HEAD TO HEAD
Does celebrity
involvement
in public health
campaigns
deliver long
term benefit?
Simon Chapman professor of public health, University of
Sydney, Sydney, Australia
[email protected]
Celebrities seem to appear
often in news reports about
health and medicine. Since
2005, my research group has recorded all
health related content on all five free-to-air
Sydney TV channels. As of 21 August 2011,
1657/29 322 (6%) of news items have
featured celebrities, which is substantially
lower than the proportion featuring people
experiencing disease or injury (60%), experts
and health workers (50%), and politicians
(49%).1 Celebrities often get involved
because of personal experience with a
disease or because they share the concerns
of other citizens and want to help by offering
the publicity magnet intrinsic to their
celebrity. And like experts, some probably
calculate that a public profile on good causes
might also be good for their careers.
Simon Chapman thinks that
the extra publicity that
celebrities provide can help
promote public health, but
Geof Rayner is worried about
their insidious influences
Value of publicity
Celebrities are by definition newsworthy
before they embrace any subject. When they
do, again just like experts, they turn in a range
of performances. Those concerned about
SCOTT BARBOUR/GETTY IMAGES
Geof Rayner honorary research fellow , City University
London, London, UK
[email protected]
Stuffed: Will Jamie Oliver’s campaign against junk
food bring only short term gain?
bmj.com
ЖЖBlog: Simon Chapman: Sick and famous
http://bit.ly/SNJAnl
ЖЖObservations: Jade, class, and cervical
cancer (BMJ 2009;338:b691)
ЖЖBMJ podcast: The Jade Goody effect
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20
Can celebrity involvement
deliver long term benefit for
public health? The short
answer is no, for the logical reason that
celebrity status is fleeting. Celebrities might
impart a short term boost to campaigns—
Jamie Oliver showed this at a time when the
school meals campaign was wallowing in
obscurity—but as the noble Oliver would
doubtless accept, celebrities must tread a
cautious path of support because of the risk
that the celebrity becomes the story, not the
campaign.
It’s not until you start delving into the
role of celebrity culture on health that the
negatives begin to stack up. What celebrity
culture does so effectively is promote icons
of rampant consumerism and fantasy
lifestyle. It’s hardly chance that our society’s
manufactured obsession with celebrities
has coincided with a period of starkly rising
inequality. Multimillionaire football “stars”—
mostly from working class backgrounds—
give the lie to the idea that anyone can make
it or that vast incomes are justified “because
I’m worth it.”
celebrities in health campaigns invariably
point to examples that have gone badly
wrong or that fail to change the world for
ever. They hone in on celebrity endorsement
of flaky complementary medicines or quack
diets, ridicule incidents where celebrities
have wandered off message or blundered,
or point out cases where celebrity “effects”
are not sustained,2 a problem not confined
to campaigns using celebrities. But they are
silent about the many examples of celebrity
engagement that have massively amplified
becalmed news coverage about important
neglected problems or celebrity involvement
in advocacy campaigns to promote evidence
based health policy reform.
Is there anyone concerned about action
to mitigate anthropogenic climate change
who is not delighted when celebrities stand
side-by-side with climate scientists and
thereby attract attention that a phalanx of
impeccably credentialed researchers could
only dream of? And on the flip side, is there
anyone in public health who is not appalled
when celebrities speak up for smoking (the
artist David Hockney and singer-songwriter
Joe Jackson); promote prostate cancer
screening for men, even below the age of 40
Unhealthy influences
Celebrity culture is a by-product of a society
experiencing social isolation and loosening
social bonds. We know more about celebrities
than our extended families. We could hardly
not: they are pushed in front of our eyes from
all directions. In establishing an emotional
attachment to celebrities they become, in
effect, the friends we do not know. In truth,
celebrity personas are largely fictional, and
the individuals themselves less important
than the mechanisms that promote them,
with reality television shows such as the
X Factor creating a production line of
replacements.
Economists argue we’ve become a “winner
takes all” society, with money and fame
filtering to those at the top.1 Celebrities are
measured, ranked, and valued by income,
status, and product sponsorship possibilities.
The US magazine Forbes provides an “annual
celebrity 100” list. Those on the list in 2011
earned $4.5bn (£2.8bn; €3.5bn) collectively,
a rising proportion of which came from
product endorsement. It’s a celebrity’s job
to tell people what to wear, what cosmetics
to use, or what to eat. Not so long ago one
celebrity entertainer, Ronald Reagan, told
people what cigarettes to smoke.
BMJ | 29 SEPTEMBER 2012 | VOLUME 345
HEAD TO HEAD
There are some uncomfortable
subtexts just beneath the disdain
for celebrity engagement in
health. The main one seems to
be an arrogant “what would they
know?” reaction
(Australian hard rocker Angry Anderson);
or blather about the odious nanny state
(Formula 1 driver Mark Webber after having
his car impounded for driving dangerously
on suburban streets)? What does it say that
we can be disgusted when celebrities try to
set back public health agendas but get all
bothered about celebrity efforts in campaigns
that could influence millions positively?
