By Aoife O’Donnell, Lecturer, Public Relations Griffith College and Communications Consultant at Vital Communications.
According to the World Health Organisation (WHO), social stigma when related to health 'is the negative association between a person or group of people who share certain characteristics and a specific disease.' The COVID-19 pandemic has the potential to cause the stigmatisation of people for a variety of reasons such as race, health or a person’s propensity for travel or for wearing face coverings or not. In densely populated cities in Asia, mask-wearing is commonplace following repeated threats to public health in recent years. In Ireland, face coverings have been made mandatory in indoor locations where social distancing might not always be possible. A recent survey conducted for the Department of Health on almost 2,000 people revealed that approximately 55% are self-reporting to be wearing face coverings. This is not as high as it could be considering that there is mounting evidence from studies in Britain, Germany and the United States to indicate that face coverings are extremely effective in curbing the spread of Coronavirus. Such is the lack of enthusiasm for mask-wearing in Ireland that in a recent article in The Irish Times, journalist Bernice Harrison asked if ‘face masks could be this health emergency’s condoms?’ Harrison was referring to the AIDS epidemic in the 1980s when condom use was low despite evidence of their effectiveness in AIDS prevention. Following a highly effective advertising campaign that addressed public fears around wearing condoms, however, sales increased by 40%.
The lack of uptake for face coverings in Ireland could be in part due to the lack of clarity on the messaging and also due to stigma associated with mask-wearing in the western world.
The good news, however, is that the WHO has identified ‘regular and proactive communications’ as a means of reducing stigma. How can this type of communications be used in Ireland to reduce the stigma associated with and increase the regular wearing of face coverings by the Irish public?
Language has the power to encourage and perpetuate stigma and from the outset, it has played a big part in the communications around the pandemic. Throughout the pandemic, President Trump has repeatedly referred to the Coronavirus using racist expressions such as the ‘Chinese Virus’ and other terms. Civil liberties groups amongst many others in the US and elsewhere were outraged by this and have warned that such language may inspire racism and violence. On the other hand, examples of positive language used during the pandemic include ‘shielding’ or ‘cocooning’ to describe keeping older or more vulnerable people safe and ‘staycationing’ as a term to describe being responsible and choosing to holiday at home. Although useful in simplifying the message for different groups of people, these words do also risk causing stigma in themselves. For example ‘cocooners’ could be viewed as riskier to be associated with and as a result, others might avoid them thus increasing their sense of loneliness and isolation. Similarly, people with foreign accents could be deemed to be international tourists who are not ‘staycationing’ in their own countries and therefore discriminated against when out in public. In relation to face masks and language, at the outset of the pandemic when supplies of medical or surgical masks were limited, officials introduced the term ‘face coverings,’ presumably to ensure the public used other types of coverings rather than risk a worldwide shortage of surgical masks. This seems to have been an effective strategy with people now wearing all types of cloth masks and coverings as well as medical masks.
The WHO recommends what it calls a ‘people-first’ language across all communications channels to reduce stigma. It states that the language used should respect and empower people and it stresses the important role that the media plays in using this language to positively motivate and protect people from stigma.
Real Voices and Case Studies
The use of real voices or, as they are sometimes referred to in public relations, case studies, can help to reduce stigma. This tool has been widely used throughout communications and particularly in areas such as mental health. Through the sharing of experiences in the media, people who have had COVID and recovered or who have worked with people affected by COVID can help to remove some of the mystery and fear surrounding the disease. Since the onslaught of the pandemic, we have seen numerous stories in the media of people leaving the hospital after treatment or some of the first cases explaining what the experience had been like. We have also heard stories from the healthcare workers on the frontline. In Ireland, data from the Health Protection Surveillance Centre revealed that Irish healthcare workers accounted for approximately 32% of all Ireland’s COVID-19 cases. The WHO states that “hero campaigns” should be implemented to ‘honour caretakers and healthcare workers who may be stigmatized.’ We have seen this response taking place in countries throughout the world, from the singing on balconies throughout Spain and Italy to #clapforcarers in the UK.
Celebrities can play a vital role in assisting in breaking or reducing a stigma. If you see your favourite film, music or sports star doing something, you may be more likely to engage in a similar behaviour or activity. For example, after TV star Jade Goody’s death in the UK in 2009 from cervical cancer, the NHS reported that half a million more women than usual booked smear tests. This became known as ‘The Jade Goody Effect.’ Similarly, the ‘Angelina Jolie Effect’ has been used to describe the increased internet searches in breast cancer genetics and testing in the US following her well documented double mastectomy. This is why celebrities are sometimes referred to as ‘role models’ and why ‘influencers’ have the power that they do. They have the ability to motivate people to change their attitudes and behaviours. In relation to face coverings, an example of the ‘celebrity factor’ can be seen in the highly publicised court appearances of Hollywood actors, Johnny Depp and ex-wife Amber Heard. Attending court in London, the pair were filmed and photographed wearing a variety of bandanas to cover their faces. Their appearance along with sightings of other similarly styled celebrities prompted the following headline in the Independent in the UK: ‘Celebrities have spoken: The bandana is officially the trendiest Coronavirus face mask.’
Communication of Facts
At one stage during the pandemic, the WHO reported that ‘an "infodemic" of misinformation and rumours is spreading more quickly than the current outbreak of the new coronavirus.’ The organisation stated that we need ‘clear information and collective solidarity to tackle misinformation that can contribute to stigma and discrimination.’ Tackling misinformation and clear communication is an area in which Ireland has performed extremely well during the COVID-19 pandemic. However, the communication around face masks or coverings has been less clear. In the media some health experts support the widespread and in some cases mandatory wearing of face coverings while others have debated their efficacy. On social media, conspiracy theories abound with some commentators citing mask wearing as an attempt by governments to control people.
One of the most effective responses to the containment of a disease in modern times was seen in Nigeria’s response to the 2014 Ebola outbreak. According to the WHO, in this outbreak, Nigeria succeeded in successfully curbing the spread of Ebola, in part through its targeted campaigns. In these campaigns, non-governmental organisations (NGOs) engaged celebrities, bloggers and influencers to communicate facts and address misinformation, rumour and hoaxes on social media.
One of the core functions of public relations is persuasion and one of the most difficult responses to achieve in persuasion is a change in attitudes or behaviour. Often a commonly held belief or a value is required as an anchor for a communications campaign in order to try and achieve the desired response. A study conducted by researchers from Middlesex University in London and the Mathematical Science Research Institute in Berkeley, California on ‘the effect of messaging and gender on intentions to wear a face covering’ found the message of “your community” promoted intentions to wear a face covering. The study also found that men and women self-reported negative emotions when wearing a face covering such as shame, feeling uncool, feeling face coverings to be a sign of weakness and a stigma. Although only one study, further research into public attitudes to face coverings may indicate that ‘community values’ could be an effective anchor around which to build a communications campaign on face coverings that could reduce the stigmatisation of people wearing them. Using the appropriate language, addressing misinformation and engaging relevant members of the public and celebrities with such a campaign would be effective in reducing stigma and changing attitudes and behaviours towards face coverings.
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