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Public Health Approach

Understanding Public Health

Worldwide, pornography is now being framed as a Public Health Crisis by many governments, health, violence prevention and advocacy organizations.

Pornography is a social problem and hence cannot be simply addressed by focusing on an individual level.  The paper: Health education's role in framing pornography as a public health issue: local and national strategies with international implications (2008), states:

Social issues from the public health perspective involve problems that affect individuals or groups beyond their capacity to correct. Social issues are detectable when responsibility is shifted from individuals being able to adequately make changes themselves, toward holding external social causes or influences accountable. It is clear that many aspects of pornography meet this definition of social issue, and warrant public health advocacy efforts.

An organisation that is part of our expert advisory panel, Culture Reframed, advises that pornography affects individuals, families, communities and the culture. Culture Reframed, drawing from over forty years of peer reviewed research, culled the following data on pornography:

1)     It has multiple harmful effects.

  • Limited capacity for intimacy
    • More likely to use coercive tactics
    • Increased engagement in risky sexual behaviours
    • Increased likelihood of perpetuating sexual harassment and rape
    • Decreased empathy for rape victims
    • Increased anxiety/depression
    • Habitual/addictive use

2)     It adversely affects all dimensions of health.

    • Social
    • Emotional
    • Intellectual
    • Spiritual
    • Physical

3)     It is getting worse.

    • Mainstream content is sexist, racist, and increasingly cruel, brutal, and degrading.

4)     It acts as a fast-spreading vehicle for other major public health problems:

    • sexual violence
    • depression/anxiety/low self-esteem
    • substance abuse
    • disease

5)     It is how most youth learn about and experience sex. 

Relevant Research to support these statements may be found on our Journal Articles page.

Understanding a Public Health Approach

The following information has been authored by Cordelia Anderson, M.A. Human Development, with a focus on sexuality and prevention of sexual violence. Cordelia is the Founder of Sensibilities Prevention Services, and has over 40 years’ experience working to promote sexual health and prevent sexual harm.

Many speak to the importance of prevention efforts using a “public health” approach, but it is not always clear that those using both the term “prevention” and “public health” are defining them in the same way or really understand what the terms actually means.

The basic approach used in public health seeks to: define and monitor/surveillance the problem (use data to inform practice); identify risk and protective factors; pilot and evaluate effective prevention programs; and assure broad-base dissemination. Because of the health equity principles inherent in public health, many argue it’s also a social justice approach, while some see public health as more of a “medical model.”

Some keys concepts used in public health involve thinking about systemic change as well as an individual focus and developing programs on data/research.  Public health recognizes the impact of the broader environment on the behaviour, health and choices of individuals who live within it. Public health approaches point out the impact of the environment on behaviours and the way the environment shapes or perpetuates social norms which again affect behaviours. John Briere, PhD researcher and clinician points out that “Toxic decisions seem rational in toxic environments.”

Social issues from public health perspective involve problems that affect individuals or groups beyond their capacity to correct.  That means once something is recognized as a social issue – responsibility shifts from individuals to holding external social causes or influences accountable. 

Public health involves different intensities of efforts to different tiers:

    1. Universal – efforts addressed to the whole population
    2. Selective – efforts focused on a specific sub-group with risk factors
    3. Indicated – efforts focused on identified groups already showing signs of a problem

Further to the above explanation by Cordelia, a Public Health Response works towards reaching Medical Doctors, Psychologists, Social Workers, Mental Health Experts, Child and Youth Specialists, and other allied health professionals, to provide them with a deeper understanding of the psychological, neurological and physical health issues for users and victims of pornography. This may include (and is by no means limited to) knowledge dissemination related to neurological brain changes through addiction; porn induced erectile dysfunction; internal injuries for young women whose partners replicate porn acts; and awareness of porn scripts that may result in behaviours that are harmful to children and young people.

Contained within a public health response, is the essential underpinnings of policy and legislative change. Included as a means to practically implement policy and legislation, is the requirement of an equally responsive technology sector. Within in a public health framework, there is opportunity for technology to improve educational efficiency and accessibility. Clear policies and supportive educational resources form the basis of mobilisation for the allied health sectors.


