Visuality in Contemporary Public Health Discourse

Phillip Quintero May 19, 2011

My goal here is to understand contemporary policy media through the interplay of form and content. This interplay is increasingly a dominant field of study, as evolving technology requires adaptive use of new media. All forms of advocacy are turning more towards mixedmedia content. Images, audio, and video are delivered constantly and simultaneously through television, computers, and mobile devices. People wishing to employ new technologies effectively debate the roles of sensory channels more rigorously now than was necessary or possible twenty or even ten years ago. New technologies change the ways we consider old onesthe advent of internet communication has had vast consequences for profitability and content delivery through television. Increases in bandwidth and processing capabilities have expanded the role of images and video online. Most recently, mobile use scenarios for consuming information are the dominant influence changing the way content conveys information. Therefore, we must continue to ask questions that challenge conceptions of the relation of form and content. We can no longer rely on traditional ideas about how people experience their surroundings. These are the ongoing tasks of research across industries: elections campaign managers, marketing firms, lawyers, salespeople, and academics alike. Across these fields of research there is an undeniable privileging of the visual. Recent literature has attempted to lay out various approaches to understanding this privileged position that the visual has vis--vis feeling and meaning. The relation of visuality and affect is a locus of scrutiny that I will bring to

bear on the political realm of public health. In this paper I consider two examples of contemporary public health campaigns that share a stated agenda, but vary greatly in their visual-affective components. I maintain that the more careful attention to the capabilities of visuality creates more acute affective results.

NYC In 2009, under the initiative of Mayor Bloomberg's administration, the New York City Department of Health and Mental Hygiene published a comprehensive ad campaign targeting sugar-laden beverages. The stated goal of the policy behind the Pouring on the Pounds campaign is the acknowledgement and eradication of epidemic obesity. Rather than providing a comprehensive vision of the components of a healthy lifestyle, Pouring on the Pounds argues that sweet drinks are a) a leading contributor to obesity and b) a surreptitious one. It is for this second reason that the use of visuals is notable. As put by the department of health, "Its hard to overeat without noticing it. By contrast, soda and other sugar-sweetened beverages can sneak up on you, adding hundreds of calories to your diet each day without ever filling you up."1 The goal of the campaign, then, is to make the viewer aware of the surprising amount that soft drinks, sports drinks, juices and other sweet beverages can jeopardize one's health. In one series of print ads, widely seen on subways and buses, various beverages transform into a liquid fat as they are poured into a glass.
1

http://www.nbcnewyork.com/news/health/Human-Fat-Poured-in-a-Glass--56361902.html Accessed May 17th, 2011

The image is at once simple and perplexing, displaying the kind of surrealism that contemporary digital imaging is capable of. The transition from tea or cola to fat is seamless the viewer tries to discern where the fat begins and the beverage ends. This seamlessness, which would be difficult to achieve with a physical model or a staged photo shoot, makes for a clear message: drinks are fattening. Other ads are more specific, targeting sugar as the culprit. One such ad shows a horizon of sugar packets being emptied onto bottles of sweet tea, lemonade, and cola, becoming the same fat as the sugar lands.

The intended effect of disgust is undeniably successful. The fat in the images is repulsive. The way it falls or slides down vertical surfaces conveys at a glance its viscosity. The fat is sticky, gelatinous. Lumps and waves are included as reminders that this is not to be misunderstood as the smooth and creamy thickness that is pleasing in a milkshake or creamy dessert. There is an inconsistency in texture here that is unsettlingthis is the kind of sticky thickness that we imagine onto cholesterol when we are told it sticks in our vascular system. To further the reception of this image as something damaging to our bodies, there are streaks of red, like the veins that run through our bodies, or the bloodlike liquid myoglobin that accompanies red meat. The fat exhibits a greasy sheen, and slides down the sides of the glass. The choice to make the glass overflow is consistent with the message of the adyour body is a vessel that cannot accommodate the calories delivered by 20 to 80 ounces of sugary drinks that New Yorkers are purported to drink on average per day. The designers of this ad chose to use a visually striking image that makes a clear message by depicting an impossible feat. A sort of perverse miracle, there is magic in this turning of Pepsi into fatI am struck by the similarities to contemporary visualizations of the story of Jesus' miracle at the Marriage of Cana. Magic realism is not a bad way to understand the effect of these ads, especially when taken in context. Even at poster size, having taken note of this image at all during a 7am subway commute speaks to it's efficacy where being noticed is a concern. The subway is also a striking context, being a moment the viewer is palpably aware of her own inactivity, and where she is likely to see the exact beverages depicted in the poster, whether empty on the floor, being consumed by fellow commuters, or in her own hand. Such moments highlight disgust in a very personal way, in which one becomes disgusted with oneself, for buying such a drink, with the corner store, for selling it, with the corporate soft drink

