The Role of Promotores in Community Health

Apr 17

Over the last decades, there has been an increasing interest in the development of “promotores,” or community health worker (CHW), programs to improve public health in underserved communities. But, what exactly are promotores and what is their role in these communities?

Promotoras/es are leaders, predominantly in Hispanic communities, that provide relevant health information and promote healthy behaviors to those with less knowledge and/or access to health care within their communities. Other commonly used terms for promotores are peer leaders, patient navigators, health advocates, and lay and outreach workers. Although their responsibilities may vary from programs to regions, the main role of promotores usually is to raise awareness about health issues, preventive care, disease management, and follow-up care, and to improve communication with health care providers, among other roles. The study Community Health Workers: Who Are They and What They Do, references that 66% of CHWs are women, 77% of these are women of color and 58% has a high school degree or less.

According to the World Health Organization (WHO), CHWs should be:

  • members of the communities where they work,
  • selected by the communities,
  • answerable to the communities for their activities,
  • supported by the health system but not necessarily a part of its organization, and
  • have shorter training than professional workers.

Health care providers, community clinics and state health departments have acknowledged the value and key role of promotores in promoting community-based health education and prevention. One of the main reasons why promotores have a great impact and are so effective with their outreach efforts is that they are trusted leaders in their communities. They personally know and understand what community members are going through and they can explain certain health issues, instructions and more technical terms in an easy-to-understand way, relieving patients of the burden of having to decipher a doctor’s explanations and recommendations by themselves.

The CHW concept has been used for at least 50 years. If we go back in time, we will find that the first forms of what are now promotores or CHWs took place in the 17th century, in Russia, where farm workers were called “lay people” and they would receive one year of training so that they could care for the individuals in the military. At the same time, there were similar groups in China, Kenya, Liberia and Latin America. In 1987, WHO adopted a definition for health counselors and identified some of their key roles:

  • education focused on prevention and the control of health problems,
  • promotion of healthy practices,
  • prevention and control of local and common health problems,
  • treatment of common illnesses, and
  • providing essential medicines.

WHO suggests that the first formal CHW programs were implemented in the United States during the 1950s and 1960s. These were developed with the interest of creating health resources that were accessible and appropriate for communities that did not receive services via the traditional medical system.

Many studies have shown that there are many implementation problems when it comes to promotores programs, such as the lack of resources, standardized information on promotores programs, certification issues, and organizational costs. Nonetheless, it has been proven that promotores/CHWs can make a significant and positive difference in the health of their community members. It will be interesting to see how the promotores programs movement evolves in the coming years as an essential part of the health system, as well as a communications strategy for reaching out to particular groups and communities.

A Twist in the Patient and Provider Dialogue

Apr 12

There seems to be a bit of press this month around patients having more to say about their medical care, as in the April edition of the New York Times, “Do Patients Want More Care or Less?” One of the key overall benefits of the Affordable Care Act is that millions of Americans who may not currently have any coverage at all can be insured. If the law works as planned many will have the opportunity to talk about needed medical tests and treatments with the doctors who serve them. Thanks to the internet, social media networks, and a new campaign – “Choosing Wisely” – many may come into these conversations with preconceived ideas of the care they need and even some skepticism about the services these doctors recommend.

Led by the American Board of Internal Medicine, “Choosing Wisely” aims to foster better dialogues between consumers and providers in conversations about which procedures are medically necessary. The campaign has united at least nine national medical associations, which include the American College of Cardiology and the American Academy of Family Physicians, to actually identify some of the common test s and procedures that warrant further discussion and question between the provider and the patient. Tests such as CT scans, cardiac workups and prescribing antibiotics for example, have all been noted as procedures or tests that should be up for discussion or question. There is even a list of 45 things doctors and patients should question and coming up later this month in Boston is an actual conference on “Avoiding Avoidable Care” that will convene physicians and other experts to discuss unnecessary medical care.

