By Helen Osborne, M.Ed., OTR/L
President of Health Literacy Consulting
On Call Magazine, August 21, 2008

Kapow! What a novel idea! Comics that tell health stories to get word out about important health issues!

Glenn Herdling knows how effective this can be. He’s the director and editor-in-chief of Creative Resources at Medco Health Solutions in New Jersey. He’s also been the editorial director of custom publishing at Marvel Entertainment Group in New York. In addition, Herdling has written over 80 monthly comics, including Spider-Man and The X-Men.

Herdling distinguishes comics from other forms of communication by saying they use both pictures and words to tell stories. Comics, he says, stimulate both sides of the brain simultaneously: the right side processes pictures and the left side processes words. These operations reinforce each other, and readers get a double whammy of images and phrases that convey important information.

What health consumers can get from comics

Any serious comics reader knows that comics can exist for no purpose other than entertainment. But serious readers also know that they can convey important social messages. All comics include character, plot, conflict, and resolution. And when the purpose is teaching, the comic also contains a moral or a lesson. Herdling illustrates how comics can be used for health messages by describing a story that tells people why they should buy generics rather than brand-name drugs:

“Jim” goes to the pharmacy with a new prescription and pays a lot of money for a brand-name medication. Leaving the pharmacy, he runs into his friend Fred who says, “I didn’t know you were taking that brand-name drug.” In the next panel, Fred continues, “I used to take that, too. But my pharmacist gave me this generic drug that does the same thing. I’m saving a lot of money, and I feel great.” Several frames later, after talking to both his doctor and his pharmacist, Jim buys the generic medication. In the next panel, he exclaims, “Wow! I just saved a lot of money by buying a generic medication that works just as well as that expensive drug I was taking.”

Comics cross literacy and cultural boundaries

Most comics are written at a very basic literacy level. Herdling says that children start reading comics in about the third grade and that comics are enjoyed by kids and adults with different learning abilities and styles. But as with other written materials, comics have a wide range of sophistication. Younger children usually start with characters like Archie, Betty, and Veronica, Herdling says. These are more “cartoon-ish,” and the simple stories are told with big print and few words. As kids get older and become better readers, they are likely to select comics with more action and text.

Comics can be “good equalizers” in terms of bridging cultural and societal differences. For example, Herdling says comics help open up communication between younger children and doctors or other authority figures they may initially fear. Comics can also transcend national boundaries. For example, the Japanese comics art form called “manga” is popular throughout the world.

Comics with health-related messages

Comics have been used for many years to convey important health messages. One that met with phenomenal success was a public awareness campaign about child abuse. It was created by Marvel Comics for an organization now called Prevent Child Abuse America. This was the first time that child abuse was so openly addressed in a pop culture art form. The campaign stretched beyond the message that “it shouldn’t hurt to be a child” to offer children self-help information they could really use.

The comics campaign used Spider-Man who revealed to a young victim of sexual abuse that he had been improperly touched himself by a teenager when he was a child. More than one million copies of the comic were distributed nationwide, and the mainstream media, including Time and Newsweek and morning talk shows such as Good Morning America and the Today Show, praised its effectiveness.

Comics need action to tell an effective story

Herdling acknowledges that comic book action is often violent, even in cause-related messages. He describes an anti-smoking campaign in which Captain America beat up the Smog Monster who was trying to get kids to smoke. Herdling says this level of action is intended as fun. Kids like to see something explosive on each page. “If the primary audience is children,” he says, “they like to watch Spider-Man beat up the bad guy.” It’s not only fun, but good triumphs over evil.

Adult readers also want action though perhaps not violence. Herdling describes a comic he edited for the manufacturer of a drug that’s used to treat GERD. The story went like this. A man with GERD doesn’t feel well. He won’t go to the doctor but his wife insists that he go. Together, they meet with “Dr. Feelgood” who, during the appointment, shrinks and takes a voyage through the man’s internal organs. As a result, the man learns about GERD and how medication can help. When they leave the doctor’s office, the man says to his wife, “Thanks honey. I don’t know what I’d do without you.” Herdling says the action in this comic is both the “Fantastic Voyage” the doctor takes inside the man’s body as well as the man’s conflict over not wanting to go to the doctor. The result is positive health outcomes.

Creating custom comics

If your healthcare organization wants to use a comic to get its message across, it most likely will need to engage professional help. One good way to start is to contact the custom publishing division of a large comic book publisher such as Marvel or DC Comics. When you do, you should have a clear idea of the message you want to get across and who you want to reach with that message. Herdling recommends that for each comic, there should be just one key message The publisher can handle all aspects of production, including contracting with a creative team that consists of a comics writer, editor, penciler, inker, colorist, and word-ballooner. Once a storyline is approved, it takes about four days for creating each page of art.

Printing costs are usually the largest expense of custom comics. Most comic books today are 16-22 pages and are printed on somewhat sturdier stock paper than the newsprint comics of years ago. This paper is needed to support the high quality color processing used today. The days of the Hulk in just one shade of green are long gone.

It’s certainly possible to produce comics electronically, but Herdling doesn’t recommend doing so. He says comics have more impact when people are handed paper comic books rather than given disks to download at home.

Comics may not be for everyone

Finally, while Herdling is obviously a fan of using comics to communicate health messages, he is realistic enough to know that others have concerns. For instance, some people see comics as juvenile literature. That means some people may see a comic and automatically assume its message is for kids, not them. Another problem is that some people don’t understand comic book structure. Herdling remembers a high school friend who said he couldn’t process that “picture/word thing.” To help others who react similarly, Herdling makes sure artists draw comics that follow certain standard formats. For instance, the message needs to “flow” from left to right and top to bottom.

What this all means is that comics can be another effective tool for getting complicated information across to the people who need to have it. But they shouldn’t be the only tool in your arsenal. The more ways you have to reach your audience, the better able you’ll be to communicate with all the people you want to reach.

Ways to learn more:

Glenn Herdling is the creative resource director and editor-in-chief for Medco Health Solutions in New Jersey. He also owns a creative writing studio and has written over 80 monthly comics, including Spider-Man and The X-Men. You can contact Herdling at glenn_herdling@medco.com

Understanding Comics: The Invisible Art by Scott McCloud, HarperPerennial, 1993. Written as a comic, this book has a wealth of information about all aspects of this art form.

Helen Osborne, MEd, OTR/L, is president of Health Literacy Consulting. She received two “Gold 2008 Plain Language awards from NIH for her work on the NCI booklets “Radiation and You” and “Chemotherapy and You.” Her column appeared regularly in On Call. You can contact her by e-mail at Helen@healthliteracy.com.