Tag Archives: Public Health

Global Warming and the Problem of Public Opinion

We hear references to “public opinion” all the time but we rarely reflect on what it is, and why it’s important.

Political thinkers have struggled over the meaning of public opinion since antiquity. Plato was deeply distrustful of the public, while Aristotle believed “the many … may yet taken all together be better than the few.” To Macchiavelli, “public opinion” had no moral value, yet strategically it was crucial for political leaders to pay attention to it as a failure to do so could imperil one’s rule.

Around the turn of the 20th century, the political commentator and journalist Walter Lippmann argued that public opinion has little conceptual utility because most citizens have neither the time nor interest to truly understand issues in their complexity. The philosopher John Dewey disagreed, arguing that citizens are perfectly capable of understanding their world – nevertheless, their ability to do so is subjected to different forms of “organized manipulation” (i.e. advertising, PR, etc.).

All of these thinkers were writing about “public opinion” long before polling became a ubiquitous feature of the political and media landscapes.

Whether we are talking about environmental issues, foreign affairs, health-care reform or national security, actors on all sides commonly deploy “public opinion” as a weapon to advance their arguments, as if to proclaim that they speak on behalf of “the public” where others do not. Most agree upon the strategic benefits of such an approach, but has anyone considered the consequences?

Take the issue of climate change.

In 2008, Health Canada commissioned the polling firm Environics to survey Canadians about their understanding of climate change. The resultant report suggests that climate change will have a direct effect on the health of Canadians. Given that “most Canadians” believe climate change is taking place and that “a significant proportion” can see evidence of it in their own communities, the time for the agency to act is now.

Such findings are routinely challenged by others claiming to speak for the public. The Globe and Mail’s Margaret Wente argued recently that citizens are “cooling” to the notion of global warming and that politicians ought to carefully pay attention to public opinion in advance of meeting to discuss binding international agreements. Wente cites several polls that show, for example, how concern for the environment in Canada has fallen relative to other issues (e.g. crime, the economy). She then proceeds from the national to the international scale, arguing that citizens around the world have acquired weak appetites for action, especially for endorsing what she calls “Kyoto-style” international agreements.

The environmental community also uses “public opinion” for its side. Take for example Jim Hoggan, a well-known Canadian PR professional, environmentalist, and author. In March 2009, Hoggan argued that “over 90 per cent of Americans agree that the U.S. should act rapidly to combat global warming, including 34 per cent who feel the U.S. should make a large-scale effort even if it costs a lot of money.” The David Suzuki Foundation (on whose board of directors Hoggan serves as chair) reported in 2006 that Canadians were totally confused about the causes of climate change, attributing the problem to the hole in the ozone layer more than any other factor. A big part of the problem with public understanding about climate change, Hoggan asserts, is that citizens get unreliable information and no longer know whom they should trust. In his recent book, Hoggan reports survey data that shows that 82 per cent of people polled trust scientists, while 66 per cent trust environmental organizations and television weather reporters equally. By contrast, only 47 per cent trust the mainstream media. For Hoggan “the media—print or broadcast—have not succeeded in transmitting even the most rudimentary explanation of the actual cause of climate change.” Hoggan also notes that a whopping 81 per cent of people believe that PR experts deceive the public. Surely this can’t be good news for a PR man on a mission to change public perceptions about environmental issues.

What is one to do in the face of such competing claims about the state of public opinion? I suggest that the best thing we can do is ignore the polls altogether. Indeed, the fundamental problem with the debate about public opinion is that it’s a zero-sum game that only leads us down a path to ambivalence.

In a provocative critique, the French sociologist Pierre Bourdieu argued, “public opinion does not exist.” By this he did not mean public opinion does not come to have objective qualities – rather, his instructive point was that public opinion is a social construction, and a dangerous one at that. Bourdieu’s chief concern was with how polls are reported and the fact that they often carry more weight than they should. This happens, he argues, not only because the media are incapable of dealing with complexity, but also because we do not reflect carefully enough on how “public opinion” is shaped and represented. In other words, his concern is not with the inherent worth of polls but with how they are used. For Bourdieu, “public opinion” is at best a projection of what the media and political elite think about. At worst, it is a rhetorical tool that organized groups (in politics, the economy, and civil society) wield in their respective efforts to exert power and control over public discourse and policy.

I do not believe that polls have absolutely no role to play in how we talk about urgent issues like climate change. Nor do I endorse a nihilistic argument that we ought to just tune out entirely and let the chips fall where they may. The problem is that “public opinion” has been invested with a scientific power that obscures its social and political context – it has been granted far more value and authority than is deserved.

