Better known for charming children’s classics like Cinderella and Sleeping Beauty, it comes as a surprise that Walt Disney also dabbled in the production of health education films, such as this one from 1943 (check it out above!). Today malaria, or the “winged scourge,’ as it is dubbed in this film, is considered by most to be a disease that plagues only those in the developing world. However, there was a time in the not so distant past when malaria was endemic to many parts of North America and Europe. Although the film is a tad dramatic, and obviously lacking in concern about the unabashed use of insecticides, the Seven Dwarfs market to their audience what can be considered as a comprehensive vector control program.
In addition to the life cycle of mosquitoes, this film touches on the interconnected relationship between malaria, poverty, and housing. Today, this cycle continues on in the malaria endemic world, spurred onward by widespread substandard housing conditions, high rates of poverty, and poorly integrated vector management programs. Extensive research consistently illustrates that risk of infection increases within structures that allow for contact between residents and malaria-carrying mosquitoes. Adding this, these homes are frequently located in close proximity to ideal mosquito breeding grounds, as these geographic areas are often the least desirable for formal planning and development.
Once infected by the malaria parasite, victims are often unable to work or go to school. Although missing a few days of work or school may not seem like much, reinfection is common, this recurrent morbidity has heavy economic costs. The Earth Institute at Columbia University estimates that this single disease costs Africa, where 90% of malaria mortality occurs, 12 billion dollars in lost output each year. These economic pressures, compounded with the pressures from other endemic diseases, feed back into the continued persistence of poor housing, poverty, and overwhelmed health systems in high malaria prevalence areas.
Why is malaria so difficult to control? Many control strategies require a large financial investments or serious behavior change on the part of the potential victim. For many families with financial constraints, the diversion of time and funds needed to buy a bed net, patch holes in walls and roofs, and other necessary fixes, all for a disease that is often seen as a difficult, but inescapable, fact of life, can seem an unreasonable request. Additionally, and perhaps most importantly, most of these control interventions are totally dependent on behavior change in order to be effective. This requirement of a behavior change adds a whole other level of complexity to the malaria control equation. The global prevalence of malaria spans communities, societies, countries, and continents and that means that the cultural and societal practices and behaviors vary extensively across the malaria map. For this reason, a quick and universal solution to malaria elimination is highly unlikely to exist.
So how can we optimize and tailor public health interventions to fight malaria? That question brings me back to my original point—I think that Disney had it right. The film ended by showing us the juxtaposition of the qualities of life in the two different households. Which of the two lives would you rather have? It’s simple and direct marketing. An understanding of how human motivations (which have been built into the core of marketing since…well, since a long time) can impact human health needs to be tapped into on a larger scale to effectively combat multifaceted diseases like malaria. Not surprisingly, in the public health sciences we often have issues translating messages and designing effective, culture-specific interventions for the general public. Health is a beneficial outcome of stronger human motivators, like the desire for comfort and status and the avoidance of things that give us fear. Think about it, when we choose to take the stairs at work, our action is most likely associated with our motivation to look attractive, a perceived sense of physical appearance that is associated with status. This is an oversimplification of course, but relevant.
By tying public health interventions to our understanding of human motivation, in other words, by ‘marketing public health’, we can better tackle many of the challenges associated with making and sustaining advances in malaria control.
Let’s reconsider that messy relationship between housing, poverty, and malaria. By developing and employing affordable housing modifications and other disease control strategies (from bed nets and screened windows to latrines and beyond) that are tied to the specific motivators of the target population, individuals may be more likely to choose to invest in or be open to changing their behavior. In many cases, there isn’t even a need to target malaria directly. By developing broader prevention programs that employ diverse methods, in conjunction with traditional control strategies (insecticide spraying, treated bed nets, etc.), adherence may improve not only for malaria but assist in addressing some of the root causes of other diseases related to housing and, more broadly, the built environment.
Obviously there is not blanket solution for the control of malaria. It is a complicated disease. However, in endemic areas a market-based approach to malaria interventions has the potential to make significant and cost effective strides in decreasing the malaria burden. People, no matter their socioeconomic status, are people. We want to feel affiliated with something that we believe in, be seen as attractive, and maintain status within our home community and culture. We want to be comfortable. For this reason, we must work to deeply understand the context-specific complexities of the relationship between housing, poverty, and the ‘winged scourge’; then target weaknesses within this relationship (like simple home improvements that have far-reaching public health impacts) by marketing interventions and messages that are based in an understanding of human motivation. That, and a little bit of Disney magic.
-Olivia Johns, Research Officer, ARCHIVE Global