At this time of year, maybe this year more than ever, the fever of electioneering is way hot. There is a lot about our political campaigns that one could lament, but there is a core value that gives many people pride. In the U.S. we do have a voice in determining what kind of community and nation we have. Is there too much power held by special interests? For sure. Is there too much money spent on political and media campaigns by people with hidden agendas? Absolutely. Is it frustrating that political leaders seem to spend more time getting re-elected and less time working together to solve problems? Without a doubt. However, there is no evidence that any other system is better, and most other places are clearly worse. And by the way, the private sector is not so hot either: consider banks, coal and petroleum companies, health insurance corporations.
People have opinions and positions on many issues. For people interested in health promotion, there are many health issues that either are or should be represented on election days. In other words, for the issues we think are important, it may be that some candidates are more likely to take action to advance a particular policy. This year there are a number of health-related issues that are being discussed by candidates, though there are many more issues important to health promotion that have not gained enough traction with the public to attract any attention by candidates.
One of the more common health issues debated is climate change. In spite of people who believe climate change is either a total myth or at least "unsettled science," it is a slowly worsening problem that needs to be addressed sooner rather than later. Once you find a candidate who believes the threat from climate change is real, then you've got to find one willing to risk jobs in the coal and petroleum industries, also willing to invest government funds in advancing the supply of alternative energy sources of fuel. On some days it seems like the deniers are winning that debate and the American public seems to care about nothing but jobs. It is hard to find a candidate willing to stand up to this barrage of opposition. Profiles in courage are few.
The other huge issue in health policy getting discussed and debated by candidates is the health care reform bill passed by Congress last spring. Many untruths have been told about the legislation, and since the opposition has spent the last six months shouting how it is going to ruin the nation's health care system, it is no surprise that people don't support the bill. Of course if you ask people about specific provisions of the health care reform bill, large majorities support what the bill actually will do. Nevertheless, even candidates who voted for the bill either don't cite it as an accomplishment in their campaign, or simply say it is a start which will need much more work in the future. Of course about half of all federal candidates running say they will do all they can to repeal the bill. It is not at all clear what these opponents are defending, considering all the problems in our current system.
There are many other more localized bills and policy proposals being debated in state and local elections. In California, there is an effort to legalized marijuana. Immigration reform has implications for health, both in terms of the way immigrants are treated but also how immigration policy will impact the distribution of wealth in the country. Abortion is less of an issue in general, though many candidates will state their position to increase their support from various constituencies.
While still a small slice of the electorate, the libertarian banner seems more vocal and influential than in past years. This is a mixed bag for health promotion. Libertarians want to get rid of as much government as possible, and allow the capitalist market to create solutions to community problems. They might say that the government should not be providing influenza vaccination, but should get out of the way so that the private system can efficiently fill this need. Libertarians would generally oppose government regulation unless it is required to protect against immediate threat. For example, they would support a government imposed highway speed limit, but would oppose a public smoking ban in restaurants and other workplaces. They would certainly oppose a ban on trans fat in the food industry, but would rely on educated consumers to mold the practices of the food industry. On the other hand, libertarians would also oppose drug laws, and many people, not just libertarians, are being persuaded toward that view. In general, it is hard to reconcile a hard libertarian view with public health, that believes government policy should be used as a force to improve life and health for all in our communities.
The challenge with voting with an eye toward health promotion is that candidates who are consistently true to health promotion values are rare. Of course as a voter, it is generally better to be holistic in scrutinizing a candidate, not basing support on a single issue. However, often you will find a candidate promising to support one health promotion idea or policy while disavowing support for another. This is compounded by the difficulty of learning about a large field of candidates in multiple races. In Kentucky this Tuesday, the average voter will be choosing candidates in 30-40 races at the local, state and federal level. There are not many people going into a voting booth who really are well informed about all those office holder wannabees.
Our political system does give us wonderful opportunities to participate in deciding our future, including the formation of a sounder basis for a healthy population. However, while these rights can be romanticized, exercising them can be bewildering. At the same time, developing and advocating health promotion policy solutions is also very challenging. Together they are even more confounding.
