Evaluating Impact: Storytelling Versus Metrics, Which Matters?

Stories can capture the heart of a person like a number or statistic never can. Even mind-boggling statistics are just that – incapable of being fully processed and affecting us into action. Human experience on the other hand, touches us deeply and creates empathy that we are unable to ignore.

On Thursday, I listened to Jessica Jackley (co-founder of Kiva and founder of Profounder) and Jennifer Aaker (Stanford Business School Professor and author of The Dragonfly Effect) talk about the power of storytelling. It was at a Philanthropy and Civil Society event at Stanford University that was supposed to be on social media, but focused on something much more enlightening: the power of people's stories.

Many people are talking right now about the importance of metrics in measuring nonprofit impact. Metrics quantify activity and changes that are seen as a result of a program, service, or policy. While there is a place for metrics and quantifiable successes, I believe it can’t be the only way we assess change.

While some questions are amenable to a single numerical answer, many are nuanced and require skill in listening, capturing, synthesizing and communicating in creative qualitative ways. The latter begins through asking thoughtful questions and consequently by listening to peoples’ stories.

There are two reasons that we must consider the questions we ask about impact and how we gather information to answer those questions, whether through collecting numerical data or capturing stories.

Veritas Health: Evaluation Unplugged

Greeting from California!

Veritas Health has officially relocated to the West Coast. I'm excited to start putting my newly minted Harvard degree into action. I am now working for FSG, a nonprofit strategy consulting firm, in San Francisco as an evaluation consultant.

I've been learning every day how my public health training translates into skills and expertise as a strategy consultant, and I'm sure it will take a long time to figure out how (if at all) those two totally align. But what I love about my job right now is getting to integrate my data and analytical savvy with advice for decision-makers in real-time, which is a very cool opportunity.

In addition to my day-to-day activities (mostly related to data collection and analysis), I am learning about a whole new sector: funders! I am living and breathing philanthropy in a way that I never would have expected two years ago.

So what does this mean for Veritas Health? Even though I have put off writing in this blog for the past few months, I believe there is an important role that this blog could play in the field. I hope one day this project goes beyond just a place for my friends and family to find out what I've been thinking about, but really provides stories and tips that are useful to others promoting public health!

That means that I am recommitting to writing regularly in Veritas Health. You'll see a new approach to public health issues on the site: one that places considerably greater emphasis on evaluating social sector initiatives. I hope that this will provide a forum for individuals, nonprofits, and funders to be inspired, learn, and make a greater impact in their community.

Happy reading. More to come!

Documentary Film Discussion "The Day My God Died": Child Sex Trafficking in Nepal

In Nepal, a small country in South Asia, hundreds of children are trafficked into work as sexual slaves each year. While nonprofits like Maiti Nepal have emerged to fight, prevent, and assist victims of sex trafficking, political, social, and economic circumstances in and around Nepal have created conditions where child slavery and trafficking persist.

A film that documents the personal, social and human rights abuses of child trafficking, "The Day My God Died" was recently screened at Harvard University (I found the video via the Geo Blog). A panel discussed the film following the screening and was hosted by the Carr Center for Human Rights Policy at the Harvard Kennedy School of Government.



Anuradha Koirala, Founder and Executive Director of Maiti Nepal, was among the panelists.

In attendance were academics, journalists, and anti-trafficking/slavery activists. One of my favorite questions was: "What do you think needs to happen in the Nepal, India and the US to change the social mindset so that...you can not buy another human being, that it will not be tolerated." The question was asked by a woman working to curb the commercial sex trade through reducing demand for commercial sex among men.

Koirala responded without hesitation: "Education. Education. Education. Awareness."

Watch this short video - or find a way to view the film. I'll be looking for an opportunity to see it, as well!

Since 2001 the US government has supported anti-trafficking programs in Nepal. For more information on the U.S. anti-trafficking policy in Asia read this November 2009 USAID Trafficking in Persons report.

