I want to start this blogpost with a thought experiment. Imagine you read something on social media referring to ‘the elderly and vulnerable.’ What picture is at the front of your mind? Now read on.
The response to the coronavirus has explicitly delineated between those over the age of 70 and/or with ‘underlying conditions’ and the rest of the population. This is because the experience of other countries has shown that those who fall into these categories are more at risk of serious illness and face a higher probability of death should they become infected. Those falling into these categories have been encouraged to take greater steps than others to avoid physical contact, including through social isolation, to protect themselves and to help avert a runaway number of hospital admissions that might overwhelm the NHS, placing many more at risk.
Whether this is the right policy, whether it could have been avoided with earlier or different action and so on is something I don’t have the expertise to comment on. But what I do think is that the public messaging about the Coronavirus has not only been confusing, but through its language and framing, I fear it may have had a major backfire effect which led to the current lockdown and could contribute both to more deaths and to longer term negative ramifications.
To come back to the thought experiment, the ‘at risk’ groups have commonly been described as ‘the elderly and vulnerable.’ Now think of the mental picture you had, and then think of people you know in their 70s (which may include yourself). How many would fit that mental picture? I don’t know if any polling was or has been done, but I expect that initially a great number of people in the ‘at risk’ groups neither recognised themselves, nor were recognised by others as falling into the description ‘elderly and vulnerable.’ How many older people do you know who would describe themselves in this way? How many do you know who would feel such language undermined their identity and status, or their cherished independence, especially when the measures were described in terms of ‘being protected’ (shielding) which would involve withdrawing completely from everyday life into the home, when everyone else was facing far less draconian measures. Anecdotal evidence I saw suggested that for some of the target audience at least, such terminology may have either missed them altogether or led to them to psychologically distance themselves from the message, rather than heeding the advice to distance from others.
In sum, language rooted in paternalistic benevolence (shielding the elderly and vulnerable) leads both to othering (they must mean someone else), distancing (I’m going to argue they don’t mean me) and rejection of the advice (I don’t need protecting). But it also, in my view, leads to something else: the very opposite of protecting people.
The messaging has focused overwhelmingly on our propensity to acquire the virus, not on everyone’s huge propensity to transmit it. Even the messaging about washing our hands and social distancing has framed it as a self-protection measure, not a mutual protection measure. This has in turn reinforced and been reinforced by the message that the at-risk groups are ‘the elderly and vulnerable’ with everyone else told only to anticipate a ‘mild’ illness. The implicit message is that younger people – including those over 70 who do not identify as ‘elderly or vulnerable’ – had much less to worry about. For them this was largely an inconvenience, albeit one with vast consequences for their future.
More disturbingly, and with potentially longer-term consequences, is the implicit downgrading of the human rights of older and disabled people and those with long term health conditions. This is not to deny the necessity in such an emergency to make clinical decisions based on the best prospects of treatment leading to survival and recovery. But the framing risks conflating prospects of survival, with the value to society of certain classes of people surviving. As Dr Frances Ryan has pointed out, the subtext of messaging that says no one need worry about it unless they are ‘elderly or vulnerable’ is – in the words of Morrissey – ‘they were old and they would’ve died anyway.’ (the explicit message in the Sky News graphic above). This in turn helps lays the ground for access to intubation to be denied on grounds of age alone as has it has been reported has happened in parts of Italy, or because of the existence of impairments or health conditions which do not necessarily predict prospects of survival, as in the NICE guidelines on who to admit to critical care. It also helps pave the way for the duties of councils under the Care Act 2014 to be suspended: an emergency measure to empower councils to manage fluctuations in demand and staffing, but one which does not suggest that the ‘elderly and vulnerable’ are being prioritised. Of course some of these things are just a far more acute and transparent expression of things that already happen.
So how could this be talked about in a way that might motivate a better response?
Imagine if the messaging cast us all as a potential ‘Queen Elsa’ from Disney’s Frozen, unaware of our newly acquired power to cause harm by touching things and each other? That is, imagine if it had focused on everyone’s capacity to make others ill, and rooted messaging about social distancing and washing hands in the responsibilities that flow from that fact. ‘Careless contact costs lives’ if you like.
Imagine it focused on our collective ability to bring the NHS to its knees and to endanger its staff through our carelessness, while tapping into our instinctive will to support it, as we demonstrated on Thursday night, applauding its workers ahead of the surge, and gave us a sense of collective purpose and agency to do so.
Imagine if rather than ‘protecting the elderly and vulnerable’ the message was about all of us protecting each other, or as Irish Prime Minister Leo Varadkar said ‘coming together by staying apart’. Within that framing of mutual protection and individual agency we can emphasise the particular roles and responsibilities of different groups. Rather than ‘protecting the elderly and vulnerable’, we could talk about the great sacrifice that those over 70 and with underlying health conditions will make, in their own interests and in that of their fellow citizens, including NHS staff. Rather than minimising the personal risk of the virus to younger generations, we could talk up the risk they pose to others as transmitters, with social distancing framed as an obligation not to harm others and calling upon them to support the national effort to get through this together. In sum, imagine a message of shared citizenship and of mutual obligation.
It is too early to know what impact this period will have upon attitudes to older and disabled people and those with long-term health conditions. Nevertheless, in the social and economic turmoil that is undoubtedly to come, we will need to be highly vigilant to maintain meaningful support for the equal dignity and worth of everyone, underscored by recognition of our common humanity.
We could start by recognising that language can literally be a matter of life and death and ensure that the disciplines of framing and strategic communications lie at the heart of our work to build and shape the post pandemic future.