Friday, February 10, 2012

Book Review: Join the Club, by Tina Rosenberg

Join the Club, by Tina Rosenberg, W.W. Norton and Company, 351 pages (plus bibliography and notes), 2011.

Join the Club, by Pulitzer Prize winning journalist Tina Rosenberg, is the latest in the currently vogue genre of Pop Social-Psychology/Pop Sociology. The genre, for which Rosenberg’s fellow New York Times writer Malcom Gladwell is probably the best-known populizer, typically takes a rather academic topic for which there has been recent research that either contradicts the conventional wisdom, or is profound in its societal implications.  The best works, such as Sunstein and Thaler’s Nudge or Gladwell’s Tipping Point, do both.  The journalist-author then acts as a medium, distilling the social science for the general audience, as well as forging an engaging story that can hold that audience’s attention.  Join the Club is Rosenberg’s first full foray into the genre and is highly recommended to anybody concerned with human behavior.  Though the book ultimately suffers from poor organization and the examples have all been presented with greater analytical rigor elsewhere, Rosenberg nevertheless synthesizes these stories in a new and fascinating way.

In looking at what can effectively be summed up as “positive peer pressure,” Rosenberg manages to capture a set of strategies that primarily public health workers have been using in diverse interventions with increasing success since the mid ’90.  Tying these strategies together under a single heading, she christens them the “social cure”.  At the same time, she extends the social cure beyond health, finding parallel examples in fields ranging from community churches to toppling dictators, and in so doing, dramatically expands the potential field of action for the strategy.

The material is long overdue for greater public attention and is presented through fascinating examples, but Rosenberg’s relative newness to the genre also shows through in the book’s organization, which is somewhat lacking.  While the overarching thesis jumps out from the first pages, is well argued, and more or less present throughout the text, the individual chapters often tend lack a clear sub-thesis and wander, guided more by the narrative than an organizational logic.  Chapters are generally organized into stories – essentially case studies – each of which supports the social cure thesis and shows its application in a distinct context.  Yet with many chapters coming in a 50+ pages and containing numerous side-stories and some stories even spread across two chapters, organizational logic is compromised and the reader is left to make unnecessary effort to keep track of the winding threads.

Presented as they are as stories, the individual examples are captivating, but at the same time tend towards description rather than analysis.  Though I personally found much of this history and background worth reading, the thesis was frequently lost in the thick narrative and it is easy to assume other readers may take less interest in side-shows such as the history of Pinochet’s regime, to give one example.  At times, even when discussing potentially salient factors, Rosenberg seems to digress from the social cure thesis by failing to concretely link the discussion back to the psychology of social groups.  The most obvious example of this is the discussion of branding in campaigns.  While branding is unarguably an integral part of successful behavioral interventions, it is not immediately clear what the relationship of catchy marketing is to a strategy based on the power of personal connection.

Furthermore, though the writing is consistently engaging, the book contains a number of awkward sentences comprised of mismatched conjunctions or seeming non sequiturs. The effect is to require careful rereading, or occasional reference back to a point that had wandered off topic earlier in the chapter.  Such technical flaws are surprising for an author of Rosenberg’s caliber, and leads to a sneaking suspicion of either conflicting visions from the publisher or a rushed release deadline.

None of this is to subtract from the potentially revolutionary implications of the social cure, but on the broader continuum of pop social-psych, these flaws moves Join the Club more to the end of the casual audience, as compared to policy makers and program specialists who will find it difficult to use as a quick reference.  Ultimately, however, a number of the examples will not be new to these specialists anyway, especially those working in health education or behavior change.  In fact, many of the studies – such as those of teen smoking campaigns and village health workers in rural India – are already presented in other mediums as key case studies, which typically contain much greater analytical rigor than is allowed in a book intended for the general public.

Where Rosenberg is at her best, however, she does something that these studies typically have not done: she places it in a broader strategic approach, saying that these distinct examples are all essentially different manifestations of the same psychological and social strategy. This is not small contribution, and if Rosenberg can move policy and programming research and analysis closer to a bit more holistic and generalized research its impact will be notable.  Even for the community development worker well-accustomed to running behavioral interventions, then, there is great value to be found in Join the Club.  Rather, this value is likely to be found at a broader theoretical level. Even the most studied examples such as California’s decrease in teen smoking, after all, have generally been treated atomistically in  their case studies.

This general level, in fact, proved extremely useful in my thinking about health education in Moldova.  Peer education techniques have for years been part of the bedrock of our program of behavioral interventions.  So far, however, my use of positive peer pressure has tended toward the predictable and unimaginative – youth-led campaigns targeting peers on the standard suspects of smoking and reproductive health.  Far beyond simply providing a great list of ideas as to how to spice up these campaigns, Rosenberg encouraged me to rethink the entire field of potential actions and targets.  In the most tangible sign of this reevaluation, this spring I’ll be embarking on a project that seeks to leverage positive peer pressure amongst the health providers themselves to improve the sustainability of our entire health program.  In essence, Rosenberg has encouraged me to look not just at target groups as the benefactors of the social cure, but the community organizers tasked with the nearly impossible task of improving these targets’ health.  Burnout is very high amongst our partners; so high, in fact that it is in itself a significant barrier to effective behavior change campaigns in the village.  So if a social cure strategy can help reduce burnout amongst the educators, it stands to reason it could have a large indirect positive impact on community health itself.

In the end then, there is a little of something for everyone in Join the Club.  Ultimately, Peter Walker is myopic in reducing Join the Club to simply a lesser work of the “people power” genre; he mistakes the enemies in Join the Club to be governments and corporations.  Instead, Join the Club has much more in common with the recent resurgence in behavioral economics, which has done much to debunk the myth of Homo economicus by revealing the consistent irrationality of our human ways.  The real barriers in Join the Club are our own behaviors, behaviors that we already know to be unhealthy but nevertheless seem unable to confront.  In such a context, Join the Club helps synthesize what might be the most far-reaching strategy to tackle the key human challenges of the modern era.  Despite its flaws, it is the first work out there that has begun connected the dots of positive peer pressure, and thus is highly recommended reading.

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