Category / public health

by crmayes

Public health communication & the blurry line from anti-obesity to pro-ana

Public health communication is not easy. Various industries, special interest groups and lobbyists are only too willing to skew messages about health. As such, public health researchers and advocates tend to be sensitive to the different ways a health message can be appropriated.

However, public health advocates, particularly in the area of nutrition, are inconsistent in their concern that people will misuse health-related messages. If a piece of research suggests that something traditionally thought to be “sinful” – alcohol, chocolate, or fat – is not as bad as first thought, then anxious caveats will urge restraint. Yet, if a piece of research over-sells the benefits of something traditionally thought to be “saintly” – exercise or dieting – then there is silence.

Two examples illustrate the first response.

Example 1 – Health benefits of alcohol

Every so often a mainstream media source will pick up on some research that suggests that alcohol – usually red wine – can have some health benefits. Without fail a public health spokesperson or researcher will be very quick to either discredit the research or explain to the public that the research does not provide a license for unrestrained consumption.

For instance, public health nutritionist, Marion Nestle, laments in her book Food Politics that clear guidance is complicated by ‘the inconvenient finding that moderate drinking provides health benefits – alcohol protects against coronary heart disease.’ Whether this research still holds is beside the point, Nestle’s lament that alcohol could have health-benefits reflects a distrust of the public’s ability to negotiate complex or uncertain nutrition messages.

Researchers like Nestle in the US and Mike Daube in Australia are at pains to ensure the public does not misuse or misinterpret claims about the health-benefits of alcohol.

Example 2 – Relationship between weight and health is not as clear as first thought

In 2013, the Journal of the American Medical Association published an epidemiological study from Katherine Flegal and colleagues that found people who are obese grade 1 (BMI of 30-<35) had no increased risk of dying prematurely and overweight (BMI of 25-30) people may actually have greater life expectancy.

Stacy Carter and Helen Walls documented the fall-out of this res2014-12-01 16.22.32-1earch among public health researchers.

Walter Willett of Harvard School of Public Health was indignant. He described the research on NPR as ‘really a pile of rubbish’ and that ‘no one should waste their time reading it’. A UK National Obesity Forum representative told the BBC, ‘It’s a horrific message to put out at this particular time. We shouldn’t take it for granted that we can cancel the gym, that we can eat ourselves to death with black forest gateaux’.

Like the responses to research suggesting the health-benefits of alcohol, these responses to Flegal et al’s research highlight a deep anxiety that the public will misuse public health messages in a manner that undermines their health.

Anti-obesity or Pro-ana? So long as we’re skinny…right?

Despite knee-jerk concern that alcohol or weight-related research will be misused by publics, there is very little (if any) concern that anti-obesity campaigns will lead people to eat too little, exercise too much or that such messages will reinforce and legitimise disordered eating practices such as anorexia or bulimia.

Almost every time I lecture on critical obesity discourses someone will question why there is such a overwhelming focus on obesity and little focus on anorexia or bulimia. Someone will also point out that a lot of the anti-obesity messages can be construed to reinforce idealised expectations about body image.

Compare the use of computer-generated imagery in these two public service announcements (PSAs).

  1. Measure Up – anti obesity

https://www.youtube.com/watch?v=9dL4lN6GKi4&w=560&h=315

2. The Mirror – anorexia

The parameters for the non-pathologised and non-medicalised body is very narrow, especially for young women. In addition to people questioning the differing responses to obesity and anorexia or bulimia, I have had two students tell me that they used weight-focused public health messages to mask damaging practices such as under-eating and over-exercising.

Last year, Dr Richard Newton from the Butterfly Foundation noted that an increase of children and young people with disordered eating and dieting behaviours coincides with ‘a society that is putting an increasing emphasis on avoiding obesity, controlling weight and shape through dieting’.

Psychiatrist Dr Peter O’Keefe also said that anti-obesity messages contribute to the ideal that ‘if you’re thin you’re good, if you’re not, you’re bad’.

These are serious concerns with real consequences for the lives of young people. Yet the zeal for preventing obesity and perceived urgency of the problem, gives public health advocates little time or reason to pause and consider the ways anti-obesity messages can be interpreted.

