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Critical Public Health
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The pedagogy of disgust: the ethical,
moral and political implications of using
disgust in public health campaigns
Deborah Luptona
a Faculty of Arts and Design, University of Canberra, Canberra,
Australia
Published online: 11 Feb 2014.
To cite this article: Deborah Lupton , Critical Public Health (2014): The pedagogy of disgust: the
ethical, moral and political implications of using disgust in public health campaigns, Critical Public
Health, DOI: 10.1080/09581596.2014.885115
To link to this article: http://dx.doi.org/10.1080/09581596.2014.885115
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COMMENTARY
The pedagogy of disgust: the ethical, moral and political implications
of using disgust in public health campaigns
Deborah Lupton*
Faculty of Arts and Design, University of Canberra, Canberra, Australia
(Received 29 July 2013; accepted 14 January 2014)
The developers of public health campaigns have often attempted to elicit dis-
gust to persuade members of their target audiences to change their behaviour
in the interests of their health. In this critical essay, I seek to problematise this
taken-for-granted and unquestioned tactic. I assert that the pedagogy of dis-
gust in public health campaigns has significant ethical, moral and political
implications. In outlining my argument, the literature on the social, cultural
and political elements of disgust is drawn upon. I also draw more specifically
on scholarship demonstrating the ways in which disgust has operated in rela-
tion to health and medical issues to reinforce stigmatisation and discrimination
against individuals and groups who are positioned as disgusting. It is
concluded that advocates of using such tactics should be aware of the
challenge they pose to human dignity and their perpetuation of the Self and
Other binary opposition that reinforces negative attitudes towards already dis-
advantaged and marginalised individuals and social groups.
Keywords: sociology of health; politics; health campaigns
Introduction
A recent Australian anti-obesity campaign features a video advertisement showing a
middle-aged man in his kitchen. He reaches into his fridge to take out a slice of leftover
pizza. As he holds it, wondering whether to go ahead and wolf it down, he glances down
at his belly. His other hand squeezes the flesh there, as the camera suddenly swoops into
the inside of the man’s body. The voice-over says ‘When you eat more than you need to
and aren’t as active as you should be, fat doesn’t just build up around your waist. A toxic
fat also builds up around your vital organs, releasing dangerous levels of chemicals that
bring heart disease, diabetes and cancer closer’. Viewers are treated to images of bubbling
slabs of bright yellow, blood-streaked fat covering glistening red body organs. The
camera goes back to the man as he gazes pensively through a doorway at his young sons
playing happily on a computer game. The voice-over continues: ‘Fat around your waist is
bad, but toxic fat around your vital organs is worse’. The viewer is left in suspense,
wondering if this dad will let himself and his family down by indulging his desire for
pizza and thereby adding to his ‘toxic’visceral fat.
Other advertisements in the campaign show a man drinking a sugary canned drink,
a woman deciding to walk to the shops instead of driving, a man choosing not to drive
into a fast-food restaurant, a woman taking the stairs rather than the escalator and
*Email: deborah.lupton@canberra.edu.au
© 2014 Taylor & Francis
Critical Public Health, 2014
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another woman eschewing packaged junk food at a supermarket. All feature the same
images of what the campaign refers to as the ‘toxic fat’covering body organs to dem-
onstrate how eating the wrong foods or not engaging in enough exercise could lead to
developing this substance inside one’s body (these advertisements may be viewed here:
http://www.livelighter.com.au/the-facts/about-livelighter/see_our_ads.aspx).
These advertisements, part of the ‘LiveLighter’campaign sponsored by the West
Australian health department, the Cancer Council and the National Heart Foundation,
are more recent contributions to a series of public health campaigns that have been reg-
ularly conducted for health promotion purposes in wealthy developed countries, includ-
ing not only Australia but also the USA, Canada, the UK, New Zealand and the nations
of northern Europe. In these countries, government-funded departments and authorities
(most commonly federal or state departments of health) and independent organisations
such as foundations focused on specific diseases such as cancer, heart disease, stroke,
HIV/AIDS and other sexually transmissible diseases or conditions such as obesity have
funded numerous mass media campaigns directed at health behaviours. These entities
frequently collaborate with each other in developing public health campaigns, as in the
case of the LiveLighter campaign.