This consensus by some of the top tier societies is a move forward in my opinion. Dr. Christine K. Cassel, president and CEO of the ABIM Foundation, said in a written statement: “Today these societies have shown tremendous leadership in starting a long overdue and important conversation between physicians and patients about what care is really needed.” “Physicians, working together with patients, can help ensure the right care is delivered at the right time for the right patient. We hope the lists released today kick off important conversations between patients and their physicians to help them choose wisely about their health care.”

It would be wonderful if the “Choosing Wisely” campaign supports an open dialogue and encourages more providers not to take consumer questions as a personal affront. It may also lead to greater acknowledgement that some of the tests and procedures recommended and actually performed weren’t really necessary, which could lower medical spending. According to the New York Times article, some sources say that one-third of these expenditures in the U.S. are for unnecessary treatments.

As citizens of the U.S., we want access to the best, affordable care possible. Yet learning the pros and cons and side effects of potentially unnecessary procedures can still be daunting to the average consumer. Hopefully, medical school curriculum will include some guidance for future physicians who want to help patients through the process of making an informed decision. I’d also be interested to know what insurance companies have to say on this topic and am looking forward to skimming through a copy of “Overdiagnosed: Making People Sick in the Pursuit of Health” by H. Gilbert Welch, which should shed some light on how this new shift on consumer attitudes has come about. I also at least know now that the dynamic will not be so foreign to my provider should I so choose to question a recommendation.

Join Ogilvy and the Washington Business Journal for “Socially Responsible Behavior Change as a Business Imperative” on April 19

Apr 12

Please join us for an Ogilvy Exchange on Thursday, April 19, 8-9:30 a.m. at our Washington, D.C., office.

How do the components of our personal behavior, such as our attitudes, our motivations, or our abilities drive the purchase of Better-For-You-foods, prompt reduced use of energy, promote adherence to medication regimes and adoption of healthier lifestyles, and more?

And how can companies across a wide range of industries become agents of socially responsible behavior change, building on corporate responsibility commitments to contribute even more so to the well-being of individuals and society?

Join us for a thought-leadership presentation exploring the value and benefits in the emerging area of corporate social marketing, which harnesses proven behavioral science models and theories to advance the twin goals of business success and social good.

Panelists are:

  • Nancy Lee, Consultant, Author and Adjunct Faculty Member, the University of Washington Dan Evans School of Public Affairs, Seattle University’s Institute for Public Service and the University of South Florida’s School of Public Health
  • Michael Sachse, Vice President, Regulatory Affairs and General Counsel, Opower
  • Vidya Plainfield, North America, Senior Category Marketing Manager, Nutricia
  • Tom Beall, Managing Director, Global Social Marketing Practice, Ogilvy Public Relations
  • Robert Terry (Moderator), Managing Editor, Washington Business Journal

Breakfast will be served and space is limited. Confirm your attendance and RSVP to Danae Goldberg at (202) 729-4294.

The Benefits of Joking About Public Safety

Apr 10

As everyone knows we are now in the month of April. This means warmer weather, cherry blossoms, pollen, severe allergies, and of course April Fool’s Day. Who doesn’t love a good (harmless) practical joke? Especially one that is a message of public education and awareness. Behold the “Philadelphia E-Lane Initiative.”

During the first week of April, the city of Philadelphia, PA rolled out what might be one of the most bold April Fool’s joke/social experiments.  Along the 1400 block of John F. Kennedy Boulevard, the spray painted sidewalks depicted the well known stick figure pedestrian peering down at a hand-held device. To accompany these lanes, street signs were also placed on light posts to ensure motor vehicles, bicyclists and other non-hand-held device using pedestrians knew they were not to cross over into the lanes for the digitally distracted. These e-lanes, as they are called, are more than just a joke; they are a message bringing attention to a chronic problem that affects cities across the country—the danger of inattentive pedestrians.

Officials in Philadelphia even went so far as to produce a mock news interview with Mayor Michael Nutter and Deputy Mayor for Transportation and Utilites Rina Cutter. Among the scenes of law enforcement removing non-users from the lanes, street interviews, and the obviously staged “protest” of anti-texting protesters the parody was able to emphasize the seriousness of the issue as no laughing matter. In his mock interview regarding the initiative, the mayor referenced the following statistic, “Every four hours a pedestrian is hit by a car in Philadelphia.” Based on this number that’s about 42 people per week, 180 per month, and 2,190 per year. Just in Philadelphia alone!