Sadly, if a piece of research suggests that it’s ok to eat a piece of cake, warnings and caveats are screamed from the rooftops. But if the research says exercise more, eat less, and lose weight, then there is only nodding agreement. After all, why give an inch when we are at war with our bodies – mine and yours.

by crmayes

Public Health has a Tobacco Problem

Image taken from page 855 of '[A series of original Portraits and Caricature Etchings by ... J. Kay; ... with biographical sketches and illustrative anecdotes. [Edited by H. P.]]'The widely circulating media reports that compare bacon to tobacco in terms of its capacity to cause cancer reveals the “tobacco problem” with public health communication.

By “tobacco problem” I don’t mean that researchers or communicators are on the take from “Big Tobacco” or that they have got the facts wrong about its association with cancer. The tobacco problem is that the success of tobacco control has produced a conceptual and political myopia. Or what I call a “tobacco control style of thought”.

Ian Hacking describes a “style of thought” as a particular way of seeing the world or problem that allows some ideas to be thinkable and actionable, while rendering other ideas as unthinkable. The success in linking smoking with cancer and the implementation of controls to regulate its use have contributed to a tobacco control style of thought.

The effect is that all public health issues are shoe-horned to fit the tobacco control model.

Eating bacon and red meat, drinking soda or frequenting fast-food restaurants, or sitting in a chair for too long are all equated with smoking. Why? Because saying bacon is like tobacco means that the problem and corresponding solution is well understood by the public and policy-makers.

Except it isn’t. All of these activities are extremely different from smoking. Eating bacon is not the same as smoking cigarettes. Everyone outside the tobacco control style of thought can see this.

The Australian Agriculture Minister Barnaby Joyce said it is a “farce to compare sausages with cigarettes“. Does Barnaby have financial and political interests in saying that? Yes. Is he wrong in saying that? No.

Sure, saying “bacon causes cancer” generates headlines, but it also distracts from focusing on the actual research on the health effects of processed meats. Public health Image taken from page 277 of 'Lilliput Lyrics ... Edited by R. Brimley Johnson. Illustrated by Chas. Robinson'communicators and researchers need to break out of the tobacco control style of thought that makes bacon or soda look like tobacco.

Public health is currently in a battle with libertarians who cry “Nanny” every time they are told that an activity or behaviour should be regulated. However, in equating activities like eating processed meat or sitting at a desk with smoking, public health communicators give the appearance of legitimacy to the “Nanny State” cry. This does real damage to the credibility of public health research and erodes public understanding of risk factors and epidemiology.

Like the boy who cried wolf, if public health communicators continue to compare everything to smoking, soon people will stop listening.

by crmayes

Consumer Ethnocentrism: Part 1 Country of Origin Food Labels

In 1989 my uncle returned from a trip to the US with a pair of basketball shoes that were not yet available in Australia. Having seen them on the feet of American basketball stars, my friends and I coveted these shoes, and I was the first to own a pair. Taking them out of their box, I noticed the label at the back of the tongue: Made in Indonesia. I was disappointed. These shoes were not from the land of Magic Johnson or Michael Jordan but from an island I knew little about, 3000

kilometers to the north of Australia. Rather than the genuine product and official brand of champions, I was in possession of a cheap imitation. My sense of disappointment was not alleviated when an older boy assured me that the shoes were in fact fake.

The revelation that my basketball shoes were not made in America was my first conscious encounter with globalised manufacturing and trade. The now commonplace statement, ‘Made in Indonesia’, took some of the sheen off the brand, which was so carefully manufactured in marketing and design offices far removed (geographically, economically and culturally) from the factories in which the shoes were manufactured.

Buying like “us”

While I would like to say that the disappointment I felt in learning that the shoes were made in Indonesia was due to concern for the conditions of the workers, this would be disingenuous and perhaps a bit much to expect of a 9 year-old. My disappointment was due to the otherness of Indonesia. These shoes were not made by people like “us” – me, my friends, Magic Johnson or Michael Jordan. They were made by “them” – people I knew little of, except that they weren’t in the NBA, didn’t play basketball, didn’t appear in the multi-million dollar commercials, and according to a friend’s father, were waiting for an opportune time to invade Australia. These feelings of parochialism, or perhaps more accurately racism and xenophobia, were an early expression “consumer ethnocentrism”.

