Archive for the ‘Health Communication’ Category

In our attempts to encourage people to lead healthier lives, we often make the mistake of bombarding them with facts and stats, do’s and don’ts, assuming the problem is a lack of knowledge. But let’s be honest – most people know that French fries are not the healthiest food in the world, fruits and vegetables are good for you, and that you really ought to exercise regularly.

So, what’s the problem? One aspect of the problem is of course the systems level issues of food access, cost, time and space to be active, etc. that we have mentioned before.

Another aspect though is one of attitude and culture.

Feel Rich, which launched in December, is attempting to address just this (sidenote: the organization’s CEO and others involved were on a SXSW Panel just this past weekend).

Feel Rich’s goal is the creation of a health and fitness culture born from the urban and hip-hop community’s love and respect for music, movement, and entertainment. Their message: health is the new wealth.

As opposed to your typical public health campaign centered on facts, stats, and do’s and don’ts, Feel Rich is attempting to first foster a desire for health (in other words, crafting an attitude and creating a culture that sees health as critical and desirable as wealth), engaging urban youth in a meaningful way that speaks to their interests. In Feel Rich’s own words – “It’s health on your terms, fitness in your style, and food choices that make sense on the streets where you live.” It’s also about making health and wellness cool.

I think it’s an exciting and inspiring approach, and the way the Feel Rich movement taps into attitudes (not just information), reminds me of the baby carrots campaign I’ve written about before. After all, whether we’re talking about the junk food industry, big tobacco, or pretty much any other product we see commercials for, appealing to emotion and attitudes is the way advertising is done. It’s long past due that prevention and health promotion advocates started utilizing this powerful strategy.

Feel Rich ties this powerful appeal to attitude and culture with empowering information on food, fitness, and health, and an array of videos and stories to engage and inspire their audience.  And with over 3 million YouTube views, it looks like they are doing just that.

I’ll close with some food for thought on this topic from David Katz’s most recent Huffington Post article:

“What if health were more like wealth?

  • If health were like wealth, we would value it while gaining it — not just after we’d lost it.
  • If health were like wealth, we would make getting to it a priority.
  • If health were like wealth, we would invest in it to secure a better future.
  • If health were like wealth, we would work hard to make sure we could pass it on to our children.
  • If health were like wealth, we would accept that it may take extra time and effort today, but that’s worth it because of the return on that investment tomorrow.
  • If health were like wealth, society would respect those who are experts at it.
  • If health were like wealth, young people would aspire to it.

This post is cross-posted at http://occupyhealthcare.net 


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The CDC calls tobacco use “the single most preventable  cause of disease, disability, and death in the United States” with an estimated 443,000 smoking related premature deaths and 8.6 million living with serious illnesses caused by smoking. In addition, according to the CDC, tobacco use is responsible for more than $96 billion a year in medical costs and another $97 billion a year from lost productivity. So there’s no question that tobacco plays a major role when it comes to our country’s (and the world’s) health, health care, and medical costs.

One of the most infuriating aspects of the tobacco saga is the role of the tobacco industry and its unlawful and deceptive practices, for which companies have been repeatedly called out and in the U.S. government’s landmark lawsuit,successfully sued. As U.S. District Judge Gladys Kessler stated in the final opinion of this lawsuit: “Despite [the] knowledge [of the harmful effects of tobacco], [the Defendants] have consistently, repeatedly, and with enormous skill and sophistication, denied these facts to the public, to the Government, and to the public health community… In short, Defendants have marketed and sold their lethal products with zeal, with deception, with a single-minded focus on their financial success, and without regard for the human tragedy or social costs that success exacted.”

The stories of deception continue to this day, with a new analysis from UCSF, published just a couple weeks ago in PLoS Medicine, showing that tobacco scientists altered their study protocols to obscure the increased toxicity of additives in cigarettes.

Despite the seemingly never ceasing stories of deception and defrauding the public, U.S. tobacco companies had the audacity to sue the federal government this past summer over proposed graphic cigarette warning labels, saying the warnings violate their free speech rights and will cost millions of dollars to print (the latter point elicits a very bitter laugh, given we’re talking about an industry that rakes in billions and billions in profit).

The case was decided in favor of the tobacco companies in district court, but is currently being appealed (and I was happy to see that 24 attorney generals filed a friend of the court brief a couple weeks ago, saying the First Amendment doesn’t prevent the government from requiring “lethal and addictive products carry warning labels that effectively inform consumers of the risks those products entail”).