This is not just a localized problem, it’s national. In 2009, on average a pedestrian was killed every 2 hours and injured every nine minutes in traffic accidents across the United States. Take a closer look and 76 percent of the fatalities occurred at non-intersections, which leads one to believe that sole blame cannot be placed on drivers. All too recently we’ve seen the effects of distracted walking including an incident involving a Michigan mom walking off a pier into the lake and another woman falling on her face during a life newscast. In Washington, DC, alone about 3 times a day someone gets hit by a vehicle. I can attest to this—as I’m sure we all can—that on a typical day I see several near misses some at the fault of the driver, but mostly at the fault of a distracted pedestrian. Overwhelming data show that DC area roads are not safe enough for transit riders and drivers, walkers, and cyclists. In order to create a safe, livable community, the situation must improve.

While I would not go so far as to hail Mayor Nutter as a “trailblazing breakthrough”—as coined by his office—and albeit it garnered a small press coverage, I would venture that it has caught the attention of various other public education campaigns with similar goals regarding public safety around the country. For instance, since 2002, the Street Smart initiative has launched several radio, newspaper and print ads around the DC metropolitan area to bring awareness to pedestrian and bicyclist safety. Last year, they kicked off their spring campaign which included ads featuring giant feet smashing cars. Other actions taken to thwart walking and texting include a recently instituted fine by the Utah Transportation Authorities which targets pedestrians engaged in “distracted walking” near its tracks.

As social marketers we work with a wide range of issues ranging from pediatric palliative care to flood insurance. For something that should be common sense, where did we lose our animal instinct of being aware of our surroundings and only you protects you? Didn’t we learn at a very young age to always Stop, Look Left, Look Right, THEN Go, but with caution? I know I distinctly remember Mr. Rodgers and my good friends from Sesame Street providing this information whether directly or indirectly through song. Perhaps if there were an App that provided views from all angles for chronic texters there might be a higher chance of success. Oh wait there is! The WalkSafe app for Android phones helps makes sure distracted walkers don‘t get slammed by an oncoming vehicle by letting them know what’s coming. I thought that’s what our eyes and ears were for, my mistake.

I don’t claim to know the answer, or even say with certainty that there is an effective solution. Perhaps you have thoughts or care to disagree, but something has to change. And since I’d rather not be the new hood ornament of a metro bus or town car I think our behaviors and actions as pedestrians is that something. Some say a picture is worth a thousand words, so why shouldn’t that same picture (even a spray painted stick figure) dictate those words and resulting actions? So, stop and smell the spring flowers and admire the world around you; it might just save your life.

I won’t leave home without Fido

Apr 05

Disaster communications and policy changes means residents and their furry family members are safer, more accommodated

Recently a colleague shared an article discussing the impact that the loss of a pet can have on humans –the grief can be extreme, akin to the loss of their human family members and friends.

Ok, so maybe I tend to have crazy cat person qualities (we have two cats at home), but as we’re heading into this year’s summer storm season, the article got me thinking about the emotional toll that disasters – and the impact of losing your pets during them –  can have on families. Many studies have explored how the love for pets and animals can lead to increased happiness, or even longevity. But the love for our pets can also influence choices we make that impact our safety.

The notion that you should evacuate with your pet was not always understood or easy to do. And although the message “don’t leave home without your pet” was part of disaster preparedness and response communications prior to Hurricane Katrina, pet-friendly shelters weren’t always easy to find or mandated by law. Communications regarding pets and disasters was usually a secondary message – as the enormity of human actions regarding their pets wasn’t fully understood, or possibly appreciated.

As a social marketer focused on disaster communications, what I find interesting is the great shift that occurred when communications and policy began to reflect what we know about human emotions, rather than fight against it. Building relevance to people’s lives is key to motivating action and changing behavior. And when it comes to disaster safety, including pets in the equation has done just that.

