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.

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