It’s The Narrative, Stupid

This policy work is killing me. 

But if I had the good sense to read my own writing, it wouldn’t be.

One of the things I have come to accept is that, although there are numerous theories on power, the one that has the most traction in practice is Lukes’ three faces of power. One of those faces – and the one that Lukes added to the two that were hypothesized before him – is about the power of ideology, the stories we tell ourselves to make sense of the world. 

The ‘classic’ example of this comes from the women’s liberation movement. While the movement demanded economic, psychological, and social freedoms for women, some women disagreed and felt their place was secondary to men. They were essentially suppressing themselves because they believed in the idea of the patriarchy. 

A similar phenomenon has been described in racism – the idea of internalized racism. 

What both of these examples illustrate is that the stories we tell ourselves define what we think makes sense. In the context of policymaking, the best description I’ve seen of this comes from Jonathan Heller, the public health leader who has done (and is doing) so much to bring the idea of community power into the practice of health equity and racial justice: 

• “[T]he narratives that are dominant shape what is thought of as commonsense in our society, and therefore make some policy proposals seem like no-brainers and others feel like they were beamed in by aliens.”

I have all sorts of ideas as to what a government needs to do to support the forming, building and wielding of community power but that doesn’t make them viable policy proposals because they don’t fit the government’s narrative, the story it’s telling itself and the country. 

And that’s the bit that’s killing me. 

The power of government’s stories is something I’m exploring with Atheen Venkataramani, an absurdly bright doctor and economist who has set up the Opportunity for Health Lab at the University of Pennsylvania. Atheen and his gang are looking at how the American dream influences health. One of the things they’ve found is that the way policies are discussed can have health consequences – even if the policies are not enacted. 

For instance, in the 1990s the US government wanted to get “tough on crime”. One of the policies it proposed was the so-called ‘three strikes laws’, the idea that habitual offenders should get a mandatory life sentence. Some of the rhetoric around this policy was racially charged, including calling some Black people “super predators”. What Atheen has unearthed is that this narrative was associated with sharp increases in low-birth-weight births among Black women but not white women. 

His current thinking is that this happened because it dented Black women’s sense of belonging and their hope for the future, which impacted their fetuses. 

Another example comes from the 2008 election of Barack Obama. It was associated with a reduction in fetal loss amongst non-Hispanic Black women. Remember his 2006 book, The Audacity of Hope? I’d say hope is a pretty powerful thing. 

I find it crazy that a narrative can have such a population-level impact but it’s not remotely surprising to another group I’m working with: Lori Dorfman, Sarah Gollust and Makani Themba. These researchers and practitioners are so convinced of the power of narrative that they think it’s time public health understood the infrastructure that creates and sustains narratives.

They define narrative infrastructure as the “networks of multi-sector organizations, cultural institutions, and other actors that collectively engage and organize to establish” the stories we tell ourselves as a society (the quote is from the current draft of their forthcoming article). 

None of this is theoretical. Remember the overturning of Roe vs Wade? Lots of people credit that to the Lewis memo, a 1971 document written by Lewis F Powell Jr., a lawyer who went on to be a member of the Supreme Court. 

Lewis was asked by the US Chamber of Commerce to share his ideas about how to promote free enterprise in the US. His memo called for corporate America to become more aggressive in shaping society’s thinking. It became the blueprint the American conservative movement scaffolded by key think tanks, such as the Heritage Foundation.

All of which brings me to the US election next week. But I’ll step back from that lighted dynamite and just say that what’s really on the ballot – at least for me – is the narrative of America, the next chapter in its story. All of the laws and policies that will come from the new administration are just manifestations of that narrative. 

It’s not the economy, stupid, it’s the narrative. 

See you in two weeks. 

Pritpal S Tamber 

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Notes

• My work with Atheen, Lori, Sarah and Makani are part of my Furthering the Narrative project that aims to further the importance of community power to health equity and racial justice by writing robust scientific articles and publishing them in respected peer-reviewed journals. It is funded by the California Endowment and in partnership with Tony Iton, the Endowment’s former Senior Vice President. 
• Two articles in the project have already been published. The first was a look at what SCOTUS’s affirmative action ruling revealed (with Daniel Dawes) and the second was on why voting is critical to the pursuit of health equity(with Jeanne Ayers and Gnora Mahs). 
• A further 13 articles are in the pipeline (but I reckon a few will fall by the wayside).
• An article that gets to the importance of narrative is The Death of “Deliverism” in Democracy: A Journal of Ideas, which seems to have been quite influential in Think Tank Land (but it’s way, way too long).
• The image behind the title is by Steve Scott / Ikon Images.