Graphic medicine tends toward the personal and the niche. In contrast, public health campaigns target everyone. In this, public health is ambitious where medicine is modest. This ambition leads to immediate and obvious barriers. The attention of the masses is hard to hold, and minds are hard to change under the best of circumstances. If you have ever influenced another person, you have likely cleared major hurdles like confirmation bias, motivated reasoning, and misinformation. Shifting someone’s beliefs or behaviors on polarized issues like public health mandates or climate change is even more difficult.
Changing the mind of an individual, a county, or a country, is a pretty big ask. Yet ambitious artists and writers have seen cartooning as an appropriate medium for persuasion since before comic strips or comic books existed. The earliest examples in the US are political tracts (Yu, 2015). These persuasive pieces can be seen as spreading a public good from the artist’s perspective.
Using comics to persuade people to make healthy choices became widespread with the growing popularity of comics. No sooner did popular comic characters emerge than creators began to enlist them in their own view of promoting the public good. Aside from the obvious (comics promoting literacy!), the following is a sampling of characters and issues have seen print in the service of graphic public health: Batman (gun safety), Blondie (emotional well-being, see Figure 1), Dennis the Menace (family stress, see Figure 1), Superman (mine safety) Spider-man (child abuse, safe sex, anti-smoking, see Figure 1), Flash and Plastic Man (social distancing, see Figure 1) and Archie (buckle-up, anti-drug). UNICEF, the World Health Organization, US Department of Health, Education and Welfare, and The American Cancer Society, have all gotten in on comics as a medium. See the website Discovery Sets: Comics on a Mission from the VCU Libraries Social Welfare History Project Image Portal for many of these examples and additional illustrations: https://web.archive.org/web/20250227232535/https://images.socialwelfare.library.vcu.edu/exhibits/show/comics/gallery
Figure 1. Example panels using well-known characters in the service of graphic public health. Sources clockwise from upper left corner: Daniel, T.S. & Morey, T. (2020); Farar & Musial (1961); U.S. Department of Health and Human Services (1981); Spider-Man, Storm and Power Man Battle Smokescreen (1982)
Editor, author, and artist Meredith Li-Vollmer and her collaborators have set out to join this large coalition and document their efforts in Graphic Public Health: A Comics Anthology and Roadmap (Li-Vollmer, 2022). Although the concept is not new, the term “Graphic Public Health” and the study of Graphic Public Health as its own sub-discipline is nascent. (Many comics in this collection even pre-date the term.) In addition to presenting an anthology of public health comics, Li-Vollmer has included generous details about the projects and creative processes behind them, inviting readers into the complex work of modern public health communication.
The anthology is divided into four thematic sections, each exploring one of four key purposes in public health comics: Health Literacy, Risk Communication, Health Promotion, and Advocacy and Activism. Each thematic section is followed by a discussion, where Li-Vollmer shares a piece of the roadmap in using comics for the respective purpose. These reflections include behind-the-scenes processes. For example, the reader gets a brief tour of some public health workers’ initial skepticism about comics’ effectiveness in 2008, panels from other related comics, and some light connections to comic scholarship (e.g., Scott McCloud, Hillary Chute). They also include commentary on her consultation with specific cultural groups, who offered not only information but feedback on culturally appropriate imagery, language, and even the picture-to-text ratios in a given comic. This roadmap component culminates in the fifth and final chapter, where Li-Vollmer offers practical advice for prospective comic creators, public health workers, and educators who want to convey public health messages through comics. With this unique combination of comic anthology and instructional roadmap, Graphic Public Health speaks to two major themes: the power of comics in public health, and the specific lessons Li-Vollmer learned over 20 years at Seattle/King County Public Health, where most of these comics were published.
The comics themselves reflect a wide range of public health topics, from the personal effects of climate change to a series of one-page vignettes focused on patients at a Seattle pop-up clinic. Li-Vollmer’s involvement is evident in her authorship of roughly half the anthology and her editorial role in the rest, giving readers a comprehensive view of her vision and impact. The artwork, likewise, is richly varied, showcasing over a dozen different artists, including underground artist David Lasky and known figures in graphic medicine Ellen Forney and Tatiana Gill.
Health Literacy: Comics for Clarity
The first section, on Health Literacy, demonstrates how comics can simplify complex health information, making it accessible to a broad audience. In this section, Li-Vollmer authored three comics focused on clear, straightforward messaging: “Stay Home with the Flu,” “Stay Safe in the Heat,” and “Climate Changes Health.” These pieces raise awareness about fundamental health risks while using concise text and visual storytelling to foster comprehension without overwhelming the reader. This chapter also does the work of anticipating a kind of criticism of public health. A critic might assert that public health is fundamentally misguided because of its over-emphasis on individual behaviors. This emphasis is misleading because many primary risks to public health are merely the byproduct of larger forces such as exploitative economic systems. Addressing that concern, “Climate Changes Health” helps the reader to understand the myriad ways in which climate change impacts every aspect of our quality of life, from our air quality to available food to disease and mood.
