When medicine is not enough…
Since we first began working in rural Kenya in 2006, Common Hope for Health has pursued a fundamentally moral mission: to serve those in greatest need. We are, of course, far from having accomplished this mission. But we have made progress. Over the past nine years, mothers, fathers, and children who previously had nowhere to turn when sick have gained access to compassionate, often life-saving medical care at our health center.
But this progress has also revealed a sobering — and perhaps radical — truth: medical care alone, at least in the conventional sense, is not enough. We experience this truth when a patient’s illness is exacerbated by “non-medical” factors, such as poverty, hunger, gender inequality, and other large-scale social forces. We experience this truth when our chronic disease patients tell us that they know the importance of taking their medications every day, and yet struggle to do so, for reasons such as drug side effects and difficulties in traveling to pick up refills, but also universal mental barriers such as forgetfulness and inadequate planning. We experience this truth when a patient presents with an illness that could have been prevented, be it malaria, malnutrition, or diabetes, for if our goal is health and not merely health care, any preventable illness is a failure.
In these and other ways, every day, we confront the realization that building and running a health center — even a well-functioning, mission-driven one — is not enough. That is why, with the launch of this new website, we are fine-tuning and clarifying our mission. From a prior focus on delivering medical care, we now turn our gaze more directly toward patients and community members and ask, “How can we help them take the best care of their health possible?”
We believe this new perspective casts sharper light on what it takes to improve health, rather than merely provide health care. We believe, in particular, that our mission must also include providing behavior care.
…We need behavior care
At first blush, the phrase “behavior care” might conjure parental connotations: children behaving and misbehaving, parents trying to improve their child’s behavior. Or it might evoke “behavioral health,” which in the United States is often synonymous with mental health. In fact, we mean “behavior” in a much broader sense — in a sense that is empowering, not paternalistic, affirming, not pathologizing. In short, health behavior is all the choices, decisions, and actions we make that shape our health and well-being. We engage in health behaviors 24 hours a day, 7 days a week. What we eat, how we move, who we interact with – in a broad sense, all of these are health behaviors. And while such behaviors are certainly influenced by external factors such as our physical environment, our material resources, and our culture, they are also heavily influenced by internal cognitive processes. And so, thinking about health behavior compels us to think about the brain: how it works, and how at times it enables us to engage in healthy behaviors and how, at other times, it gets in the way.
Put more concretely, think about a health goal that you have. It might be to get in shape, live to an old age, eat healthier, stop drinking sugary soft drinks, avoid the flu, or reduce your blood pressure. All of these can function as health goals because you can influence them with your behavior; otherwise, they would be mere wishes or hopes. For each goal, you can probably think of a set of behaviors that you need to enact in order to achieve the goal. But you probably also recognize that enacting these behaviors — and hence achieving the goal — is difficult.
And so it is for all of us, rich and poor, male and female, young and old: We all have aspirations for our health and well-being, and yet we have trouble matching our actions with those aspirations. Behavior care, as we envision it, aims to bridge the gap between aspiration and action.
How, then, can behavior care turn unhealthy behaviors into healthy ones? How can we truly empower patients to make optimal choices — choices that they themselves would like to make and know they should make? Unfortunately, no one as yet has great answers to these questions. In contrast to the dizzying pace at which new biomedical technologies emerge, the medical community’s armamentarium of “behavioral technologies” — tools to help patients overcome the underlying behaviors that cause disease — remains primitive: an annual physical, a two-minute counseling interview, a telephone follow-up call.
This is where Common Hope for Health can make unique, important contributions. We will continue to pursue our core programmatic work of providing community-based, community-driven primary care in rural Kenya. But we will also create a model for better behavior care, which is ultimately better primary care. We hope to be a global leader in this effort, as we identify key behavioral barriers that community members in Kenya face, develop innovations that lift these barriers, test and evaluate these innovations, and, finally, share the resultant knowledge with the global community. This is truly uncharted territory, and we invite you to join us as the journey unfolds.