Tag: health

A Queer Health Reading List

The following is a list of books and articles related to queer health that might be useful for some individuals interested in the topic. The list is by no means exhaustive.

HIV:

  1. Race, K. (2016). Reluctant Objects Sexual Pleasure as a Problem for HIV Biomedical Prevention. GLQ: A Journal of Lesbian and Gay Studies22(1), 1-31.
  2. Gonzalez, O. R. (2010). Tracking the bugchaser: Giving the gift of HIV/AIDS. Cultural Critique75(1), 82-113.

Research & Infrastructures:

  1. Nguyen, V. K. (2009). Government-by-exception: Enrolment and experimentality in mass HIV treatment programmes in Africa. Social Theory & Health7(3), 196-217.
  2. Murphy, M. (2017). The economization of life. Duke University Press.

Regarding MSM:

  1. Boellstorff, T. (2011). But do not identify as gay: A proleptic genealogy of the MSM category. Cultural Anthropology26(2), 287-312.
  2. Young, R. M., & Meyer, I. H. (2005). The trouble with “MSM” and “WSW”: Erasure of the sexual-minority person in public health discourse. American journal of public health95(7), 1144-1149.

Medical interventions:

  1. Epstein, Steven. 2010. “The great undiscussable: Anal cancer, HPV, and gay men’s health.” In Three shots at prevention: The HPV vaccine and the politics of medicine’s simple solutions, edited by Keith Wailoo, Julie Livingston, Steven Epstein, and Robert Aronowitz. Baltimore: Johns Hopkins University Press, pp. 61 -90.
  2. Blackwell, Courtney, Jeremy Birnholtz, and Charles Abbott. 2014. Seeing and being seen: Co-situation and impression formation using Grindr, a location-aware gay dating app. New Media & Society: 1461444814521595.

Precarity:

  1. Butler, J. (2006). Precarious life: The powers of mourning and violence. Verso.

PrEP:

  1. Fiereck, K. J. (2015). Cultural Conundrums: The Ethics of Epidemiology and the Problems of Population in Implementing Pre-Exposure Prophylaxis. Developing World Bioethics15(1), 27–39. http://doi.org/10.1111/dewb.12034
  2. Singh, J. A., & Mills, E. J. (2005). The Abandoned Trials of Pre-Exposure Prophylaxis for HIV: What Went Wrong? PLoS Medicine2(9), e234. http://doi.org/10.1371/journal.pmed.0020234
  3. Calabrese, S. K., Earnshaw, V. A., Underhill, K., Hansen, N. B., & Dovidio, J. F. (2014). The Impact of Patient Race on Clinical Decisions Related to Prescribing HIV Pre-Exposure Prophylaxis (PrEP): Assumptions About Sexual Risk Compensation and Implications for Access. AIDS Behav, 18(2), 226-240. doi:10.1007/s10461-013-0675-x
  4. Calabrese, S. K., Magnus, M., Mayer, K. H., Krakower, D. S., Eldahan, A. I., Hawkins, L. A. G., . . . Dovidio, J. F. (2017). “Support Your Client at the Space That They’re in”: HIV Pre-Exposure Prophylaxis (PrEP) Prescribers’ Perspectives on PrEP-Related Risk Compensation. AIDS Patient Care STDS, 31(4), 196-204. doi:10.1089/apc.2017.0002
  5. Calabrese, S. K., & Underhill, K. (2015). How Stigma Surrounding the Use of HIV Preexposure Prophylaxis Undermines Prevention and Pleasure: A Call to Destigmatize “Truvada Whores”. Am J Public Health, 105(10), 1960-1964. doi:10.2105/ajph.2015.302816
  6. Dumit, J. (2012). Drugs for life: how pharmaceutical companies define our health. Duke University Press.

Trans health:

  1. Plemons, E. D. (2014). It is as it does: Genital form and function in sex reassignment surgery. Journal of Medical Humanities35(1), 37-55.
  2. Preciado, Paul Beatriz. 2013. Testo junkie: Sex, drugs, and biopolitics in the pharmacopornographic era. New York: The Feminist Press at CUNY. (End of “The Micropolitics of Gender,” pp. 365 – 398).
  3. Spade, Dean. 2006. “Mutilating Gender.” In The Transgender Studies Reader, edited by Susan Stryker and Stephen Wittle. New York: Routledge, 315-32.
  4. Currah, Paisley. 2008. Expecting bodies: the pregnant man and transgender exclusion from the Employment Non-Discrimination Act. Women’s Studies Quarterly, 36(3&4).
  5. Crawford, Lucas Cassidy. 2008. Transgender without organs? Mobilizing a geo-affective theory of gender modification. WSQ: Women’s Studies Quarterly, 36(3&4): 127-43.
  6. Butler, J. (2001). Doing justice to someone: Sex reassignment and allegories of transsexuality. GLQ: A Journal of Lesbian and Gay Studies7(4), 621-636.
  7. Karaian, Lara. 2013. Pregnant men: Repronormativity, critical trans theory and the re (conceive)ing of sex and pregnancy in law. Social & Legal Studies: 0964663912474862.