The images in the LiveLighter advertisement share similarities with past anti-smoking
campaigns in Australian and elsewhere that have shown confronting images gangrenous
limbs or digits, lungs covered with black tar or distorted with a cancerous growth, a
bleeding brain, arteries clogged with a thick substance, a mouth disfigured by cancerous
lesions, emaciated people in hospital beds struggling to breathe, people coughing up
blood and so on. Indeed, the stylistic features of the LiveLighter campaign suggest that it
is replicating the Australian ‘Every cigarette is doing you damage’anti-smoking cam-
paign that was first aired in the late 1990s and then revived in 2009 (these advertisements
may be viewed here; http://www.youtube.com/watch?v=s2E5iGHBWaw). The anti-
smoking campaign featured a number of different television advertisements, each focus-
ing on a different organ or body part: the arteries, the brain, the lungs and eyes. They
began with footage of a person lighting up a cigarette and inhaling, with the camera fol-
lowing the passage of the smoke into her or his body. As the voice-over described how
the cigarette smoke was affecting the internal organs, they were shown as contaminated
and diseased. Similar images are used on tobacco packets in Australia and over 40 other
countries as deterrences to smokers (Azagba & Sharaf, 2013).
While imagery and words evoking disgust have been common in such Australian
public health campaigns, they are also frequently used in North America (Gagnon,
Jacob, & Holmes, 2010; Linnemann, Hanson, & Williams, 2013). For example, a 2009
New York City council media campaign attempted to deter people from consuming sug-
ary fizzy drinks by rendering them disgusting and showing their effect on body compo-
sition. A television advertisement for this campaign featured a man thirstily gulping
down thick yellow fat from a fizzy drink can, the stuff running greasily down his chin,
in an attempt to demonstrate how easily sugary drinks can transform into viscous body
fat. The fat is shown blood streaked to demonstrate that it is body fat rather than dietary
fat that he is consuming (http://www.youtube.com/watch?v=-F4t8zL6F0c). Print
advertisements showed the same substance being poured into a glass from a drink can.
A follow-up campaign run in 2013 used a television advertisement targeted at sugary
fruit-based drinks, and employed images of a fat male torso with the word ‘obesity’
emblazoned in large letters across it, bandaged feet showing one foot with amputated
toes in a bed with the word ‘diabetes’across the image, and in similar imagery to that
of the LiveLighter campaign, pulsing red internal organs with the words ‘amputation’,
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‘heart attack’,‘vision loss’and ‘kidney failure’(http://www.youtube.com/watch?v=xdE
2ohqKbTk).
What does this use of disgust as an educational strategy (or what I here term the
‘pedagogy of disgust’) reveal about dominant notions of human behaviour and appro-
priate educational and persuasive strategies in health education and health communica-
tion discourse and practice? What are the (often unintended) ethical, political and moral
dimensions of the use of disgust in public health campaigns? In this article, I seek to
problematise the pedagogy of disgust by addressing these questions. I begin with an
overview of the ways in which graphic and confronting images as a pedagogical strat-
egy (including those that seek to elicit disgust) are represented and evaluated in the
mainstream health education and health communication literature. I then move on to lit-
erature on the theorising of disgust, particularly writings that highlight the social and
cultural dimensions and implications of disgust. The article ends with a critique that
identifies some of the ethical, moral and political dimensions of employing the peda-
gogy of disgust for health education purposes.
The pedagogy of disgust
As part of persuading their target audiences to take up or relinquish behaviours and
practices in the interests of their health, the developers of public health campaigns, like
commercial advertisers, often seek to arouse an emotional response. Emotional appeals
may include not only the fear of ill health, disease, disfigurement or an early death, but
also shame, humiliation, concern about appearing unattractive or sexually undesirable –
and disgust. Brown and Gregg (2012) describe the ‘pedagogy of regret’used in public
health campaigns against binge drinking which feature young people experiencing nega-
tive experiences such as losing control of their bodies (vomiting, engaging in unwanted
sexual encounters or fights) as a result of becoming intoxicated. Similarly, one might
also use the term the ‘pedagogy of disgust’to encompass the use of disgust as a moti-
vating force in public health campaigns. Such campaigns have a pedagogical function
because they are positioning themselves as authoritative voices, disseminating informa-
tion to target audiences.
The linking of risk with emotion is a central strategy of health promotion. I have
elsewhere described the ‘emotion-risk assemblage’(Lupton, 2013a), or the configuration
of human and non-human actors that combine to give meaning to both risk and emo-
tion. Health promotion campaigns employing disgust attempt to configure a particular
kind of emotion–risk assemblage, in which the already emotionally resonant meanings
of risk are bestowed with additional power through their association with revulsion.
The logic underpinning the use of such images to evoke intense emotional responses
from target audiences is that members of these audiences are apathetic or resistant to
the health messages public health authorities are attempting to convey to them (Craw-
shaw, 2012; Gagnon et al., 2010; Lupton, 1995,2013a,2014). Materials employing the
pedagogy of disgust may combine facts and figures to bolster their authority, but they
are essentially attempting to elicit a negative affective response in a very overt manner.
