Tailoring health interventions: behavioural and cultural insights for health

How does a better understanding of masculinity help us to create better mental health policies? How does a culture-centred approach to health literacy improve knowledge about sexual and reproductive health among Iranian and Afghan minority groups in Sweden? And why don’t enough people in Romania get vaccinated?

Behavioural and cultural insights are still relatively underutilized in global health. By drawing on fields outside of medicine such as the social sciences and health humanities (including anthropology, history, sociology and psychology), it is possible to develop more effective health interventions.

“Recognizing and understanding the rich and diverse social, cultural, political and historical dimensions that affect health in the WHO European Region is essential to provide actionable support to countries that is tailored to their needs,” said WHO Regional Director for Europe Dr Hans Henri P. Kluge. “The Insights Unit will help health authorities to improve how their services meet citizens’ expectations – delivering respectful and people-centred care,” he concluded.

A new unit at WHO/Europe

Recognizing that, in terms of health policies, a one-size-fits-all approach is not always the most effective, WHO/Europe identified behavioural and cultural insights as a flagship area for the Region in the coming years. It established the Insights Unit to collaborate with partners and across sectors, academic disciplines and technical areas. The Unit is guided by 4 key principles:

• evidence – draw on evidence, test and evaluate it, and disseminate good practices;
• context – generate socially nuanced, culturally sensitive, people-centred health insights;
• scale – support the scale-up of interventions with proven impact; and
• partnership – work with experts, transformers, colleagues and critics.

The Unit works to identify barriers to and drivers of healthy practices. There is ample opportunity to encourage national health programmes and health authorities to use these insights to design more effective health interventions by ensuring they are relevant to their populations.

Behavioural and cultural insights in practice

Across the European Region, there are many cases of behavioural and cultural insights being used in practice.

For example, Kyrgyzstan has experienced measles outbreaks among internal migrants with low vaccination rates. Research to identify the reasons behind these low rates showed that a legislative barrier faced by people migrating from rural to urban areas was preventing them from getting routine vaccinations – an issue that could be changed to improve vaccination coverage and prevent measles.

High rates of cervical cancer incidence and mortality in Romania also reveal how cultural contexts impact health behaviours. Historical and ethnographic research has looked at the lasting legacy of pronatalist policies introduced during the Ceaușescu regime (1966–1989) and how associations with these policies have led to considerable stigma against cervical cancer screening and human papillomavirus (HPV) vaccination. People-centred health promotion efforts that acknowledge this historical stigma are needed if policies are to succeed in bringing down cervical cancer rates in Romania.

Another example is WHO/Europe’s ongoing work to support Member States across the Region to conduct behavioural insights studies in the context of COVID-19. Knowledge about the public’s fears and worries, levels of trust and risk perceptions, as well as their views on restrictions, testing and tracing, and a future COVID-19 vaccine, helps governments shape their pandemic responses.

If you want the answers to the questions posed in the beginning of this article, listen to the Health in Europe podcast, where Katrine Bach Habersaat, Nils Fietje and Anastasia Koylyu explain examples of how behavioural and cultural insights have been used to reveal the impact of social expectations on mental health, improve health literacy and understand low rates of vaccination.

Flagship initiatives

The work of the Insights Unit contributes to one of WHO/Europe’s 4 flagship initiatives to complement the European Programme of Work, which sets out health priorities for the coming 5 years. These initiatives – the Mental Health Coalition, Empowerment through Digital Health, the European Immunization Agenda 2030, and Healthier Behaviours: Incorporating Behavioural and Cultural Insights – are intended as accelerators of change. They mobilize action on critical issues that feature prominently on the agendas of Member States and for which high-visibility, high-level political commitment can be transformative.