Smokefree campaigns changed mindsets to keeping our children and communities safe from the harm of tobacco. We need a similar tide change in our thinking about the climate crisis, writes Jess Berentson-Shaw.
Climate change is the new smoking. Policy makers need to deal with it the same way.
This is the essence of an article that appeared in The Conversation. Dr Caroline Shaw, an expert in climate and health, laid out how we can apply the approaches used effectively to protect people and communities from tobacco companies and their product, to our climate challenge.
The Otago University associate professor of public health lays out the practical action people with the power to do so took, to prevent people being continually harmed by people in tobacco companies and their products. The public wellbeing “toolkit'' that she described helps policy makers, advocates, communities themselves, to actively build wellbeing and health in collaborative and the most effective ways.
The basics of this effective toolkit for building community wide health and wellbeing include:
- interventions at the policy level (taxation on tobacco products, advertising and sponsorship bans);
- creating environments that support being smoke-free (no smoking in public places such as bars, playgrounds, workplaces; plain packaging);
- community action (community-based tobacco control programmes such as Aukati Kaipaipa);
- reorienting health services to promote tobacco control by requiring health providers to collect and report on smoking status;
- helping individual smokers to quit.
This is exactly what policy makers need to do for climate change. Enough of the 'low hanging fruit' mantra. The urgency and scale of the challenge means now we must pick all the fruit and plant new orchards.
Applying this type of evidence-driven multi-levelled approach to climate change is exactly what policy makers need to do for climate change.
Enough of the “low hanging fruit” mantra. The urgency and scale of the challenge means now we must pick all the fruit and plant new orchards.
In other words we must now do all the things, and especially those things that make the biggest differences to the most people. For example large scale shifts of our transport infrastructure in cities and towns to prioritise walking and riding a bike, taxing carbon and pollution, and yes, banning advertising and sponsorships by people in the fossil fuel industry.
Put our innovative minds together and the number of activities and actions we can take at all these levels is massive.
The role of public communications
Dr Shaw also discussed the role that communications has played in this type of multilevel change work. Noting especially that recently mass media campaigns have tended to focus on individual behaviour change. Encouraging people to choose not to smoke, or choose to buy an electric car, for example.
But the dangers of such campaigns, she highlights, are that they increase inequity between people. People in governments may convince people of the need to change their behaviour, but behaviour change in an environment that is not supportive to change is far easier for those people who experience fewer material, social, educational, psychological barriers to do so.
So those who are enabled to change do, and those who are not are left further behind. This is exactly the worry with a focus on behaviour change communications aimed at encouraging people to buy electric cars as a solution to transport emissions.
However, there is another way to approach communication as part of an effective public wellbeing toolkit, and that is as a tool to build people’s understanding of and support for action at all the levels required, from policy change through to the reorientation of public services. This is the work of shifting mindsets to support structural or systems change. Because mindset shift, while less visible, is a fundamental part of an effective public wellbeing toolkit.
Large scale shifts are supported, maintained or eroded by the public mindset
Barack Obama, and any number of politicians in recent US history, have tried to fix the mess that is the US healthcare system. A system that is created for and works best for people who are wealthy, white and well.
The Affordable Care Act was enacted during Obama's administration. It was challenging and imperfect, but it gave millions of Americans access to healthcare, notably those who had been excluded because they were not wealthy, white and well. However, the health care system remains deeply problematic, with people in large corporations earning significant profits from people’s suffering.
There is little power in the hands of people or patients to advocate for a better system. Worse the Affordable Care Act remains at risk because the mindset about who “deserves” health care in the US has not changed. The mental models held broadly across American culture are ones about individualism, hard work, meritocracy. Good health is something you work for. Healthcare when you become unwell is something you earn, or come to deserve.
The narratives at play across that culture feed these, and are fed by such mindsets. Without a new public narrative to support mindset shifts, so people more deeply understand the collective benefit of socialised healthcare, the visible policy changes, the changes to the hospital environments, and community-based healthcare providers remain at risk of being dismantled. And further progress is hard to make.
The same applies to action on climate change, and all its related activities from transport, agriculture, building. Policy changes, physical environment changes, the empowerment of communities, and reorientation of community level decision making, need the support of most of (but not all) the public.
People in the public need to understand what changes will have the biggest impact, why we need them and who needs to act and how. Without supportive mindsets it is hard to get change through (the glacial pace of cycleway infrastructure in Wellington is one such example).
Alternatively the risk is that any changes that are pushed through without public understanding and support are rolled back or undermine the long term work.
Smokefree narratives and mindsets
The changes that we brought about through the various smokefree environments acts, across the 1980s and 1990s, were accompanied by increasingly powerful public narratives. Not only from mass communication campaigns, but from government, advocacy and non governmental groups, healthcare workers and researchers and communities themselves through grassroots activism.
Public narratives that identified who was being harmed, what changes were needed and who was responsible for both harm and the solution played an important role in influencing public mindsets and shaping action policy researchers found
These narratives highlighted the importance of protecting children, and people working in hospitality. Making our communities smokefree was framed as a public responsibility to keep non-smokers free from the harm the tobacco industry was causing.
It was not only about framing who needed to be cared for and what mattered most; better explanations were a strong part of the narrative and mindset shift. It was explained to the public how advertising and marketing and psychology used by the industry (such as colourful packaging, or famous people smoking) worked to hook children early to an addictive product.
While researchers and advocates spoke about the role tobacco companies executives took in covering up, minimising and obfuscating the science of harm from tobacco smoke. Building the public's understanding of how people with the money and means can manipulate information, political process and cause harm to communities, countered the “smoking is just a personal choice” narrative and mindset that will power alone would be sufficient.
The harm from tobacco smoke, the need to protect and care for people who did not have the option not to smoke, and the behaviour of people within the industry was clearly laid out by people across the sector. These narratives were not simply about changing individual behaviour (though there was plenty of that), they were about deepening public thinking and shifting mindsets.
Narrative work and mindset shifts are incredibly important today as our media and information environment has become more individualised and easier to manipulate with the advent of social media.
Such narratives were necessary, but not sufficient. Rather they were one part of the multilevel approach to building public health. They reinforced and were reinforcing of, the more visible legislative and environmental changes, like advertising and sponsorship bans. And helped to embed and maintain the changes over time.
There remain challenges in the smokefree space that we can learn from. Notably in relation to the uneven reduction of tobacco smoking. Young Māori women are exposed to the greatest harm from the tobacco industry today.
Questions remain about whether the unfavourable sentiments that arose in the public mindset towards smoking (and smokers) remains helpful to the work of reducing smoking rates in communities who need a culturally-specific approach.
To ensure narratives are working to bring benefits across our communities it is important to ask whose mindsets need to shift, and how and for whose benefit and should this work change over time?
Public mindset shifts are a science
The work of public narratives for mindset shifts today is more developed and the body of research much larger than those early days of smokefree campaigning. Narrative work and mindset shifts are incredibly important today as our media and information environment has become more individualised and easier to manipulate with the advent of social media.
As ideas of science and truth-making have been undermined by people holding fast to the status quo, supporting deeper public thinking is critical work. And as policy makers have failed to develop policies that reduce inequality, while continuing those that increase it, building public support for changes that make the biggest difference remains critical.
The work of mindset shifts, using communication and narrative strategies is long and deep, like all change work. But it's an important tool in the vital and urgent work needed to build public and planetary health and wellbeing.
