Covid, health inequality, and the avoidance of behavioral explanation

It means that interventions must target culture: group beliefs, social forces, peer networks.

Public health researchers have been able to follow the spread of obesity in a social network over 32 years, especially among pairs of friends and siblings of the same sex. Their conclusion: people tended to gain weight when their friends and relatives gained weight around them.

In the discussion of Covid, these factors are often avoided by writers in journals and newspapers, who decry "racial capitalism" or "structures" that make low-income populations or minorities more vulnerable. There are strong pressures in writing on social problems to avoid "blaming the victim." It's understandable that academics don't want to unfairly blame people that are struggling. As anthropologist Richard Shweder has noted, however, there is a problem "when victimization becomes the dominant account of suffering and when it becomes politically incorrect to ever hold people responsible for their misery." This encourages people to think and act as passive victims with few personal capabilities, which certainly does not contribute to their well-being. Shweder argues that people "need to be aware of whatever degree of personal control they have over their own conditions" without going to the extreme of laying all responsibility on individuals. Unfortunately, in sociology and anthropology, structural-only explanations are common. Witness the books that treat the poor entirely as victims such as "Blaming the Poor" or "Disciplining the Poor."

Similar pressures are at play in Australia, where the ill health and poverty of aborigines have been a contentious national issue for decades. Australian medical anthropologist Emma Kowal has argued that antiracist whites, who understandably lament Australia's past oppression of aborigines, "overstructuralize" the problem and ignore cultural and behavioral differences, which prevents effectively addressing this problem through patient work at the local and regional level. Another Australian anthropologist refers to it as a "guilt politics" that has led to no discernible improvement in aboriginal life over decades of trying.

I have worked with marginalized populations, and they commonly acknowledge their own responsibility and behavior for their life paths. They often have a better sense, or balance, than academics who lament what they see as the self-blaming attitudes of the poor. They can be hard on themselves, often too hard, given the built-in disadvantages that many have. But when people look back on their lives, they can see their own mistakes. Most of us don't like assumptions that we are powerless or simply victims of structures. It's reflexivity and personal interventions that often gives us an understanding and sense of agency toward the future, as in this effective diabetes prevention program.

Any sophisticated analysis of social problems needs to consider structures, cultures and individual factors. There are scholars who are balanced and have good models, like sociologists Martin Sánchez-Jankowski or Orlando Patterson who write on urban poverty, but they don't get the attention they deserve. If academics and commentators really want to effectively address social problems, they need to avoid overly politicizing issues and follow the evidence, which often implicates our own practices and habits, as much as it does larger systemic issues.