Autumn books: The Fight for Public Health: Principles and Practice of Media AdvocacyBMJ 1994; 309 doi: https://doi.org/10.1136/bmj.309.6962.1168 (Published 29 October 1994) Cite this as: BMJ 1994;309:1168
- G D Smith
Simon Chapman, Deborah Lupton BMJ Publishing Group, pounds sterling 19.95, pp 270 ISBN 0-7279-0849-9
How do you translate the findings of epidemiological studies into policies that actually improve population health? Chapman and Lupton's ambitious efforts to “examine both the why and how of the ways that particular public health issues become prominent and politically actionable in an issue-rich political and news environment” should greatly help. Their strategy is “media advocacy” - the use of mass media to influence public, health policy. Through many case studies, mostly concerning smoking, the prevention of accidents, and gun control in Australia, they show how creative use of the media can play an important part in public health campaigns.
There are, of course, powerful forces opposing the potentially positive effects of media coverage of health issues. Not least of these is the economic clout of the manufacturers of health damaging products. Threats by tobacco companies to pull advertising from magazines will influence the decision to publish articles about the damaging consequences of smoking.
Rich corporations can simply buy plenty of media space for their efforts to confuse what are essentially straightforward facts, such as that smoking shortens average life expectancy by several years and (more obviously still) guns are used to kill people. Even more cheaply, a rather sad list of “experts” can be found who will cloud these issues on television or in print. The fact that the central social dynamic of capital is that it is required to make more capital, whatever the consequences, aids the process.
The intrinsic processes of producing news can also act against the goals of public health. It is newsworthy when a few children have apparently been harmed by vaccinations, while the prevention of epidemic childhood diseases, in part by immunisation programmes, receives no coverage at all. Uncommon diseases, of low public health importance, receive an inordinate amount of media attention, while the toll from common conditions is, by definition, simply not news. High technology medical breakthroughs, applicable to relatively few people, will produce a better story than the workaday activities of disease prevention.
The ways in which it is possible to win against vested interests within the constraints of how the media operate are illustrated extensively in the book's main section, “The A-Z of public health advocacy.” BUGA UP (Billboard Utilising Graffitists Against Unhealthy Promotions) simply changed the messages of posters paid for by the tobacco companies. Thus “Have a Winfield” was changed to “Have a Wank - it's healthier,” the Benson and Hedges slogan “Gold is the perfect mixer” to “Cancer is the perfect fixer,” and “Marlboro” to “It's a bore.” Strategic research can also be used, as was recently shown in Britain by the killing of the “Reg” campaign for Regal cigarettes through a study showing how this appealed particularly to children, against the voluntary code governing tobacco advertising.
As well as these high profile activities, more routine methods of optimising media coverage are given. Good interview technique, the use of press releases, the incorporation of props to grab attention, and the involvement of celebrities are discussed.
The only disappointing aspects of the book relate to issues that may be considered outside its intended scope but that should at least be acknowledged. Firstly, there is no discussion of evaluating whether campaigns are successful in the final aim of improving public health. Indeed, John Snow's removal of the handle from the Broad Street pump and hence his stemming of London's cholera epidemic is yet again given as an example of successful public health practice. The epidemic was, however, disappearing, and Snow's action probably had little if any influence even though it would have provided a wonderful photo opportunity. The same may be the case today, and some campaigns could be successful at getting television coverage but have no influence on health outcomes. Secondly, little attention is paid to the views of the public. A detailed analysis of the often complex ways in which health and disease are popularly conceptualised should be at least as important an aspect of public health advocacy as knowing the fax numbers of a pack of journalists.
The limited impact of conventional health education is shown by the high regard in which it is held by the tobacco companies. A Rothman's spokesperson wrote of “fully supporting sensible and effective public education,” and others wrote that “the industry wholeheartedly supported any sensible campaign to discourage school children from smoking.” Teaching of health promotion often emphasises that simple educational activities have little effect, without offering any real alternatives. The Fight for Public Health shows that feasible alternatives exist and can even be fun.