Guest Post: A ridiculous burger

As you are probably aware, this is a time of transition for Veritas Health. I just completed my Master's degree from Harvard School of Public Health and am moving back to the San Francisco Bay Area to begin a new phase in my public health career.

Interviewing and packing has been taking up a lot of my time these past few weeks - so I am extremely grateful to Jessica Yen, who serendipitously offered to write a guest post for VH. Jessica is a great friend and public health colleague and I hope that you enjoy her writing and insights as much as I do!
- Katelyn Mack

A Ridiculous Burger
by Jessica Yen

The other day my roommate saw a report that Lotteria, a fast food chain restaurant in Japan, has a new ten-layered hamburger called the “Cheeseburger Tower.”  Ten slices of cheese alternating between ten beef patties, the burger will subtract ten dollars from your wallet and add ten points to your cholesterol level. 

The ad claims that they created the Cheeseburger Tower in response to customer demand, but really now – I’d like to have seen those focus groups!  And although one would hope that such a menu item could not possibly catch on among Japanese consumers, it’s the broader health implications that worry this household of self-professed public health nerds.

Lead Poisoning - A true global health problem

Around the world children are dying from lead poisoning and many more suffering from the neurological and physical health problems associated with lead exposure. In one region of Nigeria, lead poisoning has caused an estimated 163 deaths, mostly among children.

CNN ran a lead story on the tragic developments this week, even though it seems that the problem was first recognized back in January. Lead is a toxin that can cause serious neurological problems and even death in young children, as well as adults. The most commonly cited consequences of lead poisoning in the US are learning disabilities and behavior problems.

I am mostly familiar with the problem of lead poisoning affecting children and families through inadequate housing that contains lead-based paint. However, in the Zamfara State of Nigeria, the region where these recent lead-related deaths are concentrated, the source of lead exposure appears to be the minerals brought home by workers from the mines.

Gates Pledges $1.5b for Maternal & Child Health

The Bill & Melinda Gates Foundation has pledged $1.5 billion over 5 years to improve systems that will reduce maternal and newborn deaths and illness in the developing world. The announcement came yesterday during the Women Deliver conference.

I heard the story first on NPR  - you can access their brief interview with Melinda Gates here. But this story peppers papers from the Wall Street Journal to USA Today and has now made headlines on Politico and the Kaiser Family Foundation websites. Melinda Gates wrote her own article, 'A New Vision for the Health of Women & Children' in the Huffington Post.

The Gates Foundation sees this clearly as an area that requires public-private partnerships. In other words, they recognize that in the case of maternal & child health private organizations and nonprofits cannot have meaningful, sustainable change without the support of local and national governments.

Improving consistent access to contraceptives to prevent unwanted pregnancy clearly appears to be a major focus of the Foundation's efforts.

This investment is great news for the field of maternal and child health -- and will hopefully raise these issues to greater prominence both here in the US and abroad. In addition to raising awareness, effective use of $1.5 billion ought to have considerable impact on the health of women and children - and I hope to see and read about these improvements.

Task Force Releases Report on Childhood Obesity

To rollback childhood obesity in one generation.

Ambitious goal - to get the prevalence of childhood obesity down to 5% by 2030. No society has ever succeeded in undertaking such an enormous task - one that is complicated by deeply ingrained norms around diet and exercise, a well-financed commercial industry (not only fast/junk food, but also when it comes to diet and weight loss), and a general distrust of government-led initiatives.

The White House Task Force on Childhood Obesity released its report (commissioned by President Obama on February 9, 2010) and it combines the best evidence for tackling weight gain among our nation's kids.

It quickly lays out the facts: our children are fatter than ever and it is impacting their health.

Updating Nutrition Labels

It was only 20 years ago that we began seeing uniform nutrition labels on processed food products telling us how many calories, how much fat and sugar, and what nutrients are in the food we eat.

But many health groups believe it's time to update nutrition labels. I agree that it's time to give consumers information in a way that is useful and helps people make healthy choices. In this week's Time, the Center for Science in the Public Interest suggested a few updates for the Nutrition Facts label.

