We usually welcome a hearty debate about public education campaigns using graphic images because they focus needed attention on critical health issues. And the evidence about the effectiveness of such campaigns usually tips the debate in public health's favor. Therefore the recent series of stories in the New York Times questioning NYC's strategy to combat obesity with these sorts of messages has us thinking the point has been lost.
No fewer than six articles have been published by the Times questioning the Health Department's effort to tackle the disease with hard hitting messages even though there is ample evidence that these types of messages work. See the National Cancer Institute's report on the effectiveness of graphic campaigns warning of tobacco's dangers, for example. With obesity and the diseases it causes including diabetes, the fastest growing epidemic in New York and the U.S., why shouldn't these proven approaches to risky behavior be deployed?
Fear appeals work when the information is clear, relevant and blunt. With evidence and proponents of this approach aplenty, amazingly, the Times only found spokespersons who compare graphic anti-tobacco ads to 'Just Say No' anti-narcotics campaigns. They have nothing in common and no evidence is cited for the success of the former or the failure of the latter.
We recently published a 10-country study of graphic anti-tobacco ads that found graphic messages prompted smokers to contemplate and act on quitting, whether they are in India, Russia, Vietnam or Mexico. The Hindu, a reputable Indian national newspaper covered that study just as the Times was ignoring such evidence. Advertising Age, a Madison Avenue trade magazine, also recently dug into this issue and found that cutting spending on such campaigns has coincided with fewer people quitting.
This is not to say that all such campaigns are created equal. Efforts such as Legacy's Truth campaign showed to be effective at informing young people about tobacco industry practices, but many state campaigns have used humor appeals and celebrities to little effect. We also have much more to learn about what motivates behavioral change in the obesity epidemic but the use of graphic campaigns stands a good chance as these anti-tobacco efforts have shown.
New York City's efforts are grounded in rigorous message testing and a logical premise that years of deceitful marketing cannot be undone with feel-good messaging. To stem obesity and the tobacco epidemic, health departments need to build on what's worked whether it is palatable or not. Good medicine is often hard to swallow.