Three Issues for Health Promoters to Keep in Mind Health promoters are faced with a number of ethical considerations. Am

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Three Issues for Health Promoters to Keep in Mind
Health promoters are faced with a number of ethical
considerations. Among them is deciding how to warn audiences
without needlessly frightening them. They must also be careful not
to blame people for ill health, while at the same time encouraging
people to prevent any illnesses and injuries they can. All the
while, they must walk a fine line between making people con cerned
about illness and making them worried sick.
TIMING
When early evidence of a health risk surfaces, is it bet ter to
warn the public right away or to wait for more conclusive evidence?
This question poses a dilemma for health promoters. On the one
hand, researchers suggest that people are wary of premature
announce ments that are later shown to be inaccurate. Health news
writer Alan Rees (1994) contends that "the aver age individual is
caught in a withering crossfire of con flicting health messages and
is inclined to disregard them all" (para. 7). For example, people
were long urged to increase their exposure to sunlight to ensure
suffi cient amounts of vitamin D. Now people are encour aged to
avoid sunlight to lower their risk of skin cancer. Conflicting
messages such as these may confuse peo ple and cause them to ignore
health advisories.
On the other hand, it may take months or years to compile
conclusive evidence. During that time, peo ple may be exposed to
health risks they might have avoided. People are likely to be angry
if health officials are aware of potential risks yet do not warn
the public.
SCAPEGOATING
It is difficult to know where the responsibility for personal
health lies. For example, if children are not vaccinated, is it (1)
the parents' fault for not bringing them to a doctor, (2) the
government's fault for not providing neighborhood health services,
(3) the city's fault for not providing better public transportation
to the health unit, or (4) health officials' fault for not
educating parents about the need for immunization? Although all of
these factors probably contribute to the problem, part of a health
promoter's job is to identify the conditions that most need
improvement.
In doing so, however, it's easy to scapegoat, that is, to blame
one person or group for the whole problem. Scapegoating presents an
ethical dilemma. It makes sense to focus attention on the condition
or people with the greatest chance of making a differ ence. The
typical health-promotion message cannot describe all the factors
that contribute to a problem. However, focusing on one aspect or
group of people may seem to place blame (Burdine, McLeroy, &
Got tlieb, 1987). For example, a campaign that admonishes parents
to bring their children in for vaccinations may alienate parents
who don't have transportation to the public health unit and cannot
afford private care. These parents may feel frustrated and
criticized, and they may resent promoters' efforts. Second, people
not held to blame may feel that the problem is no lon ger their
responsibility. Ruth Faden (1987) asserts that government officials
sometimes promote the idea that people are personally responsible
for their health partly because this lets government off the hook.
There's little imperative to make sweeping social changes or health
care reform if it seems that health is solely the product of
voluntary lifestyle changes.
Evidence fuels both sides of the debate, suggest ing that
personal choices and empowerment are important to health but that,
at the same time, per sonal efforts are often constrained by
environmental factors beyond individuals' control (such as money to
afford medical care or sanitary living conditions). Health
promoters may find themselves trying to iden tify key objectives
without ignoring that every objec tive is intertwined with
others.
STIGMATIZING
Prevention is the process of avoiding undesirable out comes.
People wear helmets to avoid head injuries, they are immunized to
avoid diseases, and so on. Typically, the worse the potential
outcome, the more people try to prevent it. Therefore health
promoters try to motivate people by showing them how bad
undesirable outcomes can be.
The dilemma is that, in portraying some conditions as
undesirable, promoters may stigmatize some people as undesirable.
Guttman (1997) warns that campaign ers' good intentions sometimes
backfire when they make people so frightened of diseases that they
avoid the people who have them. For instance, an image of a child
with a disability may be frightening enough to make children
observe safety rules, but how are they likely to feel about
children with disabilities? The same dilemma applies to AIDS
publicity. People may become so frightened that they overprotect
themselves by avoiding people who have AIDS.
1. Should health promoters release information about potential
health risks immediately or wait for more conclusive evidence? How
long is it reasonable to wait? What constitutes conclusive
evidence?
2. Can you think of a way to promote public health without
seeming to place the blame on certain people or groups?
3. Do you think it is possible to warn people about health
hazards without stigmatizing people who have already been affected?
Why or why not?