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December
2002
Inconvenient
Information
An article
in the New York Times recently discussed the widespread belief among
individuals that vastly expanded government information-gathering
would "only invade someone else's privacy," not records
of their own shopping habits, video rentals, vacation spending,
Internet use and business transactions.
This is the
only the most recent instance where the members of the public reconstruct
information so as to exempt themselves from risk:
- Despite
a steady stream of messages about behavioral health risks from
every possible authoritative source, a recent survey showed that
almost one-fifth of Americans workers rate themselves as being
in excellent health although they are obese, smoke, consume three
alcoholic drinks a day and don't exercise. (Oxford Health Plan
survey)
- Even as
Americans hear alarming news reports of poor quality health care
and frequent medical errors and are bombarded by lists of best
doctors, hospitals and HMOs, less than 1 percent of them report
making changes based on this information. (Harris Interactive)
Just as there are bad doctors (but not theirs!) and bad congressional
representatives (but not theirs!), individuals recognize the general
threat, whether to health or privacy. But in each case, it is
someone else who is threatened.
No doubt this
response is an adaptive way of coping with a world that too often
is flooded with information and that seems dangerous and out of
control. But it is a pattern that should concern those of us who
expect science to guide action to improve health.
I recently
encountered a prominent government research director who noted how
his organization was spending $3 million a year disseminating the
results of its research. But when I asked how much he spent in evaluating
whether the communication was effective, he said he spent almost
nothing. The irony is that people whose life work is scientific
inquiry fail to apply the methods of science to communicate their
findings so that people understand and act on them.
As George Bernard
Shaw said, "The problem with communication is the illusion
that it has been accomplished."
Maybe there
is a threshold for health behavior change. Maybe current efforts
to reduce smoking, increase physical activity and lose weight have
already produced all the changes in individual and professional
behavior that they are going to. Yet how do we explain the successes
of seat belt use, regular Pap testing and putting babies to sleep
on their backs?
Clearly, some
health messages are acted upon. If we intend to reap the benefits
of the nation's $80 billion annual public and private investment
in health research, we cannot be satisfied with the strategies now
in use to communicate the information that it generates. They are
not good enough.
The same scientific
tools and methods we use to generate knowledge about health must
be used to generate knowledge about all-too-human resistance to
inconvenient information.
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