Public Health: To Care or to Control? 

Scene 1

It’s 1987 Australia. You’ve turned on the TV to see the Grim Reaper commercial. The familiar tall black figure, the sound of the crashing bowling pins, the harrowing voice-over. 

The HIV/AIDS epidemic upended public health all over the world, from the United States to sub-Saharan Africa. While one would expect nations such as Australia, endowed with financial resources and more robust infrastructure, to weather the epidemic with adequate preparation, this was not the case. In the United States in particular, funding set aside for AIDS treatment was not approved by Congress until 1983, 2 years following the first outbreak. In 1985, Ronald Reagan mentioned HIV/AIDS for the first time after his administration was criticized for inadequate AIDS funding; his first public speech on the subject did not take place until 1987, after over 47,000 people in the United States had been diagnosed with AIDS, accounting for almost ⅔ of the worldwide recorded cases of 71,751. 

Health campaigns that arose from this epidemic, like the Grim Reaper, evoked moralistic images to encourage people to take the epidemic seriously. Images condemning promiscuity, intravenous drug users, and homosexuality circulated through the CDC and other health agencies.

Scene 2

These health campaigns aren’t new though. Take a moment and try and think of other times ads have used fear-mongering images to promote public health. Maybe it’s in those “No Smoking” campaigns, a haunting image of a woman with a hole in her neck and raspy wheezes for breaths. Maybe it’s in World History class as you look at World War II era ads, warning against contracting syphilis from promiscuous women, prostitutes in the streets, those who upend the nuclear family and the American state. Women, women, women. They’re there again in the HIV ads, dirtied with handprints, promiscuous agents spreading disease. Lipstick stains, cocktail glasses, rosy blush and deep hooded eyes.

What do these efforts amount to? An effort to control people and their movements, their biological processes and decisions? This is what the French philosopher Michel Foucalt describes as biopolitics, a technology used by the state that seeks to control the lives of populations with interventions deemed to be beneficial. Foucalt describes this notion of biopolitics as not necessarily good or bad but always inherently dangerous if accepted blindly without any questioning or criticism. I hope to examine health campaigns in the lens of biopolitics through this essay today, discussing how the fine line between education and propaganda illuminates the extent to which the state extends control over people’s lives to advance what they believe is the “greater good”.

Scene 3

But these are all obviously propaganda right? But what even is the difference between public health campaigns and propaganda, if any at all?

We’ve seen social marketing campaigns to quit smoking and drive safely. But what draws the line between these campaigns and the prostitutes of World War II posters? In early 1900s Mexico City, there was no line: health education and propaganda were managed as one and the same under one department. In fact, in their campaigns, indigenous and rural populations were often portrayed as backwards and inferior.

It is easy to see how education and propaganda are intertwined.

Maybe, you think, this lack of separation between education and propaganda was just a product of its time [1]. However, these blurred lines seem to be a constant, a pattern that can be tracked across different spaces and times. This blurriness can be seen nearly 90 years later in the Czech Republic, when Vladimir Kozlik publishes two images with the Institute of Health Education of Prague that seek to encourage safer sexual practices but also encode women as lecherous and promiscuous, and those living with HIV/AIDS as dirty and soiled [2].

It is noteworthy to consider, though, the difference between who is depicted in these images and who their intended audience is. Both Kozlik’s works and the Grim Reaper ad, which only came out two years prior to his work, obviously target audiences that are not at the highest risk of exposure to the disease [3]. 

Evidently, there seems to be a dichotomy between who public health campaigns seem to target and those who are most adversely affected. On the other hand, there seems to be little to no divide between propaganda and public health education. 

Scene 4

And what use is there for blurring those lines? 

Perhaps it is to establish sovereignty in a city that has been belittled and carved apart by foreign powers, like treaty-port Tianjin. Perhaps it is to advocate for social and political change and establish a representative democracy, like the dissemination of Gandhian manuals during the independence movement in India. Clean is modern, healthy is modern, hygiene is modern. Consuming what is healthy and hygienic is modern. Eating healthy and being hygienic is modern. Sexing healthy and in a hygienic way is modern.

What does this mean for more developed nations that stumbled in the face of the AIDS epidemic? Does it look “bad” to have a public health infrastructure, which was supposed to be so robust, that couldn’t ward it off? Does it look “bad” to be unclean? Unrefined? Backwards?

Perhaps, though, we may already be unrefined and backwards. Mexico’s indigenous and rural populations, most at risk for unhygienic conditions, were targeted in public health campaigns only after extensive public health interventions were established in wealthier urban centers. Aren’t we already backwards for leaving parts of our population, seen as lowly and lesser, behind in favor of protecting those who are already more sanitary, cleaner, modern, wealthier? 

