Challenging Dogma - Fall 2007

...Using the social and behavioral sciences to improve the practice of public health.

Sunday, December 9, 2007

“Take a Loved One for a Checkup Day”: A Health Campaign that Needs Help in Promoting Health - Christelle Larose

The National Health Campaign “Take a Loved One for a Checkup Day,” is an educational campaign that was initiated by the Office of Minority Health. “Take a Loved One for a Checkup Day,” specifically targets minorities and other racial groups to motivate themselves as well as their family, friends, and neighbors to attend a health event once a year or visit a health professional (1). The main component of this campaign is to promote better health outcomes among minorities who are disproportionately affected by serious diseases and health conditions compared to the rest of the American population (1). The campaign educates racial and ethnic minorities on key issues such as diabetes, heart disease, stroke, cancer, infant mortality, child/adult immunization, and HIV/AIDS(1).

African Americans and Latinos receive fewer physician visits, preventive services, and surgical procedures than whites (2). Statistics show that as a result of receiving fewer cardiac procedures, African Americans with coronary heart disease were 18 times more likely to die than whites(2). African Americans experience a higher rate of hypertension, cardiovascular disease, and stroke compared to Caucasians (3). Also, African Americans have a higher incidence of certain cancers and a cancer survival rate of five years (3). “Take a Loved One for a Checkup Day” is framed around the belief that once an individual attends a health event or visits a healthcare provider once a year, better outcomes and longevity will occur automatically.
When examining “Take a Loved One for a Checkup Day,” one must question: is access the only factor that prohibits better health outcomes, or are there other aspects to this problem? “Take a Loved One for a Checkup Day” attempts to help minorities and other racial groups have better health outcomes by encouraging them to seek access to health care once a year. However, this campaign is a flawed system that ignores salient factors such as: social factors, self-efficacy, and financial barriers.

Social Factors are Often Ignored

“Take a Loved One for a Checkup Day” fails to incorporate how social factors affect people’s health outcomes. Social factors include one’s race, cultural influences, and environment. This campaign stipulates that better health outcomes and longevity will occur once an individual seeks care from a health provider once a year. Therefore, one would conclude that in order to have longevity all they have to do is visit a physician once a year and they might live until they are 100 years old.

“Take a Loved One for a Checkup Day” focuses on improving the health outcomes solely among minority populations. However, this campaign fails to take into account that access does not guarantee equal care among the minority population. African Americans and other ethnic groups suffer from covert and overt racism /discrimination on a daily bases. African Americans and other ethnic groups report that because of their race, physicians do not properly explain their illness and treatment (2). Some African Americans seek less care due to the historical experience that existed within the formal healthcare system. During the time of slavery, slaves were abused and disrespected while being involuntarily used as medical research subjects (3). As a result, African Americans are more likely to distrust the health care system and delay receiving care. African Americans and other minority groups tend to believe that physicians and hospitals have a “profit motive in treatment choices” (3). Also, in order to avoid discrimination within the health care system, African Americans and other minority groups may turn to their faith to overcome illness instead of seeking care.

“Take a Loved One for a Checkup Day” does not take into account those whose behaviors are dictated by their culture (ex. taking home remedies to treat an illness). Many may find it pointless to seek treatment elsewhere if it is provided within their own cultural network. According to Theordare, Robert, Darren, and Leah: “Focus on access to healthcare professionals ignores the most important determinant of health: the patient himself or herself in a sociocultural context.” (4). Mexican Americans are more likely to use natural healers for mental disorders rather than seeking psychiatric care because of their culture values, beliefs, and traditional health practices(6).

Language creates barriers and often times prohibits specific minority and other racial groups from seeking access to care. Chinese people have strong cultural values. Hence, when they arrive in the United States, they might be unfamiliar with U.S. concepts and terminology of illness. Therefore, a new citizen’s failure to understand the U.S. health care system prevents them from utilizing available services or treatment (5). Illegal immigrants in the United States fear receiving health screenings because they think they will be deported for their illegal status (6). When weighing the options between getting deported or the possibility of having a better life for your children and yourself, illegal immigrants tend to not go for health screenings.

Living in a crime-infested neighborhood not only instills fear in individuals when leaving home, but causes them to delay seeking care unless for an emergency. Access to health care is an important element in increasing better health outcomes among the minority population, but it is not the main element. “Take a Loved One for a Checkup day,” must realize that racism/discrimination, cultural differences, and one’s environment are barriers that will lead to a reduction in the number of people who will visit a physician once a year.


“Take a Loved One for a Checkup Day” does not address how self-efficacy is an important aspect in changing behavior. Self Efficacy is a concept that was created through the Social Cognitive Theory. Social Cognitive Theory states that “behavior change is affected by personal factors, environmental influences, and attributes of the behavior itself” (8). Self-Efficacy is defined as the “conviction that one can successfully execute the behavior required to produce outcomes” (7). Bandura states that “outcome and efficacy expectations are differentiated because individuals can believe that a particular course of action will produce certain outcomes, but if they entertain serious doubts about whether they can perform the necessary activities such information does not influence their behavior”(7). Therefore, when an individual’s self-efficacy is low, they may not attempt a behavior change.

