Fear as a Tool

angry doc was a little miffed at this advertisement when it first came out.



Certainly in healthcare we all use a little bit of fear and scare-tactics to promote health, but it seemed to me putting the ad through the point of view (and in the TV commerical, the voice) of a little girl and guilt-tripping parents is a little bit of a low blow.

Nevertheless there is a message there and awareness should be raised, and so I did not rant about it.

The ST Forum today carries a letter from another doctor who is also unhappy with the ad, but for a different reason:


June 26, 2006
Don't reinforce prejudices by using disabled people to put across message

Public communication campaigns are meant to provide information, correct misperception, influence perception and attitude, and encourage responsible behaviour.

In using the mass media to do this, the communicator has to balance the message with the execution of the campaign.

In public health campaigns, using the fear factor is an effective way to drive home the message.

In a recent advertisement promoting pneumococcal vaccination for the young, a child in wheelchair was shown as a victim of non-vaccination.

The vaccination helps to protect against peneumococcal infections and thus can prevent the severe complications of the infection.

Though this public education campaign has a good intent, it is important to use evidence-based cause and effect link (like smoking being the most prevalent cause of lung cancer) to put across the message.

Otherwise, advertisements based on small variables can cause unnecessary and unfair generalisation and stigmatisation of disabled people.

The advertisement portrays a direct cause-and-effect slant, giving the impression that people become wheelchair users as a form of retribution for not doing something right.

This impression can reinforce the notion that people with disabilities are a burden to society and also wrongfully place the blame of a person's disability on him or his family for their inaction in preventing his disability.

In fact, over 90% of wheelchair and mobility aid users can be attributed to accidents, cerebral palsy, muscular disorders, diabetes, stroke, and ageing (frail elderly) rather than as a result of non-vaccination. The advertisement also portrays a very depressing and introverted view of disabled people.

The child on wheelchair was shown to be very inward and was unable to play or participate in any activities with the sister. This again reinforces the stereotypical perception that a person who is disabled is doomed and cannot engage actively in mainstream society.

In 2004, a survey commissioned by the National Council of Social Service revealed that people with disabilities were generally thought to be dependent and as having poor esteem, and that they didn't have opportunities to interact with the public.

The survey showed that 74% of the respondents remarked that people with disabilities had greater difficulties coping with day-to-day demands of life and 50% thought that disabled people could not have the same ambitions as able-bodied people.

This is not unexpected given that some advertisements persist to reinforce such unfair and wrong perception.
It is unfortunate that today, despite having the right motivation and appropriate devices, a disabled person could still be handicapped because the society and community make it so, by projecting untrue stereotypes and reinforcing social and physical inaccessibility.

There is really nothing to stop a child with disabilities from participating in mainstream activities. Wheelchair users can play tennis, basketball, modified hockey and football, and even sail. Like it or not, there is implicit prejudice in us, bias that emerges from our unconscious beliefs.

We learn to make associations, for example, old with grey hair, thunder with lighting, and so on. If we really aim at being an open and inclusive society, then efforts must be made to eliminate as much as possible these unnecessary prejudices in all our public communication.

Could the advertisement have achieved its intent without singling out disabled people? We believe so.

Dr Ow Chee Chung
Executive Director
Society for the Physically Disabled


angry doc is confused.

As far as he could make out from the advertisement, the boy is unable to play with his sister normally because he has had brain damage from meningitis. He certainly didn't get the idea that all disabled people are a burden to society and that they or their family are all to blame for their disabilities.

Is it unfair to depict a brain-damaged boy in a wheelchair as being unable to play with his sister?

Will it be acceptable to depict the same boy, NOT in a wheelchair (and WITHOUT any physical disability), as being unable to play normally with his sister?

Is it wrong to depict physically-disabled people as being unhappy?

The physically-disabled do face many barriers and many prejudices in our society, but angry doc doesn't really think that this advertisement, disagreeable as it is to him for an entirely different reason, reinforces prejudices against them. People get the impression that physically-disabled people have a hard time in our society because they see them having a hard time in our society, not from a TV commercial.

Leaving aside the fact that physical disability in some cases is indeed a cause-and-effect result of preventable complications of diseases (e.g. in stroke, diabetes, and some accidents, as mentioned by Dr Ow), angry doc thinks it will be very hard for people in the health promotion business to do their job if people suffering from any condition may not be portrayed as being unhappy.

Should anti-smoking campaigns not be allowed to depict the sufferings of lung-cancer patients, because lung cancers are not invariably caused by smoking, and that some people view the dying process and struggle against cancer a noble 'learning process' and not necessarily a tragedy?

Should anti-drunk-driving campaigns not be allowed to show the aftermath of traffic accidents, because most traffic accidents are not the results of drunk-driving?

Should safe-sex not be a focus of anti-AIDS campaigns, because not all HIV transmission is through sexual intercourse?

I am sure you can think of other examples where the disease is not caused solely by the behaviour we are trying to discourage, or where the disease is not 'guaranteed' preventable by the behaviour we are trying to promote.

Does that mean that we should not depict patients and victims as patients and victims, for fear of offending sensibilities of those who fall outside our target 'cause-and-effect' group?

Will the day come when we no longer dare to portray certain groups of people in a negative light, even when the context is accurate, appropriate, and fair, for fear of public backlash, or being seen as being politically-incorrect or insensitive?

Perhaps the ad is not the only party using fear as a tool here.