conglomerate for engineering and marketing such an effective addiction, and perhaps even with the government, for disrupting the morning routine with this awareness. Combined with the facts that over 4 million people ride the subway every day and that I, on my commute, have nowhere to escape to for the next 35 minutes, this ad campaign can be ensured of long, widespread exposure. As if to say that the image I have described were not enough, the NYC campaign also includes three video ads in the same vein. They serve to make explicit the imagery implicit in the printed images. The first is set against a stark white backdrop, as in a photographers light box. As synthetic horns play an upbeat melody, a hand opens an alumni can, and from it fat of the kind described above pours into a glass. Then, in a step that spells out the implicit connotations of the print ads, a young man drinks from the glass. Cutting in over the music, the viewer hears exaggerated, slow gulping noises. The fat quickly slides out of the glass, overwhelms the drinkers mouth, and drips down his face, onto his shirt. The music cuts, and a synthesized gong plays ominous tones to punctuate the caption, with the quantitative portions highlighted in magenta: Drinking 1 can of soda every day can make you 10 pounds fatter a year. Dont drink yourself fat.2 With this, a large volume of the fatsubstance, perhaps 10 pounds worth, falls onto and covers a dinner plate. The ad goes on to
2

NYC Health PSA 1, http://www.youtube.com/watch?v=Hjgew2ysFIQ Accessed May 16, 2011

recommend the viewer drink water, seltzer, or low-fat milk instead. A second video features the same man and the same music as the first. In this video, the man is sitting at a bar in a diner, opening and eating sugar packets at a feverish pace. The diners on either side of him look on incredulously, and the camera cuts to their disapproving smirks. The viewer, of course, identifies with these diners. Like them, we would be bewildered if someone were to eat plain sugar at all, let alone in such quantities. Both diners, however, sip their own drinks, and the ad goes on to point out that the viewer shares their hypocrisy: Youd never EAT 16 packs of sugar. Why would you DRINK 16 packs of sugar? There are 16 packs of sugar in one 20oz. bottle of soda. All those extra calories can bring on obesity, diabetes and heart disease.3 A third video narrates a day in the life of a hypothetical New Yorker. The video tries to show how habitually drinking sugary beverages can quickly add up. The video includes a still image of the equivalencyin this case, that five beverages contain the same amount of sugar as 93 singleserving sugar packets. The video goes on in a serious tenor to explain some of the health risks of high sugar consumption, including images of an obese man using a wheelchair, a foot that is infected and blackened from diabetes, a man under cardiac arrest, and a man in a hospital gown, representing a cancer patient. The video ads do not have the wide distribution or graphic detail that print ads have, but
3

NYC Health PSA 2, http://www.youtube.com/user/drinkingsugar#p/a/u/2/62JMfv0tf3Q

they do make a statement that is more explicitly aggressive. The temporal extension of images in a video allows for the use of narrative, perspective, and other techniques of cinematography to achieve varied impressions. The print ad is striking in the vein of magic realism; the paradoxical presence of a realistic yet impossible image in the most mundane of settings. The video presents a more finely crafted series of contrasts to make a similar impact. On one hand we have the happy campy music, the winning smile of the actor, and the colorful, appealing design of the cans and bottles. On the other hand are images of human fat and foot ulcers, facts with unsettling consequences, and the repetition of the medical havoc sugary beverages can cause. The Pouring on the Pounds campaign is indeed intended to be heavy-hitting.4 This is a remark appropriate to its dramatic visuals and specific target. The NYC Department of Health uses imagery to design a campaign that targets a single habitual behavior that it wants individuals to stop. Drinking fewer sweet beverages is the only thing this campaign suggests we do. To that end, it relies more heavily on the emotional reaction to its ads than the rational one. This is a consistently growing trend in public discoursewhat Lauren Berlant calls visceral politics.5 Berlant identifies a trend in political discoursethat there is a shift from the notion of a rational critical public to an affective public that sees political attachments as an amalgam of reflexive opinion and visceral or gut feeling.6 However, it would not be satisfying to leave our analysis at this level. That is to say, we gain very little from the insight that the visual component of the Pouring on the Pounds Campaign achieve an effect that is simply more visceral than is possible through text. The fact of the emotional responsea response that is dependent on the

