Two articles caught my eye today. The first is on some of the experimental programs coming out of the Affordable Care Act to design effective community prevention. But since we don’t see a lot of evidence that awareness-raising campaigns can work in and of themselves, new approaches are being tried out. The article points to distrust of the government, the short-term thinking that results from living in poverty, and easy access to less healthy food as some of the reasons why preventable disease continues to be the leading cause of death in America.
It’s instructive to compare this article to a recent study on the factors leading to maternal mortality in India. Summarized nicely here, researchers from the Public Health Foundation of India (PHFI), the London School of Hygiene and Tropical Medicine, and the University of Aberdeen looked at the success of a recent government program (JSY), a conditional cash-transfer program meant to create incentives for women to go to hospitals to give birth. What looks like thoughtful qualitative work revealed that “good care” looks different to Indian women than it does in many other cultural contexts. Moreover, the structural constraints women face are so great that cash incentives are not likely to change maternal mortality rates dramatically: many women don’t have the right to choose when they want to get pregnant and where they will deliver, and one in three women said they couldn’t go to hospitals because there was no one to look after other children at home.