As the sociologist Earl Babbie might have put it, the idea of “public opinion” is probably useful in the context of scientific research, but in the world of culture and politics it could only ever be a “figment of our imaginations.” He did not mean that such concepts are entirely useless, just that we need to remember that the important question is: what do we do with our concepts?

Rather than assenting to what “public opinion” data tell us citizens want our political leaders to do, I think we desperately need to generate new forms of public expression, to raise critical questions about climate change instead of simply responding to those questions posed by others. Until we do so, we are liable to be governed only by the polls, and by those who sponsor them.

** Note: this column also appears under a different title in The Mark News here

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Filed under climate change, Health Issues, Health Promotion, Politics, Public Health

Purple Pills and Puffery

This post is about promotionalism and the pharmaceutical industry. Some of the ideas come from a paper I wrote a couple of years ago (This Ad May be Bad for Your Health) published as a chapter in my book Communication in Question. I was compelled to revisit some of the ideas that informed the paper after listening this afternoon to the latest podcast from White Coat, Black Art – Dr. Brian Goldman’s always stimulating and informative program on CBC Radio 1. You can stream the podcast at the CBC site here.

The section of the program that most intrigued me was Goldman’s Q&A with the vice-president of creative development at the Brand Institute, which bills itself as “the world’s premier healthcare, consumer and business to business (B2B) brand identity consultancy.” Among other services, the firm develops catchy names for drugs and the conditions they are designed to alleviate thereby helping pharmaceutical companies build brand equity and value. According to the executive interviewed, a number of important considerations go into the process of naming a new drug: the name should highlight the product’s unique selling features, it should include embedded concepts that can evoke emotion, it should be memorable and easily pronounced in multiple languages, and it should have a “pleasing tonality”. A case in point is the drug Lunesta, the popular prescription sleep aid – it connotes lunar images and has a soothing tonality that also affirms the product’s “inherent therapeutic properties.”  Roland Barthes must be spinning in his grave.

While you’re waiting for the podcast to download, here’s some promo from the Brand Institute’s website, broadcast as a news story a year or so ago on Fox Business and hosted on the agency’s YouTube page:

Of course, this story is about more than semiotics. Drug advertising is big business. The global pharmaceutical industry is the world’s most profitable stock market sector, with annual revenues exceeding $600 billion. Pharmaceutical sales in North America topped a staggering $265 billion in 2005, and in the United States, where 90% of the continental market is located, big pharma spent close to $5 billion that year on advertising alone. Millions of dollars can be made providing valuable treatment for genuinely sick people, but billions more can be made by convincing healthy people that there may be something wrong with them. Manufacture a risk, cultivate anxiety and deliver an easy treatment. It’s ontological security and a cool buzz in a bottle. 

For communication scholars, there are plenty of reasons to be concerned, which I outline in the aforementioned book chapter. Most importantly, advertising is about more than just the promotion of goods or services that are designed to inform and educate consumers and pad the corporation’s revenues. It is a cultural technology that incorporates images, persons, and commodities into what is often a seamless discourse that blurs the distinction between products and people. The rhetoric of drug advertising encourages individuals to focus increasingly on their minds and bodies as sites of real or potential disease that demand constant attention and administration. Some argue that this serves as an effective tool of governance and as a potential technology for social control. It surely this demands more vigilance on the part of consumers to resist the promotional efforts of drug companies and advertisers, but it also requires more robust state regulation to protect citizens.

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Filed under Everyday Life, Health Promotion, Lifestyle Risks, Politics, Popular Culture

Thank You for Smoking

In what must be a sign that public health advocates are making big gains in the legal and PR battles against Big Tobacco, news today that the biggest cancer purveyor in the U.S., Philip Morris, has taken the City of San Francisco to court over a new bylaw banning sales of cigarettes in pharmacies.

The company argues the ban is unconstitutional because it suppresses its rights to communicate with its consumers – cigarettes are not illegal and drugstores are licensed retail sites. The response from the city falls in line with a public health argument to protect and prevent all citizens from disease and to promote healthy environments. In short, we shouldn’t have to encounter promotional materials for products we know to be harmful in an environment that is supposed to promote health and well-being.

Of course, these issues are never so cut and dried. With pharmacies turning into grocery stores, grocery stores into clothing stores, and clothing stores into coffee bars, the lines that once separated clearly appropriate from inappropriate retail sites for products like cigarettes and alcohol are becoming increasingly blurred. Walgreen’s, for example, has intervened claiming it would lose millions of dollars, equal to 9 percent of a store’s non-pharmacy sales, if the ban takes effect. It argues the ban unfairly targets drugstores because grocery stores like Safeway, which profess to market a “healthy lifestyle” but also sell pharmaceutical and tobacco products, are exempt.