The health education literature and documents discussing campaign materials are replete
with writers advocating for the use of what are variously referred to as ‘shock tactics’
or ‘distressing’,‘threatening’,‘disturbing’or ‘graphic imagery’in mass media cam-
paigns to provoke behaviour change in target audiences (Lupton, 2014).
Thus, for example, the developers of the LiveLighter campaign note that it ‘uses
innovative, hard-hitting strategies to jolt people out their complacency about being
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overweight or obese …The creative approach is graphic and confronting’(campaign
pamphlet). Two official evaluations of the Australian ‘Every cigarette is doing you dam-
age’anti-smoking note approvingly that the advertisements ‘produced a strong visceral
“yuk!”response’in viewers (Hill & Alcock, 1999, p. 14) and that the proportion of
respondents describing smoking as ‘disgusting’increased following of one of the cam-
paign’s phases, which was one of the campaign’s objectives (Donovan & Jalleh, 2004).
Such statements as ‘fear appeals constitute a fundamental element in health risk com-
munication’(Cho & Salmon, 2006, p. 91) are routinely made in the health education
literature.
There is an extensive literature directed at evaluation of the effectiveness of using
confronting emotional appeals in public health campaigns and other materials such as
cigarette packets, almost all of which takes a cognitive or social psychological and
quantitative approach (e.g. Azagba & Sharaf, 2013; Brown & Richardson, 2012; Cho &
Salmon, 2006; Humphris & Williams, 2013; van ‘t Riet, Ruiter, & de Vries, 2012; Wit-
te & Allen, 2000). Much of this research focuses on the use of fear elicitation rather
than disgust. However, there is evidence of a growing interest among health education
and health communication researchers in evaluating the effectiveness of disgust, either
separately or combined with fear appeals (see e.g. Humphris & Williams, 2013; Lesh-
ner, Bolls, & Thomas, 2009; Wakefield et al., 2013; Wu & Morales, 2012).
Evaluations of the effectiveness of confronting emotional appeals are equivocal.
Many researchers have concluded that ‘graphic imagery’, including disgust-inducing
images, can be effective in conveying the main messages of the campaigns and evoke
feelings of discomfort, revulsion and shock in target audiences about the risks posed by
behaviours such as cigarette smoking, excessive alcohol use, illicit drug use and over-
eating. Not surprisingly, given the dramatic nature of the images and related verbal
warnings that are employed, these campaigns clearly capture audiences’attention. These
responses are often considered to be evidence of the success of such campaigns. Indeed,
combining fear and disgust appeals are viewed as particularly effective in public health
campaigns in terms of drawing attention to the health threat (Wu & Morales, 2012).
However, the evidence from this research is less clear about the capacity of shock-
ing imagery and texts to influence sustained behaviour change. Indeed, some studies
have suggested that these images and texts may have the unintended and counterpro-
ductive effect of causing target audiences to avoid the confronting messages by
responding with perceptual and cognitive defence mechanisms –in effect engaging in
avoidance or denial that the risk affects them or a fatalistic acceptance of risk (Brown
& Richardson, 2012; Cho & Salmon, 2006; Humphris & Williams, 2013; van ‘t Riet
et al., 2012; Witte & Allen, 2000). The researchers’suggested solutions for overcoming
this phenomenon of ‘attentional disengagement’include such strategies as limiting the
incidence of distressing or confronting imagery and separating this imagery from infor-
mation components of the advertisement (Brown & Richardson, 2012), investigating the
interaction of fear responses with other strong emotional responses (including disgust)
(Witte & Allen, 2000) or targeting ‘high threat’material to individuals ‘high in avoid-
ance orientation’(van ‘t Riet et al., 2012) for maximum effect.
A more critical stance going beyond questions of efficacy to those addressing the
ethical, moral and political implications of using these tactics rarely makes an appear-
ance in this literature. Yet, I would contend that these implications need to be identified
and addressed before persisting any further with attempts to use disgust for pedagogical
purposes as part of promoting public health.
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Theorising disgust
There is a fascinating literature on the social, cultural and political dimensions of dis-
gust. For reasons of space, I am unable to do full justice to this scholarship here, but
seek to identify some main aspects that are relevant to the argument I am presenting.
While many critics disagree with the notion of a universal ‘core disgust’response that
operates across cultures (Durham, 2011), the acculturated meanings and understandings
associated with disgust in specific social and cultural contexts may be identified. Sev-
eral scholars of disgust as it is experienced in developed societies such as the United
States and other countries in the global North have pointed to the association of (non-
human) animality with disgusting phenomena, as well as to evidence of the human
body that is in extremis (dead, very ill, diseased or corrupted in some way). ‘Animal
reminder disgust’(a term first coined by Rozin and his colleagues) relates to phenom-
ena that remind people of the animality or fleshly reality underlying the veneer of
human civilisation, confronting us with the idea of our physicality, our vulnerability
and the inevitable decay of ageing and death (Haidt, Rozin, McCauley, & Imada, 1997;
McGinn, 2011; Rozin & Fallon, 1987).
