Tag: outcomes

Thoughts on Personal Responsibility

Complex and Conflicting Thoughts on Personal Responsibility

Posted on by jabittan
I’m really hesitant to criticize others for not taking sufficient personal responsibility for the ways they live and the outcomes of their lives. A lot of factors influence whether you are economically successful or whether you are fit and healthy. Some things we seem to have a lot of control over, but many things are matters of chance and circumstance. Placing too much blame on the individual doesn’t seem fair, yet at the same time, there is clearly an element of personal responsibility involved. I’m not sure where I land on how we should think about this division.

 

What is clear, however, is that there can be negative consequences when we take away people’s agency in their decision-making and life outcomes, and when we erode the authority of those who are reasonably critical of negative lifestyles and ways of thinking and being, we can put ourselves and societies in vulnerable positions.

 

Sam Quinones writes about these tensions in his book Dreamland and he highlights how patient responsibility and physician authority devolved between the 1980’s and twenty-teens as a quick fix, there’s-a-drug-for-that mindset took hold of the American healthcare system. He writes, “…patients were getting used to demanding drugs for treatment. They did not, however, have to accept the idea that they might, say, eat better and exercise more, and that this might help them lose weight and feel better. Doctors, of course, couldn’t insist. As the defenestration of the physician’s authority and clinical experience was under way, patients didn’t have to take accountability for their own behavior.”

 

I’m usually hesitant to say that the problem is people’s lack of accountability, because how often do we really control how much exercise we can get when many of us live in places where walking is difficult because our streets are not safe, or are not well designed for pedestrian use, or because half the year it is dark early and we get lots of snowfall? How often do we not know what kinds of exercises we should do, and how often do we have people who are only critical of our current state rather than supportive and encouraging? How often have we had a bad break and poor advice on how to get back, only leading to a further defeat, deflating our sense of self worth? In addition to all this, how often have we seen people use the personal responsibility argument in bad faith? To justify not helping others or to rationalize their greed or excessive self-aggrandizement?

 

But at the same time, as Quinones shows, responsibility is important. We need to think about what we can and should be doing to help improve our own lives, without hoping for an easy fix in the form of a miracle pill. We can’t just throw out the opinions of experts and devalue their authority because they are willing to say things that are discomforting for us, but are likely correct in terms of how we can make our lives better. Somehow we need to work together to build a society that recognizes the barriers and challenges that we face toward becoming the successful and healthy people that we want to be, but encourages us to still work hard and overcome obstacles by taking responsibility for our actions and (at least some percentage of) our outcomes. I don’t know what this looks like exactly, and I’m not sure where the line falls between personal responsibility and outside factors, but I am willing to have an honest discussion about it and about what it all means for how we relate to each other.

New Considerations for the Public vs Private Discussion

Posted on by jabittan
In the past I wrote about the importance of privacy in our politics from the point of view of Jonathan Rauch and his book Political Realism. We have almost no trust in government, and we frequently say things like, “sunshine is the best disinfectant,” but the reality is that politics is made much more complex when it is in the open. Difficult negotiations, compromises, and sacrifices are hard to do in open and public meetings, but can be a little easier when the cameras are turned off and political figures who disagree can have open and honest discussions without the fear of their own words and negotiations being used against them in the future.

 

In The New Localism, Bruce Katz and Jeremy Nowak acknowledge the difficulties faced by governments when open meeting laws force any discussion to be public. The laws come from a good place, but for local governments that need to move fast, make smart decisions, and negotiate with private and civic sectors to spur innovation and development, public meetings can lead to stagnation and gridlock. A solution proposed by Katz and Nowak is for local governments to authorize private corporations overseen by public bodies and boards to operate economic development areas and to take ownership of public asset management.

 

They describe how the city of Copenhagen has used this approach, “Copenhagen has found that by managing transactions through a publicly owned, privately driven corporation, operations run faster and more efficiently in comparison to how local government traditionally tackled public development projects.”

 

The private corporation running local development is publicly owned. It is still accountable to the local elected officials who are ultimately still accountable to the voters. But, the decisions are private, the finances are managed privately, and negotiations are not subject to public meeting laws. While the corporation has to demonstrate that it is acting in the public interest, free of corruption, it can engage with other public, private, and civic organizations in a more free and flexible manner to accomplish its goals. Leveraging the strengths of the private sector, publicly owned private corporations that put local assets to work can help drive change and innovation.

