“Until recently, health education was seen as ‘beneficent’ by nature” states the French journal Sante Publique. However, recent ethical reflections on the methods and objectives of many behaviour change campaigns has revealed “a number of problems or abuses” that “often contradict…the very goal of health promotion.” Hence the quandary that arises when determining how to best present such campaigns.
REFLECTING ON ETHICAL CAMPAIGNS
The World Health Organization calls on health educators to “observe the ethical obligation of…obtaining patients’ informed consent.”
Doing so involves “adequately informing [the audience] of the purpose and nature of the intervention and possible alternatives.”
This “exchange between health professionals and patients” involves “respect, freedom from intimidation, and [the use of] suitable language” to present “scientific information in popular form.”
Based on this information, the audience can “balance benefit against risk” and “make a rational decision” as to the relevance of the intervention to their life.
REFLECTING ON UNETHICAL CAMPAIGNS
Interventions that meet these obligations are “ethically distinct from campaigning communications aimed at sensationalising.”
Sensationalism involves the intentional misrepresentation of data designed to “impair people’s ability to make informed decisions.”
Bred of the paternalistic attitude that “physicians know what is best,” these campaigns either understate or overstate the risks or benefits associated with an intervention to cajole an audience who might otherwise reject a program.
As Health Communication observed, this infringement contradicts the very goal of health promotion as a “psychologically subjected” audience acting on “strong faith” may take up an intervention that poses great risk to them.
THE PRINCIPLES OF PRESENTATION
According to the Canadian Medical Association, interventions that enable the audience to “play an active role in decision-making” do five things:
1. Correct the audience’s misconceptions about risks or benefits.
Campaigners “should present the results of clinical trials in terms of absolute reductions in morbidity or mortality…rather than as relative reductions” so as to avoid disinformation.
Misconceptions can lead to hysteria and rash decisions, as evidenced in a study that “found young women overestimated their risk of dying of breast cancer twentyfold and the benefit of screening sixfold.”
2. Specifically recognise the potential harm.
Interventions make the suggestion that “by taking part in them, [the audience] can be even healthier or maintain their health longer.”
“Making such suggestions…puts a special onus” on campaigners to clearly and concisely state the adverse effects that may be suffered.
3. Balance the influence that physicians have over patients.
Prompted by a campaign, the audience may seek counsel with a physician. However, a physician may “intentionally or inadvertently use their authority to coerce patients” into decisions that may not be in their best interests.
Encourage the audience to discuss the pros and cons of the program with their physician, reminding them that physicians are not infallible.
4. Avoid the “evangelical fervour” of consumer marketing.
With mass media campaigns, the need to grab audience attention may lead to sensationalism and other tactics unbecoming of the medical industry.
However, “there is nothing wrong” with ethically conceived mass media approaches to marketing health interventions – so long as they are able to generate an “objective discussion of the benefits and harm[s].”
5. Provide clear, concise information.
“The data should be provided in a language that [the audience] can understand and in an atmosphere that is not intimidating and that fosters independent thought.”
This ensures the audience “does not merely agree to someone else’s recommendations.”
IN CONCLUSION: A CASE STUDY
Studying the “deleterious psychological and medical outcomes” of large-scale anti-tobacco campaigns, the Journal of Ethics criticised their “hard-hitting” nature for “demoralising and instigating victim-blaming” against the audience.
This demoralisation caused patients to “avoid or delay seeking medical care, resulting in the downstream risk of worsening…morbidity and morality.”
The study concluded that there is an “ethical burden for creators of public health campaigns” to frame messages in a way that builds a patients’ resilience and avoids stigmatising themes.