One suggestion was to make "unhealthy" content like sugar and fat stand out using different colored text. I think that this could be misleading, given that not all fat is bad for you and it could lead to making less healthy choices. However, I love the idea of having the calorie count (per serving and per package) displayed clearly on the packaging. This is particularly important for beverages and "snack" foods -- like those $.99 chips or peanuts that are usually 2.5-3 servings and many more calories that people probably realize!

I would make it easier to read nutrition labels by changing words such as "sodium" to "salt". Hopefully innovators will see this as an opportunity to create a change in a space that will affect millions of peoples' food choices over the next few decades and will get involved.

How would you change the nutrition label?

Remember the Food Pyramid?

Every five years the US federal government reviews the Dietary Guidelines for Americans. Remember the days of the "Food Pyramid" and then the recent 2005 edition of the "My Pyramid"? Well, if you missed my past post on the topic you should see the Harvard School of Public Health rendition - the Healthy Eating Pyramid - which has a much simpler and scientific food guide for health!

Marion Nestle noted author and public health professor said in a blog post in the Daily Green today that the new recommendations acknowledge

"The need to change the food environment to help individuals meet the Dietary Guidelines."

This is a huge step in the right direction. No longer are our food addictions being looked at simply from the perspective on the individual, but as rooted firmly in the policies and norms of the communities we live in. Our environment impacts our choices, and our food choices affect our health.

There will be an opportunity for public comment on the new guidelines early this summer.

Allentown High School Student Wins Top Public Health Honors!

Two girls from *near* my hometown in Pennsylvania won top honors from the Robert Wood Johnson Foundation in the YES Competition for high school students.

According to the news release,

"Shoshanna Goldin, a 17-year-old student at Moravian Academy in Bethlehem, Pennsylvania, won for her research project entitled, Energy Epidemic: Teen Perception and Consumption of Energy Drinks."

Not only is she interested in public health, but also the epidemic of obesity. Overconsumption of energy (i.e. calories) is what leads to obesity, right?!

Way to go Shoshanna!

Caution: Camel Orbs are NOT Kid Friendly

Photo from the HSPH website

Candy or tobacco? Do you think your child could tell the difference?

Harvard School of Public Health professor, Gregory Connolly, recently published an article in Pediatrics on the dangers of this Camel Orbs, a dissolvable nicotine tablet, widely available in the US.

(Click here for the news release)

Note: I looked up the Colbert Report segment that references Camel Orbs and embedded it below. I think Stephen Colbert is hilarious. Thanks, Kelsey for your comments!

 

The Colbert Report	Mon - Thurs 11:30pm / 10:30c
Cheating Death - Tobacco Mints, Breast Milk & Hallucinogens
www.colbertnation.com
Colbert Report Full Episodes Political Humor Fox News

Breastfeeding Saves Money, Saves Lives

Most parents enter labor expecting to breastfeed. Many are confronted with numerous challenges (some from the start, others as they go back to work) to continue breastfeeding throughout infancy.

A CNN news report highlights the challenges and public health importance of promoting and supporting new mothers in breastfeeding their baby throughout the first 6 months of their child's life.

This challenge makes me wonder how much of the problem is one of

• Biology - Moms physically aren't able to breastfeed their kids.
• Education - Moms don't know to breastfeed - exclusively - until their child reaches 6 months.
• Awareness - Moms don't know about the benefits/risk of breastfeeding - or not - on their child's health.
• Social - Relationships (partners, family members) and social norms interfere with moms' decision or ability to breastfeed.
• Structural/Political - Policies and structural factors like break time at work inhibit moms from being able to breastfeed or pump throughout the day.

As a quick aside: the new health care reform law makes it mandatory for employers to provide breaks to female workers who are lactating (i.e. breastfeeding). I expect that will begin to address some of the structural barriers mentioned above!

World Health Day 2010

Today, April 7, 2010 marks World Health Day.

I've been thinking a lot about my own health habits. It's easy to get complacent when it comes to our health. We expect that our bodies will just keep on functioning like they always have. Usually reality hits us when it's too late.

