Seriously Funny: Using stand-up as a health education and social change tool v3 Seriously Funny: Using stand-up as a health education and social change tool “And here is the news: New research has shown that laughter actually is the best medicine. Pharmaceutical giant GlaxoSmithKline has responded by acquiring a 51% share in Michael McIntyre. Competitors AstraZeneca are in talks to merge with Eddie Izzard. The Labour Party has renewed calls for the nationalisation of Jo Brand. In other news...” Mark Burns 2020 v3 Contains some swearing and sex education content 1 Seriously Funny: Using stand-up as a health education and social change tool v3 In Glasgow, not unlike the rest of the UK, humour is a big part of cultural identity. “The Glasgow banter”, “the patter” (i.e. the manner by which Glaswegians typically communicate) is peppered with comic observations, one-liners, sarcasm and self-depreciating funnies. What better way to engage a community like this than through the medium of comedy?” From “Laff Yer Heid Aff”: The role of comedy in increasing public awareness of common mental health problems. 2 Seriously Funny: Using stand-up as a health education and social change tool v3 Acknowledgements When I started off in stand-up my partner told me all I needed was some good gags. I finally figured out what she meant when she kept stuffing a hankie in my mouth. A joke suggested to me by my editor and friend, Dr Nigel Mellor. Thanks Nige, for everything, including inspiration around self-awareness and honesty in research. 3 Seriously Funny: Using stand-up as a health education and social change tool v3 Contents 1. Warm-up Act: Summarising Stand-up as a Health Education Tool 5 2. Practical Jokes: An Overview of How to Make the Best Use of Stand-up 9 3. Public Health for Readers not from Public Health 12 4. Beyond a Joke: Beginning to Think about Health Stand-up 14 5. “Stop it. You’re Killing Me”: What’s the Purpose of Health Stand-up? 26 6. No Laughing Matter: Theories of Humour 40 7. How to Find the Funny - and What to do with it When you do 64 8. “Is This Some Kind of Sick Joke?” Offensive and Inoffensive Health Stand-up 91 9. Performing: The Who, Where and When 107 10. “What a Performance”: Tricks of the Trade 127 11. “Thanks, you’ve been a Great Audience” is Just the Beginning: The Importance of Follow-up 131 12. Evaluation: “You Can Lie so as Not to Hurt my Feelings. I Won’t Mind” 141 13. “Have You Heard the One About...”: Sharing the News on Health Comedy 149 14. The Last Laugh: Some Conclusions 153 15. What Passes for the Truth: Me, Comedy and This Guide 155 16. Music and Stand-up 1: Food Glorious Food 158 17. Music and Stand-up 2: Anna Sinner Parties 163 4 Seriously Funny: Using stand-up as a health education and social change tool v3 1) Warm-up Act: Summarising Stand-up as a Health Education Tool Health education has a lot in common with stand-up. Both can often be challenging, about breaking taboos and dealing with personal/professional or political issues. What is this document for? This guide/discussion paper is about exploring stand-up comedy as a tool for health education, as well as other social change issues. In it I suggest that comedy may reach and motivate target groups in a way that traditional approaches can’t. Particularly key “harder to reach” groups who suffer from health inequalities. Although they may also love other forms of popular culture, stand-up is more affordable than producing your own blockbuster movie. Stand-up does also have a limited history of being used by health organisations. Many professional comedians also now base their acts around their experience of different health conditions. I hope this paper will appeal to health commissioners, service providers and campaigners. This is as well as workers in other related fields of social change, and last but not least comics themselves. I explore how stand-up could be used in a number of different ways including: • Education about particular health conditions, as well as individual lifestyle topics, e.g. sex and relationships • Tackling the wider determinants of health and the politics of health It could be used with the public as well as in professional training and to influence policymakers. However, stand-up probably should not usually be seen as something freestanding. Often it would also need to be part of a wider programme of work. Partnership working may also be important here. What is health stand-up? Health stand-ups ideally should have a range of comedic and educational skills. Indeed, perhaps they might have more in common with after dinner speakers, who speak amusingly on a topic, than with old-fashioned gag merchants. They are there to empower people not just entertain them or make them feel temporarily better. Stand-up could be used to: • Engage people who aren’t otherwise interested in health • Give information in a fun way, including about useful skills • Point out absurdities in personal beliefs around health • Show up the contradictions in how society is organised and why this makes people sick • Break taboos and share pain so that people feel less alone and more able to open up honestly to each other about what they are feeling • Encourage reflection, discussion and exploration of issues • Enable action for change 5 Seriously Funny: Using stand-up as a health education and social change tool v3 Stand-up and health education/communication theory A doctor wouldn’t dip into a pill jar and pull out any random drug to treat a patient. Similarly, a psychotherapist wouldn’t just say any old thing to a client. Health stand-up needs a comparable level of intervention expertise. We need to know what works when and why. Health stand-up would probably work best if combined with relevant health education or communication theory. I describe a number of these. Social marketing for example highlights the importance of initial research into the target group. This could be in terms of: • Their current behaviour and what might alter it • If comedy is a good way of engaging them • Where shows could be put on etc. The Transtheoretical model looks at where individuals are in terms of a journey towards healthier behaviour. Comedy maybe particularly useful in engaging people who are not even yet thinking about a particular health issue. They might be drawn in by the approach not the content. It may also be useful with health campaigners or professionals who are committed to an issue. With them it could be used as a bonding exercise or a way of gently challenging their assumptions. AIDA stands for attention, interest, desire and action. It is a way to structure how to engage people and increase the chances that they do what you want. It is useful for highlighting that there are stages after the stand-up event that are also important e.g. follow-up by health professionals. Indeed, health stand-up is a team activity. The cognitive-affective-behaviour approach builds on all this by stressing the importance of focusing on skills, attitudes and beliefs as well as information. Relationship marketing as its name suggests is about establishing long-term relationships between organisations and their target groups. Much of what I have said so far may sound very top-down. However, stand-up could also be about enabling professionals and lay people to reflect and debate together about illness, services and the wider determinants of health. Laughter as a tool for health and social change Laughter has a special place in stand-up. Some jokes may be clever and worth a smile or even a groan. Audience will probably expect to laugh at an act too, however. Jokes that make us laugh may also have additional benefits. This could be in terms of opening people up to new ways of thinking or creating closeness within a group. There are a number of different explanations as to why people find things funny. One is around superiority. Many jokes are based around one group being better than another or certain people being stupid, lazy or inferior in some other way. An 6 Seriously Funny: Using stand-up as a health education and social change tool v3 example would be that obese people have only themselves to blame and have no will power. Perhaps health stand-up could twist this to show organisations that promote unhealthy foods as morally inferior instead. It then becomes a way of tackling issues of power imbalances. Another way of looking at laughter is incongruity resolution. People laugh at some kinds of joke when they realise that the incongruity can be made sense of or resolved in another way. It may be a good way of tackling people’s irrationalities around health e.g. enjoying themselves to death through smoking. Similarly, it could highlight absurdities in how society is organised in a way that damages health e.g. the links between tobacco company profits and children smoking. Catharsis is the third explanation I look at. Here laughter is a physical release of tension. Another way of looking at this is that we are happy because we laugh. We don’t laugh because we are happy. There are many health and social issues that have emotions like shame or anxiety attached to them. Humour is a way of approaching them that allows people to deal with these negative feelings.