A Sydney Morning Herald article compares the top and bottom ten Sydney locations across five health outcomes and finds stark differences. But does this format miss the point?
Just to bookend my post about the lame new safe sex ad from THT that somehow fails to sell condoms, here’s a condom ad from Ansell that doesn’t sell safe sex.
Niall over at Dangerous Minds considers this a terrible failure; I’m not so sure. Ansell are in the business of selling their condoms, not safe sex generically, and their strategy here is differentiating SKYN condoms from all the others. It’s sex-positive and it’s honest: it says no more than what most condom users feel about them.
Unlike the THT ad this one makes an explicit statement about benefit: they’re different, ‘this changes everything’, and of course there’s the name SKYN (‘skin’). If someone else who hates condoms sees this ad, tries the product and likes it, there’s your safe sex outcome.
And while I’m not wild about the sexy half-naked woman making ‘come hither’ eyes, I’m pretty damn sure this ad is targeted at men, who still (in this century!) tend to buy condoms. And at least it’s showing a woman who’s definite about what she likes and dislikes. Just… what is she lying on!? Is that bedspread denim?
Just one teensy-weensy little irony here… SKYN condoms are the worst condoms I have ever used. They’re the only condoms I have ever found actually painful. I get that for the receptive partner all condoms can dry out and get grippy and become uncomfortable/painful. The trick is to apply reapply a good water-based lube before you feel any discomfort.
BUT – and here’s where it gets weird – I was the penetrative partner. We used them several times, and I suspect the thinness of the synthetic latex enables it to fold, causing crinkles that pinch the skin.
At the time, we were heading towards a relationship but it was still casual and we hadn’t been mutually tested yet, and the sheer discomfort contributed to some occasions of unprotected sex — only the second time in my life I have done that. But that’s a personal experience and your mileage (inchage?) may vary.
Last night I celebrated a good friend’s birthday at his sister’s restaurant, and this morning I woke with a marvellous hangover. I love an occasional hangover because they’re so reliably easy to fix: toast with marmite and Oxford marmalade, strong black tea, soluble aspirin, Lupe Fiasco, a hot shower, followed by phở gà đặc biệt and cà phê sữa đá for lunch and an afternoon nap. All these little rituals create an enjoyable program for an aimless Sunday. At some point during breakfast, I replied to a tweet by Salman Rushdie.
I was moving pretty slowly at this point and it took me a while to even notice he’d replied. When I did, what I noticed first was the massive derpstorm erupting on my ‘Interactions’ list. You know at a public forum, when someone up the back asks a question, the moderator usually repeats the question so the rest of the audience can hear it? The Twitter equivalent is retweeting someone before you disagree with them, so others on your stream can make sense of your objection. But Sir Rushdie didn’t do that: he replied directly to my tweet and his followers gleefully piled on, all of them tragically mistaken as to what I had replied to him about.
It wasn’t about the word, ‘heroine’. It was about his completely illogical argument:
Caster Semenya ran into trouble, if you’ll pardon a small sporting pun, because her performance on the field outstripped what’s expected of women athletes. An Observer article claims “The IAAF says it was obliged to investigate after Semenya made improvements of 25 seconds at 1500m and eight seconds at 800m – the sort of dramatic breakthroughs that usually arouse suspicion of drug use.” Yet the IAAF ordered gender verification testing and failed to protect her confidentiality in the process.
It’s impossible not to sympathise with Semenya over the ‘ordeal by gender’ she underwent. Nonetheless, to conclude that she was vindicated by gender verification testing would be to accord that process far too much credibility. It remains a deeply controversial procedure involving arbitrary line-drawing exercises amid the kaleidoscope of multi-factorial influences on primary and secondary sex characteristics. It was designed to pick out ‘impostors’ — people competing as women who were ‘really’ men — at a time when the sheer diversity and number of different intersex conditions was not well understood.