It's Public Health Week!

This week is National Public Health Week 2010 - and there are many ways you can get involved to promote a Healthier America. You can view a video and get tips on how your individual actions and easy changes can have a HUGE impact on our nation's health! To find out more visit: http://generationpublichealth.org.

Here are some of my favorite tips:

• Go for a run! (or bike ride)
• Get proper sleep and find time to relax.
• Wear a seat belt every time you ride in a car!
• Buy locally grown produce (almost available here in New England...)
• Recycle
• Advocate for policies and programs (health, transportation, agricultural or other) that will improve the health of your community!

Veritas Health: Back from Hiatus?

Life has never been busier. With school work, classes, legislative events, teaching, and flying around the country Veritas Health has gotten short shrift. Sorry to all my readers! And this has come at a terrible time -- Health care reform has passed, been signed into law, been revised, and signed again! The School Nutrition Act in Massachusetts has been passed by the Senate and will likely make its way to the Governor's Office for a signature this year. And the Child Nutrition Reauthorization Act (...the one that sets prices for school breakfast and lunch reimbursement and sets school food standards) is back on the table in Congress with the introduction of the Healthy Hunger-Free Kids Act of 2010.

Top Picks in 2010 Health Care Reform: Bill Passed!

I can't believe we've passed national, comprehensive health care reform! A first for public health. With all that I learned from the esteemed Bob Blendon in Political Strategies, I knew it would be a long shot. Presidential diplomacy likely played a strong hand in back deal negotiations, as well as the organizing and activity of pro-reform groups in putting pressure on key (read: moderate) legislators!

Here's what pumps me up about national health care reform:

1. Millions of uninsured (an estimated 32 million, to be exact) will now be covered! This means greater continuity of care and hopefully less late, untreatable conditions get prevented and treated early!
2. National menu labeling for chain restaurants! Calorie counts will be visible at point-of-purchase for most chain restaurant menu items across the United States (and the National Restaurant Association sings its praises in the Wall Street Journal blog...miracles do happen!).

There are tons of hurdles yet to be overcome when it comes to implementation and the elephant in the room is cost controls on skyrocketing premiums. I've heard it said that legislators want to "Tackle coverage first, then deal with cost." Whether that approach helps or hurts the health of Americans will be closely monitored, I'm certain!

Vote for Veritas Health Content!

I want to hear from you! See that new poll to the right of the this post??

In order to keep this blog interesting and relevant to my readers I want to know what you would like to see more of on Veritas Health? 

And, if you don't see what you want to read represented to the right, just comment below and I'll be sure to address it! Thanks for reading VH. 

Can't get enough of VH? Follow me on Twitter or link to me on Delicious.

From Cigarettes to Snus: Tobacco Advertising Returns!

I had read about the tobacco industries attempts to shift its marketing from cigarettes to a "spitless" tobacco (or what it is calling Snus), but it didn't really sink in until I was reading Entertainment Weekly.

Sitting on the T on my way up to Cambridge I saw this ad. My first thought while reading it was "That's interesting...Camel is promoting quitting smoking?" It's fascinating how quickly I recognized it as a smoking ad...

Embrace Life PSA (Video)

How often do you wear your seatbelt? If you live in California, chances are you wear your seatbelt every day (a 2007 survey found that 92% of Californians wear their seatbelt). Having lived in California, I am pretty sure that people wear seatbelts because chances are you will get pulled over if you (or someone else in your car) is not wearing a seatbelt. I know that all too well.

But if you live elsewhere in the country, you might not wear your seatbelt. Or maybe you wear it occassionally. In North and South Dakota only 58% of residents wear a seatbelt.

Yet, how do you communicate the importance of seatbelt safety? Everyone knows they should wear their seatbelt. But many just don't...it's too uncomfortable, it's a hassle, i'm only driving a short distance...it won't happen to me.

People make excuses.

Well, take the time to watch this *short* 90 second PSA from Essex, UK. It might make you think differently next time you get into the car.

