Senior director's column: Global impact — are we ready?
By Merry Bullock, PhD
There is much talk lately about psychology’s potential contributions to addressing various global challenges. For example, ameliorating climate change, global health, educational attainment, poverty, migration, literacy, child survival and family planning. There is no doubt that psychology is relevant — we broadly agree that human behavior plays a core role in addressing these and other worldwide challenges. We also broadly agree that psychology has the tools to understand behavior change, and to design, evaluate and implement behavior-based change strategies within socio-ecological systems — individual, organizational, community and public policy levels. This understanding of the importance of behavior is reflected in discussions being held at the global level in the United Nations and throughout several of its offices about sustainable development (see the cover article), health, well-being, education and poverty reduction. These conversations recognize that mental health and well-being are essential for economic and social development.
So far so good. But a consistent lesson from countless “on the ground” programs as well as summits, forums and high level meetings is that our knowledge of what works, where and for whom is still limited. Some examples will illustrate: One of the conclusions in the report from last year’s USAID Summit (June, 2013) on the theme “behavioral change strategies for population level child survival outcomes” included the need for much more research about what works at scale to bring about change. We know that successful interventions are multifaceted, community based and local, but we have little comparative knowledge to help chose among interventions for particular locations, to document cost-effectiveness or to take successful programs to a regional or global scale. Similarly, at a recent NIH conference on “Solving the Grand Challenges in Global Mental Health (June, 2014), speakers pointed out that, although there are powerful projects and interventions underway, there is still concern that we know too little about cultural specificity in global mental health.
In a recent article, Gary Darmstadt from the Bill and Melinda Gates Foundation wrote in Global Health and Diplomacy:
“We were initially puzzled by the realization that decades of investment in global health have left us with a vast graveyard of pilot programs that have rarely, if ever, been successfully scaled and, even less so, evaluated. ... We have learned that the achievement of measurable impact from the deployment of health innovations will require sustained efforts to promote social and behavior change. ... the spread of highly efficacious solutions ... will not only require changes in the practices and organizational forms of existing delivery systems, but we will also have to tackle long-standing community beliefs and norms ... and individual and collective disincentives for the adoption of new ideas, mental models, and practices.”
There is also recognition that to change behavior, one needs to directly change actions. It is not sufficient to merely provide knowledge or change attitudes. Psychology has a lot to offer in this process, from “basic” principles of behavior, such as effects of incentives or the overwhelming impact of context and framing, or the importance of individual, family and community interactions. Psychology’s models and methodologies are valuable tools in thinking about and evaluating behavior change mechanisms. There are many sage thinkers who have pointed out the myriads of ways in which it is valuable to broaden the range of “mainstream” knowledge and methodologies, to move toward multidisciplinary and transcultural approaches, and to listen with respect to local perspectives in order to be positioned to address major world challenges.
Perhaps it is psychology’s own understanding of the breadth of behavior that brings a unique perspective to addressing global issues. For example, basic studies of learning and cognitive processes, especially under adversity, highlight the importance of perceived control in maintaining healthy behavior — and provide a powerful psychological explanation for why actions that promote autonomy, control and “empowerment” also promote achievement and well-being. Similarly, basic studies show both the importance of incentives and motivation in maintaining behavior, and provide tools for evaluating the short and long term incentive structure of situations and organizations. These can be useful tools in making the translation from resources to implementation.
For psychologists, making a transition to thinking globally requires new sets of skills. These include learning to work, discuss and listen across disciplines, across cultures, and across languages, legal systems, terrains and time zones. They also include shifting focus from ameliorating pathology to promoting sustainable well-being; a shift in concert with the rhetoric of global mental health (the recent NIH-WHO summit was titled "Solving the Grand Challenges in Global Mental Health") and global psychology (the 2014 International Congress of Applied Psychology’s theme is “From Crisis to Sustainable Well-Being”).
As psychology increasingly defines its disciplinary knowledge as not just content, but also skills and competencies, it will be important to explore and describe these competencies in an international context. APA’s Committee on International Relations in Psychology, has recently embarked on a project to articulate what international competencies may be. It will be important to engage broadly in this discussion so that psychology can be poised to engage with others in addressing the new directions of global impact.