WorldCanvass: Communicating for Social and Behavioral Change (Part 2)

WorldCanvass: Communicating for Social and Behavioral Change (Part 2)


– Hello, and welcome to WorldCanvass from international programs
with the University of Iowa. I’m Joan Kjaer. We’re coming to you from FilmScene in downtown Iowa City. This is part two of our three part series, investigating some of the
major public health issues facing populations
around the world, and my guests in this segment are Edith Parker, professor of community
and behavioral health in the University of Iowa
college of public health. Thank you for being here. – Thank you. – Mhmm. Next to her is Will
Story, who is an assistant professor of community
and behavioral health also in the University of
Iowa college of public health. Thank you Will. – Thanks. – Mhmm. So, Edith, I want to go to you first. You wrote the nomination
letter for Rebecca Arnold for this year’s international impact award and we’ve just had the
opportunity to talk to Rebecca and I suspect that the
kind of passion she brings to this work is very familiar
to you, with other students and other colleagues you
work with in public health. Why is this field such
a compelling and sort of personally engaging field? – Great question. You know, I think what
draws, interestingly enough, what draws a lot of
people to public health is either they’ve had
international experiences like Rebecca have or some come
to us and then go on. I think it really is really
what distinguishes public health from say medicine
is the focus on prevention. I think it’s really
exciting, you’re also working with communities and not
sort of one individual at a time, but really
trying to do, to help people to really to do healthy behaviors. As Rebecca said, that not
necessarily by telling them what to do. We say information is
probably necessary, but never sufficient to get somebody
to change a behavior, but rather how you can
set up really supportive environments to help that
person do what will impact their health, but also
just their quality of life. – [Joan] So therefore, the
sort of humility we heard from Rebecca when she was talking about providing some tools. She’s not responsible
for all of the success there may be now in
childs health or whatever, you do what you can,
the communication side, but then these field
workers, family members, everybody pitches in. That’s what the behavioral community health part of all of this is. – Absolutely, absolutely,
and a real strong emphasis for our students both if
they’re going on to do research or to do practices
Rebecca has, or I suspect Rebecca does a little bit
of both, is participation. Not coming in with the idea
of what needs to be done here, but coming in with the skill
set of how you can engage with communities to say what
are your issues here? How can we work with you to sort of identify what those are
and then to help you to attack those or really reduce them if it’s a health risk factor. – [Joan] Mhmm. Help me understand how it would work. I know that there are non
governmental organizations that are sometimes involved. There might be a ministry of health in a particular country or
there might be a local government that sees a need and so on. The conversation that needs to happen, is your assistance, say
as USAID funded operation, that assistance would be requested by the home government or by the community or would the USAID say gosh we see a real problem here of a population
with great poverty and very little ability
to feed it’s children or we see very high mortality rates, how does that identification
of a community in need happen? – I’m gonna actually
probably turn that to Will. – [Will] Sure, and I think
Rebecca addressed this as well in some of her work with
the Peace Corp, especially when she was embedded in a community, but I think the first
thing is working with organizations that are
present in that community. If you’re identifying children in need, people that are particularly vulnerable, socially excluded, for whatever reason, that’s it’s finding an
organization that is there to meet their needs. A lot of times it’s a local organization that may be a really small
non governmental organization. It may be a community health
worker with the government that’s working in partnership with that non governmental organization. As far as getting that
funding to those people who need it in a way
that’s helpful to them, that’s where partnerships
are really important, and I think what we do in our department in order to really address
community health needs is working in partnerships
with the community. It’s finding those
organizations that are there partnering with them to identify the needs of the community first of all, what they perceive their needs to be. And then finding a way to articulate that to an organization like
USAID to be able to bring in funding that’s really
critical to meet those needs and then, going forward
to continue to work in partnership with that
community to address those needs and to report on those needs. So building the capacity of that community of that organization to be able to monitor how children are progressing and growing, how their behaviors are changing, the caretakers behaviors are changing, the providers behaviors are changing, to be able to report back to
that donor so that hopefully, you can continue to
support that organization and that community, but
