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#Health Equity

Using Storytelling to Trigger Epiphany, Action, and Change

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Over the last year, Harmony Labs has been developing an audience-narrative architecture to help the Robert Wood Johnson Foundation (RWJF) and its partners find “narrative strategies” and actual storytelling that would activate people in the U.S., especially healthcare professionals, to dismantle structural racism in America’s healthcare and public health systems. The foundation of this work was research on audiences and the health equity narrative landscapes they inhabit. This initial research helped surface the most promising opportunities for content testing and validation, from which our project partner Story Strategy Group convened groups of professional storytellers, anti-racism experts, community leaders, and content strategists to develop new stories that might transport audiences toward a target narrative of health equity. This piece is one in a three-part series from some of the subject matter experts and storytellers who worked on this project. You can explore the full findings here.

The post was originally published on Medium.

 


 

I am a story consultant who works with social justice organizations and public defenders to use storytelling to get audiences to empathize and act. I’ve consulted on hundreds of criminal and civil cases and have an 80% success rate, including several acquittals in jury trials where our client was facing life in prison or the death penalty. I attribute this success to providing attorneys with actual storytelling techniques that trigger empathy.

My social justice storytelling work involves interviewing people and identifying the stories they’re living: their story purpose, allies, obstacles, and goals. The information I glean is then used by social justice organizations to shape stories that align with their audience’s stories. By doing so, we can find common themes that unite disparate groups and encourage them to work together. I believe that of the hundreds of people I’ve spoken with, almost every person could empathize with an issue if it related to their story goal.

The Health Equity Narratives Project, sponsored by the Robert Wood Johnson Foundation, was designed to provide advocates for health justice with narrative strategies to support their goals, including the bold and urgent objective of dismantling structural racism in healthcare systems.

My role on the project was to take the anecdotes or issues identified by healthcare experts, turn them into stories, then ensure the stories we told achieved the project goals, within the constraints of Facebook image ads, and a testing-friendly format selected by the research team.

Our goal with these testable stories was to get audiences to recognize the problem of racial inequities in the healthcare system and agree that action must be taken to address the imbalances suffered by people of color. Achieving this meant challenging people’s biases.

Storytelling Empathy, and Epiphany

Stories are universal, and make us human. We use stories to justify our life choices. Almost all of us can name a story that changed our lives. When asked how we chose our partner, or a career, we will tell a story. This is the power of storytelling in our lives. When the right story is told in the right way, an audience’s views on the world — and their attitudes, beliefs and behavior — can change.

In my work, I use the terms “story” and “storytelling” literally. A story is a mechanism that must be constructed for an audience. It must have certain key features — a protagonist, a story goal,and obstacles. This is the DNA of western storytelling, and it’s what people expect in a movie, novel or TV show, as well as in a criminal trial, ad campaign, or social justice initiative.

The goal of the storyteller is to create empathy. Action can be achieved with empathy.

In my trial work, the jury is the audience, who usually are biased against the client, who is often part of a marginalized group, such as the poor, mentally ill, or unhoused. Bias against such groups makes it easy for juries to convict the client, and law enforcement and prosecutors often rely on such bias to make their jobs easier.

I help the defense attorney tell the jury true stories about the incident, client, and case that prove the jury’s assumptions false. In the moment the jury realizes their assumptions were wrong, they have an epiphany.

Epiphanies are outcomes determined by the audience themselves based on the events of the story. Having an epiphany is more powerful and feels more true than simply being told what to believe.

The importance of an epiphany is that it opens the door to empathy. For example, in one murder trial I consulted on, the client was silent and avoided eye contact. The prosecution depicted him as a dangerous “loner” living in a shack and roaming public parks at night. We represented the client’s actions to show that he was an introvert — an avid reader who lived in a room behind his father’s house out of deference to his stepmother, who resented his presence. Instead of spending his free time at his father’s house, he went to the park to avoid a confrontation with his stepmother. The same actions given proper context allowed the jury to have the epiphany of seeing him differently.

It’s important to note that we did not call the client an introvert — we let the jury come to this conclusion based on the actions of his story. This re-framing of the client’s personality and actions caused the jury to have an epiphany that their assumptions were false and allowed them to review the entirety of the case with empathy. They ultimately found the client not guilty. Post-verdict interviews proved the validity of using storytelling to allow the jury to empathize and act impartially.

