Advertising, Child Development and Child Health, Education, Health Education, Media

Shame Won’t Make You Healthy. Really.

Some of you public health and social marketing gurus have likely already come across the recent slew of ads in Georgia, published by an organization called Strong4Life, that are ostensibly part of an effort to curb childhood obesity. A lofty goal, indeed, but a misguided approach, the criticisms of which have already begun. The images are pictures of overweight and obese children with a variety of captions, including “It’s hard to be a little girl if you’re not,” and “Fat may be funny to you, but it’s killing me,” and “Fat prevention begins at home. And the buffet line.”

Shaming rarely works as a strategy for behavior change. It’s been shown in efforts ranging from drug use behavior to HIV-prevention goals and marketing campaigns. If you click on the images in the Strong4Life campaign you get taken to video spots of these children, who seem burdened by sadness and depression (which can be both causes of and side effects of being overweight – exacerbating these emotional states does not help in weight loss endeavors). Recognizing if one is at an unhealthy weight is an essential step towards healthy weight loss, but the children do not appear buoyed by information, support, and new ideas on ways to be healthy. They seem downtrodden and embarrassed, the very characteristics that a shaming and body-bullying culture easily pounce on and cultivate. The video of Bobby, which portrays a mother who appears shamed by her son’s question doesn’t make me want to hit the gym or eat a platter of vegetables. Instead, the voyeuristic quality of the mock confessions feels more than a bit exploitative and it triggers a gut reaction of sympathy and protectiveness, making me want to yank the camera from the hands of Strong4Life. It’s like they took a message from the Jillian Michaels’ school of adding insult to injury, splashing in an additional dose of fear and intimidation, and expecting that this will result in a lifelong substantial increase in meaningful self-esteem.

The well-developed criticisms of this campaign point out that not only does shaming and negative marketing not induce healthy behavior change, but that these ads do nothing educationally. One girl near-tearfully admits that she gets made fun of at school because she’s fat, and the video slams down a tag line of “being fat takes all the fun out of being a kid” before fading out. While the Strong4Life campaign has a “Get Started” tab offering facts about nutrition and screen time and physical activity, the impact of the original image has already been made. Advertising relies on quick one-liners, on stark imagery, and emotional reactions. In this case, what we see is a tag line reiterating that this girl is not a normal kid, a solitary image of an overweight girl connected to an emotional plea on her part of loneliness and victimization. It’s powerful all right, but not empowering. The ad emphasizes fat loss, heightening the importance placed on size, instead of cultivating an interest in healthy lifestyles and appreciation of the fact that people come in different sizes and can be equally healthy. Critics of the appreciation-of-all-sizes approach say it borders on supporting obesity, which I see as short-sighted. Very high weight status can certainly indicate other problems, like diabetes, early heart and respiratory problems, and difficulties engaging in physical activity. But it’s also essential to make sure that the message that larger sizes are universally unhealthy is quashed, and it’s vital to promote instead that appreciating people of all sizes is essential – and more importantly, that valuing people regardless of size is a priority. This is a topic that deserves that kind of nuance.  I would welcome ads that excitedly show kids engaging in active lifestyles, enjoying sports and enjoying healthy, full diets – creating characters in ads that viewers want to emulate, as opposed to characters that viewers are meant to distance themselves from or who are meant to be repelling, is not only good business sense but inclusive and supportive. These ads further emphasize and underscore the cultural norm categories of “normal weight kids are normal” and “overweight kids are not normal and therefore not ok” – this certainly won’t help curb teasing or bullying in this arena. And since we do know that consistent, positive social support is one of the key factors in healthy behavior change, it’s obvious why public health experts met this series with skepticism. And here’s what else we know – healthy lifestyle changes significantly decrease mortality, regardless of baseline body mass index. Changes in fitness level are what alter all-cause mortality, not changes in BMI.

