H1N1 and the “crisis in the clinics”: Apathy, risk, and the problem of communication

Yesterday I spent the better part of an hour with Joanne Laucius, a reporter at the Ottawa Citizen. Ms. Laucius phoned to interview me about the public health authorities’ messaging surrounding the H1N1 issue, particularly as it relates to vaccination and the “crisis in the clinics”. The conversation began with her providing a 3-5 minute description about how she wanted to frame her piece. It went something like this:

Public officials are telling us too all get vaccinated one day, then just priority groups the next, followed by letters home to parents advising that everyone be vaccinated, followed by announcements that the vaccine supplies are dwindling, followed by more announcements that there will be plenty available for all … by Christmas. Amidst all this confused messaging it’s no wonder people are panicking and flooding the vaccine clinics. What mistakes were made and how could we learn from them in the future?

The headline of the story that appears in today’s paper is: “Deaths trigger lineups, scrambling, fear: Before vaccine became available, apathy ruled roost.” You can link to it here.

My response, fragments of which are recounted in her story, was as follows:

1. I wanted to comment on the Ipsos Reid poll, released on October 22nd and widely reported on October 23rd, which suggested that public health officials were failing to get the message out about the importance of vaccination. While I understand the impulse to survey citizens about their intentions during a health emergency, it is dangerous for health officials to develop their messaging and operational plans on the basis of such data alone. Public behaviour is subject to dramatic shifts in a crisis situation because the situation on the ground is constantly evolving. When we are dealing with life-and-death circumstances, communication based on polling data can be especially problematic. This doesn’t mean polling data are not useful, only that they are very limiting in their utility. It also doesn’t mean that this is what health officials actually did (although it appears to be the case). But when media report on these numbers in order to place blame at the feet of health officials, we need to put the meaning of those data into context.

2. If we do place our faith in the polling data and conclude that a majority of Canadians were not intending to get vaccinated, this would confirm what risk communication scholars already know: the biggest threat in a time of public health crisis is not widespread panic but apathy. Very rarely do people panic in crisis situations. They may over-prepare but they do not lose self-control and behave unpredictably. I referred to the example of the anthrax attacks in the U.S. in 2001, when people began to stockpile antibiotics to protect themselves from infection: this may have been unnecessary but it was hardly a sign of panic. This surprised the reporter so I was pleased to see this message about apathy in her story.

What are the implications from a practitioner’s perspective? I argued that the major task facing health communicators who confront an apathetic public is to amplify risk messaging – sometimes this means it is necessary to arouse fear about the consequences of inaction. Fear arousal is a delicate task and one that is often done poorly. Following the reports about the polling numbers, I observed far more direct and assertive messaging from health officials last week, particularly the head of the Public Health Agency of Canada, Dr. David Butler-Jones, and Health Minister Leona Aglukkaq. I did not witness fear-mongering on their part. It’s my assessment that the messaging was consistent with the recommendations of risk communication experts. In other words, the public health authorities were doing a reasonably good job in amplifying the risks of indifference.

3. The problem (getting back to the “shifting ground in a crisis” argument) is that the deaths of the two Ontario adolescents last weekend over-amplified those risk messages, creating operational challenges for public health officials in delivering the vaccine (long lineups, people not on priority lists showing up, people asking too many questions instead of just rolling up their sleeve, etc.). This was the point I was making about the “side effects of successful risk communication” (an argument that draws from the theory of reflexivity). At no point have I seen public health officials use these deaths as a rhetorical weapon to whip the public into a state of constant fear. That the risk amplification efforts of health officials coincided with these deaths may have had the unanticipated consequence of making official announcements appear to be more dire than I believe was intended.

4. The report also attributes to me an argument about the distinction between emotional and rational behaviour.

“When you’re dealing with health, people react more to emotion triggers than rational ones. Only when you can see and feel the problem are you motivated,” [Greenberg] said. “It’s not possible to motivate people through biostatistics.”

I did not argue that people either behave emotionally or they behave rationally. What I did say is that during health crises people respond more to emotion-based messages than technical or scientific ones. People responded strongly to the news about the deaths of the 13 and 10 year old children because they could symbolically insert themselves into that situation. Those children could have been our own; they could have been a niece or nephew, the child of a friend or neighbour.

Although the probability of death among non-high risk individuals remains low, the emotional connections we have to children overcomes any impulse we might otherwise have about acting on the basis of statistical calculations about harm. Does this mean people behaved irrationally by flooding the clinics? No, it doesn’t. It might mean they acted on the basis of mistaken beliefs or that their emotional response was inappropriate. Irrational behaviour occurs when our actions consistently lead to a deterioration in our resources or prevent us from learning and improving how we respond to situations. There is no evidence of irrational action here, just as there is no evidence of panic. References to an irrational and panicky public tell us more about what officials and the media believe about human behaviour than it does about how humans actually behave.

