Rosegrant and Meijer (2002) observed that “significant reduction in child malnu- trition is possible, but it will require renewed (emphasis added) efforts from na- tional governments, international donors and research institutions and civil society”
(p. 3440S). It is in response to that exhortation that this chapter concludes with a nutrition-campaign objective and four accompanying propositions (P’s) that could guide future investigations into child malnutrition in Africa.
Nutrition-campaign objective: To assess the effects of enhanced health-care pro- viders’ communication strategies on parents and caregivers charged with the nutri- tional health of children at risk for malnutrition.
P1: Health-care providers in intervention groups will be more likely than those in comparison groups to use argumentation and negotiation to communicate child malnutrition-related information to parents and caregivers.
P2: Argumentation and negotiation communication strategies will each be a posi- tive predictor of parents’ and caregivers’ delivery of appropriate nutrition to reduce child malnutrition.
P3: Health-care providers who use argumentation and negotiation to convey child malnutrition information to patients and caregivers will be more likely than those in comparison groups to report significant reductions in malnutrition.
P4: Among parents of and caregivers to children at risk for malnutrition, percep- tions of benefits from argumentation and negotiation aimed at reducing child malnutrition will be positively associated with health-care providers’ use of argumentation and negotiation to convey child malnutrition information to the parents of and caregivers to malnourished children or those at risk for malnutrition.
Conclusion
Sub-Saharan African nations attribute their urban health challenges to eviscerating national population policies, burgeoning urban migration, dwindling public-health services, and taxing political and economic environments. But as the two epigraphs at the beginning of this chapter indicate, urban health is as much a bane of sub-Saha- ran Africa as is the singular issue of child malnutrition. To the degree that Africa is in the throes of a higher incidence of child malnutrition, this chapter outlines at the outset some of the theoretical perspectives that frame much of health interventions in Africa, identifies their missing component, and then argues that health specialists (e.g., nongovernmental organizations and multilateral donors) strive to ensure that parents and caregivers, as participants in a development process (read: preventing child malnutrition), become more responsible than is traditionally the case for the nutritional health of their charges. The application of TCA will acknowledge and de-emphasize strategic action, along with its emphasis on both open and concealed actions, which guide current health campaigns, and will emphasize communicative
140 C. B. Pratt
action, which can be particularly beneficial to child malnutrition-management ef- forts for at least three reasons.
First, parents of and caregivers to children at risk for malnutrition can engage in a communicative action as partners in “interactions in which all participants har- monize their individual plans of action with one another and thus pursue their il- locutionary aims without reservation…” (Habermas 1984, p. 294). This permits an unfettered, unconstrained communication among all parties.
Second, parents and caregivers are parties to making cogent arguments that could lead to negotiated compromises and agreements on whether a strict nutrition- management program is necessary in the first place; to establishing a process that approves messages and themes used in a health campaign; and to raising “validity claims… to truth, rightness, appropriateness or comprehensibility (or “well-formed- ness)” (Habermas 1984, p. 39). The alignment of ideal speech acts with symmetry conditions serves as an enabler of understanding and consensus building.
Finally, parents of and caregivers to children are also parties to open, free, and unconstrained conversations that frame symmetrically each participant’s world- views, yet ensuring their consistency with their lifeworld. Ford et al. (2005) de- scribed this approach as community integrated management of childhood illnesses, in which “community engagements,” “guided conversations,” or dialogue occur at many levels: “inside households, between household members and other com- munity members, among community members and local health workers and ser- vice providers—since this is the environment in which children grow and develop”
(p. 385). And all parties in interactive situations are amenable to integrating the cultural tradition into the messages. Because current health-communication pro- grams tend to give all of those considerations short shrift, even as they consciously and dutifully apply the tenets of health-communication theories to the field and express the strengths of full participation, future health campaigns or programs that benefit from lessons learned from investigating the four propositions outlined in this chapter will have a better chance to respond more effectively to the challenges of Africa’s urban residents’ health.
In light of the preceding analysis, then, it must be acknowledged here that not all strategic action should be avoided, even within the context of applying current health-communication theories to ground activities. Granted, its open form tends to be significantly more symmetrical and more audience-centered than its concealed form. Thus, to the degree that influence is the goal of strategic action in a con- cealed form, communicative action is accentuated in that it engenders symmetry conditions amenable to having parents and caregivers negotiate to engage in action geared toward reaching both an understanding and a consensus among all parties working toward alleviating the nutritional risks or preventing malnutrition in Af- rica’s teeming children population. The current dominant health-communication theories have proved feasible in helping enhance the nutritional status of Africa’s children. This chapter, however, concludes that such theories need to be reframed on the ground in a manner that palpably complements the African inclination to negotiate and argue in decision making, particularly in those situations in which a child’s nutritional health is the beachhead for its physical and educational develop- ment, its social adaptation, and its overall well-being.
141 11 Beyond Thinking and Planning Strategically to Improve Urban …
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