The response that these ads are cultivating “important conversation” is somewhat moot. It may get people talking, and it hopefully it will encourage media platforms with a larger audience than this blog to come out with constructive, evidence-based, supportive tips and strategies for a healthy lifestyle – but the fact remains that these ads are contributing to the negative, body-shaming noise that fuels so much of popular media and it remains that the effect can be really damaging and counter-productive at the outset. Individuals who ultimately are successful at losing large amounts of unhealthy weight (or who more consistently use condoms, for example) do so not merely because someone called them fat (or because they knew someone who became infected with HIV) – this has happened many times over to individuals seeking or needing to enact behavior change. The change happens because they not only begin to see themselves as deserving of these changes, but also because they become helpfully informed with concrete action steps that help move them through behavior change, are supported and consistently cheered on, and because they know what to do if they feel themselves slipping.

The bottom line is that discussions about healthy living need to happen to prevent long-term chronic health problems, and these conversations do need to happen early. But they shouldn’t start with shaming, embarrassment, or the putting on display of children who have weight problems and asking them to broadcast what’s so horrible about it while telling them that their love of the buffet is what got them to this point. We can do better.

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Child Development and Child Health, Education, Epidemiology and Population Health, Health Education, Politics, Public Health, Sexism, Women's Health

This Fight is Literally Never-Ending

The Center for Disease Control’s Division of Adolescent and School Health (DASH) will lose $10 million in funding if the Fiscal Year 2012 Omnibus Appropriations bill, which sailed through the House of Reps, comes to be. And to kick the prevention specialists at DASH while they’re down, the funding for absitence-only “sex education” will make an unwelcome return.

The DASH has proven time and again that the CDC, as well as state health agencies, are capable of creating health education initiatives that teach students and adolescents the best ways to stay healthy and prevent both chronic and infectious diseases. They have worked with school districts as well as other governmental organizations to not only create effective STI-prevention and teen pregnancy prevention initiatives, but also do an incredible job of monitoring the risky behaviors that teens are currently engaging in across the United States – including substance use and abuse, sexual behavior, drunk driving, physical violence, and depression and suicide, as well as tracking the rates of victimization that teens experience in the form of sexual assault and dating violence. Understanding how common these behaviors are, knowing in what areas and regions they seem to erupt more intensely, and determining what demographics on a national level are at greatest risk for some of these behaviors is essential for targeted education and prevention initiatives.

Without these prevention strategies, and without the ability to track the rates of risky behaviors to know how to develop such strategies, we will be left to treat the consequences (STI care, HIV treatement and care, babies born to teen moms), which are of course ultimately far more expensive. The CDC has (or had) the resources as well as the expertise with its impressive body of scientists and researchers, to do so. And lest we forget, abstinence only education? Doesn’t do teens any favors, and in fact leaves them woefully misinformed in how they should protect themselves when they do ultimately engage in sexual activity.

RH Reality Check details this upsetting news here. On the heels of Sebelius’ decision, this has been a pretty devastating month for adolescents.

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Education, Feminism, Health Education, Politics, Public Health, Rape and Sexual Assault, Reproductive and Sexual Health, Sexism, Women's Health

Sebelius Caves, Girls Pay the Price

By now, I’m sure you’ve all heard that Kathleen Sebelius, the Secretary of Health and Human Services, has blocked the recommendation of the Food and Drug Administration that the over the counter (OTC) drug Plan B, commonly known as the ‘morning after pill,’ be made available without a prescription for girls of all ages. It is currently available without a prescription to girls ages 17 and up, and requires a prescription for girls ages 16 and below.

It is worth noting that this is the first time a Secretary of HHS has overruled the FDA. This is not insignificant. The purpose of HHS is to promote the health, safety, and well-being of Americans. The FDA is an obvious component of this. While the FDA is an agency of HHS, the purpose of the FDA is to promote and protect public health, through the regulation of OTC and prescription medications, vaccines, food safety, medical devices, and more. They do this through clinical trials and testing, which is how we come to know of drugs’ side effects as well as how significantly they aid in the relief of what they purport to treat. The FDA recruits researchers who understand both the purpose of and execution of this research. Attempts have been made to loosen the regulations of the FDA; for example, some terminally ill patients have petitioned the FDA to allow them to access experimental drugs after Phase I of a trial – the FDA has denied these requests due to the lack of research regarding a drug’s long-term effects post- Phase I. The FDA is not without criticisms; they have been accused of being both too hard and too lax on the pharmaceutical industry. Members of the FDA have also expressed feeling pushed to present certain results. Scientists at the FDA complained to Obama in 2009 that they felt pressured under the Bush administration to manipulate data for certain devices, and the Institute of Medicine also appealed for greater independence of the FDA from the powers of political management.

