Should we guilt-trip the public?
Research findings on health have a tendency to make people feel guilty about their life styles. Should we, the researchers, attempt to avoid this guilt-tripping quality? Or, should we in fact be putting it to good use? There seem to be two main ways in which guilt-tripping about health happens: One is deliberate guilt-inducing messages that aim to alter health behaviours or life styles, the second is via inadvertent guilt-inducing messages.
With work focussing on social inequalities in health, populations who already probably feel marginalised and excluded are most likely to be on the receiving-end of research messages. Making them feel guilty is just burdening them with even more troubles…
Targeting people’s life styles puts the onus on them to change, when most of the mechanisms that produce health inequalities originate in the social structures people are subjected to. Ultimately, “poor people behave poorly” (Lynch, Kaplan et al. 1997) because of their material and socio-cultural circumstances. It’s the social structures, services and environments that ought to be changed to favour choices and life styles. Yet the current taste for ‘nudging’ or ‘nudge theory’, the idea of softly incentivising people to make the ‘right’ choices, seems like just another more insidious way of putting the onus on individuals.
Many of the guilt-inducing messages that stem from health research end up in the ears of the most guilt-receptive subgroup of our species: mothers.
Over the last number of decades where progress in biomedical research, screening and treatment has been rapid , the opportunities for mothers to feel guilty about the impact of their every breath and thought on their children has increased exponentially. Research stemming from the developmental origins of adult disease (DOAD) and a lot of the recent work from epigenetics is potentially very guilt-inducing for mothers, especially pregnant ones.
Thanks to much of the fascinating epigenetic research, a mother may now feel the burden of responsibility for her unborn baby’s future propensity for trainspotting, debauchery, or their inclination towards comfort-eating… but now, add to that the character traits and health outcomes of her baby’s babies’ lives…
In an article from Discover magazine some of the current big names in behavioural epigenetics were interviewed and the crux of their work explained. It was in the article’s title that I thought solace could be found. The idea that “Grandma’s Experiences Leave a Mark on Your Genes” could actually be liberating for our guilt-vulnerable mothers: don’t worry about screwing-up your baby, they’re probably already in a world of trouble because of what your own mum got up to, not to mind her mother…
The intergenerational transference of health capital goes so far back in time, is so complex, and may even be reversible in some cases that it’s not worth worrying about at the individual level.
None of this has helped answer my initial quandary about guilt-tripping the public regarding their health. As I write today, I don’t see it as a valuable technique for improving health or adjusting health inequalities. When it comes to the most guilt-receptive among us, here’s one possible interpretation of recent research: an extended queue of the guilty precedes you, to whom you can freely defer your own guilt.
Lynch, J. W., G. A. Kaplan, et al. (1997). “Why do poor people behave poorly? Variation in adult health behaviours and psychosocial characteristics by stages of the socioeconomic lifecourse.” Social science and medicine 44(6): 809-819.
Grandma’s Experiences Leave a Mark on Your Genes by Dan Hurley (http://discovermagazine.com/2013/may/13-grandmas-experiences-leave-epigenetic-mark-on-your-genes)