Measuring Needs and Motivations for the new Public Health Agenda

By February 18, 2011Uncategorized

Having recently blogged about the Values Gap and also the connection between Values and occupational class, I now want to address the issue of “needs” in more detail. After all politicians and those delivering public policy will say they wish to meet people’s needs as have political philosophers in the past, some of whom have argued for the distribution of resources “to each according to their needs“.

Thus understanding needs is really important; but when we talk about them, are we clear what we mean by them?

Looking at history one might speculate whether a past lack of clarity as to all the human needs that required satisfaction could have led to some substantial political and policy blunders? For example if someone had been in a position of influence and held inner directed values, viewing things from the prism of their own values might possibly have prevented them from fully appreciating that those who have yet to even satisfy outer directed needs, might not have responded to their no-doubt well-intentioned exhortations to seek to immediately move to satisfying similar inner directed needs to themself. Thus instead of securing dynamic change in line with the expectation of ones values, one might have ended up with a Values Gap and the demotivation of those who held different values!

Therefore whatever the varying views on how public policy should develop in the coming years, perhaps we should all have a shared understanding of what we mean by “needs“, in order to more effectively debate together the various ways of addressing them.

Some key approaches in Needs Theory

To most psychologists, need is a psychological feature that arouses an organism to action toward a goal, giving purpose and direction to behavior. Needs themselves evolve as a result of economic situation, life-cycle, social network and circumstance.

Maslow: A Theory of Motivation

The most widely known academic model of needs was proposed by psychologist Abraham Maslow. In his Theory of Motivation, he proposed that individuals have a broad hierarchy of psychological needs, which range from basic physiological needs like safety through to self-esteem through to self-actualization – though I think self-activity or autonomy are a better description of that latter term – that they then seek to satisfy. The British Values Survey draws much from this academic and theoretical source as well as from Shalom Schwarz’s World Values Survey.

Maslow’s hierarchy is often drawn as a pyramid with one need progressing to another in an upward direction from a base. Unfortunately, I think this shape tends to represent a lot of its use in the very Outer Directed United States for self-help and management theory, which through the prism of that values set sees the achievement of needs in particularly individualistic terms. Indeed past surveys have shown over 50% in the U.S hold these values as their primary value set compared to 30% in the UK.

My own personal view, based on utilising this typology of needs in very practical terms for research insight and policy interventions, is that the satisfaction of those needs is equally a collective action problem which then assists motivated self-help. Thus I would see the same order of needs as Maslow explained in his Theory; but this time framed in the shape of an inverted pyramid operating more as a “pit of demotivation”. I subsequently discovered that the academic John Adair had already made a similar inversion of the pyramid (Leadership and Motivation, 2006, pages 28-30), making the important point that the traditional pyramid shape:

“makes it look as if our greatest needs are in the lower ranges, and that they narrow in size as you progress up the pyramid. But physiological needs, for example, are limited; you can only eat so many meals a day. In fact there are fewer limitations the further up you go. Therefore if you persist with the pyramid model, it makes more sense to invert it..”

The advantage of this alternative design is that it:

  • Makes it clearer that to get people up the sides of the “pit” one needs supportive personal social networks as well as other forms of collective action including the enabling hand of the public, private and voluntary sectors working in partnership.
  • Re-frames what is traditionally visually presented as an achievement “hierarchy” into something more akin to an equalities challenge in order to seek to secure support for tackling this in public policy terms.

In making the latter point I would agree with Dan Pink’s view of psychological needs in his book Drive, that we all have the potential to display forms of inner directed values early on in life with the right nurture that satisfies needs. However the social networks people inhabit and the social norms those networks generate, could hold back or prevent individuals satisfying various needs so one could start at the bottom of the “pit” and either take longer time to get to the top of it or indeed never reach the top of it in terms of needs satisfaction!

To give an example, nowadays, for many self-esteem and the esteem of others might be something we address the most in our childhood,  teenage years and early adulthood, through educational attainment and our development of our own strong personal social networks separate from our parents. However for some people esteem needs may remain an unsatisfied need throughout all of adult life. This then might inhibit the satisfaction of other needs too.