FDA May Tackle Serving Size Concerns in Food Labeling Overhaul

"Once you pop, you can't stop!"

What clever marketing. Like a self-fulfilling prophecy, really. I mean "Bet you can't eat just one!" -- that'll get you, too.

Well, it's time we faced the facts of American food culture straight up. Bigger is better, and more makes you merrier. Tell me, who eats for breakfast a bowl filled with only 1 cup of cereal or -- heaven forbid -- 1/2 cup of granola? And how many people eat 1 oz (about 6-10) of tortilla chips and stop at that?

Yet, if you look at the food labels -- that is what a typical serving size would be!

While food companies have known this (and exploited it) for years, the US Food and Drug Administration (FDA) has been slow to catch on...

Jamie Oliver (Naked Chef) Takes on Child Obesity at Ted

Jamie Oliver gives a Ted Prize speech on childhood obesity at the Ted Conference in southern California. He believes that the food reality in America is awful and that action must be taken.  Oliver is a food ambassador that commands attention, even of our nations tech leaders!

This is not a research presentation; it's a passionate, moving talk on the realities of death and the TRUE costs of a poor food culture.

Let's Move! ...to Prevent Childhood Obesity

It's no surprise that childhood obesity is drawing more public attention than ever before. Evidence is growing on the ill-effects and complicated origins of childhood obesity, making inaction impossible both for public health programs and politicians.

We can prevent childhood obesity. And that's precisely what the White House initiative, Let's Move!, intends to do.

Soda Causes Cancer, Could it be?

A study done in Singapore has found that drinking 2 or more sodas per week is associated with nearly twice the risk of pancreatic cancer than staying soda free. The study was published this month in the journal Cancer Epidemiology, Biomarkers, & Prevention and reported on WebMD.

It's no surprise that the beverage industry is doing all it can to discredit the study; however, the methods used seem surprisingly sound. In fact, while the American Beverage Association claims that other studies have shown no association between soda and pancreatic cancer, a 2005 study out of Harvard School of Public Health found that soda (i.e. sugar sweetened beverage) consumption was associated with increased risk of pancreatic cancer in women, particularly those who were overweight.

Pap Test PSA: Video

Saw this PSA from the Michigan Department of Community Health (on BroganBlog) and thought it was a pretty clever 30 second ad. Why do I think it works:

1. Good use of humor. (Come on, you laughed a little, right?)
2. Simple, clear message. 
3. Songs just get stuck in your head.
4. Links to birthday so you don't just think about getting tested once, but once a year.

What do you think about this PSA? Was there anything missing?

Text4Baby Service Launched Today

Ever have trouble keeping track of taking your vitamins? How about making sure you make (and keep) your doctor's appointments? Get enough exercise? Well this can be even more complicated when you are pregnant or are caring for a new baby!

Today Text4Baby (text BABY or BEBE to 511411) was launched by large coalition of partners -- and it's designed specifically to help pregnant women and new moms. The service is free and sends 3 well thought out text messages to your phone as reminders about: nutrition, health care, flu prevention and treatment, mental health, and more. The service is in English and Spanish.

If you sign up - let me know what you think! You can get much more information on their website, Text4Baby.org.

You can read more about it at the following sites (great publicity!):

• Healthy Baby Campaign Uses Text to Reach Mothers - on the ABCnews website.
• Tech Daily Dose - a public policy, tech website

Slimming Down School Milk: Did it have an impact?

Schools are getting smart and thinking more about where kids are getting their calories from in school. With childhood obesity continuing to rise (even though adult obesity seems to have slowed down), the implementation of sound school wellness policies is imperative to curbing unhealthy habit forming behaviors in kids' lives.

There is not a ton of data on how school nutrition policies have impacted student health or changed children's consumption of certain foods. (Though if you're interested, I've done a ton of research in this area on sugar-sweetened beverages). But now we have data on one common policy: switching school cafeterias over to serving kids lower-fat milk (1% or fat-free).

