One of the topics that I found quite intriguing in the Urban Health course was on Normality and Deviance in Sociological perspective. In small groups the lecturers (Nanna and Charlotte) instructed us to reflect on literature by Howard S Becker entitled “Outsiders. Studies in the Sociology of Deviance.” Using the study questions provided the three of us in the group I was in delved into the subject matter.
Notably, there are various definitions of deviance. In statistics, the deviant is something that varies widely from the average. In medicine, it is pathological, revealing the presence of disease or a dysfunctional organ or system. From a sociological perspective deviance goes beyond the individual deviant to encompass the judgement process by society as a crucial aspect of phenomenon. In this regard, Becker highlights that the sources of the deviance go beyond the individual deviant and are located within the social situation of the deviant or in the social factors surrounding the deviant. This brings to light a relativistic view in which deviance refers to the failure to obey group rules. Becker’s points out that while some rules apply to some segments of society, there are other rules that are applicable to a particular society as a whole. Therefore, deviance is created by society because it is society that identifies who the deviant is. This is because society makes the rules which if infringed or violated constitutes deviance. In this case , deviance goes beyond the act that a person commits to embrace the notion that it is the application of others the rules and sanctions to the “offender”. The offender therefore, is the deviant or outsider. Deviant behaviour is that which people have labelled as deviant behaviour.
Essentially, the study of deviance has focused on the need to maintain social order. Deviance refers to that which varies from the norm. The word deviant usually has a negative connotation. In their evaluations of organisational studies Gretchen M. Spreitzer and Scott Sonenshein of University Michigan Business School point out to this negative connotation when the write that:
“Traditionally, deviance refers to intentional behaviors that depart from organizational norms that threaten the well-being of an organization, its members, or both.Included in these types of dysfunctional behaviors are stealing and incivility”
The authors also point out that out 40 definitions of the concept that compiled, only two were used in a non negative ways. In fact, most literature shows that in the past, there was strong opposition to the notion that positive deviance can even exist as a concept.
However, one may wonder whether or not there are situations where deviance can confer advantages to society. Is there deviance that can be deemed positive
This may surprise you. If it does, remember you are not alone. I was also quite surprised to find that there is various literature on positive deviance. Here, I refer to some information that I stumbled upon.
Let us start from looking at what positive deviance means. According to World Vision International, positive deviance means straying from the norm, but in a beneficial way. Tina Rosenberg in reference to positive deviance titled her article on the New York Times blog as “When deviants do good”. Authors like David R Marsh and his colleagues have compiled literature entitled, “The Power of Positive Deviance”
The research fraternity has also not been left out. For instance, a simple search on PubMed with the words “positive deviance” reveals that the concept is of interest to various research areas.
The topic of positive deviance has been used in several fields in both developed and developing country setting. Some areas include hospital setting, public health, child protection, education and the private sectors as part of business management. Positive deviant behaviour refers to the uncommon practice that confers advantage to the people who practise it compared with the rest of the community or peers.
Positive deviance approach
David R Marsh and his co-authors, in the writing on The power of positive deviance, highlight that:
“Identifying individuals with better outcome than their peers (positive deviance) and enabling communities to adopt the behaviours that explain the improved outcome are powerful methods of producing change”.
The Positive Deviance approach therefore, enables the community to discover these successful behaviours and strategies and develop a plan of action to promote their adoption by all concerned.
Positive Deviance Approach Used to Address Malnutrition: The case of Vietnam
The positive deviance approach has been used to address undernutrition in various communities. While literature cites that the approach was used as early as the 1960s to combat malnutrition in Haiti, the indication is that its use was enhanced from the 1990s. Rosensberg, in her article “when deviants do good”, shades light on how the approach was applied to tackle malnutrition in Vietnam in 1990. In the effort not fall back on food which had been tried earlier, an intervention that would not create dependency but would be relatively sustainable was sought. With the help volunteers from the local village, families whose children were not malnourished were identified. Observations were then made to identify how differently these children were fed compared to the rest of the community, the norm.
It was gathered that:
the mothers of these children in their individual capacity collected shrimps as the worked in the rice paddies. They added the shrimps and sweet to the children’s meals a practise much against the norm that an adult diet should not be given to children. Furthermore, the trend in the village was that if a child had diarrhoea then they should be fed. However, if a child had diarrhoea, the positive deviant parents fed them even the more frequently and washed the children’s hands before eating.
Consequently, their children were well nourished. Therefore, the deviation from the norm conferred positive effects on the nutrition status of their babies. Having learnt this, these positive parents were requested to share their practice with mothers who did not do something similar. Within 6months, the general nutritional status of the children in the community improved. A district that initially had two thirds of the children malnourished now had over 40% were well nourished and about 20% moved from severe to moderate malnutrition.
Since then, various organisations have applied the approach in an effort to combat malnutrition in various countries and communities- in each place using different, local solutions. Some countries that have tried include, Indonesia, India, Zambia, Congo. Organisations that have supported the positive deviance approach in managing undernutrition include UNICEF, World Vision International, USAID. Furthermore, the Tuft University, USA has come up with a basic manual highlighting steps and procedures on to implement PD.
The proponents of the approach argue that PD is worthy approach to be included in the policy framework of nutrition interventions. They state that the advantages include that:
It is sustainable: Focuses assets within the community and not needs. This points to what is already there rather what should be there.
It empowers the community: With the volunteers and mothers working together
It is cost effective as the resources are with the community.
The Positive Deviance Initiative at Tuft University has also proposed that PD approach can be considered when dealing with concrete problem that meets the following criteria:
• The problem is not exclusively technical but also relational and requires behavioural or/and social change.
• The problem is complex, seemingly intractable, and other solutions haven’t worked.
• Positive deviant individuals or groups exist solutions are possible.
• There is sponsorship and local leadership commitment to address the issue.
Some challenges and opportunities
It is important to note, however, that the PD approach in management of malnutrition has not been without criticism. It has been argued that there has not been adequate research that has included controls. In a systematic review done by Piroska Bullen, this was raised as concern. However, the same study indicated that qualitative results suggest that the program is both feasible and acceptable to communities in a range of developing country settings – both urban and rural.
In 2009, the American Nutrition Institution backed a study by Vossenaar et al, suggested the PD approach could be useful as a practical approach for developing culturally specific and realistic dietary recommendations compatible with reduced cancer risk. In this regard, iindividuals who manage to consume a healthful, risk-lowering diet in a situation of widespread unhealthful eating could provide insights into how appropriate consumption can be achieved. This healthy eating might overcome barriers of adverse cultural pressures, economic restrictions, or educational deficits prevalent in urban areas today.
Dealing with urban health may require a collection and combination of interventions. Besides, Positive Deviance has been associated with helping to reduce rates of female genital mutilation in Egypt, improved prisons in Denmark, helped the mentally ill in Pittsburgh strengthen social connections and cut infections at Veterans Affairs hospitals across the United States. Who knows, Positive deviance might make a substantial contribution towards thinking outside the box. Let me know what your opinions are.
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