Critical Disability Studies:

  1. McRuer, R., & Wilkerson, A. L. (Eds.). (2003). Desiring disability: Queer theory meets disability studies. Duke University Press.
  2. Cheslack-Postava, Keely, and Rebecca M. Jordan-Young. 2012. Autism spectrum disorders: toward a gendered embodiment model. Social science & medicine 74(11): 1667-1674.
  3. Jack, Jordynn. 2011. The Extreme Male Brain? Incrementum and the Rhetorical Gendering of Autism. Disability Studies Quarterly 31(3). http://dsq-sds.org/article/view/1672/1599
  4. Garland-Thomson, R. (2005). Feminist disability studies. Signs: Journal of Women in Culture and Society30(2), 1557-1587.
  5. Shakespeare, T. (2006). The social model of disability. The disability studies reader2, 197-204.
  6. Breckenridge, C. A., & Vogler, C. A. (2001). The critical limits of embodiment: Disability’s criticism. Public Culture13(3), 349-357.

Masculinity & health:

  1. MacLeish, Kenneth T. 2012. Armor and anesthesia: exposure, feeling, and the soldier’s body. Medical anthropology quarterly 26(1): 49-68.
  2. Oudshoorn, Nelly. 2000. “Imagined men: Representations of masculinities in discourses on male contraceptive technology.” In Bodies of technology: Women’s involvement with reproductive medicine, edited by Ann Rudinow Saetnan, Nelly Oudshoorn, and Marta Kirejczyk. Columbus: Ohio State University Press, 123-45.
  3. Serlin, David. 2006. “Disability, masculinity, and the prosthetics of war, 1945 to 2005.” In The prosthetic impulse: From a posthuman present to a biocultural future, edited by Marquard Smith and Joanne Mora. Cambridge: The MIT Press, 155-86.
  4. Shakespeare, T. (1999). The sexual politics of disabled masculinity. Sexuality and disability17(1), 53-64.

Gender theory, race, and reproductive health:

  1. Waggoner, Miranda R. 2015. Cultivating the maternal future: Public health and the prepregnant self.” Signs 40(4): 939-962.
  2. Franklin, Sarah. 2013. Biological Relatives: IVF, Stem Cells, and the Future of Kinship. Durham: Duke University Press. (“Miracle Babies” and “Reproductive Technologies,” pp. 31 – 67 and 150 – 84).
  3. Murphy, M. (2012). Seizing the means of reproduction: Entanglements of feminism, health, and technoscience. Duke University Press.
  4. Roberts, Dorothy E. Killing the black body: Race, reproduction, and the meaning of liberty. Vintage Books, 1999.
  5. Bridges, Khiara. 2011. Reproducing race: An ethnography of pregnancy as a site of racialization. Berkeley: The University of California Press. (“The Production of Unruly Bodies” and “The ‘primitive pelvis,’ racial folklore, and atavism in contemporary forms of medical disenfranchisement,” pp. 74 – 100 and 103-43).

Just Trust Me: Part III

“You can’t health care-access your way out of this problem. There’s something inherently wrong with the system that’s not valuing the lives of black women equally to white women.” -Raegan McDonald-Mosley

Last week, my post scratched the surface of the history of oppression disguised as medical treatment. Today, I want to talk about how this mistreatment, and the historical trauma that ensues, exhibits itself in patient-practitioner relationships.

Many of us have experienced the helplessness of not knowing how much a medical procedure will cost until it’s over. It’s a terrible feeling: it feels like everyone is communicating without you; ‘above’ you. For many non-white and immigrant patients, this feeling lasts for the entire appointment: from scheduling to decision-making to discharge.

Traditionally, there are four types of patient-physician relationships, each with varying levels of patient power and involvement in decision-making. There is also a distinction between patients preferring an active or passive role in decision-making. Acknowledging the relationship between trust and decision-making preference, these researchers suggest that, for black patients, race may impact both: such that a patient who trusts her individual physician “may have residual mistrust of the health care system that limits [her] ability to relinquish decision-making control.” Cultural differences, as well as fear that the doctor does not have one’s best interests at heart, can influence the relationship between patients and their physicians in Hispanic populations as well.

