Health promotion is an important step in preventing and screening for disease.
There is no doubt that “big names” can play a significant role in raising awareness of health issues. Whatever your views on celebrity culture, it has a profound ability to change our understanding and behaviour regarding diseases.
Angelina Jolie was, quite rightly, applauded in May 2013 when she revealed that she had undergone a double mastectomy after testing positive for an inherited mutation in the BRCA-1 gene. In Jolie’s case, it was estimated that the mutation gave her a more-than-80-per-cent chance of developing breast cancer.
It can’t have been easy to go public with something so personal. However, the genetics of breast cancer became a talking point, and Jolie was credited with bringing that about.
A study published last week in the journal Breast Cancer Research confirmed what has been dubbed “the Angelina Jolie effect” – since her announcement, and the media coverage, there has been a significant increase in the number of referrals for women in Britain to have the same genetic test. Demand almost doubled in the months following the coverage. A further analysis of the data showed no increase in inappropriate referrals, suggesting that it did not simply result in the “worried well” requesting the test, but those who would genuinely benefit. In all, there is no doubt that lives were saved because of Jolie’s decision to talk publicly about her surgery.
We’ve seen this sort of change in behaviour before, when soap operas flag up a health issue. It’s impossible to ignore television’s role in educating people and stimulating debate. Despite all the public health campaigns around HIV transmission, the peak in requests for testing came in January 1991, after the EastEnders character Mark Fowler was diagnosed with the virus. It was a similar story after Peggy Mitchell was diagnosed with breast cancer.
I was working in a dementia clinic at the time Mike Baldwin in Coronation Street was diagnosed with Alzheimer’s disease, and nearly every patient I saw spoke to me about it. In fact, whenever a celebrity speaks out about a condition they have, or a soap opera plot line tackles a disease, there is a spike in public interest. Charities report increased traffic to their websites, people talk about the condition with their friends and families, and inevitably more people present to their doctors asking for advice, reassurance or testing.
We have, by and large, swallowed the idea that all this “awareness raising” is a good thing, that we can never be too aware, too knowledgeable. We like the idea that someone else’s tragedy – real or fictional – can be made to have meaning for us all. It is reassuring that one person’s misfortune can be turned into a powerful public good.
But in the self-congratulatory puff that surrounds these periods of interest, I think we forget the transient nature of it all. Take, for example, the celebrity Jade Goody. A contestant on Big Brother (UK), she became a household name and was rarely off our television screens. She was diagnosed with cervical cancer and her diagnosis, treatment and subsequent death in 2009 from the disease was widely publicised.
The “Jade Goody effect” on the number of women presenting to doctors asking for cervical screening was remarkable. Between mid-2008 and mid-2009, more than 400,000 women came forward for screening. Among women between the ages of 25 and 29, more than 30,000 extra screening appointments were made in the five months before Goody’s death.
And yet research published last year showed that cervical screening had since slumped to a 10-year low.
The brutal truth about “awareness raising” is that it is temporary. The effort must be maintained. One celebrity or soap opera storyline does nothing in the long term to effect behaviour. Real behaviour change requires a far more subtle, sustained engagement between professionals, charities and the general public.
I worry that those who should be educating the public – namely, doctors and charities – have come to rely on the celebrity effect too much. We’ve stopped thinking of innovative ways to engage the public. The truth is that the world of celebrities is superficial and transient, and so is the impact they have on health.