Archive for the ‘Empowerment’ Category

In our attempts to encourage people to lead healthier lives, we often make the mistake of bombarding them with facts and stats, do’s and don’ts, assuming the problem is a lack of knowledge. But let’s be honest – most people know that French fries are not the healthiest food in the world, fruits and vegetables are good for you, and that you really ought to exercise regularly.

So, what’s the problem? One aspect of the problem is of course the systems level issues of food access, cost, time and space to be active, etc. that we have mentioned before.

Another aspect though is one of attitude and culture.

Feel Rich, which launched in December, is attempting to address just this (sidenote: the organization’s CEO and others involved were on a SXSW Panel just this past weekend).

Feel Rich’s goal is the creation of a health and fitness culture born from the urban and hip-hop community’s love and respect for music, movement, and entertainment. Their message: health is the new wealth.

As opposed to your typical public health campaign centered on facts, stats, and do’s and don’ts, Feel Rich is attempting to first foster a desire for health (in other words, crafting an attitude and creating a culture that sees health as critical and desirable as wealth), engaging urban youth in a meaningful way that speaks to their interests. In Feel Rich’s own words – “It’s health on your terms, fitness in your style, and food choices that make sense on the streets where you live.” It’s also about making health and wellness cool.

I think it’s an exciting and inspiring approach, and the way the Feel Rich movement taps into attitudes (not just information), reminds me of the baby carrots campaign I’ve written about before. After all, whether we’re talking about the junk food industry, big tobacco, or pretty much any other product we see commercials for, appealing to emotion and attitudes is the way advertising is done. It’s long past due that prevention and health promotion advocates started utilizing this powerful strategy.

Feel Rich ties this powerful appeal to attitude and culture with empowering information on food, fitness, and health, and an array of videos and stories to engage and inspire their audience.  And with over 3 million YouTube views, it looks like they are doing just that.

I’ll close with some food for thought on this topic from David Katz’s most recent Huffington Post article:

“What if health were more like wealth?

  • If health were like wealth, we would value it while gaining it — not just after we’d lost it.
  • If health were like wealth, we would make getting to it a priority.
  • If health were like wealth, we would invest in it to secure a better future.
  • If health were like wealth, we would work hard to make sure we could pass it on to our children.
  • If health were like wealth, we would accept that it may take extra time and effort today, but that’s worth it because of the return on that investment tomorrow.
  • If health were like wealth, society would respect those who are experts at it.
  • If health were like wealth, young people would aspire to it.

This post is cross-posted at http://occupyhealthcare.net 


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Speaking of New Year’s Resolutions, here’s another one to add to our lists: give wisely. With the holiday season just behind us, many have volunteered time and/or donated money, and perhaps even made resolutions to do a better job of it in 2012.

Our #occupyhealthcare principles, and an array of other important causes, are being actively pursued by nonprofits around the world, and many of us have and will in the future donate our money and volunteer our time with these organizations.

In doing so, it is important to remember that good intentions are not enough – a trap we often fall into in social service fields. We think we are helping others, so we go home feeling good about ourselves, but we don’t spend nearly enough time challenging our assumptions about whether or not what we’re doing (or what organizations we support are doing) is actually making any kind of sustainable difference.

The Boston University Economics Club highlights one common trap we fall into in an article entitled “When is it a bad idea to give the poor free stuff?”This criticism of TOMS Shoes also describes the problem of free stuff outcompeting local goods, but goes further, pointing out issues such as doing things for instead of with people, marketing ploys disguised as awareness raising,  harboring a “whites in shining armor” mentality, and failing to match the needs of those on the ground.