ideally that community would be thriving at the end of that, that they would be able to sustain that on their own with their own resources. – Yeah, what can you
tell us about the work you individually do, the research you do, the sort of focus you
have in your own teaching and in your research and also you, Will? – Well I have actually done
international work before, and have a project just
finished up a couple years ago in Ghana
where we were looking at burulis ulcer, which is a flesh
eating bacterial infection, and trying to figure out
the transmission rate, and I’m not sure we’ve
done it definitively but made some progress,
but a lot of my work now is here in the state of Iowa where we’re working with colleagues down in Ottumwa, Iowa on a community academic partnership funded by the centers for disease control
around obesity and trying to increase physical activity
within the community. Using a lot of the methods, I think that we train our students
for for global health as well as for working here in Iowa, not necessarily that Doca and Ottumua are are the same, but when you’re coming into a community, then you are an outsider when you’re coming from
Iowa City to Ottumua, in much of the same way that you might be when you’re going to Bangladesh. How do you sort of understand what’s going on in that community, reach out to folks, do assessment, design an
intervention or program activities and then evaluate it to see if it worked. That’s where a lot of my work is now. I’ve also done a lot
around childhood asthma and looking at environmental causes. I think the theme of all of these has been really doing a participatory approach. – Yeah, well before we move to you, Will, I’m very interested in
this project in Ottumwa, and I know that there are communities all over Iowa and in
many parts of the country where people are concerned
about high obesity rates in children who have higher obesity rates than all of us would like. What kinds of programatic interventions are you and the community developing? – Sure, it’s very
interesting, we’re actually using a model that is
not that dissimilar to what Rebecca was talking about in terms of community health worker. This is one where we
identify key influentials in the community, we
call them health advisors or we’re calling ours
physical activity leaders. They’ve been identified as people who are really important and other people’s community member’s social networks, have a lot influence, and we’re recruiting them to sort of be leaders
for physical activity to encourage those within
their social group, their network, be at a church, be at a friendship,
maybe they’ll establish a walking group, maybe
they’ll just try to say, hey Edith, instead of going
to work, go to the gym first and then go to work,
but sort of the messaging but working with folks who
are already familiar to those who are trying to help
change those behaviors. – [Joan] Thank you. – Sure. – [Joan] So, Will, what do you
concentrate on in your work? – Again, it’s similar to
what Rebecca was talking about earlier, in that just
like there are a lot of biological determinants
of health, and when you’re talking about behavioral health, there are also a lot
of social determinants we have to consider. Decisions that people have
to make in order to choose to live a healthy lifestyle,
those decisions may look very different for different people, depending on your education,
your income level, your race, ethnicity, and even some social and cultural factors, so that’s really a lot of my research and teaching is really wrapped around
better understanding those social determinants of health and health seeking behaviors. Most of my work actually all my work at this point is outside the United States in South Asia and Sub Saharan Africa and I really focus on three areas. One is looking at families. How can families be involved in decision making about health? Here in the United States, a lot of times we’re talking about obesity prevention and all the diseases
that are wrapped up with obesity and encouraging physical activity. In a lot of the communities
where I work in, it’s about getting access to care, especially for mothers. In Bangladesh where I do
a lot of my work as well, 70% of the moms are still
delivering their children at home, and a lot of them are
delivering those children with untrained traditional
birth attendants. It’s just the way that
their parents have done it so it’s generation after generation, but it’s communicating
how to get those women the care that they need when they need it, whether that’s bringing
skilled care to them or getting them to a health facility to receive that type of care, and how can the family be involved
in making those decisions? A lot of times women
aren’t empowered to make those decisions on their
own, maybe their husband is controlling some of
the financial resources in their home so she needs
to seek his approval. How’s he involved in that
decision making process? Does he value her health
and their children’s health as a really important
financial investment, and it should be considered that way. How’s the community
involved in that process? That’s really the
secondary of my research is looking at the community as a resource, so as we invest a lot
of time into education for maybe human capital, and to financial areas for economic
capital, people are also investing into their
relationships, maybe who don’t have access to financial