Racial bias, conscious or otherwise, has been found to influence treatment decisions. Black patients are systematically under-treated for pain due to false beliefs of biological differences between blacks and whites: such as black people’s skin being thicker, or blood coagulating more quickly. This is exacerbated by existing power structures between whites and non-whites, as well as between doctors and patients. In over 200 personal stories from black women of their childbirth experiences, NPR found a constant theme of being devalued and dismissed by medical providers.

39th Minority Health Conference – 23 Feb

The 39th Minority Health Conference will be held at the Friday Center in Chapel Hill next week (Friday, February 23, 2018). According to the conference website, “This year’s theme, Reclaiming the Narrative, is based in the recognition that the world is organized by the stories we tell. Stories have the power to influence the way we view ourselves and others and have the power to shape our actions. Given this sometimes unacknowledged influence, we must ask who are the storytellers, and who benefits from these narratives. The answers to these questions can offer an understanding of how we as public health professionals can progress and push public health agendas forward in a meaningful way. This year’s theme challenges us to end perpetuation of damaging rhetoric against marginalized communities. It highlights how resilient communities have fought to speak truth to power and refused to have their voices silenced and how public health practitioners can join such efforts. By reclaiming the narrative, communities and public health practitioners can reconcile the past and present and take agency in the future to promote health for all people.”

The event will feature keynote lectures from Monica Raye Simpson, Executive Director of SisterSong Women of Color Reproductive Justice Collective, and Vann R. Newkirk II, MSPH, a staff writer at The Atlantic.

Information about registering for the event in person is available here, but there is also an option to watch a live webcast of the event.

Fore more information about the event, visit their website.

Just Trust Me (Part II)

“Dr. X, or whoever she was, she must have been experimenting on me…she left a big scar on my neck … I don’t want that lady to ever touch me again. I don’t like her and I don’t trust her.

Last week, I introduced the issue of trust in the medical setting and how it may vary across scenarios and patient characteristics. But to truly understand why some patients don’t trust the healthcare system, we absolutely cannot ignore the history of their oppression by its hands.

The most well-known medical violation under the guise of research in the U.S. is the Tuskegee “study,” a 40-year-long theft of human rights that, brilliantly and viciously, utilized both government and community-level networks to recruit black men in Macon County, AL. Most had syphilis. The participants, many of whom had never seen a physician, were not made aware of the dangers, causes, and treatment options for their disease. They were not offered informed consent, nor the option to leave the study, and many died.

But Tuskegee is only the tip of the iceberg. Henrietta Lacks’ cells were cultured without her consent during her battle with cervical cancer in 1951 and are still widely used today. Gynecologist J. Marion Sims ran “practice runs” of his procedures on enslaved women. A common belief in the 20th century was that those who could not pay for medical care, many of them poor minorities and immigrants, “owed their bodies” to science. Harry Laughlin performed forced sterilizations on “socially inadequate” Puerto Rican women until the 1970s. The list could go on.

Today, this unfathomable history is manifested in mistrust in healthcare and scientific research. Evidence suggests that black patients are less likely to trust physicians, are more worried about medical privacy and experimentation than are white patients, and are less likely to participate in clinical trials. Some patients are not fully aware of the history to their mistrust – it is a cultural feeling that has been passed down through generations. This is called historical trauma. In addition, racism is still rampant in the healthcare system, both intentional and subconscious, which I will delve into in Part III. These features make this issue even more difficult to address.

Just Trust Me (Part I)

Well I’m not trained medically, so I’m taking a lot of what they say on faith.”

This was the response of a 47-year-old man, whose interview was part of a study on patients’ trust in hospitals.

There is no universal definition of trust that will apply to every scenario. Physician training, patient’s racial and cultural background, personalities, and expectations all come into play as their relationship evolves. One recurring theme in the study cited above was “sensing that you are in good hands.” Some mentioned that their trust developed from knowing the sheer amount of training required to be a medical provider. Other patients pointed out that being desperate, or having few other options, accelerates the formation of trust.

The Trust Project at Northwestern emphasizes the role that vulnerability plays in forming trust. Generally, once we come to trust someone, we open up to them; we expose vulnerability. In the healthcare system, it works backwards: being sick, worried, or simply confused by jargon (this is called information asymmetry), the patient often begins her relationship with her provider in a state of vulnerability.

