Hegemony: noun \hi-ˈje-mə-nē, he-jə-ˌmō-nē\. heg·e·mon·ic adjective –  Political or cultural dominance or authority over others.

For example:

“The hegemony of the popular kids over the other students means that they determine what is and is not cool.”

I lived most of my life neither knowing this word nor saying it out loud until my daughter Larissa was working on a sociology paper at university on something called “hegemonic assumptions”.   

Here’s how these assumptions might look: when white, middle-class people of privilege start thinking we understand what it’s like to live in poverty because we spend one afternoon every Christmas volunteering at an inner city soup kitchen, we’re making a whack of hegemonic assumptions.

Yet we get to feel noble about this rare foray into another world, and we also get to teach all of our friends touching little lessons about the poor unfortunates we saw lined up there.

Almost as if we know anything at all about the lived experience of those people.

Which, of course, we don’t.

Once you start looking, it’s easy to find other examples of hegemonic assumptions at work throughout society including in education, business, health care, religious organizations and the media.

Modern health care is rife with hegemonic practices. Studies on doctor-patient interaction show that medicine reinforces the common hierarchy seen in the larger society by:

• stressing the need for the patient to comply with the social superior/expert’s judgement
• directing patient attention towards the immediate causes of illness (pathogens, diet, smoking) and away from structural reasons over which physicians believe they have little control.(1)

In fact, health care practices around the world often reflect our own Western values of rationality, competition and progress, which is why we encounter clear expectations that the countries we’re helping should replace their local traditional health structures with our superior alternatives.

Minorities of any sort are popular targets of hegemonic assumptions.  Here’s how the authors of a report published in the Canadian Social Work Review describe what they call heterosexual hegemonic practices within health care(2):

“These practices affect the quality of the health care received by lesbian clients, particularly with regard to access to care, depersonalized care, and medical decision-making.

“Lesbians are rendered invisible by the assumption on the part of health care workers that women clients are heterosexual.”

Similarly, people suffering from an affliction that Kansas City psychologist Dr. Ann Becker-Schutte calls healthy privilege tend to make hegemonic assumptions all the time.

As I wrote here in Heart Sisters, if you don’t have personal experience living with a chronic and progressive illness, you may have no clue what it’s like not to be you.

Consider, for example, the Silicon Valley Quantified Self hypemeisters busy designing health tracking apps for sick people.

Erin Gilmer is an attorney trained in health policy law, who has had to put her legal career on hold because of multiple debilitating medical issues. As a speaker at Stanford University’s Medicine X conference last fall, this young, educated, articulate white woman who now lives in poverty wagged a figurative finger at those hypemeisters and their hegemonic assumptions that their technology would somehow help under-served patients like her:

“I worry about whether I should try to get a prescription or pay my electric bill. I don’t want an app to tell me how to track my fitness goals. And digital medication reminders are not what I need when I’m poor and can’t afford medicine.”

Yet the (young! healthy! not sick!) hypemeisters at Med X continue to forge ahead as if they already know what’s best for those they have likely not taken the time to actually meet. 

The business world is also a hotbed of similarly uninformed hegemonic assumptions.

If you’re a senior business executive who gets to make Big Decisions all day long, for example, you may have no comprehension at all about what it’s like to be your company’s employees on the other end of those decisions. Some executives, according to Deloitte’s 2012 “Culture in the Workplace” study, are wearing rose-coloured glasses when it comes to knowing what’s going on right under their noses.

The study found that most executives have an inflated sense of their own relevance in workplace culture, as the Deloitte study found:

• 83 per cent believe senior leadership regularly communicate the company’s core values and beliefs, while only 67 per cent of employees agreed
• 81 per cent of senior executives agree that senior leadership acts in accordance with core values and beliefs, compared to just 69 per cent of employees.

Canadian Gerard Seijts of the University of Western Ontario’s Ivey School of Business said in an interview in Food Service and Hospitality(3):

“We’ve seen this in a great number of organizations where people in senior leadership positions really have no clue what’s happening at levels below them.

