Monday, December 5, 2011

Similarities and changes

This is the the next to the last week of the two classes I teach in the second term at the Johns Hopkins Bloomberg School of Public Health.  I have kept up one blog entry a week during this term, so we have two more blog entries before the term is over.  This morning, in scanning the CNN website, I cam across an interesting article that you can see if you click here.  This article caught my interest for several reasons.

First, and foremost, this I had recently been lecturing in my health economics class about health behaviors.  Along with that face, in the economic evaluation class that I teach online, we have discussed the cost-effectiveness of many health interventions, and behavior change interventions are one of the types of interventions that we can discuss.

Beyond that, I also find it interesting because I belong to a number of diverse social groups.  At least one of them is aimed at health behaviors--specifically running.  The organization called Back on My Feet draws people from the community to run with (mostly) men who are either homeless or in recovery.  The running allows the men to set goals and realize achievement.  There are a few additional services the men receive if they keep up with the running.  The intent is to get them focused on life in general.

The organization seems to work.  If you look at the men involved and the community volunteer runners there are not necessarily a whole lot of similarities in gender (the majority of community volunteer runners are female), weight or BMI.  Why does the organization work while the findings are that positive behaviors are generally easier to encourage/build when we are in similar rather than diverse groups?

I don't have any easy answers.  An obvious answer is self-selection.  The people who choose to run in Back on My Feet (both the men and the community volunteers) have chosen to participate and they know what they are getting themselves into.   The more interesting question is what about incentives or preference formation or constraints or resources suggests that we would do better making positive changes in our health behaviors in groups of individuals more similar to us.  And, on top of that, if we could actually put this fact to use, how would we determine whether it is cost-effective to purposefully form groups of similar individuals?  What if there was simply "open registration" and we didn't get enough of one type of individual--however we might define types?  Should we let people sort themselves or make a conscious effort to engineer certain combinations?

Never any easy answers when it comes to health and health behavior changes.  Most important thing, I think. is to have a goal and to have someone to help you to make yourself accountable for reaching thta goal--whoever it may be.

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