Public service media: A matter of life and death

By Dr Mai Elshehaly and Professor Mark Mon-Williams

Culture is one of the defining aspects of humanity. This is not to say that other species do not demonstrate cultural customs, but the extent to which humans pass down traditions is arguably one of the most important features that distinguishes us from all other animals. Indeed, Joseph Henrich has argued that the transmission of information through culture is a matter of life and death. Henrich’s arguments are supported by the observation that Burke and Wills starved to death in the middle of the Australian outback in their ill-fated expedition of 1861. Notably, the place where Burke and Wills died was not lacking in food and supported Aboriginal Australians who lived in the area. The problem was that Burke and Wills had not been taught the skills that they needed to survive in the environment in which they found themselves. Thus, Burke and Wills serve as a salutary reminder that humans thrive through the cultural transmission of local and temporally adaptive information.

The comforts of modern life mean that most people living within developed countries are not placed in extreme life-threatening situations where they need to find food and shelter in an untamed environment. Nevertheless, there are large swathes of our population who experience premature death as a function of the place they live. Conversely, the world’s population (on average) enjoys a better quality of life than the preceding generations. In the words of Hans Rosling: things are bad, but they are better. Things are better because humans have found an efficient process for transmitting accurate information (we call this process ‘science’), and have created excellent systems for transmitting information through the generations (we call these systems ‘schools’ and ‘universities’).

Public Service Media (PSM) is a crucial partner in the fight against the health inequalities that blight our country and the world. In essence, PSM enables equitable access to accurate information (thanks to regulation and moderation), and the transmission of reliable information is the most powerful tool that humans possess in our fight against existential crises, totalitarian regimes, and social injustices (including health inequalities).

Covid-19 has accelerated health inequalities

The Marmot review of 2010 shone a spotlight on the health inequalities that blight the UK, showing that the many people who die prematurely each year, as a result of health inequalities, would have otherwise enjoyed between 1.3 and 2.5 million extra years of life in total. Marmot made six policy recommendations:

1. Give every child the best start in life
2. Enable all children, young people and adults to maximise their capabilities and have control over their lives
3. Create fair employment and good work for all
4. Ensure a healthy standard of living for all
5. Create and develop healthy and sustainable places and communities
6. Strengthen the role and impact of ill-health prevention.

In 2020, Marmot published a new review showing that the problems identified in 2010 had not improved – in fact, the inequalities had become worse. He reported that people can expect to spend more of their lives in poor health; improvements to life expectancy have stalled, and declined for the poorest women; the health gap between wealthy and deprived areas has grown so that living in a deprived area of North East England is worse for your health than living in a similarly deprived area in London (to the extent that life expectancy is nearly five years less). It is clear that the strategies implemented by governments over the last decade have not delivered the policy changes recommended by Marmot, and the geographical gaps have deepened. For example, in Bradford (the UK’s youngest City and sixth largest) there were 12 wards in the bottom 10% of the ‘Index of Multiple Deprivation’ in 2015, but by 2019 this had increased to 14 wards.

Moreover, the bleak picture painted by Marmot in 2020 preceded the onslaught of the covid-19 pandemic. In Bradford, we have been tracking the lives of over 13,500 children and their families via the ‘Born in Bradford’ longitudinal birth cohort study. Our Born in Bradford project allows us to monitor changes over time, and enabled us to establish, accurately, how the UK’s lockdown affected the most disadvantaged members of our communities. The evidence from Born in Bradford was that the lockdown exasperated the inequalities already plaguing our District. We found an increase in markers of poverty with a substantial number of families experiencing multiple vulnerabilities. Food security decreased and physical health behaviours worsened. Mental ill health become rife and the risk of poor mental wellbeing was higher in the increased number of families struggling financially. Digital inequalities limited access to remote education: South Asian heritage children had less access to computer equipment and the Internet compared to White British children. Classroom inequalities increased with teachers expressing concern over the disproportionate effect on vulnerable children and children with special educational needs and disability (SEND).

The aftermath of the pandemic

In the UK, the rates of covid-19 are now falling rapidly and the social restrictions are easing thanks to the availability of vaccines. Unfortunately, the lasting damage created by the lockdown remains. Covid-19 has highlighted the inequalities within our society, and it has also worsened the problem. Thus, there is an urgent need for a renewed attack on the inequalities that are crippling our communities. The ethical and moral imperative for action is unarguable, but the economic case is also overwhelming. Our health services were not designed for the appalling levels of poor population health that we are experiencing within the UK. Our population is suffering from high rates of preventable disease (including mental ill health) that would have been unimaginable to the founders of the NHS. Moreover, these non-communicable diseases are concentrated in our most deprived areas. Notably, there is a growing mountain of evidence that shows acting early (i.e. helping children adopt health lifestyles) is the most effective way of tackling long-term physical and mental health problems. There is also a growing body of evidence that shows early interventions save public finances in the long term. This makes sense – the long-term costs of treating the sequelae of issues such as childhood obesity are well documented.

