Why Shame Is A Bad Public Health Tool Especially In A Pandemic

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Believe me I get it. I'm frustrated and angry to. After all, it's been four months of this. We know the right things to do. And when you see someone wearing a mask or groups of people hanging out close together, it's easy to get mad, even if in all fairness. Once or twice. Open defiance at this Castle Rock Colorado restaurant large crowds, no social distancing, and there's some news coverage right now. That caters to this anger. You know what I'm talking about. Many Americans are out and about on this memorial day visiting newly reopened businesses seems from the unofficial kickoff to the summer showing many Americans not practicing social distancing measure. I'm telling you to wear a mask where a damn ask, but this Kinda thing anger public shaming the urge to yell at people who aren't doing the right things. That can be precisely the opposite of productive. Yeah, as the researcher I've been. Watching all this unfold through that Lens Julia Marcus is an epidemiologist and professor at the Harvard. Medical School, she said he's HIV prevention. And for scientists Julia, who work in HIV or sexual health or even substance abuse? They know that shame can be a huge barrier when it comes to public health, and in these first few months of the Cova pandemic I was watching this same pattern happen where you know, these kind of absolutist public health messages and moralistic undertones were potentially contributing to what became rampant shaming of people who were flouting public health guidelines or doing things that people felt. Felt were high risk, and when we shame people for their risky behavior in a way that distracts us from where risk is really happening, which is typically much less visible like in prisons and nursing homes and food, processing plants, and those don't inspire the same moral outrage. I think for two reasons one. They're not right in front of our faces, but also to we don't think of those as people having fun and a pandemic which I think people really upset. Matt rage, Julia says might feel good to act on in the moment, but it's not gonNA solve our biggest problems right now. I find that taking that rage home, and really screaming alone has been very helpful for me to. Do that as well or you know my rage these days first of all I would say that knows no bounds, but also. To be honest. My regions more directed at institutional failures than individual ones. To episode Julia Marcus on the role. Shame plays in public health crises. We talk masks. School reopenings in the long road ahead. I'm Maddie's defy, and this is shortwave daily science podcast from NPR. Julia Marcus has written a bunch of great pieces for the Atlantic about why. Shame is not helpful right now and how we can do things better. She's looked this when it comes to mask wearing social distancing and how we open college campuses, we talked about all those things, but the first thing to say here is that there is a fine line between public shaming and some positive forms of peer pressure. I, yeah I WANNA make a distinction here between social norms and shaming I. think social norms are very powerful and. That can be one of the best ways I think to change. Health behavior is like well. Everybody else is doing it so I'm going to do it because it's more like i. want to feel good when I go in the grocery store and I'm not gonNA. Feel great if I'm the only one not wearing a mask, so, but there's a difference between making people feel bad about their risky behavior and making people feel good about engaging and protective behaviors as a way of like becoming part of What the new social norm is Marie right? Right Okay Julius. You've written a bunch of great pieces for the Atlantic. Let's talk about your most recent one I. It's you know how to not open colleges this fall. You started out by describing an email that went out to students at Tulane University earlier this month July seventh. What what happened there? Yeah I mean I I I don't WanNa. Pick on two lane here. Becher, that was it just an example of some of the communications that were starting to see toward students who are on campus this summer and have been having some parties. And there was an email that we're not to students that really condemned stat behavior as disrespectful, indefensible, dangerous selfish, and made it very clear in bold all caps that hosting parties of more than fifteen people would result in suspension or expulsion from the university and that if students wanted the school to remain open, they needed to be personally responsible. I'm in their behavior and When a university says, we will hold you accountable for having a party, and actually there will be dire swift punishment when inevitably there is an outbreak at a party. Students are going to be terrified to disclose that they were there. And students have now said this at the University of Connecticut were interviewed and surveyed about what kind of thing is going to work for them what their concerns are about the fall. And they universally said we. We are early close to universally said we're really afraid of how infection and risky behavior are going to be stigmatized such that we outbreaks will not be able to be controlled, so there needs to be appropriate consequences for putting your community at risk, and I would never say otherwise but that needs to be balanced against the need for public health efforts to be separate from discipline. And we've already seen contact tracing start to break down outside of campuses, because people are afraid to talk about having been at event that that they know is something they should not have been doing yeah. So. You know kind of following that thread. The part of this pandemic that's been hardest for a lot of people is is social distancing in in several of your pieces you wrote about how a lot of the advice especially in the beginning was almost like an abstinence based approach like stay home. See Nobody which absolutely made sense kind of at the. The beginning, but tell me about why. That approach doesn't necessarily make sense for the long-term well asking people to abstain from all social contact indefinitely or until we've scaled up. An effective vaccine is just not going to be a sustainable public health strategy, and I think now our messaging has evolved a bit especially as there's been an accumulation of evidence around. The risk is highest like