Do people need information?

from a mosaic mural by Ben Shahn; image from here

I have occasionally pooh-poohed the idea that what people need in order to change their health behaviors is information. I bristle at phrases like "we need to educate women"*. One of my major gripes with text4baby was that the whole shebang is based on the idea that pregnant women just need better access to accurate information.**

Maybe I should step back and explain why I've had this opinion before I go on to say that I was maybe wrong.

There are a few prongs.

• First, it's kind of insulting. I think public health overall is really bad at this, e.g. Look at all these bacon-eaters/heroin-shooters/couch-potatoes/cig-smokers/unsafe-sex-havers/reckless-drivers; let's tell them they shouldn't eat bacon, shoot heroin, potate couches, smoke cigarettes, have unsafe sex and/or drive recklessly. Because surely they don't know this already. My thought has always been along the lines of of course everyone knows that already.
• Second, even in cases where people do in fact demonstrably 'know better,' they often demonstrably don't act in the best interests of their health. There are a billion reasons, from health is not my top priority to bacon is yummy to I'd have to take 3 buses to get to the clinic and the fare just went up again. Just telling them which other possible worlds are better for them doesn't cause them to inhabit those worlds straightaway.

OK, but then again,

• Is my assumption that of course everyone knows that already coming from a place of privilege? I grew up in a house full of books and smarty-pants dinner conversation where you could be put on the spot for what you knew or didn't, and attended good schools, and have had time and money to invest in becoming at least moderately health-literate. To the extent that I extrapolate from what it's like in my head to what it's like in other people's heads (hint: a lot), my ideas about what people know or don't know might be off.
• Furthermore, I know nothing. For example, before I got snagged and fascinated by childbirth, here's what I knew about it: inhumanely painful. And here's what I knew about breastfeeding: [crickets] and make sure you cover up.
• We covered breastfeeding in class (Women, Children and Adolescents: A Public Health Approach) on Thursday. Now, this is a class comprised entirely of women, all of us pursuing higher education, all of us childbearing age, all of us choosing to be in a class about women's health, and it became immediately obvious that collectively, we knew just about nothing about breastfeeding. The TA, bless her patient midwife's soul, answered the following questions: is it bad for the baby to breastfeed for too long? is it bad to breastfeed two babies at once? doesn't it make your boobs sag? how much bigger does it make your boobs get when they're full of milk? won't a mom with big breasts suffocate a baby? won't a mom with small breasts not make enough milk? shouldn't you stop when a baby gets teeth? how long is an average breastfeeding session? isn't breastmilk fatty, and isn't that bad for babies?

I wrote previously on this blog that for people to change their health behaviors, information is necessary but not sufficient. In fact, I don't think this is always true; my class on social and behavioral sciences made a convincing case that often people change their behaviors due to marketing influences, rather than any abstract consideration of pros and cons.  For something like breastfeeding,  it's probably more critical and effective to work on public opinion rather than individual knowledge (well, that and eliminating other societal barriers so that women who already want to breastfeed can do so more successfully). However, we also shouldn't assume that the baseline of basic knowledge is high.

I'm being really dithery. Overall, I guess the idea is that it's important not to over- or underestimate the value of providing basic health education. If we overestimate its importance, we will fail to provide the underlying supports that make prudent health behaviors into realistic choices. And if we underestimate its importance, we deprive people of the ability to make a truly informed choice, regardless of how great the underlying supports might be.

I invite your thoughts and comments!

*"we need to educate women" = 19400 ghits; "we need to educate men" = 6880 ghits

**I will eventually stop self-promoting via this paper...I think