So hard hitting it hurt

Hard-hitting adverts change behaviour. You have to shock people in to altering their behaviour. Just like the Grim Reaper adverts right? Right?

This week the Heart Foundation launched its new ad campaign targeting everyone who has made a poor life choice in a hard-hitting campaign that drilled in on the idea that if you don’t look after your heart health, you are selfish and don’t love your family. Now, that is not my cynical take on this – the ads were incredibly direct, incredibly focussed on the individual and incredibly brutal.

Its is fair to say, the response online was a little less than supportive of this brave campaign move – with people from advertising panning it (especially Dee Madigan – who called it a “monstrosity”), and public health luminaries also questioning the angle. The Heart Foundation doubled down on their content early on and backed it to the hilt – extolling the fact that so many people had gone to the website and there was a “discussion going on” as proof that this campaign had hit the mark.

Brave move *heart emoji*

Now, overnight – no doubt after a few frantic board discussions, the Heart Foundation has walked their decision back and decided to edit part of their advert, deciding to remove the opening scene of the mother tucking her son in and apologised for offending basically everyone. They stand by their stance that if this campaign drives people to have their heart checks than its a job well done. I don’t begrudge them for feeling the need to do something drastic. Something that shakes up the conversation. I’m just not sure this is it..

Did the baby go out with the bath water?

So is there anything wrong with this kind of hard-hitting mass media if it gets results? Well, putting aside from the heartbreaking tweet I saw from a father who was now stressed his eight year old daughter with congenital heart disease might hear this advert and think her disease is because she didn’t love her family enough; and putting aside the thousands of loved ones who are left behind to hear this message after their family has died from heart disease – what’s the problem?

Everyone gets really excited about the Grim Reaper campaign in the 1980’s that saved Australia from the AIDS epidemic. It was ground breaking advert content that changed the direction of modern Australia and saved many deaths – particularly amongst men who have sex with men. Except it didn’t really do it alone. This ad campaign was incredibly memorable. Definitely striking. It did lead to increases in testing – particularly in people who didn’t need to be tested – but what prevented an rapid increase in the spread of AIDS was not this ad. I feel the Heart Foundation response to double down on this campaign lines up with the champions of the Grim Reaper.

The Grim Reaper ad campaign ran for three weeks on TV, had short run in print marketing and was on the radio for a couple of months. Around the same time there was the early implementation of policy for testing of blood donations. Very solid sexual health promotion work particularly focussing on condom usage. The increase of needle exchange programs. Attempts to improve sexual health education in schools (still a work in progress). Policy and health promotion programs made a difference. Advocacy and interventions made a difference. The Grim Reaper gets the credit.

Surely that is ok though – the work got done. Who cares who gets the credit. Well – some people do. Like the community that the Grim Reaper ad campaign was supposed to help – the men who have sex with men. Who reported significant issues and ongoing negative impacts from this campaign – that continue on.

Mass media health campaigns that focus on fear, stigmatisation and shame are really popular and have been since the 1940s (when the original Grim Reaper campaign ran preventing road trauma – told you it wasn’t ground breaking). Politicians love it – Kevin Rudd’s launch of his government’s “Don’t turn a night out into a Nightmare” Binge Drinking Campaign in 2008 was heavy on negative messaging, fear-based content and targeted a group of young people who thought they were “bullet-proof”. It even had a video game. Neato. Campaigns before and since on everything from road trauma to obesity to smoking to methamphetamines take the same route. This are ongoing questions over the efficacy in actually changing behaviour (Soames Job 1988, DeJong 2002, Stylianou 2010) and while there is evidence and support of its efficacy (Fairchild, Bayer et al. 2018)- employing fear harnesses stigma and must be done with great care

What do you want – love and rainbows?

I know how much people love punchy, scary ad campaigns to “scare ’em straight” – but can we just try and be a little more inventive? I know that is hard when a Minister wants something punchy that “will make a difference” – so advocacy and education is needed.

I’d personally love to see more campaigns that actually addressed some of the Social Determinants of Health and swam a little upstream from blaming individuals and creating stigma and shame. (Tell him his dreaming).

I’d really love to see some that consider the Ottawa Charter for Health Promotion when they are developing a campaign. I’d really love to stop seeing marketing that focuses so purely on the negative and is aspirational and inspirational – that connects with us more at a intellectual levels than through primal fear. That enables us. That creates a supportive environment for change. That strengthens our community – rather than telling people who have had heart conditions they don’t care about anyone else. Would it kill everyone to use some humour for a change?

I’ll leave you with my favourite Grim Reaper advert – and perhaps my favourite injury prevention advert ever. It deserves to be a template of thinking out side the box, but it doesn’t tick enough fear boxes. Social Death is a real winner in my eyes as it taps in to something other than brutal fear of death. Its a little aspirational. A little bit call to action. A little bit funny.

DeJong, W. (2002). “The role of mass media campaigns in reducing high-risk drinking among college students.” Journal of Studies on Alcohol, Supplement(s14): 182-192.

Soames Job, R. F. (1988). “Effective and ineffective use of fear in health promotion campaigns.” American journal of public health 78(2): 163-167.

Stylianou, M. (2010). “The Return of the Grim Reaper.” History Australia 7(1): 10.11-10.18.

Fairchild, A. L., R. Bayer, S. H. Green, J. Colgrove, E. Kilgore, M. Sweeney and J. K. Varma (2018). “The Two Faces of Fear: A History of Hard-Hitting Public Health Campaigns Against Tobacco and AIDS.” American Journal of Public Health 108(9): 1180-1186.