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EDITOR'S CHOICE |
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I remember sitting in the office of the chairman of the Human Services Committee of the District of Columbia City Council. The Queen of England had recently completed a visit to the city and a contingent of schoolchildren was preparing to go to London to visit the Queen. The chairman noted how excited the children were about the trip, and I commented that I too would be excited if I were one of those children and were going to London. The chairman looked at me with the expression of an experienced legislator who was about to give the health officer a lesson in cultural competency. "London!" he exclaimed. "These kids are excited because they are going to the airport. These children," he pointed out, "live in a part of the city where they see airplanes fly up from the horizon and over their homes, but they have never seen where they came from." I suddenly understood that these children had had experiences vastly different from those of most Washingtonians. This in a city less than 10 miles square!
Days later the chief medical officer came to see me. She had just left a room full of elementary schoolchildren. Our department was holding forums around the city to talk to children about public health and prevention. This was part of our effort to address the needs of the city’s children and ingrain healthy behaviors in them at an early age. We discovered that these children had seen and heard our many prevention messages on television and radio and had seen some of our written materials. They knew that avoiding drugs and cigarettes was an important health behavior. They knew about "the birds and bees." They even knew that condoms would prevent sexually transmitted diseases.
But they also had a frightening and intimate knowledge of handguns. Their knowledge of the various types of illegal drugs, their side effects, and techniques to get the "best high" was also of great concern. These were bright kids who had a concept of finances and a knowledge of the "business of the street" that would make the chair of any MBA program take note.
These kids had heard our messages but when they put them through the filters that they used every day, they found our messages tough to reconcile with their reality. The world these kids lived in was one where health care disparities were accepted as a way of life, secondary to issues of poor housing, poverty, and the tasks of everyday existence. For some, an acceptance of hopelessness and helplessness defined the filters through which they heard our prevention messages. In short, our messages simply were not relevant to them.
As we work to improve the health of our communities, we must address the root causes of such filtering. The reason for unhealthy behaviors is not that the public does not fully understand healthy ones; it is something more deeply rooted in the ills of our society. Unhealthy behaviors start in part as a response to a social environment that fosters no alternatives. To change that environment is the real challenge.
Where do we start? We start at the beginning.
This article has been cited by other articles:
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  H. M. Treadwell, M. E. Northridge, and T. N. Bethea Confronting Racism and Sexism to Improve Men's Health American Journal of Men's Health, March 1, 2007; 1(1): 81 - 86. [Abstract] [PDF]
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 Minerva BMJ, May 10, 2003; 326(7397): 1044 - 1044. [Full Text] [PDF]
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