In the light of our new understanding of gender as a spectrum rather than a binary, ‘verification’ testing is begging the question. Let’s imagine the ‘verification’ test instead said Caster Semenya was intersex, or that her physical sex was male. To compete in the Olympics, she would first be required to undergo gender reassignment surgery. This is analogous to the social model of disability: the impairment isn’t purely physical; it’s equally caused by the impoverished concept of gender used in élite sport.
Hence the challenge I posed to Sir Rushdie: why support the system of binary gender differentiation that creates this kind of dilemma?
The answer has nothing to do with honouring Caster Semenya. If you read it carefully, his tweet makes very little sense. How can Caster Semenya be a ‘bigger heroine’ than two people not capable of being called a heroine? Unless gender doesn’t matter to heroism — in which case, why even register the difference? It would cost nothing and make more sense to write about ‘greater heroism’, but that wasn’t Rushdie’s real interest.
No, the answer comes from the delighted outrage of his followers. Sir Rushdie wasn’t offended by my tweet; he wanted an excuse to rant about “PC language policemen”. He was primed and ready to respond and didn’t even notice my tweet wasn’t about word choice. We’ve seen this before, when Justin Shaw and Ben Pobjie wrote about ‘hysteria’. It’s baiting up a crowd, getting them ginned up for action. And they lapped it right up: huzzah, a chance to rant about political correctness and prove I think alike with Salman Rushdie! Many of his followers were so concerned about the decline of the English language, they forgot to use verbs.
It was Britain that created a television show for Grumpy Old Men. And a spinoff, Grumpy Old Women. Given the thrust of this post, let’s collectively noun them Grumpy Old People, and permit me to abbreviate that to GOP. (Which may give you a clue as to how such people are positioned in American society.) Although they needn’t be old, there’s a strong correlation of GOP-ness with increasing age and self-importance, along with Relevance Deprivation Syndrome.
While I could quite happily watch 12 hours of Clive James in a sitting, his brand of mordant critique isn’t the usual fare on such television shows: instead, they’re invariably full of whinging about the price of milk (increasing) and the standard of English (declining). No, the essence of GOP is trivia, and that’s what’s so sad about this little tiff on Twitter. It’s Salman Rushdie performing cheap tricks for the peanut gallery; the smallness of it is depressing. This incredible writer, brain the size of a planet, seeming unable to perform the most basic forward thinking about ‘how my endorsement of wider gender norms might reinforce the specific instance I’m decrying’. Going from trolling an entire religion (if you’ll permit the exaggeration) to trolling a couple of feminists on Twitter. And when challenged…
Britain’s largest HIV organisation, Terrence Higgins Trust (THT), has just launched a new safe sex campaign advertisement, misleadingly titled “Condom Moment”:
New it may be, but it feels awfully familiar. For reasons I’ll explain, as a piece of marketing it makes literally no sense, but as a safe sex advertisement, it’s totally recognisable. That’s interesting in itself: it suggests the safe sex campaign has become a genre. Like harrried-mum-with-air-freshener and car-on-a-winding-road-with-Sting-or-Enya clips. No longer trying to persuade anyone of anything, you’re just taking up time before you shove your logo in front of the audience to maintain brand recognition.
That sucks because it seriously constrains your options for future innovation. It’s like the joke about two old men who’ve been fishing together for so long they have numbered their jokes. “No. 45! — and they both fall about. A new guy tries it on, “no. 92!” and they scratch their heads: “Are you sure you’re telling it right?”
As marketing this piece makes no sense because it’s a condom ad that fails to sell condoms. It starts with couples getting frisky in unusual places, then presents a slow-motion montage of grim faces, frowning, anxious, fearful, awkward, pulled out of the moment by a rising crescendo of worried whispered thoughts. As a fairly think-y person, this resonated with me; it often takes me a while to shut down my brain and just get in the moment. But then the ad ends and coloured text appears, telling the viewer to use condoms. And that’s not an ending, it’s a Powerpoint slide. Whatever happened to ‘show, don’t tell’?
