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.

Small ‘l’ liberals, White Australia & Citizenship

Last Thursday Leigh Sales “grilled” Prime Minister Malcolm Turnbull over proposed changes to Australia’s citizenship laws. Changes include a more stringent English language test, proof of integration into Australian society, and a four-year waiting period for permanent residents to apply for citizenship.

Sales considered these proposed changes to be an aberration of Australian liberalism and out of step with Turnbull’s own political philosophy.

Towards the end of the interview she asked:

LEIGH SALES: Before you became Prime Minister, your image was that your values put you in the small ‘l’ liberal tradition of Alfred Deakin and Malcolm Fraser.

Can you today name one policy position that you hold that aligns with that tradition rather than with the conservative wing of your party?

Ironically, the policy that Turnbull could name is the very policy under discussion. The tightening of citizenship laws, especially using racialised notions of cultural values, English-proficiency, and religious belief is deeply entwined with the legacy of Deakin.

Historian Joanna Cruickshank, quoted Alfred Deakin in an article on the enduring power of white supremacy in Australia. Speaking in 1903, Deakin said:

“A white Australia is not a surface, but it is a reasoned policy which goes down to the roots of national life, and by which the whole of our social, industrial, and political organisations is governed.”

Another Australian historian, Stuart Macintyre, quotes Deakin during a debate on the Immigration Restriction Act (1901) saying:

The unity of Australia is nothing, if that does not imply a united race. A united race means not only that its members can intermix, intermarry and associate without degradation on either side, but implies one inspired by the same ideas, an aspiration towards the same ideals, of a people possessing the same general cast of character, tone of thought…

Turnbull is careful to avoid explicit appeals to race in the ethno-biological sense. However, his emphasis on the “unique” Australian values – “freedom, equality of men and women, mutual respect, the rule of law, democracy, a fair go” – serve as markers, shibboleths and “tone of thought” for indicating who is “in” and who is “out”.

The subtly of these dynamics was demonstrated when asked about who can integrate into Australian society. Turnbull gives a quick – “of course they are” – in response to Sales’ question “Are Jews who celebrate Hanukkah integrated into Australian cultures and values?” In contrast, he gives a bumbling non-response to the question about whether a woman who wears a headscarf is also integrated.

MALCOLM TURNBULL: Well, people are free to wear whatever item of clothing they like. I mean, bear in mind, I say again and again, whenever I talk about Australian citizenship and Australian values, I say that the foundation of our success, our extraordinary success, is mutual respect.

And that means… It’s a two-way thing. You respect others in their diversity and they respect you. It’s also about respecting the equal rights of men and women. And that is vitally important.

This and other tortured debates about the right and wrong way of applying Australia values of a “fair go” and “mutual respect” reveals the implicit way some forms of life are accepted and others are rejected.

Turnbull’s proposed changes to the citizenship laws do not stray far from those who went before him. From Deakin to Abbott, Australian liberalism (spelled with a small or large ‘l’) has tied itself in knots to restrict the entry and freedom of racialised others. Despite his progressive shtick and love of public transport, Turnbull is no different.

Pete Evans may sneer at medical science, but sneering back is a bad idea.

Writing in The Saturday Paper, Martin McKenzie-Murray describes celebrity chef Pete Evans as “sneering” at the importance of medical qualifications and that the “medical industry is corrupt”. Evans continues,

What do you need a qualification for to talk common sense? Why do you have to study something that is outdated, that is industry-backed, that is biased, that is not getting the results? That would be insane to study something that you’re gonna waste your time with? That’s just crazy.

McKenzie-Murray is quick to dismiss Evans and describes his interview as “a pathetic performance”. There is much to criticise Evans for. But these are good questions.

What gives someone authority to tell others what to do in relation to their body and health? How is medical and nutrition science produced? What are we to make of the way this knowledge and advice seems to shift over time? Do scandals of corruption and bias in one area of scientific research taint other areas?

These are the kinds of questions philosophy of science and science and technology studies deals with. In fact, Ray Moynihan, research fellow at Bond University, has addressed similar questions in his occasional health column for The Saturday Paper.

As I was writing this I received an email for a conference at Georgetown University that is exploring the question “Does Industry Influence Medical Discourse?” Presenters are asking some of the very questions Evans is asking about the basis of authority, knowledge production, and different conceptions of evidence.

One presenter, philosopher and bioethicist Carl Elliott has spent much of his career critiquing the influence of the pharmaceutical industry on medical practice and research. To be sure, Elliott and other scholars are not drawing the same conclusions as Evans, but nor do they conclude that “everything is ok” in the world of modern medicine.

