MMHEM: An Innovative Framework for Public Health Interventions

Among marginalized communities of color, well-intentioned public health interventions may inadvertently lead to a widening of health disparities due to design flaws that could cause variability in the behavioral responses and penetration of these interventions. Compounding this is the “inverse prevention law”, a term coined by Julian Tudor Hart, which states that in a system where healthcare is a commodity influenced by market forces, economically disadvantaged people, who are most at risk for poor health, are the least likely to receive preventive health measures.

To meaningfully engage communities affected by the inverse prevention law, we believe that public health interventions should be designed with a greater emphasis on the science of human attention and related cultural factors. Human attention is one of the most precious commodities of the modern era, and even the public health sector needs to compete for it as efficiently and effectively as possible.

Dr. Olajide Williams; President and Founder of HHPH and Chief of Staff of Neurology at Columbia University Irving Medical Center and Dr. Ewelina Swierad; HHPH Project Manager and Associate Research Scientist at Columbia University Irving Medical Center identified the knowledge gap in this area and developed MMHEM as a solution.

MMHEM incorporates art, culture and science across different levels of an individuals’ social and physical environment. M stands for Multisensory and highlights the importance of engaging as many of the five human senses as possible in health education. Scientific evidence suggests that engaging multiple senses enhances learning and facilitates immersion. The second M stands for Multilevel; it highlights the well-established fact that the most effective health education strategies target not only the individual, but also the social and physical environment in which the individual resides. H.E. stands for Health Education and the third M stands for Model.

We sat down with Dr. Olajide Williams (OW) and Dr. Ewelina Swierad (ES) for an interview to learn more about the model and here is what they shared with us.

1. What made you want to pursue research in the field of health education?

OW: Martin Luther King once said, “of all the forms of inequality, injustice in health care is the most shocking and inhumane.” His words imply that health care is a social justice issue and that all citizens, regardless of color or creed or economic means, should have the right to basic health care.

In my mind, this justice begins with education. Education creates powerful self-advocates. Studies confirm that the more educated you are, the better your health is likely to be; conversely, the less educated you are, the more likely you are to die from preventable disease.

I am inspired by those who sacrifice themselves – in part or in total – for the benefit of others; faceless individuals who give selflessly through small and large acts of altruism in pursuit of a better relationship, a better home, or a better community. Most of these folks are unknown, they are the unappreciated, unassuming, unsung heroes performing gallant acts in secret for no apparent reason other than because it is just what they do. Our world needs more people like them and they deserve to live long, healthy lives.

E.S. My work in the health and psychology fields stems from my commitment to social justice. Using data to help others, especially disadvantaged communities, lies at the heart of all my professional pursuits.

Being an immigrant has also deeply shaped who I’m becoming as a researcher – it has opened my eyes wider to the value of culture and human connection. Without a doubt, the mesmerizing world of the arts, humanities and science informs my research, and I feel fortunate to explore their interconnected relationship with my talented colleagues at our lab. From Leonardo da Vinci’s uncanny ability to discern patterns between disciplines, to Einstein’s commitment to clarity whenever explaining complex ideas and Maya Angelou’s repository of humanity and courage, it becomes clear to me that public health still has much to learn about the role of the arts in health promotion. But the research we do at HHPH under the inspiring leadership of Dr. Williams gives me hope that we will eventually close this gap.

2. What was the process of working on the model like?

OW: We began by conducting a retrospective analysis of health education programs, including our own, to identify which components worked best and whether common themes existed. It became quickly apparent to us that the most effective components fell into three buckets – those related to art, science and culture. We then scouted the scientific literature for evidence-based relationships between these three domains in the context of public health education/promotion and began mapping out connections.

There was vast amount of information pointing to a greater need for cross-sectoral and cross-disciplinary collaboration and a richness of non-academic approaches in the world of commercial advertising, marketing and visual arts. Whether it is a painting or a poem or a song or a dance or a gritty urban drama, the ability of these art forms to powerfully stimulate human imagination and emotion while effectively communicating ideas and concepts was in our mind, stunningly underutilized in public health. 

3. What is different about this model vs. other health education models?

ES: What we aspired to achieve with MMHEM is conceptual clarity – we wanted to simplify the complexity of health promotion and create a functional model for translation into both research and practice. As Einstein put it, we wanted to “make things as simple as possible, but not simpler.” We did this by building upon existing traditional health promotion models such as the socio-ecological model, theory of planned behavior and elaboration likelihood model. Moreover, because we incorporated nontraditional approaches from non-academic sectors, our model is not only integrated, it is integrative in nature. An example of a nontraditional approach is our use of hip-hop and the arts as vehicles for interactive health education for children.

4. Why is a multidisciplinary model important in health education?

OW: We believe that art and science exist along the same continuum – you can’t really pull them apart. This is why so many art forms have powerful health benefits – and why music occupies more real estate in the brain than language itself. Music improves our mood, enhances learning, reduces stress and cements memories. This symbiosis between art and science is at the heart of our work – it is in the design, implementation and evaluation of our programs. Even the composition of our team is designed to harness the symbiotic effects of art and science: it is why we have members from diverse sectors and cultural backgrounds including public health experts, medical doctors, nutritionists, psychologists, entertainment industry professionals and artists. We even have an advisory board made up of only 5th graders!

5. How does MMHEM account for how children learn?

ES: Children learn best when they are fully engaged. We know this from decades of research on learning. Therefore, the most effective health education is one that creates an immersive experience and not just an age-appropriate lecture. Art is immersive, whether in the form of a captivating mural or a classical music symphony. By adding cultural relevance – like the Polish composer Jimek’s orchestral rendition of Hip Hop Classics – art becomes even more resonant. However, these efforts need to be filtered through the prism of scientific methods and processes for optimal impact on children. In fact, when we used this approach for our program, Hip Hop Stroke, it resulted in children as young as 10 years old, utilizing the wealth of information they learned in hip-hop songs to recognize stroke in family members and appropriately call 911 on their own, in one case overruling a parent who did not want to call 911.

6. How can teachers support and benefit from this research?

ES: Our work is intricately guided by teachers and frontline educators. We do this during the design, development, implementation and evaluation phases of our work through the use of focus groups, semi-structured feedback surveys and formal consultation with professional curriculum developers. MMHEM can be adopted by School Wellness Councils, Physical Education teachers and Health Education teachers. To facilitate this, we have created standards-based, culturally-responsive, immersive health education resources tailored for specific grade levels. These health education resources, focus on a variety of health topics, including nutrition, physical activity, mental health and stroke, just to name a few.

7. What is the next step for MMHEM?

OW: A deeper dive into the intrinsic mechanisms of health behavior change and the development of tools for measuring the more downstream subconstructs of our model to facilitate its application.

8.  How can others get involved in your work related to the model?

OW: We invite teachers to use and share our free resources and implement our interactive curriculums in their schools. We welcome donations – monetary and in-kind – from stakeholders and individuals who share our passion for this work. You can also learn more about MMHEM and send us your questions or feedback here