Public health doctors “hopeless” at using mediaBMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7422.1056-a (Published 30 October 2003) Cite this as: BMJ 2003;327:1056
All rapid responses
Promoting public health: two brilliant campaigns, but…
EDITOR,—Please suspend your disbelief. The exchange that I describe
here, which I overheard this week, did actually take place. It leads me to
share this completely anecdotal and totally implausible account, which
even I find hard to believe actually occurred, but it did. As a single
chance overheard conversation it may well be completely unrepresentative,
may quite probably be completely unworthy of attention, and I have no
brilliant solutions to suggest as a result of it; but more than anything I
could invent (and I assure you again that I did not) it illustrates one of
the hidden hazards of trying to communicate important health messages
through the media to the public at large.
In a striking example of humility and good sense, public health
doctors in the UK, led courageously from the front by Professor Sîan
Griffiths, president of the Faculty of Public Health, have acknowledged
and addressed the challenge of improving how they present issues to the
media and thence to the public at large.1
Dame Yve Buckland recently notes,2 quite correctly, the success3 of
the Health Development Agency’s obesity and overweight management
briefing,4 following on from the Chief Medical Officer of the Department
of Health’s inclusion of obesity as a major concern in his 2002 annual
report,5 itself following on from a National Audit Office report on
tackling obesity in England in 2001.6 The overall campaign by public
health and other doctors and health care professionals on this hugely
important issue has attracted a lot of media coverage of a very helpful
and supportive nature, and seems very effectively to have got the message
across, and to have set in place enthusiasm for returning to this issue.
Admittedly, there are no real signs of any effect on people’s habits yet,
but that would be too much to expect. A brilliant and successful start to
a hugely important campaign with massive consequences at stake for the
The Malnutrition Advisory Group has recently returned to the highly
important topic of the prevalence, cost, causes and consequences of
malnutrition in people, particularly those who are elderly or ill, whether
in hospital or at home,7 following on from their important work in 2000.8
The overall campaign led by doctors and dietitians and other health care
professionals on this very important issue has attracted a lot of media
coverage of a very helpful and supportive nature, and seems very
effectively to have got the message across, and to have set in place
enthusiasm for returning to this issue. Again, there are no clear signs of
any effects on people’s habits yet, but that would be too much to expect.
A brilliant and successful start to a highly important campaign with
considerable consequences at stake for the public health.
Even a rather jaundiced cynic such as myself would find it very
difficult to fault the way in which these campaigns have been conducted,
and the way that the media has reported them. In particular, I have seen
no report or hint anywhere in the media (that does not mean that that may
not have occurred, but I haven’t seen it myself or heard from anyone who
has) that might suggest any incongruity between these two messages
appearing so close together.
The success of both campaigns can be illustrated by the fact that
well deserved coverage on the problem of childhood obesity was given early
this week on the main BBC 6 o’clock news; this coverage was quite detailed
and fair; not quite as one might have done it oneself, perhaps, but put
across quite clearly and helpfully by the reporter in a supportive way. A
couple of days later, the same news bulletin gave well deserved coverage
to the problem of malnutrition, particularly in the hospitalised or in the
frail and elderly at home, as a “special report”; again, the coverage was
quite detailed and fair; not quite as one would have done it oneself
perhaps, but put across quite clearly and helpfully by the presenter in a
Two very positive results for two very important health issues. Enter
stout party, meandering around a large store of one of the UK’s major
supermarket chains the day after the second of these television
broadcasts. Among my other peculiar and probably undesirable habits, I do
tend to listen to other people’s conversations as my hearing is quite
acute (perhaps the only thing about me that is) and I probably have some
vague sort of idea of trying to copy the success of Alan Bennett, who has
written some brilliant plays allegedly quite largely based on
conversations that he has overheard over the years; of course, the chance
of me emulating his feat is about as likely as my writing the next great
American novel, or being elected to the soon-to-become vacant Regius Chair
of Physic at Cambridge, but one can always live in hope. I do not carry a
tape recorder when shopping (I’m not obsessive), and I normally forget
them straight away, but this conversation which I overheard was so
striking that I made a note of it almost immediately after hearing it.
With the exception of a couple of words that I have made slightly politer
than they were, for publication in a respectable journal (obviously I
hadn’t thought of writing to the BMJ), and a couple that I couldn’t quite
make out, the scene went thus:
Two (sounded like elderly, confirmed when I rounded an aisle)
gentlemen, presumably acquaintances greeting each other by chance whilst
doing some shopping. I assume also that by the time I got into earshot
they had introduced themselves and were just continuing a minor, friendly
chat. At no time did I hear anything that could have identified them in
First voice: “Did you see that bit on old folks all being starved on the
news last night?”