But what I’d like to turn to is public reaction to the graphic labels fight. Certainly, there are those that support the use of graphic labels on cigarette packages as a way to discourage tobacco use (there is in fact quite a bit of scientific evidence supporting this). But there are also those clamoring about the “nanny state”.

Public health professionals are pretty used to such “nanny” claims, and I think Yale University’s Dr. David Katz captured it perfectly in his Huffington Post article, “Public Health and the Illusion of Your Autonomy”, a few days ago:

“You may think you are defending your autonomy by opposing a ban on toys in Happy Meals. But while you are resisting the tyranny of public health, you are playing right into the hands of a large and rich corporatio­n that is far more concerned with its profits than the health of your child.”

EXACTLY. Why are some people so much more willing to be dictated by for profit corporatio­ns (whether in the fast food industry, tobacco industry, or otherwise)  than the recommenda­tions of public health and medical professionals?

They are infuriated by the idea of government placing graphic warning labels on cigarette packets, but seemingly unfazed by the continued deceptive practices of tobacco companies  (including supposed public service announcements about the harmful effects of cigarettes, which have been shown to be ineffective and sometimes even cause youth to start smoking or have more favorable beliefs about tobacco companies – which is exactly what they have worked to achieve).

They are infuriated by the idea of curtailing the freedom of McDonald’s to put toys to Happy Meals, never mind that it was most likely a decision made after “highly-paid marketing executives told them how to manipulate you by manipulating your children,” as David Katz puts it.

What can we do on this front? My advice today is not so much specific action steps, but more about thinking critically. First, let’s look into the “illusion of our autonomy” in a variety of different arenas – who really controls our behaviors and choices, and what are their motives? Then let’s ask, what can we do – on the ground in our communities and in the policy sphere – to limit the sometimes manipulating and deceptive influence of those with their bottom line in mind instead of what’s best for our health and well being? If you have any thoughts about these questions or related topics, please sound off in the comments!

(This post is cross-posted at http://occupyhealthcare.net)

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I have written about the behavior shaping role of the entertainment and news media before, but of course, marketing plays a huge role too. And the behavior shaping role of marketing has been in the spotlight this past month, specifically in the context of marketing of junk food to children. Between the continual delays and watering down of what are alreadycompletely voluntary recommended nutrition standards for marketing foods to kids (composed by the Federal Trade Commission’s Interagency Working Group on Food Marketed to Children) and the release of a study revealing that popular cereal brands “pack more sugar than snack cakes and cookies”, it seems like a good time to take a closer look at the world of fast food and junk food marketing to kids.

As the Prevention Institute points out:

*The food and beverage industry spends approximately $2 billion per year marketing to children.

*The fast food industry spends more than $5 million every day marketing unhealthy foods to children. 

*Kids watch an average of over ten food-related ads every day (nearly 4,000/year).

*Nearly all (98 percent) of food advertisements viewed by children are for products that are high in fat, sugar or sodiumMost (79 percent) are low in fiber.

In a study comparing the nutritional content of food items observed during advertisements (during 84 hours of primetime and 12 hours of Saturday-morning TV broadcast during the fall of 2004) to the recommended daily values, researchers found that a diet consisting of observed food items would provide 2,560% of the recommended daily servings for sugars, 2,080% of the recommended daily servings for fat, 40% of the recommended daily servings for vegetables, 32% of the recommended daily servings for dairy, and 27% of the recommended daily servings for fruits.

This disproportional marketing of foods high in fat and sugar might be concerning in and of itself – but the real problem is that it’s working. Beyond the evident fact that childhood obesity is an enormous problem in the United States, numerousresearchers and government agencies have found specifically that marketing and advertising of foods does in fact impact children’s food preferences, as well as purchase requests directed to parents and short- and long-term dietary consumption.

Moreover, in recent years, researchers at the Yale University Rudd Center for Food Policy and Obesity have concluded that “the traditional models used to explain advertising effects have overemphasized the importance of children’s understanding of persuasive intent”, echoing an Institute of Medicine Report which points out that although the most common models used to explain the effects of food marketing assume a conscious and rational path from exposure to behavior via persuasion, more recent psychological models suggest repeated exposure to food advertising can lead directly to beliefs and behaviors without active, deliberate processing of the information presented.

In this context, branding and cues such as cartoon spokescharacters, colorful packaging, and pictures have been identified as important in this link between food advertising and beliefs and behaviors. Studies have shown that children 3-5 years prefer the taste of baby carrots, milk, and other products out of a McDonald’s bag and that kids 4-6 years prefer the taste of graham crackers and gummy fruit snacks with Dora, Shrek or Scooby Doo on packaging.

