Sunday, June 17, 2012

A Public Challenge

It's been a long time since I've watched a telethon.  I have more entertainment options at my disposal than I used to.  Yet I definitely have childhood memories of not only the Jerry Lewis Labor Day telethon, but PBS fundraisers, which that network seemed to air with the regularity of Sesame Street.  I don't ever remember giving anything on any of these occasions (I had a limited budget and no checking account or credit card), but I nonetheless emotionally invested in the fundraiser's ability to meet certain "challenges."  As a clock ticked down, I would hope against hope that random strangers would call in pledges so that the challenge could be met (and they usually were...funny how that worked). 

I'm not sure if anyone has ever done a study to compare such a technique to a control technique in which dollars are solicited without suggesting a desired unified total within a limited amount of time.  But it does seem that people respond to the concept of a "challenge," even if logically there is no real reason for the challenge or particular benefit for its attainment.

And yet, how rarely do we see instances of "challenges" outside of sales, marketing, or fundraising efforts.  We are told all through school that "setting goals" is important, and most of us do operate with some long-term aspirations that we might call "goals," and many of us set short term "resolutions" for ourselves, but unless you are a contestant on a reality television show, rarely do people live life responding to any kind of concrete, tangible, dictated "challenge."

Even rarer (in practice if not in theory) is the idea of a societal challenge.  The most famous one that I can think of is JFK's appeal for a man to be on the moon by the end of the 1960s.  Actually, that's the only successful one that I can think of at all (alas, we failed to meet the "George W. Bush challenge" of going to Mars by the end of 2010).  There have certainly been public health challenges that have received some degree of publicity.  I am particularly nostalgic for the optimism expressed in the idea of a "smoke free class of 2000."  And much as I would love for Michelle Obama to successfully inspire the end of childhood obesity within a generation, I fear that we will see the end of underage smoking prior to the end of childhood obesity.

Of course, bold challenges in the public health realm are likely more about raising awareness and inspiring an incremental change rather than any realistic hope of attaining the totality of the stated goal.  But what would it take to truly accomplish a radical paradigm shift?  It would probably look something like this--an article in the Journal of the American Medical Association that suggests that "preventable" childhood deaths can be wiped out the way that smallpox was wiped out.  I'm not going to pretend that I understand all the math in the linked article, but it's obvious that this isn't a mere P.R. vehicle.  These researchers truly believe this can happen and they present a formula for how it can happen.

It's intriguing to consider this article in tandem with this other one that I ran across a few days ago.  With the technology that exists now, it's not difficult to envision a time in the not-too-distant future when automobile collisions could be almost completely eliminated.

If the possibility exists, all that is needed is motivation.  And what could be more motivating than a concretely-stated public challenge?  Everybody loves "grass roots" efforts, but it seems to me that there is a time and a place for the top of the plant to shake up the roots.  Maybe we can get PBS to put up a constant countdown ticker until all "preventable" deaths are prevented.


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