How we created an intimate ethnography to inform future health policy.
There are moments in life when the stars align and you rush to go where the path leads. In 2016, we had the opportunity to help inform developing health policy and programs in California—and we took it. We created two ethnographic videos designed to be used by the California Department of Health Care Services (DHCS) to inform policymakers at the state and federal levels, senior program designers, legislators, and service organizations in California.
DHCS is working to prevent early childhood obesity and support child wellness through policy and practice. DHCS conducted formative research with the National Opinion Research Center (NORC) to understand how to develop the best prevention approaches. An element of the research was creating two video ethnographies: The first chronicled the experiences of low-income parents as they seek to raise healthy children. The second highlighted professionals who are engaged in innovative community wellness interventions across California. DHCS chose anthropologists because of our ability to engage diverse populations, evoke their hopes, views, and experiences, and share those in a compelling and faithful way. Videos would enable viewers to gain an audiovisual sense of the respondents and the contexts in which they live.
We worked to shape the project so that it had strong contextual and cultural sensitivity. We wanted to develop an emic perspective with participants; their telling of their own story was central. We recommended approaches that we believed would make the project process and products valuable to all of the stakeholders.
Working with DHCS and NORC created a nearly ideal environment to develop the videos in a manner that was consistent with the best of anthropological practice. From the development of questions, to the recruitment of participants, through fieldwork, and finally through the editing of video and creation of the final products, DHCS, NORC, and the participants joined us in a collaborative process. Co-creation was fundamental in working with each person to tell their story. We had key issues to explore and needed to be able to tell a visually engaging story, but the conversations and observations evolved through establishing rapport with the participants and shaping the agenda together. The result was a site and shooting plan that the participants largely controlled, populated with people important to them and their stories, and set in the places in which they live and work. Over the course of filming, most participants populated the videos with family, friends, and/or co-workers. Over 100 people were either active participants or part of the intentional depiction of community and contexts. In short, the participants led the way. We asked them to explain the meaning, the purpose, and the cultural grounding at each step and encouraged them to shape the vision that others would see.
Participants shared both the strengths and challenges of their lives and communities, in some cases revealing sensitive information or details that could place them in danger. We accepted their trust and ensured that they were safe in the process and honored in the outcomes, while not disguising the challenges they face. For community leaders, we offered an opportunity to share their difficulties and successes in working with communities that struggle with extraordinary challenges and strive to raise fully well children. We ensured methodological integrity and collaborated to develop the most faithful, sensitive, and useful products possible.
We moved from an early focus on obesity prevention to ways of developing and nurturing early childhood wellness—exploring how parents and families work to raise healthy children in mind, body, and spirit. This shift reflected the parents’ and providers’ beliefs that obesity is a symptom and that holistic wellness is the true path to prevention. Too many health interventions have focused on the individual in isolation and in attempting to shape her/him to enact a Western vision of (generally) physical health. These interventions frequently fail, wasting time and resources, and leaving participants frustrated with both the process and the outcomes. We approached video planning from a perspective of health and wellness as deeply cultural and contextual constructions. To truly understand how to support individuals, families, and communities in being fully well requires an essential grounding in strong and healthy cultures.
We shot a total 150 hours of video over 13 individual ethnographies and developed two feature length videos. Each of the two videos has its own story arc that incorporates multiple participants and is also thematically complete. The narrative is distinctly anthropologic, even as the events and views are uniquely those of the participants. We invited them to be thoughtful and reflective; we respected their knowledge and expertise. They responded by sharing their views, their histories, their friends, families, and colleagues with us, and by digging deeply into the context and meaning of health and wellness. Each ethnography was personal, intense, and often intimate—some including tears and all including laughter. The process of creating the videos honors the ethnographic tradition of clear and evocative storytelling to complement careful and methodologically sound data collection and analysis. In keeping with our co-creation objectives, each participant had opportunities to view and comment on their segment and then the whole video before they were finalized and made public.
The videos have been disseminated across DHCS and the USDA, Food and Nutrition Service. DHCS has also shared the videos with partners and stakeholders including other state organizations and expects to continue to use them with diverse audiences. Our purpose was to tell thoughtful stories that respected and honored each of the participants’ lives, knowledge, and work, and that could educate a larger public. DHCS is ensuring that the videos are being disseminated to those publics and that what they learned from the participants is used in policy and program planning.
We also created a thematic video clip library that represents the diversity of geography, gender, and ethnicity for community participants, and geography, topic, and clientele for community leaders. The video clips are being used for public presentations, briefings, and in education settings.
A final report became a confidential vehicle for telling more comprehensive and intimate stories and to illustrate issues not appropriate for the public videos. It also was an opportunity to discuss methods and process and to illustrate the anthropological difference. Finally, the report allowed us to discuss our analysis of the process and the data and to suggest policy and programmatic ways to use the information.
View the videos on the DHCS website.
Cathleen Crain, MA and Nathaniel (Niel) Tashima, PhD, are managing partners at LTG Associates, Inc. and co-directors of this project and the videos. Reiko Ishihara-Brito, PhD was staff ethnographer. Erick Lee Cummings was the videographer. The team was recognized for the videos at the 2017 Praxis Awards and the videos were chosen for the 2018 Ethnographic Film Festival at the Society for Applied Anthropology Annual Meeting.
Cite as: Crain, Cathleen, and Niel Tashima. 2018. “Through an Ethnographic (Video) Lens Brightly.” Anthropology News website, July 17, 2018. DOI: 10.1111/AN.916