Who's Afraid of Noncommunicable Diseases? Raising Awareness of the Effects of Noncommunicable Diseases on Global Health

Figures & data

Table 1. Selected priority interventions for noncommunicable diseases

Prevention

• World free of tobacco by 2040

• Salt reduction to less than 5grams/day by 2025

• Promoting health diets and physical activity

• Reducing harmful alcohol consumption

Treatment

• Universal access to essential medicines and technologies

Figure 1 Mass education, fear, and public health promotion.

Table 2. Fright factors and media triggers

In their “Pointers to Good Practice” for communicating about risks to public health, the U.K. Department of Health identified a number of risk characteristics that make risks generally more worrying for audiences (U.K. Department of Health, 1997).

Fright Factors

Risks are generally more worrying (and less acceptable) if perceived:

1. to be involuntary (e.g., exposure to pollution) rather than voluntary (e.g., dangerous sports or smoking)

2. as inequitably distributed (some benefit while others suffer the consequences)

3. as inescapable by taking personal precautions

4. to arise from an unfamiliar or novel source

5. to result from man-made, rather than natural, sources

6. to cause hidden and irreversible damage, e.g., through onset of illness many years after exposure

7. to pose some particular danger to small children or pregnant women or more generally to future generations

8. to threaten a form of death (or illness/injury) arousing particular dread

9. to damage identifiable rather than anonymous victims

10. to be poorly understood by science

11. as subject to contradictory statements from responsible sources (or, even worse, from the same source).

Media Triggers

A possible risk to public health is more likely to become a major story if the following are prominent or can readily be made to become so:

1. Questions of blame

2. Alleged secrets and attempted “cover-ups"

3. “Human interest” through identifiable heroes, villains, dupes, etc. (as well as victims)

4. Links with existing high-profile issues or personalities

5. Conflict

6. Signal value: the story as a portent of further ills (“What next?”)

7. Many people exposed to the risk, even if at low levels (“It could be you!”).

8. Strong visual impact (e.g., pictures of suffering)

9. Links to sex and/or crime

Table 3. Risk framing and support for public health policy

There is considerable evidence that people presented with balanced arguments place weight on those they already agree with, exhibiting what is termed confirmation bias. A recent study from the United States randomly allocated one of four versions of an authoritative news story about diabetes to people who had declared different political allegiances. Each story was identical except for how they described the cause of diabetes. One said nothing about the cause (the control), whereas the three others cited genes, individual lifestyle choices, and social determinants. They were then asked whether they agreed with two statements on the reason people get diabetes, one specifying social determinants and the other genes. Democrats were most likely to agree that social determinants were a cause, regardless of which version they read. Independents reading the version where social determinants were the cause were more likely to agree with this explanation than those who read the control story, but the social determinants version had no effect on Republicans’ views. Each group was then asked about collective actions to tackle diabetes, such as restrictions on junk food. Democrats reading the social determinants version were significantly more likely than controls to support action but Republicans were less so.

Table 4. Selected tactics for generating a sustained, rational response to NCDs

• Evidence: disseminating the economic and health rationale for increasing attention to NCDs at the national level as well as evidence of how prior policies have reduced mortality and morbidity at affordable cost and, in some cases, with savings.

• Popular Education: mass marketing of the consequences of NCDs using emotive and recognizable symbols, not just evidence, focusing on three areas:

(a) complications of NCDs—such as blindness, impotence, and amputations in the case of diabetes

(b) inequalities in NCDs—emphasizing gross divides in risks among vulnerable groups and affluent ones

(c) human rights case for addressing NCDs—moral imperative to protect people's health from forces beyond their control

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