On Being Poor, Feeling Poor, and Being Treated Poorly

Poverty Mindset Seminar

Dates: :	October 24th and 31st at 9:00 – 11:30am
Location:	October 24th at ISERP room 801 October 31st at MSPH 14th Floor Conference Room
Facilitator:	Erika Blacksher

Readings

Background (optional)

Archer MS, “Introduction: How Does Structure Influence Agency?” Structure, Agency and the Internal Conversation, (Cambridge University Press 2003), pp. 1-16.

Week 1 & 2 Readings

Moody-Adams M, “Race, Class, and the Social Construction of Self-Respect,” The Philosophical Forum XXIV (1992-93), 251-66.

Sayer A, selected readings from  two chapters of The Moral Significance of Class (Cambridge University Press 2005)

Ch 3: “Recognition and Distribution,” pp. 52-69

Ch 8: “Responses to Class II: Explanations, Embarrassment, and Justification,” pp. 206-11 (note: the whole chapter is available if you wish to read it)

Sharkey PT, “Navigating Dangerous Streets: The Sources and Consequences of Street Efficacy,” American Sociological Review 71 (2006), 826-46.

Cockerham WC, “Health Lifestyle Theory and the Convergence of Agency and Structure,” Journal of health and Social Behavior 46 (2005), 51-67.

Supplemental Readings (optional)

Childress et al, "Public Health Ethics, Mapping the Terrain" Joumal of Law, Medicine &Ethics, 30 (2002): 170-178.

On Being Poor and Feeling (and Doing) Poorly: Week 2

Oppression does more than simply limit someone’s options at the time of choosing. It also infects the conditions under which growing persons are socialized. Oppression may damage someone’s capacity to care about what is worth caring about and it may deform the nature of a person’s concern for herself. She may grow to value or seek the very persons or circumstances that keep her in oppressive conditions.

                                                                   --Marilyn Friedman

We may believe a human is free, if ever, when she not only has a range of options but an education that enables her to recognize those options as such and the self-respect that makes her choice among them a real one. Ignorance, lack of imagination, and lack of self-respect are not just external constraints on the range of your options: they can cripple the power of choice itself.

                                                                     --  Christine Korsgaard

To recap, this two week seminar explores the interplay between structure and agency as it relates to health with a particular interest in the agential and structural impediments to good health outcomes among those who are resource poor. Although the plausibility of the basic premise (i.e., exploring the ‘interplay’ between structure and agency) was called into question by Jimi, further discussion led him to clarify that his contention lies not with the possibility of conceptually distinguishing agency from structure, but rather with the complexity of empirically sorting one from the other. It is imperative for those in the business of measurement to capture the complexity of the interrelationships and to resist oversimplification.

Cockerham’s article goes to some length to establish the sort of complexity (see the ‘box-arrow salad’ on page 57) involved in understanding and explaining the health lifestyles individuals adopt/enact. Using Weber’s life chances/choices construct, Cockerham proposes a series of variables that constitute life chances and express life choices and diagrams their interrelationships. The diagram and Cockerham’s discussion of it raises some questions we may wish to consider.

