Entertainment Education and 'Contagion

MECO 6928 | Nicoletta Forlano | SID 311307868 1

Entertainment education and Contagion1. Hollywood’s contribution to awareness raising on public health issues.

Hollywood has been successfully producing epidemic disaster movies since the seventies. Post-apocalyptic scenarios have always titillated our fantasy. From Outbreak to I am legend, passing through 28 days later, we have been transported through deserted cities, annihilated populations, fanatic militaries, impeccable health officers and villains. Audiences have crouched in chairs for years, scared by a world of fantasy close enough, but safely far enough, from our real lives. Then, came Contagion.

Gone are the days of females’ health officers sporting a 24/7 model’s look or scientists with Apollo like bodies, zombies or improbable quarantined cities that made movies harmless to watch. Contagion brought in a different scenario, suddenly matching reality.

In 2003 we have all followed with apprehension the SARS epidemic, watching the news showing people walking around wearing surgical masks. Somehow, since then, we have all been exposed to what a public health threat is. And with it, the Spanish flu epidemic, the single most deadly event in our most recent history that killed over 50 million people, became less distant.

Contagion uses SARS and models its own virus on an existing one, the Nipah virus, an emerging zoonosis transmitted from bats to pigs and from pigs to humans. The movie identifies which agencies deal with such issues and offers us a scenario of what could actually happen. This is what puts a distance between Contagion and its predecessors: a perfectly plausible picture. Its reality based narrative, a tightly gripping plot and a stellar cast turned this Hollywood blockbuster into a formidable educational vehicle.

The movie’s dark opening, a black screen framed by somebody coughing, is the glooming door into a banal world that we know will become lethal. A single cough is about to transport us through two hours of public health lesson without being aware of it.

This paper wishes to analyze Contagion through the lens of entertainment-education (EE), which is considered a popular strategy to incorporate health awareness messages in mainstream media2.

Gwyneth Paltrow, one of the many stars that crowd the movie, suddenly appears as the owner of the cough, looking sweaty under the yellow lights of a bar in a waiting lounge. Close ups of her hands, an innocent bowl of peanuts and the small surface of her credit card lead our conscience to make connections between her health status and a still oblivious external world. When her


blackberry rings, we hear the soft conversation between two adults who just had casual sex. Another ‘tick’ in the virtual list of our alerted brains. We are just connecting the dots: everything she touches is infected.

In our globalized world, the one that cheap travel has transformed into a flat planet, distances have shrunk. Planes cutting the skies in all directions have transformed time zones to mere lines on a map that can be easily crossed while comfortably sleeping in a pressurized cabin. The world is suddenly a much smaller place. So when scenes from London, Tokyo or Hong-Kong come up on the screen, we understand the virus has already crossed many borders totally undisturbed.

In the movie’s first few minutes, transport has turned into another kind of vehicle, not just that one that moves our bodies around but one that provides a free ride to the most unpleasant (g)host. Surfaces have turned into deadly weapons, which will innocently transform a few, or the multitude into unaware infected carriers.

It doesn’t take long before our lethal virus starts reaping its victims. And because Paltrow leaves the scene so quickly –she is dead within the first ten minutes– we know this is not the usual ‘deadly-virus-threats-world-but-goods-prevail’ kind of story.

Contagion‘s realistic unraveling was supported by Professor Ian Lipkin, the director of the Northeast Biodefense Centre and epidemiology professor at Mailman School of Public Health at Columbia University. Lipkin, involved in the West Nile virus and SARS outbreak, is the scientific mastermind behind Contagion. Hired as a technical consultant for the movie, he and his team worked out a whole scenario: “My team built a 3-D model of our virus and then worked out how it would spread and evolve, how it would be discovered, how the public health and medical communities and governments would respond regionally and internationally, how vaccines would be developed and distributed.”3

Contagion’s characters are very ordinary: families, scientists with loose jumpers and very human conscience fought between feelings and ethical values, obtuse burocrats, and they all frame a story that nails us down without the need of special effects. As Steven Soderbergh, the director, put it “We were looking for something that was unsettling because of the banality of the transmission. In a weird way, the less you trump it, the more unsettling it becomes.”4 He managed in the intent. And Contagion became a sound public health pamphlet tackling the issues of public health at large, healthy behaviors and the responsibility of human kind in today’s new health threats, the so called ecological diseases5.

Research to date indicates that EE can influence the audience’s “knowledge, attitudes and overt behavior regarding an educational issue”6, as it creates


opportunities for learning by attracting the audience attention and thus leading to attitudinal and behavioral change.

