Health promotion’s contribution to a “Culture of Fear”

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The resource I kept returning to in 2003 was Frank Furedi’s ‘The Culture of Fear, Risk Taking and the Morality of Low Expectation’. The concept of risk taking has always been part of health education and health promotion. It has been portrayed both in a positive sense, pushing oneself to limits in adventure activities as a personal growth experience; and also in a negative sense, viewing initial drug use of adolescents within a risk taking framework and proposing interventions aimed at stopping the behaviour. However, in ‘The Culture of Fear’ a shift in the portrayal of risk is elaborated, seeing it as an almost exclusively negative phenomenon - western societies’ fear of the taking of risks.

Fear, like risk taking, has also been an area of interest to health promoters especially the use of fear in mass media health campaigns. The thrust of fear in these campaigns is personalized, for example a car crash shown with the intent of conveying the message ‘if you drink and drive this will happen to you’. Furedi (2002) maintains that now fear does not operate through this personal experience approach. The defining feature of this new western view of fear is “the belief that humanity is confronted by powerful destructive forces that threaten our everyday existence “ (p.vii).

The media are replete with fear-based stories linked to health warnings, and health promoters have been drawn into the ‘be careful’ mantra. Simple generalized messages that emerge from the media’s stories minimize the complexity of the role of fear in health messages. Careful research has delineated the more detailed perspectives that need to be taken about the use of fear in health communications: How much? On what issues? To what audience? Through which medium?.

More importantly, Furedi (2002) challenges health promoters about the morality involved in their simple messages. He cites a campaign by the UK-based Health Education Authority (HEA) which helped to equate sunbathing with skin cancer, with the media establishing this as fact, despite the contrary views of specialist dermatologists. An important point Furedi (2002) makes is “Questions about what we give up in order to be safe are rarely explored” (p.38). This is a poignant reminder of the recent relinquishing in many countries of beliefs, behaviours and freedoms as a reaction to the global alert from terrorist activities.

In the field of health promotion, individuals, groups and populations are categorised by risk factors as if these risk factors act autonomously from the individual and their social context. Risk consciousness, Furedi maintains, has been adopted by health promoters. Its use creates a moral overlay to our practice. Deborah Lupton’s work is cited (1995) where she describes ‘healthiness’ replacing ‘godliness’ in the regulation of health behaviour and as the standard of living.

The Preface notes that whilst the earlier edition of the book (1997) concentrated on fear in relation to health, the environment, technology, new products and personal security this second edition (2002) includes how risk aversion influences interpersonal behaviour. This is an important perspective for mental health promotion and the global burden of disease. For example, in western societies we have a generation of young adults who feel at ease disclosing detailed personal information to the anonymity of an internet chat room, but in times of trouble, fear the physical presence of another, thus limiting interpersonal encounters and the opportunities for gaining support. Young people report being in an internet chat room as a positive experience. It removes the risk perceived in the ‘physical presence’ of another in an interpersonal exchange. This throws out a challenge to mental health professionals, whose training is underpinned by face-to-face ‘talking therapies’. In the next decade, will help seeking and help receiving be re-shaped through the practice of disclosure and personal encounters via electronic communication mechanisms; or will reliance on electronic communication increase loneliness and isolation of individuals?

Another perspective in the book that drew me in was discussion on the language we use to define and explain risk and how culturally bound that is. Additionally, the author points out, there is a dehumanizing aspect in the phrase ‘groups at risk’ – where lives are seen as circumscribed by specific risk factors. This puts limits on their agency and blocks an examination of their resilience. The language of risk and the preoccupation with risk factors limits a focus on strengthening resilience. Health promoters seem to have lost the focus on ‘well being’ and the desire to offer people opportunities to take risks as personal growth experiences. From a mental health promotion perspective, the exploration of life’s opportunities and experimentation is no longer viewed positively. Those who take risks are not seen as brave, but foolhardy. In western society the way risk is viewed has changed.

I hesitated to write about this book as my 2003 resource, fearing I was falling into the trap of enhancing the focus on fear, by buying, reading and reviewing the book. But risk is socially constructed and health promoters are active participants in that construction. For me the book has provided much food for critical reflection.

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