Resources and Further Reading

Our work is only part of a rich tradition of scholarship on influence, equity, and morality. If you’re interested in learning more, please see the additional resources on influence and equity below.

Organizations of Note:

  • Presence at Stanford Medicine focuses on improving the human experience in medicine.
  • The AAMC Center for Health Justice is dedicated to working across disciplines and organizations to further the cause of health equity for all.
  • The Center for Disease Control’s Office for Minority Health and Health Equity (OMHHE) focuses on health disparities and women’s health among the initiatives of the CDC.
  • Frontline Solutions is a Black-owned consulting firm that helps businesses transform their internal cultures and external impact to incorporate an equity lens.
  • Ramp Your Voice! promotes the empowerment, inclusion, and self-advocacy of disabled people across the United States and abroad.
  • The Ambassadors for Health Equity fellowship offers an opportunity for talented individuals across for-profit, non-profit, and cultural fields to learn about building a Culture of Health throughout their enterprises.

Concepts in Influence and Equity:

Cultural competence refers to the knowledge and ability to do cross-cultural work in an effective and responsible way. While our tool doesn’t necessarily incorporate cultural competence, we highly recommend that policymakers think about this concept, particularly when their interventions might impact communities outside of their own.

Policymakers who want to investigate their own cultural competence can consult the National Center for Cultural Competence’s checklist or policy assessment.

Unintended Consequences of Paternalistic Policymaking:

When paternalism is used in place of Influence, negative consequences are sure to result. Some of these consequences may in fact be intended, such as the historical policies of Jim Crow. However, in the current political era, negative consequences are more often the result of unintended consequences. Policymakers who use paternalism, i.e. who do not come from or include the populations their decisions affect, usually lack the experience or knowledge necessary to understand the full implications of their policies. Unfortunately, individuals who have been historically marginalized typically bear the brunt of these negative consequences. Here are some examples of how paternalistic policymaking can backfire:

  1. Treating groups or neighborhoods differently can reinforce ideas that minorities are ”irrational” - bringing back pernicious old forms of paternalism. In 2008, Los Angeles tried to ban the construction of new fast food restaurants in a part of South L.A. - a specific area that had high obesity rates, but was also the most racially diverse area of the city. Such a ban did nothing to address the structural causes of obesity among this population, while sending a strong message that the individuals in this area specifically needed to be told what to do by the government for their own good. In fact, obesity rates in South L.A. increased after the ban.
  2. Different groups have different needs. Policymakers from privileged populations may have no insight into what is actually good for individuals in marginalized populations. Consolidating Medicare’s bariatric (weight-loss) surgeries to regional certified hospitals was intended to ensure that all patients received the best-quality care possible. However, this policy resulted in a considerable decline in the rates of minority patients actually opting in to surgery. Minority patients didn’t wish to receive treatment outside of their preferred hospitals, likely due to the bonds of trust they’d built with local medical professionals. The end result of this change only widened health disparities.
  3. Policies that are well-designed in theory can have unintended consequences in execution that widen pre-existing disparities. The Affordable Care Act provided subsidies toward purchasing health insurance for most Americans and expanded Medicaid to cover many more individuals based on household income. However, legal challenges made this expansion optional, and 24 states - primarily Southern and conservative ones - chose to reject it. In these states, low-income individuals fell into a coverage gap: they made too much money to be eligible for Medicaid, but made too little to receive subsidies to buy marketplace insurance. Again, a policy meant to help disadvantaged individuals actually harmed them in practice.
  4. Messaging campaigns that try to be inclusive of minority representation can sometimes just reinforce untrue and harmful stereotypes. New York City took a hard line against teen pregnancy with subway ads aiming to shame young mothers, but the children pictured in their copy were almost all members of racial minorities. By seeking to ‘represent’ specific populations, the policymakers in this case instead targeted the individuals they were intending to help, exposing them to further discrimination. Messaging of this sort may have backfired for white populations as well, allowing them to dismiss teenage pregnancy as a problem for other communities only.
  5. Using penalties or punishments to change behavior can put extra burdens on society’s most vulnerable populations. Soda taxes have been linked to decreases in obesity in targeted cities - unfortunately, they’ve also been shown to be heavily regressive, burdening lower-income individuals the most. Proponents of soda taxes might simply suggest this means the taxes are working and lower-income individuals will eventually change their behavior. However, obstacles such as extensive work hours and the high availability of soda in certain neighborhoods are disproportionately more likely to make it difficult for lower-income individuals to change their routines.

A policymaker acting with good intentions might still make mistakes in any of the above situations. The only way to be certain that one understands how a policy would affect a specific group of people is to involve those people in the decision-making process.

Ultimately, this is how we choose to differentiate between paternalism and influence: Paternalism assumes that the policymaker knows best and need only implement their will on their target population. Influence requires that the policymaker not only consult but collaborate with those who will feel the effects of their policy.

Only then can equitable, just influence be created and utilized ethically.