The ad could have shown one of the partners whipping out a condom and the other showing visible relief and redoubled enthusiasm as their worries evaporate and they get back into the moment. You know, actually marketing the product, i.e. condoms, and the benefit, worry-free sex. Instead, they stuck to the genre of the safe sex PSA, concluding with an imperative textual instruction. At which point I was literally shouting at my screen and calling for the campaign manager’s head… I really need to dial back my coffee intake.
In the comments, someone objected to the stereotype of gay men getting it on in a toilet, and THT made a very telling remark in reply:
We agree it would have been fantastic to have more couples in different locations, but – with a limited budget and tight schedule – we understand why the team who donated the clip had to focus on the most visually compelling shots.
As a social marketer this rang some Big Ben-sized alarm bells for me. ‘Donated’ is not a good word in this context. It’s hard enough getting an agency you’ve commissioned to stick to the brief, as I have personally and recently experienced, but it’s even trickier when the agency is donating the work. You need a lot of clarity in the roles each party will play in co-constructing the message.
In this film, there is some evidence of front-end input of focus group or interview findings on the reasons people give for not using condoms, but it flubs the ‘product P’ — one of the most basic elements of the marketing mix. It looks like the film maker was either briefed badly or didn’t take the brief, but it ends with the THT logo and so they’re ultimately responsible for it.
In social marketing, diffusion is the hidden premise in nearly all our campaign strategies. After all, we set population-wide objectives for campaigns only funded enough to reach a tiny fraction of society at large. So if only 1-in-10 or 1-in-100 of our target audience actually sees our message — and I’m being optimistic here — how could that influence the other 9 or 99? The implicit assumption is usually that our message will ‘diffuse’, i.e. spread onwards and outwards through word of mouth.
There’s a theory that supposedly describes how this happens: Rogers’ (1962) Diffusion of Innovations theory. He studied how farmers came to adopt new technology for automated farming, and why some picked it up really early and others waited a really long time. He graphed the adoption curve and divided it into segments: innovators, early adopters, early and late majority, laggards.
The implication for someone who wants to start a trend is that you need to identify the early adopters in a population — people who have LOTS of social connections — and convince them, and then the other segments will follow like dominoes. This was certainly the message of Malcolm Gladwell in his book The Tipping Point, and both Gladwell’s and Rogers’ theories have turned up in massive RCT studies of community-level HIV prevention interventions, like Project Accept (Khumalo-Sakutukwa et al, 2008).
The problem is both theories are wrong.
Rogers just takes the normal curve and labels the standard deviations A, B, C, etc, and then assumes because A before B therefore A causes B. Post hoc ergo propter hoc. Gladwell assumes spread is determined by characteristics of well-connected, charismatic people (like himself). But as Duncan J Watts demonstrated in real time using 16 separate bunches of real people downloading, sharing and rating digital music tracks, it’s not about particular well-connected individuals, it’s about having a large proportion of easily influenced people that matters (Watts, 2001).
To use a disease metaphor, we’re not looking for superspreaders like Typhoid Mary — it’s about what proportion of your population are vulnerable (ie. not immune) to the message you’re trying to spread. This poses all sorts of really interesting questions for campaign planners.
One is: what would information immunity look like?
And another: how would I track diffusion of my idea?
At a very superficial level, as Tyler
Cowen Horan has shown, it’s possible to measure diffusion of links or hashtags on social networks like Twitter, using automated content analysis tools like OpenCalais and the publically available feed of all tweets for a given keyword. That will give you a quantitative and social network view of the spread of a particular marker of an idea. But it won’t give you any clear sense of how people are making sense of it. That first question — information immunity — complicates the hell out of the second one.
So I was interested to see friends on Twitter discussing changes to the Healthy Kids Check as reported in a Fairfax news article:
Preschool mental health checks by Jill Stark (SMH, 10 June 2012)
THREE-YEAR-OLDS will be screened for early signs of mental illness in a new federal government program that will consider behaviour such as sleeping with the light on, temper tantrums or extreme shyness as signs of possible psychological problems.
