Posts Tagged ‘Health 2.0

11
Feb
10

Health 2.0: four decades of experience

As I’ve posted before, I’m interested in Health 2.0. I say that from the perspective of someone with nearly 40 years of experience in social science and cancer public health. I hope my long-term perspective can add something to the discussion of this interesting trend, especially the recent discussion kicked off by the Susannah Fox and the infamous “Darthmed” concerning the value of Health 2.0.

If you’ll indulge me a little I’d like to step back to when I studied sociology in the late 1960s. The conventional methodology of sociology was survey research. Surveys as a social science tool go back to the 1940s, and many of the field thought we knew enough to reduce prejudice, poverty, crime and other social ills. I was in a PhD program in sociology and fell in with some rennegrade sociologists who were skeptical. They maintained surveys were not a sound basis for verifiable “scientific” sociology. They argued that the data had too many poorly understood variables in linguistics, scales that were not consistent with statistical mathematics, and data gathering interaction effects to claim it was a verifiable body of knowledge. Also efforts to apply sociology wasn’t getting much in the way of results. I ended up dropping out of the degree program because I realized we didn’t know enough about the platform — about consciousness, brain function, semantics, and behavior drivers — to have a solid scientific theory of human behavior.

I went to work in local public health for a couple years and then entered a school of public health to get an MPH in health education. I remember having debates about the ethics of using what some students though was such powerful behavior change technology that we needed to have rules for using it. You’d think we were talking about nuclear energy! I had to laugh and say, “Look, a year after you get out of here you’ll be willing to hit people over the head with a two-by-four to get them to change their health behavior!” I’d already gotten some experience with how difficult “good” change could be to produce.

When I graduated I eventually went to work for a nationwide cancer organization just as the first smoking cessation programs were being developed. Techniques of education and group support were being used to encourage people to give up cigarettes. It seemed simple: give rational people solid infomartion about how bad cigarettes were for them and they’d be motivated to give them up. It turned out not to be so simple. After years of effort and tweaks to programs it became clear that, as an old friend from Mississippi told me, “the juice ain’t worth the squeezin'”. It became clear we weren’t going to solve the smoking problem one person at a time. Because “activism” in the 1960s and ’70s was associated with confrontational marches in the streets protesting the war in Vietnam, most nonprofit organizations wouldn’t touch anything political like “advocacy” as we know it. Finally, however, some militants began to articulate “non-smoker‘s rights”. Before, the social norm was that smokers had a “right” to smoke in public and it was rude to ask them not to. Eventually the first excise tax on cigarettes was passed in California to increase their cost. Jacking up the price began to get behavior change. The social context began to change as well. People began to recognize that smoke hurt not only the smoker but anybody around, and non-smokers had a right to protest. Eventually higher taxes and laws to restrict smoking in public were passed across the country. It took a couple of decades but the social perception of smoking changed from accepting to negative and mass behavior change began to come about. When I look back over about 35 years of smoking wars I’m kind of amazed that there has been as much change. Because it took so long it seemed for years like nothing was happening. The key, at least for smoking, was monetary disencentives and– after perceptions changed — restrictive laws. So what lessons am I suggesting?

  • Individual change is difficult to get, especially if the society doesn’t have attitudes that reinforce the change.
  • You need to work on societal attitudes and even laws that may positively or negativel sanction the problem you’re trying to solve. Billions will be spent by commercial interests to maintain the behavior.
  • It takes a long time to achieve much change because there’s resistance on the individual, group, and economic levels.
  • Giving citizens more power and authority over their health today is part of a long trend. Another quick example: in the1970s the Women’s Health Collective wrote a book called Our Bodies, Ourselves because women were dissatisfied about how male gynecologists were treating them. It was a signature piece of the feminist movement that produced real change. I think “our bodies, ourselves” is a good slogan for all of us. To my mind Health 2.0 is another step in this tradition.
  • Health 2.0 is oriented to a lot of technology. By itself technology will not produce much change, but over time it can become a great platform to facilitate communication and information but only once social perceptions and attitudes change.

The technology of Health 2.0 is still primitive. It’s mainly, as far as I can see, preliminary, disconnected equipment and software. It needs to mature into an integrated system that works seamlessly for people, has supporting institutions at all levels, has just-in-time information at the user’s fingertips, and is premised on a model where the person is in charge, not the doctor-institutions we’ve adopted for the last couple of centuries. Health behavior change has never been easy. There’s nothing new in that situation. Health 2.0 fans need to keep moving ahead as early adopters and enthusiasts. But really visible results are not likelhy to emerge for years. It may take a new generation to see widespread adoption of someting that would be a real paradigm change. You’ve got to have patience and understand that all this will be in constant evolution. Whatever behavior you’re looking for needs to be well interlocked with complementary systems.

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