and educational resources. They’re investing in their
relationships, and we call that social capital, so how are they investing into those relationships so that they can gain new
ideas and new resources, maybe from people they wouldn’t normally associate with. Finding ways to link people who are, as I was mentioning
earlier, socially excluded with people who are more in the mainstream and have those new ideas
to be able to promote better health and so getting
those people are more excluded, more included
so that they can have the same choices that are
available to everyone. Then, evaluating the third
area is really evaluating interventions that are
promoting stronger homes and households and stronger communities to be able to promote
those healthy lifestyles. – You mentioned working in Bangladesh, but you also wrote to me
about an effort in India to engage religious
leaders to help eradicate polio and in Rwanda, managing childhood illness at home, can you
tell us a little more about any of those efforts? – This isn’t my own work. These are great examples of how people are bringing health and addressing those social and cultural determinants to bring health to those who need it. In India, which was recently
this year declared polio free, which is a huge accomplishment, as we’re thinking about eradicating
polio from the earth, which is just amazing to even consider. Some of the most resistant
populations happen to be small pockets of
people who again are more marginalized, excluded in
India, which is predominately Hindu, they are lower caste, also Muslims who are in that area of India, just didn’t have the opportunities
that other Indians did, and didn’t have access
to the same information. They were listening to
moms or religious leaders who were promoting information and a lot of misinformation about immunizations, specifically related to polio, and there are a lot of misconceptions
about immunizations from some really far fetched ideas about some conspiracy, to just some basic ideas that it might not be
effective at all, so why would I want to harm my child. Any parent can understand when you’re putting something foreign
into your child’s body, it’s a very traumatic experience. If you have no idea of what it’s for and what it can do to help them, then you’re gonna face a
very difficult decision. It’s those pockets that
are really resistant, so working with those
religious leaders and I think it was over 70% of those religious leaders who were, again, partnered in, considered a partner in this campaign
to eradicate polio, not considered a participant in a program, but considered a partner
and a collaborator, 70% of those religious leaders actually chose to promote
immunization to the people in their congregations to be
able to make a difference. I think that was one of
the big reasons why we saw polio eradicated. Rwanda, just briefly is a different story, after the genocide in ’94
saw a lot of investment in bringing community health workers and bringing health to the home, and again that’s a really
important thing in rural areas. People don’t have access
to care as bringing that health to the home,
and that government has made a huge commitment to community based management of childhood illnesses. A lot of these illnesses
that kids are dying of in countries like Bangladesh and Rwanda, diarrheal disease, pneumonia, malaria, they’re managing those
illnesses in the home, being able to provide
treatment in the home, again, fairly late
providers who are able to identify basic symptoms of disease and get that treatment to them as quickly as they need it
so they can survive longer. – Mhmm. So within the college of public health in your particular areas,
you see students coming in who want to be in this
field, but who start as all of us do, without
knowing very much, how do you get them into this program so that they understand what
their eventual role is likely to be, what the outside
parameters are of that role, when we might be pushing
something beyond the comfort zone of a community
so that you create enemies rather than building partnerships, how do you talk to your
students about such things? – Go ahead, – You know I think we have a pretty strong curriculum for sort of issues. We have new class, relatively
new, called health equity and it handles a lot of the
issues that Will was talking about, social determinance, but also sort of interpersonally how you
work with different cultures, practice cultural humility
of understanding others. We actually have been very
fortunate in the last few years to begin to have funds to
send students for internships, both from donation from the Baker family, that has supported some students, I think you may hear from some later tonight, but we’re really trying with Dean Curry has also put some funds in to really begin to set up opportunities for students to go overseas and to experience it. I think what I’ve been pleased about, the initiative asset
on the committee is the committee’s strong belief
that we need to have opportunities for students
such as Rebecca who already came with a fair
amount of experience. She sort of said, I want to go and we had to hold her back,
because she already knew, but others that may not
have any experience and how to make sure that we have
a safe valuable partnered experience for them and
we’ve identified some possibilities there. – [Will] I think it’s
listening to their story, hearing what they, what the
