The art of warning: Eye-catching images portray public health dangers

Luscious and wonderful images that spread like a virus to inoculate people against disease -- these are words curator Michael Sappol, PhD, used to describe the pictures included in the upcoming National Academies' exhibit, "An Iconography of Contagion: 20th-Century Health Posters and the Visual Representation of Infectious Disease." Dr. Sappol is a historian at the National Library of Medicine of the National Institutes of Health.

"These are rich, cultural documents," he said, and they provide insights into the interplay between the public understanding of disease and society's values.

The show, which will be on display beginning this month in Washington, D.C., explores the use of these images since the early 1900s.

Over the years, public health posters have focused on a range of new and old diseases -- from tuberculosis and syphilis to HIV/AIDS. They communicated messages about infection control and prevention and aimed to alter behavior and public perceptions. But these historic images become even more striking when considered in the context of the eras during which they first appeared.

"The posters reflect the fears and concerns of the time and also the knowledge that was available," explained Mary Wilson, MD, an associate clinical professor at Harvard Medical School and of population and international health at the Harvard School of Public Health, Boston.

This dynamic is evident in the portrayals of disease vectors. Some World War II-era posters warning of malaria depicted mosquitoes with Japanese features, "giving the illness the face of an enemy," Dr. Sappol said. Another example he offered is a syphilis poster from the same period. It featured an image of an alluring woman who also is scary in a sexually aggressive way, while ignoring the fact that men were equally culpable in spreading the disease, he said.

But the HIV/AIDS posters of the 1980s were an "enormous breakthrough," he added. They sought to destigmatize the disease carriers instead of making them the focus of wariness and caution.

The emergence of an art form

Posters as a form of mass communication first emerged in Western and Central Europe in the mid-1800s. Soon after, this approach became a cutting-edge form of advertising. Vibrant, eye-catching announcements publicizing everything from theatrical events to politics papered public spaces -- in part because of advancements in photography, color and design techniques, as well as mass production.

It was "a moment in visual culture when images began proliferating," Dr. Sappol said. "People were barraged by pictures trying to get them to do things. Public health crusaders at this time were also trying to mobilize the public. The two forces came together."

Ultimately, the use of posters became a mainstay of such efforts.

Whether urging people to carry handkerchiefs, use condoms, refrain from drinking unsanitary water or get vaccinated, through the years the posters have employed a mix of rational arguments and emotional images. To the extent that they tap into people's fears and belief systems, they can educate and change behavior -- but first they must get public attention, Dr. Wilson said.

For now, the early 20th-century dream that the medium would be part of more coordinated and cumulative health campaigns seems far away. The crusaders at that time had hoped that visual representations would lead "the public to act to address the problems in their own bodies and their own communities, and to build political support for government action and medical intervention," Dr. Sappol said.

Still, Dr. Wilson noted that "images remain extremely powerful in shaping perceptions and actions, though now we receive more images through different media, including electronically. ... Cartoons, covers of magazines, brochures and certainly advertisements all shape our actions and beliefs in ways that we are often unaware of."

Though the posters included in the exhibit are entertaining to view, in their heyday they sought to complete serious educational missions that were matters of life and death.

"These [deal with] terrible diseases," Dr. Sappol said -- a fact he hopes people will keep in mind. Otherwise, he added, because of the interest and beauty of the posters, the exhibit could "just be too much fun."