Scene 5

Alas, HIV/AIDS is not the last public health crisis to challenge the public health infrastructure of industrialized nations.

COVID-19 upended all life in the United States. Millions were encouraged to stay home, partake in social distancing and mask mandates. Some were less than pleased with these changes, taking up arms to protest at state capitols. My body, my choice, they wailed. I can’t breathe, they chanted. Maybe we scoff at them as they co-opt the movements for women’s health and racial justice to protest the very measures that are meant to protect them. Maybe we fail to realize that even though these efforts seek to put our health first, they’re the same as those women with the red lips and rosy cheeks, ads scoffing at indigenous folks, the “Stop AIDS” over our most private parts. 

Some people decry stay-at-home orders as threats to our liberties. But perhaps it is dangerous that people recognize only now that the government easily exercises power over our bodies, even to keep us safe. That is biopolitics.

But another salient feature of biopolitics has reared its head again: the disproportionate rate at which we are exposed to health risks, targeted in campaigns against these risks, and ultimately controlled to prevent these risks from spreading. We celebrate the acts of healthcare workers who put their lives at risk to take care of the sick. But what about the delivery workers? The grocery workers? The factory workers and Uber drivers? We are encouraged to stay at home to stay safe, but the vast majority of people who are unable to stay home are Black and Brown. Essential workers are pushed to serve others as “heroes” while wealthier celebrities have complained how staying at home feels like being in prison. 

Our public health campaigns, encouraging us to social distance and stay home, are just a microcosm for this inequality of vulnerability that is especially pronounced during times of crisis.

Perhaps we will never evolve past this fear of uncleanliness, inferiority and backwardness. Perhaps it is through this fear that we finally see the intricate balance between education for the greater good and agendas that compromise our bodily agency. Perhaps we are at a crossroads, where we need this fear. As regulations are lifted, case rates fluctuate up and down, and vaccinations are increasing, maybe we just need our own Grim Reaper to put us in our place, prod us in the direction of something more normal-ish.

 

Footnotes

[1] During the early 1900s, Mexico was considered to be at a crossroads, looking to modernize following the violent Mexican Revolution. After the Sanitary Code of Mexico was adopted in 1891, health education programs were boosted significantly, viewed as fundamental to the nation and essential to the modernity of Mexico City. These education programs took the forms of public lectures and talks, conventions such as the Popular Hygiene Exhibition of 1910, and the Section of Hygienic Education and Propaganda’s promotional pamphlets, television broadcasts, and radio shows.

[2] Kozlik’s works with the Institute of Health Education of Prague include Stop, which depicts a woman with dirty palm prints all over her nude body and a “Stop AIDS” sign over her genitals, and Vernosti proti AIDS, which consists of a light colored background, littered with lipstick stains and the words “Vernosti proti AIDS”, translating roughly to “loyalty against AIDS”. According to the Wellcome Collection’s copy of Vernosti proti AIDS, the image cites promiscuity as a risk factor for AIDS.

[3] Kozlik’s works seem to target those who engage in sexual activity with women; however, at the height of the AIDS epidemic, gay and bisexual men, disproportionately people of color, were contracting the virus at the highest rates, with thousands becoming infected. Similarly, the Grim Reaper ad, which only came out two years prior to Kozlik’s works, obviously targets the cis, heteronormative nuclear family, an audience not at the highest risk of exposure to the disease.

 

Works Cited

“A Timeline of HIV and AIDS.” HIV.gov. U.S. Department of Health and Human Services, April 8, 2021. https://www.hiv.gov/hiv-basics/overview/history/hiv-and-aids-timeline. 

Agostoni, Claudia. “Popular Health Education and Propaganda in Times of Peace and War

in Mexico City, 1890s–1920s.” American Journal of Public Health 96, no. 1 (March 26,

2006): 52–61. https://doi.org/10.2105/ajph.2004.044388.

Alter, Joseph S. Gandhi’s Body: Sex, Diet, and the Politics of Nationalism. Philadelphia,

PA: University of Pennsylvania Press, 2000.

Kozlik, Vladimir. Vernosti Proti AIDS. 1989. Wellcome Collection.

https://wellcomecollection.org/works/aprpbat9.

Lorenzini, Daniele. “Biopolitics in the Time of Coronavirus.” Critical Inquiry 47, no. S2 (April 2, 2020): 1–6. https://doi.org/10.1086/711432.

Rogaski, Ruth. Hygienic Modernity: Meanings of Health and Disease in Treaty-Port

China. Berkeley, CA: Univ. of California Press, 2014.

———. Stop. 1989. Wellcome Collection. https://wellcomecollection.org/works/wr28e35n.