28 World Health • 49th Year, No. 2, March-Aprill996
Culture, health and the media
Moria Tereza Maldonado & Mark Belsey
Keeping an eye open for lost cash. For all too many poor children, the only school is the street.
T
he information and communica- tions revolution has catapulted health information into the headlines of newspapers, radio and television programmes around the world. Lemuel Shattuck, with the Boston census of 1845, was one of the first people to promote data gathering for the development of modern public health programmes, but it was not until the turn of the century that modern market research began, with an American breakfast food manufacturer who did postcard surveys on the readers of popular magazines. Since then, commercial interests have been at the forefront in exploiting the behavioural and com- munication sciences for promotion purposes - with numerous conse- quences, both beneficial and harm- ful, for public health.Positive and negative influences
Traditionally, societies have ex- pressed and reinforced their health
beliefs through their own modes of cultural and social expression, but now traditional beliefs and modern commercial messages increasingly coexist in the developing world.
Public health authorities often be- moan the negative impact of both these influences on health. It is only in the past few decades that leaders in health have begun to understand and tap both sources of public infor- mation for health development. In the industrialized world, health care, nutrition and healthy lifestyles have been popularized in magazines and newspapers, although many of these countries still condone false images, for instance in advertisements associ- ating youth, fresh air and glamour with tobacco products.
The influence of culture and the media on health beliefs is often just a by-product of changing fashions, quickly outmoded or invalidated by subsequent discoveries. Beliefs can also be affected more deliberately, however, for instance through the dissemination of the results of re- search, including stories by health
Popular culture and the modern media can easily mislead people but they can also be used to lead them to better health for themselves and their children.
and science writers in the popular media, or through the explicit efforts of local or national authorities to develop media campaigns and pro- grammes as an adjunct to a larger health promotion effort.
Brazil, with its diversity of cul- tural and social backgrounds, and the coexistence of traditional and modern belief systems, faces a special challenge in conveying health concepts to the public. One of the most successful areas of positive influence has been the promotion of childhood immuniza-
tion, which is now widely accepted
by all segments of the population.
Radio, newspapers and television have been particularly effective in making people aware of the need for preventing childhood diseases through immunization.
On the other hand, breast-feeding serves as an example of both posi- tive and negative influences. Only 6% of Brazilian children are exclu- sively breast-fed after the first two months of life. Radio, TV, newspa- pers and popular magazines, with the support of local and national authorities, present essential infor- mation on breast-feeding and its advantages. But these media have also been known to present advertis- ing and images which associate
World Health • 49th Year, No. 2, Morch-Aprill996
beautiful and well-nourished infants with milk formula and baby foods.
These images of "ideal" beautiful babies have a strong effect on mater- nal emotions. In a programme for
"newborn mothers" in a large hospi- tal serving the poor in Rio de Janeiro, a young woman said, "I don't believe this dirty water coming out of my breast is important for my son. This is not the real milk we could buy, so my baby will not get fat and beautiful like the ones they show on TV." She was referring to colostrum, so rich in substances that protect the newborn against many diseases early in life.
Beliefs come from feelings as well as knowledge
Feelings are difficult to modify, particularly when they are deeply rooted in cultural myths and beliefs.
In many areas of Brazil women will not wash their hair in the first days after the birth of their child because they believe that if they do so they will go crazy. This is the popular explanation of postpartum psychosis or depression. In Zimbabwe there is a common belief that obstructed or prolonged labour is a sign of marital infidelity. Dr Jane Mutambwira trains traditional birth attendants to distinguish between the "medical"
and "cultural" causes of obstructed
labour-showing how the latter are very, very rare and the former should be promptly referred to hospital for care.
Emotional needs, originating in a particular cultural context, may also create obstacles to the absorption and use of correct information. Many adolescent girls in some cultures become pregnant despite access to contraception. The wish - some- times unconscious- to get pregnant as a means of attaining the status of a woman, or to prove to themselves that they are fertile, is a powerful factor undermining the influence of correct and sensible information.
Programmes that integrate scien- tific concepts and popular culture must take into account the subtle ways in which thinking and feeling are intimately combined, thus im- proving the likelihood of messages being absorbed and acted upon by the community. The work of Dr Galba Araujo in the poverty-stricken regions of north-east Brazil, illus- trates this principle. He noted that mothers brought their dehydrated children to the hospital only when they were almost dead, and only after first taking them to traditional heal- ers -women who knew special prayers for dealing with this condi- tion. By working with these women and convincing them to include oral rehydration therapy with their
A school in Brasilio. Schoolchildren serve os promising pathways to convey health concepts to the general population.
29
The "polio drop". Thanks to public information
drives, immunizaion is now accepted widely by the population.
prayers, he enabled them to become more effective as community health agents, with far greater influence than the doctors in modifying the beliefs of the community. Dr Araujo had a similar impact on maternal and perinatal health when he encouraged the traditional birth attendants to attend deliveries in health centres and posts where more skilled support was available in case they ran into difficulties. Recognizing the physio- logical advantages, he also supported the birth attendants in their prefer- ence for the traditional manner of giving birth in a sitting or squatting position.
These are just a few of the many examples that exist of how both traditional beliefs and the modem media can be used to promote good health. •
Or Moria Terezo Moldonodo is a psychologist and on author. Her address is Av. N.S. de Copocabono 1394/602, Rio de Janeiro, 2207Q-O 10, Brazil. Or Mark Belsey is Programme Manager of the Maternal and Child Health and Family Planning Unit, World Health Organization, 121 1 Geneva 27, Switzerland.