The phenomena that arouse this type of disgust include human bodily products and
breaches of the ‘envelope of the body’(Haidt et al., 1997) such as wounds, views of
internal organs, blood, vomit, excreta, the corpse and so on. The underpinnings of this
type of disgust appear to be symbolic and philosophical, related to loss of rational con-
tainment of the body and the challenge to the Cartesian duality of mind and body that
attempts to position humans as superior to other animals (Haidt et al., 1997). It is par-
ticularly relevant to the pedagogy of disgust employed in public health campaigns, as
evidenced in the examples of advertisements discussed earlier, in which bleeding, gan-
grenous, amputated or diseased body organs were prominent features.
Some theorists have also made reference to what I term ‘liminality disgust’: that
generated by the transgression or indistinctness of cultural boundaries (Douglas, 1969;
Kristeva, 1982; Miller, 1997). There are overlaps of liminality disgust with animal
reminder disgust, but they also differ from each other in some aspects. Liminality dis-
gust may be generated by in-between organic substances –the slimy, the oozing, the
mucoid and the viscous. Such matter cannot be rigidly categorised into binary opposi-
tions such as inside/outside, solid/fluid and life/death and therefore provoke anxiety,
unease and disgust. Here again, this type of disgust may be commonly viewed in public
health advertisements, such as the viscous fat shown in the LiveLighter and New York
anti-soda campaigns.
Importantly, however, liminal disgust need not be elicited solely in response to
organic matter but may be a response to symbolic categories and their breaching.
According to Douglas’(1969) well-known writings on purity and danger, any anoma-
lous phenomenon, including individuals and social groups, may be identified as impure,
contaminating and disgusting as part of a cosmology constructed of organising princi-
ples of understanding and dealing with the world. Those phenomena that are designated
as anomalies are treated with revulsion because they threaten the ordering of a society
and the principles by which it is governed.
This raises the issue of the moral and political uses of disgust. Several scholars have
argued that disgust can be employed as a means of distinguishing Self from Other, rein-
forcing prejudice and bigotry, marginalising outgroups and therefore operating as a
challenge to their human dignity (de Melo-Martín & Salles, 2011; Nussbaum, 2004;
Taylor, 2007; Tyler, 2013). This ‘moral disgust’may be interpreted as a response that is
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primarily based on understandings of what is appropriate and just social behaviour. It is
often accompanied by anger and contempt for those who are categorised as ‘disgusting’.
Practices considered morally wrong according to the accepted norms of behaviour in
specific cultural or social groups may evoke disgust, even when there is no obvious or
direct relationship to physical matter. These understandings are phrased through judge-
ments that attribute ‘rightness’to certain social groups and ‘wrongness’to others that
are based not on potential biological contamination but assessments of moral worth and
social standing (Deigh, 2006; Durham, 2011; McGinn, 2011; Miller, 1997; Nussbaum,
2004; Shimp & Stuart, 2004; Tyler, 2013).
Moral disgust is intimately related both to animal reminder and liminality disgust,
particularly as it is expressed in relation to health threats. As I will demonstrate in more
detail below, individuals or social groups who are considered to be animal-like in their
lack of control of their bodies or to straddle cultural boundaries, lack appropriate
hygiene and bring illness or disease upon themselves and thus allow their bodies to be
corrupted are frequently responded to with moral disgust. This raises important ques-
tions for the use of the pedagogy of disgust in public health communication campaigns.
Ethical, moral and political dimensions
In relation to the use of disgust and shame in the law, Nussbaum (2004) contends that
disgust is an unreasonable emotion because it projects our fear and anxiety about physi-
cal decay and death onto the certain individuals and social groups, people who are
already socially marginalised and stigmatised. Instead of attempting to reduce their
social disadvantage, our disgust positions them as inferior. We turn away from them,
representing them as less than human as ourselves. It is here that disgust poses a threat
to the worth, equality and dignity of those who are positioned as its object. Nussbaum
argues, therefore, that disgust should have no role in constructing and enforcing laws,
as it fails to recognise the humanity of all people.