Ethnocentrism is the attitude that distinguishes between an “in-group” and “out-group”. Terence Shimp and Subhash Sharma developed the concept of consumer ethnocentrism to ‘represent the beliefs held by American consumers about the appropriateness, indeed morality, of purchasing foreign made products’ [1: 180]. According Shimp and Sharma’s study on the psychology of ethnocentric consumers ‘purchasing imported products is wrong because, in their minds, it hurts the domestic economy, causes loss of jobs, and is plainly unpatriotic’ [1]. While Shimp and Sharma focused on the 1980s American automobile industry, I suggest that consumer ethnocentrism is increasing in the food industry through current debates over country-of-origin labelling and local sourcing movements.

Global Food and Ethnocentric Consumption

The global food system has led to an increase in ignorance and confusion about where food comes from and the conditions under which it is produced. This ignorance is manifest in at least two forms. First, a general ignorance about the way food is produced and where it comes from, i.e. what season does asparagus

grow or what part of a pig does bacon come from? And second, where geographically does the asparagus I purchased in the supermarket come from or a more complex question, where was my microwave dinner produced, and were the ingredients all from the same location? Unlike my basketball shoes, the country-of-origin labelling on food products is not as clear. And some food products may use ingredients, manufacturing processes and labor from a variety of countries.

Since the early twentieth century, the Commerce (Trade Descriptions) Act 1905 and Commerce (Imports) Regulations 1940 has enforced country-of-origin labelling for clothing imported into Australia [2], with similar legislation in place in the US (Tariff Act of 1930). However, these laws do not address the importation of food products. Over the past decade, country-of-origin labelling for food products has become a significant issue for consumer’s, workers’ unions and food companies in the US [3, 4], Australia [5-7], and the European Union [8, 9].

Country-of-Origin Labelling and Food Safety

There are a number of reasons why consumer groups and sectors of the food industry want country-of-origin labelling regulations for food products. A common reason is food safety. With the interconnection of the global food system, governments and consumers are concerned by food poisoning outbreaks, such as bovine spongiform encephalopathy (BSE) or “mad-cow disease”, and possibility by the threat of cross-contamination [10]. The recent outbreak of Hepatitis A in Australia associated with Nanna’s Mixed Berries from Chinese factories has re-invigorated the country-of-origin labelling debate.

A second argument for the introduction of country-of-origin labelling is to protect domestic markets. For example, canned food company, SPC Ardmona, made 150 redundancies and closed a production factory in Australia. According to the Australian Manufacturing Workers’ Union this is partly due to a lack of adequate labelling laws that allow major supermarkets in Australia to stock cheap imported foods without being required to inform the consumer [7]. Furthermore, while the label may state “Made in Australia” this is allowed ‘even if only a few of the ingredients are grown in Australia’ [5]. As a result, companies that use local workers and ingredients are squeezed out of the market by cheaper imported goods.

Food safety and the protection of domestic markets are significant issues, yet they can also become enmeshed with more explicit manifestations of consumer ethnocentrism. With products and brands representing “us” or “them”. In Part Two, I discuss the example of “in-group” ethnocentric consumption in relation to Dick Smith’s response to Kraft Foods ownership of Vegemite. In Part Three I use the call for US consumers to boycott French products in response to the French government’s refusal to join the “coalition of the willing” to highlight “out-group” ethnocentric consumption.

References

  1. Shimp, T.A. and S. Sharma, Consumer Ethnocentrism: Construction and Validation of the CETSCALE. Journal of Marketing Research, 1987. 24(3): p. 280-289.
  2. Australian Customs Service. Australian Customs Service Fact Sheet. 2007 [cited 2012 March 19]; Available from: http://customs.gov.au/webdata/resources/files/FS_clothing.pdf.
  3. Lusk, J.L., et al., Consumer Behavior, Public Policy, and Country-of-Origin Labeling. Applied Economic Perspectives and Policy, 2006. 28(2): p. 284-292.
  4. Loureiro, M.L. and W.J. Umberger, A choice experiment model for beef: What US consumer responses tell us about relative preferences for food safety, country-of-origin labeling and traceability. Food Policy, 2007. 32(4): p. 496-514.
  5. Peacock, M. Food Labelling inquiry chair disappointed Federal Government drops key recommendations. PM 2011 [cited 2012 February 6]; Available from: http://www.abc.net.au/news/2011-12-01/food-labelling-inquiry-chair-disappointed-federal/3707464.
  6. Blewett, N., et al., Labelling Logic: Review of Food Labelling Law and Policy. 2011, Commonwealth of Australia: Canberra.
  7. Australian Manufacturing Workers’ Union. SPC regional job losses show need for food labelling laws and watchdog on supermarkets. 2011 [cited 2012 March 19]; Available from: http://www.amwu.org.au/read-article/news-detail/749/SPC-regional-job-losses-show-need-for-food-labelling-laws-and-watchdog-on-supermarkets/.
  8. Miller, J.W., Country labeling sets off EU debate, in The Wall Street Journal. 2011, News Corporation: New York.
  9. Department of Environment, F.a.R.A. Country of origin labelling. 2011 [cited 2012 March 19]; Available from: http://www.defra.gov.uk/food-farm/food/labelling/country-origin/.
  10. Smith DeWaal, C., Food Protection and Defense: Preparing for a Crisis. Minnesota Journal of Law, Science and Technology, 2007. 8(1).
by crmayes