“That is an example of disengagement — people in leadership positions not listening to the whispers in an organization [and being] too optimistic about what’s happening.”

Arguably, nowhere are hegemonic assumptions as obvious as in the field of international aid. We readily accept, after all, that we have so much, and “those poor people” out there have so little. And who doesn’t want to help feed the hungry, cure the sick or educate the children of the Third World?

But Berlin human rights consultant Michael Hobbes describes a fistful of  examples of unfortunate hegemonic assumptions made by well-meaning yet shortsighted decision-makers in his compelling New Republic piece called Stop Trying To Save the World:

“A project in Kenya that gave kids free uniforms, textbooks, and classroom materials increased enrollment by 50 percent, swamping the teachers and reducing the quality of education for everyone.

“And communities in India cut off their own water supply so they could be classified as ‘slums’ and be eligible for slum-upgrading international funding.”

Here’s another example: according to Hobbes, it turns out that one of the key problems among NGOs distributing free textbooks to schools in isolated rural areas of Africa was that the textbooks were in English, the second or third language for most of the kids. Of all the third-graders given textbooks, only 15 percent could even read them.

Clearly, somebody who was fluent in English but ignorant of the reality abroad made a hegemonic decision to order useless English-only books.

But such ignorance doesn’t just happen when we’re trying to imagine what’s best for people in far-off lands. Hobbes reminds us of the official response in the U.S. after Hurricane Katrina hit the Gulf Coast in 2005:

“The American Red Cross sent confused volunteers, clueless employees, and, bafflingly, perishable Danish pastries to the Gulf Coast because it hadn’t invested in training its U.S. staff in actual crisis response.”

I spent a number of years working in disaster response for another international non-profit agency. My projects also included running a local street outreach program feeding the homeless.

Nothing made my trained volunteers feel better than feeding hundreds of hot meals on a cold winter evening to long line-ups of our clients, many of whom would later spend the rest of that night sleeping in downtown doorways or under the bridge.

Yet over the years, I began to suspect that we just might be on the wrong track.

One of our partner agencies, for example, published a regularly updated 12-page resource booklet for the homeless residents of our town. It listed dozens of entries on where to find free food, or where to get free clothing, or blankets, or hot showers, or bus tickets, or emergency cold weather overnight shelter.

I developed a niggling low-grade worry that somehow my dedicated band of volunteers and I were helping to make it easier for those living on the streets to stay on the streets, when what I really wanted to do was to get them off the street entirely and into safe, sustainable housing.

Worse, our non-profit agencies seemed to be unwittingly taking the heat off local government agencies in addressing homelessness. And why should they, really – when so many local do-good community organizations are so willing to keep patching up the cracks in a systemically broken system that makes homelessness somehow tolerable?

But as I learned, handing out clean socks or a bowl of hot soup does little to change the day-to-day reality of those who find themselves marginalized and living on the streets.  Nor do temporary cold-weather homeless shelters. Nor does an annual hot turkey dinner with all the fixings that we serve them at Christmas.

Almost as if we know anything at all about the lived experience of those people.

Which, of course, we don’t.

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(1)  Encyclopedia of Medical Anthropology, Volumes 1-2, edited by Carol R. Ember, Melvin Ember.

(2) Daley, A et al. Lesbian invisibility in Health Care Services: Heterosexual Hegemony and Strategies for Change. Canadian Social Work Review / Revue canadienne de service social. Vol. 15, No. 1 (Winter/hiver 1998), pp. 57-71

(3) Rebecca Harris. “Culture Club”. Food Service and Hospitality, June 2013. 27-30.

See also:

• An open letter to mobile health app developers and their funders
• Why 74% of smartphone apps are dropped by the 10th use
• “If you’re clueless and you know it”
• Self-tracking device? Got it. Tried it. Ditched it.
• Healthy privilege: when you just can’t imagine being sick
• First, the Quantified Self. Now, the Over-Quantified Self

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