So is this ‘the most horrifying ad’ ever made? The new advert by St John ambulance is entitled Helpless. In just two minutes we witness various scenes from the life of a man diagnosed with cancer. The advert is shot beautifully in muted colours and the accompanying music lends further pathos to difficult and sensitive moments (as he shares the terrible news with his wife, says goodbye to his daughter, loses his hair, undergoes chemotherapy). But perhaps contrary to expectations we then see the same man move through treatment, regain his strength and resume his life (conveyed by a shot of him in the pub laughing with a mate). However the story of redemption takes a shocking twist when in the final scenes he begins to choke on a burger at a celebratory barbecue. His friends and family watch helplessly as this man who has overcome what many of us most fear – cancer – gasps for breath and fades out of consciousness. We then see the strapline appear “First aid could help prevent up to 140,000 deaths every year. The same number of people that die from cancer.” Viewers are encouraged to ‘be the difference’ and to text a helpline for advice and a free pocket guide on learning first aid including: choking; heart attack; severe bleeding; helping an unconscious person who is breathing; and one who is not breathing. So why do so many charities rely on shock tactics or negative imagery to promote their brand? Are these ads actually conveying accurate health information?

This particular campaign was developed after research conducted by St John Ambulance showed that people overestimated how many people die of cancer than lack of first aid (according to the charity by four times). Sue Killen, St John Ambulance Chief Executive, is quoted as saying

In situations where first aid could help save a life we don’t have to feel helpless, because learning life saving skills is so simple. That’s why it’s so concerning that fewer than 1 in 5 of us knows even basic first aid. This has got to change if we are to stop up to 140,000 lives from being needlessly lost each year.

There are several interesting points about this advert. Firstly there is little doubt that it is effective in grabbing your attention and it would not be surprising if it garnered some awards for the creators BBH London. The strong narrative structure works to draw the viewer in very quickly to this distressing scenario and uses skilful editing. This was also used effectively in the memorable 2010 advertisement for John Lewis which captured the life of one woman from birth to old age (though not death) and was accompanied by a reworking of Billy Joel’s ‘Always a Woman’ (rereleased on iTunes to take advantage of enormous public interest). This advertisement was noted for provoking an intensely emotional response in audiences (presumably with resultant increase in sales for the store).

However with ‘Helpless’ we are not watching an advert designed to sell a commercial product. This is a charity attempting to modify public behaviour and increase awareness. As we know from other health advertising audiences are fickle and these are difficult goals to achieve. As noted earlier it has already been dubbed “horrifying’ and notably “hard hitting”. But if we look more closely at the statistics used to drive home the message then what appears to be a simple story becomes arguably more complex. Indeed the statistics used by the charity have been challenged and the organisation has been asked to fully clarify their claim that as many as 140,000 lives could be saved by using first aid. Let’s not forget that all advertisements must adhere to the Advertising Standards Code which requires statistical evidence to be ‘objectively substantiated’.

It is too early to say whether or not this advert will actually make any impact on the numbers of people actively seeking training in first aid.  Additionally we still don’t know that a large increase in those trained would lead to a significant decrease in deaths. These are questions that require long term quantitative research, however in the meantime St John Ambulance are featuring in online forums and media outlets and generating a buzz of publicity that most charities with limited funds will envy. Clearly this interest has been helped by initially screening the advert during the first episode of the new series of Downton Abbey (ITV) and thus gaining around 9 million viewers (and the attention of many media journalists).

There is a broader concern here though. As various charities and organisations in the health and social care field must jostle for positioning (and funding), campaigns such as these – controversial ones – do generate considerable public reaction (for example the campaign for British Heart Foundation that depicted a young woman drinking cooking oil). The Advertising Standards Agency recently published a report on public perceptions of advertising and found that charity advertisements were the cause of considerable concern though there was an understanding that shock messages can help mobilise action for deserving causes. Other campaigners have turned their back on negative shock campaigns believing these to demean those they are trying to represent and to contribute ultimately to ‘compassion fatigue’. It seems that we are living in an era where the voluntary sector is expected to take up the slack created by government cuts and this intense pressure may help to explain why so many health and social care organisations pursue campaigns involving temporary shock value. It may appear surprising that charitable organisations ‘turn most readily to shock advertising’ but in the current climate this is unlikely to change.