This last one is a particular pet peeve of mine – we often fall into the trap of taking up the cause du jour, never mind what people on the ground actually need. Daniel Halperin addresses the issue of well-intentioned but far-from-optimal (as far as improving health outcomes) donations towards HIV/AIDs prevention and treatment in a wonderful 2008 op-ed in the New York Times. He speaks of the 100-to-1 “disastrously inequitable” imbalance between U.S. spending on AIDS programs ($3 billion) vs. safe-water projects ($30 million) in Africa. This despite the fact that most African nations have a stable adult H.I.V. rate of 3% or less and despite the fact that in certain African countries, AIDS money remains unspent as even state-of-the-art H.I.V. clinics cannot accept such large influxes of cash, and in others, children suffering from basic diseases are left untreated (as clinics cannot afford to stock basic medicines) while H.I.V.-infected children are offered exemplary treatment.

Another example is breast cancer related “awareness-raising” and fundraising in the United States. Injury, violence, and a host of other diseases all claim more lives than breast cancer.  This is not to say breast cancer doesn’t deserve any attention, but all the hype seems to have contributed to misperceptions about the risk of breast cancer vs. other cancers and diseases, not to mention the ridiculous slogans that objectify women, potentially furthering social norms that contribute to gender-based violence and other problems. On top of this, many of the efforts are entirely nonsensical (e.g., Yoplait’s pink yogurt lids) – unless your goal is to increase revenue for the companies that sponsor them. Even more distressing is when the products being promoted in the name of breast cancer awareness actually contain ingredients that have been linked to increased risk of breast cancer.

As one blogger put it, “The ostensible focus of all this pseudo-philanthropic pink jockeying is a kind of nebulous breast cancer “awareness,” rather than any serious effort at prevention or investigation into what actually causes breast cancer in the first place.” One of the comments on this blog post captures the issue well: “If there was some real research into the root causes of cancer or providing widespread access to quality healthcare (prevention, early detection, dealing with the disease, cure) for women, maybe I would understand. Instead a friend gives me a T-Shirt that says “Save the ta-tas” and I am supposed to believe that all is right in the world.”

How can we avoid some of the traps mentioned above, and give in ways that are more likely to contribute to actual, sustainable change?

*Choose wisely – be critical, and do your research. It’s hard to truly measure a nonprofit’s impact, but we can at least try to get a better sense of their work. What exactly does the organization do? How well does what they do match the needs of those they aim to help? What does research and evaluation say about the kinds of tactics they use? Is their work sustainable? Are they engaging and empowering those they try to help?  In addition to these, goodintents.org provides a fabulous list of  Dos and Don’ts for Disaster Donations and issues and tips related to voluntourism, and Think Before You Pink provides questions to ask before you buy pink (but much of what they say is relevant to looking into any cause).

*When volunteering, maximize your impact by volunteering in a way that puts your skills to use. Check out sparked.com: even more than their online, micro-volunteering approach, I appreciate the idea of trying to match a person’s skills (web design, marketing, legal, etc.) with the needs of an organization.

*Start local. Contributing your time and money to local organizations doing good, smart work (choosing wisely is still important) can help build a sense of community (for you and those you work with) and help you build long-term relationships with the organizations you choose to support and those that turn to the organization for its services. It can also be easier to get a sense of an organization’s work when you can be there in person – it’ll make for wiser giving anda more personal sense of the impact the organization and your support is having.

Here’s wishing everyone Happy and Wise Giving in 2012!

(This post is cross-posted at http://occupyhealthcare.net). 

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Note: This post is cross-posted at Occupy Healthcare – be sure to check out the other posts there, and check out #occupyhealthcare on twitter too, the movement is growing! 

In my last post, I wrote about the importance of occupying an array of fields that impact our country’s health. Lest this task seem too daunting to be accomplished, I thought I’d take a moment to highlight some success stories on this front.

