Coercive tobacco control health promotion: the curious case of Mayor Duterte

News of Davao City, Philippines Mayor Rodrigo Duterte, who is running for the Presidential election, has warranted international media attention and sparked global outrage for his contentious comments regarding an Australian rape victim. This instance sheds light on the character portrayal the media capitalizes on. His strategy of being portrayed in a threatening light has been thought to have resulted in his success in managing Davao City.[1]

Before garnering worldwide attention for his racy remarks, Mayor Duterte was positively regarded for his work in making Davao City smoke-free by various organizations, including the World Health Organization. It is widely known that tobacco is a leading cause of death, illness and impoverishment; tobacco is a wicked policy problem. But, Mayor Duterte has employed a unique solution to tobacco control by utilizing his reputation as a ‘feared’ leader to coerce citizens into quitting and refraining from using tobacco products. A prime example is the city’s billboards depicting the mayor crushing a cigarette in his fist.

It is understood that fear tactics should be used carefully when seeking to achieve long-term behavioural change; since fear tactics evoke immediate emotion in individuals and if executed improperly the associated lessons generally do not carry out into behavioural change in the long-term. Despite this knowledge, fear tactics have succeeded in making Davao City the first 100 percent smoke-free city in Southeast Asia.[2]

Protection Motivation Theory provides a theoretical understanding of successful fear tactics. According to the theory, individuals gauge both their threat and coping appraisals. When both the threat (i.e. health dangers of smoking) and coping (i.e. self-efficacy to overcome a smoking addiction) appraisals are high, the individual has a high protection motivation, resulting in the fear tactic messaging having an effect on the individual.[3]

Mayor Duterte’s strategy aligns with the Protection Motivation Theory, as the threat appraisal is high since people are afraid of the mayor and he may have enforcement elements (such as: social, political, or police) that act to emphasize his influence. In fact, it has been well demonstrated that the most effective tobacco control measures are coercive and not voluntary (for example, regulatory by-laws banning smoking in public places).

Granted, fear tactics likely worked alongside other tobacco policy tools creating a comprehensive approach to tobacco control in Davao City, resulting in the decline in tobacco consumption prevalence.

Despite the negative attention Mayor Duterte has received, his work highlights the tremendous impact a coercive political leader can play in influencing health outcomes by championing health. It also further warrants research to explore cultural considerations in employing health promotion models of change. Perhaps certain types of strategies work better than others in Asian contexts, which may lead to consideration of alterations to some existing health promotion models of change.

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[1] http://www.filipinewsph.com/2016/04/veteran-lawyer-backs-duterte-over-rape-joke.html?m=1

[2] “Davao City first smoke-free Metropolitan City in Southeast Asia”. (2013, July 29). Tempo: News in a Flash. Retrieved on March 28, 2015 from: http://www.tempo.com.ph/2013/07/29/davao-city-first-smoke-freemetropolitan-city-in-southeast-asia/

[3] Rogers, R. W. & Prentice-Dunn, S. (1997). Handbook of health behavior research 1: Personal and social determinants. (pp. 113-132). New York, NY, US: Plenum Press, xxviii, 505 pp.

Let’s Talk About Mental Health...

John is 28 years old. His friends and family have given him nicknames such as “All-Over-the-Place, John”, “Psycho John”, “Hurricane John”, “Attention-Seeking-John”, and “Sad-Sam-John”, among others.  Some of John’s loved ones describe him as being the life of the party, constantly laughing, and always ready to help. Others say he lacks boundaries, is short-tempered, rude, immature, impulsive, self-centered, and unbearable.

John is one of the “lucky” ones. Two of his childhood friends realized there was more to his behavior than attention-seeking and being difficult. John has a mental illness and got the help and support that he needed in time.

Fact 1: According to the National Institute of Mental Health (NIMH), 57.7 million people (ages 18 and older) in America experience mental illness each year.¹

Many of us believe that mental illness doesn’t affect us and as such, we remain ill-informed. Statistics show that at some point in our lives, many of us will interact with people who suffer from a mental illness. According to the U.S. Department of Health and Human Services (DHHS):

a)      1 in 5 adults in America experienced a diagnosable mental disorder (2014);²

b)      At least 1 in 10 young people suffered from major depression (2014);³

c)      Half of all chronic mental illnesses show first signs in individuals as young as 14, with three quarters of mental health disorders beginning before the age of 24;⁴ and

d)      1 in 25 Americans live with a serious mental illness (major depression, schizophrenia, or bipolar disorder).⁵

Fact 2: Many individuals who suffer from mental illness do not receive the medical and emotional help they need. 

