H1N1 versus Swine Flu: The public health perspective and the news media's fear tactics

A keyword web search of news pages featuring 'H1N1' returned 104, 283 results for the past month. A keyword web search of news pages featuring 'swine flu' returned 40, 092 results for the past month. As for the Web outside the news bubble, 'swine flu' returned 118,000,000 results and 'H1N1' returned 130,000,000 results for the past month. While this is not comprehensive, it indicates that professional media use 'H1N1' and that among laypeople the term 'swine flu' prevails.

The medical and public health community would prefer the term H1N1, as it is accurate and 'swine flu' is not. The US Secretary of Agriculture has released a statement asking the public to stop calling H1N1 flu 'swine flu' because it is adversely affecting sales of pork products. This virus is being compared to the influenza outbreak of 1918 rather than the outbreak of swine flu in the 1970's.

Regarding the use of the term 'swine flu' versus 'H1N1' in the popular media, Francesca Maresca, Coordinator of Health Outreach, Promotion and Education (HOPE) at Rutgers Health Services (RHS), said, "In general I have been very dismayed at the general media response to H1N1. In my opinion, it has been geared toward creating fear. When you look at the facts - 35,000 people die each year from seasonal flu. Do we see that in the news? No. What we see is the occasional horrible death and it is labeled as an epidemic. But it's not. From a public health perspective this is definitely a concern. How H1N1 actually manifests itself in the general population still remains to be seen. Yet the most basic public health messages are still the most effective preventive methods - wash your hands, cover your cough/sneeze, stay home if you are sick." For an example of flu information resources Maresca recommended Cornell University's Health Services website.

Cornell University's Health Services website offers downloadable flu awareness campaign materials. Cornell's materials are coordinated so they form a cohesive identity; the materials all feature the same fonts, match colors, have a template for layout and employ both the Unversity logo and a logo for handwashing promotion.

Cornell's "Rest Up" poster uses REST UP as an acronym to describe an action plan for people who think they may have the flu. Often when an acronym is used, the initials will be stacked directly atop eachother, like so:

Review your symptoms (by phone) with a health care provider...

Encourage your body to stay hydrated by drinking water...

Stay home (out of class, work, public settings) until you...

Treat symptoms (e.g., fever, cough, sore throat, etc.) with...

Stacking characters makes reading difficult; while a vertical orientation is natural for Asian-lanuage readings it is not so for readers of written English (an obvious reason is that characters in Asian languages signify entire words). This poster solves the problem of reader discomfort by staggering the initials and their lines like so:

Review your symptoms (by phone) with a health care provider...

Encourage your body to stay hydrated by drinking water...

Stay home (out of class, work, public settings) until you...

Treat symptoms (e.g., fever, cough, sore throat, etc.) with...

This system is more reader-friendly and inviting.

Rutgers University Health Services has devised a very appealing method of delivery this year, putting cold and flu care supplies in paper takeway cartons typically used at restaurants. Labels with the RHS logo and "Cold & Flu Care to Go" have been applied to the cartons, playing on the theme of convenience and comfort associated with takeout food―which, as everyone knows, college students love. These boxes are sturdy, economical, have handles for convenient carrying and are easily broken down for disposal and recycling. Or, they can be kept and used repeatedly. RHS will be tabling events throughout October for flu care, setting up outside dining halls and other locations. RHS also distributes materials through Residence Life.

My favorite thing about these kits is that they have a thermometer. I would be curious to know how many college students actually own a thermometer. Having a fever is often the surest sign of flu, so this is a big hurdle to overcome. This small tool that most people leave behind with their childhood homes can prevent a lot of contagion.