 

Directly calling back Jonathan Rauch’s ideas, these corporations create space for negotiations that would be publicly damning for an elected official. They also prevent elected officials from having undue influence in development and public asset management, preventing them from stonewalling a project that might be overwhelmingly popular in general, but unpopular with a narrow and vocal segment of their electorate. This prevents public officials from pursuing a good sounding but ineffective use of public resources to signal loyalty or virtue to constituents. Removing transparency and making the system appear less democratic, as Rauch suggests, might just make the whole system operate more smoothly and work better in terms of the outcomes our cities actually need.

Sample Bias and Obliquity – Lessons from the Education Model

Posted on by jabittan
I studied political science for a masters and focused generally on public health. A big challenge in both areas is that the people who end up participating in our studies or who are the targets of our interventions are often different in one way or another from the general population, and that makes it hard to tell whether our study or intervention was meaningful. We might see a result and want to attribute it to a specific thing happening in society or that we introduced to a group, but it could just be that the people observed already had some particular quality that led to the outcome we saw. Our theory and our intervention may have just been a small thing on the side that didn’t really do what it looks like it did.

 

Another challenge in both areas is accomplishing our goals without being able to directly address our goals. We may want to do something like prevent drug overdose deaths, but public opinion won’t support safe injection sites, legal drug use, or free needles for drug addicts. We can work toward our goals, but we often have to do them in an oblique manner that purports to address one thing, while in the background really addressing another thing.

 

These experiences from my educational background come to mind when I think about the following quote from Kevin Simler and Robin Hanson in their book The Elephant in the Brain. Their example is about education, but it relates to what I discussed above because it shows how our current education system seems to be doing one thing, but really accomplishes another goal in an indirect way. It does so by taking qualities that people already have, and purporting to provide an intervention to enhance those qualities, but runs into the same selection bias I mentioned in my opening paragraph.

 

“Educated workers are generally better workers, but not necessarily because school made them better. Instead, a lot of the value of education lies in giving students a chance to advertise the attractive qualities they already have.”

 

Education can do a lot of things for us, but pin pointing exactly what it does is tricky because the people attracted to school are in some ways different from the population that is not attracted to higher education. It is hard to say that the schooling is what made the big difference or if the people who do well in school had other qualities that set the stage for the difference observed between those who do well at school and those who don’t. This doesn’t mean school is a waste or that we should invest in it less, but rather that we should consider a wider range of schooling options to allow people to demonstrate their unique qualities in different ways.

 

The other piece I like about the quote is the obliquity of schooling and education in our journey to tell others how amazing we are. It is hard to demonstrate one’s skills and qualities, but going through an obstacle course, such as college, is a good way to show our positive qualities and skills. Education is one obstacle we use to differentiate ourselves and advertise how capable we are in a socially acceptable manner. There is something to be learned when thinking through policy from the education example. Direct approaches to policy-making sometimes are impossible, but indirect routes can open doors if they make it seem as though another good is being pursued with the outcome we want to see occurring incidentally.

Personal Medical Decisions?

Posted on by jabittan
A couple weeks back my grandma sent me a message on Facebook that was a picture of two very obese individuals eating a giant pizza and drinking soda. A caption on the photo read, “This is why I don’t want to pay for your healthcare.” As a person who is interested in and taken classes about public health and health policy, I actually think about these things all the time. I recognize the importance of making smart health choices, but I also understand that health outcomes can be a result of a complex web of social determinants of health. There are factors that are beyond our control in regard to living healthy, and there are some factors that seem like easy decisions to some people, that are monumental challenges to others. Despite the amount of time I spend thinking about these things, I don’t have a clear answer in my head for when people need a tough love kick in the pants versus compassion, and when a given outcome is generally more the result of poor individual decisions and habits or more the result of uncontrollable social determinants of health. There likely is no clear answer to this question, and I think it is reasonable to say, “I have thought about this a lot and I don’t know.”

 

This leads me to another factor that compounds the complexity of healthcare decisions: What choices, decisions, and behaviors are personal, and which ones should be considered public? If I chose to smoke, is that a personal decision even though there may be public consequences if I die early, have poor health overall, and require more emergency medical care which ultimately drives everyone’s healthcare premiums up? Do I have to exercise every day to stay healthy as a public good and not just as a private good? If I go get an x-ray on the ankle I sprained to make sure it isn’t broken, is that going to take time away from medical professionals who could help someone that really needs it when all I likely need to do is ice it a little bit?

 

In the book The Elephant in the Brain, Kevin Simler and Robin Hanson write about Steve Jobs and his decision to forgo cancer treatment as recommended by the American Medical Association’s best practices. Jobs is an interesting case because the fortunes of a company that many people love rested on his medical decisions. Beyond just his own health and the considerations of his family, people felt that they had their own money on the line if they owned apple stocks. If Jobs lived and survived his illness, it would be good for Apple, but if he denied standard treatment and died, what did that mean for the public?

