Thursday, March 19, 2009

For me, one of the biggest differences between being a student of biology and a student of public health is the emotional exhaustion I now experience. Biology was a much more mentally demanding discipline- demanding memorization of countless organisms, structures, cell signalling pathways and the interactions between everything under the sun. Health Promotion, Education and Behavior places more strenuous demands on my heart than my mind. It also orders me to a careful reckoning of how my mind and heart are interacting- is my compassion for a particular situation leading me to jump to a solution, rather than deliberate over the best use of limited resources? How do I balance the urgency of life and death with the need to not be wasteful, to choose the best intervention?

This week I've been working on a short paper on the cholera outbreak in Zimbabwe, which has necessitated reading a vast quantity of UN "on the ground" reports. I sort of stumbled into this topic, having lived in Latin America during the epidemic of the 1990s. Cholera, that classic well- studied -yet- unsolved problem of public health, was what brought me into the field in the first place, so it's only fitting (though unintentional) that my first "real" paper be an attempt to wrestle with it.

"Knowledge alone is not enough to change behavior"
"An educational curriculum is NOT a health promotion program"

New mantras- they don't replace DNA => RNA => Protein though.

Bits and pieces...tools in a toolbox...

These things take time.

Wednesday, March 11, 2009

no more ghetto

Some days I really miss my Conservative Christian Ghetto. That place where no one admitted to smoking or drinking, divorce was unforgivable, people with same sex attraction were sick and twisted, and the goal of everything was to lead people to a personal relationship with Jesus Christ.

I'm not romanticizing that place. . . but everything made so much sense there. The black and whites of "never do anything that might possibly cause anyone to stumble," "love the sinner and viciously condemn the sin," and "you have a responsibility to share the Gospel with everyone you meet" are difficult to carry out, but simple in conception.

I don't know when I left it forever. It could have been the day a left-leaning Episcopalian priest's daughter became one of my best friends. Perhaps it was the day I enrolled in college as a biology major. Maybe it was the day the guy with whom I danced my last dance at senior prom hung himself.

Somewhere along the way I left it, and there's no going back to easy answers. Soon, I will be receiving my first lesbian wedding invitation, from someone who has been a dear friend for twenty years. She has very different ideas than I do about how to interpret Scripture, and she and the woman she'll be spending her life with are both very committed Christians, active in their church. On occasion I get 3 AM phone calls, as a friend leaves the gay bar he works at to drive home to his boyfriend. I listen to his questions- which are so often the same as mine. "If God wants me to love Him, shouldn't He make it easier?" "Why should I believe that God is more than a Cosmic Sadist?" "Why did God allow sin, injustice, torture, Why doesn't He rescue the innocent and powerless?" This friend is asking questions again, after a season of being satisfied with Richard Dawkins and vodka. I'm proud of him, and I can't say that I would bother, after tragically losing a marriage and being "turned over to Satan" by a church.

Jesus not only loved sinners, he let sinners love him. These two have certainly loved me, during some of the toughest days of my life.

So when I'm handed information about GLBQT issues and health disparities, I can't just let it wash over me. It matters that men who have sex with men have a higher rate of HIV infection...and it matters that African American women (thanks to the men who have sex with women and men phenomenon) have ridiculously high rates of new HIV infections compared to the rest of the US population. And it matters that lesbian women have higher rates of cervical cancer. It also matters a heck of a lot that people who are involved in homosexual activity (probably not the current/correct phrasing) fear "coming out" to their healthcare providers. I am an evangelical who takes Romans 1 at face value. However, that doesn't trump my conviction that everyone should get adequate (well, ideally. excellent medical care).

How do I be Christlike in engaging homosexuality as an individual, with those I love (and love me)?

How do I be Christlike in engaging homosexuality as a public health proffessional?

(and that's just one of the "how do I go about being a Christian in public health?" questions)

Wednesday, March 4, 2009

Stage Theory and the Movies

Somewhere, in my daily routine of prowling through news and blogs, I stumbled across the upcoming film A Powerful Noise. While I added it to my mental list (along with Milk and Slumdog Millionaire) I found myself annoyed by what feels like a glut of "activist movies" in recent years.

On one level, I feel guilty about that annoyance. My sister considers me an "Eco human rights nazi," and she's not without cause for that assumption (the organic tea in my cabinet, my canvas grocery bags, and personal boycott of Hershey, Nestle and M&M/Mars, for example) I have been thrilled and grateful that movies like Hotel Rwanda, Amazing Grace, and the three above are being made and watched. However, I'm perturbed that what I see happening is people watching these movies, having an extreme emotional reaction and then joining half a dozen facebook groups.

Then it clicked- stage theory. The bane of my existence this semester has been a class called "The Theoretical Foundations of Health Promotion". It has been centered around learning about various theories of human behavior (specifically related to decision-making and behavior change) and their limits and usefulness in health intervention programs. Depending on which model of stage theory you embrace, there are 7 (Precaution Adoption Process: Unaware of Issue, Unengaged by Issue, Undecided about Acting, Decided to Act, Decided Not to Act, Acting, Maintenance) or 6 (Transtheoretical Model/Stages of Change: Precontemplation, Contemplation, Preparation, Action, Relapse, Maintenance) stages.

The beauty of stage theory, and why it's revolutionized public health, is that it allows programs and interventions to reach out to individuals who are not currently aware of a need for change. Which helps me see that, yes, there is a place for emotional humanitarian films -they shock people who are unaware of issues and pre-contemplators into acknowledging injustice. However... I'm not sure that connects to making them aware of the injustice that is currently taking place around the world. I'm fairly certain it doesn't motivate them to ask how their daily comforts and indulgences encourage injustice, and there certainly seems to be little organization around making the connections between the ugliness on screen and change in behavior.

So, where do those of us who are (or are becoming) community organizers, human rights advocates, public health professionals meet and further engage the movie viewers? Once the world is on the silver screen, how does it move into people's hearts?

One line from Hotel Rwanda has driven me for years:
"I think that when people turn on their TVs and see this footage, they'll say, "Oh my God, that's horrible," and then they'll go back to eating their dinners."

I've not yet found where it's driving me.