When developing a health promotion campaign, psychologists also need to make ethical decisions about how the campaign is developed and how the campaign is communicated. When introducing a campaign to schools, for example, consent is an important ethical consideration, as seen in the study by Lowe et al.  In addition, equity is an important ethical consideration – making sure that the program is accessible to everyone, regardless of income or level of education. Finally, it is important that health promotion does not stigmatize people with health problems.

Informed consent is difficult with health campaigns.  Campaigns are usually decided at the governmental level and then implemented without the consent of the population.  Campaigns that use fear-arousal techniques may show commercials with graphic images or disturbing scenes that the viewer was not expecting.  In the case of children, they may see these images without the consent of a parent. But when doing experimentation to test the effectiveness of a program, informed consent must be obtained.  This means that the participants should know what the potential outcomes of the program would be – and that they have the right to leave the program at any point. The program should be explained to them in terms that they can understand.

Lowe et al (2004) implemented the Food Dudes program in London schools to see if a superhero-style video promoting eating more fruit and vegetables would positively affect eating behavior in 5 to 10-year-olds. Two schools received the program and one school served as a control. In all three schools, researchers measured the baseline for eating fruit and veg. They did this by observing their snack time behavior and sending questionnaires to the parents. The baseline would be compared to their eating behavior during the program and then four months later. As a result of watching the Food Dudes eat fruit and veg to defeat the “Junk Punks,” researchers found a significant increase in fruit and veg consumption both at home and at school. Four months later, children were still eating up to 12 times as much fruit and veg as they were at baseline. For children in the control group, there was no change in eating habits.

In this study, it was important to get consent from the parents for their children to be part of the study.  In addition, parents in the school that was chosen as a control group would also have to give consent.  Since the program was successful, it was also important that the program then is offered to the school that served as a control group.

But this study also raises the ethical concern about equity.  The researchers increased the amount of fruit and veg available to the students throughout the study.  It is important, however, that when such campaigns are run, children should have equal access to fruit and veg.  It is problematic to send a message about a healthy diet when this type of food is not accessible to people in the community.  In this case, the school provided the food. When children do not have access to such food but feel that the “superheroes” have such food, this can make them feel isolated from the community or feel stigmatized.  The lowering of their self-esteem breaks the rule of “no undue stress or harm,” so psychologists need to try to figure out ways to remove these barriers to better health.

Another example of equity issues is when a health campaign recommends a medical treatment that may not be available to all people. Chapman & Mackenzie (2012) criticize many anti-smoking campaigns that advocate nicotine replacement therapy by saying that it is basically “impossible to stop on your own.”  This message may make people feel helpless – I want to stop smoking but I cannot afford NRT. The researchers argue that campaigns need to communicate that people can quit on their own and that there are ways that this can be done besides NRT.

In healthy campaigns, it is important that people with health problems are not portrayed as “irresponsible.”  Research has shown that health problems such as obesity are the result of genetic, cognitive and environmental factors – and are not simply due to someone’s bad dietary choices. An anti-obesity program in Atlanta was criticized for showing images of obese children and communicating that it was the fault of their parents that they were obese – and that this was costing the state a lot of money.  This not only may cause harm to the children used in the campaign, but it is unlikely to change behavior. 

Bränström carried out a study of the use of sun protection. Over 700 participants were interviewed about their perceived risk of skin cancer and how often they used sun protection.  The findings were that most people underestimated the risk of skin cancer and most seemed optimistic that they would not get it.  In debriefing the participants, it is important that they are informed about the true risks, but in a way that does not put them down or make them feel ashamed of their behavior. In addition, when reporting the information in the study, it is important that their information is kept anonymous to protect their identity.

Ethical considerations are complicated in health promotion.  On the one hand, when health is important, a campaign may be necessary that some are not excited about – for example, smoking bans.  And yet, when people buy into a campaign and have given their consent, it is more likely to be effective. In addition, it is important that we address topics that make us uncomfortable – for example, obesity.  But this needs to be done in a way that does not marginalize people. Although it is important to educate people about the steps they can take to improve their health, it also needs to be recognized that health problems are not totally in our control – even when people try their best to “be healthy.” Finally, it is not enough to educate people about health issues.  An ethical campaign will also find ways to remove barriers to improved health so that it is not just those with privileges that benefit from the campaign.