In our societal conception of health today, we are accustomed to hearing optimist language in advertisements and in hospitals themselves about the possibility and potentiality of healthcare. The Boston Children’s Hospital greets visitors to their website with the header, “Our Team. Our Patients. #1 together. Making the impossible possible.”[i] The (RED) campaign to fight AIDS is filled with hope and its bright red letters on its many products is one of the most recognizable logos today. Partnering with celebrities like Ed Sheeran and brands like Coca Cola to raise money to be used towards providing antiretroviral treatment to some of the most vulnerable populations in Africa, the website boasts its hundreds of millions of dollars raised to date, and features pictures of mothers smiling with their AIDS-free babies.[ii]

According to Merriam-Webster, the definition of “optimism” is: “1. a doctrine that this world is the best possible world; 2. an inclination to put the most favorable construction upon actions and events or to anticipate the best possible outcome.”[iii] Today, we see optimism everywhere, from television commercials to rooting for one’s football team; but nowhere is optimism more present than in the field of health. In healthcare and global health, optimism is universally encouraged; yet, is this way of thinking truly beneficial to the realities of health in our world?

On the one hand, optimism is a necessary part of our daily lives: we have a biological need for optimistic thought.

On the one hand, optimism is a necessary part of our daily lives: we have a biological need for optimistic thought. In a study on how positive psychological factors impact our lives, Park et al establish a correlation between optimism and health, “Empirical research shows that optimism…relates to good health and a long life.” [iv] Additionally cited studies show optimism slowing the onset of HIV in men, decreasing levels of general pain in both men and women, as well as lowering the risk for stroke. As Park et al explain, the positivity of optimism contributes to both biological and psychological wellbeing, and while they cannot guarantee a causative relationship between the two, optimism is clearly holistically beneficial to us. Indeed, our “inclination to put the most favorable construction upon actions and events” is what many of us do on a daily basis; whether in schoolwork, professional work, or our personal lives, optimism often plays a key role in motivating ourselves and, to put it simply, being happy.[v]

However, optimism has its dangers, a fact we can clearly see in the field of global health. Medical anthropologist Svea Closser, in her study of polio eradication efforts in Pakistan, identified what she calls a “culture of optimism” that pervades global health, bringing both benefits and drawbacks. On the one hand, global health is hopelessly dependent on donors, and some level of optimism is necessary to keep donors motivated fund these programs.[vi] On the other hand, however, such optimism can often cloud the reality of the problems these eradications efforts face.[vii] Among many examples of the pitfalls of this culture of optimism, Closser cites the example that researchers in the 1980s knew that eradicating polio would be extremely difficult, but that still “a consistently optimistic stream of rhetoric and planning… proceeded as if these difficulties did not exist.”[viii] In another example, Closser lists different policymakers’ quotes from 1987 through 2007, tracing how in each year that passes, the end date for the project extends by a year, while still maintaining optimistic language. In 1987, one scientist stated, “Global eradication could be achieved as early as 1995,” and in 2006, a WHO official said that “I am still very hopeful that an aggressive approach will stop transmission in Pakistan in 2006.”[ix] Of course, what is missing from these statements is the fact that these end dates are not being met, year after year. This kind of rhetoric has caused policymakers to ignore significant factors that continuously contributed to the stagnant progress of the eradication campaign, such as cross-border transmission.[x]

However, optimism has its dangers, a fact we can clearly see in the field of global health.

In fact, the limitations to optimism are not unique to global health; in a recent article from The Atlantic, journalist Derek Thompson reported how optimism plays out in the relationship among citizens and political and economic reality. He explains how the concept of the “American dream,” filled with often undue optimism, is inconsistent with the reality Americans face: because of this optimism, Americans are less likely to support anti-poverty programs, leading to lower levels of social mobility.[xi] Conversely, Europeans are relatively more “pessimistic about social mobility… and those pessimists are more supportive of welfare policies.”[xii] What Thompson’s article shows is that optimism is in no way tied to or correlated with reality, and that sometimes, optimism can actually have the opposite effect. Both Closser and Thompson warn us that while optimism is an important way of thinking for our everyday lives, when spread across a whole culture, it can often blind us to realities that we are not willing to or feel that we cannot afford to address.

Who we cannot forget in any study of global health are the individual patients and afflicted people of any form of ill health. One might think that optimism is the patient’s ability to embrace optimism is nothing but beneficial, a type of placebo effect. But often, this kind of optimism that is so engrained in our culture is also frustrating for patients. In a piece in The Atlantic, a woman named Lori Wallace who lives with advanced breast cancer explained her disappointment in hospitals’ method of marketing. Reporter Sam Harnett explains, “The advertisements feature happy, healed patients and tell stories of miraculous recoveries. The messages are optimistic, about people beating steep odds. However, Wallace says the advertisements spread false hope, and for a patient like her, they are a slap in the face.”[xiii] Similar to what Closser noticed in her study of polio eradication, Harnett highlights how “these advertisements tug at emotions, just like other advertising that is trying to win over consumers.”[xiv] This dynamic is hardly beneficial for hospitals too: hospitals end up spending a small fortune on advertising, while misrepresenting and even disrespecting, in Wallace’s opinion, the real experience of cancer.[xv] Optimism turns into a sales pitch, a pitch for money that is certainly necessary, but using a style that is unrealistic and unbeneficial.