Due to the stigma and pre-conceived notions surrounding mental illness, many who suffer from it are rejected, abused, and discriminated against. As a result, they do not get the help that they need.  Those who do get help often end up in institutions that resemble human warehouses, as opposed to comforting environments that offer healing.⁶ The National Alliance on Mental Illness (NAMI) states that in America:

a)      60% of adults and 50% of youth between the ages of 8 and 15, with a mental illness, did not receive mental health services in the previous year.⁷

b)      90% of those who commit suicide have a history of mental illness.⁸

Fact 3: People with mental illness did not get this illness because they are weak, immature, self-centered, or stubborn.

Mental illness affects each person differently. Until a person is diagnosed with a mental illness, it is very easy to misunderstand or dismiss their behavior. According to the US DHHS:

a)      Genes, illness, trauma, and family history are some of the factors that contribute to mental illness;⁹

b)      People with mental illness can’t just overcome their illness with willpower—they genuinely require treatment, mental health services, and community support to get better;¹⁰

c)      People with mental health problems can get better and some recover completely.¹¹

Fact 4: Just because someone is mentally ill does not mean they are unpredictable and prone to violence.

With all the devastating cases of mass killings, many people assume that those who suffer from a mental illness are capable of committing an act of violence towards others or themselves.

The World Health Organization (WHO) states that “mental disorders are important risk factors for other diseases, as well as unintentional and intentional injury” (2014).¹² The US DHHS states that:

a)      Only 3%-5% of those living with a serious mental health issue have committed violent acts.¹³

b)      Those living with a serious mental health illness are 10% more likely to be victims, rather than perpetrators, of violent acts.¹⁴

c)      We likely each know a friend, family member, or colleague with a mental illness and do not realize they have it, because they are productive, active members of society living full lives.¹⁵

Fact 5: A person living with a mental illness is capable of obtaining and keeping employment.

Some mental illnesses are severe enough to disrupt daily life, making it hard and sometimes impossible for an individual to get and hold down a job. As such, many people assume that all those with mental health needs are unable to perform as well as their colleagues, or even keep their jobs. The US DHHS states that:

a)      Many people with mental health needs, who are receiving help for their illness, have good attendance, are motivated, and perform equally (or better) than their colleagues.¹⁶

b)      Identifying and treating mental illness in good time has great benefits, such as fewer reports of absenteeism, lower medical costs, more productivity, and lower disability costs.¹⁷

What can you do?

1)      Learn about the different types of mental illness. This knowledge could help you identify the common warning signs¹⁸ and better support someone you know with a mental illness.

2)      If you think someone you know might have a mental illness, seek professional advice. Putting labels on mentally ill individuals or making jokes about mental illness is harmful, disrespectful, and unkind.

3)      Start having conversations about mental health and illness. By acknowledging its existence and impact on society, we are taking steps to better understand and manage mental illness, while being supportive of those who suffer from it.

4)      One size does not fit all when it comes to treating mental illness. Do not discourage loved ones from pursuing various forms of treatment and support. Medication alone will not work in all cases. Many patients also need therapy, other forms of self-help, and community support to get better.

5)      Be as supportive as you can. It’s certainly not easy dealing with a loved one with a mental illness. But those with mental illness do not deserve to be ostracized or mistreated. Support from family and friends can go a long way in managing and recovering from mental illness.

  References

1.      National Institute of Mental Health (2013). The Numbers Count: Mental Disorders in America. Retrieved May 5, 2016: http://www.lb7.uscourts.gov/documents/12-cv-1072url2.pdf

2.      U.S. Department of Health and Human Services (2014). Mental Health Myths and Facts (2014). Retrieved May 4, 2016: https://www.mentalhealth.gov/basics/myths-facts/index.html  

3.      U.S. Department of Health and Human Services (2014). Mental Health Myths and Facts (2014). Retrieved May 4, 2016: https://www.mentalhealth.gov/basics/myths-facts/index.html  

4.      U.S. Department of Health and Human Services (2014). Mental Health Myths and Facts (2014). Retrieved May 4, 2016: https://www.mentalhealth.gov/basics/myths-facts/index.html  

5.      U.S. Department of Health and Human Services (2014). Mental Health Myths and Facts (2014). Retrieved May 4, 2016: https://www.mentalhealth.gov/basics/myths-facts/index.html  

6.      World Health Organization (2014). Mental Health: a state of well-being -10 Facts on Mental Health. Retrieved May 5, 2016: http://www.who.int/features/factfiles/mental_health/mental_health_facts/en/

7.      The National Alliance on Mental Illness (n.d.). Mental Health Facts in America. Retrieved May 4, 2016: https://www.nami.org/NAMI/media/NAMI-Media/Infographics/GeneralMHFacts.pdf

8.      The National Alliance on Mental Illness (n.d.). Mental Health Facts in America. Retrieved May 4, 2016: https://www.nami.org/NAMI/media/NAMI-Media/Infographics/GeneralMHFacts.pdf

