Does shame make us healthier?

I felt a deep sense of discomfort as I watched a government school teacher ask a young girl stand up in morning assembly and berate her in front of all her snickering peers. Her crime? She had tried Vimal. Chewing tobacco is endemic in the areas where I work. Both men and women use it throughout the day, and schoolteachers report that young children also have begun trying it. In fact, I often see small children coming to shops to pick up packets for their parents.  Some of the other students had reported this young girl’s transgression to the teacher and thus her punishment was public humiliation.  I watched her desperately hide her face as she began to cry, forced to remain standing as the teacher continued on for about 10 minutes. The other students giggled and whispered as they watched her squirm.

I know that some would applaud this teacher for showing the student that there were consequences for making this poor health choice.  I, too, feel that educators should play an active role in positive health behavior promotion. The negative effects of tobacco should be emphasized from a young age in schools, which often does not happen. I know that teachers here worry about their young students using tobacco because it is so readily available. However, my feeling of discomfort came from my belief that shame causes us to hide; to withdraw. It closes conversations, rather than opens them. We see this all the time in the United States, where suspensions and expulsions for tobacco and drug possession are the norm.

In the public health field our top priority should be to empower communities to achieve healthy outcomes in an equitable and sustainable way. Can we do it in a way that is not punitive? Can we skip the embarrassing interrogations and discuss why children make these choices in the first place? With children we have a chance to influence health from the very beginning through quality education. We must let them know that they can ask questions, communicate with teachers, and take care of their own health. Shame-free.