what's settings or higher risk, in which ones are lower risk, but I think we continue to still have a tendency toward absolutist messaging and I think that our goal should be to two inch. People tour to a place where they are living their lives in a way that addresses all aspects of their health, while trying to keep tr- risk of transmission low, and so one way that that could play out is encouraging outdoor activities, especially in spacious areas, opening up more outdoor space for people, and there's been a tendency to close beaches and close parks where people gather, but. But I actually think doing the opposite on could could be helpful, but the essential point is. We can't stay in our homes forever and many people couldn't stay in their homes for the last few months because they were working sure, but it's clear from other areas of public health that asking people to abstain from something that they fundamentally need or strongly desire is not an effective public health strategies, so we have to find ways of making our messaging more nuanced, that allows people to get what they need to be able to live sustainably while keeping the risk of transmission low until you there. There are examples of nuanced messaging from others accessible public health campaigns. Right I. Mean You work on HIV? Can you give me an example of that? Yeah, so we you know we don't tell people don't have sex. Because that's the best way to not get HIV, we may save the safest thing you can do to avoid HIV transmission is not have sex, but we understand that many people are going to have sex, and that it's a you know a part of a healthy life, and so here are some safer ways to have sex, both in terms of certain sexual acts in in terms. Terms of protection different ways you can protect yourself and you know becomes a more nuanced message, but it's much more sustainable for people and realistic and the long term, and it also acknowledges people's basic human needs right, and there's also this idea that talking about ways to reduce risk encourages people to take those risks, even though from a public health standpoint. We know that isn't true. So I'm wondering Julia like. Why do people hold onto this concern? Like what is this really about yeah I, mean this is definitely not new. It comes up a lot. I think especially around drug, use and sex. And I think the reason it especially comes up in those settings is that those are behaviors that we have a lot of moral judgments about particularly in this country, and there's this kind of moral outrage that happens when we think about people engaging in risky, which is often pleasurable, behavior, sex, drug use, and these days going to the beach like. it's kind of playing out in this new way now with social contact and partying and people having a good time in a pandemic, which it's actually a public health win when we find ways to support people in enjoying their lives, and and getting their basic social or sexual needs, met while remaining a safest possible, and you've made the point that we've. We've already seen this play out with the corona virus, public health officials, hesitating to give people detailed ways to protect themselves instead of avoiding risk altogether, I mean I remember. We reported early on in this pandemic when Dr Burks of the White House Coronavirus Task Force said. We don't want people to get this artificial sense of protection because they're behind a mask. This lack of consistent messaging is one of the reason that a lot of people still aren't convinced that masks are helpful, so you know. Julia, how do public health officials effectively reach? Those people yeah I mean I. Think in general we always see some resistance to any new public health intervention, condoms, and you know pre exposure prophylaxis for each V. I mean every intervention that comes out. There's resistance. There's challenges with implementation. There are moral concerns you know. This is all kind of par for the course, but I think what's new here and a bit different is not necessarily just the polarization which we do, see an Ciaran things like vaccines, but the politicization. Politicization I don't think there has been I can't think of an example where a sitting president has flouted public health recommendations and I think that that has created kind of a politicized around masks. That wouldn't have necessarily been there and so how do we overcome that? And how do we reach people I think again it comes back to hearing people's concerns, acknowledging them, and then working to overcome those barriers in our messaging and I. Think there are some good examples of that there have been a couple of great mask campaigns that have come out of California acknowledging that people dislike wearing them and acknowledging the reasons why people dislike wearing them. And I would guess that they are more effective in reaching certain populations than campaigns that that are more focused on this. Just wear ask. It's really easy kind of messaging. Yeah and don't you care about your community and don't you want to not kill people and That kind of messaging is like early days of AIDS. Messaging around condoms that I think was not as successful as the messaging that really focused on what the barriers were, and how people could overcome them. Yeah, yeah, with all this stuff that we've been talking about colleges masks. You know keeping safe distance. It's pretty tough because the stakes feel so high like this is really a nasty virus, and when we see people, you know not doing the right things, the instinct there to shame them to get mad for a lot of us at first instinct and I. I guess it's just that we need to take some patients to push past them. Yeah, I mean I, think it's really. Valid to feel angry about what's happening right now, and for people who are not necessarily taking care of themselves or their community and putting other people at risk. It's very frustrating to see, but I think especially for public health professionals. It's on us to do the work to avoid the shaming and the anger and the moralizing in our messaging. Because we've learned that that doesn't work in other areas of health and really try to take the time to craft messaging. That is going to be more effective. Julia Marcus. Checkout episode notes for a link where you can find her writing to the Atlantic. Can say the Atlantic is crushing it these days, but the magazine, not the ocean. I mean

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