There are some uncomfortable subtexts
just beneath the disdain for celebrity
engagement in health. The main one seems
to be an arrogant “what would they know?”
reaction. Celebrities are not experts: they
can use embarrassingly naive language and
may have no idea about levels of evidence
or all the work that has gone before. But
playing to the media’s appetite for those
experiencing health problems, celebrities
often speak personally and bring compelling
authenticity to public discourse. A leading
Always-on social media feed celebrity
culture. Stephen Fry, the comic actor, has
3.7 million followers on Twitter; pop star
Lady Gaga has 8 million and Justin Bieber a
staggering 16.4 million. Feeling low after his
recent tour, the singer tweeted, “I love my
beliebers. Thanks for making me feel better.”
The principles are clear: in exposing or
inventing their lives celebrities play the role of
substitutes, avatars, projections, and proxies.
Followers are encouraged to live with them,
through them, and possibly for them. The
collective mental health effect of these fake
friendships remains to be assessed.
Celebrity endorsement
Celebrities help shift products, that much is
certain. Perhaps it’s not just economics but
also evolution? Our ancient ancestors, forced
to choose among potentially lethal wild
berries, picked what they recognised. In our
image drenched consumer society, our mental
equipment receives many thousands of images
daily but our subconscious records only a
minority and only a few reach through to our
conscious behaviour. Even if we don’t actually
like the celebrities in the advertisements or
voice-overs, the recognition rubs off on the
product. But cognitive heuristics can’t explain
BMJ | 29 SEPTEMBER 2012 | VOLUME 345
Sydney health and medicine reporter told
me once that “Experts are fine, but they are
not a living thing.”3 She went on to explain a
litany of problems that journalists routinely
encountered in using experts, such as an
inability to imagine an audience outside
their often middle to high brow cliques.
A recent article by Nature’s online editor,
Ananyo Bhattacharya, reminds us of the
tensions between science and the media and
why scientists are so often hopeless news
participants.4
Unrealistic expectations
Why do we expect perfect outcomes after
celebrity engagement yet are realistic about
the need to sustain public campaigns
beyond their first burst? In 1999, cricketer
Shane Warne accepted a six figure sum to
use nicotine replacement therapy to quit
smoking.5 The challenge for the paparazzi
rapidly became to be first to photograph him
smoking again. It didn’t take long. Warne was
a world class cricketer but a very ordinary,
relapsing smoker. This was an important
message that many experts failed to exploit,
instead climbing on a cynical populist
bandwagon about his alleged motives.
the power of celebrity any more than genetics
explains obesity. Celebrity has become
mainstream marketing strategy, even of
public bodies like the BBC. It’s even an issue
of politics, with Boris Johnson, the mayor of
London, overtaking all other UK politicians
in the popularity stakes after the publicity
associated with this summer’s Olympics.
The mingling of celebrity, business, and
politics is hardly new. Possibly the first to
employ the power of persona to sell products
was Lillian Pinkum (1819-93), America’s first
female millionaire. Her bottled restorative elixir
for women (in fact, a 40% proof spirit) carried
her face, making her recognisable to millions.
Her modern analogue could be the actress
Gwyneth Paltrow, who through her website
encourages her fans to purchase “doctorformulated” patent remedies like protein
shakes and food supplements. Thankfully her
widely promoted colon cleansing routines do
not form part of the package.
Longer term solutions
New measures are certainly needed to
promote public health. Campaign groups
like 38 Degrees bring together the lobbying
power of thousands of ordinary people
through the internet. In the future health
Publicity about (then) 36 year old Kylie
Minogue’s breast cancer led to an increase
in unscreened women in the target age
range having mammography6 but also to
an increase in young women at very low
risk seeking mammograms and thus being
exposed to unnecessary radiation and false
positive investigations.7 But what if such
a celebrity had instead had pre-cancerous
cervical lesions detected by a smear test and
her story went viral generating increased
awareness of the importance of smear testing
(as Big Brother star Jade Goody’s experience
did in the UK)? The ambivalence about “the
Kylie effect” reflects enduring debate about
the wisdom of breast screening, but it should
not blind us to the potential value of celebrity
engagement in important causes.
Competing interests: The author has completed the ICMJE
unified disclosure form at www.icmje.org/coi_disclosure.
pdf (available on request from the corresponding author)
and declares no support from any organisation for the
submitted work; no financial relationships with any
organisation that might have an interest in the submitted
work in the previous three years; and no other relationships
or activities that could appear to have influenced the
submitted work.
Provenance and peer review: Commissioned; not
externally peer reviewed.
Cite this as: BMJ 2012;345:e6364
It’s not until you start delving into
the role of celebrity culture on health
that the negatives begin to stack
up. What celebrity culture does
so effectively is promote icons of
rampant consumerism
campaigners must be nimble across multiple
levers of change. Rather than relying on
media stunts they need to look to legal action
and perhaps more local campaigns—by us,
not for us. We can draw inspiration from the
old sanitarian movement, whose campaign
to clean up a dirty world succeeded, often
with unpopular people at the helm.2
Modern health campaigners need to go
on the offensive against junk food, alcohol,
gambling, and other often celebrity linked,
commercial propaganda. Some celebrities
might help, but let’s not look for saviours,
buoyed by the happy thought that the work
is done when a celebrity is involved. That’s a
lie too.
Competing interests:GR was formerly chair of the UK Public
Health Association and board member of No Smoking Day
and many other health campaigns. He is chairman of the
photography organisation Photofusion.
Provenance and peer review: Commissioned; not externally
peer reviewed.
Cite this as: BMJ 2012;345:e6362
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