Second voice: “Yes. I see you’re stocking up then.”
First voice: “Yup, better get the stocks in.”
Second voice: “No need to overdo it!” (Both laugh)
First man (I have rounded the aisle and am now in sight, but scanning the
shelves and studiously trying not to draw attention to myself): “Only the
other day they were going on about us all being too fat…”
Second man: “Yeah, mainly kids but they seemed to say everybody.”
First man: “Bloody health scares. They don’t seem to know what the hell
Second man: “They’d be better off shutting up…silly buggers don’t know
what they’re talking about. Always another scare.”
I have shuffled off into the next aisle where I can eavesdrop more readily
without being noticed by the speakers. Fortunately the store is quiet and
no-one else seems to notice me either.
First voice: “Bloody mad cows.”
Second voice: “And that thing, what was it? You know…from China or
First voice: “Oh, yeah. No-one I knew got it. Hardly anyone did, did
Second voice: “Didn’t stop them making a bloody fuss. Still, I gave up
First voice: “Some years ago, wasn’t it? Me too.”
Second voice: “Don’t miss it now”.
First voice: “Too bloody expensive anyway”.
I suppose at that point I should have interrupted and tried to put
them right, but prudence and cowardice prevailed (they did have a fair bit
of fruit and a few cans that could have been thrown).
I repeat again that the conversation did actually take place, even if
it sounds as if it must have been invented by me (as I admitted earlier,
the chance of my writing a successful play are, alas, highly remote). It
is an accurate rendition, a couple of euphemisms, indistinct words,
silences and grunts apart. I make no claim that this chance overheard
conversation is in any way representative, and know nothing of the people
involved (obviously, I therefore do not have their permission to repeat
this overheard conversation, but as the exchange is so anonymous – in
respect of participants and location - I think that it is not unethical to
set it out; I have no way of identifying who they were, and didn’t really
look at them such that I would be able to identify them, partly
intentionally and partly because I was trying so hard to be inconspicuous
and to eavesdrop surreptitiously; I would refuse to take part in any
attempt to identify them as that I feel would definitely be unethical).
Clearly, the important messages of both of these campaigns had been
effectively conveyed by these campaigns, which seem to have been superb
examples of their type and just the sort of thing that we should be
striving for. As I have made plain, I know nothing whatsoever of the
background of these gentlemen; although I assume from their conversation
that both had heard both recent messages; both had heard messages about
SARS; and, some years ago, both had heard messages about cigarette smoking
and altered their behaviour in response.
There we have it. I very much doubt whether any sensible message
could or should be drawn from one quite probably totally unrepresentative
exchange overheard by chance by one individual (who has no way of
verifying his observation, but would be mind-boggling stupid if he tried
to make it up; indeed, I think that I am being mind-boggling stupid in
relaying it but feel that as it did occur, and graphically illustrates an
unforeseen and effectively unforeseeable outcome arising from two superb
and effective public health campaigns, that I should). Short of some form
of centralised Stalinist control of health messages, which I believe would
be absurd, impractical, and almost certainly counterproductive in the
views of media and public alike, I cannot see a way around this one.
Should we all take up something simpler instead, such as alligator
dentistry, being leader of the Tory party, or being an old-fashioned
socialist in today’s Labour party? Any ideas?
1. Ferriman A. Public health doctors “hopeless” at using media. BMJ
2003: 327: 1056.
2. Buckland Y. HAD response to comments on: “Parents key to reducing
overweight in children, 11 Oct, 2003”.
Bmj.com/coi/eletters/327/7419/8321i#40451, 12 Nov 2003.
3. Kmietowicz Z. Parents key to reducing overweight in children. BMJ 2003;
4. Mulvihill C, Quigley R. The management of obesity and overweight: an
analysis of reviews of diet, physical activity and behavioural approaches.
London: Health Development Agency, 2003.
5. Hastings G. Does food promotion influence children? A systematic review
of the evidence. London: Food Standards Agency, 2003.
6. Department of Health. On the State of the Public Health: the annual
report of the Chief Medical Officer for the year 2002. London: Stationery
7. National Audit Office. Tackling obesity in England. London: Stationery
8. Malnutrition Advisory Group. The prevalence, cost, causes and
consequences of malnutrition: guidelines for its detection and management
in the community. Redditch, Worcs: British Association for Parenteral and
Enteral Nutrition, 2003.
9. Malnutrition Advisory Group. Guidelines for detection and management of
malnutrition in the community. Redditch, Worcs: British Association for
Parenteral and Enteral Nutrition, 2000.
The author has worked for the health service, government, industry and journals, but has no axe to grind in respect of this communication. He re-emphasises that he would have nothing to do with any attempt to identify those described in it.
Competing interests: No competing interests