In the last article, I explored how health promotion campaigns sometimes fail to resonate because they engage only with the visible tip of the iceberg of culture. By neglecting the deeper, submerged realm of values, beliefs and an unspoken framework, these campaigns risk alienating the very people they aim to reach.

In this article, I look at the submerged three quarters of that iceberg, to the quiet, symbolic and emotionally charged spaces where illness is felt, meaning is made and suffering is given a story. This article continues with the idea of the sublime, not as abstract poetry, but as a working lens for making health promotion not only more effective, but more human.

Mental Health: When Western Framing Misses the Mark

Mental health campaigns often use language designed to destigmatise: “Depression is an illness like any other” or “It’s okay not to be okay”. These are noble, needed messages in many contexts. But they don’t land equally across all cultural landscapes.

In many communities, mental distress is not framed as illness. It might be seen as a spiritual issue, a family shame or a test of endurance. Publicly naming it, or even admitting to emotional pain, can carry deep consequences.

In many cultures, emotional distress is described somatically, such as “my head is burning”, “my stomach is heavy”. Or, in some cultures, such as South Asian communities, seeking help for depression may be interpreted as weakness or risk damaging family honour.

The disconnect: Messaging that fails to engage these metaphors and social dynamics does nothing to reduce the stigma. In fact, it bypasses it entirely.

A campaign that engages deep culture and acknowledges the sublime would not just translate its tagline from a source language (and culture) like English into local languages. It needs to translate the target cultures’ worldviews. This could be done by introducing local idioms of distress, community engagement or framing therapy as a strength rather than a confession.

Public Health and the Shadow of Shame

Health promotion often includes campaigns aimed at reducing harmful behaviours: drug use, smoking, obesity, unsafe sex. These messages tend to rely on shock details, invoking fear, statistics and narratives about personal accountability.

However, for individuals who already feel marginalised, these messages can backfire. If a person’s identity is already associated with “risk”, such as low-income communities, ethnic minorities, LGBTQ+ individuals, health messages can compound feelings of blame and social shame.

In collectivist cultures, where honour and face are central, public acknowledgment of issues like HIV or substance abuse can feel catastrophic, not just for the individual but for the family and the community.

The disconnect: Public shaming can push problems underground. What heals is dignity and not exposure and blame.

Effective campaigns that address deep culture must move away from blame and instead honour dignity, celebrate care-seeking and highlight stories of resilience within those very communities.

Grief, Death and the Myth of Autonomy

End-of-life care campaigns are another area where health messaging frequently misfires. “Plan your death”, “Choose the care you want”. These messages come from a worldview that values individual planning, legal clarity and procedural control.

But in many cultures, death is not a medical or a legal event. It is a passage steeped in mystery, collective ritual and deep spiritual belief. Decisions may rest with family elders, and talking openly about death may be avoided out of respect for fate or fear of summoning misfortune.

A doctor asking “Do you want to be resuscitated?” may be met with silence, not because the question is misunderstood, but because it is culturally unspeakable.

The disconnect: what seems like empowerment in one culture may feel like a violation or an affront in another. So, the message will fail.

End-of-life messaging must engage with these taboos, rituals and emotional undercurrents. This could mean working through trusted community figures, respecting ritual timelines or allowing for co-interpretation of what death and choice mean.

From Instruction to Invitation

Across all these examples, one pattern emerges: these are campaigns that instruct, rather than invite and fail to access the deeper currents of people’s lives.

Instruction assumes authority and clarity. It tells you what to do, what they ought to do. This is top-down. Invitation acknowledges uncertainty, complexity, friction, discomfort and the person’s deeper story. This is empowerment. The recipient joins the health promoter on a journey because the message is written with respect. This does not have to be how public messages are created for certain communities. The invitation would work better for everyone, rather than the instruction. The invitation involves just a tiny tweak to the message, a subtle but profound shift – a shift in the approach and attitude from the message creator. It is a small shift, but one that allows messaging to reach the human being, not just the behaviour.

Building Health Messages that Resonate

To reach the submerged layer of the iceberg, to truly engage the sublime in health communication, it is not just the messages that would need to be redesigned but the mindset behind them.

There are five shifts that can help achieve this:

·       From data to story:

People are not moved by statistics, but by what it means. Integrating real patient narratives, metaphors and culturally resonant storytelling helps bridge the gap between public health goals and personal values.

·       From translation to conceptual equivalence:

Translations of health messages from source to target language usually miss the emotional logic of the target audience. Instead, the aim must be for conceptual translation. When designing information for any given community, just ask the question: does this idea make sense in their world?

·       From individualism to relational models:

Shift the focus from “you” to “we”. Consider how decisions are made in families, communities and spiritual frameworks. In many communities, health is social and messages should reflect that.

·       From top-down to co-creation:

Design with and not for, right from the conceptualisation phase. Engage communities, cultural insiders, local health workers, community leaders and patients from those communities to shape messaging from the ground up. This is exactly that: the message should emerge from the bottom-up and never top-down.

·       Have humility:

Do not aim, as an outsider, to gain “competence” in someone else’s culture. You cannot. At best, you can gain vague notions, small insights. The better posture is cultural humility. This is a willingness to listen, to ask better questions, to be comfortable with what you do not know and learn. The answers you receive will transform you. This is how you contemplate the sublime.

Thank you for reading,

Mark Gibson

Leeds, United Kingdom, May 2025