Reflections on the United Kingdom’s first public health film festival

In 2014, the United Kingdom held its first public health film festival. Encouraged by similar models abroad, the organisers sought to use film to engage the public in wider conversations about health and bring like-minded people together. Despite the best efforts of those working within it, to many, public health can be seen as tiresome, uninspiring and irrelevant. Yet, film and cinema have a long history of being used to inspire, develop skills, change attitudes and influence culture.

This festival highlighted a real gap between professional and lay understanding of public health. Despite many film-makers creating content with implications for public health, they may be unaware of the discipline and the role it plays in society. They may also have an under-appreciation of the potential impact of their own films.

Why should the public health community be interested in film? Human beings are strongly influenced by emotional levers and enjoy experiencing life indirectly through the stories of others.^1,2 This capacity is not often utilised by those working in public health, who tend to depend on facts and evidence to influence. The success of commercial videos that have influenced the health decisions of mass audiences, such as the MTV Shuga TV series,³ should encourage those working in public health to seek out and learn from those fluent in the language of art, aesthetics and dramatisation. Those who have learnt this language are adept at consciously and subconsciously affecting viewers and socio-political landscapes.

We ourselves found it difficult to answer the fundamental question ‘What is a public health film?’ We found that the richness of the medium of film and the complexity of public health were inspiring, and the festival was an opportunity to move away from viewpoints that have become entrenched in our discipline. For example, a film discussing farmer suicides in India (Nero’s Guest⁴) highlighted how modern commerce, international trade and the absent voice of the poor negatively impact the mental health of thousands of people. This is not an issue widely discussed in the United Kingdom, yet we are nevertheless involved in this phenomenon by our desire for cheap produce and goods.

Another difficult challenge was the task of reaching out to the general public locally and nationally. The project required us to explain to people outside of health what public health was and why they should care about it. It was humbling to discover that the concept of a public health film was met with suspicion and the certainty that the event would be boring and lecture the audience. Yet, films such as Contagion⁵ and the Dallas Buyers Club⁶ proved to be popular, with audiences displaying interest and enthusiasm in the underlying themes of pandemics, sexually transmitted diseases, patient rights, stigma and the health care industry. Commercial feature films are excellent at engaging the public tired of hearing about what they ‘should’ be doing to be healthy – public health by stealth, if you will. Entertainment can draw out public health issues in ways that are meaningful to audiences, and this interest can be followed up with engagement events. For example, the film Wall-E⁷ was often met with confusion by our stakeholders, but we saw in this film a beautiful discussion of our society’s current dependence on ‘conveniences’ – fast food, motorised transport, easy rubbish disposal and the implications this has on our health, planet and society.

‘Edutainment’ is a concept currently receiving a great deal of attention by development agencies as a means to influence levers that impact health.⁸ Films are culturally relevant and extremely powerful in today’s society and are set to become even more so as technology makes filmmaking and distribution easier, cheaper and more accessible by more people.

We found many excellent documentaries that were instrumental tools for health advocacy in marginalised and underrepresented groups. Examples include Nero’s Guest, described above, and Sea of Change,⁹ a film that was a vehicle to draw attention to the difficult experiences faced by blind and partially sighted people in the United Kingdom when trying to use shared traffic spaces. The film brought its advocacy group to the attention of the House of Lords, the public health community and the local media.

Short films give film makers freedom to experiment with ideas, form and approach and is where we found the majority of public health professionals becoming involved with the filmmaking process. Short films have the advantage of being shared easily and quickly. All it takes is an upload to YouTube, and your message to the world can be given a life of its own.

Currently, film is woven into our everyday lives, influencing culture and shaping our beliefs and attitudes. Films are produced by different organisations with a range of agendas. Not all of these agendas are conducive to improving population health, yet as a profession, we do not invest significant amounts of time evaluating possible positive or negative effects of the film environment.

If the public health community wants to use film to improve population health, it will have to learn how to navigate the existing film landscape and develop an appreciation of how film affects its audience and why.

Our festival benefited from input from independent film makers and people from the following organisations: the Public Health Film Society; the UK Faculty of Public Health; the British Medical Association; the Nuffield Department of Population Health and The Oxford Research Collaboration in the Humanities (TORCH), both at the University of Oxford; Oxfordshire County Council; the American Public Health Association; the Terence Higgins Trust; and the International Committee of the Red Cross. It was a great opportunity to discuss the role of film with people inside and outside of public health, and also inside and outside of the United Kingdom.

In summary, the festival demonstrated that there is a real appetite to explore ways to bridge the gaps between the public, public health professionals and the film industry. We feel that the time is right to explore this interdependent relationship, for the good of our common aims.