Tuesday, January 23, 2018

Herd Immunity and Other Civics Lessons


On Jan 15 Aaron E Carroll (NYT,  Section, The Upshot) wrote a good article about why the public should get vaccinated against flu - Still Not Convinced You Need a Flu Shot? First, It's Not All About You.

While urging the public to do so is a perenniel pursuit, Carroll focuses on the role of herd immunity

Photo & captions from NYT article 

I quote the author here - 
"If you fall into one of the lower-risk groups (i.e., adults age 18-50), you might still think that the flu isn’t such a big deal, and that you don’t need to worry much. I could argue that there’s evidence that even if the shot doesn’t prevent you from getting the flu, it could make your illness less severe. But even this misses a huge point. You don’t get immunized just to protect yourself. You also get immunized to protect those who can’t protect themselves."(my bolding) 

Carroll makes his point further by citing statistics of childhood deaths from chickenpox  between 2004 – 2007.  No children died of chickenpox during these years (US), even though young children are not given the vaccine.  

Carroll explains - 
"But, their older siblings were – thus protecting them from getting sick…and perhaps dying. “That achieved the herd immunity necessary to slow or prevent the rates of infection significantly.”

For many years I've thought about health and science concept such as herd immunity and tracked if and how they are embedded into health messages for patients and the public. In short, I don't see this important concept foregrounded enough. 

I'd like to introduce the way my co-authors and I talk about the aspect of health literacy related to seeing oneself as part of and a contributor to the larger group's health and well being ( Christina Zarcadoolas, PhD., Andrew Pleasant PhD., & Dr. David S Greer, ) in Advancing Health Literacy: A Framework for Understanding and Action, Jossey Bass 

In that book we defined a component of health literacy we call CIVIC LITERACY. 

In part, "Civic literacy includes understanding how to act with the collective good in mind (Gaventa, 1993; Kawachi & Berkman, 1998)."

 "When a person has both a sense of individual and collective identity they are better prepared to consider and coordinate personal and collective interests.  Civic literacy comprises a range of understandings including:
Judging the sources of information 
Judging the quality of information 
Knowing where and how to access information 
Knowing how to advocate for yourself and others 
Understanding the relationship between your actions and the larger social group 

I continue to believe that health education/outreach, health messages and campaigns can be strengthened by integrating the role that civic literacy plays. Using more positive framing than negative/punitive, health messaging can use dual benefit strategies - ("Take the Stair: Burn Calories + Save Energy ).  It's equally important to not assume that people "get it." 
Real world example - take the stair signs.  They're fairly ubiquitous in NYC building now.  When they first started to be displayed about 5 years ago, in my best non-intrusive ethnography fashion, I'd simply ask people about the signs as we stood at the elevator.  I can't tell you how many people grumbled,  "I don't think taking the stairs is gonna save me any energy." 
Advice:  You have to make sure you explain the dual benefits effectively.   

Messages implicating the consumer's responsibility to consider and protect the health of others can strengthen campaigns ranging from second-hand smoke, and handwashing in hospitals, to disaster evacuation directives and, of course, flu vaccination. Creating patient/consumer messaging that taps into and advances a person's civic health literacy would be a very good thing. 

Carroll's phrase - It's Not All About You - would be a perfect start.