Nevertheless, good candidates who support health promotion initiatives are frequently elected. There is good justification for health promotion advocates being optimistic, but it is an essential character trait for those who make this their business.
Sunday, October 31, 2010
Friday, October 29, 2010
Election Day and Healthy Halloween
This time of year we frequently see health and safety advice related to Halloween: 1) too much sugar promotes obesity; 2) sticky candy risks cavities while hard candy can break teeth or braces; 3) caution about unusual looking candy that may be poisoned; 4) pedestrian hazards when costumed children are out in the street; 5) knife injury risk from pumpkin carving; 6) adult alcohol abuse encouraged by beverage makers using Halloween-themed marketing. All these are legitimate concerns which are addressed by health promotion advocates in different venues.
This year local, state and federal general elections come just two days after Halloween. While the annual holiday is always October 31, Election Day is on the first Tuesday of November, some years as late as November 7. For this reason, it is unusual for there to be so little separation between the two days, and such intense competition for the attention of the public. It is hard to miss the comparison.
The election is like Halloween in a number of ways. The holiday is about deception, with people presenting themselves as someone or something they are not. So are the election campaigns. Halloween generates spending and stimulates the economy. So do the elections, with billions of dollars of campaign spending. Halloween tries to scare people, such as with ghosts, vampires and pirates. Elections scare people with the ugly, hateful things candidates say about each other.
In addition to the general comparisons, the health concerns of Halloween also apply to the elections. Some campaign candy is dangerous because the promises may prove to be toxic. Just like the holiday candy is very appealing but has no nutritional value, many of the campaign ads and promises are empty of ideas and careful thinking. Just like trick-or-treaters are sometimes hit by big vehicles in the street, many times worthy ideas and genuine leadership are run over by big campaign budgets from special interests. Finally, just as people may be injured while cutting out a jack-o-lantern, candidates and campaigns must suffer soul scars from the destructive words and actions they hear about themselves and say about others.
What I'm talking about is not really health promotion, though a significant part of health promotion takes place in the political system of which elections are an important part. We rely on these leaders to craft and support important health policies, after surviving the very sordid affairs elections have become.
Both Halloween and elections as currently conducted are detrimental to health. This generation of kids will survive another round of trick-or-treating and America will survive another election cycle. However, it is hard to not believe that health promotion is in order for both.
This year local, state and federal general elections come just two days after Halloween. While the annual holiday is always October 31, Election Day is on the first Tuesday of November, some years as late as November 7. For this reason, it is unusual for there to be so little separation between the two days, and such intense competition for the attention of the public. It is hard to miss the comparison.
The election is like Halloween in a number of ways. The holiday is about deception, with people presenting themselves as someone or something they are not. So are the election campaigns. Halloween generates spending and stimulates the economy. So do the elections, with billions of dollars of campaign spending. Halloween tries to scare people, such as with ghosts, vampires and pirates. Elections scare people with the ugly, hateful things candidates say about each other.
In addition to the general comparisons, the health concerns of Halloween also apply to the elections. Some campaign candy is dangerous because the promises may prove to be toxic. Just like the holiday candy is very appealing but has no nutritional value, many of the campaign ads and promises are empty of ideas and careful thinking. Just like trick-or-treaters are sometimes hit by big vehicles in the street, many times worthy ideas and genuine leadership are run over by big campaign budgets from special interests. Finally, just as people may be injured while cutting out a jack-o-lantern, candidates and campaigns must suffer soul scars from the destructive words and actions they hear about themselves and say about others.
What I'm talking about is not really health promotion, though a significant part of health promotion takes place in the political system of which elections are an important part. We rely on these leaders to craft and support important health policies, after surviving the very sordid affairs elections have become.
Both Halloween and elections as currently conducted are detrimental to health. This generation of kids will survive another round of trick-or-treating and America will survive another election cycle. However, it is hard to not believe that health promotion is in order for both.
