28th October 2022

Drawing on disgust: the use of fear and shame in public health campaigns

Public health campaigns are increasingly being used by the NHS to combat public health problems. But are fear tactics really a good way to change our behaviour?
Drawing on disgust: the use of fear and shame in public health campaigns
Photo: Vitalii Pavlyshynets @ Unsplash

Have you ever looked at the images on a cigarette pack and wished you hadn’t? Or maybe watched an advert describing how many units are in a pint and did some alarming mental maths? Public health campaigns try to gain our attention long enough to change our opinion, and potentially our behaviour, by provoking disgust and fear.

The history of fear and disgust in public health

The media we consume has a profound influence on our perceptions, especially when ideas are portrayed in a repetitive format, such as in advertisements. Fear tactics have been used in science media and communication for as long as public health has existed. When the 1987 AIDS public information films played in cinemas, they featured dramatic music and imagery to promote the government slogan, “Don’t die of ignorance.” While these films had a marked impact on the nation’s opinion, they also stigmatised minority groups who were affected at the time, namely the LGBTQ+ community.

This approach of shaming those who need help is seen again and again. The Australian government produced a campaign against smoking and obesity, using evocative images designed to create a negative response or association with what the audience is seeing. This negative response can often evolve into a culture of disgust towards a group of people who practice unhealthy habits.

Does it work?

While the government’s aim may be to shame people into quitting smoking or losing weight, it may actually do the opposite. Studies have suggested that confronting people with graphic images and alarming messages can actually result in avoidance of these messages and denial of the risks involved in their behaviour.

Public health campaigns also often fail to recognise people are selective in the media they absorb, and that certain groups will perceive different levels of risk. During the Covid-19 pandemic, the government’s “can you look them in the eyes?” posters and adverts were used to shame young people, who were not as severely affected by the virus, into following the social distancing rules. However illegal raves and underground parties still occurred, one even infamously landing a University of Nottingham student with a £10,000 fine. Another example of this is anti-smoking campaigns, with smokers being significantly less likely than health experts to perceive advertisements as negative or fear-inducing.

A better approach to public health

How then can governments spread their message in a way which will prompt behavioural changes? You may remember the government’s Change4Life campaign, which included colourful animated figures. Public Health England describes the campaign as a “flagship social marketing programme aimed at tackling obesity.” In a 2014 TV advert on the topic of ‘hidden food nasties’ the narrator demonstrates how much fat is in pizza by measuring out a thick lumpy yellow substance in a wine glass. In the advert, the little figures make sounds of disgust and throw away their unhealthy food. In more recent years, the campaign has focused on more constructive ways to reduce obesity like the “60 active minutes” ads which show families spending time together playing sports. These examples provide solutions to the problem rather than just shaming the audience.

Understanding the causes of behaviour

Behavioural psychology may provide further clues. The ‘behaviour change wheel’ is a framework which uses research from the behavioural sciences to develop more effective interventions. The theory revolves around three conditions that underlie behaviour: capability, opportunity, and motivation. The interventions used to encourage or discourage certain behaviours must alter one or more of these conditions to have a significant impact. This framework has been used to design campaigns such as changing the recycling habits of students in a London university. The university restructured the building to provide more bins, providing the students with the opportunity, as well as the motivation to recycle.

Campaigns like Change4Life are a good example of science communication promoting easy ways to change your routine to be healthier but many government messages still rely on producing fear or shame. While the messages within them are important, public health campaigns often do not have the intended consequences. In the future, more positive health campaigns which focus on helping those who need it may produce healthier results.

Freya Anderson

Freya Anderson

Chemistry BSc from the University of Liverpool, currently studying an MSc in Science and Health Communications at the University of Manchester

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