Most of us have heard of the “social contagion theory.” Created by researcher and Harvard professor Nicholas Christakis, the idea is basically that your friends can make you fat–bad habits like obesity, smoking, and unhappiness are “contagious” by three degrees, which includes friends of friends.
Microclinic International (MCI) founder Daniel Zoughbie decided to hedge his bets that good behaviors could be just as contagious as bad ones after his Palestinian grandmother died as a result of diabetes. Zoughbie sought to apply a “microclinic” model to diabetes prevention, where small peer groups would motivate and hold each other accountable for desirable health outcomes and goals in preventing or ameliorating the highly treatable disease. (Think of Grameen style peer accountability, but for health outcomes).
Microclinics are small peer networks that meet in homes, community centers, or coffee shops, forming a social infrastructure. Eight years after its inception, MCI runs its microclinics in an array of international settings, from a remote island in Kenya with an HIV rate of over 30% (one of the highest in the world) to the Kingdom of Jordan, where diabetes runs rampant. The results have been remarkable.
In Kenya, for example, a series of microclinics were organized to tackle the problem of HIV-related stigma. Through extensive fieldwork and close collaboration with local partner Organic Health Response, MCI helped form 47 groups composed of nearly 550 community members on Mfangano Island in Kenya’s Lake Victoria to engage in discussions covering topics ranging from the biology of HIV and HIV medications, to stigma reduction, and community outreach strategies. (Groups were supported by local health workers and educators.)
Building on existing strong familial and community ties, microclinic participants eventually became comfortable disclosing their HIV status and communicating about prevention as well as the successes and challenges they were having with their own treatment. By the end of the pilot, over 84% of all microclinic participants disclosed their HIV status to their group, underscoring a major change in attitude around stigma compared to control communities.
With astounding success abroad, MCI decided to try its hand at an exotic location closer to home–Bell County, Kentucky, in the heart of rural Appalachia. It turns out that the power of social contagion works similarly around the world.
Kentucky ranks among the top 10 states with the highest prevalence of diabetes, obesity and high blood pressure, and Bell County is no exception. The county has an obesity rate of 35.9%, a diagnosed diabetes prevalence of 13.9%, and a hypertension rate of 35.2%. In partnership with U.S. health insurer Humana, MCI recruited at-risk participants eager to try their hand at healthy living by forming homegrown microclinics.
Just as in every other country, peer groups were formed based on pre-existing ties, and members met once a week, supporting each other through changes in eating and exercise habits. Some groups motivated adherence by requiring no-shows to buy the group a healthy breakfast the following week. Dodging one’s group commitment was difficult–in a small town, participants were bound to run into each other in grocery aisles, church pews, or power walking down main streets.
Once again, results came quickly. By the end of the 40-week pilot, 95% of participants had dramatically improved in at least one category (blood pressure, cholesterol, blood sugar, waist circumference, and BMI). Furthermore, in both international and domestic programs, health outcomes continue to be sustainable as participants have made compounding improvements in nearly all locations.
The importance of understanding the distinct cultural context of any intervention–whether health, aid, or sustainable development–is increasingly perceived as a make or break factor for success in social transformation. What’s remarkable, however, is the fact that despite different geographic locations, diseases, and behavioral issues at play, the ties that bind us turn out to be strikingly similar around the world.