In particular, one friend had a problem with the idea that GPs might be using a 3yo wanting to sleep with the light on to diagnose a mental health disorder. A few different people engaged on three things I discuss here, and there was fruitful discussion about these aspects of the proposal, but my friend kept coming back to the 3yo wanting the light on. This particular example clearly resonated with this friend’s strong concern about the pathologisation of natural processes in parenting and child development.
For my part, I noted that it’s about identifying known precursors or risk factors for future mental health conditions, rather than the GP diagnosing a current disorder. This enables a ‘watchful waiting’ approach or possibly a referral to a child mental health expert for further investigation.
My own receptiveness (lowered information immunity) to the idea was increased by having recently read, shared and discussed on Facebook an article about ‘high reactive babies‘ — a temperament with a low threshold for alarm at small changes in environment, routine, noises, smells, that predicts anxiety in adulthood. This resonated with me personally, as a colicky baby who grew into an anxious adult with a touchy tummy and insomnia.
This research isn’t mentioned in the article but it’s clearly a really important piece of background knowledge needed to interpret the new information; without it, it’s hard to understand why a 3yo wanting the lights on is relevant to anxiety the disorder, rather than just anxiety as a normal and natural emotion known to be experienced by 3yo children in the dark. From a diagnostic point of view, it’s not the status of the light, on or off, that matters — it’s about the intensity of the anxiety and the strategies the child uses to manage the situation and their feelings.
Another key piece of background knowledge would be knowing that diagnoses are made based on the overall picture — the constellation of elements — whereas a screening tool developed with specialist referral as the intended endpoint will tend to pick out one or two key factors that are present in most cases of the disorder.
Both aspects are presented in the article, but they are laid out sequentially in quotes from different experts. This is journalistically unexceptionable: one is always going to have to precede the other, and it makes more sense to present concern before response, problem before solution. The problem lies in how it presents all three quotes as equivalent in authority:
- Prof Allen Frances, chair of the DSM-IV task force, author of a book titled Am I Okay? (Expressing concern about overdiagnosis of ADD and autism resulting from ambiguous definitions in DSM-IV)
- Anna Sexton from East Brunswick has children aged 3, 5 and 6 who all sleep with the hallway light on (Concerned this behaviour will be viewed as abnormal)
- However, Chris Tanti, chief executive of headspace, the youth mental health foundation (Says early intervention did not automatically lead to children being labelled; Quotes figure that only 19% of clients showing signs of mental illness end up with a diagnosis)
I guess you could argue that Chris Tanti gets the last word, but unlike in oral argument (think of the closing statement in a trial), in text there’s no guarantee the reader even finishes the article.
And thinking in terms of information immunity, let’s compare which ‘accounts’ (ways of telling the story) will seem most familiar (a key measure of susceptibility to persuasion) to an audience of parents: they’ve read lots and lots of articles about ADD and autism and overdiagnosis, and Prof Frances appears to be arguing against his own interests as a diagnostician(+10 credibility points!); Anna Sexton has read the same articles and shares the concern of the credible Professor, so she’s a caring and informed parent; whereas Chris Tanti is using numbers, talking about a scenario most parents don’t want to imagine ever applying to their kids, and his argument seems to suit his professional interests. In terms of who the parent-reader sympathises with, it’s two against one.
I’m not taking a swipe at Jill Stark. This is a conscientious, intelligent, balanced and cogently presented article about a really important policy proposal. Setting up that closing ‘conversation’ between the quotes about overdiagnosis practically guarantees it will be discussed by parents. It does better at provoking diffusion than most campaigns in my own field, which often foreclose on discussion by finding and presenting a ‘single [simple] minded proposition’ that nobody can argue with (and so nobody does).
