By: Greg Vigdor
Washington Health Foundation President & CEO
Looking to improve your own health? Or maybe you’re hoping to improve the health of your family or your community. One of the keys to building better health is learning how to protect ourselves from Injury and Disease. Now let's be clear- there is nothing absolute about this protection. Despite all efforts, a meteor may indeed fall on your head. Or, anyone of us may find that some rare form of cancer or infectious disease has pulled our name at random and we will be dealing with a most unwelcome challenge.
But there are things that can be done to create "protections" for us. Some of the greatest health advances of all time have been discoveries made in the face of horrible infectious “diseases” like yellow fever, smallpox and the plague. We learned that cleaning up water systems, eliminating large numbers of mosquitos or otherwise devising defenses from germs can save hundreds of thousands of lives. Some of the most important health work on this planet NOW remains trying to make sure that we can apply this knowledge across the entire globe, not just in those countries with the money or peace to apply it.
We also know that there are things that can be done to protect us from "injuries". What's more, as we have conquered many infectious diseases in this nation by our public health interventions, the threat to our health from injuries has become more significant. As have our efforts to do something to win this fight.
For example, motor vehicle accidents have become a leading health indicator over the last generation, both in terms of deaths and non-fatal injuries. In many states, it is one of the leading causes of accidental injuries and death. And we have intervened as a society to try and make car travel safer, even as the danger has become more evident, through speed limits, mandatory engineering of roads and cars, and the now legal insistence that we wear seat belts. Washington state is a national leader in encouraging people to wear seat belts (as we have noted in our Report Cards), and the advance in getting people to do this has been a combination of laws, health education over time as to why one should want to, and financial penalties for failing to do so. The approach is to make it unacceptable or inadvisable at the societal level to not wear a seat belt, but ultimately something that registers with us as individuals to actually take the healthy action.
That is critical- because when you really dig into the prevention strategies for injuries and disease, they are things that ultimately require us as people to take action. We have found that most people do want to be healthy. So this shouldn't be that hard, right? But it is – perhaps because so many of us are wired to resist change. Or, on the flip side, some of us are wired to take more risks. And perhaps for some of us the issue is that part of our unique identity as Americans is to assert our independence. In particular, to be highly suspicious when the government insists that we do something, even if it might be good for us. Laws and scare tactics will not be sufficient to break down this barrier. If anything, they reinforce the reaction that it is big brother telling us what we have to do!
The seat belt experience in this Nation shows us that we can make progress in preventing injuries, but that it takes a lot of money and time to reach our goal. So, as we move to a health age where protecting requires personal action, how can we speed up or improve the process for getting people to accept healthier behaviors as we identify them?
Consider the example of prescription and over the counter drug abuse and misuse. You might be surprised to learn that prescription drug abuse became the leading cause of unintentional death from injuries in this state in 2008 – supplanting motor vehicle deaths. This issue has emerged nationally as a major health issue as well. While some in public health were a bit slow on the draw in realizing this shift was occurring, efforts are now growing to do something about it. Many of these responses are important as part of a solution - laws enforcing the protections against using or dispensing these drugs, "scare" public education campaigns showing the horror of what can happen when they are abused, and even practical methods of helping to get the supply of unused medications out of circulation (such as drug disposal programs).
But it will take more. It will take engaging those that are affected by the danger to understand it and change their behavior. We need to know, from their point of view, why it is that they do what they do…. and what might help convince them to change. It may sound pollyannish, but the reality is that personally engaging and convincing us to change behavior is a critical part of the 21st century model for accelerating the adoption of healthy behaviors by people. Unfortunately, many still believe that the model remains the traditional legal enforcement and scare message approach. Others believe it might be even more effective with some financial penalties thrown in for good measure, because money is supposedly everything to us Americans.
We, on the other hand, perceive most contemporary health challenges as complex issues requiring multiple levels of responses. Especially if we are hoping for faster resolutions. So we have been exploring issues with this in mind, and especially incorporating our notions of people-based health solutions as the part of the equation we can explore.
One relevant example of this approach was our recent effort to determine how to promote better health for young adults on college campuses. Working with the Washington State Attorney General's Office, we embarked on a project to learn from college students by listening to them about their health issues. We then took what we learned and helped the students customize their own Health HoME to put them on the road toward a healthier lifestyle. One fast discovery was that prescription drug abuse and misuse was one of the big issues at play, and much of our project honed in on this issue as a priority matter.
We quickly learned that one of the core lessons to be learned through this project was that those students who abused prescription drugs did so for a variety of reasons. Not simply for recreation as some might think, but also to help enhance study habits and a host of other reasons. Perhaps our most important finding was that for many the drugs were a response to the pressures they were facing - to make the world a better place, to compete with their classmates for the very few jobs that seemed available, or to pay for the ever growing cost of their college education. Changing health behavior then requires a very different approach if this underlying stress is at the heart of the issue.
What we also learned is that the messenger in this work really does matter. Students were clear that it was not helpful when governments or adults (other than parents) told them what they couldn’t or shouldn't do. Nor were students swayed by the words and warnings of media celebrities. We found the biggest influences were most often student peers. These were the people who could relate to their circumstances and were walking in their shoes.
We began to explore some of the possible ways to promote health based on this knowledge, including initiating a campus led network of health activists. We ran out of resources to take these solutions to scale, but remain hopeful we can rekindle interest in this project. But for now, we think this first phase of our College Health Program illustrates well the point of this article - that we must truly work to engage people from their circumstances if we are to speed up the process of getting people to take action to minimize risks from injury and disease. Just telling us we can't or shouldn't is often not enough.
At some point, we hope this approach will be accepted as an advance, equivalent to the germ discoveries so many years ago. Those discoveries allowed us to tackle major infectious diseases across the globe. In the same way - we would be well served to use today’s discoveries to find better ways to drive real health behavior change. And not fall into the old formula of using only legal enforcement and scare tactics. If we can reach beyond that in Washington state, we will be well on our way to becoming the Healthiest State in the Nation.