This phenomenon of over-optimism is clearly widespread through our culture, and among different spheres of our society. What does this mean for global health? The key word here is “culture”: though it is an incredibly strong force, it is also one of the hardest to change. Instead of an economic-centric culture of optimal results and efficiency, we need a more sensitive understanding of the complex world in which we live. Surely, donors want their money to go to good use, but good use can only be guaranteed by a mindset focused on realistic assessments and strategies. The culture of optimism is not necessarily unethical (although it can be, when it pains people like Wallace), but it is definitely misleading. What we need is a shift in culture to one in which health workers and program organizers are held accountable and prioritize realistic goals and results. As Harnett put so gracefully after speaking to Wallace, what we need now is “realism—acceptance of both the world’s beauty and its harshness.”[xvi] There is a place for optimism in global health, but not to the point that it clouds our vision of what is truly being experienced and what we need to do.

 

References:

[i] Boston Children’s Hospital. (2017). Retrieved November 1, 2017, from http://www.childrenshospital.org/

[ii] Our Impact. (2017). Retrieved November 1, 2017, from (RED) website: https://red.org/our-impact/

[iii] optimism. 2011. In Merriam-Webster.com. Retrieved May 8, 2011, from https://www.merriam-webster.com/dictionary/optimism

[iv] Park, N., Peterson, C., Szvarca, D., Vander Molen, R. J., Kim, E. S., & Collon, K. (2016, May/June). Positive psychology and physical health: Research and applications. American Journal of Lifestyle Medicine, 10(3), 200-206. Retrieved from http://journals.sagepub.com/doi/full/10.1177/1559827614550277#articleCitationDownloadContainer

[v] Park, N., Peterson, C., Szvarca, D., Vander Molen, R. J., Kim, E. S., & Collon, K. (2016, May/June). Positive psychology and physical health: Research and applications. American Journal of Lifestyle Medicine, 10(3), 200-206. Retrieved from http://journals.sagepub.com/doi/full/10.1177/1559827614550277#articleCitationDownloadContainer

[vi] Closser, S. (2012). “We Can’t Give Up Now”: Global Health Optimism and Polio Eradication in Pakistan. Medical Anthropology: Cross-Cultural Studies in Health and Illness, 35(5), p. 386.

[vii] Closser, S. (2012). “We Can’t Give Up Now”: Global Health Optimism and Polio Eradication in Pakistan. Medical Anthropology: Cross-Cultural Studies in Health and Illness, 35(5), p. 386.

[viii] Closser, S. (2012). “We Can’t Give Up Now”: Global Health Optimism and Polio Eradication in Pakistan. Medical Anthropology: Cross-Cultural Studies in Health and Illness, 35(5), p. 389.

[ix] Closser, S. (2012). “We Can’t Give Up Now”: Global Health Optimism and Polio Eradication in Pakistan. Medical Anthropology: Cross-Cultural Studies in Health and Illness, 35(5), p. 390.

[x] Closser, S. (2012). “We Can’t Give Up Now”: Global Health Optimism and Polio Eradication in Pakistan. Medical Anthropology: Cross-Cultural Studies in Health and Illness, 35(5), p. 391.

[xi] Thompson, D. (2017, January 19). The Dark Side of American Optimism. The Atlantic. Retrieved from https://www.theatlantic.com/business/archive/2017/01/the-dark-side-of-american-optimism/513680/

[xii] Thompson, D. (2017, January 19). The Dark Side of American Optimism. The Atlantic. Retrieved from https://www.theatlantic.com/business/archive/2017/01/the-dark-side-of-american-optimism/513680/

[xiii] Harnett, S. (2017, October 8). The Painful Side of Positive Health Care Marketing. NPR. Retrieved from http://www.npr.org/sections/health-shots/2017/10/08/555370189/the-painful-side-of-positive-health-care-marketing

[xiv] Harnett, S. (2017, October 8). The Painful Side of Positive Health Care Marketing. NPR. Retrieved from http://www.npr.org/sections/health-shots/2017/10/08/555370189/the-painful-side-of-positive-health-care-marketing

[xv] Harnett, S. (2017, October 8). The Painful Side of Positive Health Care Marketing. NPR. Retrieved from http://www.npr.org/sections/health-shots/2017/10/08/555370189/the-painful-side-of-positive-health-care-marketing

[xvi] Harnett, S. (2017, October 8). The Painful Side of Positive Health Care Marketing. NPR. Retrieved from http://www.npr.org/sections/health-shots/2017/10/08/555370189/the-painful-side-of-positive-health-care-marketing