 

“The point here,” write Simler and Hanson, “is that whenever we fail to uphold the (perceived) highest standards for medical treatment, we risk becoming the subject of unwanted gossip and even open condemnation. Our seemingly personal medical decisions are, in fact, quite public and even political.”

 

The kind of medicine we pursue and the lifestyle we live are never going to be restricted to just ourselves. We will at the very least be judged by others for our health and medical decisions. Our choices may or may not have major financial implications for other people, but that doesn’t mean that we can make our choices in a vacuum.

 

What is important to remember here is how complex the line is between personal and societal responsibility. Our individual decisions can have bigger impacts than we realize, and it is hard to keep something just within our own bubble. Added to that are questions about liberty and the authority of the state. It is not an easy question to ask if your diet should be controlled by anyone other than yourself, or if you should be forced to exercise and sleep a certain amount. Approach questions about healthcare understanding that these questions don’t have clear answers, and whichever choice we make is going to have strange consequences as a result of these complex inter-dependencies.

Praising Effort

Posted on by jabittan

In the book 59 Seconds by Richard Wiseman, the author looks into the role that motivation and positive reinforcement play on children and their development. One area that Wiseman focuses on is academic performance and praise.  He reviews the work by Claudia Mueller and Carol Dweck and sums up their findings with the following quote, “The results clearly showed that being praised for effort was very different from being praised for ability. …children praised for effort were encouraged to try regardless of the consequences, therefore sidestepping any fear of failure.” Mueller and Dweck studied over 400 children and their performance on tests and puzzles. The researchers administered tests to all of their participants, and collected and scored the results.  Half of the students were told they did very well and must be very intelligent, while the other half had their tests collected without being told anything.  After tests had been collected and graded the students were given similar tests with similar problems and the students who had been praised actually performed worse than the students met with silence.

I think about this study frequently, both with how I would approach young kids (I don’t have children and don’t interact with kids too often) and with how I approach myself. What Wiseman suggested from the research is that children who were told they were smart ended up being afraid to truly apply themselves. If they put in a full effort and failed, they would risk losing the praise of being smart. The identity label we attached to them would fizzle away and they would lose the praise they received.

On the other hand, children praised for being hard-working, for studying hard, and for working well with others have a reason to continue to apply themselves. Being hard working is not the same as just being talented or naturally smart. It is a mindset and a disposition that can be cultivated over time and developed, even if we don’t seem to have some natural special something to make us smart, creative, or exceptionally insightful.

The way I think about this research in my own life is in thinking about praising effort over praising identity. In myself, when I think about what I want to do, what I could do moving forward, and about the things I should be proud of myself for doing, I try to think about the habits, focus, learning, and hard work that I put forward. I don’t judge my blog by the number of viewers, I don’t just myself by my bank account, and I don’t judge my fitness by how many people I beat in a half marathon. Instead, I ask if I truly worked hard, if I was consistent and applied myself to the best of my ability, and if I am using my resources in a responsible way to help others. We should all try to avoid judging ourselves and others based on fleeting identity cues, and instead we should judge ourselves and praise ourselves and others based on the level of hard work, engagement with others and the community, and the efforts we put forward to make the world a great place.

Unfolding Outcomes

Posted on by jabittan
In her book Packing Light, Vesterfelt also writes, “Most of life is unfolding on the road in front of us. The “outcome” can change as fast as the scenery.”  This quote is important for me because it represents a lot of the thoughts that I have about my future. I am unsure of what I really want in life, and often have trouble with answering questions along the lines of where do you see yourself in 5 years, 10 years, or any length of time. In the past I know that I was locked in to an image of what success was, and I knew the outcomes I wanted: a big house, a classic muscle car, lots of medals and awards from running races.  Over time, I have had to try to identify what skills I have and what opportunities present themselves to me, matching the skills I have. With this process I have had to look at what goals or images of success I had in my mind (the outcomes) and get to the base of those goals and ideas of success to try and understand where they came from.
With life constantly changing, and new opportunities presenting themselves to me I have learned to let go of the outcomes, and focus instead on trying to be the best version of myself that I can be. It is an incredibly stressful process because I am constantly looking for security, but the things that seem to be “secure” to me don’t seem to be interesting or rewarding. Learning that the outcomes can change, and allowing the outcome that I desire to shift has allowed me to have a more dynamic approach to my every day life. I do not feel so locked in to a particular goal or vision of success, and allowing those goals to change reduces the stress I feel, and also seems to provide me with more time to allow myself to reach a state where I feel successful with the person I have become.