Tuesday, October 11, 2011

A brilliant thought that just occurred to me ... a note on culture

As a public health professional, I have been indoctrinated to continually consider culture and heritage as a part of interventions. We should, our professors say, carefully examine the normative values immanent in our target populations. We should analyze and plan and really, really think about not only what we say, but how we say it, and how we act when we do so. It's all about sensitivity.

I was thinking the other day, then, about the classroom environment and different teaching styles, and how professors should really be applying these same principles of cultural sensitivity to their students. We are, as master's students, existing in our own culture. We have specific norms and values, specialized language that describes our experiences, and certain socioeconomic concerns (i.e., we're generally poorer than poor). We have arguably created our own subset of society here in our public health school.

Why do I get the impression, though, that some ostensibly enlightened educators are contradicting their own teaching by refusing to understand students' viewpoints? I wouldn't necessarily call it hypocrisy, but I just don't understand how students at SRPH don't constitute a population that deserves consideration on par with needy community members. We're a group of people with specialized interests, and we ought to receive "interventions" (in this case, education) that has the same quality of the interventions we are designing in our courses. We don't berate or belittle people for doing things "wrong" in a health setting; why would we do this to students, who occupy an analogous social realm?

I'm going to bust out an old cliche: Practice what you preach! That's an imperative that is imposed on all of us that are in the health and wellness industries. Like it or not, people are unlikely to trust a nutritionist who only eats cupcakes, a doctor who smokes, or a public health professor who doesn't attempt to understand students' very legitimate cultural norms.

This is what we are called to do, thinking outside of the box. Cultural sensitivity isn't only good for understanding life in the colonias or in other countries, it's important right here in your own backyard. Learn how to apply it in your immediate surroundings, and you're certain to succeed when the tough situations arise.

I've come to the conclusion that being proficient at public health is really just being proficient at life. Here are the basic tenets of our profession, as I interpret them:

  • Ask people what they want and need,
  • Be nice,
  • Try to understand people that are different from you,
  • Admit that you don't know everything,
  • Admit that you sometimes break things,
  • Don't lie,
  • Don't waste money or resources,
  • Make sure what you're doing is working,
  • Don't hurt anyone,
  • One size does not fit all.
Were I a public health professor, I would give my students this list and then turn them loose to study whatever health topic they found interesting. I would give them the freedom to intuitively create interventions and then provide constructive feedback. This field isn't about following a formula to achieve a prescribed end. It's about engaging people and showing them that they can change their own health status and maybe even that of their community. It's about coming up with effective, exciting, and innovative ways to get things done.

It'd be great if that started at the institutional level, but I'm running out of faith that academicians can deliver what people really need. If they can't even get it right in the classroom, how can they get it right in the real world? Tough questions.

Tuesday, October 4, 2011

"All you have to do is ..."

During my second semester of graduate school, my department head said something particularly insightful that I believe will stick with me during the rest of my academic and professional careers. He told us during class that anyone who says, "All you have to do is ..." to fix a public health problem is frankly an idiot, and we should stop listening when we hear those words. Although I don't always agree with my professors, I thought that was a heck of a comment.

This type of attitude is rampant among the general public, but it also insidiously invades academia. "All you have to do is get people to lose weight to lower mortality rates." Well, yes and no. Maybe.

It depends. (FYI, that's the answer to everything in public health. It just effing depends.)

I have been in the fatosphere and other radical public health communities for a couple years now, and it always shocks me when people take traditional viewpoints about obesity and other public health concerns. One professor told me he was talking about sizing chairs for a growing population, and almost the entire class took the "blame the victim" approach, calling for people to lose weight instead of making sturdier furniture.

I wonder if most public health professionals have ever tried to perform the behavior that they are asking of others. I have quit smoking, recovered from an eating disorder, lost 30 lbs., started a vegetarian diet, and lowered my risk-taking behaviors during the past 5 years. These experiences have all given me an authority to speak to how difficult changing your life can be. Do you know how many times I've tried to quit smoking? Because it's too many for me to count. I've stopped for up to 3 years at a stretch, only to cave during a particularly difficult time in my life. I wonder if anyone in my classes has had this problem, as well.

Without these first-hand experiences, I think it would be awfully hard to tell people what they should be doing to improve their health. If you've never had to make an invasive behavioral change, how can you expect to explain the importance of your initiatives to people in the midst of health problems? What kind of credibility do you have? It seems a little paternalistic and insulting to hand down these health edicts without first understanding the context of the situation.

So there's my little rant for the day about how we have the responsibility to relate to our target populations ... and if you can't, then stay the heck out of their business. I don't need someone to insult me into reaching a "normal" BMI, and I don't need someone who's never picked up a cigarette to tell me how bad smoking is. Don't tell me to wear a helmet or drive slower if you've never had the gall to go fast, just once.

"All you have to do is ... empathize with your target population?" Seems about right to me.