Hurricane Katrina became a catalyst for focusing more attention on the need for consistent communications, and policy – so that relief efforts weren’t hindered.  For example, a poll conducted by the Fritz Institute in 2006 showed that 44 percent of those who didn’t evacuate during Katrina stayed because they didn’t want to leave pets behind. In contrast, only 18 percent reported that they stayed behind because of relatives. That was a wake up call. An article in Dog’s Life Magazine marking the 5-year anniversary of Katrina also documents the public awakening to the plight of animals killed or left homeless and the resistance from residents to leave them behind after Katrina.  Gloria Dauphin, assistant to the CEO at the Louisiana SPCA is quoted as saying “We learned that animals must have a place at the table when it comes to disaster planning and response. We learned that saving pets [means] saving people.” Following Katrina, the federal Pets Evacuation and Transportation Standards Act (PETS act) and amendments to the Stafford Disaster Relief Act addressed needs for household pets during disasters. Many states and communities have followed suit with local laws to protect pets, and by extension, their owners. And more than ever, officials and organizations are focused on outreach efforts that prioritize pet resources and tips.

Skip to present day: Is it working?

When Hurricane Irene threatened the east coast last August, I found myself urging my parents, who live in Bethany Beach, Del., to evacuate. A mile inland from the coast, I had cause to worry – not just about them – but because that week in August just happened to coincide with “Grandparent camp,” when my parents take care of my two young nieces. This time they had another addition – one of their fuzzy granddaughters – my cat Lila. Here she is…

Understandably, they were initially concerned about being there in case something happened to the house, but everyone’s concern for my nieces and my questions about “What will happen to Lila?” if they stayed too long  got their attention and got them on the road to Washington, DC. Leaving Lila behind didn’t even come up as an option. Instead, they were equipped with the list of shelters along the way that took pets, just in case they needed to stop.

Some may find that staying behind and putting yourself and your family in harm’s way for your pet is a bit extreme. I have certainly felt that way – but working through the  evacuation steps during Hurricane Irene underscored the emotions we can feel when it comes our pets. I’m happy to see that a choice between being safe and protecting your pet isn’t one we have to make as often, due to widespread acceptance of pets as part of the disaster preparedness, response, and communications process.

Click here for more resources and to find a pet-friendly shelter in your state. And if my suggestion doesn’t motivate  you to learn more, maybe this picture will:

Click for more puppies, I mean resources.

See? Cute puppies always work.

A New Look at “Product”

Apr 04

“Public health is everyone’s responsibility and there is a role for all of us, working in partnership, to tackle these challenges.”
Andrew Lansley CBE MP, Secretary of State for Health, March 2011

Last week, I had the pleasure of participating in the National Social Marketing Centre’s Behavior Change and Corporate Responsibility Conference in London.  While there, I was treated to a number of engaging presentations from leaders in the public and private sectors, and I enjoyed the lively discussion about the importance of corporate involvement in solving the world’s most pressing social challenges (something I personally strongly support).

Regarding this latter point, one presentation in particular, has really stuck with me.  It was Tabitha Brufal’s discussion of the goals, structure, and activities to date of the U.K. Department of Health’s Public Health Responsibility Deal.

The Public Health Responsibility Deal is the U.K. government’s initiative to engage corporations in committing to specific actions that support public health goals within the alcohol, food, physical activity, and “health at work” arenas.  As can be expected, the Responsibility Deal has not been free of criticism, with some detractors saying that the motives of corporate partners aren’t “purely altruistic.”

My response:  why do they have to be?

If we lived in a world without wine and beer, without chocolate and cheese, and without televisions, movie screens and laptops, perhaps we would be healthier.  But that is not the world we live in.  For most of us, these “pleasures” surround us, every day.  We work long hours, care for children and aging parents, and try to find time for friends and leisure activities.

Against this backdrop, it’s easy to over-indulge and under-exercise.  Initiatives that make it easier, more accessible, and more enjoyable to make healthier choices are critically important.  And that’s where the corporate sector, their marketing muscle, and their “products” can contribute.