The commissioner of the FDA, who is a physician, reports to the Secretary of HHS. Sebelius’ job is not one of medicine or research, and requires a background in neither. It does require a background in politicking, which is exactly what we’re seeing here. The purpose of pointing that out, and of articulating that this is the first time a Secretary of HHS has overruled an FDA recommendation, is that Sebelius’ refute would not be based on differing scientific results, or research that opposes the FDA’s recommendations – because there is none. The override has different drivers, and the assumption floating out there – for good reason, since there is little alternate explanation – is to appease social conservatives and the anti-abortion contingents.

Plan B is not the abortion pill. It is the equivalent of an increased dose of a daily birth-control pill, and has no effect on already established pregnancies – it prevents pregnancy from occurring. Scientists within the FDA unanimously approved the access of the drug without a prescription for girls of all ages, after an expert panel put the recommendation forward. It is, to quote a USC pharmacist, one of few drugs that is so “simple, convenient, and safe.”

The conservative Family Research Council claims that requiring a prescription will protect girls from sexual exploitation and abuse – I fail to see how requiring a girl to get a prescription will protect against sexual violence, especially since girls may be attempting to get Plan B because sexual violence has already occurred. This comment is also a flagrant indication of misunderstanding of sexual violence and abuse – a young girl is not likely to disclose to an unknown physician that she is being sexually abused or assaulted and that’s why she needs a prescription for Plan B. Make no mistake, this ban is a victory for anti-abortion rights activists. If a girl cannot prevent a pregnancy from occurring, she is subsequently faced with trying to terminate an existing pregnancy (again – that could have been prevented!). Given how reproductive and abortion rights have been systematically chipped away at for the past few years, this girl who did not want the pregnancy and tried to prevent it from happening but was denied because she is shy of 17 years, will be in an even worse position. This is what anti-abortion activists are counting on – that once she is pregnant she will have to carry to term.

Plan B can prevent abortions from happening. HHS, with its mission of protecting the health and welfare of all citizens, should do everything they can to protect the health of girls’ reproductive development, which includes the prevention of unwanted pregnancy at its earliest stage. The girls under the age of 17 who need Plan B the most are the ones who also need it to be as easily accessible as possible. Much like requiring parental permission for abortions for girls under the age of 18, this ban actually can put girls at risk. Many girls will not have the family support, financial means, or healthcare to manage a pregnancy; some girls may face parental and familial abuse if they have to admit to needing to prevent a pregnancy with Plan B. What if a girl is a victim of sexual assault within her family? Should she be forced to deal not only with this trauma, but also have to determine how to prevent herself from being forced to carry a fetus to term as a result of this tragedy? Most girls under the age of 17 do not have easy access to clinicians and hospitals on their own, nor are they able to navigate our increasingly complex healthcare system on their own, which they would not only need to do to access Plan B, but would need to do within 72 hours for the pill to be effective. Girls whose bodies are not ready for pregnancy, girls who were victims of assault and rape and incest, girls whose futures will be dramatically changed and opportunities truncated – they all become casualties of this ban. Before we start sex-shaming and proclaiming that they shouldn’t have had sex if they didn’t want to deal with the consequences, let’s remember that these girls were not miraculously impregnated. Whether consensual or not, a boy was involved. This is a gendered issue – the girls are the ones who will have to deal with the lack of access to Plan B, physically, mentally, and emotionally.

Originally, advocates in 2003 successfully petitioned Plan B to be available OTC for girls 18 and up (after having been available with a prescription since 1999), but a judge overruled that decision and lowered the age to 17 after he deemed the decision had been made politically, not for scientific reasons. It appears that history is repeating itself.

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Education, Feminism, Health Education, Media, Public Health, Sexism, Women's Health

Looking for More Attention? Drop Some lbs.

At least that’s what Skinny Water is promising in their latest advertisement, which I spotted yesterday. The ad shows a woman facing a throng of cameramen snapping her picture, elegant earrings dropping to the top of the headline which says: “Skinny Always Gets the Attention.” Take a look:

Thinspiration, thanks to Skinny Water

A close-up, to see all the text:

Close-up, for good measure.