This ethical argument should also be extended to the public health domain. The
overriding moral imperative in public health endeavours tends to be focused on the
attempt to pursue a utilitarian ‘health for all’ideal. As a consequence, other ethical
issues and their moral underpinnings can sometimes be neglected. Little commentary
from within public health has sought to examine the ethical questions associated with
inspiring negative emotions in target audiences. As evidenced in the literature reviewed
above, there appears to be a widespread, unexamined agreement that if a public health
issue is at stake, then it is appropriate to use confronting tactics to persuade people to
change their behaviour. When negative emotional appeals are held up to scrutiny within
the public health or health communication literature, this is generally on the basis of
debating whether or not they are effective rather than the ethics of their use. Indeed, the
conviction of many health education advocates that using graphic and confronting
images and other warnings in public health campaigns is justified can be so strong that
they may respond very emotively themselves to challenges to this position (Alderman,
Dollar, & Holtz, 2010; Lupton, 2013a).
An ethical critique, however, is not so much interested in the effectiveness of these
tactics but rather in their implications for justice. If there is a convincing argument that
a public health campaign fails to meet ethical principles, unless a simple utilitarian ethi-
cal stance is taken (whereby the ends always justify the means), whether or not it is
effective is beside the point. Such questions may be asked as: To what extent do
audiences for these campaigns give their consent to be exposed to these disturbing
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images or language? How do such campaigns contribute to the stigmatising of certain
individuals or social groups? Do the negative emotions aroused by such campaigns con-
tribute to the intensity and longevity of psychological states as anxiety, shame, guilt,
self-loathing and fear of social rejection or death on the part of audiences, and is this a
desirable outcome? At what point does ‘persuasion’slide into ‘coercion’? To what
extent do public health campaigns present illness and disease as the fault of those who
develop them –effectively ‘blaming the victim’–in the face of evidence that such con-
ditions are the product of a complex interaction of social and economic as well as self-
chosen lifestyle factors (Gagnon et al., 2010; Guttman & Salmon, 2004; Lupton, 1995,
2014)?
Haidt et al. (1997) contend that all categories of disgust act as either literal or sym-
bolic ‘guardians of the temple of the body’against disease, pollution, loss of dignity or
spiritual desecration. I would further argue that all types of disgust centre on distinc-
tions between Self and Other. Those members who rank the most highly in social hier-
archies tend to be considered less disgusting than others (Deigh, 2006; Nussbaum,
2004; Tyler, 2013). A repeated motif across the centuries in portrayals and descriptions
of the infected and diseased is their representation as the uncontained and feared Other.
The Other has routinely been conceptualised as ‘risky’, polluting the bearer of disease
and as threatening the integrity and social or physical health of an individual or group
(Ali, 2008; Crawford, 1994; Gagnon et al., 2010; Lupton, 1995,2013a,2013b,2013c).
In relation to disease, throughout history groups such as Jewish people, Chinese and
other foreigners, non-white people, prostitutes or other ‘licentious’women and the poor
have been constantly singled out as particularly worthy of disgust for their supposed
immorality, lack of hygiene and inability to control their bodily urges (Brandt & Rozin,
1997; Lupton, 1995; Nelkin & Gilman, 1991).
Disgust is closely associated with the emotions of fear and hatred incorporated into
such responses as racism, sexism, homophobia and discrimination against fat people,
those with disabilities and the elderly. Contemporary examples include negative
portrayals of Chinese Canadians in relation to the SARS epidemic (Ali, 2008), the rep-
resentation of elderly people with Alzheimer’s Disease as ‘zombies’or ‘walking
corpses’(Behuniak, 2011) and of the aged body generally as ugly, decayed, incontinent
and diseased (Van Dongen, 2001), portrayals of fat people in the news media as repel-
lent and grotesque (Boero, 2007; Lupton, 2013c) and representations of people with
HIV/AIDS as the living dead (Niehaus, 2007).
When members of social groups are portrayed as the disgusting Other, there is often
a slippage between ‘monsters’and ‘people’. Such individuals become dehumanised and
demonised, no longer treated as ‘real’humans due the kinds of rights and privileges to
which others are entitled (Ali, 2008; Behuniak, 2011; Nussbaum, 2004; Tyler, 2013).
Thus, for example, smokers as often portrayed as immoral, stupid and impure, and even
as less deserving of medical attention (Rozin & Singh, 1999).
Many of these issues are simply ignored or discounted by public health authorities
who continue to use negative emotional appeals in social marketing campaigns in ways
that expose the whole community, not just the target groups, to the fear- or disgust-evok-
ing images they have created. There is little recognition of the consequences that may
result from the fear, shame, revulsion, guilt, humiliation, self-loathing and anxiety that
such campaigns deliberately seek to inspire, or even of the discomfort audiences may
feel when forced to view these images, whether they are members of the target audience
or not.
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The psychologically or socially vulnerable may be most affected by these appeals.