Wednesday, October 27, 2010
Healthy in a Hurry Revisited
During the summer I blogged about food deserts and talked about one solution being tested: using corner or convenience stores to provide access to fruits and vegetables. This entails a public private partnership in which the store owner makes space for selling fresh produce and posting signage in and outside the store, to promote purchases of these healthy foods by consumers. On the public side, city government 1) provides management consultation to help the store owner get up to speed regarding the handling and sale of perishable produce; 2) assists with establishing a delivery chain to be sure shelf or bin space is continually replenished; 3) supplies low interest financing to offset the costs of store modification; 4) provides local communications and marketing support to build a customer base for the new foods. The test in Louisville is called Healthy in a Hurry; so far two locations have been established with more being planned. Photos linked here will give readers better understanding of this concept.
I serve on a team to evaluate the effectiveness of the corner store concept. We have quickly learned that the enterprise is very complex. We have considered a number of questions directly related to the operation of Healthy in a Hurry, but also more basic questions about food deserts. For example, while it is true that low income residents in disadvantaged urban neighborhoods don't have stores selling fresh, high quality produce, and that these residents typically eat unhealthy diets, are those two facts related? Are the poor diets determined by poor access, or does low consumer demand, as a first cause, provide a market in which full-service grocery stores cannot be successful? Because we are sold on the value of healthy eating, we assume that if healthy foods are made available in the food desert, so that people are able to make healthy choices, they will. In the real world, this may not be the case. Access is a critical resource, but also important are peoples' motivations, decision making, values, and so forth, as well as social norms and interpersonal support for buying and preparing meals with fresh fruits and vegetables. The evaluation team is discussing ways to obtain answers to some of these questions, but the task at hand is to look for the operation and success of the Healthy in a Hurry stores.
Immediate issues for the stores are the junction between the range of produce sold and the consumer demands of the surrounding neighborhoods. Those people more favored by life's lottery are accustomed to buying and preparing a wide range of fresh fruits and vegetables. They have had opportunities to be exposed to many fresh products that might be rarely part of inner city diets. Some examples are asparagus, egg plant, apricots, and cherry tomatoes. While a full service grocery store has a large enough customer base that someone will buy anything stocked, in one of these convenience stores, it is more critical to know what people in the neighborhood will actually buy. A related question is How much can that consumer demand be changed? Can we, as outsiders, influence the local residents to value and purchase new products not part of their traditional diets? The answer is a very guarded yes. Consumer behavior can be changed, but rarely is it a quick process. In the case of the Healthy in a Hurry project, time is of the essence. Unless people begin to buy these healthy food choices, the effort is not sustainable and the produce sections will go away, without long term government subsidy.
Other things are being done to enhance the diets of inner city residents. The public schools are reducing the sugar, fat and salt content of their menus, and expanding the availability of fresh fruits and vegetables. At the same time, they have begun to limit the selling of junk food from vending machines and school fund-raisers. In Louisville, there is an effort to support and encourage community gardens: public property on which people can plant small garden plots. The idea is that anything grown in a garden not only helps family budgets go farther, but usually will be healthier foods than things purchased in packages and cans.
Another strategy which is becoming more and more common is to organize and provide space for urban farmers' markets. This is a way to bring fresh produce into urban neighborhoods. Logistical problems include mechanisms to enable the use of credit cards and food stamps for market purchases. In general, farmers' market fare is more expensive than produce sold in a bog box retail store, though quality is often better. Nevertheless, price differentials between the farmers' market and a grocery store will be an issue for low income families.
Both of these strategies (community gardens, farmers' markets) are being promoted in Louisville, and many other communities around the U.S. We don't yet have good data on who participates and how these might actually improve the nutritional status of disadvantaged Americans.
As an innovation, Healthy in a Hurry is an exciting concept. We need to learn much more about how it contributes to health in the inner city, and how to make these stores the most effective.