Below the headline and photo of the various flavors, it also says “Zero calories, Zeor sugar, Zero Carbs, Zero Guilt.” With all that’s not in this water, you might wonder what it does offer. The website tells me that depending on the flavor of water, they’ve added vitamins B3, B5, B6, B12, C, A, and E. They’ve also thrown in magnesium, folic acid, calcium and/or potassium.

Despite trying to market itself as healthy, Skinny Water is instead perpetrating the cultural message that the best – nay, only – way to ensure that you get attention is by being skinny. This of course positions them well to try to push their product on those women who have been pulled into this lie. This ad tells us that the best way to skinny is not through healthy food choices and exercise and an understanding of what “skinny” means for our particular body type and shape, but essentially through fasting – which is what zero calorie drinks are the equivalent of.

In fact, Skinny Water is doing precisely the opposite of what a health-conscious company and product should be doing. Promoting the idea that those who are skinny deserve attention more than those who are not creates communities that support harmful diet-related behaviors and disordered eating for the goal of a wispy appearance . Not to mention reinforcing the ever-present undercurrent of disapproval of those who are overweight – or even normal weight! – and do not bow to the hierarchy of beauty that says those who are thin are the best. It’s just one more item in the laundry list of products that tell women their size and appearance are what is most important and will attract loyal friends and fans.

In defiance of that, let’s use our brains to remind ourselves why Skinny Water is wrong. While the website details the added vitamins and dietary minerals of each drink, it’s far better to get your needed supplements through a healthy diet rich in cruciferous  and dark and leafy vegetables, fruits, whole grain and lean proteins. Washed down, in fact, by regular old water that keeps you hydrated and helps your body process and absorb nutrients. Skinny Water is telling its buyers that by adding these vitamins and minerals to their product, one can cut out food entirely and survive on a calorie-free but vitamin-rich manipulated water diet. Don’t be fooled! (I know you aren’t. Hopefully, you’re equally horrified.) For example, the“Power,” “Sport” and “Fit” drinks are all fortified with calcium, magnesium, and potassium – to help activate metabolic enzymes, keep your blood regulated, and support strong bones and teeth. Do you know what else can do that?  Bananas, yogurt, kale, almonds and cashews, and quinoa. Frankly, there seems to be little difference between the “Power,” “Sport” and “Fit” drinks despite the claim that they each support different “goals” of the drinker – which lends support to the conclusion that these are madly marketed products that don’t substitute a healthy, well-rounded diet and instead are capitalizing on the now-entrenched notion that women care more about being skinny than anything else.

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Child Development and Child Health, Defining Gender, Education, Feminism, Pop Culture, Sexism

JC Penney Doesn’t Think You’ll be Very Smart. But you ARE Pretty!

I’m sure some of you have come across a picture of the t-shirt that JC Penney recently pulled from their website and for which they received a healthy dose of criticism and bewilderment. In case you missed it, take a gander below:

A picture of the unraveling of years of work, courtesy of JC Penney

On sale for girls between the ages of 7 and 16, we have a (100% cotton!) long-sleeve that says “I’m too pretty to do homework, so my brother has to do it for me.”

While I generally believe in giving people the benefit of the doubt, I find the trail of despair leading up to this travesty of childhood romping wear to be filled with too many witnesses to feel that this was done in error. Which, in turn, means that a lot of people at JC Penney thought this was funny.

This offense hits a lot of home runs – making ‘pretty’ and ‘intelligent’ mutually exclusive descriptions; saying that apparently being pretty is so exhausting and life-encompassing that homework just can’t be attended to (this particularly just doesn’t seem like a smart pic for a 6 year-old – if pretty is this exhausting, she’ll be burned out by 10); not-so-subtly prioritizing those batted eyes over brain activity; and, for the grand finale, adding that since being pretty is a lady’s job, the man has to pick up the slack in the smarts department. That’s a lot of manipulation for one t-shirt. You can be pretty but not also smart, being pretty takes a lot of work (doesn’t come naturally), pretty is prioritized and therefore takes precedence over being smart anyway, the boys can be the brains.

