Views adult education for the poor as an important mechanism of increased community agency and individual self-awareness
This is effective only if it works against the traditional model where the teacher knows everything and the students know nothing.
As applied to health, this can take the form of health communication where members of a community work together to come up with solutions to local health problems and how to communicate that information.
Aims at behavior change, but this often needs to be a gradual, iterative process of getting people one stage towards better health than where they are now
The goal of public health is often to get people to do things that they do not want to do.
Precontemplation
Contemplation
Determination
Action
Maintenance
Relapse
Exit and re-enter at any stage
They focus on the individual and exaggerate individual agency by ignoring socioeconomic constraints.
Trust is important
Fallacy of empty vessels
Context matters
What is compliance?
How religion fits in
Sense-making
Be mindful of stigma
Human aspects of illness experience
Pre-existing beliefs influence how new ideas are accepted!
Understanding that people receive health messages within the context of their own beliefs is essential to achieve effective communication between health promoters and the public.
How can we understand the other’s point of view when developing health communication programs, rather than expecting your audience to share your point of view?
Consider how power differential between givers and receivers of health information affect how the message is received
Consider the impact it has when providers or health communicators consider a person’s noncompliance as a problem of disobedience
Religion includes beliefs that help people make sense of the world in times of crisis, including sickness and death.
Health inequalities are influenced by:
Power
Income
Wealth
How can health communication campaigns amplify stigma?
The illness experience may include social and psychological dimensions – like stigma – that cannot be cured with medicine.
Scapegoating & discrimination
Amplified social tensions
Hampered reporting
Questions about motivations of authorities
Social marketing
Social mobilization
Positive deviance
Edutainment
Method of health communication that markets health behaviors and products
Similar to how commercial advertising markets snacks, cars, dish soap
Involves developing a ”brand” that is appealing to the target audience
Can pair with information to make health-related products available and affordable (or free) to low-income people
Identifying the specific target audience segment(s)
Describing the benefits you will offer
Creating interventions that will influence or support the desired behavior change
Social marketing is critical because it looks at the "Four P's" and the provision of health services from the viewpoint of the consumer.
Product: The desired behavior you are asking your audience to do, and the associated benefits, tangible objects, and/or services that support behavior change.
Price: Cost of overcoming the barriers the audience faces in making the desired behavior change - financial, emotional, psychological, or time-related costs.
Place: Where the audience will perform the desired behavior, where they will access the program products and services, or where they are thinking about your issue.
Promotion: Communication messages, materials, channels, and activities that will effectively reach your audience.
Focuses on interpersonal communication as the central element in changing people’s health behavior
Direct person-to-person health education delivered by trusted peers
Works on the premise that people are most likely to change their health behaviors when they are encouraged and supported by a peer that they trust
The partners trained thousands of mobilizers from high-risk communities to visit households, promote government-run child immunization services, track children's immunization history and encourage vaccination of children missing scheduled vaccinations, and mobilize local opinion leaders.
Materials promoted vaccination awareness and safety, household hygiene, sanitation, home diarrheal disease control, and breastfeeding.
During the 1980s, Sierra Leone used social mobilization to increase routine immunization coverage during the Universal Child Immunization (UCI) initiative.
Religious leader engagement was a central pillar of the strategy, which also involved partnerships with the media.
Focus on what works for that population:
Use data-driven messages and engagement approaches, trusted messengers, & preferred communication channels
Recruit trusted mobilizers from the local community
Promote vaccination where people worship, learn, and play in their communities.
Adapt program to changing local contexts, such as increased urbanization
Carefully link and coordinate with service delivery to ensure that immunization services are responsive to communities and culturally appropriate
An approach to health education that builds on what people are already doing that is working well
Looks for someone who is doing something that seems difficult (such as a mother who feeds children healthy and nutritious foods with very few resources, or a sex worker who gets clients to consistently use condoms)
Then creates opportunities for those people to teach others within their communities how to perform those difficult tasks
Behavior change information and ”nudges” conveyed via films, tv or radio soap operas, street theater, and so forth
Works on premise that making the communication engaging and entertaining will make the health information palatable and memorable
Aims to increase audience members’ knowledge about an issue, create favorable attitudes, shift social norms, and change overt behavior of individuals and communities
In the weekly drama, Taru never makes an actual speech or lecture. In your opinion, what might be the advantage of this type of indirect messaging?
Just watching a program or movie is a rather passive experience. What do you think might be the advantages of conducting organized discussion groups for encouraging social change?
During the 2014 Ebola epidemic in West Africa, health-care workers attempting to safely remove still-contagious corpses were chased, lied to, and assaulted.
A mob attacked a team of eight health-care workers, politicians, and journalists as they attempted to distribute information about Ebola. Two days later, their corpses—including three with slit throats—were found in the septic tank of the village’s primary school.
