Dr Lesley Henderson is reader in sociology and communications in the Department of Social and Political Sciences, Brunel University London. She lectures on Sociological Approaches to Health at the London School of Hygiene & Tropical Medicine
In an unprecedented move, prime minister Boris Johnson announced strict new curbs on life in the UK to curtail the spread of Covid-19. The public must now stay at home except for shopping for necessities, exercise, medical need and travel to and from essential work. Police can enforce these restrictions and disperse gatherings of more than two people (who do not live together).
This decision comes in the wake of images of young people partying in crowded pubs and nightclubs and families visiting seaside resorts over the weekend. These were at odds with the UK government’s advice to “flatten the curve” of Covid-19 by “socially distancing” from other people. Iconic beauty spots such as Snowdonia National Park were reportedly busier than at any time in living memory. These stories have attracted sharp reactions on social media. A Twitter hashtag branded it #selfish and described the people involved as #COVIDIOTS. On one hand, it seems extraordinary that some members of the public did not appear to take the pandemic seriously. On the other hand, their response can be more usefully seen through the lens of a government communications failure. It is worth contextualising this by considering what we already know about the dynamics of health, risk messaging, and public behaviour.
So what are some of the communication challenges specific to Covid-19? Firstly, regardless of whether the government has changed tack in response to changes in 'the science', the UK public has faced rapidly changing messages. These have been 'top-down' and frequently conflicting. The government initially focused on public health messages, such as the 'catch it, bin it, kill it' campaign and advised anyone who was unwell with a fever or cough to remain at home and not go to work or school. This shifted to warnings that over 70’s should self quarantine and shifted again to risks to children. This confusing discourse was accompanied by fragmented school closures. This means public health messages about the need for appropriate social distance were circulating at the same time as parents were expected to adhere to the usual regulations concerning school attendance. It is little wonder then that people could see no obvious problem with their children, or themselves, attending social events. After all, they had been free to mix as usual in schools, universities, offices, pubs and hotels which remained open for business.
It also seems extraordinary that little planning has focused on public communications, given that it is mostly accepted that media campaigns can change a population’s health behaviours. For example, the HIV and AIDS crisis of the late 1980s Don’t Die of Ignorance campaign and the more recent swine flu epidemic's Catch it, Bin it, Kill it campaign.
We have considerable tools at our disposable, well beyond health education leaflets posted through our letterbox. There is a unique opportunity for engaging diverse groups by learning from global awareness strategies. We have a variety of niche personalised messaging opportunities. Different platforms can engage different audiences. The fact that we are yet to witness a cohesive government communications strategy is alarming given the unprecedented crisis we face.
This gap is even more surprising as changing public behaviour lies at the heart of solving the crisis. Familiar handwashing tropes are being intertwined with new advice regarding physical contact. The emphasis on the term 'social' as opposed to physical distancing was a significant error because proximity does not align with social connection—ask any sociologist, anthropologist, or teenage gamer. We are being required to make sense of unfamiliar terms ('flatten the curve', 'shielding') prompting many to seek clarification, for example, on the differences between self-isolating and quarantine. At the same time, recent 'pro-social', 'pro-environment' behaviours need to be unlearned as they present new risks. So delivery drivers will not accept plastic bags for recycling, and nor will shops refill reusable coffee mugs. Spending more time in nature has only recently been promoted in terms of positive benefits to our well-being and now we are being warned that it is safer for us to stay in cities and towns.
While Covid-19 might be new, we already know a great deal about how best to communicate with diverse groups. Even so making a positive impact on behaviour, as opposed to reaching large numbers of people, is complicated. We need only look at the history of anti-drugs education, a classic 'top down' approach to find extreme examples of misguided health advertising campaigns failing to connect with their target audiences (iconic images became ironic pin ups). With the prospect of a safe vaccine still some time away, the role of the media is critical. Media representations play a vital role in informing public and policy opinions about the causes and solutions to ill-health. The media focus to date has been on the threat posed by so-called outsiders which fits neatly with a post-Brexit narrative and the British popular press. A related part of the problem is the intangible nature of a threat from an invisible virus. Any successful campaign needs to make Covid-19 visible with some attempts at this by inventive users on social media through short films illustrating how Covid-19 can spread through touch or conversely be reduced through self-isolation.
We also know that public health campaigns that fail to account for structural and material inequalities create challenges. Campaigns to encourage members of the public to compel their healthcare provider to wash their hands (prompted by SARS or H1N1) do not work, because they fail to address differences in power between patients and professionals. Requests to work from home, connect online and distance close family members ignore power differentials and assume social and cultural capital that is unevenly distributed. So far, messages have assumed that audiences are blank slates ready to be the recipients of health advice. Still, we know that understanding social practices, as well as myths and misconceptions are vital to successful public health communications.
The final challenge is promoting collective responsibility to the population rather than to the individual. Audiences have grown used to industry strategies campaigning around the 'principle of choice' which has been used to dismiss concerns, for example, regarding the global marketing practices of Big Food. UK audiences witnessed Boris Johnson’s apparent struggle with the idea of restricting personal freedom to contain the epidemic. These messages are clearly at odds with his libertarian beliefs, and successful communication requires trust in an authentic messenger (which is why the video message from NHS Belfast respiratory team may reap some rewards).
Media can undoubtedly help create new community norms, engage audiences in novel ways and bring about social change, but without recognising the social and cultural context in which communications are being constructed, received and distributed these are unlikely to succeed.
This opinion piece is republished from bmj blogs - read the full version here