The companies participating in the Responsibility Deal to date have pledged to make fundamental changes in their products, in their workplaces, and in their marketing practices.  Alcohol manufacturers are reformulating products to lower the alcohol content, and encouraging retailers to promote these lower alcohol versions.  Food manufacturers are reducing salt, trans fats, and calories in their products.  Companies are offering workplace smoking cessation programs, health checks, and physical activity opportunities — and they are stocking their on-site cafeterias with healthier foods and supporting community-wide initiatives to promote active travel (e.g., biking, walking) to/from work.

It makes sense that so many of these efforts involve re-imagining a product or service… after all, products and services are the lifeblood of corporations.  But what struck me so clearly last week was how truly critical it is for the private sector to be encouraged to create innovative new products and services that make it more accessible — and more enjoyable — for all of us to make healthier choices every day.  And how crucial it is for public health leaders to invite corporate leaders to sit at the same table, share goals, and identify opportunities to collaborate and achieve a meaningful impact.

Sure, companies will likely reap some benefits from this collaboration that are not directly related to the public health challenge at hand.  But isn’t this “value exchange” one of the cornerstones of social marketing?  Don’t we promise benefits like:  in exchange for  choosing fruit over candy you will feel better, have more energy, lose weight, etc.?.   Or, as seen in action at the conference: in exchange for your active participation in this afternoon’s discussion, we’ll grab a pint across the street at the end of the day.

In my view, the world’s most challenging public health issues will never be solved unless all parties with a role to play come together and truly collaborate.  It’s time for us to look through a different lens, focusing on where the goals and objectives of the public and private sectors intersect.  It’s a win for individuals struggling to make healthier choices.  It’s a win for society and the public’s health.  And it’s a win for corporations seeking to differentiate themselves from their competition, create innovative products and services, and grow their business.

Sugar: The next public health crisis?

Apr 04

Having worked in Ogilvy’s Social Marketing Practice for almost 12 years on campaigns that address public health issues like heart disease, cancer, and addiction, I was intrigued by the recent 60 Minutes piece “Is Sugar Toxic?” that made connections between the sweet substance and each of these issues.

The highlights for me included:

  • Sanjay Gupta’s interview with Dr. Richard Lustig, an endocrinologist, who gives an evolutionary explanation for our sugar cravings, saying “there is no food stuff on the planet that has fructose that is poisonous to you.  It is all good.  So when you taste something that’s sweet, it’s an evolutionary Darwinian signal that this is a safe food.”  To which Gupta replies:  “We were born this way?”  Lustig:  “We were born this way.”  Cue Lady Gaga.
  • Kimber Stanhope’s research linking sugar consumption to an increase in risk factors for heart disease and stroke, which I thought was the most compelling piece of the segment.  She’s in the middle of a five-year study with results that already show that consuming sugar increases our LDL (“bad”) cholesterol, which in turn increases our risk for heart disease.
  • Sugar activates areas in our brains like cocaine does.  Says neuroscientist Eric Stice:  “If you overeat sugary foods on a regular basis, it causes changes in the brain that basically it blunts your reward region response to the food, so then you eat more and more to achieve the same satisfaction you felt originally.”  Now this I believe.  Just try “quitting” sugar, and you’ll undoubtedly experience some of the same withdrawal symptoms drug addicts face.

As the piece ended, I couldn’t help but picture the scene from “Thank You for Smoking” where the M.O.D. Squad (the “Merchants of Death” representing the tobacco, alcohol, and firearms industries) sit in a darkened corner of what I always imagined was Old Ebbitt Grill.  Does the sugar industry belong at the table too?  I think the science is fascinating, and it certainly makes me want to cut back on my own sugar consumption—but just like I can’t imagine life without a glass of wine every once in a while, I can’t imagine it without a grilled cheese on (gasp, sugar-laden) white bread or (double gasp) a cupcake.  I guess you could say that I’m a proponent of the “everything in moderation” mentality.

That doesn’t mean there isn’t a place for awareness and education—especially for the average American who consumes 130 pounds of sugar per person each year.  Lustig’s parting statement:  “Ultimately, this is a public health crisis.  And when it’s a public health crisis, you have to do big things, and you have to do them across the board.”  What do you think he means, and do you agree?

