The Stitch ›  Equitable Health is More Than Just a Nudge Away

Equitable Health is More Than Just a Nudge Away

We’ve been thinking a lot about the long overdue public acknowledgement and anger about men who abuse their power, its impact on all women and the importance of thinking about systemic, social and cultural inequality in how we approach our own work.

We speak to two experts this month about what we gain from looking at public health through a “gender lens” and what we miss when we assume that men and women have the same needs, motivations and behaviours. It’s an important message, especially in the era of #MeToo and the growing attention to sexual assault and violence (an epidemic from which the global public health and humanitarian aid community is not immune.).

How does gender play a role in your work? Has the recent movement to expose sex and gender-based violence influenced your thinking? Talk to us – we’re looking forward to hearing more.

Sherine and Mike

“All issues of health are not because of biological pathogens. Health is created through different distributions of power in society.”

Alicia Ely Yamin, Adjunct Lecturer, Harvard T.H. Chan School of Public Health

Spotlight on Gender

Why now? Hidden Brain looks at the triggers that may have awakened the #metoo movement, looking at concepts of social proof and horizontal violence in a post-Trump world.

Behavioural Economist and Nudge author Cass Sunstein is tackling the question as well by asking: are we at a moment when people feel more free to express outrage they have always felt, or is this a revision of social norms leading more of us to express outrage we have not previously felt?

Iris Bohnet, behavioural designer and author of the book What Works, has a smart proposal for aid organizations trying to even the playing field: don’t bother trying to change people’s mindsets. De-biasing organizations instead of individuals is quicker, cheaper, and more effective. 

This month we dig into some of this with Brittany Iskarpatyoti, a gender research associate at MEASURE Evaluation, and Alícia Ely Yamin, an adjunct faculty member at the Harvard TH Chan School of Public Health, visiting professor at Georgetown Law and a member of the UN Secretary General’s Accountability Panel for Women, Children and Adolescent Health in the SDGs. Could be the best four minutes of your day…

The Stories We Can’t Stop Thinking About

You won’t know until you try it!
said all parents everywhere, always. But like a stubborn two-year-old we don’t experiment with new choices and ideas – often to our own detriment. In fact, the reason why you hire the “safe” choice to fill the open spot on your team is also the reason you order the same dish at your local restaurant: a bias towards the status quo. “Experimentation is an act of humility, an acknowledgment that there is simply no way of knowing without trying something different,” writes the author.

Still struggling to make sense of the blockchain? Join the club. But with organizations like CDCWFP and UNICEF already testing the waters, you may want to brush up on your ‘distributed ledgers’ and ‘Merkle Trees.’ For development, it could be a game-changer – tracking aid dollars, or determining land and property rights, even for public health surveillance. The caveat, say experts: you need reliable energy supply and open access to the Internet.

Are we training for measles eradication?
Measles cases affected 20 million people in 2016 and killed almost 90,000 children. The global health community is torn about when to begin a global eradication program. As the writer asks, could the failures—and near-successes—of other eradication campaigns ultimately teach us how to conquer measles? All this while measles cases in Europe are soaring; up by 300% in 2017.

The Research We’re Curious About

Behavioural design for better health care.
Taking medicine. Missing an appointment. Overprescribing. Excessive medical testing. Exercising. What do all of these things have in common? They’re behaviours at the centre of a healthcare system that’s often inefficient and ineffective. Behavioural science firm ideas42 researched how to re-invigorate a system by integrating behavioural design teams (BDTs) to pilot approaches that bring greater focus on human behaviour. They found a variety of ways and best practices for design improvements with the potential to stick. 

You are not a top performer.”
Stings doesn’t it? Researchers have been trying for a long time to get doctors to stop writing antibiotic prescriptions for illnesses that didn’t require them. In a study published in the Journal of the American Medical Association, they found using that message in the form of an email ranking – you are not a top performer – was enough to get those doctors to change their habits, and to sustain that change over time. A reminder that “the human need for social approval often trumps rational decision making.”

How vaccine hesitation spreads.
This research explores how public trust and confidence in vaccines varies around the world (67 countries), reminding us that low confidence areas can often predict disease outbreaks and mass resistance to immunization campaigns. Non-vaccinators can reduce herd-immunity, making it easier for outbreaks to take root and epidemics to spread. So, what’s making people distrust vaccinations in the first place, and how do we change those perceptions if they’re misplaced? Keep reading in the next section!

This will be okay for you, but GREAT for all of us.
How do you develop interventions when there’s little individual benefit, but large collective benefits? This just-published research on social mobilization has huge applications for development and global public health work.  

The Lessons That Are Sticking With Us

Advocacy that works
Definitions of advocacy are inconsistent, campaigns are rarely based on theory and causality is a problem, says International Initiative for Impact Evaluation. They dug further and found the most important factors linked to successful advocacy programs are: who does the advocating and messaging, which channels they use, whether incentives are offered and if the target group is compared to another group in campaign messages. Check out their toolkit to design and evaluate advocacy impact.

How different countries nudge the anti-vaccine crowd
Encourage the people you know to create a social norm around vaccination – making it clear that everyone does it. If you’re a doctor, make sure you emphasize that you recommend a vaccination, not simply that the child you’re treating is due for one. And if you’re a policymaker, consider investing in better immunization registries, which are often incomplete and out-of-date. And you may not be surprised to hear that information is great to support existing behaviour, but not enough to sway it.

Walk the talk
If you liked our interview with Brittany from Measure Evaluation in this month’s issue, have a look at their new quick and practical guide to better integrate gender into monitoring, evaluation and research.

What’s Distracting Us From Work

How do we get ahead of crazy, if we don’t know what crazy thinks?
Mindhunters: we know, we know, it’s gruesome TV watching at times, but a fascinating attempt to capture a defining moment in criminal psychology. It’s less about the killing and more about the research to understand who serial killers are and to categorize their behaviour to solve and predict future horrors. The series is based on a book, if you’d rather stick to Eurovision and Top Chef reruns on your off-hours.

We also recommend going back to the TED talk archives for this 2015 presentation from Dan Ariely. In nine jam-packed minutes, he explores the question, “how equal do we want the world to be?” and shows that people are more averse to inequality in healthcare and education than other forms of wealth.

This Newsletter Was Produced While

Mike reviewed qualitative research for immunization in Asia, listening to the Budos Band on repeat and struggling with the hard problem of consciousness before his birthday.

Sherine battled theories of change, while dipping into different hypotheses about the afterlife, and searching for insights to help manage toddler kleptomania on the playground.