Short Wave - Why Shame Is A Bad Public Health Tool — Especially In A Pandemic

Episode Date: July 24, 2020

So much of dealing with the pandemic is about how each of us behaves in public. And it's easy to get mad when we see people not following public health guidelines, especially when it looks like they're having fun.But Julia Marcus of Harvard Medical School says there are pitfalls to focusing only on what we can see, and more empathetic ways to create new social norms. Julia's written about that for The Atlantic. Here's some of her recent work. Email the show at [e-mail] pcm.adswizz.com for information about our collection and use of personal data for sponsorship and to manage your podcast sponsorship preferences.NPR Privacy Policy

You're listening to Shortwave from NPR. Believe me, I get it. I'm frustrated and angry too. After all, it's been four months of this. We know the right things to do. And when you see someone not wearing a mask or groups of people hanging out close together, it's easy to get mad.

Even if, in all fairness, you've been that person 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. Scenes from the unofficial kickoff to the summer showing many Americans not practicing social distancing measures. I'm telling you to wear a mask.

Wear a damn mask. But this kind of 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 an HIV researcher, I've been watching all of this unfold through that lens. Julia Marcus is an epidemiologist and professor at the Harvard Medical School. She studies HIV prevention. And for scientists like Julia, who work in HIV or sexual health or even subsist,

since abuse. They know that shame can be a huge barrier when it comes to public health. And in these first few months of the COVID pandemic, I was watching this same pattern happen where, you know, these kind of absolutist public health messages and, you know, moralistic undertones were potentially contributing to what became rampant shaming of people who were flouting public health guidelines or, you know, doing things that people 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, too, we don't think of those as like people having fun in a pen. which I think makes people really upset. That rage, Julia says, might feel good to act on in the moment, but it's not going to solve our biggest problems right now. I find that taking that rage home and really screaming alone has been very helpful for me, Julia. Do you do that as well?

You know, my rage these days, first of all, I would say it knows no bounds, but also to be honest, my rage is more directed at institutions. failures than individual ones. So this episode, Julia Marcus on the role shame plays in public health crises. We talk masks, school reopenings, and the long road ahead. I'm Maddie Safaya, and this is Shortwave, the 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 at 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. Yeah, I want to 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. 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 going to 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 in protective behaviors as a way of like becoming part of what the new social norm is. Right, right. Okay, Julia, so you've written a bunch of great pieces for the Atlantic. Let's talk about your most recent one first. 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 7th. What happened there? Yeah, I mean, I don't want to pick on Tulane here, but that was just an example of some of the communications that we're starting to see towards students who are on.

campus this summer and have been having some parties. And there was an email that went out to students that really condemned that behavior as disrespectful, indefensible, dangerous, selfish, and made it very clear in bold in all caps that hosting parties of more than 15 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 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. Students at the University of Connecticut

were interviewed and surveyed about what kind of messaging is going to work for them and what they're concerns are about the fall. And they universally said, we are, or at least close to universally said, we're really afraid of how infection and risky behavior are going to be stigmatized such that, you know, 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 an event 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 social distancing. And 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 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 where risk is highest, like what settings are higher risk and 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 inch people toward a place where they are living their lives in a way that addresses all aspects of their health while trying to keep 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 closed parks where people gather. But I actually think doing the opposite 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. 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 strategy. 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. And Julia, there are examples of nuanced messaging from other successful 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 say 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 part of a healthy life. And so here are some safer ways to have sex, both in terms of certain sexual acts and in terms of protection, different ways you can protect yourself. And, you know, it becomes a more nuanced message, but it's much more sustainable for people and realistic in 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 on to 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, right? Like we, 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 getting their basic social or sexual needs met while remaining as safe as possible. And you've made the point that we've already seen this play out with the coronavirus. public health officials hesitating to give people detailed ways to protect themselves instead of avoiding risk altogether. I mean, I remember we even reported early on in this pandemic when Dr. Birx 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. And you know, 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 HIV. 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 around things like vaccines, but the politicization. I don't think there has been, or 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 climate 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. Right. And I would guess that they are more effective in reaching certain populations than campaigns that are more focused. on this just wear a damn mask, it's really easy kind of messaging. Yeah, yeah. And don't you care about your community and don't you want to not kill people? And, you know, 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 a safe distance, you know, it's pretty tough because the same. 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, it's that first instinct. And I guess it's just that we need to take some patience to push past that. 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.

Check out our episode notes for a link where you can find her writing at the Atlantic. Which, can I just say, the Atlantic is crushing it these days. The magazine, not the ocean. I mean, I don't know, maybe the ocean, too. I'm not sure what it's up to. This episode was produced by Brent Bachman, edited by Debra George, and fact-checked by Rebecca Ramirez. I'm Maddie Safaya.

Thanks for listening to Shortwave from NPR. Until recently, Edmund Hong says he didn't speak out against racism because he was scared. My parents told me not to speak up because they were scared. But I'm tired of this. Listen now on the Code Switch podcast from NPR.