Health Horizons

The Doctor Will See You (on Television) Now

How media is playing an outreach role in countries where healthcare access is challenging.

Superheroine Burka Avenger brings messages of gender equality and health to Pakistan in the form of a television cartoon.

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Two years ago, a television cartoon in Pakistan made waves for its star, a superheroine named “Burka Avenger,” who promotes positive social change while clad in the titular billowing black silk outfit. With the tagline “don’t mess with the lady in black,” the show presents plotlines promoting gender equality, environmentalism and health.

The idea that TV can alter behavior isn’t new, and concerns about its health effects are myriad. Set aside the sluggish flabbiness associated with binge-watching full seasons of “House of Cards,” and one still must consider the false health information, unrealistic self-images and toleration of violence that media is thought to spread.

But recent evidence shows that the upsides of TV and other media can extend well beyond children’s programs like “Mister Rogers’ Neighborhood” or “Burka Avenger.” Call-in programs on sexuality in Pakistan and mental health in Bangladesh are providing otherwise inaccessible health information to the public. In India, where satellite and cable TV has recently broadened its reach, television is changing health and well-being. In each case, it is women and girls who may benefit most.

Nadim Uddin Siddiqui, a middle-aged and slightly pudgy Pakistani doctor, is a bit of an odd choice for what the British might call an agony uncle. Nor does his show — the somewhat confusingly titled “Clinic Online” — seem immediately engaging. Aesthetically, the show’s sparsely decorated TV studio lands somewhere between a U.S. public television newscast and an episode of “Between Two Ferns” minus the jokes. But the program offers something more valuable than laughs to its Karachi, Pakistan, viewers: frank advice on sexual health questions. In keeping with the overall practical bent, the questions seem to fall firmly into medical and practical territory, covering topics like fertility, illness and marital harmony.

“Clinic Online” is not the only one of its kind. A quick search on YouTube turns up a few other Hindi- and Urdu-language sex advice shows that invite viewers’ text messages, phone calls and emails. A program in Bangladesh, which features Dhaka University psychology professor Mehtab Khanam, uses a similar format to offer advice on mental health.

The programs meet public needs by circumventing problems that prevent access to care. In both Bangladesh and Pakistan, patients seeking healthcare must overcome excessive medical costs, lack of available providers and even citywide riots that can shutter clinics for days. Stigma and poor standards of confidentiality in clinics compound the burden for people in need of sexual or mental health advice, while women can be further hobbled by restrictions of their movement outside the home. A call-in show — free to viewers, accessible by phone and anonymous — addresses all those barriers at once, and provides culturally competent advice, per a recent NPR article.

Although an informal setting, the shows involve actual healthcare professionals offering medically sound advice. But fictional, non-medical programs might be just as powerful at altering health behavior — even if, unlike the “Burka Avenger,” they don’t do it with explicit messages.

A paper by Brown University economist Emily Oster quantified the impact of soap operas on Indian homes and found a range of impacts on health and gender equality. The study captured data in the first few years of this millennium, a period when TV ownership spread from 30 million to 112 million Indian homes. As cable shows became standard viewing, families acclimated to the urban values the programs presented. In essence, this urbanized the whole country — even those who didn’t move. “The introduction of cable decreases the differences in attitudes and behaviors between urban and rural areas by 45 to 70 percent,” write Oster and her co-author, UCLA economist Robert Jensen.

After seeing soap operas’ educated, middle-class women characters, TV watchers changed “behaviors traditionally associated with women’s status,” many of which have health implications. “Women report increased autonomy (for example, the ability to go out without permission and to participate in household decision-making) and lower fertility,” and tended to cease accepting spousal abuse.

Influential soap operas aren’t unique to South Asia — and some take healthcare on more explicitly. A Kenyan program called “Shuga,” for instance, starred a pre-Oscar-winning Lupita Nyong’o and treated her character almost as a human public service announcement. The show, a sort of African “Gossip Girl,” worked with an Italian behavioral economist to determine the best sexual health messages to work into storylines. (Episodes describing medication for an HIV-positive character addressed public confusion about antiretroviral drugs, for instance.)

In other media, an intermix of good and bad elements — the ultraviolence of new movie Mad Max, say, tempered with its empowered and ostensibly feminist protagonist — can be tougher to parse. Still, the role that actors, producers and directors may play in public health shouldn’t be discounted. Fred Rogers told CNN at the end of his career that he aspired to be on television “because I hated it so, and I thought there’s some way of using this fabulous instrument to nurture those who would watch and listen.” Well-intended TV shows with positive messages, “Burka Avenger” included, can nurture those who watch and listen.

So don’t mess with the lady in black. Let her heal you instead.

The “Health Horizons: Innovation and the Informal Economy” column is made possible with the support of the Rockefeller Foundation.

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M. Sophia Newman is a freelance writer and an editor with a substantial background in global health and health research. She wrote Next City's Health Horizons column from 2015 to 2016 and has reported from Bangladesh, India, Nepal, Kenya, Ghana, South Africa, and the United States on a wide range of topics. See more at​

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Tags: healthcarehealthtelevision

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