The main summer holiday season is coming to an end in London.  Traditionally, August is a quiet time where we catch up on long overdue administrative tasks and discuss potential collaborations for the coming months.   However, with City Health in Odesa less than two weeks away, I find myself in a reflective mood.   The last few months have seen a range of health stories in the media. Some got barely five minutes of interest, others generated coverage on television, and debate online.  What, I have been considering, are the actual impacts on our populations of this media interest?  People are exhorted to stop smoking, eat healthier, avoid sugar, drink less (if any) alcohol, be more active, avoid too much sun, and practice safe sex. No doubt there were also a few other topics that slipped passed me. How effective is this kind of advice?

These stories originate from a variety of sources.  Government departments, public health teams, charities, advocacy groups, and researchers all produce campaigns or materials which are aimed at the media. For many, I suspect, a key measure of success is getting the item on the radio or tv news or an article in the newspapers.  At this point I shall confess my own sins.  There have been many occasions where I have been involved with campaigns and have been delighted when an event or campaign has been picked by the media.  In the drugs world there are specific angles that are newsworthy.  New drugs, associated with extreme behaviours, are particularly popular.  Regrettably, I have to acknowledge that the level of media interest does not equate to less harm affecting individuals or communities.  Worryingly, in fact, there is some evidence that this coverage even increases harm in some cases.  For example, online searches for buying novel psychoactive substances rocket after newspapers highlight the “horrors” of the latest new substance.  While we were basking in the warm glow of media interest, the truth is we were achieving little for our vulnerable groups, although we might have enhanced our status with our peers and helped secure future funding.

The same dynamic doesn’t perhaps apply to all health areas, but I rather think we underestimate the impact and harm that headlines and attention-grabbing messages can wreak.  One example from this summer springs to mind.  A report on the potential for e-cigarette vapour to damage lung cells got mass media coverage.  Now this is an important issue, and I am glad it is being researched.  What was unfortunate is that in many cases the coverage suggested that previous efforts to suggest vaping is safer than smoking was flawed.  This is a real life, real harm situation.  Vaping has potential risks, but they are significantly lower than smoking.  It is a tragedy, and I use that word with consideration, that the broader health community can’t just align behind a simple, publicly acceptable, message that if you can’t give up nicotine then vaping is a better choice than smoking.

Similarly, discussions about the health risks and potential benefits of alcohol consumption have been media fodder for many years.  The recent Global Burden of Disease study is to be welcomed in terms of its clarity about there being no safe level of alcohol consumption, although I doubt it will stop future headlines suggesting red wine is good for your heart or commenting on drinkers living longer than the abstinent.  My concern here is that I don’t think we have developed the nuanced messages that might engage with those who drink, to help them do so safer.  I worry that many will be tempted to turn a deaf ear to health messages about alcohol.  

I don’t want to leave out obesity.  A fish shop in Glasgow gained national prominence for its “Crunch Box”.  This contained battered, deep fried, fish, sausages, burgers, chicken nuggets, onion rings, chips and a bottle of Irn Bru (a sugary soft drink). All this for £10.  This became an internet sensation and was picked up by the mainstream media.  Unsurprisingly, its health implications were raised. But here we had an interesting phenomenon. Although nearly every story mentioned public health, or obesity, it does seem professionals resisted the bait. Sadly, this didn’t stop the news making it into a case requiring some form of intervention or the nanny state trying to interfere with the enjoyment of ordinary people.  In fairness, I should make it clear that the Crunch Box was intended as an occasional treat for friends or family.  What the comment sections and on line discussion show is  that many people feel that public health is hell bent on interfering with their lives and enjoyment, that they are another problem to be faced rather than a means of improving lives.

Lack of appropriate messages and exasperation that health bodies are committed to taking pleasure from life is a major barrier to our engagement with our populations. We need to support the understanding that people can improve their health without giving up all of life’s pleasures.  Several studies (including one from Pennsylvania State University) highlight the benefits of adding a little hope to our health messaging.  Perhaps we should start working with communities to identify what works for them in their real-life environments, listen to their ideas, and prove to be real allies, rather than foes.  The benefits for all concerned would be significant.

              

D.Mackintosh photoDavid MacKintosh is the Head of Community Safety for the City of London, and has also been the Policy Adviser/Director to the London Drug and Alcohol Policy Forum (LDAPF) since 2001.  The LDAPF works to support policy delivery and promote good practice across the drugs, alcohol and community safety agendas.  He has been involved in a number of innovative campaigns around issues including drug driving, substance misuse in the workplace and improving awareness around drug safety in clubs and pubs. The LDAPF is funded by the City of London as part of its commitment to improving the life of all those who live and work in London.  For the last eight years he has also been seconded to the Greater London Authority to provide advice around substance use issues and health inequalities. 

Prior to this post David worked for the United Kingdom Anti-Drug Co-ordination Unit (part of the Cabinet Office) for two years, primarily on young people and treatment policy issues.  This followed on from some 8 years in the Department for Education and Skills where he worked in a number of areas including international relations and higher education policy. He spent ten years as chair of an East London based service provider and is currently a trustee of Adfam (families, drugs and alcohol) and the New Nicotine Alliance (which aims to improve public health by raising awareness of risk-reduced products).