What Makes Narrative Change So Hard?

(Photo by iStock/IPGGutenbergUKLtd)

In December 2014, a group of health activists from around the world staged a mock carnival outside a hospital in Barcelona, Spain, to protest the inflated price of Sovaldi, a then-new drug for Hepatitis C sold by the pharmaceutical corporation, Gilead. As part of the carnival, passersby could spin a mock wheel of fortune, to determine the price they would pay for their medications. It always stopped at the highest price, $84,000, the market rate for a single course of Sovaldi.

That protest, as described in the new book The Art of Activism by Steve Duncombe and Steve Lambert, (and which I attended and helped fund as part of my then job at the Open Society Foundations’ Public Health Program) was just one effort in a decades-long campaign by activists around the world to bring down the price of essential medicines and ensure they are accessible and affordable to everyone. Years later, many of those same activists would once again join forces to campaign for equitable global access to COVID-19 vaccines as part of the Free The Vaccine campaign, in collaboration with the People’s Vaccine movement.

Beyond campaigns targeting specific medications, a broader aim of the access to medicines movement is to “change the narrative” about medicines as a whole, to get society to view medicines as public goods rather than private goods—and thereby change the entire system by which medicines are developed and marketed and distributed.

Narrative Change has emerged as a field over the past few years, as nonprofits and foundations long focused on supporting human rights saw that many of their hard-won policy victories were being reversed, or were just never implemented in practice. An entire ecosystem of organizations such as the Frameworks Institute, Narrative Initiative, and ReFrame has developed, based on the insight that in order to achieve lasting, systemic change, it is not enough just to change a few policies. We need to shift the underlying system of stories that help people make sense of the world.

This is evident in the case of COVID-19 vaccines. Although the Biden administration eventually called last year for a waiver of intellectual property protections that would enable countries in the Global South to manufacture COVID-19 vaccines for themselves, international consensus on this has proved elusive. Groups such as the Health Justice Initiative in South Africa, I-MAK, and Medecins Sans Frontieres continue to cry out against a global intellectual property system that prioritizes profits over lives. But how different things could be if our underlying story of medicines was that they are public goods. We can get an inkling of this from Jonas Salk, developer of the first polio vaccine. Asked who owned the patent, Salk famously replied, “Well, the people, I would say. There is no patent. Could you patent the sun?”

Narrative change is difficult, though. Despite the fact that most Americans feel medicines are far too expensive, despite the logic that new COVID-19 variants are more likely as long as most of the world remains unvaccinated, despite the fact that taxpayer money funds much of the research leading to new drugs, including the COVID-19 vaccines, we still refuse as a society to treat medicines as essential public goods. Another area that illustrates this is that of immigration, where narratives driven by a sense of threat and insecurity seem to dominate, and as the Migration Policy Institute points out, “the stickiest negative narratives about migration are often interwoven with perceived threats to economic, physical, or cultural security, even if these threats are not well supported by data.”

Many reasons can be found for the slow pace of change and even reversals of previous advances in these and other areas. One is a disparity in resources and communications capacity: in the case of medicines, the voices of small groups of poorly funded activists are easily drowned out by pharmaceutical corporations with their armies of lobbyists and huge marketing budgets. Other explanations have been offered: organizations work too much in issue-focused silos rather than looking at the bigger picture; funders don’t put enough money into narrative change, or focus too much on the short term.

There is validity in all of these, but nonprofits and funders can go too far in pointing fingers at their own shortcomings. The reality is that they are playing on an inherently uneven field. An approach within the field of social and political psychology called System Justification Theory helps explain why this is so.

System justification theory was first developed in 1994 by psychology professors John Jost and Mahzarin Banaji and over the 28 years since then, there has been plenty of research to support it. As Jost outlines in his 2020 book, A Theory of System Justification, humans are motivated to defend and justify systems even if these systems work against them. According to Jost, “people exhibit system-justifying tendencies to defend and rationalize existing social, economic, and political arrangements—sometimes even at the expense of individual and collective self-interest.” 

Because of system justification, humans tend to see the existing order not just as the way things are, but as natural, or even the way things ought to be. This makes us more likely to accept unwelcome social and political situations. It reduces support and motivation for activities that challenge the system, even among groups who are disadvantaged by the system. For example, a study in 2016 found that, instead of seeing the social system as the source of their problems, many low-income racial and ethnic minority women attributed poverty to drug and alcohol addiction and “character deficiencies of the poor.” System justification helps us feel better about the way things are, even if it harms us. It also reduces support for system-challenging protest activity.

