Dealing with dilemmas in health campaigning

Campaigners on public health issues face a number of dilemmas when tactical choices in public debating involve uncomfortable mixtures of benefits and costs. Key dilemmas for campaigners are whether to acknowledge weaknesses in their own position, whether to advocate research to address claims by opponents, whether to acknowledge vested interests on their own side, whether to debate with opponents, whether to launch attacks on opposition individuals and groups and whether to criticize extreme behaviour by those on their own side. Drawing on the literature on scientific controversies, these dilemmas are outlined, with illustrations from the Australian vaccination debate. Dilemmas in health campaigning warrant attention because choices made can affect both the success of policy initiatives and the image of professions, sometimes with trade-offs between these. However, dilemmas have been neglected because most studies of health controversies give little attention to campaigning tactics. Campaigners can choose options that seem to maximize the likelihood of winning in the short term. However, options for short-term advantage may establish a precedent for approaches to campaigning that undermine commitment to free and open debate to possible long-term disadvantage.