1. Socialization and experience (box 2) appear to be classed as life chances/structural constraints, or at the very least the product of such constraints and not yet labeled as “agency.” Yet, I understand Sharkey’s article to suggest that those variables (socialization and experience) involve agency in a non-trivial sense. The adolescents in his study made choices about how to interpret and select from their imposed environments, with the latter comprised of class circumstances, race/ethnicity, and living conditions. The adolescents’ interpretation of these structural constraints influenced their experience of them and in turn informed their choices about who to hang out with, where to hang out, and what to do with their time. The adolescents’ interpretation and experience was influenced by the expressed norms and expectations of adults (a form of socialization) in those communities. These adults of course live in the same imposed environments (comprised of the same structural constraints) as the adolescents, suggesting that they too engage in some creative interpretative undertaking to socialize in the positive ways that appear to help some children avoid violence.
• How then should we understand socialization and experience within the paradigm Cockerham lays out?
• What are we to make of the adults and adolescents whose norms and behaviors conform to the received/dominant view that poor, blighted neighborhoods produce violence? Are they not making choices? Does that make them mere conduits of structure?
2. Perhaps the notions of ‘imposed’ and ‘selected’ environments would have some utility for another public health case—childhood obesity. Research suggests that a number of variables are operative in the production and distribution of obesity including: food media and advertising; school lunches (nutritious or no), locations (walkability and bikeability), and programming (recreation, recess); neighborhood features such as the availability or inaccessibility of nutritious food that is affordable, the safety and invitingness of sidewalks for walking, parks for recreation and socializing, etc; and parental norms (body image, culinary tastes) that influence food buying and meal preparation practices as well as recreational activities. The case of childhood obesity seems to represent in some ways a starker case than violence, because when children are very young, they are literally fed by their parents, practices which influence children’s neurobiological formation (though perhaps early exposure to violence does the same?). Anyway, as with violence, the variables involved obesity represent an interplay of constraints (class circumstances, living conditions, and so on) and agency and raise interesting questions about where to draw the boundaries of the self.
• Some ethicists argue that “it is not sufficient to show that social-cultural factors influence an individuals actions; it is necessary to show that those influences rend that individuals actions substantially non-voluntary and warrant societal interventions to protect him or her.” Does an obesogenic environment render individual actions non-voluntary?
• Did you think the legal case against McDonalds had any merit?
• Do you find NYC’s ban on transfats in public restaurants paternalistic? (For a definition of paternalistic, see a definition in the attached article, pages 175-76, which is also the source of the quote above.)
• To revisit the violence example, are the adolescents studied by Sharkey who live in violent neighborhoods and fail to tap into the positive socialization acting voluntarily when they commit acts of violence? That is, even if the imposed environment influences them, does it render their actions non-voluntary?
3. Last week’s discussion left me with the impression that people generally did not care much for or thought very useful the notion of self-respect as used by philosophers to refer to an individual’s belief that she and her life plan has worth and that she has the ability, skills and confidence to carry it out (some philosophers distinguish these two dimensions, referring to the latter as self-esteem). “Projectivity” was mentioned as perhaps the more interesting and useful concept, defined in Cockerham’s article as “the imaginative generation of possible future trajectories of action in which structures of thought and action may be creatively reconfigured.” This term seems to me to be not unrelated, however, to self-respect as philosophers use it because the latter is intended to encompass an individual’s capacity and ability to imagine, plan, and revise her interests, goals, and life plans. Anyway, I want to revisit these notions (use whichever you like) because I think the discussions hopefully generated by the first posed questions may enable to revisit this notion in a constructive way.
• Do you think that the agency exercised by the adults and adolescents in Sharkey’s study can be characterized as self-respect or projectivity? If not, how would you characterize it and what, if any, relationship does it have to a person feeling and acting in ways that suggest he values his life, his health, his future?
• Cockerham’s article provides a definition of life chances (ala Weber through Dahrendorf) that raises a question about whether or not life chances can be so constraining as to eclipse some aspirations, dreams, imaginative projections into the future, a possibility raised last week. The definition describes life chances as the: “crystallized probability of finding satisfaction for interests, wants, and needs, thus the probability of the occurrence of events which bring about such satisfaction.” This definition, as I read it, suggests that life chances only limit the probability of satisfying interests, wants, and needs. It does not suggest that life chances can limit, truncate, or eclipse from view certain interests, wants, and needs. But some people, perhaps some of the adolescents in Sharkey’s study who adopt violence as a form of coping and survival, life chances do make it difficult to imagine a different (a better) way of being in the world. What are we to make of individuals who do not form interests in non-violent ways of being and acting? Do such instances qualify as suspect versions of ‘adaptive preferences,’ the latter of which all humans do. How should we describe the suspect versions of behavioral adaptation? What do we risk when we fail to describe the damage that can be done to humans by adverse, deprived environments? What do we risk when we do?

