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The uncomfortable truth is vital to public health

The Australian Heart Foundation’s shock campaign advertisement about poor heart health has been criticised for being insensitive, which means it well and truly achieved the objective of sparking a conversation.

But did it cross the line of what is acceptable, even in today’s environment of using ‘disruption’ as a game changer?

The fact that the Heart Foundation conceded to the outrage by reworking the ad then withdrawing it completely, after initially defending the campaign, suggests that it went too far.

As a similar health organisation, FARE also seeks to raise serious issues in the public domain and the policy arena by telling the truth – through evidence-based advocacy – no matter how uncomfortable that truth may be.

In the case of the Heartless Words campaign, it could be argued that that the personally-confronting context of being responsible for residual harm to others was too narrow and simplistic in its creative licence to not be regarded by many as deeply offensive.

How and why negative and positive framing of messages/images resonate with audiences is often controversial and subjective, making it a challenge to hit the mark when raising awareness or trying to change behaviour in the public interest.

Negative election campaigning is also renowned for causing ructions and volatile debate about fairness and ethics. It’s a controversial and complex subject.

The recent federal election and the Heart Foundation campaign have many people hot under the collar, but experts such as tobacco campaigner Simon Chapman caution against blacklisting negative campaigning altogether.

The Emeritus Professor at Sydney University has published more than 520 articles in peer reviewed journals and 21 books about public health campaigning. Professor Chapman’s article, Is it unethical to use fear in public health campaigns? resonated with me as I read the various arguments over the controversial heart advertisement.

The efficacy and ethics of fear campaigns are enduring, almost perennial debates in public health which re-emerge with whack-a-mole frequency. Supported by evidence-based reasoning about motivating behaviour change and deterrence, these campaigns intentionally present disturbing images and narratives designed to arouse fear, regret and disgust.

Health problems can be profoundly negative experiences unappreciated by those not living with them. Pain, immobility, disfigurement, depression, isolation and financial problems are common sequalae of disease and injury. It is beyond argument that these are outcomes which are self-evidently anticipated and experienced as adverse, undesirable and so best avoided. Efforts to prevent them are therefore, prima facie, ethically beneficent and virtuous.

Chapman’s article assesses and responds to five key criticisms of fear-based messaging: that they are ineffective; campaigns target victims; people feel criticised, devalued, rejected and stigmatised; changing health-related behaviour is difficult and there are constraints; and it’s wrong to upset people. It finishes with the simple, yet powerful argument that public health is not a popularity contest.

Without fear or favour, FARE stands by its defence of the public interest and will continue to tell it as it is – every uncomfortable truth about Australians’ alcohol consumption, the risks of disease and dying, and the vulnerability of children through neglect and violence.

A strong reason why we do this is because ultimately the use of fear-based messaging by anti-smoking campaigners worked and was transformative. Just look at rates of smoking in Australia today.

FARE will continue to tell the uncomfortable truth to cut through the noise of the alcohol industry’s phony corporate responsibility, which aims to distract from the need for stronger regulation to reduce harm.

We are the only independent, national voice ensuring that the personal, social and economic toll from alcohol is not hidden. We continue to work proactively to ensure that government and the alcohol industry, who both bear responsibility for the burden of harm on consumers, are held accountable.

In all our communications on alcohol research and policy we honour the principles of being in the public interest and being evidence-based, and we will continue to use negatively framed messaging that is mindful of the line between giving offence and awakening people to the plight of alcohol harm.

Michael Thorn

Michael was was Chief Executive of the Foundation for Alcohol Research and Education (FARE) from January 2011 until November 2019

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