Reframing the hierarchy as a Pit rather than pyramid makes it clear that, in motivational or self-efficacy terms, for some people, self-help is not enough and the satisfaction of their needs is a challenge for public policy to support and enable them.

Gough and Doyal: A Theory of Human Need

A second view of need is the work of political economy professor Ian Gough. He has published on the subject of human needs in the context of social assistance provided by the welfare state. With medical ethics professor Len Doyal, he also published A Theory of Human Need.

This book was also strongly referred to as a theoretical base in the Young Foundation Report on Britain’s unmet needs: “Sinking or Swimming” which was  published in 2009. It is very good starting point in understanding current social needs and it is important to be aware of it as it may contribute to the development of the baseline for developing outcomes for future public health and wider public policy issues.

Gough and Doyal’s view goes beyond the emphasis on psychology: an individuals needs are representative of the costs of being human within society. A summary of their views is below:

In the view of Gough and Doyal, each person has an objective interest in avoiding serious harm that prevents the endeavor to attain his or her vision of what’s good, no matter what that is exactly. This attempt requires the ability to participate in the societal setting in which an individual lives. More specifically, each person needs to have both physical health and personal autonomy. The latter refers to the capacity to make informed choices about what should be done and how to implement that. This requires mental health, cognitive skills, and chances to participate in society’s activities and collective decision-making.

How are such needs satisfied? Doyal and Gough point to eleven broad categories of “intermediate needs” that define how the need for physical health and personal autonomy are fulfilled:

1. Adequate nutritional food and water
2. Adequate protective housing
3. A safe environment for working
4. A supply of clothing
5. A safe physical environment
6. Appropriate health care
7. Security in childhood,
8. Significant primary relationships with others
9. Physical security
10. Economic security
11. Safe birth control and child-bearing
12. Appropriate basic and cross-cultural education.

How are the details of needs satisfaction determined? The authors point to rational identification of needs using the most up-to-date scientific knowledge; the use of the actual experience of individuals in their everyday lives; and democratic decision-making. The satisfaction of human needs cannot be imposed “from above”.

It is interesting to note that the Gough and Doyal approach seems to focus on areas where the intervention addresses ability rather than motivation. For many of our current public health challenges it is the latter as much as the former that needs to be addressed and the more psychological Maslow approach may thus prove equally relevant. However it is right that there is further debate on these approaches to understanding needs and in any case there is much overlap between them.

Whatever approach to needs one develops from this debate, this will all remain just academic theory unless those in public policy have a more developed and objective way in future to measure the impact of their interventions in terms of satisfying needs, that goes well beyond the prism of values driven judgments.

The role of Values Based Segmentation in understanding Needs

What comes out of our work with values based segmentation is the greater emphasis in our methodology on understanding how people are satisfying immediate needs that are directly relevant to them.

Values based segmentation is a useful measure of where society is, at any given point, in satisfying its needs as well as the motivations and values that are derived from them.

Segmentation that understands “Needs, Motivation and Values” in order to address the “why” of behaviour in order to better change it, is in future likely to prove very useful to public bodies.

Needs are the base from which people then express their Values.  Some communities are still seeking to satisfy needs in terms of safety and security and communications need to address the values that derive from those needs far more in order to be able to have an effective two-way conversation. It enables us to gain insight into those communities where, for example, its economic development is being held back by unsatisfied needs around safety and security so that a range of new approaches are needed to develop new needs within communities to influence values to increase levels of motivation. and community resilience.

Values based segmentation can help create baselines for metrics as well as measuring subsequent outcomes. It could therefore provide useful insight for pilot programmes within the new Public Health Service in terms of contributing to the new Public Health Outcomes Framework.

Charlie Mansell is Research and Development Officer for The Campaign Company. If you want to see what your own primary values set is, why not take the simple Values Questionnaire here.

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