Beyond Band-Aids: Social well-being as a strategy for health, social development gains

    Children at a primary school in Nepal interacting with members of a local NGO. Photo by: Hina Shaikh.

    Human rights, health and social development goals are often intertwined in a mosaic-like development context. Take, for example, the multiple international instruments, World Health Organization documents and U.N. programs that make up the Millenium Development Goals.

    One of the most enduring dilemmas in addressing multidimensional human rights goals is the narrow, “Band-Aid” character of interventions and aid policies that target specific rights problems but not the context that incubates them. There are multiple reasons for this, from funder priorities to system fragmentation and the need for short-term results, compounded by the difficulty to identify causal factors within a context — and producing evidence to show that change in the causal factors would have an impact on the problem.

    This is not a revelation, or a new concern. Numerous examples of such narrow programs exist. HIV and AIDS interventions that seek to empower at-risk women with condom negotiation skills or better access to prevention resources may not address the broader, and still gender-related, problem that women may lack access to economic or social resources, or that male status may be signified by the number of mistresses. Similarly, dispensing multivitamins to children to address malnutrition, though addressing elements of the U.N. Convention on Rights of the Child, is a short-term remedy that does not touch the factors that underlie a nutrition deficit in the first place.

    In the context of security and development, Seth Kaplan, in his 2008 book, “Fixing Fragile States: A New Paradigm for Development,” argued that humanitarian aid and economic reform would not rebuild the Democratic Republic of the Congo in the long-term, following the country’s brutal conflict and pervasive sexual violence. Rather, he advocated for leveraging local capacities and existing structures to avoid short-term or short-sighted results.

    The alternative to Band-Aid approaches does not necessarily entail large-scale economic development or structural reforms. At the Center for Social Well-Being and Development, located in the Milken Institute School of Public Health at the George Washington University, we work to understand and use a social-ecological approach to achieve health, social development and related human rights goals in a global context.

    CSWD frames goals by looking at multiple, interacting factors in several domains — individual, family, social group, community, culture, political and economic — that form a context, or social ecology, within which there may be barriers to the achievement of these goals. This interplay within a particular setting can shape vulnerability, as well as resiliency and the capacity for positive outcomes. CSWD strives to provide practical tools for using the social-ecological approach among children, adolescents and families in vulnerable populations.

    We have operationalized the idea of a “health-supporting social ecology” in the construct of social well-being — derived in part from the WHO definition of health: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”

    Promoting social well-being is understood as a precursor to achieving linked health, social development and human rights goals. In practice, this means the development of effective planning frameworks and intervention and evaluation strategies that are based on a social-ecological approach. We work collaboratively with local partners to assess a given problem — such as health disparities, sexual or labor exploitation, increased violence or increased HIV and AIDS risk — in terms of the interacting, contributing factors in which it is embedded, and identify strategic points of intervention that can reduce the specific vulnerability pathways and improve social well-being.

    For example, CSWD staff, on behalf of UNICEF, completed a unique situation analysis of children and women in 2011 based on the social-ecological framework as an analytical tool for advancing human rights in Belize.

    Based on the collection and synthesis of data for the situation analysis, we have developed and tested specific tools to increase awareness of this approach among Belizean practitioners, nongovernmental organizations and the general public. Building on our research, we are in the process of developing an unprecedented website in Belize that will include a tutorial on the use of the social-ecological approach and a searchable database of programs and resources organized by the contributing factor domains and life cycle stages set out in the analysis.

    The goal is to support NGO capacity to conduct a full assessment-implementation-evaluation process and thereby leverage resources across sectors in a strategic manner aligned with the assessment of contributing factors. CSWD staff also developed the Adolescent Well-Being Framework for UNICEF’s Americas and Caribbean Regional Office. This framework contributed to the development of the Caribbean Youth Development Action Plan 2012 and an adolescent module for UNICEF’s Multiple Indicator Cluster Survey. CSWD developed training materials to help agencies and practitioners use this framework for adolescent programming and monitoring, including a matrix of potential indicators and measurement tools.

    A primary motivating factor underlying CSWD’s work is that the social-ecological approach, as a conceptual tool, makes intuitive sense, but its application may be challenging precisely because it is broad and holistic in character.

    In a program-funding environment where accountability and evidence are essential, it is often safer to fall back on narrowly targeted solutions because they present less of a monitoring and evaluation challenge. CSWD is engaged in an ongoing process of developing systematic planning and tools for applying this approach and for evaluating the impact of interventions on a given set of contributing factors as well as on outcomes relative to the problem of concern. Some of these tools are now being applied and tested.

    We believe that the more these tools are implemented and the more evidence is generated, the more likely funders will be willing to support longer-term, sustainable solutions for health and social development.

    Want to learn more? Check out the Healthy Means campaign site and tweet us using #HealthyMeans.

    Healthy Means is an online conversation hosted by Devex in partnership with Concern Worldwide, Gavi, GlaxoSmithKline, International Federation of Pharmaceutical Manufacturers & Associations, International Federation of Red Cross and Red Crescent Societies, Johnson & Johnson and the United Nations Population Fund to showcase new ideas and ways we can work together to expand health care and live better lives.

    The views in this opinion piece do not necessarily reflect Devex's editorial views.

    About the author

    • Mark C. Edberg

      Dr. Mark Edberg is the director of the Center for Social Well-Being and Development, located in the Milken Institute School of Public Health at the George Washington University. The Center offers a variety of expertise to support its mission of promoting the understanding and use of a social-ecological approach to support positive health and social outcomes to reduce vulnerability worldwide.