Access to healthy foods is an important determinant of health and an important factor in health inequities. The Food Trust, a non-profit based out of Pennsylvania, is tackling this problem, aiming to make healthy food available to all. Among their many innovative projects is the Pennsylvania Fresh Food Financing Initiative, a grant and loan program to encourage supermarket development in underserved neighborhoods throughout the state, an idea that is now being replicated nationally. Some other creative developments in the field of nutrition and healthy food access: taking a page out of the junk and fast food industry’s book, with their billions spent on marketing, and branding baby carrots in a way that’s fun and exciting; and tapping into behavioral economics to redesign cafeteria lunch lines in a way that increases purchase of healthy foods and decreases purchase of unhealthy foods (an inexpensive and effective approach!).

Given that homicide and suicide are among the leading causes of death among those age 1 to 34, violence prevention is another key aspect of attaining the health our society deserves. Chicago-based CeaseFire combines research and street outreach to track violence, interrupt and intervene (with well-trained professionals from the communities they represent with a background on the streets), and engage in longer term risk reduction and behavior and norm change. Even more exciting – it’s working.

Neither access to healthy foods nor neighborhood safety – not to mention walkability, pollution-free environments, and a host of other things – is possible without intelligent and innovative urban planning. Thankfully, we have the likes of The Congress for the New Urbanism working to promote walkable, mixed-used neighborhood development, sustainable communities and healthier living conditions.

And while our national political discussion is so bogged down by discussions of whether to help low-income individuals and families that we haven’t had a conversation about how best to help them, organizations like the Family Independence Initiative, which was featured in the New York Times this past summer, are taking an approach radically different from our typical social service model, tapping into the strengths and support systems of low-income families, allowing them to determine their own paths and advance together. This too, has been shown to work.

Across all of these health-related issues, the media plays a role in shaping behaviors and norms, and Hollywood, Health, and Society is bridging two drastically separate sectors with its work to provide entertainment industry professionals with accurate, timely, and engaging information and case examples for health storylines, as well as study the content and impact of these storylines.

Of course, just because it’s not all about healthcare doesn’t mean healthcare isn’t at the table – healthcare providers can play just as important role in prevention and promotion as they do in treatment, and places like the Codman Square Health Center make that crystal clear. A community health center in one of the most impoverished areas of Boston, the Center provides a range of public health and community services (ranging from computer classes and financial help to fitness opportunities and hands-on cooking classes, not to mention youth services, civic engagement initiatives, and a close linkage with the Codman Square Academy charter school).

So, as daunting as the task of occupying for health seems, there are many people in many places doing amazing things. To quote the founder of the Codman Square Health Center: “We need to create integrated systems that promote community and health values. Like all change such cultural shift will take a generation or more to accomplish. But I am reminded of the story President John F. Kennedy told of the French leader who asked his gardener to plant a rare tree on his estate. ‘But the tree won’t bloom for 100 years’ the gardener said. The response: ‘In that case, plant it this afternoon.’”

So here’s to starting planting – and occupying. Cheers.


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I came across this post by Craig Lefebvre several weeks ago, in which he considers what we may all want to start thinking about as we start a new year of social marketing.

He writes,

“What if we…

  1. didn’t have target audiences – but co-creators
  2. didn’t have distribution systems – but places where people could play
  3. didn’t use focus groups – but designed research to fit the puzzle and people
  4. didn’t assess knowledge and attitudes – but sought insight into people’s motivation and values
  5. didn’t start with analyzing people – but first assumed that it was something in their environment
  6. didn’t create messages and stories – but focused on crafting exchanges
  7. didn’t track program output – but what, how often and from where people saw and heard from us
  8. didn’t aim at target audiences – but served people
  9. didn’t focus on changing behaviors – but offered people new ways to solve problems, meet their needs and reach for their dreams
  10. didn’t focus on evaluation as the end of the process – but sustainability as the start of the next one”

I think I’m going to print this list and put it up by my desk – it so eloquently captures what I think should be some of the core tenants of public health (and other) work.

Many of these points relate to things I’ve been mulling over as a result of a community organizing course I’m currently taking. One of the first articles we read for this class was an article entitled “Services are Bad for People,” by John McKnight, in which he argues that service systems are often antithetical to powerful communities. They serve clients, they don’t empower citizens. They are hierarchical, not democratic. They have a vested interest in people needing them, not in tapping into the problem solving capacity of the people so that people can collectively shift power and change their own communities.