People in Guinea, Liberia, and Sierra Leone had suffered more than two decades of human-rights violations and atrocities at the hands of the military before Ebola arrived, eroding public trust in authority figures. The fact that health care workers, imbued with official authority, were mostly foreigners probably didn’t help inspire confidence among the locals either.
“Wherever epidemics occur, fear and rumors are often not far behind.”
What was the disconnect between the common narrative in US media about Ebola in W Africa and the situation on the ground?
“Attention to the human aspects of the illness experience is not a strength of biomedicine”
How was this exemplified in the W African Ebola crisis?
What is this an important aspect for health communicators to keep in mind, in general?
Can this be changed, or can this be overcome? How?
2-21 days
High fever
Diarrhea
Vomiting
Respiratory distress
Hemorrhage (sometimes)
1976, 1995, 2007, 2018, 2019
1994 (chimpanzee)
2000, 2007
1976
1996
LOCATION | DATE | DEATHS/INFECTIONS |
---|---|---|
Democratic Republic of the Congo | 1976 | 280 deaths / 318 infections |
Sudan | 1976 | 151 / 284 |
Democratic Republic of the Congo | 1995 | 250 / 315 |
Uganda | 2000-2001 | 224 / 425 |
Republic of Congo | December 2002-April 2003 | 128 / 143 |
Democratic Republic of the Congo | 2007 | 187 / 264 |
Uganda | December 2007-January 2008 | 42 / 131 |
Average CFR = 50%
Total cases: 28,646
Total deaths: 11,323
CFR = 40%
2 regimens
Ervebo
Used during active outbreaks in a ring vaccination strategy
Licensed in 2019 for adults over 18 who are not pregnant or lactating
Zabdeno + Mvabea
Prophylactic
Doses given 8 weeks apart
Licensed in 2020 for individuals over 1 year of age
Strategy to vaccinate contacts of known cases
Contacts: w/in last 21 days, lived in the same household, were visited by the patient after they developed symptoms, or visited the patient or were in close physical contact with the patient's body, body fluids, linen or clothes.
Contacts of contacts: Neighbours, family, or extended family members at the closest geographic boundary of all contacts, plus household members of all contacts who do not live in the same locality as the patient.
Health care workers and frontline workers responding to the outbreak who may be in contact with Ebola patients.
The ring captures a social network of individuals and locations that may include dwellings or workplaces further afield where the index patient spent time while symptomatic, or the households of individuals who had contact with the patient during the illness or after his or her death.
Each ring may be composed of an average of 150 persons.
Patiently & sensitively distributing accurate info re: Ebola treatment & prevention did work & was more effective than attempts to debunk witchcraft & traditional medicine
Messages like “science and medicine are our only hope” and “traditions kill” follow logically from clinical and epidemiological framings of contagion— but pay little attention to the historical, political, economic, and social contexts within which they are delivered
Engagement across communities with flexible protocols that communicate problems, request help in developing local solutions, and enable their implementation are likely to be more effective in changing high risk practices than standardized approaches.
What are the obstacles within the global health communities for decision-makers to (a) recognize this and (b) fundamentally integrate it into program planning for either long-term responses or emergency response?
8th Ebola outbreak in Uganda
1st to emerge in the capital, Kampala (pop 6M)
Index case: 34yo nurse working in children’s ward of national hospital, diagnosed after death
Seeded 2 clusters: extended family (n=4) & hospital (n=3)
Subsequently, cases have spread to 3 of Uganda’s 10 cities
Co-occurring with mpox outbreak
Infected individuals are being treated successfully at remdesivir
Week 12 Infectious Disease in Historical Context, the Opioid Crisis, and Global Abortion Policy (4/15 & 4/17)
Johnson, The Broad Street Pump (p. 16-22)
Barry, The Influenza Epidemic of 1918 (p. 23-29)
Please see Blackboard for 4 additional readings for our new topics
Discussion section: Cholera in Haiti
Week 13 Health Systems & Programs (4/22 & 4/24)
B & C, Synopses and Conceptual Tools for A History of Health Institutions and Programs & Health Systems and Aid (p. 337-343 & 379-384)
Greenough, Coercion and Consent in Smallpox Eradication (p. 355-367)
Remnick, Hundreds of Thousands will Die (on Blackboard)
Additional readings TBD
Discussion sections: Prioritization in Global Health
Week 14 Global Mental Health & Global Health Ethics (4/29 & 5/1)
B & C, Synposis & Conceptual Tools for Ethics, Projects, and Human Rights
Patel, Treating Depression Where There Are No Mental Health Professionals (p. 424-427)
Farmer et al., Structural Violence & Clinical Medicine (p. 324-332)
Brown & Closser, Global Health: Your Life, Your Life Decisions, Your Moral Obligations (p. 480-490)
Additional readings TBD