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Evidence-based communication approaches to raise awareness, promote preventive behaviours and attitudes toward respiratory wellbeing are needed to turn negative messages about lung disease into lung health for all.
Of the leading causes of death in this country, lung disease is the second biggest, following closely behind heart disease. Yet lung disease slips under people’s radars and is disproportionately under-funded across a range of its key conditions.
Lung cancer is the least funded of all commonly diagnosed cancers in Australia, yet the leading cause of cancer deaths. The survival of people with pulmonary fibrosis is as low as some of the most devastating cancers, and one in eight Australians over the age of 40 have either asthma or chronic obstructive pulmonary disease.
Chronic respiratory disease disproportionately affects Indigenous Australians and there are worse outcomes for millions of Australians related to socio-economic disadvantage, occupational and environmental exposures and geographic location.
The negative impact of societal stigma on behaviour change
Lung diseases, despite their prevalence, generally attract little sympathy for some of the reasons above, but additionally because of the misguided belief that lung disease is self-inflicted and hence the sufferer is to blame.
By contrast, this lack of sympathy in our community does not extend to people who develop cardiovascular disease, even when there are clear associations with common risk factors such as smoking and air pollution, and lifestyles that some people appear not to be addressing while taking medications to reduce their risks.
This contrast between the equally important heart and lung stories provokes us to think about how we can use effective communication strategies to help people understand the desirable and actionable nature of aiming for lung health as a strategy that yields benefits across an individual’s lifetime.
Communicating messages about lung disease has been challenging around the world, not just in Australia. This relates to the community’s belief that lung disease can be attributed to just a few nasty risk factors — smoking, particular occupations or very severe air pollution.
These beliefs could well be a consequence of effective messaging about preventable exposures, but are just as likely due to poor understanding of the universal nature of lung disease, and its potential to develop over a lifetime of exposure, not just one single event. As with all organs, the lungs do not look after themselves.
Cumulative insults from birth to death contribute to each individual’s risks of developing abnormal lung function and clinically important lung disease, and hence also provide opportunities for prevention, and for optimising lung health.
Successful public health campaigns
One of the most successful national health promotion campaigns over recent years has been the campaign to reduce tobacco consumption across all age groups and social categories, resulting in progressive drops in smoking prevalence and reductions in smoking uptake in teenagers.
Similarly, “Slip, slop, slap” in Australia has been remarkably effective in promoting sun protective behaviours, none of which have instantaneous appeal: avoiding getting a tan, wearing a hat, slopping on sticky goo at the beach and keeping covered outdoors.
Key to the success of both of these campaigns has been government support and multifaceted strategies closely aligned with purpose. In the case of smoking, this included prohibiting smoking in public places, workplaces and public transport, markedly increasing prices over time, reducing access in shops, restricting advertising and introducing plain packaging with health warnings.
Without these strategies, the marked reductions in smoking and smoking uptake would likely be far less dramatic. In the case of both smoking and sun protection, the addition of incentives to comply, of refashioning the community’s understanding, adding ideas around looking healthier and disincentives starting in childhood (“no hat, no play”) strengthened these initiatives.
Positive, actionable and diverse communication is key
We can learn from these campaigns and the evidence base that underpins effective communication of health messages. This begins with emphasising the gains that can be made by looking at positive actions that enable people to both understand and feel empowered by opportunities to maximise their lung health.
These messages should focus on day-to-day events that are within an individual’s power to achieve, and not simply on the negative consequences of particular behaviours that must be avoided. Indeed, the messages should be clear and enable people to avoid things that they do not like, such as recurrent respiratory tract infections, rather than invoke them to give up things they feel are overwhelmingly difficult.
Further, these messages should be catchy, succinct and relevant to them, in their own culture, language and demographic and communicated through multiple channels, social media platforms and conventional public health messaging.
Future-proof strategies for the next generation
We now understand that lung health and the factors affecting it begin at birth, so that lifelong efforts to achieve and maintain lung health drive good or bad outcomes into the future. We can empower people with the concept that lung health is in their hands, and looking after their lungs has long term consequences that will work in their favour.
Avoiding negative messages and framing lung health as something to be embraced, we cheekily propose that “I lung you” or “I love you with all my lungs” could be used to convey very simple but engaging ideas about lung health.
These encompass life enhancing actions such as maintaining physical activity, maintaining healthy weight and a healthy diet, protecting against respiratory infections with vaccination, masking in risky situations, breathing clean air and exercising in green spaces.
This is a turn-around from the well-worn track of fear-based messaging about lung disease but speaks to everyone and promotes whole of life lung health as an opportunity to be seized, personalised and made one’s own.
Professor Christine Jenkins is Program Head, Respiratory at The George Institute for Global Health; Professor of Respiratory Medicine at UNSW Sydney and Clinical Professor in the Concord Clinical School, University of Sydney.
The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.
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