I serve on a team to evaluate the effectiveness of the corner store concept. We have quickly learned that the enterprise is very complex. We have considered a number of questions directly related to the operation of Healthy in a Hurry, but also more basic questions about food deserts. For example, while it is true that low income residents in disadvantaged urban neighborhoods don't have stores selling fresh, high quality produce, and that these residents typically eat unhealthy diets, are those two facts related? Are the poor diets determined by poor access, or does low consumer demand, as a first cause, provide a market in which full-service grocery stores cannot be successful? Because we are sold on the value of healthy eating, we assume that if healthy foods are made available in the food desert, so that people are able to make healthy choices, they will. In the real world, this may not be the case. Access is a critical resource, but also important are peoples' motivations, decision making, values, and so forth, as well as social norms and interpersonal support for buying and preparing meals with fresh fruits and vegetables. The evaluation team is discussing ways to obtain answers to some of these questions, but the task at hand is to look for the operation and success of the Healthy in a Hurry stores.
Immediate issues for the stores are the junction between the range of produce sold and the consumer demands of the surrounding neighborhoods. Those people more favored by life's lottery are accustomed to buying and preparing a wide range of fresh fruits and vegetables. They have had opportunities to be exposed to many fresh products that might be rarely part of inner city diets. Some examples are asparagus, egg plant, apricots, and cherry tomatoes. While a full service grocery store has a large enough customer base that someone will buy anything stocked, in one of these convenience stores, it is more critical to know what people in the neighborhood will actually buy. A related question is How much can that consumer demand be changed? Can we, as outsiders, influence the local residents to value and purchase new products not part of their traditional diets? The answer is a very guarded yes. Consumer behavior can be changed, but rarely is it a quick process. In the case of the Healthy in a Hurry project, time is of the essence. Unless people begin to buy these healthy food choices, the effort is not sustainable and the produce sections will go away, without long term government subsidy.
Other things are being done to enhance the diets of inner city residents. The public schools are reducing the sugar, fat and salt content of their menus, and expanding the availability of fresh fruits and vegetables. At the same time, they have begun to limit the selling of junk food from vending machines and school fund-raisers. In Louisville, there is an effort to support and encourage community gardens: public property on which people can plant small garden plots. The idea is that anything grown in a garden not only helps family budgets go farther, but usually will be healthier foods than things purchased in packages and cans.
Another strategy which is becoming more and more common is to organize and provide space for urban farmers' markets. This is a way to bring fresh produce into urban neighborhoods. Logistical problems include mechanisms to enable the use of credit cards and food stamps for market purchases. In general, farmers' market fare is more expensive than produce sold in a bog box retail store, though quality is often better. Nevertheless, price differentials between the farmers' market and a grocery store will be an issue for low income families.
Both of these strategies (community gardens, farmers' markets) are being promoted in Louisville, and many other communities around the U.S. We don't yet have good data on who participates and how these might actually improve the nutritional status of disadvantaged Americans.
As an innovation, Healthy in a Hurry is an exciting concept. We need to learn much more about how it contributes to health in the inner city, and how to make these stores the most effective.
Monday, October 25, 2010
Celebrity Chef or Lunchbox Health
In the days when I was attending grade school, I carried a lunch to school every day. The preferred container at that time was a metal lunch box, fashioned in basic shapes and colors, sometimes with graphics portraying animals, cars, or other objects attractive to kids. Lunch boxes were gender specific in color and design, but marketers had not yet made the connection between TV or movies and a whole range of unrelated products. I don't remember lunch boxes with designs from the Disney children's movies of that time.
On the inside of the lunch box was a lunch made by my mother. Evey day the menu was different. Many days I didn't know what the lunch contained until lunch period. Just like students universally compare test scores, we always compared lunches. The conversation went something like this: "What did you get for lunch?" "I got PB&J." "I got cottage cheese and tomato." (gestures indicating gagging.) "Do you want to swap? I'll give you my sandwich and some chips for your PB&J." And so it went. Sometimes a classmate would forget her lunch. The class and the teacher would usually find enough remnants so that all would be fed.