Granted, nothing is quite that black and white. And McKnight himself says that well-run services have their place. But ultimately, I think his point is right on and extremely underappreciated in the public health community and in service-related professions more broadly.

As Lefebvre has pointed out, we should have co-creators (point #1) and offer people ways to solve their problems, meet their needs, and reach for their dreams (point #9) – which, interestingly, is probably the key to sustainability (point #10). Communities taking ownership of initiatives means initiatives actually have a chance of continuing onwards, instead of being dependent on the whims of outsiders, who eventually run out of grant money or time.

The other much under-appreciated aspect of creating change that we have discussed at length in our community organizing class is the importance of relationship-building. We go in so focused on research and program/business plans (both of which are important, no doubt) that we forget this most fundamental of things. And just as Lefebvre points out, and just as we’ve talked about in our class, the keys to relationship building are seeking insight into people’s motivations and values (point #4), and finding the shared values that allow for the exchange (point #6) of resources needed to achieve a common purpose.

Of course, I also can’t conclude this post without a quick note about Lefebvre’s point #5 – don’t start with analyzing people, but instead first assume it’s something in their environment – which is something I harp on pretty often, in this blog and elsewhere. We keep trying to change people’s behaviors without considering the myriad of things in their environment that might be encouraging the behavior and/or preventing them for changing it. Let’s focus our efforts on changing the systems and environments within which we live – after all, health starts where we live, learn, work, and play.

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The last – and inexpressibly inspiring – session of our winter term course on community health centers was a couple days ago. It just happened to coincide with my reading of Atul Gawande’s latest New Yorker piece, which interestingly linked in with a lot of what I have been mulling over as a result of this community health center course.

But let me start at the beginning.

The Movement

The community health center movement started about 45 years ago, with roots in the civil rights and social justice movements of the 1960s, and with some incredible leaders at the helm. At the dawn of this movement, community health center leaders saw health as but an entry point to solving a broader range of problems, without raising the same level of opposition as more blatantly political “social change” programs. The goal was to not just to provide primary care and related outreach and patient education, but to address social determinants of health through job development, nutrition, sanitation, and social services. All while maintaining a core principle of respect for and involvement of community residents.

While this belief in community ownership has persisted through the years, the idea of health as but an entry point to solving a broader range of problems seems to have diminished (though, thankfully, not disappeared). Most of community health centers have become primarily – some almost entirely –deliverers of medical care, with little attention paid to the broader – and more fundamental, in many ways – needs of these communities: education, employment, food access, civic engagement, health promotion/prevention (e.g. promotion of healthy eating and exercise, injury and violence prevention, etc.).

This is not to say that they are not doing absolutely amazing work – because they are. That, if nothing else, has become clear over the course of this class. Health centers provide needed high-quality primary care services to largely underserved populations (the under- and un-insured and the homeless, among others), preventing further complications and emergency room visits, while maintaining community engagement (aided by the legal requirement that governing boards of community health centers must be composed of at least 51% consumers) and a range of enabling services (such as provision of translation and transportation services).

So, needless to say, all our visits to community health centers over the course of the last two weeks have brought us into contact with awe-inspiring, committed leaders – most of whom have worked in their respective centers for upwards of 20 and 30 years. Pretty amazing to someone like me, from a generation that changes jobs every few years – to be passionate enough and challenged enough by a place to remain there for decades and still speak about it with such fervor would be one of the greatest blessings in life! While all our visits have been wonderful, our visit yesterday to the Codman Square Health Center was inspiring on an entirely different level.

