When driving through the town of Omagh the other day I found myself (somewhat unsuccessfully!) trying to quote the great Ulrich Beck from memory.
We had just driven past a health promotion poster showing the midriff of a man wearing boxer shorts. Instead of carrying the words “Calvin Klein” (or some such) the waistband of the pants repeated the single word “cancer”. The message on the poster is that, for men, a waist measurement of over 37 inches increases the risk of getting cancer. We then spotted the female version of the poster – the middle section of a woman with low-slung jeans held up by a “blingy” belt carrying the words “Type 2 Diabetes”.
My companions in the car, both resident in Northern Ireland, but not from there, were shocked. “But these people have got pretty normal bodies!” was the general gist of their comments. And, indeed, a swift drive-by perusal of the men folk visible in the streets and highways of County Tyrone indicated that the waistline on the poster was one that many of the local male population would give their right arm for. And although one wouldn’t normally drive around assessing female bulges, I can report that the same was true of the women observed. Compared to much of what was on show that bright and sunny morning, the cancer risk bloke in the boxers and his pre-diabetic lady friend with the sparkly belt were pretty much “beach-ready”.
The relationship between body mass index and the risk of eventual ill health has been an epidemiological staple for years, of course. And the distribution of fat on a person’s body (are you an apple or a pear?) has been an issue of great fascination for health promoters for a similarly long time. Put these together and you soon arrive at the idea that risk communication could focus on waist measurement as a single, simple figure. One that even the most numbskull population might be able to get their collective heads around and then do something about. The Northern Ireland poster campaign of summer 2013 is just a striking example of a movement that has been afoot for several years.
But from a sociological point of view, the observations of my driving companions are important. If the dangerous condition being highlighted is plainly common and widely seen as normal, there is a possibility that the health promotion message might backfire. Rather than bringing about the fear-induced behaviour change desired (“Blimey… time to lose that muffin top – I don’t want to die!”) it might engender a common-sensical scepticism (“That can’t be true, or else people would be falling like ninepins”). Or, of course, a feeling of sagacious resignation based on the observation that “everything is dangerous and, in the end, you’ve got to die of something”.
Back in 2010, the Daily Mail reported the findings of a scientific review that reported that every extra inch on the waist increases the risk of bowel cancer by 3%. The comments on the Daily Mail blog in the following days were instructive:-
“Maybe, maybe, maybe, why don’t these people shut up until they are sure. Something will get you in the end. If its not one thing they are harping on about it’s something else. These people are being paid inflated wages on false pretences and should be shunned”, opined Jimflyer.
“That means 90% of the population are going to get bowel cancer then? Do these people get paid to do these studies and reviews? Might as well throw ourselves off cliffs now….” chipped in Cookie12.
“The people I have known with common cancers such as bowel and breast have not had the slightest excess weight on them whatsoever. I am in no way convinced of the link”, added the intriguingly named 4047224.
The Beck quote (which unfortunately appears not to have found its way into health promotion theory and practice) is this one:-
The non-acceptance of the scientific definition of risks is not something to be reproached as irrationality in the population; but quite the contrary, it indicates that the cultural premises of acceptability contained in scientific and technical statements on risks are wrong. The technical risk experts are mistaken in the empirical accuracy of their implicit value premises, specifically in their assumptions of what appears acceptable to the population.
Couldn’t have put it better myself, Ulrich! It’s just a shame that no one in the health promotion world was listening back in the ‘80’s. And, to quote the words of Don McLean, “they’re not listening still – perhaps they never will”.