"To make money, we lose our health and then to restore our health we lose our money."

            I’m back! I’ve actually been home from Botswana for about two weeks, but I’m just now getting the chance to post a blog entry. This is going to be really short, but I just wanted to highlight a few things I learned about the U.S. while in Botswana. I don’t know who said the quote in the title, but I think it sums up something important I learned in Botswana: in the U.S., we seem to take our health for granted, when in reality it is the most valuable thing we have.

            Botswana had a very large Ministry of Health (MOH), and as a result, I think the entire country was pretty health-conscious. The mindset there seemed to be that prevention is the best option, and the next option is treatment. In the U.S., I think that culturally there is a norm to just assume that if you fall ill, the doctor will be able to fix it. Taking steps to improve health and prevent disease is often considered something that only “health nuts” do. However, the reality of the situation is that chronic disease, which includes heart disease, stroke, cancer, diabetes, and arthritis, is the leading cause of disability and death in the U.S. And the four most common causes of chronic disease are what the CDC describes as “modifiable health behavior”—lack of physical activity, poor nutrition, tobacco use, and excessive alcohol consumption (http://www.cdc.gov/chronicdisease/overview/index.htm). Making healthier choices could prevent or prolong the advent of chronic disease for many Americans.

            I think this is the area in which having a strong public health body could truly benefit the U.S. I’m not calling for universal healthcare or socialized healthcare (that’s an entirely different discussion). I just feel that the government sees health as something that pertains to individuals rather than populations, which is simply not the case. Public health is a unique sector of the medical community because it aims to improve the health outcomes of many individuals at once. Because, at the end of the day, we are not as unique as we think we are. The majority of us, and I’m certainly guilty of us, don’t always take care of ourselves as well as we should. And this creates a vicious cycle. Disease takes its toll on the body and the mind. How can someone with constant pain due to arthritis be productive at work? How can someone who is addicted to cigarettes focus when the only thing they can think about is their next smoke break?

            This is where public health, specifically the field of behavioral epidemiology, comes in. Behavioral Epidemiology focuses on public health issues that stem from the practice of certain behaviors. As I learned in Botswana, behavior change in a population is very difficult to accomplish. In the 1990s, when Botswana had the highest HIV prevalence in the world, the government began implementing education and prevention initiatives throughout the nation. Then, once anti-retroviral (ARV) medications became available, the government invested in those medications, providing them for free to all HIV-positive citizens. Although the introduction of ARVs did cause a significant decrease in Botswana’s HIV prevalence, the numbers have now hit a plateau. This is because, for the majority of the population, awareness about HIV has not translated into behavioral and lifestyle changes in sexual behavior. Botswana’s Ministry of Health is aggressively promoting behavior change through many initiatives.

            Behavior change is induced by the creation of persuasive health messages, which is the focus of many of my communication classes. When a message is effective, it disseminates information in a way that causes cognitive dissonance for the person receiving the message, forcing that person to reframe previous beliefs and ideas into a new paradigm that incorporates the message presented. In Botswana, I was able to see firsthand how the use of convincing health messages induced behavior change, especially among the youth, which is now the subgroup with the lowest rate of new HIV infections. I believe what I learned in Botswana can be directly applied at home. As a physician, I will have to promote behavioral change in order to improve the health of my patients, especially since chronic disease, is best dealt with by changing behaviors. However, my individual efforts are not enough. The U.S. needs to experience a cultural shift which puts health at the forefront of our lives. And, I think the U.S. government should be instrumental in creating that shift. The government should invest in public health because it is an investment that extends the life and enhances the productivity of the nation. Healthy people are simply able to do more and be more effective in their work.

            I think that ultimately, my experience in Botswana has taught me the importance of communication within the realm of public health. While learning effective ways to communicate with my patients is vital to my future career, I now recognize the importance of learning to communicate health information to the public in a way that will induce the behavior changes necessary to improve health at the macro level. As Paul Rusesabagina, the man who inspired the film Hotel Rwanda, states in his memoir, An Ordinary Man: “Words are the most effective weapons of death in man’s arsenal. But they can also be powerful tools of life. They may be the only ones.”

P.S. In the next few days, I’m going to be posting my journal entries from each day in Botswana, so you can read about what we did there, so keep checking for that! Happy April!