Wait, no makeup?

Apr 03

Being from the South, I learned from an early age that you never leave the house without putting on your makeup—even if you  are only going to the grocery store.  My mom used to say “you never know who you are going to meet and you should always look your best,” and in the same breath would say “you are perfect they way you are.” Really?  If I am perfect the way that I am, why do I have to wear makeup?

Two women from Charlotte, N.C., asked that same question.  They started The Naked Face Project in which they have abandoned their beauty routines for two months to find the answer to this question: Why do they do these things anyway?  They were encouraged to do this because of questions young girls posed to them, “If you tell me I’m beautiful just the way I am, why do you color your hair or wear makeup?”  The women couldn’t find an answer.  It’s like some unwritten rule that we as women are following.  Who made these rules?  Cosmetic companies.  Well, I am not sure if they made the rules but they fuel our need to keep our beauty regimens.

Cosmetic companies go to great lengths to market to women.  No matter where you look—online, TV, radio, magazines—there is an oversaturation of beauty tips and products that we need to look beautiful so we can get the guy or job.  Companies advertise beauty products and claim that it will improve my appearance, make me attractive to the opposite sex, and promise a general lifestyle enhancement.  Magazines like Redbook tells it’s readers that by using a particular perfume you will be able to “magically reel him in” or by using a particular eyeliner your eyes will “look bigger, brighter, and much sexier.”  I wonder what would happen if social marketing fornatural beauty was conducted with equal enthusiasm.  Would photo-shopped photos of celebrities be so prevalent? Would cosmetic companies be a multi-billion dollar industry?

The Naked Face Project has given the women in Charlotte and other participants a new appreciation for natural beauty.  After abandoning their beauty routines for two months, they realized that they are the same person whether they follow those routines or not.  Why? Because they appreciate who they are and found true, authentic confidence within themselves.

When we wear makeup, high heels, and color our hair, we feel good about ourselves.  It gives us a sense of confidence.  However, like the women in Charlotte, we need to understand that real confidence comes from within.  Am I saying you have to abandon your beauty routines? No.  Just don’t get so caught up with the outward appearance that you neglect what is on the inside.  We are perfectly created as is!

Deadly Silence: Black women and Breast Cancer

Mar 30

For the past few weeks I’ve been following the ongoing feature published in The Washington Post called Black Women in America, which stems from a new nation-wide survey by the Post and the Kaiser Family Foundation that paints an interesting portrait of the lives of Black women. The survey includes interviews with more than 800 women and covers topics such as body image, personal finance, discrimination and overall happiness.  Last week’s article, “Breast cancer toll among black women fed in part by fear, silence” really stopped me in my tracks.

According to the article, Black women are less likely than women of other ethnicities to get breast cancer, but are more likely to die from it.  Death rates are 41 percent higher among African American women than among white women.

A separate study published last Wednesday in the International Journal of Cancer Epidemiology, Detection and Prevention compared mortality rates of black and white women in the nation’s 25 largest cities. The study found nearly five black women die per day from breast cancer.

The article provides the following factors that may contribute to these alarming rates:

  • Black women are getting their diagnoses at later stages
  • Black women are more susceptible to aggressive tumors
  • Lack of information about the importance of breast screening
  • Lack of access to high quality care
  • A sense of hopelessness and fear

As a communicator, I have to ask myself with so much information available on breast cancer why are so many Black women dying from it, and how can we turn this around?

One solution the article identified is the power of word of mouth marketing – in other words, simply hearing stories from other Black women who have had breast cancer would make the difference.

Many Black women interviewed said after they were diagnosed and shared their experience other women began revealing their experiences with the disease. The energy and collective strength that empowers women to boldly participate in breast cancer events, such as Susan G. Komen Race for the Cure, is not being translated into the Black community.  Messages about early detection and images of other women, who look like them, who had the disease and survived, are not being shared.

Black women are suffering in silence.  And their silence is deadly.

