Providing clarity around health is about more than helping people understand a health condition and what to do. It’s about improving health literacy, connecting the dots and giving people the bigger picture.
In 2011, Dr. Dean Schillinger sat in the audience at a Youth Speaks event as poet Erica Sheppard performed: Death Recipe – a spoken word piece exploring how diabetes had spun her family into a cycle of health violence they couldn’t break out of. Erica’s performance shed light on how diabetes is more than a personal challenge with food & sugar, but was deeply rooted in her family’s environment, stress, and barriers to physical activity.
The impact the performance had on the audience was the germ of an idea that would become a unique collaboration between physicians, heath professionals and young poets. At the time, Dr. Schillinger was the Chief of the Diabetes Prevention and Control Program for the California Department of Public Health. And he was looking for compelling ways to raise awareness about the unprecedented levels of type 2 diabetes (T2D).
But beyond shedding light on this invisible epidemic – how do you let people know that diabetes is not just in their family, but their community? How do you convey that unlike Type 1 Diabetes, T2D is not totally outside of their control, but that it’s facilitated by the environment and by companies that target communities and kids with high-sugar products?
When looked at that way, it’s not as much about getting individuals to eat better and change behavior, but about creating clarity and a change in perspective – giving a group of people a new mindset that’s energized by social justice.
The Bigger Picture is born
The UCSF Center for vulnerable populations partnered with Youth Speaks to create writing workshops with young poets. They took a page from the Truth Campaign, which capitalized on how youth respond to anti-establishment messages. So the Bigger Picture went into the schools and worked with student writers, looked at how number of amputations in their communities compared to amputations from the Gulf wars, and looked at how things like soda and candy had become part of their culture and was marketed directly at them through celebrity spokespeople.
For example, they learn that the young people of color who are targeted by the beverage industry are the first generation expected to live shorter lives than their parents.
The students quickly got that it’s not just about “being good” and eating less junk food, but that there are other factors: safe places to exercise, strong marketing, access to fresh food, and even their own cultural norms.
The students filtered the information and insights through their own personal experiences and created spoken word poems that became films. These are not sanitized public service messages for kids like you see on TV. These are compelling, raw, articulate, well produced pieces, filmed in their own neighborhoods that take a hard look at the challenges.
In 45-minute school assemblies, videos are screened, there’s a live poetry performance by a student, and facts are reframed. After assemblies, they consistently see a difference in what the students know about T2D before and after. And when they ask: Who here knows someone with T2D? and all hands go up -- that’s a moment of clarity. It’s not just your family. The epidemic becomes visible.
The Bigger Picture was primarily rolled out in the Bay Area. As of 2016, they started partnering with organizations throughout California that are already working to change environments. The idea is for each community to take a local approach. For example, Stockton is having a potable water crisis - so they incorporated that into the Bigger Picture in that community. Others areas have focused on energy drinks and the combined effect of caffeine and sugar.
Clearly, even for the most motivated individual, it’s a challenge to change behaviors when you live in an unsafe neighborhoods or a food desert. But helping people see their part of a bigger community can pull people out of dealing with these challenges in isolation. It’s clarity not just of the condition, but of its impact on the community – and that clarity can empower communities to act.
Special thanks to Natasha Huey, from Youth Speaks!
Read more about the @BigPicCampaign and check out more of the videos at TheBiggerPicture.org
Geri Lynn Baumblatt is the Executive Director of Patient Engagement at Emmi. She is on the board of the Journal of Patient Experience, a regular contributor to the Association for Patient Experience, and regularly participates in health literacy and shared decision making, patient engagement and experience conferences at organizations like AHRQ, the Brookings Institute, the Society for Medical Decision Making, the Beryl Institute, Stanford Medicine X, and the Center for Plain Language. Catch her in October at MedCity Engage, HARC, and the Partners Connected Health Symposium.