9.      U.S. Department of Health and Human Services (2014). Mental Health Myths and Facts (2014). Retrieved May 4, 2016: https://www.mentalhealth.gov/basics/myths-facts/index.html  

10.  U.S. Department of Health and Human Services (2014). Mental Health Myths and Facts (2014). Retrieved May 4, 2016: https://www.mentalhealth.gov/basics/myths-facts/index.html  

11.  U.S. Department of Health and Human Services (2014). Mental Health Myths and Facts (2014). Retrieved May 4, 2016: https://www.mentalhealth.gov/basics/myths-facts/index.html  

12.  World Health Organization (2014). Mental Health: a state of well-being -10 Facts on Mental Health. Retrieved May 5, 2016: http://www.who.int/features/factfiles/mental_health/mental_health_facts/en/index4.html

13.  U.S. Department of Health and Human Services (2014). Mental Health Myths and Facts (2014). Retrieved May 4, 2016: https://www.mentalhealth.gov/basics/myths-facts/index.html  

14.  U.S. Department of Health and Human Services (2014). Mental Health Myths and Facts (2014). Retrieved May 4, 2016: https://www.mentalhealth.gov/basics/myths-facts/index.html  

15.  U.S. Department of Health and Human Services (2014). Mental Health Myths and Facts (2014). Retrieved May 4, 2016: https://www.mentalhealth.gov/basics/myths-facts/index.html  

16.  U.S. Department of Health and Human Services (2014). Mental Health Myths and Facts (2014). Retrieved May 4, 2016: https://www.mentalhealth.gov/basics/myths-facts/index.html  

17.  U.S. Department of Health and Human Services (2014). Mental Health Myths and Facts (2014). Retrieved May 4, 2016: https://www.mentalhealth.gov/basics/myths-facts/index.html  

18.  Parekh, R. (2015). Warning Signs of Mental Illness. American Psychiatric Association. Retrieved from: https://www.psychiatry.org/patients-families/warning-signs-of-mental-illness 

Images

1.      Mental Health America. (2016). Mental Health Month [Image], Retrieved May 5, 2016: http://www.mentalhealthamerica.net/may

2.      Mental Health America (2015). Infographic B4Stage4: Changing the Way We Think About Mental Health [Image], Retrieved May 5, 2016: http://www.mentalhealthamerica.net/infographic-b4stage4-changing-way-we-think-about-mental-health

3.       Growth Guided (2015). Here Are Five Issues Millions of Americans Face When Getting Help With Mental Illness [Image], Retrieved May 5, 2016: http://www.growthguided.com/here-are-five-issues-millions-of-americans-face-when-getting-help-with-mental-illness/

4.      Fanpop (n.d.). Mental Health Awareness – “Snap Out Of It.” [Image], Retrieved May 5, 2016: http://www.fanpop.com/clubs/mental-health-awareness/images/36499936/title/snap-out-photo

5.      Fricke, P. (2013). Functional Mental Disorders. [Image]. Retrieved May 5, 2016: http://www.siue.edu/~pfricke/

6.      The London Therapy Center (2015). Some Mental Health Facts & Myths [Image], Retrieved May 5, 2016: http://www.thelondontherapycentre.com/#!some-mental-health-myths---facts/a1jq7

International Dance Day

Touch the cosmos

the source of our divinity

illuminating

the face of the ancestors

so we can see our children

woven above beside below

unite all within

our flesh and bones

and memory

the Earth is turning

humans in mass migration

turtles gather in silent preparation

the heart is injured

make dance

a movement of love

a movement of justice

the light of truth

~Lemi Ponifasio~ (KARAKIA [Prayer])

International Dance day celebrates the birthday of the awe-inspiring creator of ballet, Jean-Georges Noverre. The celebration of this day has fallen on the 29th of April since the year 1982 initiated by the International dance committee of the UNESCO International Theater Institute. This day celebrates the universal art form represented by dance.

Almost every culture around the world has their own unique style of expression through rhythm, movement and music. Dance has played a very important part of my growing up and has acted as an outlet for my creativity and emotions. Most times it allows a person to be the best version of themselves.

Each year an outstanding choreographer from around the world. This year Lemi Ponifasio from Samoa and New Zealand was featured, he is the founder of MAU and has worked with communities around the world. MAU is a Samoan word that means a declaration to the truth of the matter, and dance could be described as a window to the truth within our selves. Lemi's message represents the spiritual aspect of dance and how it is binds us to earth. It is also signifies the connection between our creativity and our bodies.

Dance has also been featured in many different aspects of our lives. One way is the inclusion of dance in many of our exercise lives through Zumba and other forms. We also find dance to serve therapeutic purposes whether it be long term or short term stress relief. So hopefully you can dust the old dance shoes off and celebrate this day.