The Wellcome Institute’s travelling cinematic exhibition of public health films, Health, lies and video tape provides a highly entertaining journey through the archives of public health video but lays down a challenge to today’s health educators.
It’s easy to laugh at the early attempts at health education on smoking, diet and sexual health. When plucked from the cultural context of the late 20th century and placed under our tech savvy gaze, we wonder if anyone, anywhere, changed their health behaviour as a result.
Two of the topics, smoking and diet, are of particular interest. Statistics suggest falling smoking rates are a public health success story. In 1974, when The Smoking Machine, http://wellcomelibrary.org/player/b16769703#?asi=0&ai=0 was doing the rounds in schools, 45% of all adults smoked. By 2013 only 19% of men and woman described themselves as smokers.
The ‘F’ Word
Conversely, in the last 30 years the number of people, described as “fat” by health educators in Cruel Kindness, http://wellcomelibrary.org/player/b16676166#?asi=0&ai=0 has quadrupled. Today 1 in 4 British adults is obese (don’t mention the F-word). The UN has warned 50% of UK adults will be obese by the middle of the century.
Can the differences in fortune of these two public health issues, one a triumph and one a health catastrophe, be explained by the success and failure of health information?
The answer, of course, is no. The UK, portrayed in the feature length health melodramas of the 50s and 60s, is as unrecognisable as our modern attention spans.
Today’s health education campaigns fit into a 140-character tweet or an advert, seconds in length. Sport England’s video, This Girl Can, http://www.thisgirlcan.co.uk/ is 90 seconds of modern day promo perfection – it had millions of views and prompted a surge in sports participation.
The technological revolution in the media used to deliver health messages has been mirrored in other areas of life and changed the human habitat. The way we purchase, prepare and eat food has been transformed. Food marketing and processing have seen our portion sizes and waistlines expand. But while it may be socially acceptable to breakfast, lunch and even dine at your desk you certainly won’t be smoking.
Smoking, unchanged by technology, has remained the rather grubby, mechanical habit portrayed by The Smoking Machine all those year ago. Emerging trends suggests that e-cigarettes will eventually make the humble fag redundant as new smokers (that’s children to you and me) opt for the cleaner technical alternative and go straight to vape.
Smokers have been squeezed out of the workplace, transport, and restaurants, even pubs. High taxation and prohibition have worked in partnership with health education to produce the dramatic falls in smoking rates we have seen over the last 30 years.
People are tricky. A professor of medicine at the screening remarked that information isn’t enough. She used herself as an example. She knows alcohol is bad for you, she knows she drinks above recommended safe levels, but she has no intention of changing her drinking behaviour because she enjoys it.
The same was true of my smoking behaviour. I stopped when my children started. I didn’t want to encourage it, though, in truth, the horse had already bolted.
We make risk/ benefit decisions about our health and the health of our families on a daily basis and it’s our absolute right to do so – whether that involves adhering to our medication, choosing to eat unhealthily or smoking 20 a day.
The decision to change behaviour generally comes with a shift in circumstance -when your personal risk/benefit pendulum swings. But we can only make these decisions if we have the information and knowledge at our fingertips in a way we can access and understand.
Health inequality kills
This is the real challenge to everyone involved in health promotion today and why different local and culturally specific campaigns are needed to close the widening gulf of health inequality.
Social inequality kills 200,000 people in the UK every year, according to Sir Michael Marmot, President Elect of the World Medical Association.
Scratch the surface of the smoking success story and a different picture emerges. Smoking rates for manual/routine workers are 31% compared to 12% for higher managerial professions (who are also far more likely to smoke fewer than 10 cigarettes a day).
Income, social deprivation and ethnicity also have an important impact on obesity. Women and children in lower socioeconomic groups are more likely to be obese than those who are wealthier. Obesity is a major driver in in the epidemic of Type 2 Diabetes.
CCGs are ideally placed to respond to the health education needs of their local communities, to involve the people most at risk in the co-creation of the materials to tackle their health problems.
The powerful influence of clusters is also becoming apparent. Get one person to make a change in social group and you change the norm – others will soon follow. These clusters can be real or virtual – sharing experience within communities of patients is a great way to motivate others.
This local targeting has proved successful in the past. Fifteen years ago we worked with primary care trusts helping them to challenge local health priorities head on – Hillingdon targeted diabetes while Tower Hamlets focused on adult under-nutrition. It’s encouraging to see the CCGs are again able to take a local view working in partnership with others but harnessing the power of social marketing. The Fresh campaign for a smoke free North East is just one example.
It’s time for new solutions to old problems. New powerful public/private partnerships that harness the power of social marketing in all its forms are needed but these will miss the mark unless there is a move towards co-creating solutions with the very people whom campaigns most need to help.
Published on: September 14, 2015