Virtual Mentor. August 2007, Volume 9, Number 8: 583-590.
Use of Images in Public Health Campaigns
Illustrations that have commented on medicine and society have evolved over the last 150 years from being judgmental and harsh towards racial and ethnic minorities to now emphasizing the positive aspects of diversity.
Illustrations have long been used to make statements about the current culture—pop, political, or otherwise. In the past, these images, which included cartoons, commented about culture and society's often-negative perception of the "other," but today they are more culturally diverse and place higher value on ethnic and racial variety. Rather than advancing cultural stereotypes, physicians and government health officials now use cartoons and other visual media to encourage greater health awareness among the entire population. The evolution of cartoons and animated images effectively demonstrates shifting attitudes about the intersection of culture, society, and medicine.
Cartoons as a Social Barometer in 19th-Century America
Cartoons have been used by newspapers since the 1800s to offer stinging assessments of public officials and affairs.
The best known cartoons during this era began appearing in newspapers in the 1870s and usually presented strong views about "hypocrites, industrialists, the professions, the rich, the idle, immigrant groups, workers, and participants in the latest fads and fashions" .
The venom of the cartoonist's pen extended to medicine, physicians, and racial minorities and still managed to include some political editorializing. The general framework for these political-medical cartoons was "observation of a problem, fear of the spread of disease or injury, attempt to secure official action, anger at government's failure to act…and appeal to right-minded citizens for immediate action and for reform of government" . An example of this type of cartoon, entitled "Our Honored Guest," was drawn by Frank Bellow and appeared in Harper's Weekly in 1871 . In this image the Grim Reaper carries a doctor's bag labeled "cholera" and "Asia" through dirty streets in a U.S. town and is greeted by disheveled governmental officials. The caption of the illustration reads, "We bid you welcome believing that you will find the condition of our streets to suit you as well as anything in Asia" .
This particularly striking cartoon took aim at local community conditions, government officials, physicians, and immigrants. It reflected the common perception of physicians as more likely to be responsible for death than for its prevention, and it depicts the disdain that many citizens felt toward the national governments of both the United States and the country or area where a disease originated, believing that capitalist greed resulted in worse health for Americans.
It is interesting to consider how this cartoon might be re-drawn in 2007, given that the national attitude towards immigrants is particularly contentious. It should be noted that in the caption the cartoon did not address individual people, but rather geographical regions, choosing to comment implicitly about the type of people who lived in these areas. Given the political correctness of today's society, this cartoon would probably be found to be in poor taste, since purposefully portraying specific countries in a blanket, negative way is now frowned upon. In addition, doctors' skills are generally held in higher esteem today than they were 150 years ago.
Using Images to Educate the American Public
The use of images to draw society's attention to health and medicine moved away from the politically provocative newspaper cartoons and towards government-issued visuals during the first half of the 20th century. Between 1920 and the 1960s the United States government forwarded its public health agenda with the help of animated movies. These reels featured the work of Theodore Geisel, better known as Dr. Suess, who led the animation unit of the U.S. military during World War II; Walt Disney; and the creators of Popeye, to depict the dangers of stomach cancer, tooth decay, and tuberculosis among others . Many of these short movies were aimed at soldiers who were being taught how to
Soldiers, however, weren't the only intended audience. Immediately after World War II, messages about health matters peaked and "animation became the main medium for public health education" .
Despite the many benefits of this medium, it was not without problems. Public health images were often sexist or laden with stereotypical racial caricatures. For example, "in a 1942 film titled Use Your Head a marine in the South Pacific named Private McGuillicuddy defecates in the woods instead of a prescribed latrine. A fly with thick glasses and buck teeth spots the infraction and rings a triangle dinner bell shouting 'Come and get it' in a caricatured Japanese accent" . These movies, outdated by advances in medical prevention and treatment, described disease in alarmist tones. Donald Crafton, an animation historian, reflected that these older films "…tended to provoke anxiety about the body and its susceptibility to illness...But they also sought to reassure people that with proper vigilance—as well as the help of an expert doctor and new medical technology—dread disease could be averted" .
It is during this era of animated public health movies that one can most clearly see the shift from blaming the government and its policies for disease as it did in the 1870s to a more friendly view of government, in part, of course, because the government was responsible for creating these cartoons. Still the depiction of non-traditional Americans in unfriendly terms persisted and these films continued to rely on stereotypes and stigmatization.
21st Century Use of Images
In the 21st century, images have moved beyond paper and film and onto the Internet. No longer are public health messages packaged for young adults or soldiers but for children and those with low health literacy. Today's images are culturally diverse, and this diversity is portrayed as a positive asset.
An example of a modern, culturally sensitive visual that can help children and those with low health literacy can be found at www.bam.gov . BAM!, which stands for body and mind, is a government-sponsored web site that utilizes images, games, and words to increase knowledge about health and wellness.
This web site, unlike the aforementioned media, is interactive and features characters that have as much racial variety as those viewing the site. BAM! was created by the Centers for Disease Control and features a diverse group of superheroes (known as the Immune Platoon) who ward off diseases, a black tween (that is, a young person between the ages of nine and 13 years old) named Kendra who is the xpert [sic] on food and nutrition; Michael, a black tween and xpert on physical activity; Elli, a young skateboarding female with dyed hair and of ambiguous heritage is the safety xpert; Matt, the blond haired, blue-eyed xpert on "Your Life"; and Kristi, a young blonde female who is the xpert on "Your Body." Each character has its own page and gives advice using kid-friendly slang, visuals, and interactive games to convey specific messages to help members of the youngest generation improve their health literacy.
This web site also demonstrates how far the message of public health has come. These types of media address physical health, as well as concerns about peer pressure, safety, and stress. Modern-day cartoons are not being used to insult those of various races and ethnicities; minorities are now being portrayed as educated and friendly.
Cartoons and visuals about medicine have evolved greatly over the last 140 years. No longer are most still images tinged with criticism of the government, critical about the role that physicians play in disease management, and reliant on negative stereotypes to forward a public health agenda. Today's images are diverse, facilitate greater communication between patients and physicians, and promote health initiatives, perhaps nonverbally indicating that the importance of appealing to the society as a whole has been recognized. Similarly, public health images have come to embrace a multicultural America, showing children of different colors and ethnicities encouraging healthy everyday habits. Now, it is unacceptable for immigrants (or their home countries) to be portrayed as incubators for disease or for foreigners to be depicted in caricatured, almost-universally disparaging, stereotypic ways. Cartoons and images that portray public health messages are now inclusive of other cultures, reflecting the changing demographics of the country.
Allison Grady is a senior research assistant and assistant editor of Virtual Mentor at the American Medical Association in Chicago.
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