Risk Communication: Preparing for the Worst
The second section, Risk Communication, makes a case for comics as a medium for preparedness messaging. Here, Li-Vollmer explains that health communicators need to avoid overly dramatic or disturbing images, which can alienate audiences or make them avoid the message. Instead, comics can achieve a balance between engagement and realism, helping readers mentally rehearse scenarios without becoming overwhelmed. This section includes seven comics on topics from pandemic preparedness to disaster planning, all written by Li-Vollmer. Her pandemic comics, which date back to 2008, reflect her earliest work in public health comics: “No Ordinary Flu.” This comic was written to educate the public on avian flu preparedness; in hindsight, it also foreshadows aspects of COVID-19, including masks, social distancing, and workforce challenges. The disaster preparedness comics, “Survivor Tales” and “Disaster Buddies,” use a slick art style to prompt mental rehearsal for situations like floods and earthquakes, enhancing preparedness without fear-mongering. One particularly notable excerpt is intended for rapid distribution in the event of an acute crisis. These shared fragments offer a glimpse of what to expect at a “medication center” during a public health emergency such as a mass anthrax attack. Although this piece exists only as an artifact for now, Li-Vollmer explains its potential use in future crises.
Health Promotion: Inspiring Action
In the Health Promotion the analysis focuses on campaigns designed to promote healthier choices among target populations. These comics reach audiences based on demographics (e.g., parents and seniors), professions (e.g., prescribers), and values (e.g., environmental awareness). This section includes the “Don’t Hang onto Meds” campaign, a four-part series illustrating the risks of leftover medications through stories tailored to different groups. Another comic, “Why Testing for Lead Helps Kids and Their Growing Brains,” informs parents about the importance of lead testing for children. In her discussion, Li-Vollmer introduces the first quantitative measure of the effectiveness of a graphic public health campaign. She notes that “Don’t Hang onto Meds” campaign contributed to a 221% increase in relevant website hits, though she remains modest about attributing the increase solely to the comic’s impact. She also outlines potential future research to better understand the efficacy of comics in health promotion, including qualitative studies on audience engagement.
The question of effectiveness is seldom directly addressed elsewhere in the text, though it lurks behind the scenes. Were Li-Vollmer’s skeptical colleagues from 2008 actually correct? The case for comics is mostly implicit and made with demonstrations of comics and an explanation of the creation process. However, for decision-makers and resource-allocators, there are limited resources for any one campaign or issue. Why should public authorities sponsor comic-based public health messages? It appears that we may lack strong evidence to support their use. Comics have inherent appeal, but their use is not appropriate across all topics and for all audiences. For example, communication via comics is not inherently more space-efficient than text and so may be inappropriate in circumstances where space is limited. (Yu, 2020). As Graphic Public Health continues to emerge as a subdiscipline, future studies are likely to add rigor to the evaluation of the medium. Nevertheless, this collection will stand as a robust proof-of-concept.
Advocacy and Activism: Amplifying Voices
The anthology’s final thematic section, Advocacy and Activism, showcases comics with a more personal tone and purpose, highlighting social justice and the experiences of marginalized groups. This section includes excerpts from 3 previously published Li-Vollmer-edited works: Sketches Outside the Margins: Patient Stories from the Seattle/King County Clinic (2016-2018), Comics 4 Health Coverage, and Lines Drawn: Parents and Teachers Who’ve had Enough (co-edited with Mita Mahato).
Sketches Outside the Margins profiles patients at a free pop-up clinic. These works invite readers into the lives of clinic patients and the broader healthcare challenges they face. These stories convey the novelty of seeing a doctor in a basketball arena in the immediate vicinity of the Space Needle. They also illustrate the deep impact that free clinics can have while subtly advocating for more equitable healthcare solutions in the U.S. Comics 4 Health Coverage, meanwhile, turns the view toward the artists themselves as each artist recounts their personal health insurance struggles and reflections. Lines Drawn explores various perspectives on gun safety as it impacts school-age children. Through these pieces, Li-Vollmer allows creators to explore abstract visual styles, collage, and personal storytelling, adding emotional depth and artistic diversity to the anthology.
Public health, even graphic public health, runs the risk of being as engaging as a dusty pamphlet in the doctor’s office. Being boring is a fatal flaw in public health messaging, because failure to engage the audience necessarily means failure to directly influence the audience. This is a place where comics have the clear potential to at least play a part in a campaign. Comics are inherently engaging. That said, do the examples collected in Graphic Public Health successfully accomplish this crucial mission?
The didactic instruction comics are necessary for some projects. For example, a large collection of David Lasky’s illustrations were actually printed on cards to help providers communicate with patients about medication conditions and side-effects. However, the liveliest comics in the anthology are those that you would not find in a doctor’s office waiting room. From a reader’s point of view, it is much more interesting to witness Lasky as he turns his lens inward to illustrate his one-page tale of tax woes, underground comix confessional-style. Similarly, it is a privilege to get a peek into the inner world of the people who use a gigantic free clinic in a basketball arena—each of these are mini-dramas the narrative hook of a boring thing happening in an exciting setting.
