Design, Visual Communication and Public Health: Investigating Multidisciplinary Approaches
Design, Visual Communication and Public Health: Investigating Multidisciplinary Approaches
On the 5th of September 2024 a group of interdisciplinary scholars, graphic designers, artists and public engagement experts gathered at TORCH for a unique opportunity to discuss the radical potential of graphic design in shaping public health campaigns and improving vaccine uptake. The rationale for the workshop was that the role of design in public health remains poorly understood and evidenced, particularly in low-resource settings. This is despite the significant impact that visual media campaigns, delivered by governments, health services and third sector organisations, may have on how people interpret and respond to public health campaigns. As the convenors, we believe this is also a question about the structures of knowledge in public health: design, arts, humanities and social sciences remain at the periphery of discussions and policy making around health-seeking behaviour, where scientific discourse continues to be inexorably centred.
The seeds of the workshop were in an earlier collaboration between graphic designer Constanze Hein (Berlin University of the Arts) and medical historian Sally Frampton (University of Oxford) who in 2021 were awarded funding from the Oxford/Berlin Research Partnership to run a series of seminars for Visual Communication graduate students at the University of Arts, Berlin on the subject of “Communicating Vaccination”. Drawing from medical humanities, the history of public health and contemporary design theory, students were encouraged to explore these histories and create their own visual material on the subject of infectious disease. It was clear from this work that it was an area that could enrich both scholarly and design approaches and which benefited from interdisciplinary dynamics. Hein and Frampton joined forces with Debo Collins Adeyanju, Senior Researcher and Lecturer in Communication Science at the University of Erfurt to further develop ideas, drawing on Adeyanju’s expertise in the field of vaccine uptake in Sub-Saharan Africa. More recently, designers Lucienne Roberts (State Academy of Fine Arts, Stuttgart) and Rebecca Wright (Central Saint Martins, University of the Arts, London), co-founders of GraphicDesign& have joined us.
Presentations
The workshop began with an introduction by Sally Frampton on the historical context to vaccines and communication. Illustration and design have been integral to the interpretation of vaccines since their invention at the tail end of the eighteenth century. In its earliest iterations, much of the visual depiction of vaccines emerged from a critical perspective on them. One example is the 1802 etching Vaccination by Charles Williams. Here already, in just one image, the complexities of medicine, politics and power are laid bare. A grotesque image depicts babies being shovelled into a vaccine monster by cow-horn sprouting doctors. The monster is covered in the names of other killer diseases like plague and leprosy. On the right we see the babies being excreted out of the monster. This alarming image plays on semi-popular misconceptions of the time, such as the idea vaccines would cause other diseases, as well as suspicions about what the effect of being vaccinated with cowpox might be (might you grow horns?)
Vaccination, 1802 by Charles Williams (Credit: Wellcome Collection).
Images like Vaccination have often opened conversations about the social history of vaccines. But there is a strong media history component too. How much of Williams’ own opinions lie in this etching? Ot was this simply his response to demand for anti-vaccine satire? William’s etchings were popular and sold by print sellers, so another question is: who brought, viewed and responded to this image? The caricature clearly tapped into anxieties people felt about a medical procedure that was for many, still a strange unknown, anxieties that Williams etched into perpetuity for our continued consumption today.
Frampton then went on to discuss later developments in the mid-twentieth century as visual communication developed as a field and began to be applied more rigorously to public health campaigns. These were gaining pace with the introduction of new vaccines for diseases like diphtheria, pertussis and polio. In the UK, the Ministry of Health utilised design (alongside film) to communicate messages. One example was the Ministry of Health’s well-known 1959 red and black Polio poster, both simple and striking with its use of bold typography and block colours.
Vaccination against polio. Colour lithograph, ca. 1959 (Credit: Wellcome Collection)
The next presentation was by Constanze Hein. Hein noted that, since the nineteenth century, posters have been part of the landscape, particularly in urban areas, and a consciously social endeavour. Hein highlighted the importance of seeing the influence of wider discourses of twentieth-century design upon medicine, and in particular the influence of military campaigns and their repackaging into public health promotion. A fascinating example Hein gave was the redeployment of the design and iconography of the infamous “I want you for the U.S Amy’ campaign from the First World War into polio campaigns of the 1960s.
1960s Polio Vaccine Promotion Leaflet, UK
The next talk was from designers Lucienne Roberts and Rebecca Wright. They reflected on the need to advocate for the radical potential of graphic design and the necessity of continuous engagement with the questions of who and what graphic design is for. Roberts and Wright discussed the development of their seminal 2017 Wellcome Collection exhibition Can Graphic Design Save Your Life? which also produced the book of the same name. Through this work Roberts and Wright have explored the subtle (and not-so-subtle) ways in which design has and continues to influence how we experience health. From the hard-hitting anti-smoking campaigns of the 1980s to the design of pictogram cards to aid communication with speech-impaired patients; ultimately, good design might quite literally be the difference between life and death.