As stated by Cathy Nonas of the NYC department of Health for Associated Press, http://www.youtube.com/watch?v=Hjgew2ysFIQ 5 Lauren Berlant, The Epistemology of State Emotion in Dissent in Dangerous Times. Ed., Austin Sarat. (Ann Arbor: The University of Michigan Press, 2005) p.46

visual in this examplecarries with it consequences for how we are to understand the politics of such a campaign. In The Epistemology of State Emotion, Berlant explains that the substantive distinction between rational and affective conceptions of a public is mainly normative: like emotion, cognition involves bodily response, but while emotional expressivity is deemed spontaneous and hardwired, cognitions conventional modes of response escape notice except when they are admired as fine manifestations of self-control.7 I am interested in this connection between normativity and affect. What does it tell us that this public health campaign choses to address people on an emotional level rather than a rational one? Affective strategizing is nothing new. Classical rhetoric acknowledges the power of an appeal to pathos. Politicians and corporations alike acknowledge emotional marketing as an indispensible strategy. I seek to explore these affective dimensions of the Pouring on the Pounds campaign. Included in the concept of a public service announcement is an appeal to changing behavior. New York City government officials are trying to improve the nutrition of New Yorkers. Why would disgust be an effective emotional response to seek out? It could be that the campaign embodies a behaviorist mentalityif constant associations are made between unsavory images and sweet beverages, individuals will develop a conditioned response. This explanation, while perhaps true, is not completely satisfying. There is something more going on in the ads with the specific targeting of sugar. Despite the ads negative quality (dont drink this), and the aggressive nature of ads that are intended to make the viewer uncomfortable, there is something empowering going on. The ads effectively
6

Berlant, 47

make sugar the culprit, not the individual. By focusing on sugar, and specifically on the deceptively high amounts of sugar that are in seemingly harmless beverages, the campaign allows a space for responsive rather than penitent reform. The viewer simply has to choose a different beverage. There is a kind of solidarity performed by the ads: the fact that sugar-related problems are depicted as common, easy to be unaware of, and easily corrected enables a more positive political response than the ads might at first suggest.

LETS MOVE Lets Move is a nationwide public health campaign begun by Michelle Obama in February 2010. The goal is to solve the epidemic of childhood obesity within a generation.8 While this is a similar, if not the same goal as Pouring on the Pounds, there are significant differences in the affective content of the campaigns.
7 8

Berlant, 47 White House Biography, http://www.whitehouse.gov/about/first-ladies/michelleobama Accessed May 18, 2011

Mrs. Obama says, This issue has been a personal concern to me because Ive got young children, and there was a point in our lives when we were probably like most families; two busy parents, not enough time to cook at home, eating on the run, and I started to see some changessome pointed out by our pediatrician, who suggested that we might want to make some changes. And I found that with a few small changes I saw some pretty significant changes in my children and I thought, you know, if I didnt understand how our eating and living patterns were affecting my children and my family, Im sure there are millions of other mothers who were in my position.9 Lets Move does in many ways make the issue a personal one. The campaign notably broadcasts a familial affect. Obamas role in the campaign is perhaps the most obvious reason for this. The platform of the Office of the First Lady is by definition one of a wife and, by custom, one of a mother. There is a precedent for such projects. First Ladies in recent history have championed movements such as environmental protection, volunteerism, drug awareness, literacy, and healthcare reform.10 Obama often cites her own family as the motivation for taking on the project of childhood obesity. She also repeatedly likens herself to American moms, with whom she empathizes over the difficulties of leading a healthy modern life. I do not suggest that Obama is to be equated with her office; her experience as a lawyer, Chicago Assistant Commissioner, and Associate Dean of Student Services at the University of Chicago are certainly qualifications for taking a hand in public policy. It is, however, striking that
9