Codman Square

Bill Walczak, the founder of the Codman Square Health Center, is, among a million other things, an incredible storyteller. A son of two factory workers, his seventh grade teacher changed his life, pushing him to apply to a high school that resulted in an excellent education and a full ride to Boston University. Within a year, he was a married, college dropout, working in a factory and organizing for Caeser Chavez’s lettuce boycott.  He was also a resident of Codman Square in Dorchester, Massachusetts, a community that was falling apart at the seams. Buildings were abandoned as people fled from the racial tensions, escalating violence and crime, and crumbling education system. Labeled a “death zone” due to high infant mortality, and suffering house fires on a daily basis as people attempted to at least collect insurance money off of abandoned properties that no one wanted, the community suffered from a deep sense of hopelessness.

In 1974, a civic association in Codman Square decided to take over the basement of an abandoned library building and set up a health center, injecting some hope and excitement into this community. 20-year old Bill Walczak was chosen as chairman, because, he says, “I had a big mouth and it was a convenient way to shut me up”. (A statement that embodies his humility and sense of humor, I think). Since then, through immense hard work and tons of learning along the way (about politics, media, fundraising, healthcare regulations, building partnerships, etc. etc. etc.), the Codman Square Health Center has grown to occupy five buildings (all formerly abandoned), employ 280 people, and see over 100,000 people for services each year, including 20,000 patients, 87% of whom live below 200% of the Federal Poverty Level.

Moreover, it has stayed true to the original essence of the community health center movement – health as but an entry point to providing a much broader range of services that tackle the fundamental determinants of health, happiness, and success. The Center provides a range of public health and community services: adult education (e.g., computer classes), financial help (e.g., tax preparation, credit coaching, and personal finance classes, including a “skills for life” course for 11th and 12th grade adolescents that combines lessons in personal finance with career exploration), recreation and fitness opportunities (including a full-fledged fitness center through a partnership with HealthWorks), hands-on nutrition programs and cooking classes, parent and other support groups, youth services (including internships at the community health center), and civic engagement initiatives.

Most interestingly, inspired by the way education changed his own life, Bill Walczak, through immense initial opposition, has founded and closely tied into the Health Center a charter school, Codman Square Academy. With extended class time (9-5pm every weekday and half-days on Saturdays) and truly innovative programs in fitness, nutrition, social justice, and more, the small school (enrollment: 140, average class size: 17) serves largely low-income, minority students (99% students of color) and has seen some pretty amazing results over the course of its first ten years (100% of students accepted to four-year colleges and universities, and 73% of alumni graduated or enrolled in higher education). A full-time staff member is devoted to following students after graduation and aiding them in any way possible. It’s clear that students and faculty alike view the school as a second home.  

Integrating Services

Which brings me back to my earlier point – there are so many services that need to be integrated in order for communities to thrive. The day before our Codman Square visit, we visited Boston Health Care for the Homeless (which incidentally marked the third time I’ve heard its founder, Jim O’Connell, give his spiel – and I find myself just as moved and motivated every time), and when asked about the prevention of homelessness, Dr. O’Connell’s response was that homelessness is a prism that reflects the failures of society. Failures in education, prison/corrections, foster care, health care, welfare, housing – the list goes on.

An extremely eloquent turn of the phrase that again drives home the point that we are not going to solve a community’s problems just by providing medical care. We’re not even going to solve a community’s medical problems just by providing medical care.

This is an idea that Atul Gawande’s article touched upon. Specifically, Gawande talks about proper care for “hot spotters”, the small percentage of people who make up the vast majority of health care costs. He cites a number of great examples, prime among them a group in Camden, New Jersey, who are providing highly intense primary care, as well as a broader range of services, to these high-need patients. By building relationships, attempting to address the causes behind their medical problems and not just the symptoms, and connecting patients with social services, this small group of folks – many of whom have no academic background in medicine, but rather the skills to gain a patient’s trust and confidence – is making a huge difference.

