“Shame and Blame: Facing the Unintended Consequences of Health Messaging” on Huffpost

Today my op-ed on shame and blame in health campaigns was published on the Huffington Post. Check it out!

Shame and Blame: Facing the Unintended Consequences of Health Messaging

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.

Read the rest at the Huffington Post.

New beginnings, new directions

Today is Rosh Hashanah which means that all of us Jews are celebrating the beginning of a new year. (5771? But I was just getting used to writing 5770! Har, har.) Today is also the day I begin my MA program in Health Communication at Emerson College (in partnership with Tufts University). And you can bet pretty soon, I’m going to be even more obsessed with health issues than I already am.

A lot of people ask me what health communication is and at this point I am starting to feel like I can give them a relatively accurate answer. Health communication is essentially communications tailored for the health field – more specifically, the study of creating and disseminating messages that will be effective in getting people to change their behavior – to quit smoking, wash their hands, eat more fruits and veggies, etc. I was attracted to this field because I already work and enjoy working in communications, and I wanted to mix that together with my interest in sexual health and healthy sexuality. Basically, I chose this program because I wanted to learn how to effectively communicate a few messages in particular, like “use a condom,” and “no seriously, just use a freaking condom!”

I’m pretty sure this program was a match made in heaven because I just got the syllabus for my first class and my first assignment is to pick an illness and analyze how it is perceived in our culture. I am so excited; that’s like my hobby. I’m pretty sure I’m already halfway through a video about just that. I know I’m a huge nerd, but I can’t wait to sit down and learn some theory and some skills to create effective health messaging and save the world, one sexually active teenager at a time. But, of course, I can already tell that it’s not going to be that simple.

Today a couple posts on Feministe caught my eye. The first is from former-Feministe blogger Zuzu, and is about fat and health, and succinctly states near the beginning: “Feminists typically agree that body policing is a bad bit of business, correct?” She then goes on to argue that being overweight does not necessarily mean someone is unhealthy, and that “There’s no Duty of Health”:

“Health” seems to be a codeword these days. It’s something to throw around when you get busted as a fat-hater: “I’m just concerned about your health!”

Well, let’s talk about health. First off, why is any individual obligated to be healthy in order to be accorded all the rights and dignity accorded to all human beings? What is this, “Starship Troopers,” with health substituted for military service? If you argue that fat people don’t “deserve” certain rights because in your judgment they aren’t “healthy,” then how do you feel about disabled people and their rights? If your argument is that the disabled can’t help it and fat is a choice, do you make the same argument for religious discrimination? Because religion is a choice, too.

The second is about slut-shaming, and hits on another feminist bulwark – “My body, my business.” And this ties closely into the pro-Choice “My body, my choice” philosophy too. The author illustrates this nicely:

Clearly, there is some conflict between the feminist approach to bodies and healthcare and the health communications goal of getting individuals to make healthier choices. It assumes that there is an objectively “healthier” choice, and also places the burden on the individual to be responsible for his or her own health. Zuzu wrote:

I’ve written about this before, and it ties into the whole good fattie/bad fattie defensiveness thing, but whenever we start focusing on the health of the individual, we erase the systemic problems that contribute to health issues. This is a perfect example of the personal being political.

Institutions love to shift the burden onto the individual, because it means the institution doesn’t have to examine its own behavior or its own contribution to a problem. Let’s look at bullying. States and schools love to have zero-tolerance policies so they can look like they’re being tough on bullying — but then when bullying incidents happen, they just don’t define it as bullying, and suggest that the victim change his or her behavior. Problem solved!

It’s really tricky.

The personal responsibility issue relates pretty directly to what we were discussing here earlier about safer sex, where I argued that the most effective way to prevent STD transmission was to emphasize personal responsibility in sex education and health messaging. But we do have to be careful not to ignore the social structures and institutions that make it difficult to make healthy choices, and perhaps the ethical route is to work towards changing those institutions and systems as well as changing individual behavior.

It’s also problematic to assume that we all agree on what “healthy choices” are. I am a believer in western medicine, but even doctors and scientists don’t always agree on what’s healthy. (Coffee? Having a glass of wine while pregnant? Hormone therapy?) So who am I to tell other people how to live their lives?

On the flip side, health is one of those things that as a society, we feel is important. And so there is some context for health messaging and health education being generally accepted as a positive thing. But there are ethical potholes to be wary of, and I’m definitely going to have them on my mind as I enter this program.

As we enter into this New Year, I plan to keep blogging on sexual health issues. I am excited to see how my new program will influence and inform my thoughts. I am also terrified to see how I will manage full time school and a full time job and my own health in the midst of the stress and chaos – and still find time to blog. It’s going to be a hell of a ride folks, I hope you come along with me.