There is broad consensus that health-related communications need to present facts as the basis for guidance and informed decision-making and must not employ tactics such as fear, uncertainty or doubt – as their potential use presents significant ethical problems and dilemmas. In light of this, it is concerning to see how lightly some have heralded the presumed functionality of fear in the arsenal of health-related messaging, also when it comes to messaging relating to alcohol-related harm. Advocates have argued that instilling fear, along with other negative emotions, through tools such as Health Warning Labels (HWLs) could help to prompt desired behaviour changes. However, apart from the significant ethical and practical concerns that such a position comes with, recent studies now also cast doubt on the presumed efficacy mechanisms of such fear-based appeals.
A 2022 Irish PhD thesis by Vania Filipova suggests that fear appeal is essential for making HWLs effective in changing behaviour. Without much concern or profound reflection on the inherent ethical problems of such a stand, Filipova claims that fear, as a negative emotional response to perceived danger, can spur individuals to heed warnings and take preventive measures. The thesis claims that by evoking fear, HWLs can influence consumers' cognitive reactions and motivate them to adopt healthier behaviours.
If one leaves aside for a moment the profound ethical problems that come with such a stand, such an approach may seem appealing from a purely functional/mechanistic point of view in terms of triggering desired behaviour changes. However, a recent study by Morris et al. published in 2024 challenges this narrative, showcasing the complexities and defensive psychological mechanisms when digesting fear-based information. Their research suggests that heavier drinkers (heavy drinking being mainly associated with alcohol-related harm) may exhibit defensive processing in response to fear-inducing messages. The study found that the more severe a person's alcohol consumption, the less confident they are in controlling their drinking behaviour, leading to avoidance of health-risk infographics and decreased self-efficacy.
These findings raise further questions about the use of fear in health messaging. While fear may trigger behaviour change in certain individuals, it would seem to alienate those who are most in need of intervention, raising questions of equity and proportionality. Either way, simply inundating all consumers with dire warnings may not be working to prompt meaningful behaviour change, particularly not among problematic drinkers who either do not themselves view themselves as risky drinkers or already suffer from severe alcohol use disorders. Moreover, it raises the delicate question of whether it is ethically admittable to manipulate vulnerable individuals' emotions (individuals who may already be struggling with addiction or other mental health issues) in the quest to achieve public health goals. If HWLs are primarily designed for emotive impact as means for persuasion (fear-based) rather than a tool for information to enable rational risk-benefit deliberation, it needs to be considered whether the possibility of manipulation is indeed ethically justifiable (see Louise et al, 2015 here).
In conclusion, while fear – which always comes with difficult ethical challenges in health communications - may still appeal to some due to its presumed functional role in health messaging, its effectiveness in reducing alcohol-related harm seems far from straightforward and clear. As a result, it would seem that a policy debate that wants to consider seriously whether mandatory labelling of alcoholic beverages with simplistic and alarmist health warnings (HWLs as emotive means of persuasion rather than information promoting refined understanding) should be seen as an acceptable and feasible option forward must carefully discuss and weigh the presumed potential benefits against both the considerable ethical problems and known practical/functional limitations of such measures.