Of course, in spite of this, some people do stand up and challenge the existing order, through protest or other activities. System justification also helps explain why this is so difficult and stressful, and why it can threaten these individuals’ safety and many of their social relationships.

In the case of pharmaceuticals, system justification helps explain why, although most Americans support government intervention to limit drug prices, calls for more fundamental changes to the intellectual property system that effectively gives pharmaceutical corporations monopoly power are often seen as radical and unrealistic. Indeed, such demands seem to many to be more outrageous than the avoidable illness and deaths that systemic reform could prevent.

System justification also helps explain ongoing skepticism about human-driven climate change among particular groups, in the face of overwhelming evidence.

So, given our human tendency to justify existing systems and resist change, how do nonprofits, activists, and funders working to change deeply held social narratives overcome this inertia?

First, they need to find ways to expose the status quo for what it is—to make visible the justifying narratives and the unequal power dynamics they serve to perpetuate. Narratives are always, always tied to power—and an important first step is to expose that power for what it is. As the Frameworks Institute points out in their publication The Features of Narratives, dominant narratives, those that make the existing social order appear natural and just, embody the perspective and interests of the powerful—but do so while presenting themselves as neutral, without a particular perspective: “They seem to be told from nowhere.” An example is the narrative of meritocracy. This is seemingly neutral—anybody can succeed if they work hard enough—but in fact helps justify the position of the already rich and powerful as fairly earned, while blaming the poor and marginalized for their disadvantaged situation. One of the key steps in narrative change then is to remove that mask of naturalness and neutrality.

How do we make visible the justifying narratives and the unequal power relationships they serve to obscure? According to Sara Cobb who works with narrative in the field of conflict resolution, one way of doing this is to pose smart questions that get at contradictions. These contradictions start to niggle, and then begin to expose cracks in the dominant narrative so that the “naturalness” of the way things are, starts to wear off. Cobb says she does this in a playful way, using irony. Perhaps this is why comedy and art can be so impactful, as they can get us to see the absurdity in our daily reality, or look at the world through new eyes. The make-shift carnival outside a hospital was an effort to do just this—to help people see how ridiculous our current approach to medicines is.

This idea of exposing contradictions might also be one reason that the practice of so-called “deep canvassing” has proved successful—where campaigners have extended conversations with people, asking questions so that the person starts to see and explore the inconsistencies in their own views. Studies have found, for example, that deep canvassing helped shift attitudes towards immigration as well as transgender people, and that these changes endured for several months.  

In addition to de-naturalizing the current dominant narrative, it is important to make alternative social systems appear visible and real. Once new ways of understanding and being in the world take on sensory, visceral and emotional power, they start to seem possible, and even necessary. Just as many of us find it difficult to see the possibilities in a run-down house without the help of trained architects and designers, so we often need help to envision viable alternatives to the current social system. This is why narrative experts such Thomas Coombes have been urging human rights organizations to focus more on hope-based messages.

Popular culture is crucial in this regard. Engaging films, TV shows, games, and the like can transport us to alternative worlds on a mass scale and help expand our sense of the possible. Donors are increasingly recognizing this and have helped seed and fund initiatives such as the Pop Culture Collaborative in the United States and the PopChange initiative in the UK. Bridgit Antoinette Evans, executive director of the Pop Culture Collaborative, highlights the importance of narrative immersion in a recent publication, From Stories to Systems. Using the metaphor of narrative oceans, she says, “we have to achieve a depth of narrative immersion such that people experience a fictional way of life as possible, and begin to express first yearning, then desire, and finally, demand for this fiction to be made real.” Narrative immersion is achieved, according to Evans, through the cumulative impact of a plethora of stories and experiences that carry the same core set of ideas.

As is often the case with major, disruptive events, the COVID-19 pandemic has helped expose a range of problems and contradictions in the dominant narratives that until now have helped justify our current unequal and unjust systems. For example, there is now much more widespread interest in the ideas and issues that those health activists in Barcelona back in 2014 were struggling to convey beyond small circles of policy experts. But the opening is fleeting. It is all too common for existing inequalities and power imbalances to become even more entrenched once a crisis is over—partly because of a failure of imagination.

Many organizations and movements have a vision they are ready to share, however—of a world where there is universal health care and everybody can afford the medicine they need; a world where immigrants are seen as an asset rather than a threat; a world where LGBTQI people live long, safe, fulfilling lives and are able to fully contribute to their communities; a world that comes together to face the urgent crisis of climate change. Now is the time for the social sector to invest more than ever in the production and distribution of a wide range of stories and experiences that will help millions of us envision better, more just systems, and make them feel real.

Read more stories by Brett Davidson.