Taking a cursory glance over JC Penney’s other shirts, while the one above remains in a league of its own there are others that transgress the principles of healthy development. T-shirts that say “I’m a nerd” or “I love nerds” are the only ones in which the models are wearing  square-framed glasses; shirts that insert unnecessary interjections that should probably not be emphasized in written form, that say “Love is, like, forever”; and a shirt that shows a heart with a jagged line through it saying “if you break it, you buy it.” I didn’t know that a 10 year-old’s affection was for sale, much less that there was an insistence of ownership by the 10 year-old herself after she’d been emotionally trampled on.

Major retailers’ primary goal is profit – which means that while I’m not surprised that they aren’t particularly concerned with the social impact of their clothing, I do find it interesting that JCP thought these kind of dated gender messages would bring in the cash.

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Child Development and Child Health, Education, Feminism, Health Education, Mental Health, Politics, Women's Health

Abortion Isn’t That Simple, Mr. Douthat

Ross Douthat, one of the NY Times conservative columnists whose pieces I occasionally force myself to read, wrote an article yesterday about sex-selective abortion. In short, he claimed that the reason 160 million women were “missing” (that is, the reason they were so outnumbered in many countries like India and China, as well as other nations in the Balkans and Central Asia) was because they were “killed” via sex-selective abortion. In his words, the women weren’t “missing,” they were “dead.” (He also claims that the author of the book he cites, Mara Hvistendahl of the book “Unnatural Selection: Choosing Boys Over Girls, and the Consequences of a World Full of Men,” appropriates the issue to one of patriarchy, of greater social issues and inequities – which I agree with. He then says that “the sense of outrage that pervades her story seems to have been inspired by the missing girls themselves, not the consequences of their absence,” saying that she is more upset by the idea of abortion itself than she is about the issues surrounding abortion. Don’t you think that’s for her to decide? And doesn’t it seem she’s already decided what she thinks based on her book?)

Douthat, however, manages to contradict the crux of his argument near the start of his column.

He begins by saying “female empowerment often seems to have led to more sex selection, not less.” He then quotes Hvistendahl as saying “women use their increased autonomy to select for sons,” because male offspring bring higher social status. In countries like India, sex selection began in “the urban, well-educated stratum of society,” before spreading down the income ladder.

If this were the case – if in fact women had become truly empowered in their respective lands – culturally, politically, economically – then why would they be aborting based on the opposite – that men in their communities are still holding the cards? Are they imagining that men still hold positions of power and wealth in their countries, or are they living the ramifications of that painful reality everyday? Women do have some increased autonomy in many of these regions. But guess what? This autonomy has likely served to highlight the still very real inequities and disparities that exist in their communities, which contributes to the rates of sex-selective abortion. If women see which sex has the higher status, and one of the few autonomous decisions they can make is to choose the sex of their baby – they are likely going to choose the one with more status. This upsetting power dynamic shows just how far away true empowerment is for many of these women and their communities. If they felt their children would have the same opportunities if they were female than if they were male, the sex selection abortion Douthat decries would actually decrease. It is not the responsibility of the female fetus to ensure she is treated with the same respect and equality as the male fetus. Douthat seems to really care about female fetuses – but seems less interested in addressing the massive social, political, and economic issues that create so many difficulties for them once born. (His colleagues Paul Krugman and Nick Kristof seem to have handles on that. Too bad they were off yesterday.)

It seems that Douthat wants to push for the feelings of regret and remorse about abortion itself, separate from the issues surrounding it. Does sex-selection abortion sadden me? Yes. Does aborting a fetus that indicates it will have Down Syndrome sadden me? Yes. You know what else makes me sad? That a woman cannot afford a baby because she is single and has no familial or community support; because she has an abusive partner (homicide is the number one cause of death for pregnant women); because she has a low-wage hourly job that offers no maternity leave which could help her stay well while carrying the baby if needed; because she has no health insurance meaning she can’t access quality pre-natal care to make sure her baby would be healthy since we are systematically closing down those facilities that offer services for women who are uninsured (and also help provide birth control to prevent pregnancy!); because she has no way to pay for day care and she may have to quit her low-wage job to care for her baby; because she would then have no money for all the supplies, food, and developmental tools her baby would need to thrive which can lead to malnutrition, behavioral problems, child depression; because she could then become part of the 29.9% of families in poverty that are headed by single women, and her child could become part of the 35% of those in poverty who are under 18 years of age – the poverty rate for households headed by single women is significantly higher than the overall poverty rate.