This blog post was originally published on WomenOlogy.

The New Face of Beauty: 90-Year-Old Fashion Icon

Mar 29

I don’t think there are many females out there who have not, at one point in their lives, struggled with body image issues. Of course, there are varying degrees, ranging from the more typical thoughts of “I wish my thighs were smaller,” to a desire for plastic surgery (since 1997, the number of cosmetic procedures for women has increased over 164%), to actual struggles with eating disorders (currently, as many as 10 million females in the U.S. battle one).

So why is it that females – both young and old – seem susceptible to outside pressure to obtain a certain body shape and/or remain looking youthful? Well, research says that women often strive for the “thin-ideal,” based on the belief that thinner women and girls are more attractive, more sought after, and perhaps more successful. And you have to look no further than Hollywood to see female celebrities going to drastic measures to make sure they look as young and wrinkle-free as their younger, female counterparts. I’d also be remiss not to mention the somewhat cult following of all the Housewives on Bravo’s hit series.

While we cannot prove cause and effect when it comes to issues of body image (hence, why this topic has been studied and debated for years), there are some major culprits in perpetuating these “ideals” — and that is the mass media. Every day we’re bombarded with media messages that come in the form of advertisements, images, and texts. Now, I’m the first to admit that my guilty pleasure is reading the latest celebrity scandal in gossip magazines at the supermarket. (Ironically, I cancelled my $24 yearly subscription to one of these gossip magazines a year ago out of “moral principle,” yet somehow I continue to buy it every other week at the full $3.99 market price.) But these images aren’t just showing up in magazines. Pictures of “perfect” women (and men) appear on bus shelters, in mall kiosks, the movies, and on television. Sadly, research shows that by the time a young girl starts kindergarten she will have already watched 5,000 hours of television, including 80,000 ads. As we strive to look like the female models and celebrities we view in the mass media, we often feel disappointed with our “average” body shapes, stress about our emerging wrinkles, and are quick to point out our various imperfections.

This led me to ask, is there actual science behind these feelings of inadequacy? Well, one theoretical approach – social comparison – serves as a possible lens through which to understand how the representation of female images in the media can affect body image and self-esteem. This theory, originally put forth by Leon Festinger in the 1950s, stated that individuals have a desire to evaluate their personal opinions and abilities. We do this by comparing ourselves to others who are most similar to us, because this helps us gauge our own capabilities most effectively. However, Festinger highlighted one scenario in which individuals compare themselves to those who are different, and that is when the attraction of a particular group is so strong that an outsider aspires to be a part of that group. Basically, this is all of us who strive to look like the celebrities we see in the magazines or on TV. They’re certainly not our peers, but we definitely emulate them. Unfortunately, this “upward comparison” (i.e., comparing yourself to those better off, or at least those we think of as better off) results in lower self-esteem and feelings of inadequacy.

The social comparison theory and our obsession with Hollywood may help explain why almost 9.5 million cosmetic surgical and nonsurgical procedures were performed in the U.S. in 2010, totaling nearly $10.7 billion. Clearly, Americans and particularly women, who accounted for almost 92% of total procedures, continue to aim for perfection at all costs. It also might shed light on the fact that in the past 50 years, the number of eating disorders has doubled in the U.S.

That’s why it was particularly refreshing to see a piece on The Today Show last week that reported that M·A·C Cosmetics recently collaborated with 90-year old fashion icon and interior decorator, Iris Apfel. Known for her eclectic style, spectacles, and love of all things brightly colored, choosing Iris was a deliberate move on M·A·C’s part to represent real women (see photo below)… women who have lived long, productive lives and who have the wrinkles to prove it. Interestingly enough, this collection created by Iris hit stores this past January and sold out within days.

So what does this tell us about women, beauty, and body images? Well, perhaps the tide is starting to turn when it comes to advertisements and the mass media featuring real women, as opposed to young, “perfect” women. Our societal awareness of body image issues among women (and how devastating they can be) hasn’t been enough to fully change how females are portrayed in magazines, advertisements, movies, and television. Perhaps affecting the bottom line of businesses can…