Update: MA School Nutrition Bill

It took a little investigating (and some decoding) to figure it out: the School Nutrition Bill passed the House!

Thanks for calling and/or writing your Legislators. It does make a difference. I know there was a lot of movement on the ground Thursday morning among advocates for school wellness and nutrition policy even though I couldn't join them.

You can access the legislative history of the newly numbered bill (HB 4441) at the Massachusetts website. Each Amendment was adopted in turn, with a few hiccups (i.e. "referred to House Rules" and "Rules Suspended") along the way.

Need a little more information about what took place yesterday?? ...

Contact Your MA Legislator for School Nutrition!

Tomorrow may be a historic day for school nutrition in Massachusetts!

This Thursday, the Massachusetts House plans to vote on House Bill 4438 (previously HB 2092), also known as the School Nutrition Bill. This would be a milestone in Massachusetts school nutrition history, as no previous bill has set standards for the types and quality of food sold in school besides the VERY minimal federal regulations.

If you want our schools to be healthier places for our kids, then contact your legislator by TOMORROW!

You can find out more about the School Nutrition Bill and the Local Farm Products Bill (HB 2017), which will *hopefully* also be incorporated in the final document, at the Massachusetts Public Health Association website.

To find out who your State Representative is and how to contact them click here.

This is what I wrote to my Representative...

Fav Five Public Health Headlines

From Haiti to Brooklyn, this week's Fav Five highlights promising strategies to improve kids' health, the  fate of national health care reform, and the public health and medical response to the Haiti disaster.

Health Care Reform Revisited: Brown Defeats Coakley

In yesterday's Senate race Scott Brown (Rep) soundly defeated Martha Coakley (Dem) by 5 percentage points, according to today's headlines in the Boston Globe. While Coakley proved she is knowledgeable and articulate during the debates it seems that voters' took issue with health care reform and probably a number of other issues related to the economy, taxes, and national security.

What I think this election came down to was Massachusetts' voters deciding to mark their ballot for the candidate that best represented their own interests. A likely case for voters in every region of America.

But when it comes to heath care reform, MA is in an interesting predicament.

Altering Our Salt Obsession: A New York City Initiative

Salt is a hot topic in health right now. For more than a decade Americans have been consuming nearly twice the recommended amount of salt in their foods, mostly due to eating out more and the increased consumption of heavily processed, heavily salted foods.

Nutritionists and doctors have been concerned about individuals' excess consumption of salt (or sodium), particularly among those with high blood pressure. The US Department of Health and Human Services recommends a maximum of 2,300 mg of sodium/day (only about 1 tsp of salt), and even less for those with high-blood pressure. But many Americans consume closer to 3 tsp of salt each day.

Eating too much salt has been shown to raise blood pressure and increase a person's risk of suffering from heart disease or stroke. That's why if you or someone you know has been diagnosed with high blood pressure, your doctor has likely advised you to cut back on your salt intake and switch to low- or no-sodium products so that you can add your own salt to taste.

This week public health professionals and politicians stirred interest in salt -- particularly the abundant use of salt and salt-laden products by restaurants, especially fast food restaurants. The New York Times reported on January 11 of Mayor Bloomberg's plan to support the reduction of salt in packaged and restaurant foods by 25% over the next 5 years.

Have American Waistlines Stopped Growing?

Pam Belluck of the New York Times reported today that obesity rates have been seen to stabilize (for some groups like blacks and whites, but not Mexican-Americans) over the past 5 years. I've heard this data in several classes, and it does appear to be true. But this shouldn't be taken to mean that obesity rates are declining -- they certainly are not.

What puzzles me and other obesity researchers is: Why?

Leisure Time in Bavaria -- Germany, that is.

Snow capped mountains and miles of farmland lined the streets and highways on my way through the Bavarian Alps last week. I was on a vacation with my family in southern Germany where we spent a few days in Stuttgart and a few more in Garmisch with family who have lived there for the past six years.

What struck me most during my days was not least the cold but that despite the cold if you walked anywhere you saw at least a dozen Germans walking outside, as well.