Q&A with Michelle Obama: http://www.youtube.com/user/letsmove#p/u/26/nwzfFPkiKK0 Accessed May 16, 2011 10 Lady Bird Johnson, Pat Nixon, Nancy Reagan, Barbara Bush, and Hillary Clinton,

the Lets Move

campaign conveys a much more family-oriented approach than NYCs Pouring on the Pounds. The movement is centered around its Website, where visitors are encouraged to read facts about obesity, food and nutrition information, ideas for more physical activity, and how to start on the plan Lets Move proposes. The sight is of modern designsimple shapes, bold colors, organization that is clear and free of clutter. Comparing letsmove.gov to the equivalent space on the site of the U.S. Department of Health and Human Services shows a marked updating. The latter, older site is copy-heavy, has many disparate regions presenting a lot of information at a glance. The home page is build on gradients of beige, olive, and grey, and contains unlabeled frame divisions with dynamic content, meaning the home page will look different from day to day. The only notable color presence is in icons that link to sites for other government health initiatives, Lets Move included. I do not mean to make the point that the Department of Health needs a new web design, but rather use the fairly standard-looking government website to establish the context by which the Lets Move site is unique.

respectively.

The Lets Move site is designed with a family aesthetic. We can see that images of children pervade the site, with photo slide shows, animations and graphics that are visually appealing and simple. Each page within the site depicts a new, healthy childrens activity gardening, playing outside, sports, or gardening. A Lets Move photo stream continues the activities. In all of the pictures, Obama, children, teachers, athletes are engaged with one another, smiling, and moving. These images perform a distinct familial care. Opposed to Pouring on the Pounds, Lets Move demands the participation of parents and teachers in the fight against obesity. Also noticeably missing when compared to Pouring on the Pounds is aggression. There are no jarring images, facts confirming the status of childhood obesity are not presented in bold magenta, indeed there is almost nothing like the contrast, paradox, and disgust that characterizes Pouring on the Pounds. Contributing to the gentler affective impact of the campaign is the fact that fat is hardly ever mentioned. Obama is careful to reaffirm that the campaign is not about how kids look weight here is downplayed, it is simply an indicator of overall health. Obama mentions that she doesnt talk about weight with her own children, just health. The language of the campaign is also familiar, using words like kids and moms instead of children and parent. Where the Department of Health site encourages readers to Get advice on how good dietary habits can promote health and reduce risk for major chronic diseases, Lets Move has the simpler dictum, Eat Healthy. Lets Move also forgoes the individual responsibility featured in the NYC campaign.

Targeting children, the onus here is on families and communities to support healthy habits, rather than on the individual to avoid unhealthy ones. Obesity as epidemic (rather than fat-as-killer) is another feature which contributes to the shared framing of the problem. While both campaigns have the goal of eliminating obesity, the NYC campaign targets a specific behavior where the National one targets a national disease. Rather than targeting an individual behavior, Lets Move does propose a more pervasive influence. While small changes are emphasized, the campaign intends to influence children, parents, educators, and policy-makers regarding both nutrition and exercise. The differences in these campaigns are largely products of their visual components; the stated agenda is the same in each. This visual difference, however, is enough to inform the different receptions the campaigns have felt. Reception of the NYC campaign tends to focus on the form. The ads are contentious some applaud what they see as an effective message, others denounce the use of disturbing imagery. One result is that there are fewer challenges to content. While people may not feel that public health programs are not an appropriate function of a municipal government, there is no substantive critique of the campaigns message. Reception of Lets Move, however, ignores form entirely. Kate Harding published an article in which she, despite agreeing with the goal of the campaign, systematically challenges its premises.11 One satirical response depicts Obama as the character Fat Albert from a 1970s cartoon produced by Bill Cosby. Making Obama an obese figure herself responds to the copious imagery of her in athletic activities, and seeks to undermine her
11

http://www.salon.com/life/broadsheet/feature/2010/02/10/michelle_obama_weight Accessed

authority on the issue. The quote, on the other hand, alludes to Rousseaus anecdote of the French princess whose solution to starving peasants was to Quils mangent de la brioche. This is interesting, as the play on that quote likens Obama to a monarch who is out of touch and prescribes impossible solutions.

The stark differences between these two campaigns are best understood in terms of the affective dimensions achieved by their respective visual components. The Pouring on the Pounds campaign is a confrontational, sensational ad campaign that hopes to incite a positive reaction by working almost entirely through memorable visuals. The Lets Move campaign also intends to create change, but its visual components are secondary, in a way which supports the political platform of the program. It is encouraging for future discourse that, despite the disparate roles of images in each campaign, analysis of visuality in each can inform discussion of the way the campaigns make political impacts on the affective level.

May 15, 2011