I admit it. I used to be a professional victim-blamer. I didn’t realize it at the time and I always meant well. But as a public health educator, I sometimes contributed to people blaming themselves for their own poor health – because I didn’t mention to them how hard it might be to do the things I was telling them to do, or that there might be other things that could be done to improve their chances. This probably left them thinking that if they didn’t succeed, it was their fault.
An overwhelming majority of Americans blame people, and people blame themselves, for being fat because they don’t eat right or get enough exercise. We in the public health community tell them about all the ways obesity will harm their health. Then our society, from the medical establishment to reality TV, perpetuates this message (even though the relationship between weight and health is more complicated than that). In my days as a public health educator, I toed the party line and supported efforts to encourage individuals to change their eating and exercise behaviors to maintain a healthy weight.
When people live in neighborhoods that lack safe sidewalks, bike paths, parks, or public transit they can walk or pedal to, they’re naturally less likely to be physically active. And when people don’t have easy access to affordable healthy food, but are surrounded by corner stores, gas stations, fast-food places, and food industries pushing cheap unhealthy food, guess what? They’re less likely to make healthy choices. While the public health community is now supporting some neighborhood and policy interventions, most of our messages about food and exercise still focus exclusively on the individual without information about the influence of the environment, which probably contributes to a lot of the blaming mentioned above.
Victim-blaming can also result from the way we talk about sexually transmitted diseases. I cringed when I heard an NPR story reporting that when people are told how bad STDs such as herpes are, they are less likely to want to get tested and find out if they’re infected. I used to be one of those people who did condom demonstrations on plastic bananas and then handed out brochures with scary pictures of what might happen if they didn’t use them.
These messages, like the ones about healthy eating and exercise, were focused exclusively on the actions individuals should take, without any context about how the environment might influence their choices. When we use messages that talk about the bad or scary things that can happen to people in an effort to motivate them to change, the underlying message can easily become if you don’t do these things to protect your health, you deserve it if you get fat or get an STD – leading people to blame themselves, and others to blame them as well.
But again, look at the neighborhood. If you live in a neighborhood where there’s nothing for teens to do after school, a neighborhood where there aren’t enough jobs so people resort to selling drugs, a neighborhood saturated with alcohol advertising, you have a higher chance of contracting an STD. Neighborhood factors can create a vicious cycle. In some urban neighborhoods more than half of the young men have been in prison, most often for selling drugs. Prison gives them a higher exposure to STDs. With so many of them locked away, people in the neighborhood have fewer partners to choose from, so those who have STDs are more likely to share them with others.
There was even some level of victim-blaming when I taught stress management, though perhaps this was more subtle. For nine years, I taught patients in an outpatient clinic of a hospital that primarily served a low-income African American population how to manage stress. I offered them guidance in different forms of meditation and ways to change their thoughts. It was deeply rewarding on one level – I loved hearing things like “My family says I smile more now!” – but I worried that people would not be able to sustain the benefits long-term, and eventually I came to see it as putting a Band-Aid over a bigger, deeper problem.
The fact is that poverty and racism are stressful. Learning how to manage your own stress does nothing to get rid of the root causes, and when you are surrounded by root causes that never go away, you must continually swim upstream to take care of yourself, and may blame yourself if you don’t succeed. Meanwhile, policies that work to reduce the impacts of poverty, such as minimum wage laws and wage theft ordinances, are a different way to tackle stress at the population level.
I’m not saying we should stop talking about the importance of physical activity, healthy food, safer sex, and ways to manage stress. And I’m not saying messages directed at individuals are inherently victim-blaming. But I am saying that when we know neighborhood and policy factors influence individual behaviors and we only tell people about the individual behaviors they should change, it can lead to moralizing about those behaviors and to victim-blaming.
In the systems thinking world, some might call victim-blaming an unintended consequence of individually-focused prevention messages. It’s time to recognize and address this unintended consequence by complementing those messages with information and advocacy for public policies that promote health and well-being. It’s time to stop fanning the flames to blame the victim and work together to change the conditions that lead to poor health.