students are really passionate about and excited in is, Rebecca
talked about her passions and finding that passion. It’s a journey, and so not all students coming in are gonna know what that is right away, but giving them opportunities, I think like the college
of public health is doing in order to discover
what that passion may be, sharing my story, I was not, I knew nothing about public
health as an undergraduate, and it was really going
overseas and having that experience where I was teaching
English, that I was exposed to a world that was
outside of my little bubble and understanding that there are needs out there that maybe I
can’t address them all, but I can be a small drop
in the bucket and start to do something to make a difference, and so finding out what that may be, because there’s so much to
do, you don’t want students to get overwhelmed by all the
things that they could do. You don’t want them to
try to tackle too much. What is their niche and
how can they make a unique contribution, whether
it’s here at home in Iowa, or it’s globally on the
health of populations. – [Joan] Yeah, I was wondering
whether public health is one of those areas
like maybe social work or even teaching, where
you really have to have the heart to do it, because
you’ll se a lot of things that are very hard to deal with, you take a lot home with you I’m sure, you see some lack of
success in certain areas where things don’t get
done as quickly as you’d like them to get done,
but then if you have a certain amount of perspective where you talk to somebody whose been in the field longer they can kind of help you get a sense of that kind
of context and perspective. Do you have to deal with this certain amount of burn out sometimes, or just frustration within this field? – Absolutely. I think any career of people who are really passionately committed to it, it’s a fine line between your life, your personal life and your career and it’s blended. I think it sort of overlaps and you have to be careful to be able to draw those lines so that you don’t get burnt out. The same goes with what we’re asking our partner to do. When I’m working with my colleagues, whether it’s in India,
Bangladesh, or Kenya, and maybe we have a
grant deadline, and yes, it’s gonna do something remarkable, and potentially save a lot
of lives, and we’re both very passionate about it, we also have to respect each other’s boundaries. I think that’s especially hard sometimes when we’re sort the liaison between the donor, the funder,
and the funder may be putting a lot of pressures
on us, and we have to be able to manage that in a way that makes it possible for our in country partners to be able to do the really important work that’s happening on the ground. Can’t ever take away from that and so that comes out through, just being a good time manager, but also
being able to find ways to not take away from
implementation, but still being able to measure
outcomes, which takes a lot of extra time too. I think it is finding that balance between the two so that you
don’t burn out and you’re able to continue to do that work. I think as you go through it
with the different partners and collaborators, you’re
able to sort of be a support for one another as well. – Right, before we wrap up this segment, I wonder if you could each just tell us what you’re most rewarding
moment so far in this career has been, is there something
that really stands out? – In previous to coming to
Iowa, I worked in Detroit which I think that has
been at the nose for all the bad reasons, and I think that my partnerships there and the
commitments of folks and the strengths I saw, and
what they were coming to and contributing to our partnership, which was focused on childhood asthma, really was just a highlight, and the fact that with their input we were able to really improve kids’ asthma related health, was just really fun. – [Will] Before I came back, to academia and working in the university, I worked for a NGO and I think
for me it was seeing, it was a really small NGO
that was doing tremendous work in a way that I feel
like was really helpful to communities and putting a lot of their resources in the communities
that they were serving. I was able to see, bring
that good work to light and see a lot of funding
come in for that organization that they didn’t have before. I think that was just tremendous, because I think they were able to accomplish a lot more
over a period of time and to be a part of that
was really rewarding. – [Joan] I think we’re all very
lucky to have you both here at the University of
Iowa and I want to say thank you to Will Story, thank you also for the great
commentary you wrote for the precedence
center, I appreciate that. – It’s my pleasure. – Will Story and Edith Parker from the college of public health. I hope those of you who are with us now can stay with us for the third part, the final part of this series on public health challenges around the world. We’ll be talking to
three graduate students in the college of public health and learn about research they’ve been conducting in Gambia, India, and Equador. WorldCanvass programing
is available on YouTube, on iTunes, UITV, and the international programs website, which is
international.uiowa.edu. I’m Joan Kjaer. Thank you very much for being with us, and we’ll see you next time. Good night.

Author: Kennedi Daugherty

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