One only needs to glance at the newspapers (or Retraction Watch) to realise that medicine and scientific research is not a straight-forward or innocent enterprise. Recent examples include a “fake doctor” practicing in NSW with fraudulent qualifications, sugar industry influence on dietary recommendations, or Dr Anna O. Szust – the scientist who doesn’t exist but was able to get appointed as an editor to over 50 academic journals.

These examples of fraud and misconduct are extreme. The point is not that these examples discredit medicine or science, but that they raise questions about the social and commercial contexts in which science is produced and medicine is practiced.

Yet, even when there is no misconduct, there are questions about the results of science when it is “done right”. As I’ve addressed elsewhere, STS and philosophy of science shows that the “inside” of science is a messy, value-laden, emergent, trialled-and-eroded, accidentally-collective network enterprise that bears little resemblance to the smooth, authoritative discursive claims on the “outside.” This is not to say that science is a hoax and one opinion is as good as another. But there are questions about science worth asking.

Evans draws the wrong conclusion that medical and scientific knowledge is fake and can’t be trusted. But he is asking the right questions about how it is produced, who counts as an authority and what does it mean to be qualified. There aren’t always straight-forward answers to these questions. To double-down by saying “trust the experts, you’re a fool like Trump” only serves to entrench polarised and isolated camps.

As Rachel Ankeny said in an interview about Evans and the critical response from the Australian Medical Association and others

“They need to engage with the community — not just those who are pro-science — but the whole community,”

“It’s not about saying you’re a ‘whack job’ and shouldn’t be listened to,”

Instead of sneering back at people who question science – vaccinations, climate change or nutrition – it would be more productive to acknowledge the significance of their questions and provide ways of thinking that avoid the Scylla of scientism and Charybdis of pseudo or anti-science.

Manning Clark on making the most of faculty meetings

I have been reading Manning Clark’s A Historian’s Apprenticeship – a short book about writing the 6-volume History of Australia.

He sketched many of his initial piecemeal ideas and impressions in a little black book – ‘I began to write down ideas in all sorts of places’. He continues,

I wrote many an entry in the little black book when my colleagues at the Australian National University were telling each other at meetings of the Professional Board or the Faculty of Arts, in long a dreary speeches, how important their subject was and what a contribution they had made to the advancement of wisdom and knowledge. Sometimes the entries record the comfort derived from imagining these colleagues on the hoist in a garage for an oil and a grease in preparation for their next encounter with their academic rivals; sometimes they too are seen as being nailed to a cross, viewed from the eye of pity as men and women who would never get what they wanted – the power they coveted, or the applause or the recognition that were forever out of reach.

Sheep as the settlers’ totem: Lamb of God, sheep of the field

In working on the manuscript for my book, I have been reading and thinking about sheep and their role in settler-colonialism and the frontier wars.

Robert Kenny’s, The Lamb Enters the Dreaming, is fascinating on many levels. I particularly liked this reflection:

‘It is important to appreciate here that the connection between the religious symbolism of the Lamb and the white things wandering around the paddocks was lost to the settlers, but not to the local people. Having been brought up a Christian, it never occurred to me until I came to write this book that Jesus as Lamb of God, or myself as Lost Sheep found, had any connection to the dumb, fluffy animals that dot the countryside. Of course, I would recognise “the Lamb” as a lamb, but I would not look at a lamb in a field and think of Jesus. Or a sheep that had wandered alone onto a road and think of an apostate Christian. Since I was a small child, the separation of the symbolic Lamb from the wool-bearing sheep has been granted, the result of centuries of separation. But if I had come across the Christian symbolism of the Lamb at the same time as the novel presence of sheep, this separation would not be – and it would certainly not be if I understood the spiritual and physical worlds as unseparated.’ – Robert Kenny, The Lamb Enters the Dreaming, Melb., Scribe: 2010.

Also, it is disturbing how much of the frontier violence revolved around sheep and agriculture. This map makes the impact of colonial expansion on Indigenous life obvious.

Sheep &amp; Wheat copy

 

Boycott: A Twitter Poem

I am not Boycotting #Coopers
Boycott Upcoming ‘Avengers’ Movie
Boycott Apartheid Israel” billboards
27 Trump Brands to Boycott
Boycott Merchants Who Submit to Islam.
boycott backfires

Effective Conservative Boycott continues.
BOYCOTT AIR FRANCE
Boycott film ‘Sarkar 3’
Boycott @cnn tomorrow night
boycott these paper towels
so-called boycott

 boycott ExxonMobil.
BOYCOTT Islam
BOYCOTT BEAUTY
Boycott ‘Beast’
boycott Disney?
Boycott Everything!

boycott threats over refugee hiring hasn’t hurt
Keep the boycott on Starbucks – they are hurting badly.
Boycott Good Morning America!
Women Boycott of Women’s Day
boycott self-service
ignore our Boycott

Let’s boycott
Boycotted everything I see here long ago