Over the last 10 years, public health campaigns in New York City around smoking, obesity, and HIV underwent a dramatic shift to use fear and disgust to spur behavior change, sometimes with the unintended consequence of stigmatizing affected populations. In a new article published in the May issue of the journal Health Affairs, scholars at Columbia University’s Mailman School of Public Health explore the implications of this shift to fear-based campaigns in the present public health environment.
Beginning in 2005, the New York City Department of Health and Mental Hygiene mounted fear-based campaigns around smoking and obesity that were largely embraced by the public, with largely positive feedback to the Department. But in 2010, the fear-based “It’s Never Just HIV” campaign targeting young men of color who have sex with men erupted into a firestorm of controversy with the sharpest criticism from those who viewed themselves as socially vulnerable. The experience has lasting consequences for public health campaigns around HIV, argue authors Dr. Amy L. Fairchild, Dr. Ronald Bayer, and Dr. James Colgrove, professors of sociomedical sciences. “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.
During this period smoking declined precipitously and some data suggests that childhood obesity may have turned a corner, but HIV infections in young men of color who have sex with men continue to rise. It is difficult to measure to what extent these successes and failures can be attributed to fear-based campaigns, in part, because the campaigns were accompanied by other interventions like a cigarette tax and the distribution of free condoms. The authors note that scientific studies of fear-based campaigns around the world draw mixed conclusions: some reject the approach; others conclude that “the stronger the fear appeal the better.”
For generations of health educators, public health campaigns around health issues emphasized positive messages and highlighted healthy behaviors; the use of fear in was seen as counterproductive. 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 employing fear and graphic imagery.