Terence McDonnell offers a biographic cartography of the carefully planned and expensive HIV/AIDS campaigns in Accra, Ghana, revealing the disorder and distortion that often occurs when well-intentioned media communications are released to the public. The concept of “cultural entropy” is presented to describe the process through which the energy invested in cultural objects, in this case health communication media, “diffuses or diverts along unintended trajectories [that] are built into the interpretive arrangements of people, objects, and settings” (p. 15). Presented case studies of best-practice and evidence-based media campaigns for risk reduction behaviors— including billboards, t-shirts, posters, and stickers—show how the public can distort, misinterpret, and reinterpret intended messages. Female condoms become bracelets, billboards become free advertising space, and public posters become private household décor. While such disruptions appear random, McDonnell argues that they are patterned, widespread, and inevitable—possibly even predictable—reflecting semiotic multiplicity, the disruptive nature of objects, and the difficulty in taming culture.
Cultural entropy helps explain why the effects of behavior change campaigns are so hard to identify and measure, and ultimately so limited. Drawing on the thermodynamic principle of entropy, a trend toward increasing disorder and instability, McDonnell argues that as campaigns move from interaction to interaction—crafted by designers, vetted by opinion leaders and the target audiences, circulated through public space, and finally interpreted and used by the public—messages are most frequently diverted along unintended trajectories and eventually meanings and intentions are diffused. The book offers numerous examples to show how larger audiences and longer durations of existence result in greater diffusion and more likelihood of widespread entropy. Given the expense of creating health media campaigns, they often exist for long periods of time (e.g., billboards that are never taken down, maintained, or updated) and used to address heterogeneous audiences (e.g., the LoveLife universal campaign). However, over the life course of any object, it falls apart or is thrown away, the social world shifts making it is no longer relevant, and cultures change making objects no longer fashionable.
To measure cultural entropy, McDonnell developed a “social iconography” of HIV/AIDS media campaigns, which he explains in a very useful and descriptive appendix. Social iconography is the “study of the social practices, interactions, and contexts around visual symbols” (p. 207), distinct from typical iconography that analyzes only the content and form of visual culture with some historical considerations. Focusing on how people use and interpret images in situ differentiates the approach from more traditional AIDS iconography studies that focus on the semiotics of AIDS representation. Treating objects as instances of “agency, intention, causation, result, and transformation” (p. 207) reveals their dynamic and disordered nature. McDonnell engages in a biographic approach that follows interactions with an object across its life course. In so doing, he captures the producers’ intentions to control and contain understandings of HIV by following a rational approach to design, and the subsequent divergences and fracturing of meanings when interacting with everyday context and cultural practice.
The book details a number of powerful case studies revealing the nature of cultural entropy. Some of these cases are well known or experienced elsewhere in varied forms. Female condoms that are valued for their plastic loop become reconstructed as a fashion accessory. T-shirts that promote a trendy male condom slogan are dismissed by the youth that created them as too risqué and controversial to wear. Engagements are made with religious leaders who initially support messages, but then consider the images contradictory to religious principles and fail to or refuse to integrate the campaign materials into their own practices.
Most intriguing is McDonnell’s description of perspectives of billboard messaging across time. By walking the streets of Accra, riding in taxis and tro-tros, and sitting at bus stops, McDonnell paints the various views of campaign materials and in so doing reveals why they often fail to convey their message. Pedestrians watch where they are walking and are distracted by the traffic and traders on and alongside the road, not looking upward to see billboards. Taxi and tro-tro riders have a distorted view of the outside and do not see billboards. People sitting at bus stops have their backs to campaign messages and then hide the message from those passing. And billboards exist for so long that paint fades (especially the red often used in HIV campaigns), distorting messages and meanings over time. Situations that relate to materiality seem obvious and can be avoided or addressed, if considered. Others, particularly those related to cultural interpretations, are much more difficult to predict or control.
McDonnell suggests that health communication campaigns acknowledge entropy and loosen their grip rather than trying to predict and control. Instead of investing effort and expense on formative research, on focus groups, on cultural informants, he suggests letting creativity loose. By flooding the public with multiple messages, out of the box, risky, and even controversial (like the Kama Sutra “Use a Condom” billboard that certainly caused me to pause and take a second look), dialogue can be ignited, rather than contained. Monies can then be directed at identifying and expanding on the messages that have the greatest positive impact.
The concept of cultural entropy and the nature of social iconography offers a useful tool for understanding the socio–communicative process that extends beyond HIV campaigns in Ghana. The book falls short in engaging in a discussion of how historical, political, and cultural structures beyond materiality influence the relationships between media and public. McDonnell does not consider the impact of the evolving landscape of HIV/AIDS (from fear given limited knowledge, to prevention as the only approach, to hope given new treatment options), as affecting what is conveyed in media campaigns and how the public interprets the messages. Furthermore, while McDonnell speaks to uncertainty in making cultural objects public, he does not consider the power imbued in the messages as related to who created the messages, who the intended audience is, and how it was developed.
McDonnell’s perspectives could have been further strengthened had there been conversation with other theoretical perspectives including “culture-centered communication” and “biocommunicability,” which highlight the influence of governmentality in the ideological constructions of how information is produced, circulated, and received, how individuals and institutions participate in the process and how messages are infused with value and authority. Considering cultural entropy in conversation with these perspectives offers a more nuanced view of the inherent nature of public relations, media messaging, and health campaigns. Collectively, these perspectives inform both theoreticians and practitioners in the expansion of thought and practice related to media messaging with the intention of generating positive influence on the world. McDonnell has offered another approach to considering this complex issue. It is an eye-opening read for anyone engaged in health communication and public health.