Inspiring people to think to the future
I’ve seen lots of tremendously inspiring examples about how public health folks have gone into communities, identified a need and gone to all sorts of lengths to convince people to change their behaviors in order to ameliorate the problem. The behavioral change is often the most difficult part, which is what has been on my mind lately.
I can come up with lots of methods to motivate people to rally around an issue. You can give them the reasons why it will help, offer incentives, use logos, pathos and ethos to convince them that they should be invested in the problem. But, it strikes me that our end goal shouldn’t be just to convince people to wash their clothes far away from their drinking water source or to get their babies immunized. If communities are really to develop, they need to have a sense of responsibility and ownership of the whole process. They have to be willing and able to look around at their world, target the problems and then work to fix them. At the end of the day, it is their community and they know the problems that face them better than any outsider. In the best model, it seems to me that the public health or development worker wants to eliminate the need for his job by building people’s capacity and interest to deal with community problems as they arise.
But, I’m having trouble with the idea of how to motivate this sort of mind frame. There are so many issues that take up people’s time. When I look at how hard, for example, a rural woman in India has to work just to prepare three meals, boil water, find fuel, deal with family and keep a house, I slightly guilty for asking her to work on a larger scale when the tasks in front of her are so energy and time consuming. How do you get people to look forward into the future when the present isn’t terribly certain?
Brown for Global Health 
msoule said,
October 23, 2006 at 11:47 am
Well, I think that you identified the issue in your last paragraph. People who are short on resources are often occupied with things that seem to be more tightly tied to their immediate survival. While the health of the community is indeed one of the most important things to survival, it is difficult to raise the priority of it to core survival level (same level as cooking food, fetching water, etc) because the effects of community health work are often long-term and more invisible. This is why I am a radical when it comes to economics. As a part of my health screen I ask the people I see at the Big Public Hospital whether they feel hopeless. Many of them answer yes but it’s hard to know if it’s because of clinical depression or because their economic possibilities are so dim. Antidepressants and therapy can’t fix those symptoms. In the same vein, I think it may be difficult to get people in desperate situations to “take ownership” because they are owning as much as they can. It’s a matter of priorities and most people just don’t prioritize community health over other things. And sometimes they do but lack the resources. But that’s another question.
This is NOT to say that educating communities about health is a predestined failure. I think there are people in every community who are attuned to community health who prioritize it over (or at least equally to) the more “immediate” concerns. I think that by educating these people about the health concerns in their communities, we can plant the seeds of health awareness. I think these people best understand the systems of prioritization in their communities and can come up with the best incentives for behavior change in their community members. I don’t know how to identify them so that they might be taught, but it seems that they are the place to begin.
This is just an idea. Community health people, what do you think?
sstolper said,
October 26, 2006 at 10:32 am
First off, we all need to have a lot more patience. There’s always more of it to be had. Michael says ‘plant the seeds of health awareness.’ It’s very plausible that in some communities you are not going to find a person who can be motivated to act as strongly as you for future needs. But in sharing information and simultaneously gaining the respect of the communities in which you work, you will never have to worry about taking a step backwards. You will always have a positive effect, is the way I see it.
I just erased a paragraph I wrote about happiness and motivation and other things. I suppose I’m looking for a way to say I don’t think it’s that small a population that can be reached by community health education. I have never been to a place like India. Maybe there are places that daunt you through the sheer size of a given problem. But are there places where the entire population, or even a majority, are so depressed, so ‘feeling hopeless’, that they can’t be motivated to change their lifestyle in any way? I doubt it.
misarita said,
October 28, 2006 at 2:02 am
Patience. Thanks for the reminder.
As per your motivation question–I don’t really know how to answer it from anything other than my few experiences in different places. I think that people’s motivation to change is somehow related to their historical ability to affect change. When I was in Nigeria, I was completely overwhelmed by people’s lack of motivation to change. But, Nigeria was listed as the second most corrupt nation in the world at the time. Daily life taught the lesson that it didn’t matter if you worked for something, because the system was disfunctional enough that you weren’t guaranteed any sort of judicious outcome for your work. I think that people internalize this sort of lesson. Why would you bother to make lots of effort if you’ve never seen that effort produces results? To me, that is one of the dangers of societies where there is corruption across many levels.
msoule said,
October 30, 2006 at 11:44 am
Yes! You see a similar sort of thing in India. It’s not to the same degree because the corruption isn’t as rampant, but there is definitely at times a feeling of helplessness. I even went to a conference of students whose topic was the implications of corruption and how to fix it. They were less than enthusiastic about the possibility of rooting out corruption and weren’t really into trying to come up with creative ways to do it because they felt that it was endemic to their system. See? When things are corrupt, even changing the state of corruption is a discouraging prospect!
However, I think that many health outcomes are less politically linked than corruption. I do NOT mean to suggest that health and politics are separate. However, I do not think that the link is the strongest. And I have doubts about how much political difficulty translates to personal lessons about life in general. Personally, I am deeply disillusioned with politics in America but my disillusionment doesn’t spread to the rest of my life. While my own life is certainly not stamped with corruption that makes it difficult to get ANYthing done and I cannot comment on the strength of this particular life lesson, I just wanted to cast a little doubt on the possibility that this is the only/major contributor of a reluctance to change. What else could have been going on there in Nigeria to make change difficult? What about the program that was trying to elicit change? Was it totally properly targeted? Etc…
misarita said,
November 1, 2006 at 10:21 am
Oy. Everything was going on in Nigeria to make change difficult. I think that is why I link corruption and an unwillingness to try and change. I’m not really thinking about the health outcomes, so much as the people that I met every day and how they talked about the world around them. I think of Pavlov’s dogs–and how conditioned humans can become. And it seems to me, that if you live under a system where your honest effort quite often comes to jack, you start to be conditioned to believe that honest effort is not a worthwhile use of your time. And you just might be right, under the system where you live.
Perhaps we aren’t as affected personally because we live in a country where things function. I mean, countries with as much corruption as Nigeria are massively broken.
I’ll think more on it.