Public Education & Health: How to Approach Disability Issues
The focus of my discussion will be limited to the experiences I have had in the field of social communication and the manner in which we project images of people with disabilities in our public service communication campaigns - particularly in the area of health education.
The issue of presenting positive images of people with disabilities in the media has been the focus of discussion and action by activists working in the field of disabilities. Disability Conferences such as this one a bound with powerful and inspiring examples of people with disabilities as leaders of society, as professionals, parents, advocates, artists... but how many of the participants come from any field of work unrelated to disability? In particular, how many non-disabled participants do we have from the fields of public health, basic education, from commercial corporations or the mainstream media? My fear is that in being so exclusive, we run the risk of preaching to the converted and thereby exclude a very large and influential body of people whose work affects our lives almost every day and who are, therefore, dealing with the issue of disabilities albeit in an indirect way.
By way of an example, for several decades, tens of thousands of people have worked in the field or preventive health. Their numbers are far greater than those of people working on disabilities projects. More importantly, perhaps, they reach and influence hundreds of millions of people globally through a massive network of primary health care projects. How do these health professionals and front-line workers perceive people with disabilities and what attitudes do they in turn communicate to millions of households around the world?
Each year globally, hundreds of millions of US dollars are spent on public health projects aimed at the prevention of polio, vitamin A deficiency blindness, iodine deficiency disorders and other such disabilities. Invariably, several million dollars are allocated to the public information campaigns that accompany these projects. Almost without exception in each of these campaigns, even today, people with disabilities are portrayed as helpless, hopeless, totally dependent on others, isolated and a burden to their families and communities. For example, a few years ago a poster produced by an international NGO urged people to eat green leafy vegetables to prevent vitamin A deficiency blindness. The main caption of the poster stated, "It is better to be dead than to be blind."
Let me hasten to add that the people who plan and execute these campaigns are not necessarily insensitive or uncaring. In many cases, their commitment and professionalism would be an asset to any project.
Why, then, does this happen and what can be done to prevent or correct it? Perhaps I can share a personal example. In the mid-eighties, the Government of India launched a nationwide child immunization program aimed at preventing childhood diseases such as tetanus, measles and polio. A critical component of this program was a massive public education campaign aimed at creating awareness regarding the importance of immunization. A behavioral research study was immediately commissioned to form the basis for planning the communication strategy. The results of the study indicated that mothers who had actively sought the immunization services i.e. those who had traveled long distances and gone through considerable trouble to get their children fully immunized, were aware of the fact that without immunization, their children could be disabled or die. As communicators, we immediately concluded that in order to spur people into action, we had to convince them of the disastrous impact of having a disabled child in the family. The primary strategy was to use fear as the motivation for action. We therefore sought and projected some of the most de-humanizing images we could find of people with disabilities. The message was clear and consistent: immunize and protect your child against crippling and fatal diseases. The campaign was simultaneously released on national television and radio, and through the press and printed media, thus providing us access to over a 100 million households. The results were predictable: people flocked to the health centers to get their children immunized.
It was only after several months, after a chance encounter with a disabilities and media specialist, that I realized the full impact of our negative, fear arousal strategy: despite our good intentions as far as child health were concerned, we had unwittingly also communicated and reinforced all the negative stereotypes that exist of people with disabilities being worthless, unwanted and a burden.
I was ashamed. Determined to correct the error, I started advocating for the positive portrayal of people with disabilities in our preventive health campaigns. My efforts met with little success. Program managers were sympathetic but reluctant to jeopardize multi-million dollar projects on the basis of a moral or ethical argument. After all, they felt, what were the sensitivities of a relatively small number of people compared to the "greater good" of the millions? Second, there were no models or prototypes available of health education materials which used a positive approach. "What do you want us to say?" asked one internationally renowned public health expert, "Your child has polio, Hurrah! Hurrah!?" Third, there was no research or empirical evidence to prove that positive images can and do work.
It was time to produce prototypes and test their effectiveness. Since polio was the most visible of the vaccine preventable diseases, we produced a series of both positive and negative public service (television) advertisements (PSAs) in Nepal. The negative PSAs used the stereotypical approach of treating the disabled child as the object of pity. The positive PSAs used people with polio talking about themselves and urging people to get their children immunized.
The PSAs were screened and pre-tested in 14 Focus Group Discussions and through over 220 individual in-depth interviews. The results indicated that both the negative and positive PSAs were equally effective in conveying the desired information and that audience recall was high. The difference, however, emerged when we asked the respondents what they felt they should do after seeing the advertisements. Respondents who had viewed the negative PSAs were more fatalistic: "We can't do anything now. This is God's will." However, respondents who viewed the positive PSAs said that they would ensure that the children in their community were immunized. We then asked the respondents which character they liked the most. Those who had viewed the negative PSAs selected a non-disabled person while those who had viewed the positive PSAs selected the disabled person because they felt he was socially responsible, helpful and giving valuable advice. Finally, on being shown all the positive and negative PSAs, the respondents were asked to select their favorite film. An overwhelming 80 per cent selected a positive PSA.
What are some of the lessons we derived from our rather modest experiment? I will select just three:
- Allow people with disabilities to talk for themselves - do not talk about them;
- Portraying people as the victims or as the problem robs them of their dignity and self-esteem. Seek examples of good practice and good role models among people with disabilities and allow them to present the case;
- Integrate people with disabilities into all media and materials - commercial, public service, even school text books. Just producing a few disability-specific materials will not solve the problem because they will be overwhelmed by the other 99 per cent of the media to which we are exposed each day and which are full of images of Barbie-doll women and athletic men. We must increase the visibility of people with disabilities in all our mainstream media and activities, just as we have started increasing the visibility of other marginalized groups such as girls, women and ethnic minorities. Visibility will lead to familiarity. Familiarity to a feeling of comfort, and comfort to acceptance and partnership.