Mind and Body

'Knock it off' won't work, and Gov. Raimondo knows it

The prevention paradox plays out in Rhode Island in the latest effort to control the spread of the coronavirus

Image courtesy of the R.I. Department of Health

The latest COVID-19 data tracker by the R.I. Department of Health shows the growing spread of the coronavirus in Rhode Island, with dramatic increases in new cases and new hospitalizations. What it reflects is a continued resistance to behaviors that could help decrease the spread of the virus.

By Peter and Toby Simon
Posted 11/23/20
Changing behaviors requires a change in the perception of risk by an individual, when the common good prevails over the personal, a condition known as the prevention paradox.
What are the most effective “change” messages to support people wearing a mask? What would happen if every single media personality on TV and radio wore a mask as part of their on-camera presence in a messaging campaign modeling responsible behavior? When will President Trump admit that he lost the election, fair and square, and concede publicly? What are the limits of media manipulation campaigns conducted by government officials on social media platforms?
On Nov. 30, the new Wi-Fi mesh network will go live in Olneyville, built by ONE Neighborhood Builders under the leadership of Jennifer Hawkins as a solution to helping one of the communities hardest hit by the pandemic stay connected. The new network provides free Internet for students and families alike, an important survival tool in a pandemic-disrupted world – enabling access to education, commerce, health care and government resources, in their homes where they live.
As the R.I. General Assembly deliberates on a state budget, why not invest in building out similar networks in hard-hit communities across Rhode Island, as a way helping those residents most at risk and most vulnerable to the disruptions caused by COVID-19.
The investments could be distributed through the existing networks of Health Equity Zones. Indeed, ONE Neighborhood Builders serves as the core agency supporting the local Health Equity Zone. It is an example of bottom-up innovation driven by identified community needs.

WELLFLEET, Mass. – We left Rhode Island in early April to live in our summer place on the Cape and provide childcare to our grandkids in shifts so that their parents could work.

We continued to follow what was going on in Rhode Island because of our histories in the state. Peter was proud to have been part of building an outstanding team at his former place of employment, the R.I. Department of Health, while Toby’s career took place at several Rhode Island universities, where the work of modifying and changing students’ unhealthy behaviors was a chief responsibility.

During careers that spanned 40 years, we both saw many examples of risky health behaviors and got to hear experts such as Jim Prochaska at the University of Rhode Island show how people were able to make changes in their practices over time.

Conspiratorial paranoia is nothing new. For example, when unimmunized children were excluded from their schools during outbreaks of vaccine preventable illnesses, the anti-vaxxer parents almost always immunized their kids so they wouldn't have to take three weeks off from work.

Watching Gov. Gina Raimondo’s COVID-19 weekly press conferences became a ritual. Slowly, Peter lost interest as it became clear that her efforts to convince people to change their social behaviors was having limited impact. We actually started to feel sorry for the Governor.

Prevention paradox
Here is the best explanation of why she is failing to get the kind of adherence to good public health policy. It is called the “prevention paradox.”

The “prevention paradox” shows that interventions can achieve large overall health gains for whole populations but might offer only small advantages to each individual. For example, in thinking about getting a flu shot, flu vaccines may not necessarily protect the individual but having a high uptake of vaccine in a community will protect the most vulnerable.

But this can lead to a misperception of the benefits of “preventive” advice and services by people who are apparently in good health.

Magical thinking
If we look at college students’ sexual behaviors and STIs [sexually transmitted infections], numerous studies show that students are not consistently using condoms to protect themselves from disease. They don’t perceive the risk in part due to “magical thinking” that bad things won’t happen to them.

Although from an adolescent development perspective, this may be “appropriate,” it makes the challenge of behavioral change additionally difficult.

Students are most likely to change their behavior when that type of thinking is challenged and a friend gets an STI. Magical thinking may persist into adult years. People who perceive COVID-19 as someone else’s problem are unlikely to pay much attention to the Governor’s pleading for them to do things they don’t want to do.

They see it as too high a price with no benefit accruing directly to them. You can label this response in many ways: as selfish, or narcissistic. But, it’s basically how humans act. We don’t often think beyond our own skin.

Perception of risk
This perception of personal risk may take a while to change. Change in behavior follows the alteration of one’s own perception of risk. Thirty-five years ago, Toby was asked by a university president: “Do Brown students really get Herpes?”

As it pertains to COVID, right now, many people don’t know many people who have become ill, been hospitalized or have died.

Sadly, we may only have to wait a short while, perhaps a month or two or three. More people need to see their neighbor, their drinking buddy, their teammate, their workout friend or a family member being hospitalized or dying for the perception of personal risk to change.

Peter and Toby Simon are frequent contributors to ConvergenceRI.

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