It’s surely a sign that the ban is a threat to the tobacco industry’s bottom line. Under normal circumstances, companies in the business of sin, sickness and ethically problematic activities would never go to court and risk intensifying public discussion and heightening awareness about the negative public health implications of their product – remember the case of Nike v. Kasky. Indeed, Mitch Katz, the City’s director of Public Health, calls it “a badge of honor … to be sued by Philip Morris.” I would be surprised if Philip Morris loses this one – but the legal struggle is likely secondary in importance to the public relations battle for the public health sector. 

This case will be interesting to follow, because of the possible precedent it may set (only hours after news of the San Francisco case emerged, the Boston Globe reported that Beantown may be next) and certainly because it’s very likely to generate a contentious debate about the effects of first- and second-hand cigarette smoking. Light up folks – this one will go on for some time.

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Filed under Everyday Life, Politics, Public Health

Disease Surveillance 2.0

In the first meeting of my grad seminar on communication and public health we discussed the contributions of some leading social theorists (Michel Foucault, Ulrich Beck and Anthony Giddens), particularly their theories of governmentality (Foucault), risk (Beck, Giddens) and reflexivity (also Beck, Giddens).

A recent story in Wired magazine illustrates some of these ideas well. The piece offers an account of “threat detective” Mark Smolinski, director of the Predict and Prevent Initiative, a global health program at Google.org  (the tech giant’s philanthropic arm).

Here’s the YouTube video introducing the Initiative:

Several aspects of the article interest me, particularly how Smolinski visualizes the Google health initiative as a knowledge broker in the management of global health risks. These risks – from avian influenza to SARS, hantavirus, West Nile and other infectious diseases which are “just a plane ride away” – become perceptible to us as a result of what Giddens described as some of the consequences of modernity (see also Beck’s discussion of global risks society). But as Foucault suggests, they are also the site through which wider strategies and solutions can be generated for problematizing populations. Indeed, as Smolinski describes his job, he leverages the company’s “technology expertise to companies and nongovernmental organizations already at work in the developing world” through “merging disease research into a predictive science.” 

To make conceptual sense of these practices we would do well to revisit Michel Foucault’s The Politics of Health in the Eighteenth Century.  In this lecture, Foucault accounts for the emergence of a medical services market, the professionalization of medical practitioners, the development of benevolent associations and of 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 myriad ways in which health and sickness become matters of problematization ‘beyond the state’ contribute to an awareness of them as elements of population: “the health of each as an urgent matter for all; the state of health of a population as a general objective”.

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 new ways of thinking. This shift towards policing the social body that he argues was peculiar to the 18th century was related to the broader political and economic 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, Foucault 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.” For Foucault, the rise of social medicine characteristic of the modern era could be extended to the rise of new modes of surveillance characteristic of late modernity and embodied by the observatory and epistemological power of Google.org.



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Filed under Everyday Life, Surveillance, Technology

Politicizing the public service a danger to public health

Two news items today worth noting. The first story, from the front page of the Ottawa Citizen, reports that the Tories have clamped down on public servants during the election, “muzzling” them from speaking at conferences, to scientific meetings, or in other public engagements. The story quotes Myriam Massabki, a spokesperson with the Privy Council Office, who argues the PCO rationale is to prevent public servants from speaking up about policy issues that may influence voter decisions during the election campaign. 

The timing of the announcement is important – the Conservatives are still dealing with blowback from the agriculture minister’s conference call faux pas, and most attribute the leak of the minister’s comments to an axe-grinding bureaucrat or staffer (this is as yet unproven and we may never know the source). Regardless, the announcement will most certainly produce a chilling effect within the public service and exacerbate already strained relations with the ruling party (of course, this assumes the Conservative will carry their 2-week lead in the polls through to election day).

The other item worth mentioning in this context is from CTV. The story is about a forthcoming commentary in the Canadian Medical Association Journal by Dr. Kumanan Wilson, the Canada Research Chair in Public Health Policy, and Dr. Jennifer Keelan, both of the University of Toronto’s Dalla Lana School of Public Health. Professors Wilson and Keelan ask why the federal agriculture minister and the president of Maple Leaf Foods, the company linked to the outbreak, have been the faces of the outbreak for both the media and the public rather than the government’s own chief public health officer, Dr. David Butler-Jones.

Good question.