PSM has a major responsibility in tackling health inequalities

How can we implement strategies that will allow the policy changes identified by Marmot? There are numerous arguments that blame politicians for ideological decisions relating to a lack of investment in tackling childhood poverty. These arguments are compelling, but don’t speak to the issue of why investments are often ineffective in shifting the needle on such ‘wicked’ societal problems. The arguments can also be convenient in shifting the blame to one part of the system (e.g. central government) and thereby abdicate responsibility from other parts of the system (from universities through local governments to media outlets). Science suggests that the solutions lie across the whole complex system within which children develop, with everyone and every organisation having a role to play in tackling the health inequalities that affect each district within the UK and across the world.

PSM organisations have a major responsibility in helping achieve the mission of reducing structural inequalities within our societies. But PSM must harness the tools of science if it wants to realise its true potential in improving the public’s quality of life. The pandemic is being brought under control because we have harnessed the power of science in the fight against communicable diseases. In short, vaccines are a fantastic testament to the most powerful tool that humans possess – the scientific process. Science is the process that humans developed to ensure quality control in the cultural transmission of information. Scientific principles ensure that the information transmitted through space (i.e. learning shared across the world) and time (i.e. passed down through the generations) is as accurate as possible. It is the accurate transmission of information that allows different groups of humans and different generations to learn the skills and behaviours that will allow them to thrive in the world.

PSM organisations could and should consider a focus on supporting schools

One of the greatest achievements of human civilisation was the creation of organisations committed to providing the information needed by future generations to survive and thrive on planet Earth. The existence of schools and universities is testimony to the importance of information transmission within human society. Indeed, the progress that has been made in decreasing societal inequalities within the UK can be directly associated with the increasing access to information provided by schools to all children - regardless of background. Once more, as Rosling put it, things are bad but better – we can create meaningful change through transmitting accurate information. This suggests strongly that it is worthwhile focussing on schools when we consider how to implement Marmot’s recommended policies.

The existence of state schools within the UK provides a great opportunity to ‘level the playing field’ for our most disadvantaged children. The schools are also a useful reminder that developed countries have many advantages that are not yet enjoyed by other countries throughout the world. The presence of a state school system is a necessary factor in eradicating inequalities, but it is not a sufficient element. The problem faced by many schools within the UK is that their efforts to educate children are thwarted by issues playing out on the other side of the school gates. These problems were illustrated throughout the pandemic by the digital inequalities flagged earlier. The provision of educational materials through online platforms and the switch towards remote teaching was difficult for all children – but it disenfranchised a large number of children who lacked access to computer equipment and the Internet (and/or did not have parents who were digitally literate).

The role for PSM in working with schools (and nurseries, health visitors, parents etc) to provide the requisite information for the development of skills is immediately apparent. Proponents of PSM rightly draw attention to the need to inform and entertain citizens. But its potential can be stated in starker terms. PSM can literally save lives through the provision of information that: (i) allows parents to better support their child’s development; (ii) helps schools in their efforts to educate children; (iii) empowers children and young people to make healthy life choices. There is a great opportunity for PSM organisations to work with schools (we include nurseries etc in this broad category) to produce content that really matters to communities, and help provide children and young people with the information they need to thrive – regardless of their background.

How can PSM save lives?

The Covid-19 pandemic has shown us many examples where rapid communication of new information and the reshaping of cultural and social norms were key to saving lives. People have needed to adopt a radical shift in their understanding of what constitutes ‘responsible behaviour’. The ability to access accurate information has enabled communities to adapt the traditional behaviours shaped by their cultural heritage. This was well exemplified by religious festivals. People of all faiths were told that they should no longer congregate and worship in the way that they had previously learned was right for them.

The media (including PSM) played a large role in communicating the need for such cultural shifts. The extent to which the required changes were adopted by communities was largely influenced by the media and the extent to which communities trusted the communicated information. Thus, it is not unsurprising that there was a significant impact on the rates of infection and deaths in countries where PSM was available and trusted. Indeed, we are still seeing the ravaging impact of the pandemic in many countries where the media played a limited or biased role. In some countries, the media continued to portray traditional religious practices and social gatherings as desirable activities. This is an understandable narrative under normal circumstances but is deeply problematic within a pandemic - as indexed by the catastrophic rates of infection. In short, PSM has proved a key determining factor within the health and wellbeing of different populations throughout the pandemic.