Psychological research suggests that people who already feel disempowered, psycholog-
ically distressed or who are socioeconomically disadvantaged tend to feel worse or to
feel powerless after exposure to such campaigns (Hastings, Stead, & Webb, 2004). As a
qualitative study investigating underprivileged people’s responses to public health cam-
paigns using negative emotional appeals found, common responses were anger, retreat,
guilt, passive helplessness and despondency, rather than empowered decisions to act.
Despite these findings, the authors then go on to advocate future research into how best
to use shame as a motivating emotion (in their words, how it might be ‘usefully
deployed’) in such campaigns (Brennan & Binney, 2010). Target audiences may also
feel resentment and defensiveness towards the use of disgust tactics, a sense of defeat
and even anger and defiance, vowing to continue their behaviour in the face of obvious
strategies to persuade them otherwise (Thompson, Barnett, & Pearce, 2009; Thompson
& Kumar, 2011).
It is evident from such research and from the comments of activist groups that the
marginalised individuals and social groups to whom disgust is directed are highly aware
of their positioning. Smokers are highly aware of their status as ‘disgusting’and ‘deviant’
that is perpetuated via some anti-tobacco campaigns (Thompson et al., 2009; Thompson
& Kumar, 2011). Fat people have commented on the abuse and discrimination they have
endured, not only from strangers but also at the hands of family members since the inten-
sification of public discourse on the risks of obesity, including the representation of fat
bodies as diseased and grotesque in public health campaigns. They have noted that being
positioned as disgusting can lead to intense feelings of self-hatred and shame (Kent,
2001; Lupton, 2013c).
Another aspect to consider in relation to the use of disgust in public health cam-
paigns is the possible resistance that may be generated. Public health campaigns direc-
ted at arousing fear, shame or disgust as a means to promote the self-disciplined citizen
almost completely ignore the pleasures that may be involved in transgressive behav-
iours. As cultural theories of disgust have noted, that which arouses disgust can also be
fascinating (Haidt et al., 1997; Kristeva, 1982; McGinn, 2011; Miller, 1997). Just as
transgression and the disgusting may be fascinating, difficult to turn away from at the
same time as they repel, behaviours or bodily fluids that are culturally coded as disgust-
ing may also be a source of pleasure. Loss of control of the body, the opportunity to
engage in revelry, to use pleasurable substances, to invite the grotesque and transgres-
sive body to take over the ‘civilised’body for at least a short while, can often be very
enticing (Bunton & Coveney, 2011; Lupton, 1995,2013a,2013b,2013c; Thompson &
Kumar, 2011).
In such a context, the capacity for disgust to motivate self-discipline is weakened
significantly. Thus, for example, young women using Facebook often represent a ‘big
night out’of binge drinking as involving transgressions such as vomiting, urinating or
even defecating in public. They typically portray these transgressions as humorous indi-
cations of how drunk they were, how little able to control their bodies, rather than as
evidence of a shameful or humiliating loss of control. It has been claimed, in fact, that
public health advertisements which emphasise the excessive and transgressive nature of
such activities as binge drinking can serve to support the positive meanings people may
attribute to loss of control as part of a hedonistic Friday or Saturday night social
drinking session (Brown & Gregg, 2012).
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Final remarks
The logic of fear and that of disgust when employed in public health campaigns share
similar practices and meanings. These include the desire to shock to draw attention to
the health risk that is being tackled by the campaign. Both fear and disgust logics work
to position a behaviour or an entity (such as a disease or illness or an unhealthy prod-
uct) or even an individual or social group (who may be infected with a serious disease
or tempt others into engaging in risky behaviours) –as posing a threat. Audiences are
invited to avoid the threat either by personalising it (this is my problem) or by distanc-
ing themselves from it, ensuring that they avoid the behaviour, entity or people.
Although fear and disgust are frequently discussed in the health education and com-
munication literature as separate entities, I would contend that it is difficult, if not
impossible, to separate fear from disgust, just as risk cannot be separated from emotion
(Lupton, 2013a). As noted above, disgust responses often incorporate a fear of one’s
body’s envelope being breached, of contamination, contagion and disease and of the
individuals or groups who might cause these ill effects (although the reverse is not nec-
essarily true: fear tactics may not involve disgust). When disgust is combined with fear,
because disgust evokes repulsion and notions of dirtiness, contamination and decay,
these phenomena are bestowed with a different set of meanings. Fearsome entities may
be viewed as powerful, but when they are also presented as disgusting they become
degraded and contemptible. More so than in the case of fear alone, the meanings of dis-
gust involve notions of ‘proper’comportment, containment of the body and ideas
related to deviance and moral judgements that inspire anger and contempt for individu-
als or social groups.