“There’s a reason why we want our public health officials and our public health office to be in the lead on public health issues,” Wilson and Keelan argue. “When you have that situation, you are less likely to make other kinds of compromises for other reasons. The primary goal will be to improve public health.”
The Public Health Agency of Canada Act allows the chief public health officer to issue annual reports to Parliament and to communicate directly with the public concerning public health issues. Yet, Butler-Jones is more than just the country’s leading public health officer – he is also a deputy minister, precisely the kind of public servant the PCO/Tories are intending to muzzle from speaking on matters of public interest.
The irony here is that had Butler-Jones been the government’s public face of the issue and not the agriculture minister, the Tories would have saved themselves days of apologies and distractions, and improved the possibility of scoring that elusive majority. 

As an aside, it’s noteworthy that the headline in the delivery copy of the Citizen read “PCO tightens muzzle on PS for campaign” while the online version (at time of writing) read: “Tories tighten muzzle on PS for campaign.” A minor distinction, but an important one, especially if my hunch is right that many readers won’t know what the PCO is or the role it plays.

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Filed under Food-borne illness, Politics

Public Health Gets its Groove On

A story published in yesterday’s Washington Post reports that for the “global generation,” public health is a “hot field” of research. Although this demographic isn’t defined, let’s assume that it comprises primarily university and college-educated youth with a cosmopolitan sensibility. Echoing some of the conceptual underpinnings of Ulrich Beck’s second modernity thesis, the notion that the processes of modernization have generated unplanned side effects that present themselves as new problems in the forms of risks, the article claims that curiosity and awareness about public health dilemmas and problems is essential in the “flattened, crowded and worried world of the 21st century.” To paraphrase Giddens, risk and danger have become secularized as part of a world structured mainly by humanly created risks which can be assessed only in terms of generalisable knowledge about potential dangers (Consequences of Modernity, p.111).

The article notes that one of the major forces driving this new interest in public health is the way in which media and communication technologies “put students in touch with far-flung people and institutions,” thereby creating demand for knowledge that will enable them to navigate the global village with a greater sense of security and safety. Enter public health studies.

“Observers also credit a flowering of social consciousness in today’s students,” the article reports. “While the causes of their parents’ generation were fueled by protest and relied heavily on symbolic victories, the interest in public health reflects this generation’s more communitarian and practical outlook.”

The article tilts heavily toward an epidemiological approach to public health that relies on a rational self oriented toward stabilizing their identity in a culture of anxiety and risk, mentioning issues of communication and mass media only obliquely. It’s certainly a truism that “nearly all health stories in the news — from the possible hazards of bisphenol A in plastics and the theory that vaccines cause autism, to racial disparities in health care and missteps in the investigation of tainted peppers — are better understood with grounding in that discipline.” Public health advocates and practitioners would also be well served by acquiring a better understanding of communication practices and technologies and of understanding that they can be both produce and potentially alleviate anxiety — no doubt this would also  facilitate the development of more effectively articulated arguments for advancing public health objectives.

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Low Hazard/High Outrage?

A public health crisis or a crisis in communication? The listeriosis outbreak in Canada lends credence to Peter Sandman’s formula that risk f = hazard + outrage. Expectations of a growing death toll were confirmed today with news of an infant death in Manitoba. Yet just yesterday morning the issue seemed to be dipping below the threshold of scientific concern with the re-opening of the Maple Leaf Foods plant that was at the centre of the crisis.  But there’s a big difference, Sandman argues, between hazards and outrage. Where hazards are based on the technical assessments of experts, outrage operates in the more contingent and uncertain arena of public opinion. When news broke late last night that in August, at the height of the crisis, Tory agriculture minister Gerry Ritz cracked inappropriate and insensitive remarks in a conference call with scientists, risk communication managers, and policy strategists, the issue was thrust back into the glare of the media spotlight at high velocity.

That the Minister’s remarks were leaked partway through the election campaign suggests that even when scientific assessments of risk may be dissipating, as a communications issue they can create new and unexpected political problems. It will be interesting to see whether there will be any fallout from Ritz’s remarks – although victims are calling for the minister’s resignation, the PM refuses to apologize, dismissing his minister’s comments as “clearly inappropriate” but also arguing that the comments “shouldn’t detract from the good work that he has done to get on top and to understand this matter, to improve the system and to communicate publicly with Canadians and to make sure government officials are all doing their jobs.” Conservative strategists must be wincing at what is yet another blunder in a campaign of missteps and apologies.

With this latest development, will opposition parties, interest groups and civil society organizations concerned about food security and public health be able to put the government’s recent controversial changes to food safety regulations onto the electoral agenda?

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Filed under Food-borne illness