The future of PSM in addressing wider issues of inequality

The pandemic shows the potential for PSM to save lives through the provision of accurate information that can shape the decisions made within a population facing a communicable disease. We now need to use the power of PSM to tackle the non-communicable disease epidemic. If we are to be effective in addressing health inequalities then we need to determine what critical information needs to be supplied, how this information is best provided, and how information can be tailored for different demographic groups (recognising that an approach effective for White British boys is unlikely to be optimal for girls of South Asian heritage). In other words, we need to embrace the scientific method if we want to ensure that PSM maximises its potential.

In Bradford, we have been developing the infrastructure that allows such a scientific approach to be adopted. The Born in Bradford (BiB) children are entering secondary school and we are expanding the cohort to include all of the children within the BiB age band. This is increasing the size of our cohort to over 30,000 children and young people and the programme of work (entitled ‘Age of Wonder’) will involve the 38 secondary schools across our District. In turn, this has created the Digital Makers programme that seeks to learn how we can best upskill children and young people and teach them their digital rights. Importantly, Digital Makers is adopting the scientific method and testing different approaches so we can learn what works best and what needs to be tailored to individual communities. The potential for PSM organisations to be involved in this work is immense – and, indeed, we have representatives from organisations such as the BBC and C4 who are committed to the ethos of PSM. We work in a building (the Wolfson Centre within the Bradford Royal Infirmary) that has a large neon sign proclaiming ‘everything is connected’. The sign was created by one of our artists in residence (Ian Beasley) and captures the sentiments expressed by our poet in residence (Ian MacMillan) in his poem of that title. This well reflects our belief that artists and cultural practitioners are as important as technologists and medical practitioners in addressing the issues of health inequality.

The fact that everything is connected means that we need to consider the interactions between PSM and existing cultural practices. The growing body of evidence on norm-shaping media interfaces tells us that the role of PSM in saving and improving lives will be driven largely by its ability to capture the ‘big picture’ that considers physical, mental, cultural, and social elements in a place-based manner. Lessons learned from around the world reveal that patterns of behaviour are largely influenced by the local and temporally adaptive customs transmitted through the generations (i.e. cultural heritage). For example, in the Middle East, where 90% of young Arabs use at least one social media channel every day, it has been reported that users spend around 2 million more hours daily on Facebook during Ramadan. This seasonal increase in social media adoption is not surprising given the wider context of media consumption during Ramadan in the region. In 2021, for example, 92 new TV dramas and soap operas premiered and aired in Ramadan, and Linear TV reach in Saudi Arabia was about 97% in the first week of the holy month. Patterns like these provide insights on the interacting dynamics between behaviours, social media, and PSM. These patterns make it clear that media consumption is a product of cultural heritage, and vice versa. The question then becomes: how can PSM harness the norm-shaping ability of social media consumption to create an ecosystem for systemic change that takes local context into account and addresses inequalities globally and at home?

PSM can allow equitable access to information at a global scale and save lives

Our challenge to PSM organisations is to adopt a ‘whole system approach’, and consider their societal role in a holistic manner. PSM organisations could and should debate how they can help implement Marmot’s recommendations. There is an enormous part for PSM to play in helping to educate children and give them the information they need to develop the skills necessary to survive, thrive, and enjoy a healthy life in the place they reside. Moreover, PSM can teach children how to use the emerging digital technologies that can facilitate access to information (i.e. it can help children ‘learn to learn’). In Bradford, we have a new 10 year cultural strategy – Culture is Our Plan – that is bringing communities together with artists, cultural practitioners, scientists and medical researchers to generate lasting change for our children and young people. This initiative means we can work with our PSM partners to create a more equal society through the improved transmission of information.

In summary, PSM has the ability to reshape cultural and societal norms in a way that increases the adoption of digital technologies, and affords more equitable educational opportunities for children worldwide. In this way, PSM can enable public services to reach countries where the devastating impacts of war and instability are crippling education, and support countries where the quality of education is primarily determined by gender, religious background, and/or socioeconomic status. There is incontrovertible evidence that improving education in this way will save lives. In countries such as the UK, PSM is a necessary component in the urgent fight to save lives from non-communicable diseases, and could play a significant role in the battle we need to fight against the inequalities that are killing our communities.

By Dr Mai Elshehaly and Professor Mark Mon-Williams

Dr Mai Elshehaly is a Lecturer in Computer Science at the University of Bradford. Mai is the Director of the Digital Makers Programme (together with Dr Faisal Mushtaq from the University of Leeds), a cross-sector initiative that is building a scientific approach for the digital upskilling of children and young people in the City of Bradford, UK. Professor Mark Mon-Williams holds a Chair in Cognitive Psychology at the University of Leeds, is Professor of Psychology at the Bradford Institute of Health Research, and Professor of Vision Science at The Norwegian Centre for Vision.

Dr Mai Elshehaly and Professor Mark Mon-Williams's Profile