SECOND OPINION:Health awareness campaigns are a waste of money, writes JACKY JONES
AN AWARENESS of health risks must mean that people will change their behaviour and take up healthier habits, right. Wrong. Recent research on alcohol use in the UK has shown no relationship between awareness of health risks and health behaviour. This research was carried out on the effectiveness of a campaign to reduce heavy drinking based on the number of alcohol units that are safe to drink. Remember those numbers?
In Ireland, the HSE also runs campaigns like this and large sums of taxpayers’ money are spent producing leaflets telling us that drinking more than 14 units of alcohol per week if you’re a woman and 21 if you’re a man is bad for your health.
The “new” UK research does not tell us anything we didn’t know already – the use of risk messages in mass media campaigns do not work, they never have worked, and they never will work. In 1979, I attended an international conference in Killarney funded by the Department of Health, called Education against Addiction. Research presented at that conference 32 years ago proved that scare tactics are not effective in changing health behaviour and may have unintended negative consequences for the population. Ten years later, the well-respected King’s Fund agency in London again concluded that scary messages do not work and, indeed, are counterproductive.
In spite of all the research showing this, the wheel is constantly reinvented and agencies such as the HSE continue to use risk messages as the basis of its campaigns in relation to many topics, for example, drugs, the flu, alcohol, sexually transmitted infections, food and so on. The persistent use of fear appeals in health campaigns is an example of “flat-earth society” thinking, where people continue in the belief that a particular approach will work despite all evidence to the contrary.
Scare tactics or fear appeals describe the terrible things that will happen to people if they fail to comply with the message. In Ireland, these are widely used in leaflets, campaigns, the media and schools. Schools still invite ex-alcoholics and ex-drug addicts into the classroom in the vain hope that listening to their stories will discourage the children from trying drugs or developing alcohol problems.
Strangely, teachers would not dream of applying this form of learning to English or maths. It is assumed that English and maths need to be taught several times a week for about 13 years, but healthy behaviour can be learned in an hour. Apart from the fact that risk messages are ineffective, there are very good reasons for not using them with either adults or children because of the unintended consequences.
Warning fatigue is one such outcome where people become immune to the messages and eventually pay no attention at all. Risk factor phobia is where people become so sensitised to scary health messages that they are fearful about the dangers in their daily lives leading to a sense of powerlessness. People give up hope – everything causes cancer, so why bother? Risk messages can lead to new outcasts. The portrayal of people in wheelchairs aimed at stopping young male drivers from speeding stigmatises people with disabilities.
Jaws syndrome is another unintended consequence where the desire for the forbidden substance leads to deliberate defiance, particularly in teenagers. Because scare tactics exaggerate the risks and prevalence of harm, they create imaginary peers and the actual message is: “Everyone is doing it, so why not me?”
There are many alternatives to scare tactics. Positive role models are very effective, as are messages that increase people’s confidence in their ability to make changes in their lives. Campaigns that highlight social norms, or what is normal, are also effective. For example in Ireland, three-quarters of the population don’t smoke, two- thirds of people are not fat, more than 90 per cent of older people are able to mind themselves without needing residential care, and most people drink alcohol safely, yet we seldom see these norms portrayed in the media.
Why do agencies such as the HSE persist in the belief that risk messages work and continue to use them in their campaigns at great cost to the Irish taxpayer? The answer has to be that the people who design these campaigns are not interested in being effective, they are interested only in immediate impact, in a higher profile for themselves, or so they can be seen to be doing something. The HSE does or should know what works – after all it has a large communications section. We knew the earth was round 32 years ago, and it is time the public protested about this waste of resources.
Dr Jacky Jones is a former regional manager of health promotion at the HSE