Shame Gets a Failing Grade for Health Promotion

Is it helpful to use shame for health promotion? The impulse is certainly strong. Shame and blame have been consistent threads through years of grappling with the health impact of obesity. Along the same line, we’re seeing shame and blame trotted out for the unvaccinated in the U.S. as a the Delta variant produces a surge in COVID-19 cases.

Shame is a very natural response in some circumstances. But experience and some data suggest that shame does not work as a very robust tool for health promotion.

Shaming People into Compliance?

You oughta wanna get that vaccine has not been working too well in populations that are resistant to COVID-19 vaccination. For one thing, it seems to produce something known as reactance. When a Democratic administration admonishes people who are slow to get vaccinated, the knee-jerk reaction in polarized Republican communities is to resist. It’s not especially rational, but it’s very natural human behavior.

Some recent research on the role of shame and trust in compliance with COVID-19 recommendations seems to support the idea that shame is not a winning strategy. In this research, Giovanni Travaglino and Chanki Moon examined data on shame, guilt, and trust across three different cultures. The relationship between shame and compliance was negative. Feeling more shame predicted less compliance with COVID prevention measures. Between trust and compliance, the relationship was positive. Guilt – which unlike shame comes from within – fell somewhere in the middle. The authors summed up the implications:

“To conclude, our findings indicate that attempting to deter people from defying social distancing by blaming or stigmatizing them may negatively impact public health.

“Thus, governments and decision-makers may obtain better results by focusing on the importance of social cohesion and trustworthiness in their attempts to tackle the pandemic and manage public responses.”

Promising Shifts

In recent days, we’re seeing some promising signs on vaccination. In strongly Republican communities, we’re seeing more Republican leaders speaking up to encourage vaccination. Of course, it has a political overtone. But whatever it takes, it’s better than reactionary resistance.

As that encouragement surfaced, CDC began reporting some flickering signs that vaccination rates might be picking up in some crucial areas.

Complex Realities

But the truth is that the reasons for some people being slow to act are complicated. Issues of trust are indeed important. Not all of it – maybe not even most of it – is political or ideological. Some people are simply slower to trust and slower to act. Bullying or shaming people into doing what experts may say is best can be unhelpful. Trusted information and trusted relationships may be more powerful in many circumstances.

So shame can be counterproductive for health promotion. This has certainly been true in efforts to reverse obesity trends. It also seems to be true for efforts to get people vaccinated against COVID-19.

Click here for the study by Travaglino and Moon and here for further perspective. For more on the complexity of vaccination hesitation, click here.

Inquisition Scene, painting by Francisco Goya / WikiArt

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July 28, 2021