Peddling a semiotics of fear: a critical examination of scare tactics and commercial strategies in public health promotion

Abstract

In this study, we critically examine the ways in which a nationwide health promotion campaign – the 2013 Diabetes UK/Tesco diabetes campaign, the largest of its kind in the UK – seeks to raise the general public's awareness of Type 2 diabetes. We subject a series of six campaign images (including their layout and accompanying text) to a multimodal discourse analysis, identifying the presence of a range of fear-inducing, stigmatising and commercial strategies, through which the campaign emphasises the dangers of diabetes and advocates personal responsibility for assessing both individual and others' risk of the disease. Specifically, we describe, in multi-semiotic detail, three discursive techniques deployed in the campaign to achieve these ends: (1) the depiction of grief and amplification of diabetes-related danger, (2) the promotion of diabetes risk and localisation of individuals' responsibility for their health and (3) the commercial branding and framing of the Diabetes UK/Tesco partnership – including the promotion of goods and services – as a means of diabetes prevention and management. Our findings raise concerns about the moral legitimacy of using fear-inducing and commercial strategies in order to (effectively) raise public awareness of and responses to Type 2 diabetes, strategies which do little to address the environmental factors which are associated with increasing rates of the disease.

Keywords:

• commercialisation of health
• diabetes
• health promotion
• fear and risk
• neoliberalism
• critical multimodal discourse analysis

Acknowledgements

We would like to acknowledge the two anonymous reviewers for their insightful comments. Thanks, in particular, goes to the reviewer who took the time to assess their diabetes risk online, and whose reflective commentary thereof drew our attention to the mechanisms of the risk assessment and the inherent contradiction at the heart of this diagnostic tool.

Notes on contributors

Gavin Brookes is a doctoral researcher in health communication at the School of English, University of Nottingham. He is currently investigating the discursive constructions of diabetes and diabulimia in online health fora.

Kevin Harvey is a lecturer in sociolinguistics at the School of English, University of Nottingham. His specific research interest is in the area of discourse-based health communication, which includes corpus linguistic and multimodal approaches to health-related discourse.

Notes

1. Other factors associated with Type 2 diabetes include age, ethnicity and genetic susceptibility. It should also be noted that increases in rates of the disease might also be due, in part, to developments in, and the wide availability of, diagnostic testing.

2. Practitioners distinguish two types of diabetes: Type 1 and Type 2. Type 1 diabetes usually develops before the age of 40, and occurs when the body fails to produce insulin, which results in unhealthy increase in glucose levels. Type 2 diabetes – the more common strain – usually develops later in life, and comes about because the body either does not produce enough insulin or does not utilise the insulin that is produced (insulin resistance). Type 2 diabetes is often associated with obesity and a poor body mass index (NHS Choices webpage 2014).

3. We are aware that our initial description of the campaign images here already constitutes, as Barthes (1977, 33) observes, a metacommentary. Moreover, due to copyright restrictions, all the images reproduced in this article appear as illustrations. Accordingly, we refer readers to the reproductions of the originals which can be viewed directly at: www.pinterest.com/nhsinmanchester/talking-diabetes/

4. Hyper-palatable foods are those foods which require little chewing, are easy to swallow and typically low in nutritional value (http://www.nytimes.com/2009/06/23/health/23well.html?_r=0)

5. Interestingly, Wallis and Nerlich (2005, 11) observe that the metaphor “hit” is the most common term used to describe the action and effect of severe acute respiratory syndrome (SARS) in a corpus of media coverage of the disease. The authors note the way in which the infection is accorded an active role (SARS a killer), commonly constructed as a single, unified, lethal entity, a disease very much a “free agent responsible for its actions”, while those it affects are typically depicted as “passive, blameless victims” (Wallis and Nerlich 2005, 13).

6. This warning symbol is widely understood in Western cultures to communicate a warning to the viewer that something in their immediate environment is dangerous to them (Finan 2002, 17–18), in this case, evidently, their risk of developing Type 2 diabetes.

7. Synthetic personalisation is that communication (written or otherwise) which, although addressing a mass audience, is designed to make individual members of an audience feel as though they are being contacted on a personal and private level (Fairclough 1989), achieved, primarily, through the extensive use of first-person address and conversational linguistic style (Scannell and Cardiff 1991; Bell and van Leeuwen 1994; Garrett and Bell 1998). In reality, this implied personal, private channel of communication does not usually exist, least of all in public health awareness-raising campaigns and advertisements which are directed at mass audiences unknown, of course, to the text creator(s) on a personal level.

8. When going online to complete the risk assessment, as is advised in these posters, one is presented with yet more neoliberal rhetoric about diabetes-related health management. The questions in the risk assessment are concerned with mainly fixed biological factors, such as sex, age, ethnicity, height and, to some degree, weight. Yet, there are no questions about the availability, accessibility (and affordability!) of more wholesome food such as fresh fruit and vegetables where people live. These assessment criteria, by which risk is measured, serve to further deflect attention away from the environmental factors which contribute to the increasing prevalence of diabetes, firmly placing responsibility on the individual respecting risk management. Incidentally, even if one achieves a “low-risk” score, the user is still emphatically reminded, amid bursts of glib approbatory rhetoric, to keep up his/her standards, and that risk reduction is an on-going personal project: “You're doing a great job staying healthy! Remember to keep an eye on the factors that contribute to Type 2 diabetes, such as your weight and waist size”. It seems that, no matter who you are, no matter how low your “risk score” is, diabetes is still constructed as an ever-present threat to our health and hence, as neoliberal subjects, we are exhorted to be healthier. Yet the message is a contradictory one: the variables about which we are questioned in this risk assessment are largely out of our control, so while the responsibility of achieving and maintaining good health is formulated as an individual endeavour, the goals to which we are instructed to personally strive are ultimately unattainable.