As if we did not already know, our hands are portrait as a supreme vector for contagion. We soon learn, from the ‘epidemic intelligence service officer’ from the Centres for Disease Control, played by Kate Winslet, another name from Contagion’s stellar cast, that we normally touch our face with our hands a few thousand times a day. We should really think about washing our hands more often. A tick in the list for healthy behavior. But Winslet’s educational role comes out very strongly when she explains ‘basic reproductive ratio’ to a group a burocrats in charge of the local health department in virus stricken Minnesota. We get to learn what ‘fomites’ are, and can reconnect with Paltrow’s credit card or the elevator’s button pressed by a contagious character. This is epidemiology one-o-one and straight public health education.

In EE it is the narrative that triggers the learning. The unfolding of the story, the viewer’s interest, the engagement and involvement with the characters, all transform a pleasant, entertainment experience into a learning process. As we become transported into the narrative, “where all the mental systems and capacities become focused on events occurring in the narrative”2 we may be caught in new patterns of thinking. Green defines transportation “an integrative melding of attention, imagery, and feelings, focused on story events”7 and because the audience is deeply transported by the story is less likely to counter argue what is being shown.

Narrative communication is today considered very promising for health behavior application8. Narrative is a very basic and natural way to interact among humans, comfortable with years of story telling since their childhood.

A critical component of EE is the involvement with the characters. The plot may be more or less intriguing for a given audience, but the different players can resonate in the public and enable a bond that could result in a more subliminal form of learning. Green suggests that the “perceived realism”7 of the story plays a significant role with the audience. In Contagion, Paltrow’s husband, played by Matt Damon, is a very low key, typical guy-next-door character, very far from his super-spy, multi-talented, highly skilled role from the Bourne’s identity movies that we are more familiar with. Soderbergh is not talking to any super-human, he is addressing the millions populating the vast sea of middle class. What we are watching is our very own reality. Kids going to school, a wife looking drained in her pajamas, the greasy hair and a very normal house. And so, when Damon quickly wipes clean his daughter’s hands because she has touched something in a looted supermarket, the message comes out much more strongly than any aseptic communication we have seen millions of times on stickers and posters suggesting to wash our hands to avoid infection (contagion!) from virus and bacteria.


Emotions are powerful. Even in relation to our cognitive skills. When we are transported by a narrative, and our emotional state is aroused, we absorb behaviors unaware of the learning experience coming from the entertainment activity. An emotional experience that can help us to overcome our natural resistance towards being persuaded, especially when we are called to change our behavior, when we cannot quite see personal and direct consequences from it. This happens when the plot and the characters drive us away from our immediate reality. Therefore when we are transported in the movie’s looted supermarket, where contagious people may have touched everything, we understand how important it is to wash our hands and avoid touching our face all the time.

In EE one can distinguish among five different involvements with characters: identification, wishful identification, similarity, parasocial interaction and liking.2 In the first kind of involvement, ‘identification’, the viewer “takes on the role of a character in the narrative”; in ‘wishful identification’ the viewer has a “desire to emulate the figure”; in ‘similarity’ the viewer perceives the self as “similar to a character”; in ‘parasocial interaction’ the viewer “seeks guidance” while in ‘liking’ the viewer simply “positively evaluate a character”2. Contagion provides a good construct of its many characters and offers a broad variety of models that the audience can identify with.

The concept of involvement brings in the most widely applied theory in health promotion: Bandura’s Social Cognitive Theory (SCT), where personal cognitive factors are of critical importance. In particular, the ‘learning by observing others’, or the concept of ‘role model’9. And SCT is also the most widely adopted theory in EE, which exploits the concept of absorbing “knowledge, values, cognitive skills and new style of behavior”2 from the model. Bandura therefore stresses the potential of EE in proposing characters that will motivate viewers through wishful identification.

Contagion’s broad range of characters could play an important role in the future of public health. Kate Winslet, Laurence Fishburne, Jennifer Ehle, Marion Cotillard and Elliott Gould offer a wide selection to choose from. They all portray public health figures, whether working from the World Health Organization, CDC or a private company, the characters provide a (perceived) very realistic view of what would it means to work in such environments. They are modern heroes, putting their lives at risk for the sake of humanity3. And none is portrayed as super-human, keeping the viewer connected to a very possible reality, absolutely critical when delivering health and behavioral change messages10, where these people are humanly torn between ethics and feelings and sometimes succumbing to them. Will we see an increase of public health officials in the coming years? Because “prosocial messages embedded in entertainment (…) can influence viewers’ awareness and attitudes towards the issue they cover”2. Unfortunately, while research has indicated that EE can be


effective in delivering health messages there is a gap, highlighting a need, to find ways to effectively monitor and evaluate such results.