We’ve cut child welfare services that aid women by the tens of millions in the past few years. Georgia alone cut over $10 million in Child Welfare Services. We’ve also cut subsidies that support adoption agencies – the organizations that help women find families that may be able to care for her baby were she to carry it to term – and who make sure these families are actually fit to do so! TANF (Temporary Assistance for Needy Families) provides women and families with aid so that children can be raised in their own homes or with relatives, instead of being placed in foster care and becoming wards of the state. How much have we cut from TANF? 17 of the poorest states, with some of the highest poverty rates in the nation, have already stopped receiving funds.

Birth control, one might say? Sure – birth control is expensive, so if she doesn’t have health insurance, she isn’t likely to be able to afford birth control (hey, Planned Parenthood can help with that, too! Seeing a pattern?) And if her partner refuses to wear a condom? If she is in an abusive relationship, if she fears leaving her partner, if she relies on her partner for added economic security – she’s much less likely to argue with him about the condom use. Or even feel that she has the agency to begin a negotiation discussion at all.

These facts make me sad. And all of these facts might lead a woman to decide she can’t have a baby. And many things not listed here may lead a woman to decide that she will not have a baby. And that she will have an abortion. Is it my decision? No. It’s not. It’s not yours or Ross Douthat’s, either. Again, Douthat represents the contingent of pro-lifers who want to make it seem like pro-choicers are cheering the performing of abortions right and left. What we are cheering is the right for women and respect of women to make their own decision based on their very specific personal circumstances. And given the fact that the medical establishment has not agreed with the pro-life camp in claiming that fetuses before a month into the third trimester can feel pain (reacting to stimuli does not equal pain, to reiterate, and pain without a cerebral cortex is seen by physicians as not possible), which has most recently become the pro-life camp’s wildly off-base rationale for preventing a woman’s right to choose, and given the fetus’ place of residence in the woman’s uterus as a part of her body, not as a human, these issues that Douthat sees as “sideline” are actually very much at the center of the argument. Bottom line – it’s the woman’s body. It’s the woman’s choice. She will be the one carrying it, she will be the one birthing it. No one else. So why should anyone else decide?

Additionally, it is not a crime for a woman to not want children. Since she is able to give birth, it is her decision as to when and how that will happen. Everything about her life and future will change once she has a baby. So she needs to be sure she is ready for that. How can one disagree with that? Douthat may not like it, but “the sense of outrage that pervades his story” (see what I did there? 😉 ) seems to me more rooted in his anger and frustration with his opinion not being considered by women in these decisions and not being able to control what a woman decides to do about what is going on in her body.

All of the things I listed – the job issues, the healthcare issues, the family and community issues, the issues that arise when a child doesn’t have access to food, clothing, and developmentally appropriate stimulation – are the causes. So why don’t we start figuring out how we can mitigate those facts and issues instead of attacking the effect – the abortion – which is a decision women come to after weighing all of those facts and issues just discussed. Douthat’s fear tactics of talking about female fetuses strewn across Indian hospitals is scary imagery. So is this:

Photo thanks to ehow.com

And this:

Photo via Captain Hope's Kids Blog

And this:

Photo property of streetkidnews.blogsome.com

Want less abortions? How about providing health insurance, that covers both birth control and pre-post natal care? How about equal pay for equal work, so women are more financially and economically secure, providing them with the resources to stay out of poverty and keep their children out of it, too? How about child care in work environments, helping women who cannot afford day care can stay in their jobs and remain a part of the economy? While we’re at it, how about great public schools and clean community centers, so women know their children are being intellectually fed and socially stimulated in safe environments that help keep them out of more dangerous and potentially life-threatening social circles? How about comprehensive sex education so men and women know how to protect themselves not only from pregnancies but from diseases that can endanger a fetus and create complications during birth and cause health issues for them and their children – creating more expense, particularly if one has no health insurance.

Let’s talk then. And how about you follow me on Twitter?

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