A wheel of change for the uphill climb.

During periods of crisis, when I need to be able to understand complex issues, (or I’m at a party and want to bore someone), I sometimes start to think and talk about public health frameworks and how they may apply to a particular situation. It’s a familiar subject to me, one grounded in behavioral sciences and behavior change research, which makes it especially useful to try to understand social phenomena. Right now, as the world comes together to bring attention to structural inequities that have enabled persistent problems like systemic racism, many are being asked to think about these concepts for the first time. This particular cartoon from The New Yorker making its way on social media probably captures best how most of us are feeling, whether we happen to be the person on the right or the left.

I can’t help but draw from my work in other areas of public health, like noncommunicable disease prevention, to make sense of the social movement we are experiencing. It almost feels like, as a society, we are just making the connections between smoking and lung cancer, or trans fats and cardiovascular disease. We are learning that our actions are linked to our health, and outcomes like lung cancer and heart disease can be prevented by changes in our behavior. But there are also environmental structures in place that make it easier for us to engage in behaviors that are not so great for our health (Remember when we could light up on airplanes, anyone?). As humans, we operate pretty mindlessly throughout the day and these environmental structures often make the unhealthy choice the easy choice (Would anyone like fries with that?). Until our environments are more supportive of the choices we know are healthier for us, no amount of individual behavior change will help move our populations forward. (As an aside, my favorite book about choice architecture is Nudge, by Thaler and Sunstein).

I feel tempted to draw out these examples to what we are currently experiencing as a society, as many of us dig deeper to learn about the structures and systems keeping racism and inequity in place. Likening the social movement we are currently experiencing to learning about the connection between our behaviors and chronic diseases would, of course, be its own injustice and a massive oversimplification of the issues. But it may provide a helpful framework for those of us struggling to find our way through it.

To a certain extent, we are currently learning that it isn’t enough to change our individual behaviors so that we can actively be allies, amplifiers and anti-racists. Individual behavior change, of course, is vital. But in order to see massive shifts and achieve the outcomes we care about (a more equitable and just society), we also need our environments to shift so that the underlying systems and structures that support inequities are broken down. For many of us, this is the part that is new. This is the part that is confusing and complicated. This is the part that is paralyzing. How do we change structures? Institutions? Sector-wide practices? Historical assumptions? Generational norms? How do we make sense of the links between class disparities, gender inequities, racial inequities, and income inequities? How do we think about systems change? (As another aside, the Stanford Social Innovation Review has a great series on mastering systems change. For starters, any type of systems change requires observation, patience and reflection. And, as with any complicated project, it’s best to start small).

Yes, we are just at the beginning as the first cartoon points out. And it will be an exhausting uphill climb. But we’ll do it together. And there are models, frameworks and research to partially guide us. Right now, I’m thinking about the Stages of Change model and how that can help me see things more positively than the idea of a linear uphill climb. Here are the stages of change, starting with Precontemplation.* A wheel of change, if you will, to help us with our climb:

Precontemplation. During this stage a person is not yet considering change or is unwilling or unable to change. The primary focus during this stage is on raising awareness.

Contemplation. In Contemplation, a person sees the possibility of change but is ambivalent and uncertain about change. The primary task in this stage is to resolve ambivalence and help the person choose change.

Determination. During this stage a person is committed to changing but is still considering what to do. The primary goal is to help the person identify appropriate strategies for change.

Action. A person in the Action stage is taking concrete steps towards change but may not have stabilized (i.e. the steps don’t quite feel comfortable yet). The primary task here is to help the person implement change strategies and eliminate potential relapses.

Maintenance. Success! At this stage, a person has achieved goals and is working to maintain change. Primary focus at this stage is to develop new skills to maintain change.

Relapse. The model recognizes that change is hard, and that relapse may occur. The focus during a relapse is to cope with the consequences and determine what to do next to get back on the cycle. The good news is that there is ongoing learning, and the cycle is upward.

As a society, we are moving from Precontemplation into Contemplation. Rather, we are moving one stage further towards groundbreaking change. We’re officially on the wagon, and there are people leading the way. As the model indicates, we may relapse, but we won’t start at ground zero when we do. As long as we adopt a growth mindset that prioritizes continuous learning, we can chip away at our goal of a just and equitable society. That, to me, feels like progress and I can re-energize to keep going.

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*This model wasn’t intended to be applied to social movements, but rather, individual behavior change related to things like smoking cessation and substance abuse prevention. The extrapolations I’m making here are simply for illustration.