Only a legitimate scientific study would definitively show patterns of speech, but my perception has been similar; in the conversations I have overheard people have about the flu, they almost always use the term 'swine flu.' Because of my work with public health experts I know better than to do so, but I think I can understand the term's appeal. It may be the same sort of feeling people have about Mac's operating systems. Mac, as many know, has been naming their operating system upgrades after species of large cats (e.g., panther, leopard, tiger) and some people have no trouble conversing in these terms. Unfortunately for me as a Mac user, this is very confusing and I find numbers much easier to keep track of (I have had to say too many times, "...just tell me the number, please!"). The taxonomy of operating systems is a good subject for another day or blog, and whether users find cats or numbers more mnemonic would be an interesting study too. Did Apple, in fact, test this naming system on any focus groups before releasing OSX? Have public health or communications researchers studied the diffusion of acronyms or vernacular terms for illnesses in popular discourse?

WIC Loving Support Campaign

WIC is a U.S. Department of Agriculture Food and Nutrition assistance program for women, infants, and children up to five years of age. They initiated the Loving Support breastfeeding promotion campaign with the assistance of Best Start Social Marketing and the USDA's Food and Nutrition Service.

From their website:

Campaign Goals

1. Increase breastfeeding initiation rates among WIC participants
2. Increase breastfeeding duration among WIC participants  
3. Increase referrals to WIC for breastfeeding support 
4. Increase general public acceptance and support of breastfeeding
5. Provide support and technical assistance to WIC State and local agencies in the promotion of breastfeeding

Key Messages

1. Helping women feel comfortable with breastfeeding 
2. Tips on how breastfeeding can work around a busy schedule 
3. The involvement of family and friends to make breastfeeding a success 

I am happy to hear that the percentage of women adopting the desired behavior increased and that this seems to bear out the effectiveness of the intervention and social marketing in general. However, as someone trained in designing materials rather than marketing strategies, I was disappointed that I couldn't locate anything indicating the reasoning behind the design of their printed materials. I found extensive reporting on research design and peer counseling. I found nothing reporting on how their copy writing was tested or their images selected, nor was there an explanation of why the pamphlets and posters targeted to Native Americans were so different in look and feel from the materials produced for other English- or Spanish- speaking populations (those were the three categories for each item, examples are here: English, Spanish, Native American).

It is not my place to be culturally sensitive for a culture to which I do not belong, but I am concerned about the materials designed for Native Americans and would really like to see the design decisions explicated. It seems like a fine line between being respectful of traditional cultures and perpetuating stereotypes, particularly when the designer comes from outside the culture in question. Visual research would be appreciated in this scenario.

Also, I don't think I appreciate the use of Comic Sans as a text face on the Loving Support web pages. Babies cannot write yet, so it doesn't really say "baby," and I thought that WIC wanted people to take breastfeeding seriously. Comic Sans doesn't lend much credibility.

Another example of inappropriate use of Comic Sans: Comic Sans was used on official school forms sent home from a Montessori school with a friend's child (then a student there) and this struck me as inappropriate.

The widespread abuse of Comic Sans might have been something for the social marketing team to study before using in on the WIC website, if in fact the team was involved in the site. Sometimes these efforts are so splintered that identity guidelines get dropped between print and electronic materials. Professionals ought to be aware of the reputation of a given typeface and what it brings to a campaign, and Comic Sans being used as "default mode" for anything involving juvenalia has tainted it, arguably beyond the point of redeeming it for use on anything worth caring about.

Little things like reversing the order of copy and headline matter as well, like on the Native American "Embarrassment" pamphlet, where the copy "Don't shy away from breastfeeding." was well above the (display type-set) word "Embarrassment?" Unless the studies revealed something novel about how Native Americans read English or navigate a page of information, this is not a user-friendly arrangement.

Because I could not find the information about design decisions and because of the visual cues listed above, my suspicion is that the marketing team designed the materials and there were not 'pure' designers working on the team. Graphic designers, as a rule, are extra-sensitive to type and image and aware of the historic or cultural use of images and typefaces. Marketers have a different skill set and focus, and speak a different language. Something may have been lost in translation, which would be regrettable in light of the extensive communication research conducted for this project.