From David Krol’s April 1, 2015 post on the Robert Wood Johnson Foundation blog:

If you close your eyes and picture Appalachia, what do you see? The images that often arose first in my mind were those from LIFE Magazine’s 1964 photo essay on the war on poverty. Photojournalist John Dominis gave the nation a face to the plight of Appalachian communities in Eastern Kentucky, and poverty and economic hardship have long been central to an outsider’s understanding of the region ever since. But through my work at the Foundation, I knew this narrative was only one part of the region’s rich and diverse story. I knew there was a different story to be told, and so I wanted to shine a light on these bright spots that demonstrate how health can flourish across Appalachia….

….Seeing these unexpected outliers reminded me of the positive deviance approach to social change. This approach is rooted in the belief that communities have the best solutions to the problems they face—as opposed to solutions driven by outside experts. The first application of this was in Vietnam during the 1990s, with incredible results. Save the Children was asked to address the country’s high child malnutrition rates. At the start of the project, around60% of children under the age of five suffered from malnutrition. After identifying households without malnourished children, qualitative research methods were used to find out what these families were doing differently with the same amount of resources as their peers. Using that information, they developed and implemented local solutions incorporating lessons learned from individual behaviors and cultural norms. Two years into the project, malnutrition rates fell by 80%.

I asked myself, “What if we did the same thing in Appalachia?”

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