Trust can also vary in different facets of the healthcare system. When we say that a patient has mistrust in the healthcare system, are we referring to his relationship with his provider, institutions like his hospital and insurance company, or the notion of Western medicine to begin with? One study suggests that repeated interactions are a key to building trust, and that patients do not see their providers as interchangeable. These findings suggest that we should enhance continuity, not just access.

Patients with low health literacy may reveal trust in a number of ways. One extreme is blind faith in the expertise of the provider, and another is mistrust and suspicion. One study found that blind trust in physicians was stronger in patients who were older, perceived their prognosis to be uncertain, or sometimes of low SES. Trust in the healthcare system tends to be lower among racial minorities, due to a history of unethical treatment. Could race moderate the relationship between SES and trust? Can these two extremes be reconciled, or even coexist in a single patient?

Coffee… Good or Bad for Health?

I recently read an article that was published a few days ago in The BMJ regarding coffee consumption and health. I was curious to learn what the findings were, considering that I have heard mixed reviews over the years about the health benefits of coffee.

After conducting an umbrella review of over 200 meta-analyses regarding coffee consumption and health outcomes, Poole et al. (2017) found that drinking three to four cups of coffee a day was associated with lower risk of a variety of health outcomes. According to the article, researchers found that drinking three cups of coffee a day lowered risk for death and cardiovascular disease, compared to non-coffee drinkers. Coffee consumption was also found to lower risk of various cancers, as well as neurological, liver, and metabolic diseases. In women who are pregnant, however, high levels of coffee consumption were associated with higher risk of low birth weight, pregnancy loss, as well as preterm births. Additionally, coffee consumption was found to be associated with an increased risk of fracture in women.

A note that this study mentions is that current evidence on the topic of coffee consumption and health is mainly observational and of lower quality in nature. That said, researchers recommend that randomized controlled trials be used in future research to better understand causal associations between coffee consumption and various health outcomes.

Eliseo Guallar, professor of epidemiology and medicine at the Johns Hopkins Bloomberg School of Public Health published an editorial in response to Poole et al. (2017). Dr. Guallar comments that while coffee drinking is generally safe, people should not start drinking coffee for health reasons. Dr. Guallar continues in stating that “some population subgroups may be at higher risk of adverse effects” of coffee consumption. Additionally, Dr. Guallar expressed the importance of the amount of coffee consumption, asserting that there remains uncertainty regarding the effects of higher levels of coffee consumption. However, Dr. Guallar expressed that moderate coffee consumption is safe and can be a part of a healthy diet.

References:

Poole, R., Kennedy, O.J., Roderick, P., Fallowfield, J.A., Hayes, P.C., & Parkes, J. (2017). Coffee consumption and health: umbrella review of meta-analyses of multiple health outcomes. BMJ 2017; 359:j5024. doi: https://doi.org/10.1136/bmj.j5356 

Guallar, E. (2017). Coffee gets a clean bill of health. BMJ 2017; 359:j5356. doi: https://doi.org/10.1136/bmj.j5356 

Are You Healthy? (Part 2)

Previously, I discussed changes to our model of health due to randomized control trials and the pharmaceutical industry, as discussed in Joseph Dumit’s Drugs for Life. Here are the three primary models of health as discussed by Donald A. Barr in his book Health Disparities in the United States: Social Class, Race, Ethnicity, & Health. 

The first model is the medical model or physical health model that focuses on the absence of symptoms or other signs of disease or illness. However, Barr mentions several issues with this model of health, noting “that this approach to defining health tells us what the concept of health is not. . .It does not tell us what health is” (2014, pp. 15). He expands on this later:

“What are we to make of a condition that has no abnormal symptoms? An important example of this is high blood pressure, also referred to as hypertension; persons with hypertension develop symptoms only after a number of years. Should we consider a person with somewhat elevated blood pressure to be unhealthy based on our knowledge that his blood pressure will eventually lead to further problems? What might be the consequences of labeling such a person as ‘unhealthy,’ even if he feels fine?” (Barr, 2014, p. 16)

These are the questions that Joe Dumit attempts to answer, looking beyond hypertension to guidelines about pre-hypertension and the prescriptions of statins with no understanding of when patients can stop taking them.