As another illustration of how comics engage or fail to engage, compare and contrast Ellen Forney’s comic depicting an interview with a psychologist in the comic “Mike Archer, PsyD” with her personal slow realization that US adults have failed children when it comes to gun safety (six panels, two-page comic “Drilled”). “Mike Archer, PsyD” hardly needs illustrations for its straightforward information. See Figure 2 in which a talking head speaks to the interviewer in each panel and ends with a list of suggest reforms. It is useful information from a newer professional on the frontlines of mental health care, and it fits with this section’s larger theme of documentary-style snapshots from people in the clinic. Mental/behavioral health is the subspecialty described in this collection to exclusively feature a professional point of view and not a story from a patient—perhaps related to the stigma of mental illness compared to other types of problems treated at the clinic. It would have been possible to write this information in a paragraph with relatively little loss of information. There is little interpretive space available here and little narrative. As a result, this may serve as comics-for-comics’-sake rather than an effective leveraging of the medium.
Figure 2. A panel giving a lecture.
In comparison, each panel of the autobiographical “Drilled” also includes an illustration of the “main character.” However, rather than speak directly to the reader/interviewer, the main character reads, thinks, speaks to others, listens, observes, emotes, and mourns. Though subtle, even relatively static images draw the reader in, see Figure 3. Forney uses two pieces of comic idiom to illustrate her emotional state when she realizes that active shooter drills are universal for all children in the U.S.—a heart plopping on the table in front of her and a dark squiggly line above her head. Finally, Forney is doing yoga days later, still reflecting on the failures of adults to protect kids and illustrating the long-term impact of her lesson on herself. The message is mostly implicit.
Figure 3. A comic expressing actions and reactions, inner thoughts and emotional states, and time passing.
Both “Mike Archer, PsyD” and “Drilled” fall broadly within graphic public health but one is an illustrated lecture and one capitalizes on the pathos possible in the medium. Both are legitimate uses of comics for public health, but one is able to tap fully into the power of personal graphic narratives. This is an implicit tension throughout graphic public health. One relationship that this tension may reflect is whether the creators trust the audience to get the “right” message from their comics. Though the facts of the case are dubious and unsourced, one prominent public health comic has actually been blamed for having a precisely ironic effect on the intended audience (See Taylor (2003) who describes a tragic story of Bosnian children dying because of a landmine safety Superman comic distributed by the U.S. Military.) Do public health comic creators trust the audience? If not, comics may become direct past the point of art on toward advertising or propaganda. In this, there may be an inverse relationship between the degree of explicit messaging and amount of audience engagement possible.
Making Comics for Public Health
In the final chapter, Li-Vollmer offers direct advice for future health communicators in a “What I Wish I Knew at the Beginning” framework. Here, she underscores the importance of “interrogating” oneself and one’s project to ensure that the story serves the audience’s needs. She also provides practical tips on choosing collaborators, navigating artist partnerships, and distributing completed works. By drawing from her own experiences, Li-Vollmer aims to equip others with the tools and insights needed to create their own graphic public health works, empowering readers to carry forward the lessons and methods she developed over her career.
Conclusion: A Lasting Contribution to Graphic Medicine
In Graphic Public Health, Li-Vollmer has created more than just a collection of comics; she has crafted a versatile resource for anyone looking to communicate critical health information through comics. By illustrating the complex process involved in creating effective public health narratives, this anthology expands the field of graphic medicine and serves as a model for future projects in health communication. As both a practitioner and a guide, Li-Vollmer’s work demonstrates the potential of comics to not only inform but also to engage and inspire action, leaving a valuable legacy for both current and future public health advocates. Importantly, this collection of works and commentary can be an empathic, humanist starting point for crucial issues we face together.
References
Daniel, T.S. & Morey, T. (2020) Maintain social distance. In DCeased #1, edited by Abernathy, B., DC Comics.
Farrar, M. M. & Musial, J. (1961). Chic young's Blondie. New York State Department of Mental Hygiene.
Li-Vollmer, M. (2022). Graphic public health: A comics anthology and road map. Penn State University Press.
Spider-Man, Storm and Power Man battle Smokescreen. (1982 Series). Marvel Comics Group.
Taylor, P. M. (2003). Munitions of the mind: A history of propaganda from the ancient world to the present era (3rd ed.). Manchester University Press.
U.S. Department of Health and Human services. (1981). Dennis the menace coping with family stress. Washington, DC: Field Newspaper Syndicate.
Yu, H. (2020). Conceptual art or readable contract: The use of comics in technical communication. Technical Communication Quarterly, 29(3), 222–239. https://doi.org/10.1080/10572252.2020.1768291
