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On industry, audiences and health messages

Public health campaigners are increasingly focussing on models of media engagement due to the considerable and growing amount of evidence that media campaigns can change population health behaviours. New forms of media (that is not just the ‘traditional’ press and television) can be used to reach large audiences quickly and relatively cheaply with and with repeated exposure to desirable public health messages.  For example, a study of media and drug safety in New Zealand found that media reporting did not increase “scare mongering” but in fact played a significant role in encouraging patients to report adverse drug reactions.   This led the authors to recommend that drug safety agencies should be engaging with rather than avoiding (social) media to follow up on post-marketing concerns.

However, it is not always easy to predict success and researchers struggle to measure impact as opposed to the “reach” of a specific message. The history of anti-drugs education is littered with particularly extreme examples of misguided health advertising campaigns which failed to connect with their target audiences – where all too often the iconic images became ironic “pin ups” ‘mis’-appropriated by those they were trying to reach.

Some lessons have been learned. Mass media campaigns tend to work better where the focus is on lifestyle health promotion. Public health issues stemming from social and material conditions can cause problems. For example, campaigns to encourage members of the public to compel their healthcare provider to wash their hands (prompted by SARS or H1N1 for example) do not to work because they fail to address differences in power and roles between patients and professionals. Audiences are not “blank slates” ready to be the recipients of health advice. As one study found, even where media reporting correctly frames the issue of social isolation as a public health issue with significant health repercussions, audiences engaging with the story online can simply reframe the issue as one of “neglectful” and “inadequate” families. The relationship between the viewer and the message they take from the campaign is not always straightforward.

We live in a media-saturated world, bombarded with messages from stakeholders involved in politically-contested public health debates. Our consumption of health advertising and how we access health-related messages has changed hugely with these new forms of media, with niche personalised advertising raising important questions. Popular social media such as Facebook offers tremendous possibilities for analysing how audiences or users engage with public health messages but simultaneously also raises issues of trust and credibility. For example, normal industry codes of practise can be avoided on social media.  Thus younger audiences might be unaware of the user focused nature of alcohol marketing. For instance, a study of alcohol brands on Facebook in India and Australia found that the strategies employed built on cultural meanings that users brought to their interactions. In practice, these included a mix of country-specific (e.g. India: inspirational talks and livelihood skills vs. Australia: posts related to the brand’s tradition or heritage) and generic approaches (e.g. alcohol sponsorship of sport, music, and fashion, offering consumption suggestions, organizing competitions, giveaways, and use of memes). The ways in which different health issues are represented in the media is central to this discussion. Media representations play a crucial role in informing public and policy opinions about the causes (and solutions to) ill health. If we consider non-communicable diseases (NCDs) to be one of the main global public health challenges of the 21st century then there is little doubt that these are driven in part by unhealthy commodity industries. Media strategies employed by the alcohol, tobacco, ultra-processed foods and beverage industries arguably increase NCD risk.  So here media coverage influences public health policy debates, but how do these relationships work in practice? This raises questions about ways in which it might be possible to regulate big business in relation to the health messages they propagate through new media.

Make no mistake, industries engage with the media to influence the political climate and promote positive public perceptions.  They do this to advance their commercial goals. Their strategies thus include making “their” industry goals appear to be “our” universal goals which are “naturally” in everyone’s interests. For example, promoting the idea that people should be free to choose what they eat, even if evidence suggests these choices are unhealthy.  Campaigns around this ‘principle of choice’ can then be used to dismiss concerns regarding the global marketing practices of Big Food.

For example, a recent study examining media reporting of the Public Health Responsibility Deal (RD) in England had some interesting findings.  This work examined a public–private partnership between government, industry and other stakeholders aiming to improve public health in the areas of food, alcohol, health at work and physical activity. The findings showed how media reporting provided industry spokespersons with a high-profile platform in which messages about the consumption of food, beverages and alcohol were used to advance industry positions and agendas. This framing also legitimised industry spokespersons to advocate a position on how public health policy should evolve. Studies like this illustrate the influence and reach of industry, working inside the public health sphere to confer credibility on their viewpoints and protect their agendas.  Another example is the pharmaceutical industry which actively constructs very specific types of lifestyle behaviour in direct-to-consumer television advertising (DTCA) aimed at overweight and obese people by emphasising the necessity of drug regimens to manage healthy weight loss. In so doing this helps to establish the “universal” idea that “being thin” is the desirable norm and drugs are necessary to maintain this desirable state.

Media have an important role to play in public health behaviour and policy. Public health researchers with an interest in media need to be aware of the complex relationships which shape public discourse, be alert to questions of power and prepared to ask some key questions such as ‘who is setting the agenda?’ and ‘in whose interests does it serve?’

This article is based on an invited editorial by Lesley Henderson and Shona Hilton ‘The media and public health: where next for critical analysis?