Wednesday, April 15, 2009

How Are You Healthy?

How are you healthy?
A simple enough question.

But there's a lot more going on there than meets the eye.

After yesterday's rant, I felt the need to regain some balance by talking about something really awesome that's happening in the field of public health. The how are you healthy? campaign on and on buses in Chicago, and sponsored by various partners, really hits the spot.

It's real
All the photos are of real guys, who really wrote real things about themselves. There's just something refreshing about seeing actual guys telling you actual things about their actual lives, instead of ad copy printed next to a model. How do I know it's real? Because I know some of the guys who have written in and are shown on the website. That's how.

It's inviting
Unlike most public health campaigns, it's not about fear. It's not about guilt. It's not about putting some unattainable goal in front of you. It's not about telling you what to do, or more accurately, telling you what not to do.
I like to think of it as the perfect antidote to the usual "To Don't" list that we get from public health all the time.
The question - how are you healthy? - invites you to reflect, to celebrate what's going well, to personalize your own answer.

It's outwardly oriented
By putting the campaign on buses in Chicago, the campaign is clearly outwardly focused - not just for gay men, but for the whole city.
Most health campaigns try to 'target' an audience. I don't know about you, but when I feel targeted, my reaction is to duck, dodge, get out of the way. I don't wanna get shot. Or, when I the campaign is targeted at someone else, I breathe a sigh of relief, not my problem, I don't have to worry about it.
The other problem with targeting a message by putting it in the public square is that bus ads, subway ads, billboards, even print ads in gay newspapers are a really lousy way to target an audience - you miss most of the people you want to get, and a whole lot of people get annoyed, including a large proportion of the 'target' audience.
But more about the outward orientation of the how are you healthy? campaign.

gay. sexy. healthy.
The straightforward assertion that the words gay. sexy. healthy. belong together is a radical departure from public health research and practice over the last 30 years. It directly challenges people to question the fast and easy elision between 'gay' and 'sick' or 'immoral'. It challenges the notion that sex is what makes us sick. By starting from the assumption that gay men are healthy, the implication is that everyone can learn health tips from us, gay, bi, and straight alike. Now, if you've been in a yoga class lately, or had a personal trainer, you know that's true already.
By stressing that sexy is healthy, it challenges all those public health messages about cutting back, denying our sexuality.

rant on research
But if you look at the research literature, you could be excused for coming away thinking that gay men are disease-ridden, addicted, and self-destructive. Why? Because that's all that gets published. I've been looking hard, and aside from a paper by Evelyn Hooker in 1957, I haven't been able to find one single example of a quantitative study which starts from the premise that gay men are inherently healthy.
Recently, there's been a lot of attention paid to 'health disparities', usually implying a negative health disparity between a racial/ethnic minority and non-Hispanic whites, but sometimes a negative health disparity affecting women, and occasionally a negative health disparity affecting sexual minorities or gender minorities. I haven't found any examples of a positive health disparity affecting sexual minorities in the literature, but if you've been reading my blog lately, you know I've been finding them aplenty in raw data sets. Which implies one of two things: that researchers are not looking for positive health disparities, or that they are not making it through the peer review process and into print. My hunch is that the former plays a much bigger role, having been through the same indoctrination in public health, I can assure you that it's very hard to turn the paradigm of risk->disease around to begin thinking about positive health outcomes, and harder still to turn around ideas about who's supposed to be sick.
At any rate, the idealistic goal of identifying health disparities is that highlighting how oppressed groups suffer disproportionately will motivate political action to address the social forces causing those disparities.
But by measuring the result (health disparities) and not the cause (social forces) directly, this leaves health disparities research in an atheoretical limbo, results waiting for an interpretation. And as such, identifying health disparities but not directly measuring their causes may serve to undermine the very goal the researchers have in mind. Rather, these atheoretical results, hanging in mid-air as it were become evidence for some that the affected groups are inherently susceptible, inherently weak, and have none to blame but themselves. That these disparities, while unequal, are justified, to be expected, even fair.

back to looking outward
And the other big problem with identifying only negative health disparities is that when there are positive health disparities, there is an opportunity to learn their causes, and to export that knowledge beyond the oppressed minority group into the society at large.
And that's the other thing I love about the how are you healthy? campaign. It's gay men talking to gay men, but anyone is invited to sit in and learn what we have to say, what works, and adopt whatever may work in their own lives as well.

So tell your story. Send in a snapshot. Join the fun.


  1. Bill ---

    As a member of the team that created this campaign, THANK YOU for the love!

    FYI - the team is funded by the Chicago Department of Public Health (yes!) and includes Center on Halsted, Howard Brown Health Center, Test Positive Aware Network, and my agency, AIDS Foundation of Chicago. The campaign is part of a bigger, holistic, 5-year health project directed towards gay and bi men.

    It was initially conceived as a set of activities to reduce the initiation of crystal methamphetamine as a means of preventing HIV. In our first formative year, we decided to expand that mission to one that was more top-to-toe and not focused solely on one drug or one disease state - or deferred to deficits to the exclusion of assets.

    Beyond social marketing campaigns like "How are you healthy?", the project also holds live podcast forums, does direct internet outreach, conducts provider trainings, and operates the LifeLube website and blog.

    Our next forum is May 20, is called Generation You, and will engage in an intergenerational dialogue to help bridge the age barriers in our communities.

    You can find out more about all of our forums here:

    And any and all are invited to join us on May 20 if in Chicago. The link above will direct you to an RSVP page.



  2. Thanks for posting this, Bill. It's about time we celebrated the beauty and health of a vibrant gay community, rather than sought out additional pathologies. The last time I remember seeing anything like this was the "HIV Stops with Me" campaign I think almost ten years ago, which admittedly was targeted and disease oriented, but with a health-positive focus. It's nice to see this evolution over the past decade.