Incorporating a Public Health Approach in our work

A public health approach informs the 3-pronged PREVENT – EQUIP – RESTORE framework of eChildhood. Given the extensive data available on the harms of pornography on children and young people – particularly related to the rise in mental health issues and preventable diseases such as Sexually Transmitted Infections, work must commence with prevention.

PREVENTION requires working with our Government and technology companies to prevent the harms of pornography from occurring in the first place. Reducing access through safeguarding homes with filters and device apps is one such measure; however, using this as a solo approach has significant limitations due to the broad range of families within community and an ad hoc response to pornography harms. The viability of limiting the delivery of pornography to children through technology-related child protection buffers, modelled after measures adopted in the UK, are important to consider.

PREVENTION includes reducing access through a range of ‘Digital Child Protection Buffers’, such as:

  • Safeguarding homes with filters and device apps.
  • Internet Service Provider (ISP) filters
  • Age-verification processes to access pornographic websites
  • Mobile device restrictions through use of SIM cards that restrict access to adult content unless and until the account holder completes an age verification procedure.
  • Public Friendly WiFi

Often the argument against filtering is that kids will find a way around it. However, only a very small minority of 12-15 year olds say they have disabled filters or parental controls.

  • Despite most children having information about staying safe online, a small number of 12- 15s say they are engaged in potentially risky online activities: they are more likely than in 2015 to say they have deleted their history records (17% vs. 11%), amended the settings to use a web browser in privacy mode (10% vs. 6%) and disabled any filters or controls (3% vs. 1%). (OFCOM, 2016)
  • According to this research, 97% of kids don’t know how or have not bothered to disable filters.

EDUCATION is required in every sphere of community, including government and non-government organisations; allied health professionals and community leaders; parents, teens and children; schools and universities; cultural and spiritual meeting places; and sporting groups. 

Parents need education, tools and knowledge to gain confidence to assist children to navigate the online space. It can be overwhelming and time consuming to find and access the limited resources available to address this relatively new issue. Through provision of a 'clearinghouse' of educational resources individually targeted for parents of children; parents of teens; and educators and professionals, eChildhood encourages parents, schools, government and community organisations to have regular and consistent conversations that help kids develop an “internal filter” to reject pornography.

eChildhood identifies that the work of Culture Reframed in producing a Parents and Health Professionals Program is an essential part of the solution.

eChildhood is committed to seeking out and where possible, reviewing educational resources for parents of children, parents of teens and educational settings, to determine the suitability of these resources to support children and young people’s mental and physical health.

eChildhood will be making available a policy framework for use by community organisations, early childhood centres and educational institutions, to provide an appropriate first response when dealing with a child who has been exposed to pornography. Educational resources such as these are currently not available.

RESTORATION is a key factor in public health for those children and young people faced with negative impacts of exposure and problematic use of pornography. An important key to ensuring health and wellbeing is to prevent these harms from occurring in the first place.

“Childhood experiences, both positive and negative, have a tremendous impact on future violence victimization and perpetration, and lifelong health and opportunity. As such, early experiences are an important public health issue." 
(CDC, 2016)

A public health approach requires all levels (from the micro to the macro) of community and Government to be aware of the harms, and implement laws and policy changes that place children at the fore of protective measures. 



References to Understanding a Public Health Approach

Koop, C. E. (1986). Report of the Surgeon General's Workshop on Pornography and Public Health. United States. Public Health Service. Office of the Surgeon General, 4 August 1986. Official Report. Available from URL: https://profiles.nlm.nih.gov/NN/B/C/K/H/
Perrin, P.C., Madanat, H.N., Barnes, M.D., Carolan, A., Clark, R.B., Ivins, N., Tuttle, S.R., Vogeler, H.A, Williams, P.N. (2008). Health education’s role in framing pornography as a public health issue: local and national strategies with international implications. Journal of Promotion & Education, XV, No. 1. 2008;15(1):11-8. DOI: 10.1177/1025382307088093.
Wallack, L., Woodruff, K., Dorfman, L., Diaz, I. (1999). News for a change: and advocates guide to working with the media. SAGE Publications, California. ISBN: 9780761919247

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  • A world where kids can grow up without being harmed by accessing graphic, violent online pornography
  • Prevention of children’s access to pornography through digital child protection buffers
  • Updated legislation and education to address pornography as a public health crisis that increases children and young people's vulnerabilities to sexual harms

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