Toronto – Canada






Coercion And Population Health




It is 1950.  I am six years old and my sister is three.  Her nursery school serves a full meal at lunch.  At dinner in the evening she firmly says, “No spoonsils.”  I hold up the nightly vegetable.  “Is this a spoonsil?”  “No,” she says, “no spoonsils.”  One night we had Brussels sprouts, which I don’t like.  I pressed her.  “This is the worst vegetable,” I said, “it must be a spoonsil.”  “No! No! No!” she screams, “no spoonsils.”  Mom figures out that what she is trying to say is that while she is not disgusted by a particular vegetable, she objects strenuously to the requirement to eat them, even if just a spoonful. 


Periodically, Mom takes us to the doctor for a check-up and immunization.  A particular shot makes me very ill, but not my little sister.  I decide that while it is OK for her to have shots, I should not have any more.  I mention this idea to Mom who says she will talk to the doctor.


When it becomes time for the next shot, Mom seems to have forgotten our conversation. When the doctor goes to give it, I protest by screaming, wailing.  It is hard to keep up the act but I manage.  The doctor says I am too upset to get the shot.


A few days later, Mom takes me back to the doctor who jabs me as I walk in the door.  “See,” she says, “you are a big girl.  You can stand the pain.”  “Oh,” I thought, “you do not understand.  It is not the pain of the shot that frightens me.  It is the feeling of being so sick I want to die.”


With programs that offer these kinds of client experiences, is it any wonder that vegetable consumption and immunization are too low for optimal population health?


Mom consulted with Dad and her brother in various businesses.  She did not trust leaders who were too compulsive or too narcissistic.  She wanted adaptive capacity, flexibility.  And she wanted these qualities in her children.  “Be a big person,” she would say.  “Roll with the punches; bend like the willow.”


If we want our health programs to work, we must be less compulsive and narcissistic about the current formats.  We must bend to the child’s mind and be big enough to choose adaptive strategies.  


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