5. We also discussed how the public health authorities in Canada have been using (ineffectively) social media, the role that news organizations like the Ottawa Citizen have played in shaping the discourse of “health crisis” throughout this protracted ‘event’, and what lessons regarding communication appear to be emerging from other jurisdictions that, when the time is right, we will all want to assess. Of course, all of this was too much for a single news piece, but my hope is that there will be more coverage about the communications around this issue to come.

Global Climate Change, the Problem with “Public Opinion” and Epistemic Dependence

I recently submitted a think piece to the online news magazine The Mark. My article deals with how the term “public opinion” has been used by reporters, political officials and environmentalists to influence the debate about global climate change.

The basic point I make is that public opinion is a social construction, yet it often comes to assume an active role in public and policy debates. Indeed, we rarely contemplate the context behind how public opinion is measured and to what ends it is used. The problem is that all of the protagonists in the debate about global climate change claim to have public opinion in their corner and the interests of the public at heart. Too many citizens rely on the current state of public opinion before making up their own minds about issues and problems. Too many politicians insist on crafting policy to reflect “public opinion.” A few months ago, there was a supposedly high level of support for climate change mitigation strategies on the part of U.S. citizens. NGOs and other supporters of an international climate change treaty were ecstatic. Yesterday, new polling data by the Pew Research Center suggests a massive drop in public support (almost 20 percent over 2 years). Corporate disinformation is, apparently, to blame. Stanford University’s Jon Krosnick argue that survey data show public support remains relatively stable. What’s a citizen to do in the face of such competing claims? My argument is that the polls should be ignored.

I should probably state here that I do NOT believe that public opinion polls are useless. There is nothing inherently wrong with public opinion research. I have relied on it myself and I see the value it can bring to research. And hey, some of my closest colleagues and friends are pollsters! I also think polling data can serve an important function for organizational planning and can be the start of a process for engaging citizens in a meaningful dialogue about issues. The problem is that this rarely happens. Organizations interested in what citizens have to say rarely seek more insight or input than the responses they provide to survey questions. Jurgen Habermas cleverly called this “non-public opinion”. It is my belief that citizens require active forms of engagement in public issues if they are to formulate a coherent and meaningful position or opinion about them. What we need is not new public opinion research, but new forms of public expression and conviction.

I’ve received some very interesting feedback on my column: most like what I’ve written, some think I’m full of it, and a couple have accused me of being ‘dangerous’ because my position apparently validates the arguments of climate change deniers that environmentalists are fudging their data.

So let me be clear about my own position on the issue of climate change, if this is even important to anyone but me.

I believe our climate is changing and that human activity is a major reason for this. I put my faith in the assessments of climate scientists with no direct or obvious economic or political stakes than I do those individuals with advanced degrees who are paid handsomely not to conduct research but to question publicly the wisdom of those who do. As James Hoggan puts it in his recent book Climate Cover-Up: The Crusade to Deny Global Warming, the latter are essentially performing a PR function, not a research one. Having said this, I do not at the same time believe that science or the scientists are infallible.  I am always skeptical and will always remain critical, but I refuse to throw my hands in the air and take a relativist position on this issue.  To cite the sociologist Howard Becker, we all eventually have to confront the question: “whose side are we on”?

If I were to be philosophical about my beliefs, I would probably conclude that I’ve arrived to a position of “epistemic dependence” (to borrow from John Hardwig). This is to say that I believe that our climate is changing and that human activity is a key driver of this change, even though I have no direct evidence for the truth of these beliefs myself. I also believe that smoking cigarettes causes lung cancer, that excessive eating will make me overweight, and that drug addicts need health support and not tough love if they stand a chance at recovery, let alone the opportunity of living their lives with some dignity. I am not a medical researcher, an epidemiologist or a social worker, but I believe these things anyway.

I want to conclude by quoting Hardwig at length because his ideas resonate with my own thinking on this particular problem:

The list of things I believe, though I have no evidence for the truth of them, is, if not infinite, virtually endless…Though I can readily imagine what I would have to do to obtain the evidence that would support any one of my beliefs, I cannot imagine being able to do this for all of my beliefs. I believe too much; there is too much relevant evidence (much of it available only after extensive, specialized training); intellect is too small and life too short.

(“Epistemic Dependence,” in E. Selinger and R.P. Crease (eds.) The Philosophy of Expertise. Columbia University Press, 2006)

Global Warming, Public Health and the Discourse of Responsibility

In 2008 Health Canada commissioned the polling company Environics Research Group to survey Canadians about their attitudes and understanding of global warming and its likely impact on public health. Titled Assessing Perceived Health Risks of Climate Change: Canadian Public Opinion – 2008, the report is available in the electronic collection of Library and Archives Canada.

