April 7 is World Health Day, a celebration of the founding of the World Health Organization (WHO). As we look at communications efforts to raise awareness about this year's theme of high blood pressure and to change behaviour to help prevent it, we're reminded of some valuable lessons we've learned from women in Guatemala about listening to and supporting the people we our trying to support with our health promotion messages.
Events like World Health Day are an excellent way to focus on prevention and get a groundswell of support and messages out there to reduce chronic conditions like high blood pressure. Those of us who work in the social marketing sector are so supportive of well-designed efforts like this because we know how they can play a role in contributing to an overall health improvement in a population.
But sometimes in our day-to-day public health work, the way we deliver messages can create more obstacles than we realize. Changing behaviour does not come easily to anyone and a behaviour change project requires great insight into people's lives to understand the barriers to change.
Part of our formative research on the Grand Challenges Canada project in Guatemala is to discuss with mothers what their experiences have been like during visits to a health centre with a child sick with diarrhea. We've received really important feedback about how women and their children are being counselled in the health centre.
The major issue? Hearing endlessly about hand washing.
We know that hand washing is such an important part of preventing the spread of disease -- colds, the flu, hepatitis A, pink eye and, of course, diarrhea -- and messaging about hand washing is a key tool in our health toolbox. But we could be potentially alienating these mothers and may even drive them away if all they hear about is hand washing when what they really want is treatment for their children.
"I went to see them [the health centre] when my child had diarrhea, and all they say is wash your hands -- like it is my fault, but I did wash my hands and he still got diarrhea... It makes me want to just walk away," said one mother of three from rural San Marcos.
The reality is that San Marcos is a really impoverished area of Guatemala -- there's rarely any plumbing, (indoor or out) housing is simple (often with dirt floors) and most families raise livestock to feed their families and supplement their income. These mothers are telling us that all the hand washing in the world won't entirely eliminate diarrhea. If hand washing is the primary message they're receiving when they go to a health centre, they may start to feel guilty and not want to go back the next time a child is sick.
Some of the mothers described the messages as condescending. Taking this year's World Health Day theme as an example, if someone is lying on a hospital bed suffering from a heart attack, that would not be the time to start talking to him or her about how important it is to reduce high blood pressure!
Public health clients should be respected and offered carefully chosen health messages that meet their needs and current worries. Making a mother feel guilty or suggesting blame may make her less likely to return to the health centre. It's also a missed opportunity to remind her of the positive impact she is having by bringing the child for treatment. When a child is sick with diarrhea, we have to concentrate on counselling the mother on how to heal her child with the proper use of zinc and oral rehydration salts (ORS).
This doesn't mean that good campaigns to promote hand washing aren't important. On the contrary, they definitely are. But the mothers we spoke to in Guatemala have told us loud and clear that they have to see the value in the information they're receiving -- which means delivering the right information at the right time.
The right message at the wrong time could negatively impact health promotion efforts -- and raise anyone's blood pressure.
Meditation can help maintain a calm and focused mind, but one side benefit of that relaxation could also help with blood pressure. When relaxed, the body produces more nitric oxide, <a href="http://www.npr.org/2008/08/21/93796200/to-lower-blood-pressure-open-up-and-say-om">which in turn helps blood vessels to open up, reducing the pressure of the blood flowing through</a>.
Research shows that <a href="http://www.webmd.com/hypertension-high-blood-pressure/guide/5-ways-pets-improve-your-health">pet owners have lower blood pressure</a> (also: lower cholesterol and heart disease risk), thanks to the anxiety-reducing qualities of an animal companion.
In one 2008 study in the Annals of Behavioral Medicine, <a href="http://www.cbsnews.com/2100-500368_162-3955956.html">researchers found that happily married adults had better blood pressure</a> than happily single and unhappily married adults.
This one's a no-brainer, but exercise is one of the best ways to lower blood pressure. There are many ways that the simple act of moderate exercise can improve your blood pressure (and overall health). First, it helps with other risk factors for hypertension, like extra weight and stress. But exercise also improves the strength of your heart so that <a href="http://www.mayoclinic.com/health/high-blood-pressure/HI00024">it can more effectively and efficiently pump blood, which lowers the pressure on the arteries</a>.
Moderate drinking -- one drink for women and men over 65 and two drinks for younger men -- can actually help reduce blood pressure. <a href="http://www.mayoclinic.com/health/high-blood-pressure/HI00027">But more than that has the opposite effect</a>, according to the Mayo Clinic.
There is some evidence that caffeine can temporarily increase blood pressure, though it's unclear if there is a long-term effect. The <a href="http://www.mayoclinic.com/health/high-blood-pressure/HI00027/NSECTIONGROUP=2">Mayo Clinic recommends</a> checking blood pressure 30 minutes after a cup of coffee or caffeinated soda to see if the effect remains.
Of course, for this and many other reasons, you should quit smoking. But even second-hand smoke can have a damaging effect on your blood pressure <a href="http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/UnderstandYourRiskforHighBloodPressure/Understand-Your-Risk-for-High-Blood-Pressure_UCM_002052_Article.jsp">because it damages arteries</a>.
Several foods have been found to naturally lower blood pressure. Things like chili peppers, chocolate, beans and bananas have all been proven to lower blood pressure in humans or in trials with rats. <a href="http://www.huffingtonpost.com/2012/03/28/raisins-and-7-other-foods-lower-blood-pressure_n_1382535.html#slide=817449">Read on for more here</a>.
Eating well is essential to maintaining healthy blood pressure, but even if you live on <a href="http://www.huffingtonpost.com/2012/03/28/raisins-and-7-other-foods-lower-blood-pressure_n_1382535.html#slide=817449">beans and bananas</a>, extra pounds could harm you. In fact, one Italian study found that <a href="http://www.sciencedaily.com/releases/2007/09/070928180348.htm">hypertension in overweight patients was a secondary condition, caused by the excess weight</a>. In other words, once the weight was lost, the high blood pressure went with it.
Perhaps the best known advice for healthy blood pressure is maintaining a low sodium diet. Follow the <a href="http://health.gov/dietaryguidelines/faq.asp">USDA's Dietary Guidelines for Americans</a>: a max of 2,300 mg of sodium for healthy, young adults -- or 1,500 mg a day or fewer for those who are over 50, African-American or suffering from diabetes or chronic kidney disease.
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