Disgust is also implicated to a greater extent in repulsion: ‘Disgust makes us step
back, push away, or otherwise draw a protective line between the self and the threat’
(Haidt et al., 1997, p. 127). Hence, the common cognitive strategy identified in the psy-
chological research discussed earlier of ‘distancing’oneself from these phenomena. This
response poses a conundrum to health educators who want to draw attention to their
campaign messages by employing ‘shock tactics’: too much ‘shock’when combined
with disgust creates counter-
productive aversion.
My concern, however, is not in relation to the counter-productive nature of using
disgust as a pedagogical strategy. I have argued in this article that the use of appeals to
the emotion of disgust in public health campaigns has serious political, moral and ethi-
cal implications that require acknowledgement. While such campaigns are generally for-
mulated with the best of intentions –to promote the health of their target audiences –
the manner in which this objective is sought, and the unintended consequences that
may possibly eventuate need to be identified. Advocates of using such tactics should be
aware of the challenge they pose to human dignity and their perpetuation of the Self
and Other opposition that marginalises already disadvantaged individuals and social
groups and represents them as inferior.
References
Alderman, J., Dollar, K. M., & Holtz, T. H. (2010). Commentary: Understanding the origins of
anger, contempt, and disgust in public health policy disputes: Applying moral psychology to
harm reduction debates. Journal of Public Health Policy, 31(1), 1–16.
Critical Public Health 9
Downloaded by [Deborah Lupton] at 16:09 14 February 2014
Ali, S. H. (2008). Stigmatized ethnicity, public health, and globalization. Canadian Ethnic Stud-
ies, 40,43–64.
Azagba, S., & Sharaf, M. F. (2013). The effect of graphic cigarette warning labels on smoking
behavior: Evidence from the Canadian experience. Nicotine & Tobacco Research, 15, 708–
717.
Behuniak, S. M. (2011). The living dead? The construction of people with Alzheimer’s disease as
zombies. Ageing & Society, 31,70–92.
Boero, N. (2007). All the news that’s fat to print: The American ‘obesity epidemic’and the
media. Qualitative Sociology, 30,41–60.
Brandt, A., & Rozin, P. (1997). Introduction. In A. Brandt & P. Rozin (Eds.), Morality and health
(pp. 1–11). New York, NY: Routledge.
Brennan, L., & Binney, W. (2010). Fear, guilt, and shame appeals in social marketing. Journal of
Business Research, 63, 140–146.
Brown, R., & Gregg, M. (2012). The pedagogy of regret: Facebook, binge drinking and young
women. Continuum, 26, 357–369.
Brown, S. L., & Richardson, M. (2012). The effect of distressing imagery on attention to and per-
suasiveness of an antialcohol message: A gaze-tracking approach. Health Education & Behav-
ior, 39,8–17.
Bunton, R., & Coveney, J. (2011). Drugs’pleasures. Critical Public Health, 21,9–23.
Cho, H., & Salmon, C. T. (2006). Fear appeals for individuals in different stages of change:
Intended and unintended effects and implications on public health campaigns. Health Commu-
nication, 20,91–99.
Crawford, R. (1994). The boundaries of the self and the unhealthy other: Reflections on health,
culture and aids. Social Science & Medicine, 38, 1347–1365.
Crawshaw, P. (2012). Governing at a distance: Social marketing and the (bio)politics of responsi-
bility. Social Science & Medicine, 74, 200–207.
de Melo-Martín, I., & Salles, A. (2011). On disgust and human dignity. The Journal of Value
Inquiry, 45, 159–168.
Deigh, J. (2006). The politics of disgust and shame. The Journal of Ethics, 10, 383–418.
Donovan, R., & Jalleh, G. (2004). Tracking the 2000 National Tobacco Campaign. In Australia’s
National Tobacco Campaign evaluation report volume three (pp. 15–49). Canberra: Austra-
lian Government Department of Health and Ageing.
Douglas, M. (1969). Purity and danger: An analysis of concepts of pollution and taboo. London:
Routledge & Kegan Paul.
Durham, D. (2011). Disgust and the anthropological imagination. Ethnos, 76, 131–156.
Gagnon, M., Jacob, J. D., & Holmes, D. (2010). Governing through (in)security: A critical analy-
sis of a fear-based public health campaign. Critical Public Health, 20, 245–256.
Guttman, N., & Salmon, C. (2004). Guilt, fear, stigma and knowledge gaps: Ethical issues in pub-
lic health communication interventions. Bioethics, 18, 531–552.
Haidt, J., Rozin, P., McCauley, C., & Imada, S. (1997). Body, psyche, and culture: The relation-
ship between disgust and morality. Psychology & Developing Societies, 9, 107–131.