Most striking about the report is its illustration of why language is so crucial in discussions about climate change and public health. How issues are framed — the lexical choices we make, the metaphors and symbols we draw upon, the media through which claims are advanced — can determine whether and to what extent popular or political support may follow.

For the past few decades, public health practitioners in Canada and the United States have been guided by a belief that social justice is the underlying value in public health and that public health should be a collective concern, not an individual one alone [1]. The language used in this report will likely send a chill through both the environmental and public health communities. It’s unclear whether the Government of Canada or the firm commissioned to complete the study believes that “the responsibility for adapting to the health impacts of climate change…is the responsibility of individuals”. Although a focus on individual responsibility and a reduced role for the state in managing the environment and public health is consistent with the political ideology of the current party in power it strikes me as a dangerous position for a government department to take that is charged with protecting and promoting the health of the nation.

Framing battles in both the environmental and public health arenas illustrate the tension between individual and collective duties and responsibilities. How we will adapt to a rapidly changing global society may very well be a matter of individual concern, as the Environics report for Health Canada suggests. Yet, I would argue that the greater burden of responsibility for addressing the health implications of global climate change must fall to the institutions that regulate the polity and economy — it is the state and corporate sectors, not individuals, who have the capacity and duty to set standards and monitor carbon emissions, water quality, food standards and other systems that impact directly on both individual and community health. In other words, public health advocates (within and outside government) need to look at doing more than developing effective messaging to seek modifications in individual behaviours. “How [individuals] might be willing to change their behaviours in response to the health risks” associated with global climate change is only part of the calculation. Social conditions and the physical environment are equally, if not more important determinants of health — promoting healthy activity must involve the promotion of healthy attitudes, healthy behaviours and healthy public policy.

Notes:

1. The American public health scholar Dan Beauchamp is best associated with this line of argumentation. See for example: D. Beauchamp, 1976. Public health as social justice. Inquiry, 13, 3-14; D. Beauchamp, 1988. The Health of the Republic: Epidemics, Medicine and Moralism as Challenges to Democracy. Philadelphia: Temple University Press.

Back to the blog

After several months away it’s time to get back to blogging – it’s not that I’ve been lazy or disengaged, just distracted by other things. Here’s a summary of what I’ve been up to since (gulp) my last post in February.

In late May, I was the conference program co-chair of the Association for Nonprofit and Social Economy Research (ANSER), which met during the 2009 Congress of the Social Sciences and Humanities. The build-up to the meeting was particularly intense with more than 200 conference participants from academia and the voluntary sector — we had Canadians, Americans and conference participants from as far away as Australia. The keynote address was delivered by Michael Edwards, formerly of the Ford Foundation and now with progressive think tank Demos in New York City. I also hosted an event to celebrate the publication of my latest book, Surveillance: Power, Problems and Politics (UBC Press, 2009), which I co-edited with my long-time friend and collaborator Sean Hier from the sociology department at University of Victoria.

I spent most of my summer enjoying holidays with family in beautiful British Columbia and at our cottage in Algonquin Park. Vancouver was especially nice in late July where the temperature stayed consistently in the low 30s and the sun was always shining (quite in contrast to the misery of Ottawa, where it rained the entire time we were away).

I did get some writing finished this summer, including the final touches on a special issue of the Canadian Journal of Communication on public relations, co-edited with Graham Knight from the communication studies and multimedia department at McMaster University. This project was a long time coming, starting way back in 2008. See the  TOC here and check out the editorial and research paper I contributed. I am very pleased with how this issue turned out – lots of excellent contributions by scholars and media professionals from Canada and abroad on such timely issues as risk communication, journalist/PR relations, political campaigning, PR education, professionalism and nation branding, among many others. Post your comments below or send me a note if you have a chance to read any of the articles or reviews.

Toward the end of August I did a little bit of consulting, working with some local public health and housing advocates to help them deal with a particularly thorny NIMBY problem. My involvement in this case piqued my interest in further exploring the literature on communication ethics, deliberative democracy and theories of “public consultation”. It was clear from this experience that communities, politicians and social service providers all operate with different understandings of what consultation really entails and how it can be achieved. All cities (large, medium, even small) face important challenges in dealing with poverty, homelessness, addictions, mental illness and other structural social problems. These are not, as C. Wright Mills describes them, problems of the individual milieu – they are structural issues that require both structural and community solutions. Yet too often the stakeholders in these debates speak around or, more to the point, shout over one another – it becomes a battle geared toward winning rather than achieving mutual understanding. Communication researchers can play an important role in identifying the means and ways in which power relations operate in and through the language community stakeholders use to frame understanding of these issues, and in facilitating a process by which they can, at minimum, agree on the terms of their engagement if not on the outcomes.

