Has public health education taken a huge step back?

 

There was a time, relatively recently, when social marketing—public relations efforts focused on public health and other critical issues—led the way in terms of a focus on bottom line impact. While many product marketing campaigns were being evaluated using vague metrics (reach, awareness, attitude shift), social marketing initiatives—many of them funded by government dollars—were relentlessly focused on behavior change.

Two decades ago, I wrote an article for a predecessor to this publication, focused on AIDS education efforts around the world. I found plenty to criticize in the US—where government education campaigns were shamefully coy at a time when brutal candor was required—but at least the metrics made sense. The only thing that matter was reducing the rate of infection.

So it’s worth asking whether we have taken a huge step backwards in recent years.

A New York Times article by Peggy Orenstein raises some important questions about the “feel-good war on breast cancer,” suggesting that public education efforts have become obsessed with the idea that “raising awareness” is an end in and of itself. “Before the pink ribbon, awareness as an end in itself was not the default goal for health-related causes,” says Orenstein. “Now you’d be hard-pressed to find a major illness without a logo, a wearable ornament and a roster of consumer-product tie-ins.”

The article quotes Samantha King, associate professor of kinesiology and health at Queen’s University in Ontario and author of Pink Ribbons, Inc.: “These campaigns all have a similar superficiality in terms of the response they require from the public. They’re divorced from any critique of health care policy or the politics of funding biomedical research. They reinforce a single-issue competitive model of fund-raising. And they whitewash illness: we’re made ‘aware’ of a disease yet totally removed from the challenging and often devastating realities of its sufferers.”

Felix Salmon, blogging about Orenstein’s article for Reuters (h/t Andrew Sullivan), expands the critique: “Money which could be put to research into treating metastatic cancer—the kind of cancer which kills you—is instead put overwhelmingly into ‘awareness’ campaigns and mammograms. There’s an epidemic of overtreatment, which carries massive physical, psychological, and economic costs…. More recently, the pink wave has spread to teenage girls, who are being educated, as Orenstein says, ‘to be aware of their breasts as precancerous organs.’”

To a certain extent, this shift was reflected in a number of SABRE awards entries in the social marketing or public education category this year, campaigns focused on raising awareness rather than driving real behavior change. In numerous instances, there was no attempt to link the communications effort—often highly creative, and effective in terms of media coverage and even participation—to behavior change or health outcomes.

It is one thing to accept less meaningful metrics in the consumer marketing realm. If brand managers want to waste their money by using opportunities-to-see or advertising value equivalency to “measure” the success of their PR efforts, that’s their problem. But when campaigns are using public funds—or money donated to charity in the belief that it will solve a public health problem—we have a moral obligation to ensure that something more than vanity is being served.

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2 Responses to Has public health education taken a huge step back?

  1. Paul Oestreicher says:

    This is an important discussion. It might be a mistake, though, to blame the short-comings of diagnostics and therapeutics, and the complexities of clinical research on what are otherwise successful communication campaigns. One can argue that, too many times, public health outreach gets out ahead of the science. But how long do we wait? What opportunities might be lost while debates rage? Tough call. The way forward is with greater resources both in medical research, and public health and science literacy.

  2. Mat Morrison says:

    This is a fascinating post for me for two reasons. For one thing, it’s just lovely to see that the University of Ontario has a School of Kinesiology. However much they may protest that “Kinesiology is not Applied Kinesiology”, it’s still a somewhat alternative therapy. This might call into question Prof. King’s credentials and perspective. But that’s just a bit of a red herring.

    What I’d really like to draw your attention to are these three posts: http://blog.magicbeanlab.com/tag/cancer+meme/

    While they seem trivial (and I had only previously been interested in the topic as a useful example of viral marketing contagion) I think they might also demonstrate how Breast Cancer Awareness Month has made the fateful error of becoming the story.

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