This is not an isolated example. My experience working on hundreds of cases bears out that stories with reversals of expectations can cause the audience to reconsider their opinion of the client and the entire case.

The successful implementation of storytelling in trial has yielded extremely good results — and there’s no reason that it can’t be applied to social justice issues, too, provided we tell the right stories the right way. In the Health Equity Narratives Project, I wanted to use storytelling in the same manner, to create the same effect.

Telling the Story of Healthcare Inequities

To create the first round of test ads, I led a creative team that took ideas about racism in healthcare and healthcare systems, as well as stories about equity and access, and put them into simple design concepts with one image and very few words.

The ads featured declarative statements, such as, “The healthcare system is biased against Black mothers.” The results were as expected — the ads resonated with those that we expected to agree with them and had little effect on those groups that tended not to believe or care about such issues.

For the second and third rounds of testing, we presented the same issues, but as stories — which we know is an onramp to creating empathy. Using information gathered from experts in racism in healthcare, I crafted specific stories. Creative teams then wrote copy and applied images, which included the four key story elements of:

  1. A protagonist;
  2. A goal the protagonist is trying to achieve;
  3. Obstacles challenging the protagonist from attaining their goal, which could be an antagonist, a situation, or the protagonist themself; and
  4. An outcome.

With structural racism and multiple inequities prevalent throughout our healthcare system, we were sometimes able to combine multiple problems into one story. For example, here are three general problems faced by people of color in healthcare, according to experts:

  • Bias against the patient’s race or culture by healthcare practitioner
  • An indifferent and illogical bureaucratic healthcare system
  • A shortage of healthcare providers

We created two versions of one story that addressed all three of these issues:

ex11.png ex22.pngVersion 1 & Version 2

The images and copy in Version 1 tell the story of a doctor named Jean-Pierre who immigrated to the U.S. but is unable to practice medicine due to bureaucracy.

Version 2 is a general version of the same story. No one is named, but the images depict and imply the story of specific protagonists.

Versions 1 and 2 both worked with certain audiences, supporting our theory that presenting the same issue in a story format invites viewers in and creates the empathy people need to call for changes to our current healthcare system.

The Importance of Addressing the Metastory

A metastory is a general pre-existing story or belief held by the audience. A storyteller must know their audience’s metastory and have a relevant story that can address it in the right manner — perhaps reinforcing a beneficial metastory or countering a harmful one.

For example, in a jury trial, the jury’s pre-existing metastory might be that a homeless Black loner is most likely a murderer. By providing context and detail to his actions, we can prove the jury’s metastory to be incorrect, which can compel them to acquit.

For many social justice issues, audiences are rooted in feelings of scarcity, believing the metastory that they will have to sacrifice their goals if the needs of others are addressed. We specifically rebutted that metastory in this project by showing that everyone would benefit if the needs of a specific group were addressed. Specifically, we’d have more doctors if we eliminated the bureaucracy that prevented immigrant healthcare workers from doing the jobs they were trained for.

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This story tested well with a range of audiences because they could see how the action would benefit everyone. The key overlapping story points were:

  • Almost everyone has suffered bureaucratic frustration in the healthcare system
  • The healthcare system feels indifferent to human need
  • Helping even a subset of people would make the system more efficient
  • Having more healthcare providers with language skills and cultural sensitivity to people of color is good

Key Story Questions

As part of the Health Equity Narrative Project, our team ultimately created 105 pieces of content that sought to counter harmful metastories related to healthcare access and structural racism in our healthcare system and encourage people to take action to rectify these injustices. Of those 105 “mini stories,” many were highly successful in engaging audiences and/or moving them towards a better and more equitable narrative about healthcare and healthcare systems.

The lessons we learned are not specific to just this project. Others can apply our learnings to their own work provided they leverage the power of stories and storytelling.

When creating stories for social justice purposes, I recommend keeping these key questions in mind:

  • What do you want your audience to do?
  • What are the audience’s existing metastories? What stories are they currently living
  • For the stories you intend to tell your audience, what are the obstacles/antagonists blocking the protagonist and how does your audience relate to them?
  • Does the call to action help or harm your audience?

Creating stories that address these points is the best way to get all audiences to empathize and take action — which we need to do if we’re going to be successful at getting more people to join us in the fight for a better, more just, and more equitable future.

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