It’s already October and I can’t believe the fall term is a month old. I was appointed to be the supervisor of undergraduate studies in our program and for the final weeks of August and the first few weeks of September I was very busy dealing daily with student registration issues, attending recruiting events to entice the country’s best and brightest to come to Carleton, and in getting my own course (MCOM 5204: Media, Culture and Policy) up and running. It’s a graduate level seminar that introduces students to key issues in the study of communication and public health policy (our substantive focus): theories of public policy; media advocacy; impacts of ‘new’ media on the medical and health professions and on health promotion; audience segmentation; risk and crisis communication; framing; and program evaluation. So far it’s going very well – I have a group of 8 really engaged MA and PhD students and we are “collaborating” again this year with the city of Ottawa’s public health department on some of their current and emergent issues.

I have also been actively promoting From Homeless to Home, a film I co-produced about homelessness in Ottawa, first to a meeting of academics, then a coalition of housing and other service providers, and later to the Homelessness Partnering Secretariat, a division within the federal government. I understand the film will be screened by Cinema Politica in Montreal sometime in November. When I know the details, I’ll post them here.

In December I’ll be attending the UN Climate Change Conference to examine how environmental activists and NGOs are using traditional and ‘new’ media to campaign for a new international deal to confront the problem of global warming. This is part of a larger project which you can read about on the blog’s Projects Page. I’ve never been to the Scandinavian countries so intend to take a little time for tourism and site-seeing while I’m there. Anyone with “must do” recommendations for my time there, please leave me a reply below! I’m also getting ready to head off to Atlanta at the end of October where I’ll be participating in a crisis and emergency-risk communication training session at the Centers for Disease Control and Prevention. I was just awarded a small amount of funding to look at how public health agencies in Canada and the U.S. engage the nonprofit sector in emergency planning and response, particularly their means and methods of ‘consultation’. The trip to CDC will be informing some of that research (again, see the Projects Page for more details).

On a personal note, I love this time of year. The colours have turned very quickly and the green of summer has given way to beautiful hues of gold and red. We were recently at the cottage where my family convenes every Thanksgiving and had a stunning drive through Algonquin Park. The smell and sound of falling foliage always puts me at peace. I’m gearing up for a last outing of cycling this coming weekend in Prince Edward County with some good friends. It’s our last grasp of a season we know has already passed us by. I realize that winter is not far off. The episodic flecks of snow encountered this past weekend appear to have followed me home, even if they made only a brief appearance this afternoon. Writing now in my home office, with the dogs at my feet and a steaming cup of coffee, I don’t seem to mind.

The media conversation about surveillance: the slowly shifting sands of time

In a recent study, a colleague and I examined the media conversation around public area video surveillance in Canada, analyzing more than 500 articles from 10 Canadian cities, spanning a period of 6 years (1999-2005). We were concerned to know how video surveillance is framed (i.e. what is discussed, what is ignored) and what the coverage might mean for how citizens understand the increasing presence of surveillance technologies and practices in their lives. 

The study will be published later this year or in 2010, but here is a summary of the key findings:

1. The coverage focuses almost exclusively on situational events, failing to engage wider contextual issues relating to the pervasiveness of surveillance. 

2. The media agenda is driven largely by the claims of police and government sources — academics, privacy advocates and community groups (on all sides of the debate), in comparison, exercise very little influence over the definitional parameters of the coverage. 

3. Coverage conflates the monitoring of open, public spaces like city streets with more bounded spaces like shopping malls and banks. This raises important theoretical and political questions about how we understand and use “public” and “private” space.  

4. Despite extensive research which questions the ability of video surveillance cameras to prevent crime, the dominant theme in CCTV news stories is the “deterrence capacity” of surveillance systems. 

5. In the very limited extent to which the problems associated with surveillance are discussed, issues of personal privacy are by far the dominant concern — questions of ethics and efficacy, not to mention costs/benefits, are virtually absent. 

 

 

Like policy making and public opinion, news reporting of social issues like surveillance can fluctuate over time, subject to changes in knowledge and in the communication activities of institutional sources. This became apparent in relation to the issue of surveillance recently when the Ottawa Citizen published Our Surveillance Society, a five-part investigation of the expansion of CCTV surveillance systems across Canada; the growing problem of identity theft; the surveillant properties of social networking sites like Facebook; the use of RFID (radio frequency identification devices) by retailers and the implications for personal privacy; and the rise of sousveillance (the inverse of surveillance in which those who are typically the subjects of monitoring initiatives turn the gaze back onto those in control with the use of visualizing technologies (think activist recordings of police brutality at demonstrations, later broadcast online or via news networks)).

