Beyond Thinking and Planning Strategically to Improve Urban Residents’ Health

Abstract

This chapter identifies a missing element in the application of dominant health communication theories to health campaigns in sub-Saharan Africa. That element, the failure to empower Africa’s urban communities to engage in symmetrical communication, is grounded in argumentation and negotiation on health decisions that affect them. Therefore, it argues that Africa’s urban residents, particularly parents of and care-givers to malnourished children, take full advantage of the minuscule health resources at their disposal by applying a communicatively rational process to negotiate three universal, criticizable validity claims: propositional truth, normative rightness, and subjective truthfulness or authenticity under conditions of speech. Thus, in every aspect of engaging in a communicative interaction for accessing the full panoply of health services, even in their inadequacy, African communities are encouraged to accept, challenge, refute, deliberate, discuss, or reject the bases of ideal speech acts and symmetry conditions. All of those possible outcomes emphasize full community participation as the desideratum of making significant contributions to determining key health issues and to identifying program responses to them. In essence, then, this chapter provides a theory-grounded field guide that can enhance the delivery of health services in Africa’s urban communities, which, for the most part, are the epicenters of significant health disparities, particularly in child malnutrition.

Cities are growing larger and larger, and their populations of the poor are growing larger even faster. The consequences for health are immense.-Margaret Chan (2010, p. 18), Director-General of the World Health Organization [Sub-Saharan Africa] is the only region in the world where the absolute number and proportion of undernourished children have increased in the last decade.-Chopra and Darnton-Hill (2006, p. 544)