Thursday, 13 March 2014

The Crusade to ‘Conquer Cancer’ in Ireland, 1950s-70s - Smoking and Lung Cancer: The Rise of the Visual by Jane Hand

In this month's blog post, Jane Hand, a PhD student at the Centre for the History of Medicine, University of Warwick, writes about public health initiatives in the campaign against lung cancer in Ireland, c.1958-78. This was the subject of her MA dissertation undertaken at CHOMI, UCD (2011).

Since the late 1950s the relationship between smoking and lung cancer gained increased national prominence in Ireland, becoming the focus for a variety of both public and voluntary health education campaigns. The visual component of these health campaigns was central to the formulation of health education strategies reflecting changing perceptions of disease. In addition, as health advertising became increasingly central to public health, aspects of medicine and media consumption became more closely allied. This facilitated the emergence of a lifestyle-orientated public health centred on behavioural modification in relation to chronic disease diminution.

Fig. 1 Anti-Smoking Leaflet aimed at children, 
Department of Health and Children (NAI S16659A)
The causal connection between smoking and lung cancer was the first major chronic disease model to be explicitly linked to lifestyle factors. Consequently, health education material attempted to incorporate models of behavioural change. The initial release of anti-smoking publicity material in 1958 consisted of two leaflets highlighting the connection between smoking and lung cancer. As shown in Fig. 1 and Fig. 2, the first leaflet targeted adults, whilst the second aimed at reducing the smoking uptake amongst the young. Both publications employed visual techniques centred upon simplistic imagery, eye-catching colour usage and the juxtaposition of upper and lower case text to emphasise particular aspects of its composition to the reader. By adopting a question/answer format these leaflets provided concise and precise health information whilst removing medical jargon from their explanatory texts. Their basic function was to establish a specific mode of behaviour and correct health conduct in relation to cigarette smoking. Minister for Health, Séan MacEntee made the rationale behind the publication of these leaflets by the Department of Health exceedingly clear: ‘The reports of investigations into the death rates from lung cancer have ensured that the results must be brought to the notice of the public’.1
Fig. 2 Anti-Smoking Leaflet aimed at adults,
Department of Health and Children (NAI S16659A)
Efforts to reduce tobacco consumption amongst younger age groups remained a central objective of state-led health promotion initiatives. Consequently the “Smoking Kills Your Taste for Life” campaign centred upon the mantra ‘If You Don’t Smoke - Don’t Start, If You Do Smoke – Stop Now!’ which represented the principal component of the Department’s health education strategy for much of the 1970s. A series of health educational films, including the “Smoking Kills Your Taste for Life” filmlets, were shown in primary schools throughout the country, with Irish-language voiceovers for those schools situated in Gaeltacht areas and some others that requested the Irish version.2

The dangers of smoking were compiled in a booklet The Facts about Smoking and Health, anti-smoking posters were widely circulated and a series of shorts were aired on RTÉ television.3 The establishment of a poster competition on a non-smoking theme proved particularly popular.4 The competition itself was widely advertised using press, radio and television. Entry forms had themselves acted as advertisements, comprising a strong anti-smoking message. As displayed in Fig. 3, these provided educative information concerning the dangers of smoking whilst appealing to the public-consciousness to elicit a positive response: ‘Deep down you must know that smoking is bad for your health – but let’s face it, at your age lung cancer seems a remote possibility’.5  The use of a direct-address style in the accompanying text to this pamphlet only served to further foster a perception that confidence in curative measures was maintained within the visual expression of disease and illness.

Fig. 3 ‘Smoking Kills Your Taste for Life’ poster competition entry form
Department of Health Files (INACT 428227)