Although the series contains some minor factual inaccuracies and (in the case of CCTV surveillance) a rather thin discussion about what is actually happening in Canada, it offers a very important contribution to the media and public conversations about surveillance.  The series explores many of the problematic issues relating to increased surveillance in daily life, from what it signifies about the changing nature of trust, to the regulatory and legislative challenges associated with balancing individual liberties and collective security, to the dialectic between care and control that is inherent in modern surveillance systems. As our research demonstrated, these issues are rarely raised, let alone explored in detail.

An open and honest discussion about CCTV and other forms of surveillance in Canada is long overdue. The optimist in me is hopeful that the Citizen’s series will spark the kind of interest and energy that are required to mobilize stakeholders into beginning such a conversation. The realist recognizes that the barn doors have been wide open for a very long time…

The Janus Face of the Financial Crisis

There is a temptation when crises hit to turn inward: marshal the troops, focus on the immediate needs of your organization or sector and weather the storm. This applies whether the crisis is localized (e.g. accusations of malfeasance) or more global in context — major natural disasters, massive outbreaks of food borne-illness or disease, and dramatic economic downturns are good examples. With the global financial meltdown we are firmly in the throes of such a crisis.

Despite the gloomy predictions crises are not intrinsically negative forces in society. In fact, the research on crisis provides evidence that crises can sometimes lead to positive outcomes. In a recent book about crisis communication, Robert Ulmer, Timothy Sellnow and Matthew Seeger (all recognized leaders in public relations and organizational communication) argue that crises are opportunities for learning and development. While a crisis is a “dangerous moment” it can also be a moment of decisive intervention, providing opportunities for organizations to be stronger than they were when the crisis hit.

Chinese symbols for crisis: Danger + Opportunity

In this context, a recent NCVO survey of UK-based charities found that although the vast majority of leaders in the charity sector expect the economic situation to worsen over the next year, slightly more than one-third of them “are staying positive and have identified new opportunities and areas for growth … choosing to see the current economic decline as an opportunity, either to focus their organisation on their mission or to play a vital role in supporting their local areas.”

Rather than focusing on the constraints before them, leaders in the charity sector plan to increase their activism and service provision. While there is no question that we are all experiencing heightened levels of risk and uncertainty, the contingent nature of the present situation can also create opportunities for those who are in a position to seize them.

It is not surprising therefore that many voluntary sector public relations officers (PRO’s) are advising their executives to increase their public and media visibility throughout 2009. As reported in Brand Republic, it is expected that spending by voluntary organizations on advertising and marketing will decline; yet the need to communicate strategically by delivering high levels of on-message, targeted editorial content will only become more important.

This is especially sage advice at a time when funders and donors are expecting greater levels of adherence to norms of accountability and transparency. According to Sarah Miller at the Charity Commission, the economic situation will lead to greater scrutiny of the voluntary sector: “It is vital that charities are absolutely clear in their communications about what they do, how they do it and how they use their money. That’s the basis for increasing public trust and confidence in the sector at a time when funders and individuals may reassess their giving.”

The Yes Men Strike Again!

There is a tendency among scholars interested in media and social activism to focus on how social movements make instrumental use of mass media to enhance organization profile, to change public policy, to foster a sense of collective identity, or a combination of some or all of these things. Yet, before today’s media savvy activists were holding news conferences, the most accessible and fundamental mode of radical expression was public speech, and oftentimes ironic and satirical speech.  

Few activists are as effective in blending the spirit and practice of satire and radical rhetoric as the Yes Men, a group of pranksters who have successfully impersonated and thus “corrected” the identities of the rich and powerful. Posing as ExxonMobil and National Petroleum Council (NPC) representatives, Yes Men activists delivered an outrageous keynote speech to 300 oil barons at GO-EXPO, Canada’s largest oil conference, held at Stampede Park in Calgary, in June 2007. In November 2004, taking on the persona of a Dow Chemical executive, Yes Men pranksters conducted a live video interview with BBC News announcing that at long last the company was admitting its negligence in the 1984 Bhopal disaster that immediately claimed the lives of 3,000 people and contributed to the deaths of at least 15,000 more.

After a year of quiet, the Yes Men have struck again, and this time at the heart of the American media machine. New Yorkers awoke this morning to news that the wars in Afghanistan and Iraq war had ended, that the U.S. government had established national public health care and education, abolished corporate lobbying and placed a cap on CEO salaries. The Yes Men arranged to have 1.6 million fake copies of The New York Times printed and delivered to several key locations across the Big Apple, where volunteers recruited through the prankster’s website were on hand to distribute the news.

The Yes Men’s pranks are a prime example of culture jamming, a form of radical speech which involves efforts to disrupt existing transmissions of information. Using a combination of hoax and banditry, the Yes Men endeavour to trip up, jam or block what they see as the overwhelming power structures that govern and control what we think and how we feel. In contrast to other media activists who wish to deny and denounce with a view of negating the cultural influence of mainstream media, pranksters like the Yes Men prefer to play with and subvert the hegemonic power of conventional thought. As Christine Harold puts it in her excellent paper on culture jamming, pranking is more about the “artful proliferation of messages, a rhetorical process of intervention and invention, which challenges the ability of corporate discourses to make meaning in predictable ways.”