The second model is the sociocultural model or the model of health as functioning at a normal level. Barr looks at it in contrast to the medical model, which looks at absence, because the sociocultural model looks at the presence of an ability to function at a level that has been deemed normal (2014, p. 17). The ability to functional normally is defined in regards to one’s ability to completed five “activities of daily living (ADLs),” which are roughly, (1) eating, (2) bathing, (3) dressing, (4) using the bathroom, and (5) moving on one’s own (2014, p. 17). Of course, the entire premise of “normal functioning” is subjectively predicated on societal ideas of self-sufficiency that might vary from culture to culture or community to community.

The third model is the psychological model or the model of health as a feeling of well-being. In this model, individuals are able to assess themselves and their own health with the help of several developed measures (Barr, 2014, p. 18). However, Barr notes that these tests are often “time-specific” (Barr, 2014, p. 18). I would argue that health is always time specific and temporal. I may be healthy today, but I can quickly develop a health problem or injure myself, perhaps even resulting in a temporary or life-long disability, reaffirming the temporality of both health and disability.

According to Barr, these models can be combined to create a multidimensional model of health that presents a better picture of the health of an individual.

Improving the Nutrition Profile of Food Donations

Hunger impacts one in seven people in the United States. Children, older adults, and those who are homeless are particularly susceptible to the impact of stress and inadequate nutrition for healthy growth and development and/or disease management that accompanies hunger.

The Feeding America Network includes 200 food banks and 60,000 food pantries and meal programs that aim to get nourishing food to people in need. In fact, they serve more than 46 million people each year. To serve all of these individuals, Feeding America relies on donations from individuals and corporations. The great news is that donating food is easy. In fact, more people donate to food drives each year than watch the Super Bowl.

The less than great news is that many of the items donated are high in sodium and/or sugar, which could be particularly harmful for growing children and adults managing chronic diseases like diabetes or heart disease. Fortunately, this trend is starting to change. NPR’s WNYC provides a positive example of how Washington D.C.’s Capital Area Food Bank has significantly reduced (by 84%) the amount of junk food it supplies by being more clear in their requests for the types of foods they want to be able to offer.

The #GiveHealthy Movement is also changing how and what people donate. The #GiveHealthy movement uses technology to allow hunger relief organizations to specify the types of healthy food items they desire. For example, this may include fresh fruit, vegetables, or other healthy food items. Food drive organizers can then connect with and share specific hunger organizations’ wish lists. Donors can purchase identified items and everything will be delivered, at no cost, to the organization.

What we eat matters. What we donate matters. And there is finally support to change the nutrition profile of what we offer to support those in need. I challenge you to #GiveHealthy and to support others to as well.

 

Sources:             

Feeding America. http://www.feedingamerica.org/research/hunger-in-america/facts-and-faces/

#GiveHealthy. Hunger is a Health Issue. http://givehealthy.org/index.php/givehealthy-food-drive-2017/hunger-is-a-health-issue/

WNYC. NPR. One of America’s Biggest Food Banks Just Cut Junk Food By 84 Percent in a Year. http://www.wnyc.org/story/one-of-americas-biggest-food-banks-just-cut-junk-food-by-84-percent-in-a-year/

Are You Healthy?

To understand whether or not your healthy, you have to first understand what it means to be healthy. It seems straightforward, but in the modern age, this is a complex question.

We might at first be inclined to think that being healthy means that you don’t have any illness or injury. But is this always true? What if you have an illness that is managed by medication? What if a person has a disability but the disability doesn’t disrupt their daily life? What if you’ve been diagnosed with pre-hypertension but have no symptoms?

Joseph Dumit, Director of Science and Technology Studies and Professor of Anthropology at the University of California, Davis, discusses various changes to our view of health and illness since the rise of the randomized control trial in his book Drugs for Life: How Pharmaceutical Companies Define Our Health (Duke University Press, 2012). He argues “that being at risk for illness is often treated as if one had a disease requiring lifelong treatments, drugs for life” (6).

Dumit discusses a few prediseases in depth, looking at pre-hypertensive, pre-diabetes, and borderline high cholesterol. “Literally, a disease-sounding syndrome is produced by correlating risk factors and naming it in such a way that it becomes common sense to think about treating ‘it’ as a disease in and of itself” (165). Hence, health becomes a matter of risk where we are all bodies constantly at risk of disease. If you have pre-diabetes, are you healthy? How do we understand our health in a risk economy of health?

This intersects interestingly with Donald A. Barr’s claim, in his book Health Disparities in the United States: Social Class, Race, Ethnicity, & Health, that despite investing so much of our economy in health, US health indexes rank rather low; “[p]erhaps, our basic assumption–that more health care will lead, necessarily, to better health–is flawed.”