So, ultimately, it’s about finding a way to tackle all these different issues in an integrated and community-driven way. I think community health centers, given their roots in their communities and their historical efforts towards broad ranging social change, provide a uniquely apt home-base from which to mount such a comprehensive, holistic effort. And I think Bill Wolzcazk and Codman Square provide an amazing example of just how much can be done on this front.

It is certainly a daunting thought – tackling education and healthcare, lifestyles and environments, policy change and entrenched interests. And all at once. But as Bill Walczak concludes his reflections on a healthy city (our final reading for the course) –

“We need to create integrated systems that promote community and health values. Like all change such cultural shift will take a generation or more to accomplish. But I am reminded of the story President John F. Kennedy told of the French leader who asked his gardener to plant a rare tree on his estate. ‘But the tree won’t bloom for 100 years’ the gardener said. The response: ‘In that case, plant it this afternoon.'”

So here’s to going beyond merely musing, and starting planting. Cheers.

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Our readings from the last couple weeks have looked at the impact of the internet on journalism and government. Ultimately, I think it’s a story of two forces:

  1. The groundswell: described by Charlene Li and Josh Bernoff in their book by the same name, the groundswell is “a social trend in which people use technologies to get the things they need from each other, rather than from traditional institutions.” (I explored this idea in an earlier post).
  2. Crowdsourcing: Jeff Howe, who is credited with coining the term, defines crowdsourcing as “the act of taking a job traditionally performed by a designated agent (usually an employee) and outsourcing it to an undefined, generally large group of people in the form of an open call. Or, as he puts it in his “soundbyte version” of the definition – “the application of Open Source principles to fields outside of software.”



In journalism, it seems it’s been more a story of the groundswell, because institutions (i.e., newspapers and other traditional media sources) have been so resistant to the changes made possible – even inevitable – by the internet. As a result of this resistance, these institutions have not put out open calls, guiding the efforts of the “crowd” towards a common end goal. Instead, people have been blogging, tweeting, and discussing online, adding their own reports, observations, opinions, and analyses to the media mix – very much a groundswell effect.

This resistance of most traditional media institutions is highlighted in the blog post by Dave Winer we read, in which he analyzes eight speeches given by news execs. Winer points out that “these guys” don’t see the value of the internet, simply moving their existing editorial structure from print to the Internet as if that will take care of it. One of the speeches Winer mentions, a 2007 speech by executive editor of the New York Times, Bill Keller, truly underlines the point. Keller refers to the internet as the “great disrupter,” calls the purchasing of newspapers by billionaires “a silver lining”, and insists that the “worldwide corps of trained, skilled reporters” traditional media institutions deploy and their “rigorous set of standards” are simply unmatchable by digital newcomers. All of which betray he might very well deserve Winer’s characterization of him as someone “who clearly thinks almost everyone who doesn’t work at the NY Times is stupid.”

Keller fails to recognize that there is reporting happening online, in the form of first-hand reports from all over the world; that there can be standards online (Wikipedia’s emphasis on and patrol of verifiability and accuracy); and that the internet might actually help journalism be better (especially if the open source idea of “given enough eyeballs, all bugs are shallow” can be applied to improve verifiability, not make it worse). I’m not saying this admittedly utopian view of the internet’s impact on journalism is true, or even likely – just that it’s possible. And that news execs aren’t considering the possibility.

As Clay Shirky points out, in revolutions, “the old stuff gets broken faster than the new stuff is put in its place” – no one knows what journalism 2.0 will look like exactly. But some of the examples we’ve seen in our readings highlight the possibilities, for better and for worse. Much of what’s happening in journalism, as I mentioned, seems to be groundswell-esque ways of reporting and sharing information, with blogs, twitter, and other outlets allowing people to turn to each other for information. While a lot of work done in this realm is sharing of information reported elsewhere, there are examples of actual reporting being done – Susannah Breslin’s experiment with self-publishing long-form journalism comes to mind.