While culture jamming is often celebrated as a postmodern phenomenon rooted in the Situationist Movement of the late 1960s, there is something quite medieval about the Yes Men’s use of irreverent laughter. In his notoriously grotesque novel Gargantua and Pantagruel, published in the 16th century, Francois Rabelais reproduced and valorized the speech of the village marketplace, a language quite remote from the purities of the literary intelligentsia, clergy and courts of the time. With mockery and humour, Rabelais celebrated those moments when the solemnities of religion and authority were ritually inverted by the common folk. Writing about Rabelais and his world, Mikhail Bakhtin said of laughter that it “clarified man’s consciousness and gave him a new outlook on life. This truth was ephemeral; it was followed by the fears and oppressions of everyday life, but from these brief moments another unofficial truth emerged, truth about the world.” 

 

Healthy Cities and Governable Subjects

Ever wonder what it would be like to live in a city where everyone was healthy, wealthy and wise? A city where there were no Big Macs, where everyone rode their bicycles to work and people just seemed to be in better spirits? If you are looking for such a utopia, Manchester England may be your Xanadu.

The newswires were abuzz yesterday with reports that Britain’s National Health Service has cooperated with local authorities in Manchester to provide incentives to citizens to eat more fruit, spend more time at the gym, engage in more preventative health measures and just lead a more productive and healthy lifestyle. Manchester is hoping to fight the fat with a reward system that will operate, for all intents and purposes, like a retail loyalty card program. But rather than earning credit for opening their wallets only, citizens will earn points for spending their hard earned dollars on fresh fruits and veggies and their leisure time doing pilates. 

According to a report in the Associated Press, Manchester residents will be able to “swipe their rewards cards and earn points every time they buy fruits and vegetables, use a community swimming pool, attend a medical screening or work out with a personal trainer. Points can be redeemed for athletic equipment, donations to school athletic departments and personal training sessions with local athletes.” 

It’s a public health craze that appears to be gaining traction in the UK. Tower Hamlets, the third most deprived London borough, will be undergoing an extreme makeover of its own — according to a report by the BBC, almost £10 million of government and local money has been earmarked for a “Healthy Cities” initiative that will turn the community into a place where people will find it easier to exercise and choose healthy food: walking and cycling routes will be extended, food co-ops will be established and fast food outlets will be enlisted in a campaign to offer more healthy meals on their menus.

With below average life expectancy, low exercise rates and unhealthy eating habits, the people of Tower Hamlets are thought to be at the centre of what the local primary care trust calls an “obesity epidemic.” 

Beyond Manchester and Tower Hamlets, towns in other countries have tried similar programs. Varallo, a small town in northern Italy, offered cash rewards for residents who lost weight and kept it off for 12 months. Some U.S. companies wanting to keep health care costs down have also established reward programs for their staff through what HR types would call value-added employee assistance programs. For example, the Michigan-based Freedom One Financial Group sent 21 employees who met weight-loss goals on a four-day Caribbean cruise in 2005.

What does all of this tell us about the politics of public health today?

In The Politics of Health in the Eighteenth Century, Michel Foucault accounts for the emergence of a medical services market, the professionalization of medical practitioners, the development of benevolent associations and learned societies concerned with the observation of social conditions and innovation in medical techniques, among other things. While the state plays a variety of roles in relation to these developments, he argues, the ways in which health and sickness became matters of problematization ‘beyond the state’ contribute to an awareness of them as elements of population management. 

Central to the politics of health in this period is the emergence of concern for the well-being of the population as an essential objective of political power – this is a view of power that concerns itself not with the capacity to dominate and repress but to produce things, to manage conduct and coordinate new ways of thinking and behaving. This shift towards policing the social body that Foucault argues was peculiar to the 18th century was related to the broader consequences of the industrial period’s demographic transition, in which an urgent need arose to rapidly integrate increasing numbers of people into the apparatus of production and to control them closely. It was these forces, he argues, that made the notion of “population” appear not just as a theoretical concept, but “as an object of surveillance, of analysis, of intervention, of initiatives aimed at modification.”

The cases of Manchester and Tower Hamlets, Varalla, and many others illustrate not only Foucault’s argument that the exercise of power is concerned increasingly with managing and channeling human conduct (rather than dominating or repressing it) but it also show that while non-governmental bodies play a key role in contemporary health politics, the state also plays a fundamental role in terms of ensuring that “the state of health of a population as a general objective.” Whether this is a good thing, a bad thing or something more dangerous remains to be determined.

