There are know solutions to some of the world’s biggest health problems, but they are not applied. The problem is that ‘simple’ ends up not being so simple. For example, one of the best ways to ensure that a baby gets the right nutrients is to breastfeed. This is especially true in developing countries where the food options are often sparse and lack essential vitamins and minerals. All a mother has to do is feed the baby with the milk that her body naturally produces.
Sounds easy enough.
In the end it is complicated. Breastfeeding is time intensive and can be painful for some mothers. Dr. Karen Grepin, a NYU health researcher, refuted the idea that breastfeeding is a simple solution in a blog post last year.
I can tell you from first hand experience, breastfeeding was among the most physically and emotionally challenging aspects of raising my own son.
My son was born a week early by cesarean section due to the fact that he was breeched. This delivery likely delayed my own milk production and I spent four very distressed and agonizing days watching my son shrivel up because I was so hell bent on making breastfeeding work. The simple solution would have beee to supplement his feeding. The advice and support I received from the breastfeeding experts usually took the form of one counsellor telling me to only do Y and whatever I do don’t do X only to be followed up by another counsellor telling me to only to X and never to do Y. Oh, and I did I mention how painful it was? Picture cracked, bleeding and infected nipples and a whirlwind of hormones. Yeah.
Dr Atul Gawande, a Boston-based physician and regular contributor to the New Yorker, compares the way that the medical community accepted anesthesia verses accepting measures to prevent sepsis. In the case of anesthesia, the discovery that using gas with ether can knock out a patient and allow him or her to feel no pain was a stunning achievement. Major procedures performed without significant pain management tools was slow and hard for the doctor, let alone excruciatingly painful for the patient.
The idea spread quickly.
In the 1860’s, roughly 20 years after the discovery of anesthesia, Edinburgh-based surgeon Joseph Lister discovered that keeping surgical tools and all that surrounded a patient clean helped significantly reduce infections. Sepsis killed as many as half of all people who went under surgery at the time. Testing by Lister helped him develop an acid-based solution that may now be better known as an anti-septic.
Findings were published in the British medical journal The Lancet in 1867, but doctors did not take up the changes for decades. Why the difference? Gawande attributes the fact that anesthesia provides an immediate benefit to both doctor and patient while anti-septics add more work as a part of why two known solutions did not spread as fast as each other.
Many solutions aren’t ones you can try at home, and that’s part of the problem. Increasingly, however, women around the world are giving birth in hospitals. In India, a government program offers mothers up to fourteen hundred rupees—more than what most Indians live on for a month—when they deliver in a hospital, and now, in many areas, the majority of births are in facilities. Death rates in India have fallen, but they’re still ten times greater than in high-income countries like our own.
Not long ago, I visited a few community hospitals in north India, where just one-third of mothers received the medication recommended to prevent hemorrhage; less than ten per cent of the newborns were given adequate warming; and only four per cent of birth attendants washed their hands for vaginal examination and delivery. In an average childbirth, clinicians followed only about ten of twenty-nine basic recommended practices.
Behavior change is emerging as one of the ways to deal with these challenges. Campaigns try to encourage people to make smart health decisions (ie. wear a condom during sex, exclusively breastfeed for the first year, wash your hands before eating, etc.) through advertisements, radio programs, community leaders and more. Doing it well requires having a strong understanding of each community.
“To create new norms, you have to understand people’s existing norms and barriers to change,” writes Gawande. “You have to understand what’s getting in their way. So what about just working with health-care workers, one by one, to do just that?”
He goes on to say that we need to take a more sales-minded approach to making sure that the simple health solutions that are proven to work are actually put into action.
Simple “awareness” isn’t going to solve anything. We need our sales force and our seven easy-to-remember messages. And in many places around the world the concerted, person-by-person effort of changing norms is under way.