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Leah Berkenwald

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Shame And Blame: Facing The Unintended Consequences Of Health Messaging

Posted: 01/23/2012 11:19 am

A solemn black and white poster shows a picture of an obese girl with copy that reads: "Warning: It's hard to be a little girl if you're not." Another poster displays a woman's naked legs with her panties around her ankles and the word: "She didn't want to do it, but she couldn't say no." The first is part of the Georgia "Strong 4 Life" campaign to prevent childhood obesity; the other is part of the Pennsylvania "Control Tonight" campaign to reduce excessive alcohol consumption. Though the campaigns are unrelated, they have one thing in common: disregard for the effects of shame and blame -- the frequent unintended consequences of health campaigns.

The promotion of health and social welfare is one of those noble causes that attracts people who want to "do good." Physicians are taught to "First, do no harm," but health communication professionals take for granted that their work is "doing good" without considering that it might cause unintentional harm. For example, stigmatizing sexually transmitted infection (STI) prevention messages may make people with STIs too embarrassed to seek treatment or too ashamed to tell their sexual partners. Not only can health promotion messages lead to such negative health outcomes, they can also promote destructive social values, like fat stigma and rape culture.

Last summer, Children's Healthcare of Atlanta launched the "Strong 4 Life" campaign. Recently, critics railed against new billboard ads and television spots featuring obese children, arguing the ads will do more to increase shame and social stigma surrounding obesity than they will to alleviate the health problem. One "Strong 4 Life" poster reads: "Fat prevention starts at home. And in the buffet line." Today, we are all too aware of the serious toll bullying takes on children's self esteem and mental health. Ads like these encourage bullies, endowing them with the language they need to make a cruel dig at an overweight classmate's expense.

The Pennsylvania Liquor Control Commission's "Control Tonight" campaign intended to help young women avoid negative consequences of drinking, such as drunk driving, social embarrassment, and alcohol-related sexual assault. The sexual assault scenario was the only part of the campaign that received national attention. Women's health and rape awareness activists rightly identified the campaign as victim-blaming. Erin Gloria Ryan writing in Jezebel interpreted the ad as suggesting, "If you drink too much alcohol and end up getting raped, you should blame both your own drunk ass and your friends." After an eruption of outrage, as well as complaints from sexual assault survivors who found the imagery upsetting and triggering, the ads were pulled.

These campaigns represent more than just isolated incidents; they are characteristic of a systematic failure to consider the unintended consequences of messages in health communication. The majority of health communication work, especially social marketing, is focused on individual behavior change. Somewhere in-between education and brainwashing, health communication specialists use carefully crafted messages to motivate individuals to take steps to improve their health. But is individual behavior change an appropriate strategy for every health issue?

Framing health as individual responsibility creates a new moral order in which health is a marker of integrity. The reality is that many health issues have structural, social or cultural causes. As a result, behavior-change campaigns that do not address these barriers inherently blame the victim.

In the case of rape and sexual assault prevention, victim-blaming is especially potent. Ads suggesting that women take measures to reduce their risk of assault, like in the "Control Tonight" campaign, inadvertently blame the victim by suggesting that if a woman is raped, it's because she did something wrong. But this isn't just a hit to social values; victim-blaming actually works against the goal of risk-prevention by encouraging women to believe that they will be safe as long as they dress modestly, avoid drugs and alcohol, and don't "act slutty." This is simply not the case.

Too often, health professionals work in mission-based silos. These two campaign examples are the result of a system where interconnected health problems, such as obesity and eating disorders or body image, are conceived as separate -- even competing -- concerns. There is no license to practice health communication and many practitioners have no formal training. But even those who have studied health communication at the graduate level have not necessarily been encouraged to question the values implicit in their employer's mission, or examine the ethical conflicts that arise from the pursuit of a single, isolated objective.

We need to break down the silos and encourage strategic collaboration between mission-based groups. Health communication professionals must be better trained to anticipate the unintended consequences of their campaigns and examine the stigmas and stereotypes they reinforce. At the very least, the public-health community must agree that shame and blame are outcomes worth preventing.