blood pressure were indeed poor messengers; most Ugandans rarely see, let alone use, a postage stamp. Nevertheless, since stamps must be issued anyway, it certainly behooves the issuing postal administration to try to use the stamp as a public health messenger.
Robert A Greenwald, Division of Rheumatology, Long Island Jewish Medical Center, New Hyde Park, NY 11042, USA (rgreen{at}lij.edu)
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