On Being Poor, Feeling Poor, and Being Treated Poorly: Week 1

Contemporary interest in the social determinants and distribution of health has produced a growing body of empirical research and explanatory theories. Some of these theories emphasize the contribution of material and social resources to agents’ opportunities for health and for the avoidance of health risks. Others emphasize the psychosocial processes involved in coping with inadequate levels of material and social resources, such as social status and social anxiety. While the former approach underscores structure and the latter agency, their interaction is implicit in both.

This two-week seminar investigates the interplay between structure and agency as it relates to the poor health of persons who are resource poor. In keeping with the  seminar’s topical focus on the mind, I am interested specifically in the processes involved in the agent’s need for recognition and efforts to achieve it in contexts of material and social inequality. Two agential processes are of central interest: adaptation and resistance. The former refers to the human tendency to adapt to and normalize one’s given material and social circumstances. The latter refers to the human capacity to resist the stigma and oppression that often accompanies material deprivation and low social position. In its most suspect form, adaptation is said to involve the internalization of low social status, leading agents to adopt beliefs and behaviors that reinforce and reproduce inequality. Thus some theorists speak of agents as expressing “deformed” preferences or acting as “accomplices” in their victimization or being “damaged” selves. As a result, the behavior of marginalized groups is often “pathologized or patronized.”

Although my primary interest in these issues relate to their ethical dimensions and implications, I would like to focus the first week on broad conceptual issues. To that end, it is worth noting the obvious, namely, that to investigate the ‘interplay’ between structure and agency is to conceive of them as separate entities. If structures and agents refer to ontologically distinct realities, then one reasonably can ask, How does structure influence agency? The optional background reading (Archer 2003) speaks specifically to this possibility and may be of interest only to skeptics, if there are any among us, inclined to classify agents as “cultural artifacts” or “neural networks.”

If we agree that the basic question makes sense to ask, then I would like to initiate the first week’s discussion with two sets of questions, one focused on the conceptions and sources of agency operative in the readings and the other on their relevance to and implications for health outcomes and health policy. The questions below are intended only to set a conversation in motion; I welcome the addition of other questions not represented below (please email them to me: eb2433@columbia.edu).

 

Discussion Questions

• The Sayer and Moody-Adams readings both argue for the importance of self-respect, its social construction, and the adverse effects of material inequality on its development and exercise. Are the arguments plausible? Are you persuaded that people adapt to or even internalize oppressive norms? Should adaptation to adversity be interpreted as a deformation of agency or as a rational or prudent response to conditions of survival? How does the notion of self-respect as Rawls defines it (as characterized by Moody-Adams) relate to Bandura’s notion of self-efficacy (as characterized by Sharkey)? Are you persuaded by Sayer that the ‘injuries of class’ differ fundamentally from the injuries of race and other socially salient differences?

• The Cockerham and Sharkey readings both set out to contextualize health-related constructs they argue are conceptualized in excessively individualistic terms (health lifestyles and self-efficacy, respectively). Both approaches attempt to measure the impact of structural conditions on the operations of agency, yet both acknowledge that these conditions do not determine the exercise of agency. Agents sometimes innovate. How problematic is this for the application of sociological theory to practical policy? If self-respect or self-efficacy is an important determinant of health, how might public policy set about to fairly distribute its ‘social bases’? Are the practices commonly measured as part of a health lifestyle (alcohol, cigarette, and seatbelt use, diet and exercise) adequate? Should other practices be included with in the notion of a health lifestyle? Both pieces note the relevance of family as a social unit that bears on health-related processes of children and adolescents, a view supported in the developmental health literature. Do parental choices constitute part of children’s life chances, to draw on Weber’s paradigm (as discussed in Cockerham)?