Hastings, G., Stead, M., & Webb, J. (2004). Fear appeals in social marketing: Strategic and ethi-
cal reasons for concern. Psychology and Marketing, 21, 961–986.
Hill, D., & Alcock, J. (1999). Background to the campaign. In Australia’s National Tobacco
Campaign evaluation report volume one (pp. 9–21). Canberra: Commonwealth Department of
Health and Aged Care.
Humphris, G., & Williams, B. (2013). Is disgust the driver behind the selection of images for UK
tobacco packets? Health Education Journal. doi:10.1177/0017896913496399
Kent, L. (2001). Fighting abjection: Representing fat women. In J. Braziel & K. LeBesco (Eds.),
Bodies out of bounds: Fatness and transgression (pp. 130–150). Berkeley: University of
California Press.
Kristeva, J. (1982). Powers of horror: An essay on abjection. New York, NY: Columbia Univer-
sity Press.
10 D. Lupton
Downloaded by [Deborah Lupton] at 16:09 14 February 2014
Leshner, G., Bolls, P., & Thomas, E. (2009). Scare ‘em or disgust ‘em: The effects of graphic
health promotion messages. Health Communication, 24, 447–458.
Linnemann, T., Hanson, L., & Williams, L. S. (2013). ‘With scenes of blood and pain’: Crime
control and the punitive imagination of the meth project. British Journal of Criminology, 53,
605–623.
Lupton, D. (1995). The imperative of health: Public health and the regulated body. London:
Sage.
Lupton, D. (2013a). Risk and emotion: Towards an alternative theoretical perspective. Health,
Risk & Society, 15, 634–647.
Lupton, D. (2013b). Risk. London: Routledge.
Lupton, D. (2013c). Fat. London: Routledge.
Lupton, D. (2014). ‘How do you measure up?’Assumptions about ‘obesity’and health-related
behaviors and beliefs in two Australian ‘obesity’prevention campaigns. Fat Studies, 3,32–44.
McGinn, C. (2011). The meaning of disgust. New York, NY: Oxford University Press.
Miller, W. (1997). The anatomy of disgust. Cambridge, MA: Harvard University Press.
Nelkin, D., & Gilman, S. (1991). Placing blame for devastating disease. In A. Mack (Ed.), In time
of plague: The history and social consequences of lethal epidemic disease (pp. 39–56). New
York: New York University Press.
Niehaus, I. (2007). Death before dying: Understanding AIDS stigma in the South African low-
veld. Journal of Southern African Studies, 33, 845–860.
Nussbaum, M. (2004). Hiding from humanity: Disgust, shame, and the law. Princeton, NJ:
Princeton University Press.
Rozin, P., & Fallon, A. (1987). A perspective on disgust. Psychological Review, 94,23–41.
Rozin, P., & Singh, L. (1999). The moralization of cigarette smoking in the United States. Jour-
nal of Consumer Psychology, 8, 321–337.
Shimp, T. A., & Stuart, E. W. (2004). The role of disgust as an emotional mediator of advertising
effects. Journal of Advertising, 33,43–53.
Taylor, K. (2007). Disgust is a factor in extreme prejudice. British Journal of Social Psychology,
46, 597–617.
Thompson, L., & Kumar, A. (2011). Responses to health promotion campaigns: Resistance, denial
and othering. Critical Public Health, 21, 105–117.
Thompson, L. E., Barnett, J. R., & Pearce, J. R. (2009). Scared straight? Fear-appeal anti-smoking
campaigns, risk, self-efficacy and addiction. Health, Risk & Society, 11, 181–196.
Tyler, I. (2013). Revolting subjects: Social abjection and resistance in neoliberal Britain. London:
Zed Books.
van ’t Riet, J., Ruiter, R. A., & de Vries, H. (2012). Avoidance orientation moderates the effect
of threatening messages. Journal of Health Psychology, 17,14–25.
Van Dongen, E. (2001). It isn’t something to yodel about, but it exists! faeces, nurses, social rela-
tions and status within a mental hospital. Aging & Mental Health, 5, 205–215.
Wakefield, M., Bayly, M., Durkin, S., Cotter, T., Mullin, S., & Warne, C. (2013). Smokers’
responses to television advertisements about the serious harms of tobacco use: Pre-testing
results from 10 low- to middle-income countries. Tobacco Control, 22,24–31.
Witte, K., & Allen, M. (2000). A meta-analysis for fear appeals: Implications for effective public
health campaigns. Health Education & Behavior, 27, 591.
Wu, E. C., & Morales, A. C. (2012). How disgust enhances the effectiveness of fear appeals.
Journal of Marketing Research, 49, 383–393.
Critical Public Health 11
Downloaded by [Deborah Lupton] at 16:09 14 February 2014