Recently ABC news had a story about public school students complaining because the cafeteria lunches are too healthy and too low in calories. A whole serving of new school lunch policies has pushed food service directors to provide less fries, pizza and chicken nuggets, and more fruits, vegetables, and low fat milk. This comes on the heels of most schools eliminating junk food vending machines, and some schools putting stricter limits on food sales (such as bake sales) as fund-raising tools. While the lunch lady was never the most popular person in school communities, this raises a whole new regimen of rancor. Some students are resentful that they can't have burgers and fries for lunch every day, while other students are aggravated by what they see as force-feeding of vegetables. On top of these conflicts, some conservative parents object to the "nanny state and nanny school" interfering with the views and traditions of parents who believe they should be the driver of nutrition for kids. The health promoters behind the push for schools to be focal point in the fight against obesity perhaps feel isolated and unappreciated at best. It is much easier to produce and disseminate congenial PSAs, encouraging families to eat more fruits and vegetables.
Also this week there has been news coverage about a media campaign produced by Blue Cross / Blue Shield of Minnesota, highlighting the influence of parent's bad food habits as a developmental influence on kids. The campaign has become controversial because it is seen by some to shame and humiliate adults who are overweight. The producers felt that the extreme urgency of the obesity epidemic justified pushing the envelope of social decorum because many of the media messages used in the past were not working.
The issue is not a new one. During the 50 years of the anti-tobacco campaign, we've seen media messages making women blame-worthy for smoking while they are pregnant. We've also seen media pieces connecting cigarette smoking with male impotence. Such messages don't rely on guilt or shame, but are certainly provocative, deserving at least a PG-13 rating. Other messages have overtly associated marijuana use with a somnolent lifestyle leading to a dead end - a message some would find insulting or offensive.
So the question is, do health promoters have an obligation to be nice? How do we deal with the tension between respect and cultural sensitivity and the driver of our profession, helping people obtain and maintain better health? This is a professional dilemma shaping our identity. It is also an ethical issue, regarding recognizing a line demarcating effective practice versus guilting and manipulation.
Why do health promoters sometimes use these in-your-face tactics? Sometimes it is a lapse in judgement to resort to controversial approaches, because the epidemiology screams so loud, whether it is obesity, smoking or HIV prevention. Sometimes these messages are intentional as a way to break through the media clutter. Only provocative messages get more than a nanosecond of attention some times. In addition to grabbing peoples attention with health promotion ideas, controversial messages and approaches have a chance to create "buzz" leading to further discussions at home and at work. Most of the time, people talking about a health promotion theme is a good thing, moving people ahead in readiness to change.
Of course we have an obligation to treat clients and communities with respect and compassion. Overweight children and adults are part of a cultural minority group, facing their own set of discrimination and ridicule. We certainly don't want to perpetuate this, but neither do we want to be a Nero, fiddling while Rome burns. Much thought and wisdom are required.