Vaccines, Autism and the “Liberal Media Conspiracy”

In a media release dated November 11, the Center for Medicine in the Public Interest (CMPI) accused CBS Evening News, and singling out its lead anchor Katie Couric, for leading a witch hunt against vaccine makers and perpetuating a myth that there is a link between vaccines and autism. According to the CMPI, “CBS Evening News has aired six stories over the past two-and-a-half years that included extremist views of vaccines and autism.” The Center’s President and Director of Programs, Dr. Robert Goldberg, also alleges that CBS intentionally ignored an announcement by the California Department of Public Health that cited a lack of peer-reviewed scientific evidence supporting the link between thimerosal (a preservative found in vaccines that are commonly given to children) and autism. According to a report published in the New England Journal of Medicine, more than 5,000 U.S. families have filed claims through the Vaccine Injury Compensation Program alleging autism was caused by vaccines containing thimerosal; the majority of these claims are still pending.

There are several noteworthy observations to be made here, but I’ll restrict myself to three: 

First, there is no question that the national media in the United States has given considerable attention to claims that vaccines may be linked to autism, whether in fact there is unquestioned scientific evidence to support their claims or not (since when has media coverage of health issues ever been based on the principles of science!). Although autism advocates and parents of autistic children have long crusaded for more media publicity and federal resources to better understand autism and provide meaningful supports to autistic children and their families, it took Jenny McCarthy, a mother of an autistic child, but also a former playboy bunny, actress and now best-selling author, to thrust the issue into the media spotlight. The clip below is an excerpt from McCarthy’s interview on CNN’s American Morning, but was part of a much bigger media tour in which she also appeared in a 20-minute spot on Oprah, Larry King Live, WWE Smackdown (a professional wrestling show) and several other high profile news programs. 

McCarthy was and remains an effective advocate not just because of her lived experiences but also because of her status and reach as a Hollywood celebrity. She joins a long list of tinseltowners who have leveraged their access and appeal to both political elites and citizens to influence public opinion and policy. But while the moral commitments of some celebs have been questionable, those with the capacity and willingness to engage in the cut and thrust of political argumentation have succeeded in not only keeping the issue alive but in actually influencing hearts and minds. This is the case whether they are correct or wholly inaccurate in their claims making activities. McCarthy’s appearances have included not just media but also medical and associational conferences.

Second, CMPI’s accusations of a liberal media bias against news corporations is nothing new, certainly not to communication researchers. In 1986, political scientists Robert Lichter, Stanley Rothman and Linda Lichter published their seminal book The Media Elite: America’s New Power Brokers, which reported survey data about the political leanings of journalists at such national media outlets as The Wall Street Journal, The Washington Post and New York Times, plus several broadcast networks (including CBS Evening News). A review of the book can be found here. In general terms, Lichter et al. found that most journalists were Democratic voters whose attitudes were well to the left of the general public on a variety of topics, including abortion, affirmative action and gay rights. The researchers then compared the journalists’ reported attitudes to their coverage of controversial issues such as the safety of nuclear power, school busing to promote racial integration, and the energy crisis of the 1970s, and found that coverage of controversial issues reflected the personal attitudes or reporters, and because political liberals were dominant in newsrooms that helped to explain why news coverage tilted in a leftist/liberal direction. The study was embraced mainly by conservative columnists and politicians, who adopted the findings as scientific proof of liberal media bias. It’s clear from the recent election campaign in the U.S. that many Republicans still believe these results to be true, or at least feel that their base believes this to be true (for similar findings in a Canadian context, see Barry Cooper’s Sins of Omission: Shaping the News at CBC TV (U of T Press, 1994) and Lydia Miljan and Barry Cooper’s Hidden Agendas: How Journalists Influence the News (UBC Press, 2003)).

And third, those who have tended to pitch accusations of a liberal media bias or conspiracy tend to operate from a position of political or material self-interest. Canadian political scientist Barry Cooper is reported to have deep ties to the Conservative movement in Canada and its financiers in western Canada’s oil and gas sector. Conservatives and those in the fossil fuels industry have consistently maintained that Canada’s liberal media (led by the state-supported CBC) is driven ideologically by a socialist agenda to steal hard-earned money from the western provinces to subsidize the myriad social engineering projects (e.g., Kyoto Protocol) supported by the vote-rich regions of Ontario and Quebec. In Cooper and Miljan (not to mention many others) they have the institutional credibility and legitimacy that academe sometimes affords.

Lichter and Lichter parlayed their academic careers into a business of providing research and consulting support for some of the most influential conservative organizations in the United States when they founded the Center for Media and Public Affairs (CMPA). According to Media Transparency, CMPA received 55 grants totaling almost $3 million between 1986 and 2005, the majority of which came from three donors all with deep ties to the religious right in the U.S. 