There was undoubtedly some inequity. Some students had smaller, less nutritious lunches. Some students had extras that others didn't. In those days, nutritious mostly meant vitamins, minerals, and protein. No one worried much about sugar, fat, or salt, and people believed a healthy lunch should include whole milk.
Two things stand out about this school lunch memory from decades ago. Aside from the merits or deficits of lunch on any given day, this represented a connection between home and school, student and parent. The medium was the message, and it certainly carried some health promotion value. The second point is that even though my mother or father were fixing one lunch for me, sometimes I didn't like what I found at lunchtime, and foods were thrown away. Fast forward to the time when most kids eat lunches prepared by a cafeteria team, and it becomes clear how challenging it is to serve up healthy meals that children will eat.
Even as early as the end of my grade school days, school lunch boxes were going away, replaced by backpack pouches. However, the shift from home-made lunches to school lunches is parallel to society's shift from home cooked meals to restaurant meals. School lunches represent kids "eating out," just like adults do more and more often. There are lots of reasons for this social change, but health promotion is not one of them.
The other day I read about an effort in the New York City schools to bring successful chefs from local restaurants into the management team responsible for school lunches. The idea is to make small steps in transforming the cafeteria menus from tater tots and chicken nuggets to something more like culinary arts. It is an intriguing idea to see if those most expert in making food look beautiful and taste even better can work within the economic limits of school budgets and meet the logistical challenges of trying to please about 1.2 million children in the system. The key question is whether the chefs can add value to menus, so that kids will eat more healthy foods. Up until recently, schools have relied on sugar, salt, and fat to entice students to patronize the school cafeteria offerings. Time will tell if the chefs can blaze a trail to prepare fruits, vegetables, and low fat protein foods that don't come in cans, and in a way that fits within the school lunch budgets.
School meals have become a tool for several community goals. They have become an important component of farm commodity stabilization, linking farm production with the stable market of school meals, facilitated by government supervision and tax subsidies. Of course, school meals are now an important way to be sure that all children have sufficient nutrients to enable them to succeed in school. School lunches are also viewed as a component of the school health program: the cafeteria as a nutrition and health classroom. There is a fond hope, without much evidence, that it is more efficient to instill healthy eating values in school lunch rooms, rather than trying to change the eating and food preparation practices of parents and families.
It is probably not possible to return to the days of the lunch box, with the values it represented. That train has left the station. However, trying to mold children at school to seek out healthy meals probably won't really take hold without support from parents who have gotten the health promotion memo. Just like schools can be helped by the chef consultants, parents and families may need assistance in assembling healthy lunches, with whatever container is in vogue. Realistically, eating out has become a basic component of our society. Doing it less in school or in the community will not occur easily.
On the inside of the lunch box was a lunch made by my mother. Evey day the menu was different. Many days I didn't know what the lunch contained until lunch period. Just like students universally compare test scores, we always compared lunches. The conversation went something like this: "What did you get for lunch?" "I got PB&J." "I got cottage cheese and tomato." (gestures indicating gagging.) "Do you want to swap? I'll give you my sandwich and some chips for your PB&J." And so it went. Sometimes a classmate would forget her lunch. The class and the teacher would usually find enough remnants so that all would be fed.
There was undoubtedly some inequity. Some students had smaller, less nutritious lunches. Some students had extras that others didn't. In those days, nutritious mostly meant vitamins, minerals, and protein. No one worried much about sugar, fat, or salt, and people believed a healthy lunch should include whole milk.
Two things stand out about this school lunch memory from decades ago. Aside from the merits or deficits of lunch on any given day, this represented a connection between home and school, student and parent. The medium was the message, and it certainly carried some health promotion value. The second point is that even though my mother or father were fixing one lunch for me, sometimes I didn't like what I found at lunchtime, and foods were thrown away. Fast forward to the time when most kids eat lunches prepared by a cafeteria team, and it becomes clear how challenging it is to serve up healthy meals that children will eat.
Even as early as the end of my grade school days, school lunch boxes were going away, replaced by backpack pouches. However, the shift from home-made lunches to school lunches is parallel to society's shift from home cooked meals to restaurant meals. School lunches represent kids "eating out," just like adults do more and more often. There are lots of reasons for this social change, but health promotion is not one of them.
