Unwritten rules

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About

Societal rules provide structure for the actions and interactions of individuals and groups of people. Written rules are formalized and documented in laws, policies, regulations and budgets. Unwritten rules include worldviews, culture and norms. Societal rules are applied to individual people, groups of people, government and corporations.People, institutions and governments in charge of decision-making use underlying worldviews and narratives to justify these rules. Written and unwritten rules are central to the production and maintenance of social orders and hierarchies.

Relationship to health and equity

How we create and maintain rules governs the choices that individuals make. For example, the Community Mental Health Act (CMHA) of 1963 was created to reduce the number of people living in institutions by creating local mental health care centers across the U.S. The Act resulted in a 90% decrease in the number of people in state mental hospitals between 1955 and the early 2000’s due to the recognition of inhumane treatment people were receiving. However, the creation and expansion of community mental health care was not fully realized and people with serious mental illness and substance use disorders were denied adequate treatment. Many went unhoused. Meanwhile, others with less severe and chronic conditions had options available to them and they could choose to access those options. The CMHA, a written rule in the form of a law, had a disproportionate impact in communities of color due to the underfunding of services in those areas and overreliance on police intervention. Stigma about mental illness and substance use disorder, which is an unwritten rule in the form of a negative cultural norm, further limits access to services.

Relationship to systems and structures

The action or inaction of those wielding power set rules and hold them in place. Shifting power is required to change laws, policies, norms and how we govern. Shifting power can change who is making rules and influence what rules are created, implemented, maintained and followed.

For example, the process elected officials use to develop budgets has both written and unwritten aspects. There are written rules around lobbying for various budget items, such as laws requiring written disclosure of lobbying. There is also an unwritten culture of what is acceptable, including long-term relationships between elected officials and lobbyists that might enable influence.

Workplaces provide another example. There are often written policies around hiring and promotion. And aspects of workplace culture may be written through a strategic plan or an organization’s mission, vision and values. But other rules are not written, such as standards for professionalism or pressures to work even when sick or injured.

When power to set the rules is not shared equitably, the people who determine the rules may assume they know best, creating a society that does not support equity in opportunities for health. In a society that values respect and leadership by those most impacted by historical legacies and decisions, the sharing of power to make the rules can support health for everyone.

Additional Reading

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