By David Sinclair

Anyone who has attended a global public health conference over the past decade is likely to have heard about the Thai Smoking Kid.

Described as the “world’s cleverest anti-smoking ad”, it uses two children to approach adults to ask for a cigarette.(1) When the adults tell the children that smoking is bad for them the child responds by asking why the adult is smoking and gives a leaflet with a link to a “stop smoking” telephone line.

Within ten days, the video was apparently watched millions of times and calls to the stop smoking hotline shot up.

But did it actually impact on smoking rates? Yes, smoking has been falling in Thailand over the last decade. But the falls have been slow and arguably other initiatives such as tax increases have played a much bigger part. Perhaps it made a difference to the individuals who took the leaflet and threw away the cigarette, but what change was actually achieved at a population level?

It’s fair to say, I’m pretty cynical about the impact of many public health campaigns. In terms of physical activity, investing in infrastructure and active travel works. But I’m not convinced a few videos, posters or leaflets do.

While the much heralded “This Girl Can” campaign may have played an important role in moving the social norm, activity levels (150 minutes per week) among women are broadly the same as they were 5 years ago (c60%). And they still fall with age.

I don’t mean to imply that the only tool our (brilliant) public health professionals use is posters and leaflets. Or that this sort of material doesn’t have a role to inform people or move the social norm. But more that there are a lot of posters telling us to do or not do things, which are never tested for impact and which most of us ignore. If even road signs don’t encourage good behaviour on the roads,(2) why do we think a poster will encourage us to be healthy?

Across my time working in ageing, one of the consistent arguments has been that you can engage different generations to influence public health behaviour. People talk about how their gran encouraged them to try a vegetarian diet or how their daughter got them into parkrun. The argument is that people will do things for and with their children or parents which they wouldn’t naturally do for themselves.

I remember an AARP campaign on physical activity which attempted to use generational messages to get older people a bit more active and healthy. They used the photo of a grandfather and granddaughter dancing at the daughter’s wedding. The poster said something like “every bride deserves a dance with grandpa”.(3)

I also remember being told about a (German, I think) public health campaign/study which targeted mothers. Parents were told that it was very good for their baby to be taken outside for a walk in a pushchair. The campaign was allegedly really successful at getting mothers to take part in physical activity even though they weren’t the explicit audience.

But I’m not sure how much these interventions were tested or scaled up to a level which actually made a difference.

In terms of tackling vaccine hesitancy, there has been an argument that older people, who remember the Iron lung and the impact of polio, could play a powerful role in highlighting the importance of vaccination to younger generations, who may have been complacent about vaccine preventable diseases. But is it true that this sort of messaging/activity really works?

There is some evidence that younger people can influence the behaviour of older family members, including – according to a small, but growing evidence base – their health behaviours. But the evidence that intergenerational campaigns work at a population level is weak.

Today we live in a world where generations are both united and divided by social media. Social media is potentially a powerful tool for public health messaging as well as for misinformation. But not all generations use social media and there is undoubtedly an age divide in terms of which platforms older and younger people use.

This is where we come in. As far as we can tell, no research has ever tested the potential impact of using social media to deliver health messages across generations.

In one of our most ambitious projects ever, we want to test whether younger people can have an influence on the health behaviours of older people. With the support of a grant from the Vaccine Confidence Fund, we are going to explore whether younger people can influence older people’s engagement with vaccination through social media.

Our novel approach will aim to explore how to use social media to engage younger people to change their older family members’ perceptions on routine-immunisation (either via engaging them on social –media directly, or offline).

We don’t know what we will find, or if it will work. But I hope at least our approach will lead to a much more comprehensive understanding of the role generations could play in helping each other stay healthier.

Investing in public health is vital for the future health of our ageing population, but we need to better understand what actually works.

References

(1) https://www.ft.com/content/4b0778b8-be99-11e1-b24b-00144feabdc0
(2) https://www.neboagency.com/blog/traffic-signs-interactive-design/
(3) https://assets.aarp.org/www.aarp.org_/articles/health/active_for_life_chapter_01.pdf