Lifestyle choice: a brief note

I’m currently completing a book manuscript called ‘The Biopolitics of Lifestyle’. So when Tony Abbott made his comments that Aboriginal’s living in remote communities are making a ‘lifestyle choice’, I thought “great, I may need to write another chapter”.

This is not simply a poor choice of words, but reflects a governmental rationality that seeks to place responsibility on to individuals. Education, health, welfare, employment all become ‘lifestyle choices’ for which the individual is responsible.

The affluent, gainfully employed, highly educated sections of society make good ‘lifestyle choices’, while the poor, sick, Indigenous and asylum seekers are characterised as making bad ‘lifestyle choices’.

Abbott is not the first to use this phrase to justify . In 2002, Philip Ruddock described asylum-seekers as making ‘lifestyle choices’.

“In the main, people who have sought to come to Australia and make asylum claims do not come from a situation of persecution; they come from a situation of safety and security,” he said.

“They may not be able to go back to their country of origin but they are making a lifestyle choice.” The Australian, ‘Ruddock blames “lifestyle” refugees’ by Alison Crosweller and Megan Saunders

This governmental rationality shifts responsibility away from governments and communities, and on to individuals. It also serves to trivialize some claims (living in a remote community or seeking asylum) by comparing them to frivolous consumer lifestyle choices (Pepsi or Coke, holden or ford, apple or pc).

Of course, when we talk about the Australian Lifestyle of ANZACs, footy, beach, sun, boats, and weekends, things get very serious. Governments use this notion of lifestyle to build monuments, go to war, and demonize minorities. But that is another matter all together.

In the current context the rationality of ‘lifestyle choice’ shifts responsibility onto individuals in remote communities and justifies the Western Australian government’s decision to cut services and remove people.

by crmayes

The End of Obesity: There is something happening here, but you (we) don’t know what it is…

The rhetoric and hyperbole surrounding the ‘obesity epidemic’ serves the interests of politicians gaining headlines, journalists selling papers and the fitness industry acquiring customers, however in a recent book and interview Michael Gard argues that such statements are not supported by scientific and epidemiological literature. Rather than consensus and clear evidence of continued rise in obesity rates, and the more fundamental question of the relation between body mass and health, the literature demonstrates a plateauing of obesity and disagreement over the significance of body weight.

For a short and insightful discussion of these issues I recommend Michael Gard’s interview with Michael Duffy on ABC’s Counterpoint. Discussing the epidemiological, public health and political context of the ‘obesity epidemic’ Gard addresses key questions around health impacts, schools and children, class and life expectancy.

A point I found particularly interesting was Michael Duffy’s comment in relation to class – “You hardly see an obese person in parliament or representing a company on television.”

This comment reveals an important aspect of optics and class. There are a number of overweight and obese people in Australian parliament (and the business community) yet we don’t see them because they don’t fit our idea of what an obese person looks like. We don’t see their body as obese, not because they are physically hidden by the party, but they are hidden by our ideas of class and social status. Occasionally the obese body does emerge, as with Bob Hawke’s reported comments to Kim Beazley that he could never be Prime Minister unless he lost weight, but on the whole we don’t see their obesity as it is masked by their position, status, suit – their class.

However, it is also important to note that some in the ‘Fat Studies’ community argue that fewer fat people are promoted due to social prejudice against larger bodies. Like short stature, race and sexuality, they argue that social norms serve to exclude fat bodies from positions of leadership and power in business and political communities.