A Story of Health: Narrative in Public Health Training and Practice
Story telling has a long history in medical training and practice.
Narratives describe a patient’s experience of illness, a clinician’s experience caring for them, or both. Yet, contemporary medical practice tends to de-emphasize narratives in favor of facts and findings gleaned from laboratory tests, imaging studies, and brief hospital or office visits.
Resisting this trend, a few medical schools offer courses in narrative medicine, encouraging students to tell and closely listen to unique stories of illness. They use literature, philosophy and the creative arts to help clinicians-in-training better understand their patient’s experience and their own response.
Promoting public health with skillful narrative
Public health training and practice also use stories showing how epidemiologic data play out in the lives of individuals, families and communities. This can be tricky because the relationship between a story teller and the people in the story raises questions of consent, framing and content. People generally do not appreciate being unable to participate in how to tell their story. But a skillful narrative can drive effective public health interventions.
Ten years ago, several colleagues and I began a project that grew into six fictional stories of health and illness published as a free, online multi-media eBook featuring graphics, illustrations, short videos and links to outside resources.
We wanted to tell realistic stories of people and their families. We were joined by a gifted graphic designer, a specialist in medical communication from the CDC as well as a talented agency illustrator. As the stories developed, we enlisted additional content experts. Each chapter went through external peer review, including health professionals at the CDC, before being certified for continuing education (CE) credits.
We created a realistic personal, family, community, environmental, social, and cultural context for each story. Then we developed fictional characters, families and neighborhoods to tell stories illustrating how these multi-level variables can interact to influence the risk of illness, its prevention, and response to treatment. The storylines include rural, suburban, and city settings and people of different ethnicities.
Value of story-based learning affirmed
These stories are collected in A Story of Health—A Multi-media eBook. Protagonists are Brett, a boy with asthma; Amelia, a girl with a developmental disability; Stephen, a toddler with leukemia; Toshio and Reiko, a young couple struggling with infertility; Sam, an older man with cognitive decline; and Sofia and her family, who face threats from wildfires.
The response has been overwhelmingly favorable—more than 20,000 registrations for CE credits for health professionals for one or more of the six chapters and countless others who have downloaded chapters without seeking certification. Readers surveyed initially and three months after CE completion found the chapters not only highly informative and useful for their work but many also described the storylines, interactive features, graphics and videos as particularly engaging.
Respondents repeatedly confirmed the value of story-based learning and were drawn to the unique eco-social framework in each chapter. Their responses suggest that if clinicians, community-based organizations, advocates, and people adversely affected by social and environmental hazards were to join more frequently in telling their unique stories it could inspire improvements in personal and public health where they live.
Ted Schettler MD, MPH is Science Director of the Science and Environmental Health Network. (www.sehn.org), and Science Advisor to Health Care Without Harm. He is a founding member of the Collaborative for Health and Environment, and serves on the CHE advisory team.
This article initially appeared in the San Francisco Marin Medical Society Journal, in a special section honoring CHE's 20th year.