Can Graphic Design Save Your Life?

The Wellcome Collection, London. Until 14 January 2018.

This poster was used to raise awareness of AIDS in New York City in the 1980s. Credit: Wellcome Library, London

In 1987, with AIDS raging in New York City, six gay activists created a poster to break the silence over the epidemic. It featured a pink triangle — the badge forced on homosexual people in Nazi concentration camps, but inverted and appropriated by the gay community as a symbol of solidarity. Underneath were the words SILENCE = DEATH. Adopted by protest group ACT UP, the poster helped to galvanize action on HIV and AIDS. Equally unforgettable was Britain's contemporaneous “Don't die of ignorance” campaign: its AIDS tombstone appeared on leaflets, billboards and television advertisements.

These iconic images — along with the AIDS tombstone itself — are on display in the Wellcome Collection's exhibition Can Graphic Design Save Your Life? in London. The show gathers some 200 objects from around the world, ranging from the historical (seventeenth-century plague notices) to the modern (a technological billboard from Brazil, designed to attract and trap the mosquitoes that carry Zika and other viruses). The curators — design professionals Lucienne Roberts and Rebecca Wright, with the Wellcome's Shamita Sharmacharja — aim to show how graphic design can inform, persuade and stimulate in the context of health.

Anti-smoking postage stamps have been issued by a number of countries. Credit: Respective countries

For a show about saving lives, its opening is surprising: tobacco advertising, from the 1940s onwards. The display illustrates how the tobacco industry and its designers subverted attempts to restrict branding and add health warnings through sophisticated shock tactics. Hence, the development of the Death brand of cigarettes, and the highly successful wordless, sexualized and increasingly surreal images of purple silk used by Saatchi & Saatchi to advertise Silk Cut. At the same time, government-commissioned graphic designers tackled the risks, from pictures on postage stamps to the design of plain cigarette packaging using Pantone's 'ugliest' colour (the green-brown 448 C, 'opaque couché'). As Wright points out, “Where there is apparently no design, there is design.”

Good design can aid and add nuance to understanding.

Good design can also aid and add nuance to understanding. In the Victorian era, pioneering epidemiologist John Snow and nurse and social reformer Florence Nightingale deployed striking imagery to explore data rigorously and persuade others of their findings. On show are Snow's map of cholera deaths during an 1854 outbreak in London's Soho, and Nightingale's 1858 'rose diagram' — which showed that disease was the main cause of death among British soldiers during the Crimean War (D. Cressey Nature 507, 304–305; 2014). Graphic design in the pharmaceuticals industry is not just for branding and logos — it can also help patients to understand instructions. For example, Israeli firm Teva Pharmaceuticals used a labelling system with colours and shapes that distinguish between medicine types as well as providing corporate identity. Anatomical illustrations, from sixteenth-century pop-up books to apps, help to explain how the body works. Comic books have been used for sex education.

In the centre of the exhibition, we enter a hospital. Blue disposable curtains form a backdrop for bright interactive images designed to engage children (such as animal hide-and-seek in Barcelona, Spain), and signs designed to make hospitals more welcoming. In 2012, the UK Design Council and the Department of Health called for schemes to reduce violence in hospital accident and emergency (A&E) departments, where waits can last many hours. Research revealed lack of information as a key source of frustration. That led to a winning design including strategically placed boards describing each stage of a patient's journey through A&E, and displays showing waiting times. After a year, violent incidents in departments where the system was trialled fell by 50%.

Another example of the impact of graphic design is Scotland's 2009 Kill Jill campaign. This deliberately provocative video invited the public to save or (by omission) kill a child in need of an organ transplant. The Scottish government received complaints but withstood them. The number of registered donors tripled over the course of the campaign.

As an epidemiologist, however, I couldn't help questioning some of these reported results. The exhibition does not attempt to evaluate whether the designs actually caused the changes reported, or, if so, which aspects of the campaigns were responsible. The numbers are simply before-and-after comparisons. More-rigorous evaluation would include adjusting for other factors, taking into account longer-term trends and even conducting randomized controlled trials.

As befits a design exhibition, the structure and detail are well matched. Different sections cover different themes. Cases in the Persuasion section take the shape of a cigarette; those in Education make a question mark; the hospital curtains form an H; Medication is a green cross; Contagion a warning triangle; Provocation an exclamation mark. The font is based on the Rail Alphabet typeface designed in 1965 by Margaret Calvert, and used by Britain's National Health Service.

Perhaps surprisingly, it's the text accompanying the images that really stood out for me. It offers clear, succinct explanations of why the exhibits matter. In an age in which graphic design can be synonymous with minimalist infographics, this potent combination of words and images is as refreshing as it is fascinating.