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Column: Advocacy in Advertising? - by Kate Dieringer

November 27, 2014 - 20:41 -- Ingeborg van Schayk
This column was contributed by Kate Dieringer
Social marketing and media can redirect how we project and what we represent 
In my morning peruse of news and world reports (currently dominated by the Ebola epidemic), I trolled through the usual mélange of infographics, data hawking and compelling coverage of current events. One article caught my attention, touting a street art styled version of a presumably African child with a HAZMAT symbol over his mouth. The title leered at me from the top of the page, “From Miasma to Ebola”, and I didn’t have to read any further to be hooked into the author’s analysis of media, race and disease over the centuries.
You can read the nuances of the article from the link below, but the image was what drew me in initially. Alarming red splashed behind the child’s vulnerable face, his mouth silenced by the menacing symbol of disease and danger. Images wield power. Marketing a program or cause is an integral part of advocacy in global health. How can we as a professional community wield this power for ‘good’ instead of perpetuating fear and prejudice as the author of this particular article suggests? With social marketing becoming an integral piece of the strategy pie, we have much to gain by delving into how to get it right and do right by those represented.

Empathy’s evolutionary limitations
The marketing angle for fundraising in the nebulous world of global health is clever, strategic, and plays at our human core as tribesmen. We inherently identify with individuals and have immense capacity for empathy that at times leads to action. Empathy has limitations. Our internal barometer maxes out when victims of poverty and disease are grouped as ‘statistical victims’ vs the more identifiable, individualized portrayal that we see often in the media [1]. Limited social contacts fit into our survivalist conditioned, tribal circle. It is has been well established that we cannot conceptualize data that highlights the plight of the masses.  People respond differently to statistical vs individualized representations of burden of disease, take 750,000 malaria deaths vs one struggling child, for example. The public identifies with the child and can internalize their suffering in a more accessible way than we can for throngs of people. But how do we construct and disseminate an effective message without perpetuating fear of the other and evoking paternalism from the general public?
The narrative seen on webpages, buses and television usually reads like this, “Mary lives in Zambia and has 6 children, she suffers from x infectious disease and travels 14 kilometers to fetch water for her family”… and so forth, until the end goal of the campaign is presented to the audience. While organizations certainly need to grab the public’s increasingly distractible attention, this individualized pictorial of suffering inadvertently offends and exploits the theoretical ‘Mary’ and all those involved in the fray. Researches, policymakers, clinicians, community members all have stories; those could also be used to pull attention and resources towards diseases potentiated by poverty and inequality. Suffering is significant, pulls at our empathic human core and highlights the reality of inequality. But pairing reality with action and dignity paints a more vibrant, compelling picture.
Towards a positive change narrative
Neglected, and not so neglected, tropical diseases are suffering from a lack of innovation in branding. Perhaps it is time we took a look at rewriting the sick villager narrative, even if it is proven to ‘work’. Isn’t it just as compelling to showcase a team of collaborative partners, working towards improving delivery systems, diagnostics and treatment methodologies? Of course the patient or the global population is intrinsically at the center of the story. That fact goes without saying. But the strong circle working towards elimination of ‘x’ disease also could pull in clicks, currency and concern. Whether it is malaria, lymphatic filariasis or Ebola, these ‘tropical’ diseases are indeed in need of attention from the masses. How to drum up that response in a meaningful, positive way is the question.
Opportunity in the outbreak
With Ebola gripping the world’s attention, we have a current vehicle from which we can examine and critique this conundrum. Perhaps we can advocate towards a different depiction of the outbreak, and for diseases that disproportionally burden vulnerable societies and populations. It is also imperative that we address the fear surrounding the afflicted. In the States, media outlets hype the importation of Ebola as an African threat. This time, the message is not about feeling bad for people of Sierra Leone, Liberia and Guinea. The message is about feeling afraid that their plight can now reach those overseas. That is what is now motivating action and quite frankly unproductive panic. Governments didn't kick into high gear until the threat, or perceived threat, threw the response into the national security category. The current outbreak plays on prejudice and fear, while amplifying disparities in public health systems.  Is this “racist moral panic” something we can work to combat by advocating to transform media and social marketing in global health [2]?
With entire teams of public health professionals focusing on advocacy and social marketing, agencies and organizations have a responsibility, if not incentive, to change the narrative. We can add depth to the way we portray global health and even market need. Respect, and a more comprehensive representation of the global burden of disease, are top priorities for many. Diffusion in global health presents a charged, complex challenge [3]. Perhaps intensified attention to how the narrative is framed can result in a more respectful and powerful projection. Can we ensure this is integrated into the conflicting need to appeal to us humans, who are drawn in by a single tragic story and the human face of disease? Only time, and our collective response, will tell.
Links and references:
[1] Small et al. (2005). Sympathy and callousness: The impact of deliberative thought on donations to identifiable and statistical victims. Science Direct. Available online at:
The opinions expressed in this column are those solely of the author and do not reflect those of the author’s current or previous professional affiliations.

Kate Dieringer RN, BSN, MPH worked as a technical advisor for the Malaria Alert Center/Centers for Disease Control and Prevention (College of Medicine, Malawi) providing support for malaria programming and operational research initiatives in Malawi. Her background combines global health and emergency/trauma clinical services. She is invested in malaria prevention and control through community based partnerships, as well as health systems strengthening and investment in human capacity. Kate’s scope has focused on Latin America and the Caribbean and Africa regions involving HIV, malaria and maternal child health programming. Currently, she is working with Partners’ in Health Haiti on capacity building and clinical program implementation.