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Understanding Local Community Resistance

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Understanding Local Community Resistance

To: The Health Communication Social Network within The Communication Initiative - including the Market Place for International Development

From: Chris Morry

I wanted to let you know about a new publication from Dr Sebastian Taylor titled "Culture and Behaviour in Mass Health Interventions: Lessons from the Global Polio Eradication Initiative". You can read a summary of the paper on CIs polio website here. Dr Taylor has worked on several polio communication reviews, is on the polio Technical Advisory Group for Pakistan and Afghanistan and has written several other papers on polio communication.

In this paper he poses a number of challenging questions regarding how the polio programme evaluates and responds to communities that resist immunisation. In his own words the main thesis is that, "Interpreting resistance to vaccination as essentially religio-cultural marginalises an understanding of resistance as the rational and strategic response by households and communities to systematic conditions of inequity and exclusion."

I'd be interested in hearing your perspectives. Does this analysis ring true to you? Do we leave the polio programme and other health interventions vulnerable by seeking overly simplistic explanations for resistance? Do we place too much emphasis on a lens that paints such resistance as a matter of poor information, ignorance or propaganda?

In support of his thesis Taylor notes that culture "has been treated as a dominant factor determining resistance to vaccination" in the GPEI. This resistance, "often occurring in areas with substantial Muslim population, has been associated with fear and rumour fuelled by ignorance", as well as religious objection, which he describes as "problematically merged in a religio-cultural interpretation of resistance as a kind of Islamic obscurantism." Yet attitudes about the polio programme "appear to vary substantially within small geographic areas. Rather than being a matter of common belief, public orientation appears to be shaped by a combination of religio-cultural and more localised socio-economic and political factors - in particular, the potentially aggressive nature of mass vaccination, and the perceived under-supply of other development goods."

Just to reiterate that you can read a summary of the paper on CIs polio website here.

Please do respond to these questions:

  1. Does this analysis ring true to you?
  2. Do we leave the polio programme and other health interventions vulnerable by seeking overly simplistic explanations for resistance?
  3. Do we place too much emphasis on a lens that paints such resistance as a matter of poor information, ignorance or propaganda?

Unfortunately Dr Taylor's full paper is only available through subscription to the Journal of Critical Public Health. You can read the abstract and purchase a copy here.

Apologies if any of you are also part of the Polio Network and received a duplicate version but I felt this was worth sharing with both groups.

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Re: [Health Communication] Understanding Local Community Resista

To: The Health Communication Social Network within The Communication Initiative - including the Market Place for International Development

Bina Valaydon proposes a test for the Taylor thesis on community resistance

Chris, thank you for sharing Dr.Taylor's publication. I haven't read the publication as I have just received it so I may be partially informed. However, if the main thesis is "Interpreting resistance to vaccination as essentially religio-cultural marginalises an understanding of resistance as the rational and strategic response by households and communities to systematic conditions of inequity and exclusion", then it would be interesting to test this thesis by comparing the current findings with "immunisation resistance" in wealthier nations such as USA, UK etc. In the article below, health officials refer to "philosophical differences" as the main factor explaining resistance to measles vaccination resulting in an outbreak in Orange County - see the link below. http://www.cbsnews.com/news/measles-outbreak-in-orange-county-california-worst-in-decades.

Bina Valaydon

Re: [Health Communication] Understanding Local Community Resista

To: The Health Communication Social Network within The Communication Initiative - including the Market Place for International Development

Cornelius Wambi Gulere provides a local community perspective on the Taylor thesis on community resistance

I think a combination of ignorance and fear is at the center of this so called cultural resistance. We have been running health camps and VCTs in Namutumba district in Uganda for nearly 10 years and we had put together a formidable team of health and community workers in 99 villages. we had even partnered with Peace Corps volunteers and Medical Electives from the UK and other countries. but this created jealousy on the part of the local people and authorities that a local family based NGO could be so successful where they are not. The result was that negative forces in positions of power mobilized ignorant youths to cultivate resistance against our work. The saddest thing is that one of our directors and the Assistant program officer were murdered in cold blood under very dubious circumstances. Yes, it could be a cultural thing but this culture is created by ignorance and fear - in our case, the fear that success of the liitle NGO could lead to political capital and therefore more money. The ignorance is in the fact that the people looked at the short term benefits of money above the long term benefits of community health.

