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Shock and horror

Learn how shock and horror were used as behaviour change tools for public health.
Alex Mold: One of the ways in which health educators attempted to get individuals to change their behaviour was through the use of shock tactics. In this step, we will take a look at some posters from the 1970s, 1980s, and 1990s that attempted to shock and excite feelings of fear discussed in response to particular public health problems. However, such tactics were not without their downsides, and we would also think about some of the potential negative consequences of such an approach. Let’s start by examining some images that were designed to shock the viewer. One area where shock tactics have been a particularly common approach is in anti-drug use campaigns.
This poster, which was one of a series produced by the Department of Health and the Central Office of Information, is designed to combat heroin use. The central image is that of a young man staring into the middle distance. He has a dishevelled appearance with greasy-looking hair and a faded t-shirt. The tagline, “Skin care by heroin,” directs the viewer to focus on his skin, which is pale, spotty, and the man has dark circles under his eyes. The text beneath the image reinforces the message, telling the viewer that if they take heroin, before long, you’ll start losing weight and feeling like death. The message is clear. If you’re offered heroin, you should say no, as heroin screws you up.
The image and the text work together to present a shocking image of what will happen to you and your appearance if you take heroin. An even more shocking image is presented in this poster from a few years later. The central focus of the poster is another young man, this time lying in a hospital bed. He appears to be unconscious and is surrounded by medical staff, who are attending to him. The man is also attached to various pieces of medical equipment. The viewer is clearly intended to believe that the man is in a very serious condition, one that will have lasting consequences for his health.
This message is reinforced by the text at the top of the poster, which states, “Drugs– sometimes the after-effects never wear off.” At the bottom, we are told that the effects can last forever. The poster appears to be using a shocking image in order to get potential drug takers to think about the consequences of drug use and how this may lead to serious illness and possibly even death. These tactics, however, could backfire. This poster and the one we just looked at on heroin were not taken seriously by some young people. Indeed, they actively reinterpreted the message of these posters. Some teenagers put them up on their bedroom walls to signify their rebellion.
One enterprising rave musician even used this image on the artwork for his record. Such free appropriations suggest that the shock tactics were too far moved from some young people’s real experiences of drug use and so were of limited value in persuading them not to use drugs. One of the reasons that the anti-drug poster campaigns backfired was because young people were not shocked by the images presented and nor were they particularly afraid of the consequences of drug use as depicted in the posters, because this did not match their lived experience. But attempts to shock and make the viewer afraid in order to get them to change their behaviour were not limited to anti-drug campaigns.
Health educators also made explicit use of fear in other areas too. Here, we have a poster intended to encourage parents to follow the medicines code and to make sure medication is out of the reach of children. The central image is of two small children, a boy and a girl, face down on the floor, surrounded by open bottles of pills. The tagline reads, “Will your headache be the death of your children?” The central message appears to be that being careless with how you keep and store your medicines could result in the death of your children. The text beneath qualifies this message slightly, telling the viewer that every year, children were treated for medicine poisoning.
All of this could be avoided, we are told, if we follow directions and store medicines properly. The viewer’s desire to protect their children from harm and fears about their safety are being called upon to deliver a message about the proper use of medication. A similar set of fears about the safety of children is also at work in this image. The poster was made in 1977 by the Central Office of Information for the Ministry of Agriculture, Fisheries, and Food. It is intended to warn people about the danger posed by rabies and, specifically, the need to keep the disease out of the UK.
The central image is that of a young girl shielding her face with her arm against a snarling and presumably rabid dog. The poster clearly plays on fear and the danger that rabies could pose, especially to children. But there are other fears at work here too, such as concern about Britain’s relationship with the rest of Europe. The poster’s message seemed so uncompromising and, dare I say, unsophisticated that to an early 21st century eye, it’s almost laughable. Indeed, the tone of the anti-rabies message has been subjected to a parody by the Scarfolk Blog, a website that deliberately parodies public information posters and 1970s publications. So once again, such tactics may have the opposite effect to what was intended.
Overexaggeration of the dangers may lead to a rejection of the overall message. Attempts to shock viewers into action were not just confined to fears about death. Another emotion made use of by health educators was disgust. Disgust has a long history in public health. Some evolutionary anthropologists even claim that we are hardwired to be disgusted by matter or material that will make us ill, such as faeces and rotting food. But disgust could also be drawn upon to deal with the threat posed by behaviours and chronic disease, as well as infection. This can be seen in this poster from 1988. Here we have a glass tube pouring a brown substance into a Petri dish held by a disembodied hand.
This, we are told, is the tar or discharge that collects in the lungs of the average smoker. It is no surprise, then, as the message at the top of the poster informs us, that smokers cough. The viewer is clearly meant to be revolted by seeing the tar, and this disgust, it is hoped, will motivate them to stop smoking. Another disgusting consequence of smoking is highlighted in this poster. Here we have a young woman smoking a cigarette. Above her head is the question, does it make my breath smell? To the right of her, the response is, “Not if I stand over here.”
But we cannot see the speaker, a motif that is meant to suggest that the revulsion with which the unseen respondent feels about the woman’s bad breath. The legend at the bottom of the poster states, “Smoking– who needs it?” The poster is intended to appeal to the desire of the viewer, not to disgust others, but also to be sociable and, perhaps, desirable. Yet there are potential negative consequences, which could arise from using such tactics. There is a danger that smoking and smokers may be stigmatised by such an image, something reinforced by the sense of isolation we gain from seeing the woman alone. Indeed, stigmatising individuals and their behaviours may not have been the best tactic.
Using such negative images could drive smokers further away from societal norms and, thus, the help they needed in order to give up smoking.
So although shock and horror tactics can certainly make an impact, as we’ve seen, they can also backfire. Some images may be reappropriated by certain audiences so that the original meaning is reinterpreted or even reversed. Shock and horror tactics may also overexaggerate the danger posed by certain behaviours, actions, or diseases, leading people to ignore the real risks. And overly negative images may stigmatise individuals and their behaviours, driving them further away from the help they need. But at the same time, shock and horror messages, by their very nature, are designed to provoke, and they can start a conversation on certain issues that may eventually result in behavioural change.

In this Step we explore some health education tactics used throughout the 1970s-1990s to elicit behaviour change. Here we see examples of various health education posters that attempted to shock and disgust audiences into practicing healthier behaviour. In particular, these posters were used for anti-drug use campaigns, anti-smoking advertisements and child safety. In this video we will also learn about the disadvantages of this technique.

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A History of Public Health in Post-War Britain

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