The Center for Medicine in the Public Interest, finally, describes itself on its website as committed to discussing, debating and demonstrating how “exponential and accelerating technological progress coupled with smart public policy will enhance and advance 21st century health care by predicting, preventing, diagnosing, and treating disease with greater speed, more precision, and less cost.” This may very well be true; yet, according to PBS News, it is funded by some of the biggest pharmaceutical corporations in the world, many of which make the very vaccines it has recently come out publicly to defend. This too shouldn’t come as much of a surprise given that CMPI was established by The Pacific Institute, a think tank founded in 1979 whose mandate is the promotion of “the principles of individual freedom and personal responsibility … through policies that emphasize a free economy, private initiative, and limited government.” 

Center for Medicine in the Public Interest may have a compelling case for media bias. The news and entertainment media in the U.S. may very well be guilty of providing insufficient attention to the scientific debate about autism. On these grounds many advocates and parents of autistic children, and public health advocates in general, may actually find some common ground. Nevertheless, when an organization like CMPI sets out to accuse media organizations of supporting what it describes as extremist and partisan views it will need to open its own practices and positions on issues to similar scrutiny.

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Update: See this New York Times editorial (13 February 2009) exonerating the medical and pharmaceutical establishment from the claims by McCarthy and others of a causal connection between vaccines and autism

The market meltdown and voluntary sector: News media beginning to take notice

In a previous post I criticized Canadian news media, key government departments and leading non-profit organizations for lagging in their reporting and public commentary about the impacts of the global economic slowdown on the voluntary sector. Although not all have begun to speak publicly, kudos to those that have done so. Among news media, the public broadcaster and Globe & Mail have reported in remarkable synchronicity this week on how the market meltdown is impacting charitable giving across the country.

Looking just to the CBC and Globe coverage some interesting patterns may be starting to emerge. Last week the Salvation Army in Ottawa reported a “jump” this year in demand for its services, while donations have dropped by $80,000. Fuel costs have also doubled for a number of agencies. The Salvation Army’s national office reports paying $1-million extra in fuel nationwide this year over last year. Meanwhile donations have not kept pace, dropping approximately $100,000 from this time last year. This news is especially troubling for charities serving communities in remote locations that depend on air or ocean transport of donated goods.

In British Columbia the situation is even more dire. The Vancouver Foundation, Canada’s largest community foundation, reports having lost $100 million to the global financial crisis and will have to reduce between $10-$15 million of funding for Vancouver community initiatives, affecting everything from youth ballet programming to blood services. The Greater Vancouver Food Bank Society, which feeds 25,000 people a week has also been hit hard – it reports a 20 percent drop in donations over the summer, which is threatening its ability to meet a likely increase in demand for the coming year. “We will never deny food to anybody and we hope we never reach that point,” said Arlene Kravitz, the society’s director of communications. “However, if the donations keep going down, we won’t have enough. We’ll have to cut.” 

In other communities, the news is not quite so bleak. Local charities in Kingston, Ontario, report that private donations have been “pouring in” despite the wider woes in the economy. According to Bhavana Varma, president of the local United Way, her charity has raised $1.6 million so far this year, more than 50 per cent of its goal and far more than it had at this time last year. In part, Kingston’s relative stability has to do with the fact that it is a small city by comparison with Vancouver, Ottawa or Toronto, where the pinch has been far sharper; but it also benefits from a stable local economy, with large public sector employers that include a university, a hospital and a military base, all of which will be relatively immune from the big job losses that are hitting large cities and those with a manufacturing based economy (at least in the short term).

The factors underlying this shift in how the national media has reported the effects of the slumping economy on the charity sector are likely mixed: we have finally moved from the single-mindedness that defines election campaign coverage, meaning that news organizations are starting to focus again on matters of greater importance than bird poop and accusations of political plagiarism; non-profit organizations are also likely becoming more proactive in their public communication activities, increasing production of information subsidies (economic updates, reports and other media releases) that are staples of the news business; and the realists among us may even argue that only now the impact has begun to finally emerge (ontological questions aside, why we are weeks behind the Brits in addressing the implications of the crisis remains unexplained). 

Regardless of the reasons for why this story is now starting to be told, it’s incumbent upon all leading social and political institutions to develop immediate solutions for tackling the problem. These should include short term actions in the form of one-time transfer payments from all levels of government to targeted charity organizations in the most affected regions and serving the most vulnerable people; long term actions that include increases in core funding by governments for the voluntary sector should also be addressed.

Canada’s voluntary sector is the second largest in the world – it engages more than 12 million volunteers, generates upwards of $112 billion in revenue, and contributes almost 7% to the Gross Domestic Product. Failing to address the impact of the crisis on the sector not only makes for bad economic policy, but it’s almost certain to intensify increased demand for charitable services, longer lineups at food banks and more people requiring the support of emergency shelters in the coming months and beyond.