If that’s not worrisome enough, the Prevention Institute has more statistics for us:

*Nearly 40% of children’s diets come from added sugars and unhealthy fats.

*Each day, African-American children see twice as many caloriesadvertised in fast-food commercials as White children.

*Even five years after children have been exposed to promotions of unhealthy foods, researchers found that they purchased fewer fruits, vegetables and whole grains, but increased their consumption of fast foods, fried foods and sugar-sweetened beverages.

*By 2030, healthcare costs attributable to poor diet and inactivity could range from $860 billion to $956 billion, which would account for 15.8 to 17.6 percent of total healthcare costs, or one in every six dollars spent on healthcare.

So what can we do? I think the solution lies in not only in trying to limit the marketing of unhealthy foods to children but also in tapping into their strategies (which clearly work) to promote healthy options to kids. As the Institute of Medicine points out, the field has “underutilized the potential to devote creativity and resources in promoting food, beverages, and meals that support healthful diets for children”. One of the few examples I’ve come across: the recent baby carrots campaign, which “takes a page out of junk foods’ playbook and applies it to baby carrots” with Doritos-like packaging, seasonal tie-ins like “scarrots” during Halloween, and TV spots that portray baby carrots as extreme and futuristic.

We have a responsibility to be creative and tap into strategies that work when it comes to marketing healthy foods – not just preach and list facts (since we all know how appealing kids find that technique).

We also have a responsibility to step up and speak up against the massive junk food and fast food industries in their aggressive marketing to children – the Prevention Institute has a great video and easy action items on this front.

Check it out and add your voice to the discussion!

(This post is cross-posted at http://occupyhealthcare.net)

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In addition to entertainment media (covered in Part I), the news media can have immense impact on the public’s perceptions and behaviors as well as policymakers’ perceptions and the policy agenda – for better or for worse. News media’s critical role in my (current) area of focus within public health, violence prevention, is something I’ve been thinking about a lot lately.

A quick quiz (take a guess before you read on): How many homicides are there in the U.S. each year? Suicides?

In the most recent year for which data is available from the CDC (2007), there were 18,361 homicides and 34,598 suicides in the United States. Twice as many people died by suicide as died by homicide. Yet, almost everyone responds that there are more homicides than suicides. Why? At least partially because the news media report on homicides far more than suicides, contributing to the perception that homicides are much more common. I’m not 100% sure what impact this misperception has, but it’s worth considering.

Moving on to things where the impact is clear – I listened in on a Prevent Connect webinar last week in which Larry Cohen of the Prevention Institute and Lori Dorfman of the Berkeley Media Studies Group spoke about violence against women and the role media plays. They highlighted a number of problematic issues when it comes to news coverage of violent incidents:

–          perpetuation of key norms that contribute to gender based violence (power/control, limited role of women, limited definition of masculinity, violence, and silence/privacy when it comes to talking about the issue);

–        language that humanizes the perpetrator (details that help audience relate to the perpetrator as a person)     and dehumanizes the victim;

–          a focus on criminal justice as opposed to prevention;

–          and a focus on individuals as opposed to institutions and policies.

Cohen and Dorfman talked about the need to reframe news media coverage, moving from a personal responsibility frame to one of institutional accountability. When a news story is framed around personal responsibility, people blame the victim. In order to advance prevention, it is critical that we focus more on the environment in which we live, including policies and institutions and how they can contribute to promoting health. (As a side note, another interesting case study in news media framing is obesity – when framed around personal responsibility, it is easy to blame those who are overweight and keep moving; when framed around the environment in which we live, then we get into prevention discussions – better access to healthy foods, more opportunities to exercise, etc.)

There were a lot of practical suggestions arising from the webinar, including working with survivors of violent incidents to speak to the media in a way that advances prevention – so that they not only explain what happened, but also express their anger that the incident could have been prevented and focus on parts of their story that they can link to what could happen next to prevent future incidents. We in public health definitely need to do more to work with advocates and media personnel to encourage safe and responsible reporting.

News media reporting can also contribute to more violence on the suicide front. Over 60 research articles have examined the issue of media reporting of suicide and found that certain types of coverage can lead to imitative behavior – examples of dangerous coverage, as well as coverage that can actually aid prevention efforts, can be seen in the diagram below.


The diagram is taken from recommendations on reporting on suicide published jointly by a number of suicide prevention organization based on the aforementioned research on the subject.

