My friend and colleague, Dean Robinson (Political Science Dept., UMass Amherst) often says something like this to try and offer some perspective on the culture of “personal responsibility” that is so pervasive we often don’t even notice it. Alarming health disparities in this region are fundamentally the result of political and policy decisions. And so will the solutions. Urging behavioral change will help on the margins, but it often just serves to scapegoat the victims and distracts us from the real pivot points.
A new report from Harvard Law School’s Institute for Race & Justice, “Getting Under the Skin: Using Knowledge about Health Inequities to Spur Action,” helps demystify the “social determinants of health” debate and provide some practical guidance for community organizations who want to make a break from this blaming and unhelpful culture, and instead leverage their authoritative on-the-ground experience to deal with some of the structural causes of health disparities. (See policy recommendations at right.)
The modern history of this socio-political phenomenon dates back to Reagan, who hit a nerve with his “welfare queen” image, which in turn informed Bill Clinton’s Welfare Reform Act of 1996 (Personal Responsibility and Work Reconciliation Act). We are confronted with a lot of fierce rhetoric these days (as Frances Fox Piven likes to say). And I am saddened to see how it often trickles down from national opinion leaders all the way down to casework.