The final presentation came from Debo Collins Adeyanju. Working from the perspective of communication studies and health psychology, Adeyanju made an argument for the criticality of improving the evidence base around visual communications’ effects on vaccine uptake. He highlighted the current, serious challenges of low childhood vaccination rates in the Sub-Saharan Africa (SSA) region. Adeyanju noted that the resurgence of vaccine-preventable diseases (VPDs) in Nigeria is becoming a major concern to health system stakeholders across the region. Over 20 million children in low- and middle-income countries (LMIC) are without life-saving basic vaccination, such as the three doses of Diphtheria, Tetanus and Pertussis-containing (DTP3) vaccines. These children account for nearly half of the four million deaths worldwide due to VPDs. There are other significant factors at play in these statistics, including lack of vaccine access, as well as wider geo-political circumstances (for instance armed conflict in northern Nigeria). Nonetheless it is clear that hesitancy is a factor in low uptake and that more can be done to combat misinformation associated with vaccination or specific vaccines in Sub-Saharan Africa. Adeyanju argued that this should be done using non-complex, non-academic, graphical-framed, grassroots ingredients. Social media influencers on Facebook, TikTok, Instagram, Twitter, etc. also need to be engaged with more in vaccination program communication. Younger people (e.g., 11-18) represent an important demographic in encouraging vaccine uptake, both in relation to themselves, their peers and their caregivers. Yet they are not always heard in public discourse nor well represented in policy or communication strategies.
Hands-on workshop
In the second half of the workshop, conversation was translated into practice as we encouraged participants to join a hands-on cut and paste design session led by Constanze Hein, to stimulate further discussion about the nuance of text, design, colour and imagery in promoting health-seeking behaviour. Participants explored how typography and imagery are used to craft messages and how design might effectively promote, persuade, or explain in a campaign. You can view our efforts below!
(Photo Credit: Alberto Giubilini)
Discussions and Next Steps
The rest of the workshop was dedicated to discussion and next steps which circled around the following questions:
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How do we evidence effective visual communication in public health?
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How might we approach visual communication in public health through a multidisciplinary lens?
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How can interdisciplinary approaches become useful to those who create health communication?
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How best might this kind of work serve low-and middle-income countries?
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What are the challenges of translating design to social media?
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Are there specific health challenges or messages that need to be communicated better?
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Are their specific histories that inform current day challenges?
While these are big questions which take more than one workshop to chew over, several pertinent themes arose from our conversation. One was the question of ethics and design. Who decides what is a worthwhile message? Is it always government-led? And if so, how does the designer fit into this nexus of decision-making? How much autotomy do they have? It’s clear applying ethics to design is not straightforward and there is a question of ‘who’s’ ethics form the message being conveyed, and which also means there is the potential for tension between ethical ‘norms’ and the designer’s creativity.
Local context was also discussed, and the question of how it might be brought to bear upon visual communication effectively – although with the caveat that there may be fewer communication tools available in low resource settings. As next steps were discussed, this proved to be a highly relevant theme as discussion ensued about a potential future focus on the HPV vaccination in adolescent girls, building on the work of Adeyanju, who has shown that access and take-up is low in parts of Africa. As part of this, the question of co-production was raised by participants. Suggestions were made of working with an advisory group of younger people to ensure their views are prioritised. This is critical for a vaccine like HPV where, while the target group are under 18, they are older children who are likely forming their own opinions about health-seeking behaviour. The question of generalisable findings was no less important and there was agreement that local studies ought also to build more general principles for purposeful design for health. The usefulness of this work, many felt, might be extended by a building a toolkit for those in the visual communication field.
We are grateful to our wonderful participants for joining the workshop and for what was a thought-provoking and enjoyable afternoon.
We are grateful for the generous support of the ETHOX Centre, the John Fell Fund Professor Erica Charters and Professor Mark Harrison in enabling us to run this workshop.
Convenors:
Debo Collins Adeyanju
Sally Frampton
Constanze Hein
Lucienne Roberts
Rebecca Wright
Participants:
Lizzie Burns
Alberto Giubilini
Milly Farrell
Charlie Firth
Sam Martin
Nabila Puspakesuma
Samantha Vanderslott
Vaccination, 1802 by Charles Williams (Credit: Wellcome Collection).