This campaign attempts to get individuals who rarely seek healthcare access to motivate their family, friends, and neighbors to seek access once a year. This campaign fails to take into account that there is a strong association between self-efficacy and behavioral change. For example, an individual who has low self-efficacy will not go for a check up once a year just because their family, friends, or neighbors are performing that specific behavior. Also, an individual who attends AA meetings but has low self-efficacy will not stop drinking unless they believe internally that they have the capabilities to stop drinking. According to Jim Grizzel “people’s behaviors lead to certain outcomes….and their expected outcomes are filtered through a person’s expectations or perceptions of being able to perform the behavior in the first place(8). Thus, how can the campaign “Take a Loved One for a Checkup Day” expect a person to seek care once a year if they do not believe that seeking care once a year is going to better their health outcomes or lead to longevity?

Financial Barriers

The biggest flaw of this campaign is that it focuses solely on access and ignores other factors that influence access, such as economic barriers. The intent of this campaign is to encourage racial and ethnic minorities in low-income neighborhoods to seek access in order to have better outcomes. Several questions can arise among these individuals when thinking of the campaign, “Take a Loved One for a Checkup Day.” For example, how can I seek care once a year if I lack insurance coverage?, when I receive care, how can I pay for my prescribed medication if I am suffering economically?, or will I have to pay out of pocket because I am not fully covered by Medicare/Medicaid? People without insurance are more likely to delay care, receive care in emergency rooms/ underbudgeted hospitals, and wait 7-8 hours before receiving appropriate care (2). Neighborhoods that have a high proportion of African American or Latino residents have fewer physicians practicing in their communities, which also can also lead to a delay in health care access(2).

Other factors that “Take a Loved One for a Checkup Day” failed to take into account are the proximity to a doctor’s office and access to transportation in minority communities. In minority communities, people will often have to travel a long distance in order to reach the nearest hospitals and wait a long time for public transportation(9). Ask yourself, if you were a stressed single parent would you wait 2 hours for public transportation and an additional 7-8 hours at the hospital? Or would you delay receiving care and work overtime? Thus, racial and ethnic groups who suffer from economic hardships are more likely to have poor health outcomes because they delay health screenings.


Overall, “Take a Loved One for a Checkup” was created in order to provide better health outcomes among minorities and other racial groups who are disproportionately affected by serious diseases. This campaign assessed that the only way to create longevity and better health outcomes is increased access. Once an individual receives access once a year this will lead to better health outcomes and longevity. Thus, this campaign places the blame on bad health outcomes on the individual because if access is given and people do not seek it, then poor health outcomes are their own fault. However, this campaign failed to realize that increased access does not guarantee better health outcomes. “Take a Loved One for a Checkup Day” needs to realize that social factors, self-efficacy, and financial barriers are other salient factors that prohibit people from gaining or receiving equal access.

“Take a Loved One for a Checkup Day” can increase better health outcomes by providing health care access not just once a year, but once every three months. Also in addition to visiting the doctor once every 3 months, there should be fully- funded programs that discuss nutrition, exercise, and overall better health tips. “Take a Loved One for a Checkup Day” should provide transportation vouchers for families who find transportation unaffordable. Therefore, for this campaign to work effectively it must analyze factors on a macro rather than micro level.


1) US Department of Health and Human Services.Closing the Health Gap
Campaign Washington, DC http://
2) Thomas S. Bodenheimer, Kevin Grumbach “ Understanding Health Policy: A
Clincial Approach” 2002, pg 22-24
3) Johnson,Jerry, Smith Nancy. Health and Social Issues Associated with Racial,
Ethnic, and Cultural Disparities. Recognizing Diversity and Aging. 2002:25-
4) Pincus T, Esther R, DeWalt DA, Callahan LF. Social Conditions and Self-
Efficacy Management are More Powerful Determinants of Health than Access
to Care. Annals of Internal Medicine 1998:129:406-411.
5) Grace Xuegin Ma, PHD. Between Two Worlds: The Use of Traditional and
Western Health Services. Journal of Community Health, Vol. 24, No. 6,
December 1999
6) Washington State Department of Health Office of Environmental Health
Assessments. Summary Results of Yakima Farm worker focus groups about
pesticides in health care.
pdf/focus group summary 0309922final.pdf.2003
7) Hale, J. L., Householder, B.J., & Greene, K.L. (2003). The Theory of Reasoned
Action. The persuasion handbook: Developments in theory and practice (pp.
259 - 286)
8) GrizellJim, Behavior Change Theory and Models.
9) US Department of Transportation. Public Involvement Techniques for
Transportation Decision- Making. Ethnic, Minority, and Low-Income

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