Contagion’s messages are not just about health education, delivering concepts such as ‘social distancing’, “no handshaking, staying home when you’re sick, washing your hands frequently”1 as Laurence Fishbourne, a CDC Deputy Director, explains on television. The movie offers a reflection on human relationships in times of widespread panic, on people’s weaknesses and feelings, on the serious impact that Internet and social media can have on public opinion in crisis situations. Characters such as Jude Law, a blogger with very little scruples, who tries to profit from the pandemic by pushing an unlikely medicine, are offering the scary perspective of how the mass can decide to react. Because the word contagion does not just mean “the transmission of a disease” but also the “spreading of an attitude or emotion from person to person”, hence we can be infected by a virus as much as by fear.

The movie provides a vision of society whose structures, laws and ethics can be melted away when it has to deal, unprepared, with such an unknown enemy. Not only we can relate and identify ourselves to the characters and learn from their actions, we can also relate to the situation and engage in thinking that we would not normally seek. So, where is the extra added value that this movie can bring?

Contagion’s messages may reach an audience involved in policy and decision-making and provide hints to foster larger contribution to science and research, so that when a pandemic strikes in real life, the appropriate responses and measures are already in place, and panic can be avoided.11 Scientists are already showing that more coordination is needed in addressing zoonosis, responsible nowadays for what could be, tomorrow, the cause of a major pandemic. We are all aware of SARS, swine and avian flu, and today’s humans and animal specialists are joining forces, through “One Health”12 to tackle, together these emerging diseases. These specialists are dedicated to catching those viruses that jump from animals to humans and to understand what causes such jump.

Contagion offers a glimpse of what a pandemic could bring to society and put the highlight on the forefront defense line: public health specialists. Soderbergh has nicely framed it: “It’s not that Warner Brothers is in the habit of making $60 million PSA’s, but I do want people to come out of this film with an understanding, were these things to happen again, of what is going on.”4 The public must be made aware not just about how pandemics and contagion work, but also about the work that needs to be done before, exactly to avoid the pandemic, as well as during and after the emergency has stricken. Our politicians must keep in mind that the new emerging ecological diseases are precisely triggered by the impact of activities such as deforestation, agricultural practices and the culling or displacement of wildlife, and prevention should be focused on the cause rather than on the effects.13 But they must also engage in


serious risk assessment and management to provide sound measures to avoid, first of all, the contagion of fear. “In order to get sick you must get in contact with the virus, in order to get scared you just need to get in touch with a rumor”1 Fishbourne warns. And we know how Internet and social media can act as incredibly fast vectors. There is a need for plans and guidelines to be adopted in major public health crisis, making populations aware of such plans to ensure that responses will be taken in a credible manner, and panic can be contained14.

Contagion’s slightly less than two hours have transported us in a fiction scenario that could eventually become real. The panic, the shredding of the social thread, the ethical questions health officials and politicians will face in the event of a major public health threat, the annihilation of personal and public ethics. What we are offered is food for thoughts, and there is something for everyone. Hopefully EE will confirm the research around the theory and a blockbuster movie, with all the limits intrinsic to its very own nature, will have done its educational share.

[2738 words]


References

1 Contagion. Dir. Steven Soderbergh. Perfs. Matt Damon, Kate Winslet, Gwyneth Paltrow, Jude Law, Laurence Fishbourne. Warner Bros, 2010.

2 Guse-Moyer, E., 2008. Toward a Theory of Entertainment Persuasion: Explaining the Persuasive Effects of Entertainment-Education Messages. Communication Theory 18 (2008) 3 Lipkin, I. W., 2011. The real threat of ‘Contagion’. The New York Times, 11 September 2011. 4 Lim, D., 2011. A virus movie determined to get real. The New York Times, 26 August 2011. 5 Jim Robbins. The Ecology of Disease. The New York Times, 12 July 2012. 6 Papa, M. J. at al, 2000. Entertainment-Education and Social Change: An Analysis of Parasocial Interaction, Social Learning, Collective Efficacy, and Paradoxical Communication. Journal of Communication

7 Green, M. C., Garst, J. and Brock, T. C., 2004. The power of fiction: Determinants and boundaries. The psychology of entertainment media: Blurring the lines between entertainment and persuasion. (pp. 161-176).

8 Hinyard, L. J and Kreuter, M. W., 2006. Using Narrative Communication as a Tool for Health Behavior Change: A Conceptual, Theoretical, and Empirical Overview. Health Educ Behav 2007 34: 777 9 Nutbeam, D., Harris, E. and Wise, M., 2010. Theory in a Nutshell. McGraw-Hills. 10 Joseph Petraglia, 2009. The Importance of Being Authentic: Persuasion, Narration, and Dialogue in Health Communication and Education. Health Communication, 24:2, 176-185 11 Contagion: Reminder That Public Health System Must Be Prepared For Lethal Disease Outbreak. Johns Hopkins Medicine, News Releases, 9 July 2011

12 http://www.cdc.gov/ONEHEALTH/

13 Scientists embrace the “One World” approach. 2011. Bull World Health Organ 2011; 89:860–861

Documents

Entertainment Education and 'Contagion