But I’m worried by how that discussion played out in my Twitter stream. I’d like for Prof Frank Oberklaid, who mentioned sleeping with the lights on, to have some way of knowing that example backfired. I’d like for the people developing the policy to know there’s concern about a key question — who does the diagnosis, if any, the GP or a specialist? These are qualitative questions whose answers could feed back into better communication approaches and better health policy, if only there was some way to capture them…
A modest proposal
Imagine you’re about to send out a press release about a new campaign or policy initiative. You know it’s likely to provoke discussion, perhaps involving issues that are tricky to deal with in a standard health news article format. You’d like to see the discussion without engaging in surveillance of semi-private spaces like @-response discussion threads on Twitter. And you’d like the ability to answer key questions arising in the discussion — or at least to signal that you’ve heard and acknowledged them being raised.
This is not a technically difficult problem to solve. Let’s get a consortium of health communication practitioners and researchers and journalists together; Croakey would be perfect for this. The consortium builds a website where people launching campaigns or policy initiatives can register and create a landing page with a short URL, which they offer to health journalists to include in their articles. Readers can follow the URL to a page that lets them ask a question and receive a notification when an answer has been posted. They can also see other questions that have been asked, and vote on them if they had the same concern. Answers should be written by experts involved in the policy — they need to be substantive, as people can easily see through tightly-controlled PR responses.
I’d focus on Q&A and voting, as I’ve come to doubt the discursive utility of comment threads in this hyperpartisan era. And I’d want to let health journalists in on access to the usage metrics it would generate — after all, they need feedback too on what issues matter and how different article structures influence understanding and discussion of their work. In this age of the “Australian Vaccination (sic) Network” and climate change “debate”, the need for post-publication opportunities to answer questions and correct misconceptions is screamingly clear.
This is a more or less random assortment of articles that interest me, but if I had to pull a uniting theme out of my, um, brain, it would be the status of the LGBTIQ community in the present moment. That’s in relation to both mainstream politics in Australia and the United States and to the HIV epidemic.
Remember the bad old days when conservatives wouldn’t let teachers even mention homosexuality in case their students caught the gay? Well, the LNP in Queensland is clearly stuck in that era, claiming that QAHC’s concern for such things as LGBTIQ youth suicide prevention shows it has ‘lost its way’ — even though it was encouraged and funded to do these things by QLD Health.
Campbell Newman’s government has announced plans to replace the HIV prevention programs, but not the suicide prevention ones: it would rather gay teenagers kill themselves than tolerate the public visibility of healthy homosexuals telling them it’s okay to be gay. Which leads me to…
One of the most thoughtful contributions to LGBTIQ health debate I’ve read in a long time. In this account, gay marriage was a fight the conservatives picked with us – as Bill argues, they were looking for a political controversy that would sustain heteronormativity now that the closet doors had burst open.
What we might want to worry about, at this point, is the more sophisticated forms of social control that will inevitably emerge and follow in the aftermath of those blunt instruments, the closet and the fight over gay marriage. They’re likely to involve new ways of pitting ourselves against each other, instead of LGBT against the Religious Right. And they’ll be subtle, less visible. One of them, as gay marriage rights spread around the world, is most likely going to be a new puritanism about promiscuity.
If you’re an Australian gay man, I’d love to hear in the comments if you’ve heard about PrEP yet.
PEP is short for post-exposure prophylaxis, meaning you start a month-long course of 2 or 3 antiretrovirals within 72 hours of a possible exposure to HIV infection. PrEP stands for pre-exposure prophylaxis, where you take a 2-drug combination with very few side effects — one pill every day — before you have the sex that might otherwise cause your infection with HIV.
Given the expense of the drug, it will only be cost effective if it’s highly targeted, i.e. only available to people who would otherwise almost certainly become HIV-positive anyway. That’s also why its longer term side effects, like increased risk of bone fracture, aren’t more of a strike against it.
When the debate about this strategy finally hits in Australia, listen carefully for all those people saying ‘why can’t those filthy barebackers just be
boring married like me?’ That’ll be that puritanism I was talking about under 2/, above. Its consequences come through loud and clear in this frank and cogent account of a PrEP experience from an anonymous San Francisco man.