Sometimes you’ll hear reference to how an issue is “framed”.
This reflects the reality that news is competitive, stories have two sides and interpretations are relative.
Good public health advocacy is very much about how the narrative around a particular controversy or debate gets framed.
Look at the ongoing debate about the potential health benefits and risks associated with making vaping more accessible in Australia. It’s a good example of how proponents of different approaches frame the issue differently.
In summary, vaping (using e-cigarettes) with nicotine included is largely illegal in Australia, although some people manage to access nicotine legally via prescription or via certain imports provisions. Tied up in a range of controversies about benefits, risks and personal choice, is an ongoing debate about whether vaping is more likely to be a way “into” smoking (ie, as a gateway) or a way “out of” smoking (ie, by providing a significantly less harmful alternative to combustible tobacco for people dependent on cigarettes).
The enthusiasm on both sides of the debate is palpable and by mid February 2018 there was a clear political dimension to the issue underpinned by an ongoing parliamentary enquiry.
The anti-vapers have framed the pro-vaping crowd as funded by “big tobacco” who are re-using the tactics tobacco companies employed through the 1980’s and 1990’s to promote cigarettes (astroturfing etc). If they can successfully portray the e-cigs advocates as “shills” of the tobacco industry then they can effectively compromise much of the co-ordinated advocacy.
The anti-vaping crew did this brilliantly in an exclusive with the Sydney Morning Herald in mid 2017 which claimed submissions made to a parliamentary enquiry were facilitated by tobacco giant Philip Morris. This came as a complete shock to many vapers and defused the impact of hundreds of submissions made by honest, interested people who had no idea Philip Morris was even involved.
The pro-vaping crew frame the issue as a public health tragedy where “unelected nannie state advocates” are holding the political decision makers “to ransom” over an issue that will cost thousands of lives. They paint Australian policy makers as falling behind the innovative, liberal, evidence-based, rational approaches being introduced in the UK and elsewhere.
They are pointing to recent studies and saying “show us the risk”.
As each major report is release it is re-framed to suit the arguments of the different sides.
In January 2018, the pro-vaping crowd were celebrating a key conclusion from National Academies of Sciences, Engineering and Medicine (NASEM) report into vaping which found that there was “substantial evidence except for nicotine, under typical conditions of use, exposure to potentially toxic substances from e-cigarettes is significantly lower compared with combustible tobacco cigarettes”.
So they were likely surprised that their opponents had argued publicly not just that things were going badly for them that week, but that they were in the middle of their “pessimus sabbati” (worst week ever).
It’s an environment where counter views are framed as definitive. Arguments or claims by the pro-vaping crowd never seem to be simply challenged, questioned or put into context – they always seem to be “eviscerated”
For their part, the pro-vaping crew have tried to portray a lack of action on vaping as a “lost opportunity” and to paint the prospect of wider access to vaping as a kind of a public health campaign. All of this in the absence of strong clinical trial evidence that shows vaping can effectively help people quit.
So you get the point right? Pro-vapers frame vaping in the harm reduction/health promotion context. They are hankering for a campaign that would encourage intransigent smokers to switch to vaping. Those opposing think this would be irresponsible and put a tighter frame around e-cigs – arguing they are effectively quit smoking devices that should be tightly regulated in the same way as nicotine patches and gum.
So public health advocacy is not just about rational arguments. Because punters and politicians are not persuaded by rational arguments, science and evidence. They are persuaded by how things are framed. (Which incidentally is a shame given how much is at stake)
Who are the good guys? Who are the bad guys? Are the bad guys really behind what is being proposed? What metaphors help sell the benefits? How are the risks dramatized into consumer language? What creative epidemiology can be employed? How can we discredit the individuals involved? Who benefits? What strings are being pulled behind the scenes?
These are the questions that drive the framing of so many public health debates.
The language of health-related advocacy is not just the language of science and evidence. It is the language of rhetoric and persuasion.
It is evident on both sides of important debates about health funding, health efficiencies, cancer screening, medicines reimbursement and electronic health records. Hopefully you’ll recognise it when you hear it. No matter your natural leanings.