Think of an inspiring success story. How about a refugee who, despite years of poverty and exposure to war, becomes a physician and teaches the world about peace? Or those with disabilities who overcome tremendous barriers and succeed beyond all expectations?
From these stories, we learn to admire individuals who 'overcome the odds', through telling hero stories about their courage and resolve.
There's nothing wrong with these stories in and of themselves. These people do exhibit courage and resolve in face of the odds. But if we link courage and determination to only success stories, we risk losing sight of the work done and courage exhibited by people who are in similar situations but for whom the stars have not aligned. The darker side of these stories is that we may start to assume that others who do not overcome adversity are failures.
We see this darker side when some talk of those who are suffering or struggling. People dealing with depression are told to "snap out of it". People living with poverty are told to "make better choices". People diagnosed with obesity are told they simply need to eat less and exercise more. Conversations about discrimination, chronic stress, experiences of violence, limited education and other factors are often dismissed as illegitimate "excuses".
"Looking to individual choice and resilience as the one solution to all problems selectively disregards all the different influences on our health and our lives."
If we are caught up in these types of stories, we focus on what individual people do, or fail to do, to overcome the barriers. We praise our successful heroes and blame the rest, looking to attitude and action as the key factors. We lose perspective on what else shapes the trajectories of people's lives. Even if we don't believe this deep down, these prevalent stories serve as part of our society's stock of stories, influencing our reactions and ideas about how to solve the problems we have.
This way of thinking limits our ability to consider solutions. We lose focus on the actual barriers we and our neighbors face, and fail to consider collective solutions that could remove them altogether. Looking to individual choice and resilience as the one solution to all problems selectively disregards all the different influences on our health and our lives. This prevents meaningful discussion of the problems we face as a society, and the sorts of structural solutions that could bring about healthier individuals and communities.
We need to shift to discussions that recognize both individual and social forces, and how the two can be aligned to address the problems we face together. If improving the health of Canadians is the end goal, then we have to get out of this trap of only focusing on individual-level solutions that don't address problems at the source. We need to shift our thinking to what makes us most able to respond to the problems we face together, in our communities and countries.
The first step is to recognize when you read or hear an individual praise or blame story. Topics like poverty, addictions, diabetes, newly arrived refugees — any argument that implies people have brought their current state upon themselves or that they "just need to deal with it" — falls into this intellectual trap. If we notice when it happens, we can then interrupt that well-worn story.
What might happen if we switch our brains into curiosity mode? What if we asked ourselves questions to make the other person more fully human, such as:
"If we situate individuals in the broader dynamics that give shape to their lives, we have a better chance of improving the health and well-being of all."
- How much do I really know about this person, and their life?
- What social and economic struggles might they be facing?
- How are they important in other people's lives, and what positive impacts might they be making?
- How would I feel about being judged this way, if people only had this much information about me?
We might then expand our curiosity outward, placing the individual in their broader social environment:
- What resources make for a strong foundation for all of us to be more able to respond to the challenges?
- What policies make it harder for this individual to change their routines?
- What does the evidence say about the best practices to improve the lives of people in this situation?
These last questions bring us to the social determinants of health, and open up the field to considering upstream solutions to the problems we face in our communities.
The key is to remain open to learning from others, to hearing more complicated stories. With this foundation, we can have new conversations geared to solutions — some of which have already been demonstrated to work. This does not mean that no one will ever suffer, or that all disease will disappear. But if we situate individuals in the broader dynamics that give shape to their lives, we have a better chance of improving the health and well-being of all.
Patricia Thille is a post-doctoral fellow at the Wilson Centre for Research in Education, a joint centre of the University of Toronto and University Health Network. She is a physical therapist with a PhD in Sociology. Dr. Thille focuses on questions of how to align caring for individual persons with caring for populations.