How personal responsibility framing undermines efforts to improve public health
by: Fernando Quintero
posted on Thursday, April 30, 2015
The default frame is alive and well.
One of the key lessons in our media advocacy trainings is how framing — how we see and understand the world around us — affects how people understand what to do about community health problems.
In the United States, a common or default frame is the idea that people’s behavior is determined by personal motivation, not by the situations they find themselves in. This makes advocating for health policy challenging since many policies are designed to change the conditions or situations surrounding individuals (the environment) rather than changing individual behavior.
On one hand, this frame has provided a compelling cultural narrative for our country, reinforcing the value of personal responsibility for overcoming harsh odds, as in the Horatio Alger “pull yourself up by your bootstraps” myth. This narrative is also reinforced by the media, which thrive on stories of heroes fighting adversity.
But this frame is not only pervasive, it’s pernicious, for along with the personal responsibility value comes a blame-the-victim mentality. This frame essentially says that if you’re sick, it’s your fault for not taking care of yourself. If you’re poor, it’s because you didn’t have the wherewithal to succeed financially. If you’re a victim of sexual assault, it’s likely that you dressed seductively or drank too much alcohol.
This frame fails to make the environment visible and show that what surrounds us shapes us. For example, residents who live in neighborhoods where there are few grocery stores to buy healthy food or no outdoor places to play and exercise often suffer higher rates of obesity and nutrition-related diseases. Even highly motivated people can’t always surmount surroundings that undermine their efforts to stay healthy.
For advocates pushing for policy change to improve the health of their community, this personal responsibility frame — which often gets repeated and amplified through the stories we tell — says to decision-makers and voters: Why do we need a new law or regulation (government interference) when people should simply make better decisions?
Two recent related news stories reminded me just how costly this personal responsibility/blame-the-victim frame can be. The first was a story about a new bill proposed in the Missouri legislature that would severely limit the type of food that could be purchased by the state’s food stamp recipients, including steak and seafood.
“I have seen people purchasing filet mignons and crab legs with their EBT cards,” State Representative Rick Brattin, who proposed the new law, told the Washington Post.
A separate Washington Post story reported this month on House Bill 2258, which if signed into law would prevent families receiving government assistance from using those funds to visit swimming pools, see movies or get tattoos. State Sen. Michael O’Donnell, the Wichita Republican who advocated for the bill, said the legislation is designed to pressure those receiving Temporary Assistance for Needy Families to spend “more responsibly.”
O’Donnell’s statement is not only a huge insult to hardworking parents who are doing their best to stretch every penny to cover food, rent, transportation costs, child care and other expenses, it perpetuates the dominant frame of low-income people as irresponsible spenders. It’s as if we’ve entered a time machine and are back in 1976, the year Ronald Reagan declared his thinly veiled racist/sexist war on low-income mothers of color, aka “Welfare Queens.”
In a 2013 National Journal article titled “The Return of the Welfare Queen,” it reported that 25 Republican-led states had rebuffed billions of federal funds under President Obama’s health care law to offer Medicaid insurance to more low-income people. To justify this unprecedented rejection of federal aid, these governors and state lawmakers said they didn’t believe Washington would keep its promise to pick up the tab.
“But all of this opposition carries an unmistakable undertone of class warfare, a theme easy to exploit in states such as Kentucky, packed with low-income white voters who have a strong distaste for the federal government. To hear the rhetoric coming from Capitol Hill and the campaign trail, Medicaid and food-stamp recipients are a bunch of shiftless freeloaders living high on king crab legs and free health care, all on the backs of hardworking Americans.”
New Medicaid recipients “have no personal responsibility for their health,” said Republican state Sen. Joni Ernst of Iowa in a memo from the state capital, according to the National Journal article.
Ernst is not alone. Decision-makers as well as voters throughout the country continue to hold on to a way of thinking that is inaccurate and unjust. And it underscores the urgency for advocates to reframe the conversation and show — and name — the systems and structures in place that make easier for some to succeed and more difficult for others.
One example of reframing the conversation to illustrate how the environment plays a role in poverty comes from a U.C. Berkeley report released October 2013, “Fast Food, Poverty Wages: The Public Cost of Low-Wage Jobs in the Fast-Food Industry.” It shows that the majority of people enrolled in major public benefit programs — 73 percent — are members of the workforce.
“Unfortunately, their wages are so low that it is impossible to sustain a family independently, even with full-time work. They are forced to turn to public aid to meet basic needs,” wrote Boston College graduate Julie Bolduc for a Wheelock College blog shortly after the release of the study.
“With this data, the report makes the case that public assistance dollars are subsidizing corporations who should pay their employees adequate wages,” she wrote.
Bolduc cited a report by the Daily Kos, which showed the 10 largest fast-food companies earned a profit of $7.44 billion in 2012. Despite these profits, their employees were forced to depend on $3.8 billion in public assistance. In fact, workers in the fast food industry are the lowest paid in the economy with an average hourly wage of $9.09. What’s more, the pay disparity between fast-food workers and CEOs (among the highest-paid executives in the U.S., with an average compensation of $26.7 million in 2012) is the most unequal of any industry.
“People of low-income status are often those that come to bear the stigmatization over the need to turn to welfare and other public assistance programs to survive,” Bolduc wrote. “The U.C. Berkeley report demystifies this stereotype and offers a broader view of the roots perpetuating poverty among the working poor.”
It’s this kind of reframing that helps audiences look beyond the “portrait” of poverty and see the landscape more clearly. And it sets up another important strategy for advocates: presenting solutions. From activists working to increase the minimum wage to establishing paid sick days for all full-time workers, these efforts must be highlighted in order to provide a more complete story.