Public Health Ethics by Stephen Holland

Author:Stephen Holland [Holland, Stephen]
Language: eng
Format: epub, pdf
Publisher: Wiley
Published: 2014-12-04T00:00:00+00:00

Ethics and behaviour modification techniques

In order to pursue the ethics of behaviour modification we need to sketch out the main behaviour modification techniques (Callahan 2000). The focus in this section is on State-funded attempts at behaviour change. (Some of the techniques discussed here can be construed as nudges, the strategy for getting people to choose healthily favoured by libertarian paternalists, which was analysed in Chapter 4.)

Mass health communication campaigns

Health communication campaigns comprise the main type of State-funded interventions aimed at changing health behaviours. These include promotional activities such as health education, health information and health advice. Despite appearing innocuous, health communication campaigns raise some disquieting issues (Faden 1987; Gostin 2002a: 345ff; Salmon 1989; Witte 1994; Gostin 2000; Guttman 2000; Guttman and Salmon 2004). They can be stigmatizing (educating the public about AIDS is a well-known example; Douard 1990). More subtly, they can tacitly reinforce social conventions detrimental to sections of society (Saha 2002). Some health communication campaigns are simply patronizing, or otherwise offensive (Davis et al. 1995). They can be used cynically, as, for example, when politicians or the health service want to give the impression that a public health issue is being addressed, whilst knowing that the relevant campaign is unlikely to be effective: ‘The sad but plain truth is that a substantial proportion of the population is not interested in messages about their health if these messages prescribe a behavioural change. Health recommendations are mainly embraced by the healthy’ (Michels 2005: 3). In some campaigns, health promoters are tempted to indulge in deceptive devices, such as exaggerating the health benefits of behaviour change, downplaying or ignoring detrimental evidence, and using subliminal health messages (Campbell 1990; Johannesen 1996).

Social marketing is an aspect of health communication (Andreasen 2001). Commercial advertising and marketing are very closely allied to what health promoters are attempting in that both aim to motivate behaviours by manipulating preferences. Since commercial advertising and marketing are highly successful industries, it seems natural that health promotion has much to learn from them. However, this idea is troubling:

By imitating the techniques of the business marketer, who very often appeals to people's strong longing for social and, in particular, sexual success, one can more effectively make people change their lifestyles than by using the methods of traditional education.

Is this way of operating, in general, unethical then? (Nordenfelt 1995: 191)

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