How Narratives Give Data Meaning
Data plays a key role in public health policy and practice, but data does not open minds or change mindsets. Narratives do. That is why it’s important that public health and community leaders set the foundation for narrative change by foregrounding new, more inclusive visions that make room for everyone to find health and fulfillment.
What’s Missing?
Data, these days, is as valuable as currency and as essential as electricity. It is foundational fodder for developing, implementing, assessing, and strengthening public-health policy and practice. Like currency and electricity, it is a powerful tool that works best when minded carefully and used knowledgeably.
And yet, while essential for the type of work many in the social and public sectors wish to do, data cannot work alone. While it can contribute to building important policies and practices, data, even overwhelmingly clear and compelling data, simply doesn't gain trust, change minds, or galvanize movement. Different people interpret the same facts differently depending on their existing mindset, and, if that’s not plausible, they simply ignore the data. Ironically, an abundance of studies demonstrates this dynamic.
Data can help formulate goals and strategies, and help develop sound policies. But it can’t make others ready to hear a new story or a new take on an old story. For that, a companion tool is needed: narrative.
A Big Story
A narrative, especially as it relates to the social, cultural, and public sectors, is a pervasive belief or principle that exists at many levels in a society. A narrative of this type is an implicit, repeated expectation, assumption, value, or bias that is embedded within culture.
This is how the American Medical Association (AMA) and the Association of American Medical Colleges (AAMC) Center for Health Justice define narrative in their 2020 publication Advancing Health Equity: Guide to Language, Narrative and Concepts:
Narratives can be understood as collective stories, or systems of meaning. These stories are woven into the fabric of everyday life; they circulate widely and are embedded in our national psyche. They “provide the necessary mental models, patterns, and beliefs to make sense of the world and our place within it.” They shape our language, our thinking, and our actions. They are mostly taken for granted and accepted as natural, when in fact they are not. They are expressed in a wide variety of formats, including legal codes, the arts, mass media, corporate reports and scientific literature.
Narratives are embedded in the structure of the health care system, and in the ways in which we think about patients, families, communities and neighborhoods we serve—and even ourselves.
Narratives help people move through the world, though not always to the benefit of every individual. Alonzo L. Plough, the Robert Wood Johnson Foundation’s Vice President for Research and Evaluation and Chief Science Officer, defines narrative this way:
Built on the underlying and often unspoken beliefs that comprise cultures, narratives influence people’s interpretation of how things are, how things should be, and what is better or worse. They are built over time, and are often sustained by a dominant group in order to institutionalize and maintain its power.
To work toward more equitable systems, it is necessary for changemakers to confront and shift these dominant narratives that maintain the inequitable status quo.
For example, consider the common cultural assumption that wealth is available to anyone in our country who works hard enough. If the narrative is that wealth is up to each of us individually, the implication is that race (a feature ascribed to an individual) – not racism (a system of discrimination) – is the primary reason for racial wealth gaps.
Similarly, the common cultural assumption that wellness is granted to those who take care of themselves implies that personal failings—not structural ones—are responsible for health issues and healthcare gaps.
Shifting Narratives
The American Medical Assocation and the AAMC conclude that these types of narratives around race, individualism, and meritocracy “create harm, undermining public health and the advancement of health equity; they must be named, disrupted and corrected.”
Imagine if the narratives around health and wealth prioritized equity and community instead of competitive individualism and the “level playing field” myth. Plough says that working to move narratives into alignment “with culture, cultural context, and cultural identity is a powerful tool for social change and transformations in power structures.” The AMA and AAMC put it plainly: “dominant narratives lose some of their power when they are unmasked for what they are—tools for creating and reinforcing power.”
The process of shifting narratives in this way is called narrative change. The DASH Framework specifies Narrative as a key part of systems change, hand in hand with Building connections & sharing power and Equitable policy & practice. Public health and community leaders can set the foundation for narrative change by foregrounding new, more inclusive visions that make room for everyone to find health and fulfillment.
Marshall Ganz, the activist and scholar whose teachings, writings, and actions have contributed to social change for decades, elaborates on three parts of a type of community-oriented leadership he calls public narrative: the story of self, the story of us, and the story of now. First, a change-maker shares the hopes, goals, and values that are important to them; then, they connect the story of the community to the vision and values just articulated; and then they show how the time to act decisively has come.
Consider how marriage equality gained momentum. The message “love is love” resonated as an important truth for many people, regardless of their sexual orientation or politics. Changemakers working to shift societal narratives underscored this truth by recounting personal narratives. It was the individual stories of same-sex couples in decades-long relationships, parenting children together, wishing to grow old together, or sharing last moments with each other that pushed many Americans who may have previously ignored or even protested the issue to shift their mindsets.
If you were to poll people on whether it’s data or stories that better move public-health policy and practice, the majority might say data. It’s true that data is an essential component of responsible development and implementation. But to move public health decisions and resources toward equity and effectiveness requires a firm understanding of the narrative—where it is and where it needs to go.