Other examples of reporting are more like crowdsourcing than a groundswell – with a leader or institution directing the process – Denton’s blog empire, WikiLeaks, and OffTheBus come to mind. It is interesting to note that traditional media institutions are not moving into this space of directed crowdsourcing, or even grappling with the potential it has to revolutionize journalism. If they would stop fighting the change, and figure out how to leverage it, perhaps they would move into this space, and perhaps it could help them change with the times instead of being steamrolled by them.



In government, although there are some examples of people turning to each other to accomplish things that government used to do (we talked in class about an example of citizens pitching in money to hire construction workers to pave a road that their government just wouldn’t get around to paving),  it seems more a story of crowdsourcing. That is, government guiding (and responding to) input from the crowd. I’ve mentioned Mayor Menino’s New Urban Mechanics approach before, and this past week’s reading has introduced me to other fascinating examples. One is the e-Democracia Project in Brazil, which “aims to engage the citizens in the lawmaking process to achieve tangible legislative results.” The project’s website allows citizens to share information about a problem that requires a legislative solution, identify and discuss possible solutions, and even draft the bill. We also read about Manor, Texas, a city on the forefront of Gov 2.0 innovations. The process involves “using open source technologies that empower citizens to co-create government with officials and city employees”. Similarly, Expert Labs is looking to connect policymakers with “the vast community of knowledge that lives on the web” (although this begs the question – what about connecting them with citizens more broadly?).

So, in a way, government seems more willing than traditional media institutions to engage with the internet and open source philosophies. Not sure if this says government is more innovative and open to change than we usually assume or if it says media institutions are depressingly not innovative and open to change.  Maybe a little bit of both.

Of course, although government is slowly dangling its toes into this new pool of opportunities, there are a lot of barriers to its jumping in fully, beginning with the bureaucracy and red tape inherent in governmental institutions that make change – particularly revolutionary and transformative change – very difficult. As Alex Howard points out, the “cultural shifts required for full adoption [of open government] are not in the DNA of many federal or state agencies”. Howard also points out further complications of the move to open government – it’s risky, incremental, and an unfunded mandate; there are security and privacy risks to consider, as well as the danger of inevitable crashes and failures (particularly when considering the weight of certain government decisions, like nuclear launches and court rulings).

Ultimately though, the revolution is coming – incrementally, but inevitably – and both journalism and government are going to have to deal. In doing so, among other things, it will be interesting to see the balance between the groundswell/“people turning to each other” approach and the crowdsourcing/institutions guiding the crowd in collective action approach.

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Just attended an incredibly exciting and inspiring talk by Rishi Manchanda, the founder of RxDemocracy, a group whose two-fold mission is to advance civic participation through health care and to improve health through civic participation – creating a “virtuous cycle” of civic health and health equity.

RxDemocracy  is partnering with civic organizations to bridge this gap, bringing meetings with local politicians and voter registration into clinical settings and persuading health providers that they will be serving their patients better by opening up the conversation to include civic engagement. After all, public policy is an important determinant of health and research suggests that there is a link the other way around – those who are engaged feel a higher sense of control, and thus fare better health-wise.

Dr. Manchanda pointed out the barriers to creating the civic health/health equity virtuous cycle, including the biomedical paradigm of the medical profession (something I’ve been thinking about a lot as I’ve moved from biomed undergrad to public health) and the divide between community organization/civic engagement and healthcare (with healthcare often seen as just the curative, expensive, high-tech side of things).

He also highlighted the fact that healthcare is second only to education as an access point for many to society, making it a huge untapped civic organization. One symptom of this, Dr. Manchanda pointed out, is that physicians themselves (despite being very well educated) vote 9% less often than the public and 22% less often than lawyers.

Another theme that arose from this talk is the idea of advocating with those you are trying to help versus advocating for them, which ties in perfectly with the idea of community engagement and empowerment (linked with Amartya Sen’s capability approach) that I have been thinking about a lot lately (and which is an area of public health with huge potential for use of new/social media and digital technology – along the lines of new urban mechanics). More on that soon!

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