On a related note, in the last year or so, bullying has captured the attention of the nation, and stories linking bullying and suicide abound. Most of the news media coverage linking specific suicides to bullying in a direct, causal way are inaccurate, and even more concerning, this kind of coverage is dangerous: vulnerable people (particularly those already contemplating suicide) who see such coverage relate to the victim’s experiences being bullied and may be more likely to attempt suicide as a result.

Indeed, as covered during yesterday’s Suicide Prevention Resource Center webinar, there are a number of prevailing suicide narratives in the media, and they can play a dangerous role in suicide contagion. One such narrative is that of bullying leading directly and inevitably to suicide. One example they talked about in the webinar: headlines proclaiming Phoebe Prince “bullied to death”. The big picture: Prince had moved to a new country, her parents had divorced, she was struggling with poor grades, recently broke up with her boyfriend, had a history of depression and had previously attempted suicide.

This is not to say that bullying does not have terrible impacts – it often does. But in simplifying the story, and making it sound like Phoebe Prince’s death by suicide was a direct result of bullying she experienced at school, and nothing else, the news media risks leading other vulnerable youth who are experiencing bullying to see suicide as an answer. Alternatively, media could touch on the complexities of these issues and focus on resources for prevention (for bullying and suicide), sources of support (particularly mental health services), counter-narratives of hope and recovery, etc., all of which could help prevent suicides instead of risking perpetuating them.

Public health professionals have a responsibility to work with media to ensure recommendations regarding safe and responsible reporting are followed and to ensure prevention efforts are getting attention. And media personnel have a responsibility to seek out and follow such recommendations, realizing that the stakes are as high as they get – their reporting can be the difference between life and death.

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As anyone who knows me knows by now, Gilmore Girls is my all time favorite TV show, warranting almost daily viewings through much of college and grad school. Sometime during the course of my public health studies, it began to strike me how terribly unnecessary the Gilmore Girls’ penchant for junk food (greatest understatement ever – pop tarts and pizza made up entire food groups, fruits and vegetables were strange colorful things they didn’t know what to do with, and cooking never went beyond heating up stuff in the microwave) is to the show and its storyline.

And don’t even get me started on the fact that despite the consistent eating of junk food, the consistent avoidance of healthy food, and a disdain for exercise, these ladies are “model-skinny” as another blogger pointed out, remarking that “Gigantic Girls” would’ve been a more realistic show title.

The topic of Gilmore Girls and junk food received some coverage at Gilmore News.com a few months ago and elicited further discussion at The Gilmore Girls Companion, as I discovered when googling Gilmore Girls and junk food to find a picture to accompany this post.

I still love Gilmore Girls, but how easy would it be to keep everything about this show the same and just have them eat healthy – not freaky hippie they’re-so-strange healthy, but everyday healthy with more cooking and more snacking on things like smoothies and carrots. This, by the way, is the other problem with portrayal of healthy eating in TV shows and movies – when people do eat healthy, they’re often portrayed as extremists who eat very strange things or subsist on salads alone. There is a happy medium, there are not-weird healthy foods you can cook quickly, and portraying this happy medium as a daily part of life would help normalize healthy eating.

We welcome the characters of TV shows to enter our homes every week – we become friends with them, entering their lives for a blissful 30-60 minutes…what they do does have an impact on what we, consciously or subconsciously, consider “normal”. In other words, TV shows play an important role in setting norms and shaping behavior.

The public health community realizes this, as evidenced by various efforts (such as the Harvard Center for Health Communication’s work with Hollywood producers for the Designated Driver campaign, which I wrote about in an earlier post) and – I was so excited when I first heard about this – even a dedicated program at the University of Southern California Annenberg Norman Lear Center called Hollywood, Health & Society.

The program is dedicated to improving the quality and quantity of health storylines in TV, film and digital media. They provide television writers with free, on-demand access to top medical experts to inform and shape storylines as they are being created. Writers also receive a range of information and story ideas via newsletters, tip sheets and briefings from health experts. The program has conducted over 1500 consultations with scriptwriters working on over 150 television shows, including Grey’s Anatomy, Sesame Street, House, Mad Men, Law & Order: SVU, Private Practice, CSI: New York & Miami, One Life to Live, Breaking Bad, several Spanish-language telenovelas and many more programs.


More on this topic in Part II! (Now that I’m done with finals/graduation/and a whirlwind couple of months of traveling, I’m looking forward to updating more regularly. Thanks for reading!).

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