May 12 2015

If you’ve taken the subway in New York City during the last 10 years, the sight of slimy fat being poured from a can of soda probably stays with you. Remembering this image is the point: by taking you out of your comfort zone, the city’s Department of Health and Mental Hygiene left an impression, and maybe even convinced you to think twice before buying a sugar-sweetened beverage.

In a new article in the journal Health Affairs, scholars at Columbia University’s Mailman School of Public Health recap the reasons behind use of fear-based tactics and examine the consequences of controversies around ads targeting HIV and teen pregnancy.

Lead author Amy L. Fairchild, professor of Sociomedical Sciences, identifies these five New York City campaigns as key signposts in the evolution of fear-based strategies:

"Cigarettes Are Eating You Alive," 2006.

Beginning in the early 2000s, in the face of increased marketing by tobacco companies and stalled smoking cessation rates, New York City Health Commissioner Thomas Frieden, today director of the Centers for Disease Control and Prevention, embraced hard-hitting tactics that employed fear and graphic imagery. In the first such campaign, posters and television spots depicted diseased heart, lung, mouth, teeth, and throat. Public reaction was mainly positive, according to Fairchild and her co-authors. One contemporary observer commented, “They are disgusting, horrible, and distasteful; and they helped.”

"Pouring on the Pounds," 2009.

This viral video shows a man attempting to drink semi-congealed fat poured from a can of soda. “Don’t drink yourself fat,” the ad warns. The stomach-churning images, while humorous, entailed a threat. “I think what people fear is getting fat, so we need some statement about consuming so many calories,” said Thomas Farley, who was the city’s commissioner of health at the time. Farley and others believed shocking imagery was needed to “break through the socially structured fog that encouraged the consumption of toxic substances,” Fairchild and co-authors write.

"It’s Never Just HIV," 2010.  

Conceived to combat rising rates of HIV among men of color who have sex with men, TV ads evoked a horror movie style, interposing images of young gay men who “glance fearfully (even shamefully) at the camera,” in the authors’ words, with grizzly depictions of osteoporosis, dementia, and anal cancer. Critics argued that it painted gay men as disease-ridden vesselsl; others defended the campaign, saying the bitter medicine was needed. The episode had lasting consequences for public health campaigns around HIV, argue Fairchild and co-authors. “Although the Department of Health has continued with its fear-based obesity and tobacco efforts, as of 2015 the hard-hitting approach seems to have been shelved for HIV,” they write.

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"Think Being a Teen Parent Won’t Cost You?" 2013

Controversy returned several years later when the Human Resources Administration released a campaign against teen pregnancy that many felt stigmatized young mothers. While Mayor Michael Bloomberg defended the effort, arguing that it was “past time” for a “value neutral” approach, the Department of Health stated that stigma was not “an effective way to communicate these issues.”

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"Be HIV Sure," 2015.

In sharp contrast to the fear-based “It’s Never Just HIV” campaign, the Health Department’s new HIV campaign accentuates the positive with photographs of happy, loving couples of various races, ethnicities, and orientations. In one ad, transgender television personality Carmen Carerra stands with her arms crossed projecting confidence. Accompanying the images is a stern message with a specific aim: “One night can change your HIV status. Be Safe, Be Sure, And Get Tested Frequently.” Viewers are given several options to seek information on free testing, including by text.  The hashtag #BeSureHIV takes the campaign into the social media age.

Says Fairchild about these campaigns, “There’s a reason we see public health turning to fear. We live in a culture that bombards people with incentives to consume products that are clearly unhealthy. It is a duty of public health to sound a meaningful warning.” Adds co-author Ronald Bayer, “You can’t fight unhealthy seductions with abstract odds and probabilities. It’s like trying to put out a fire with a water pistol.”