During the 1970s an emphasis on the harmful effects of tobacco smoking on the lungs became more overt. The utilisation of various shock tactics, specific medical knowledge and biological explanations became increasingly standard practice. Science was becoming as much a part of the various promotion techniques employed, as were those pleas to health consciousness. Increased biological knowledge facilitated the emergence of a series of intellectually founded anti-tobacco smoking campaigns, particularly those instigated by the Irish Cancer Society, such as “How Smoking Affects Us” reproduced as Fig. 4.6 The caption serves to draw the reader’s attention to the integral message of the leaflet thus preventing any possible misinterpretation.7 By combining text and illustration the pamphlet successfully attempts to heighten its educative purpose. Ultimately the use of a diagram coupled with numbered explanations serves to convey an otherwise complicated medical message in a concise and understandable format.
Fig. 4 Anti-Smoking Leaflet produced by the Irish Cancer Society,
Department of Health Files (INACT 
The 1970s represented the era when persuasion media as a method of health education became central to public health campaigns. Analogous to Britain, state expenditure on health promotion increased dramatically reaching £110,000 for the year 1970-1971, thereby facilitating the application of new-style advertising campaigns highlighting the tobacco and lung cancer risk.8 Campaigns developed a more scientific and biological character. The use of a series of precise anatomical diagrams designed to outline the effects of smoking on the body became evermore commonplace Whereas almost all anti-smoking propaganda produced during the late 1950s and 1960s had focused exclusively on the relationship between smoking and lung cancer, the 1970s was notable for widening the scope of the anti-smoking crusade. No longer was the lung perceived as the only body organ to be affected by the adverse effects of prolonged cigarette smoking, but rather its additional detrimental effects, as displayed in Fig. 5, Fig. 6 and Fig. 7, on the heart, brain, and nose and throat in particular were increasingly expounded.
Fig. 5, Fig. 6 and Fig. 7 The Better Health Pack Leaflets
on the bodily effects of smoking (NLI Ir614 h4)
Moreover, the focus altered somewhat with increased state interest in the effects of smoking on the pregnant woman. The dangers of smoking in pregnancy were highlighted in a special article entitled ‘You and Your Baby’ which was distributed nationally by the medical profession to expectant mothers.9 With the formation of the Health Education Bureau in 1975 and its greatly increased budget following the appointment of Charles Haughey as Minister for Health in 1977, state sponsored health campaigns adopted a more sophisticated composition.10 The tar and nicotine content of cigarettes was increasingly emphasised to create an anti-aesthetic surrounding the habit of smoking.11 The promotion of anti-smoking material centred on the endorsement of behavioural change rather than on compulsion, with the media providing the key factor within a new style of health activism. 

The modification of individual behaviour through the initiation of highly stylised visual health campaigns became central to public and voluntary information programmes. As encapsulated by MacEntee, lifestyle choice and behavioural change became pivotal to the success of anti-smoking education campaigns centred upon the concept that ‘If you have never smoked, don’t take it up; if you are already a smoker, give it up, or at least do not smoke immoderately’.12 By accepting the epidemiological argument for a connection between smoking and lung cancer both the state and voluntary organisations alike firmly aligned themselves to the implementation of a programme of preventative measures. This was achieved through the adoption of visual illustration as the main feature of health advertisement material. The promotion of anti-smoking material within Irish public health campaigns relied upon the efficacy of visual advertising in producing health responses on the part of the public. Ultimately this ‘visuality’ in promotion methods was key to the rise of a new health ideology based on individual responsibility for healthy lifestyles and behaviours.

Jane Hand is a doctoral student at the Centre for the History of Medicine, University of Warwick. Her PhD is entitled 'You Are What You Eat: Chronic Disease, Consumerism and Health Education in Britain since the Second World War' and she may be contacted at j "dot" hand "at" warwick "dot" ac "dot" uk

Author’s note:
The images reproduced in this post were sourced directly from the Department of Health with the permission of Fergal Flynn, Department of Health.
All other primary source material is held at the National Archives of Ireland.

1. Department of An Taoiseach, ‘Cancer: Publicity Leaflets etc.,’ 11th February 1958, National Archives of Ireland, TAOIS S16659A. [Italics added by author].
2. Anon, ‘Radio programme on cigarette smoking’, 1973, Department of Health and Children, INACT 461262.
3. Minister for Health (Erskine Hamilton Childers), ‘Radio Programme on Cigarette Smoking 19/06/1973 – Written Answers’, Department of Health and Children, INACT 461262.
4. Minister for Health (Erskine Hamilton Childers), ‘Radio Programme on Cigarette Smoking 19/06/1973 – Written Answers’, Department of Health and Children, INACT 461262.
5. Minister for Health (Erskine Hamilton Childers), 'Address by Mr Erskine Childers, T.D., Táinaiste and Minister for Health at the Prize-giving ceremony in the anti-smoking poster competition in the Metropole Ballroom, Dublin, 6 January, 1971’, Anti Smoking Poster Campaign for School Children and Television Campaign, Department of Health and Children, INACT 422036.
6. The Information Services of the Irish Cancer Society, Smoking Burns You Up: How Smoking Affects Us, Leaflet Department of Health and Children, INACT 428227.
7. Cooter and Stein, ‘Coming into focus’, p. 186.
8. Coiste no gConnartha Rialtas, ‘A meeting of the Government Contracts Committee’, 6 August 1970, Department of Health and Children, INACT 422036; Minster for Health (Erskine Hamilton Childers), ‘Ceisteanna – Questions. Oral Answers – Health Educational Programmes’, Dáil Debates, vol. 254, col. 2249-2250, 23 June 1971; Berridge and Loughlin, ‘Smoking and the New Health Education in Britain 1950s-1970s’, pp 960-961.
9. Anon, ‘Radio programme on cigarette smoking’, 1973, Department of Health and Children, INACT 461262; ‘ “You and Your Baby”: A Family Doctor Publication by the Irish Medical Association in conjunction with the British Medical Association’, Department of Health and Children, INACT 461262.
10. Dwyer, Short Fellow, p. 152. 
11. Berridge and Loughlin, ‘Smoking and the New Health Education in Britain 1950s-1970s’, p. 961.
12. Irish Times, 5 Dec. 1959.