How mask shaming distracts from better policy and equity

People say “wear a damn mask” a lot these days. Does repeating this phrase and its iterations of “personal responsibility” help slow the transmission of coronavirus, or is it like shouting at drivers not to speed — cathartic but ultimately ineffective?

Behaviors, policies, and environments all play a role

The evidence is crystal clear that people wearing masks in proximity to other people can help prevent the spread of COVID-19 transmission, just as driving at lower speeds is less likely to kill people than at higher speeds. But we can’t count on pressuring enough individuals to make voluntary choices to wear masks to stop the coronavirus any more than we can expect drivers to independently adopt behaviors that won’t kill people.

“COVID stops with me” is partly true, but it only gets us so far, especially when underserved communities and people of color are often at higher risk. Are they supposed to take on a higher burden of preventing COVID-19, as suggested by the Surgeon General earlier this year?

The root of the rapid spread of COVID-19 in the US is not the hour-by-hour decisions of 328 million individuals, which don’t take place in a vacuum, but rather policy decisions on local, regional and national levels.

If we’re going to influence the trajectory of any urgent issue — whether it’s dangerous driving or a pandemic virus that’s putting people’s lives and health at risk — it makes sense to focus our energy on the systemic causes, and demand better policy responses.

Both for road safety and for reducing coronavirus transmission, we need environments and tools that make it easy for people to make choices that benefit both themselves and society at large.

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What’s good for public safety is good for public health

Public health practitioners have long recognized that truly large gains in public health aren’t to be had simply through convincing individuals to make “healthy choices,” though such efforts clearly have a role to play. They come through comprehensive approaches that recognize the social, economic and environmental determinants of health, and the need to meet people where they are.

This isn’t an unfamiliar concept to safe transportation or housing advocacy. The most immediate factor in whether someone gets hit by a car might be that a driver didn’t see her walking across the street.

But we know that policy decisions around safety infrastructure like crosswalks, transit access, driver education and motivation to pay attention, and car design all have significant effects. Even further back, poverty and chronic stress play roles in framing the decisions people make.

To focus on the two people making the choice affecting the immediate danger is to avoid addressing all those issues that affect many millions of others on a systemic basis. Yes, we all have a role to play, and masks are a big part of that. But in settings where the tide of coronavirus has effectively turned (for now), jurisdiction- or even nation-wide approaches have been pivotal, not merely enough people feeling slightly bad. Where mask wearing in particular has been important is in settings where it’s essentially universal.

Masks aren’t one-size-fits-all when it comes to equity

If we rely on individuals to make the “right” decision, bearing in mind masks are decreasingly effective or can even increase the wearer’s risk when they’re wet, or reused, or fit imperfectly, or you don’t wash your hands when removing them, every time they’re out of their homes will always put the more vulnerable at an increased risk compared to others.

They’re least likely to benefit from messages, including informal ones, and services that target comfortable, middle class folks without competing stressors, compared with changes that alter the environments in which everyone, but especially underserved people, are at higher or lower risk. It’s well documented that People of Color are more likely than white people to be put at risk for public behavior perceived as nonconforming.

If both non-mask-wearing can be a source of scorn and mask wearing can be a source of prejudice or even danger for Black people, that contributes to the same systemic inequalities that have grabbed hold of progressive discourse and made us look at what we’re doing wrong as a society in recent months. Yet few jurisdictions have adopted policies recognizing that mask-wearing might be experienced differently by People of Color as opposed to white people.

It’s clear the social expectation is not the same for everyone, in ways that are hard to predict. At a time when public institutions are susceptible to changing science-based guidance to fit elected officials’ personal interests, putting lives at risk, we do harm in assigning blame to individuals instead of looking for systemic solutions.

Save the world with policies, not shame and condescension

Shame is unhelpful for three reasons. It distracts attention from the tough tradeoffs that policy makers must face in order to protect us from further transmission (for example, do we want indoor bars open now or schools open in the fall? It’s not a 1:1 exchange but it’s relevant). It’s virtually impossible for individuals to influence more than very few people conducting very few interactions. Finally, it’s least likely to help those among the most vulnerable population groups and most likely to hurt them.

So what would reduce risk of transmission COVID-19 in the region, and beyond, without trying to convince folks they are bad people if they don’t wear one consistently (which is both hard and ethically fraught)?

Check out our post tomorrow which will explore some feasible urban policies and how they can contribute to a more equitable policy environment across the board.