The other day I read about an effort in the New York City schools to bring successful chefs from local restaurants into the management team responsible for school lunches. The idea is to make small steps in transforming the cafeteria menus from tater tots and chicken nuggets to something more like culinary arts. It is an intriguing idea to see if those most expert in making food look beautiful and taste even better can work within the economic limits of school budgets and meet the logistical challenges of trying to please about 1.2 million children in the system. The key question is whether the chefs can add value to menus, so that kids will eat more healthy foods. Up until recently, schools have relied on sugar, salt, and fat to entice students to patronize the school cafeteria offerings. Time will tell if the chefs can blaze a trail to prepare fruits, vegetables, and low fat protein foods that don't come in cans, and in a way that fits within the school lunch budgets.
School meals have become a tool for several community goals. They have become an important component of farm commodity stabilization, linking farm production with the stable market of school meals, facilitated by government supervision and tax subsidies. Of course, school meals are now an important way to be sure that all children have sufficient nutrients to enable them to succeed in school. School lunches are also viewed as a component of the school health program: the cafeteria as a nutrition and health classroom. There is a fond hope, without much evidence, that it is more efficient to instill healthy eating values in school lunch rooms, rather than trying to change the eating and food preparation practices of parents and families.
It is probably not possible to return to the days of the lunch box, with the values it represented. That train has left the station. However, trying to mold children at school to seek out healthy meals probably won't really take hold without support from parents who have gotten the health promotion memo. Just like schools can be helped by the chef consultants, parents and families may need assistance in assembling healthy lunches, with whatever container is in vogue. Realistically, eating out has become a basic component of our society. Doing it less in school or in the community will not occur easily.
Friday, October 22, 2010
Staying the Health Promotion Course
Once upon a time in the 1980s, public concern about drug abuse prevention was at a fever pitch. The issue got heavy attention in media. Political leaders, including Presidents spoke about it. Corporations wanted press coverage for charitable gifts made to drug abuse prevention efforts. Grass roots efforts in local communities proliferated to confront the "menace of drug abuse." With all this attention and support, serious government resources flowed to programs and policy strategies. While success was not proportionate to the size of the effort, progress was made.
Today, drug abuse has largely disappeared from the popular radar screen. There is little if any discussion of drug abuse in political campaigns. If there are news stories about it, they get a yawn or a change-the-channel reflex. What we don't know is whether this lack of focus and determination will lead to a resumption of the drug epidemic. There is reason to be concerned.
We have seen this with vaccination. In the 1950s and 60s, the public had firsthand knowledge of infectious epidemics. The ambient fear and respect for childhood infections translated into widespread support for vaccinating children. The new vaccines were welcomed as wonder drugs.
As the decades have passed since then, a lot of apathy has set in. Parents today have no memory of children severely sick and disabled from infections of early life. This has given rise to apathy when it comes to getting children immunized. At the same time, some parents believe, without any evidence, that vaccination is a cause of autism. In addition, birthing has seen a relative shift away from mainstream to low income minorities and particularly Hispanic families. This presents access and health literacy barriers to vaccination, making the job more complicated. Nevertheless, there is reason to be concerned that as a society we take our eyes off this particular ball, allowing rates of measles, mumps, pertussis and polio to rise again.
To an extent we are seeing this happen with a shift of attention away from tobacco toward obesity prevention. It feels like our commitment to tobacco control is running out of steam. While overweight and obesity is a very serious problem, tobacco is still with us, taking over 1,000 U.S. lives a day. We should be concerned that society may be losing interest, and will pay a price of increased smoking rather than pushing a continuing decline.
So then, the key question is how do we in public health prolong the attention span? How do we keep individuals, institutions and government agencies focused on a health promotion task when it is no longer exciting in the public's eye? How do we break the cycle of fits and starts, always moving on to
the next big thing?