Cornelius Wambi Gulere
Management of Development Consult
Chair, Lusoga Language Academic Board (LLAB),
Secretary, ALLERT Lusoga Chapter

Re: [Health Communication] Dina Díaz on Local Community Resist

To: The Health Communication Social Network within The Communication Initiative - including the Market Place for International Development. Please reply by email to add your perspectives and ideas.

Dina Díaz from Mexico provides her perspective on the Understanding Local Community Resistance thesis from Seb Taylor. NB We have provided an English translation below.

Mi aportación acerca del trabajo del Doctor Taylor es sobre inmunización y específico de la vacuna contra la poliomielitis, en primer lugar Las barreras culturales de las diferentes personas en el mundo tendrán que contemplar la historicidad de cada una de las partes: una contemplar a las personas que van a vacunar ( los profesionales de la salud quiénes son, de donde vienen y cuál es su historia y por qué quieren vacunar a las personas de las comunidades, luego habrá que observar la otra parte que es las personas de la comunidad a vacunar quiénes son, su historia, que comen, como viven y propiciar un diálogo común a través de la comunicación que ellos han tenido a través de los siglos, quizás ellos no usaban las imágenes , quizá ellos se comunican más con ruidos o con sonidos o con danzas, quizás ellos antes de curar deben danzar o bailar ante la naturaleza y después vacunar, habrá pues que conocer como pueden los profesionales comunicar un bien en salud a través del idioma o lenguaje de las personas de la comunidad no con el idioma de los profesionales, así pues primero somos personas, amigos y después podemos hacer mutuamente lo que queramos después de haber obtenido amistad y confianza, los que deberán vacunar son los mimos personas de su comunidad a sus mismos compañeros a sus iguales de color, idioma o lenguaje y costumbres, saludos desde México y aus órdenes...Dina

My contribution on the work of Dr. Taylor is about immunization and, specifically, polio vaccine, first of all. The cultural barriers of the different peoples of the world will have to be considered through the historicity of each of the sides involved: a look toward those who are going to vaccinate - who are the health professionals, where do they come from and what is their history, and why do they want to vaccinate community members - and then, opening the observation of the other side, the people of the community who are to be vaccinated - who they are, their history, what they eat, how they live - and then initiating a common dialogue through the means and style of communication that they have used across centuries: perhaps they use images; perhaps they communicate with noises, sounds, or dances; perhaps they dance before taking a cure, or they dance in the surroundings of nature after vaccination. Therefore, it will have to be known how professionals can communicate good health through the local idiom or language of people of the community - not in professional terminology so much; rather, first, as people, as friends, and, later, we - vaccinators and community members - can take up mutually that which we want, after we have obtained friendship and confidence. Those that ought to do the work of vaccinating are the same people of the same community, compañeros of the same color and language group, with the same customs. Best of health to you, at your service - Dina

Dina Díaz
Coordinación de Desarrollo Institucional

Understanding Resistance - The Health Communication view?

To: The Health Communication Social Network within The Communication Initiative - including the Market Place for International Development

Perceived resistance issues are in the view of many core to improving effective health action. Health communication is vital to that response.

Chris shared an intro to the new publication from Dr Sebastian Taylor titled "Culture and Behaviour in Mass Health Interventions: Lessons from the Global Polio Eradication Initiative". You can read a summary of the paper on The CIs polio website here..

This includes this thesis: that, "Interpreting resistance to vaccination as essentially religio-cultural marginalises an understanding of resistance as the rational and strategic response by households and communities to systematic conditions of inequity and exclusion.". Some responses follow. Please add yours - just click reply and share your perspectives by email.

Dina Díaz from Mexico: "…The cultural barriers of the different peoples of the world will have to be considered through the historicity of each of the sides involved: a look toward those who are going to vaccinate - who are the health professionals, where do they come from and what is their history, and why do they want to vaccinate community members - and then, opening the observation of the other side, the people of the community who are to be vaccinated - who they are, their history, what they eat, how they live - and then initiating a common dialogue ... more at that link

Cornelius Wambi Gulere from Uganda: I think a combination of ignorance and fear is at the center of this so called cultural resistance. We have been running health camps and VCTs in Namutumba district in Uganda for nearly 10 years and we had put together a formidable team of health and community workers in 99 villages. we had even partnered with Peace Corps volunteers and Medical Electives from the UK and other countries. but this created jealousy … ... more at that link

Bina Valaydon proposes checking this thesis by comparing the current findings with "immunisation resistance" in wealthier nations such as USA, UK etc ... more at that link

What is your critical review and analysis? What are your ideas for addressing this issue?

Thanks for engaging - Warren

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