Effectively earlier than I used to be a doctor, I used to be an artwork historical past main at Bowdoin School. Beneath towering pine timber, I spent a lot of my time in dim lecture rooms off the quad and within the quiet galleries of Maine’s artwork museums, finding out work, sculptures, and pictures to grasp not simply what was being portrayed, but additionally what they revealed in regards to the individuals, locations, concepts, and defining occasions of their time. The extra I realized, the extra I appreciated artwork’s means to each replicate the world round us and affect how we see it. On the time I couldn’t have imagined how that lens would form my work, years later, in public well being.
At present, I function a doctor and public well being skilled in behavioral well being within the San Francisco Division of Public Well being. In my position I feel usually about how we will scale back the structural and interpersonal stigma confronted by individuals who use medication. Stigma is a profound barrier to care. It might have an effect on whether or not somebody seeks remedy, whether or not a neighborhood accepts a hurt discount program, and whether or not legislators assist evidence-based insurance policies. Understanding the drivers of drug-related stigma is a crucial and mandatory endeavor.
In public well being, now we have for years acknowledged how the language we use influences stigma. For instance, phrases resembling “substance abuser” or “addict” elicit extra unfavourable reactions than person-first language, resembling a “individual with a substance use dysfunction.” Messaging that focuses on private accountability tends to extend stigma, whereas messages that emphasize structural causes have a tendency to cut back it. However whereas the analysis on language is strong, comparatively little has been completed on the position of photographs.
And but we course of the world visually. Practically 90 % of People report getting their information on-line, usually from sources saturated with images. These images usually precede textual content, and in some instances, it’s the solely a part of a narrative {that a} reader will interact with. It’s images that seize our consideration as we quickly scroll by way of tons of of social media posts. Moreover, posts with images are extra more likely to be shared than these with out, making certain that salient visuals stay on the fore of our day by day stimuli. This makes the selection of images not merely an editorial resolution, however a consequential one. Having spent years eager about artwork and its composition and that means, I wished to know: How do images form public notion of people that use medication? Which heighten stigma? Which reduce it?
To discover these questions, my colleagues on the Johns Hopkins Bloomberg Faculty of Public Well being and I performed a lately revealed message-testing experiment. Over 3,400 adults within the U.S. had been randomized to view certainly one of eight images utilized by the media in its reporting on at this time’s overdose disaster or to a no-exposure management group. The images had been chosen from actual information tales and mirrored widespread depictions of substance use: an individual injecting medication, being revived following an overdose, receiving remedy remedy, an individual in restoration, and somebody who had misplaced a member of the family to an overdose. After viewing the photograph and a brief descriptive caption, examine members had been requested questions on their present feelings, their willingness to dwell close to and work with an individual with a substance use dysfunction, and their acceptance of drug-related providers of their neighborhood.
Our outcomes had been revealing: Photographs of people in restoration had been related to decrease stigma. In comparison with the management group, examine members who considered a photograph of somebody in restoration had been considerably extra more likely to say they’d be keen to work and socialize with somebody with a substance use dysfunction. Whereas this discovering is maybe intuitive, our examine gives a number of the first empiric proof that humanizing images might scale back stigma.
Conversely, images portraying lively drug use or overdose evoked disgust and pity, however they didn’t improve stigma in comparison with the management group. It’s doable that these kind of images have been normalized. They’re generally utilized by the media and are anticipated. Folks might already affiliate drug use with sure visuals and cues, so these images might not shift perceptions as a result of they verify relatively than problem pre-existing beliefs.
Not one of the images we examined, no matter their impact on feelings or stigma, considerably elevated assist for remedy or hurt discount providers. This implies that lowering stigma is vital at an interpersonal stage however might not be sufficient to beat the “Not In My Yard” or NIMBY angle that usually blocks the siting of wanted public well being packages. Methods to flip understanding and empathy into coverage assist is a problem we wrestle with on the native stage and is one which manifests on the state and federal stage as nicely.
Nonetheless, the implications of the examine are notable. Photographs matter, as they’ve for hundreds of years. Photographs at this time don’t simply passively adorn an article’s textual content, however they inform their very own tales. They form how we really feel and the way we relate to the phrases on the web page. They’ll set up who’s seen as deserving of care and what sorts of interventions really feel acceptable. They usually replicate who we’re and what we worth. That is why I consider we as public well being professionals, journalists, photographers, and policymakers should all be extra aware of, and intentional with, our visible storytelling.
This analysis has introduced me again to my artwork historical past roots and it continues to tell my work in a deeply significant approach. Certainly, the usefulness of understanding design, illustration, and symbolism extends past artwork appreciation to efforts to shift public consciousness, destigmatize an pressing well being matter, and advance the widespread good.
As we proceed to confront this public well being disaster, I consider we’d like each instrument at our disposal, together with scientific interventions, coverage reform, group partnerships, correct and compassionate reporting, and sure, higher photographs.
Jeffrey Hom is the medical officer for science and coverage within the Substance Use Companies part of the San Francisco Division of Public Well being and practices at Zuckerberg San Francisco Common Hospital. He advises on equity-driven, population-level methods to cut back the harms of dangerous substance use and gives scientific care by way of the county’s opioid remedy and buprenorphine telehealth packages. Board-certified in inside medication and public well being, Dr. Hom beforehand led the Division of Substance Use Prevention and Hurt Discount within the Philadelphia Division of Public Well being and served as a coverage advisor in the course of the metropolis’s COVID-19 response. His current work contains “The Influence of Information Pictures on Drug-Associated Stigma: A Randomized Message Testing Experiment in a Nationwide Pattern of US Adults.” Extra details about his work might be discovered on LinkedIn.