I don't have the final answer, but offer two things to consider. The first has to do with insisting on strategic planning driven by community needs, rather than funding opportunities. Public health agencies are often seduced into designing programs because funding is available. This gives rise to a cycle of always moving on, whether or not a job has really been completed, which of course, it usually has not.
Recently, a lot of federal stimulus money has been invested in community health programs around the country. Communities were invited to compete for these funds. It was not a coincidence that the ending date for the health projects is spring, 2012. The initiation and success of these projects are part of the strategy for the 2012 Presidential campaign. Campaign strategists want to be able to point to successful stimulus spending. This point is not to fault the projects, but to say that beginning with funding opportunities is not always the same as beginning with local health priority needs.
The second way to help break the cycle is to rely more on theory-driven, evidence-based strategies and solutions, and to constantly fine tune our interventions with careful evaluation. Some of the reason for losing interest is because the things we do are not effective, so people become demoralized and give up. Demanding more connection between research and program planning, and relentless attempts to find more effective methods might keep people engaged and inspired for the long haul.
In the end, we are talking about human nature and social evolution that we have few tools to manage. Nevertheless, it is health promotion's burden to keep people striving until the work is done, not before.
Today, drug abuse has largely disappeared from the popular radar screen. There is little if any discussion of drug abuse in political campaigns. If there are news stories about it, they get a yawn or a change-the-channel reflex. What we don't know is whether this lack of focus and determination will lead to a resumption of the drug epidemic. There is reason to be concerned.
We have seen this with vaccination. In the 1950s and 60s, the public had firsthand knowledge of infectious epidemics. The ambient fear and respect for childhood infections translated into widespread support for vaccinating children. The new vaccines were welcomed as wonder drugs.
As the decades have passed since then, a lot of apathy has set in. Parents today have no memory of children severely sick and disabled from infections of early life. This has given rise to apathy when it comes to getting children immunized. At the same time, some parents believe, without any evidence, that vaccination is a cause of autism. In addition, birthing has seen a relative shift away from mainstream to low income minorities and particularly Hispanic families. This presents access and health literacy barriers to vaccination, making the job more complicated. Nevertheless, there is reason to be concerned that as a society we take our eyes off this particular ball, allowing rates of measles, mumps, pertussis and polio to rise again.
To an extent we are seeing this happen with a shift of attention away from tobacco toward obesity prevention. It feels like our commitment to tobacco control is running out of steam. While overweight and obesity is a very serious problem, tobacco is still with us, taking over 1,000 U.S. lives a day. We should be concerned that society may be losing interest, and will pay a price of increased smoking rather than pushing a continuing decline.
So then, the key question is how do we in public health prolong the attention span? How do we keep individuals, institutions and government agencies focused on a health promotion task when it is no longer exciting in the public's eye? How do we break the cycle of fits and starts, always moving on to
the next big thing?
I don't have the final answer, but offer two things to consider. The first has to do with insisting on strategic planning driven by community needs, rather than funding opportunities. Public health agencies are often seduced into designing programs because funding is available. This gives rise to a cycle of always moving on, whether or not a job has really been completed, which of course, it usually has not.
Recently, a lot of federal stimulus money has been invested in community health programs around the country. Communities were invited to compete for these funds. It was not a coincidence that the ending date for the health projects is spring, 2012. The initiation and success of these projects are part of the strategy for the 2012 Presidential campaign. Campaign strategists want to be able to point to successful stimulus spending. This point is not to fault the projects, but to say that beginning with funding opportunities is not always the same as beginning with local health priority needs.
The second way to help break the cycle is to rely more on theory-driven, evidence-based strategies and solutions, and to constantly fine tune our interventions with careful evaluation. Some of the reason for losing interest is because the things we do are not effective, so people become demoralized and give up. Demanding more connection between research and program planning, and relentless attempts to find more effective methods might keep people engaged and inspired for the long haul.
In the end, we are talking about human nature and social evolution that we have few tools to manage. Nevertheless, it is health promotion's burden to keep people striving until the work is done, not before.
Subscribe to:
Posts (Atom)