Health Inequities

This is an episode from the “What Makes Us Human?” podcast's fifth season, "What Do We Know about Inequality?" from Cornell University’s College of Arts & Sciences, showcasing the newest thinking from across the disciplines about inequality. Featuring audio essays written and recorded by Cornell faculty, the series releases a new episode each Thursday through the fall semester.

Racial and ethnic minorities, as well as people with low levels of income, wealth and education, suffer more from every major category of disease -- including heart disease, most cancers, infectious diseases, injury and homicide.

Conversations about health inequality in this country tend to emphasize healthcare, health insurance, and so-called lifestyle behaviors as the root of the problem. Instead of pointing to the social conditions that shape our choices and restrict our ability to act, personal choice and willpower are seen as the fundamental causes of disease and death.

But these factors are not the primary drivers of inequalities in health outcomes. Health inequality is shaped by the social, economic, and environmental conditions in which people live, work, and play.

As a communication scholar, my work seeks to change how people -- both ordinary citizens and policymakers -- think about these causes of social inequality and the ways to address them. This is a difficult and largely uphill battle in a country in which the ideals of personal responsibility and individualism are so ingrained. 

One strategy that has proven effective at changing hearts and minds on these issues is the use of storytelling. People interpret stories differently than they interpret facts or arguments; stories invite us to see things in a different way by connecting with characters and their situations.

We have begun to develop the science for telling what Zeynep Tufecki has referred to as “sociological stories” about health inequities – stories that emphasize how social, economic and environmental factors shape how people act, what choices are available to them, and how healthy they can (or cannot) be within these contexts. 

This is not a form of storytelling that we are used to seeing; Hollywood and television producers tend to tell “psychological stories” that emphasize individual agency. They often depict exceptional individuals who face challenges but overcome them through sheer force of will or talent. Our culture’s obsession with superhero stories exemplify this kind of narrative – exceptional people who transcend tragic circumstances with supernatural effort and ability. These types of stories reinforce the larger narrative that even the starkest challenges can be overcome with enough effort and skill.

Sociological stories paint a different kind of picture – they emphasize the varied factors that shape human experience. The popular HBO series from a few years back, “The Wire,” is a good example of this kind of storytelling – it depicted a complex web of social, institutional, and structural forces that impeded even the most inspired efforts to get above the fray.

My (own) work has sought to identify specific strategies that both convey fundamental causes of health inequities but also offer promising solutions to address them via policy change. Our research has identified a few key ingredients for these kinds of stories to be successful. 

First, they must acknowledge a role for personal responsibility while emphasizing the barriers to it. Individual choice should be acknowledged but immediately contextualized.

Second, successful stories must depict characters and situations that reflect broader trends and convey, through words or images, that many other people share that character’s experience. Otherwise, they run the risk of being interpreted as an exception rather than the rule.

Third, stories must show how specific policies that have been shown to work will help both the individual and the broader population. 

Stories that use these strategies can help audiences to see and feel the ways that people from disadvantaged backgrounds suffer higher burdens of disease. They can also increase support for social policies that would combat inequities—things like increasing support for community development in low-income neighborhoods, and restricting predatory marketing of cigarettes, alcohol, and soda to communities of color.

Stories like these are not a magic bullet solution, but they can help shift mindsets around health inequities. They can invite broader discussions of how we as a society might give people from disadvantaged backgrounds the same opportunities afforded to those with resources and privilege.