Tag Archives: health/medicine

Overweight Americans Have the Lowest Risk of Premature Death

Last year the Journal of the American Medical Association released a study aiming to determine the relationship between body mass index and the risk of premature death. Body mass index, or BMI, is the ratio between your height and weight. According to the National Institutes of Health, you are “normal weight” if your ratio is between 18.5-24.9.  Everything over that is “overweight” or “obese” and everything under is “underweight.”

This study was a meta-analysis, which is an analysis of a collection of existing studies that systematically measures the sum of our knowledge.  In this case, the authors analyzed 97 studies that included a combined 2.88 million individuals and over 270,000 deaths.  They found that overweight individuals had a lower risk of premature death than so-called normal weight individuals and there was no relationship between being somewhat obese and the rate of early death. Only among people in the high range of obesity was there a correlation between their weight and a higher risk of premature death.

Here’s what it looked like.

This is two columns of studies plotted according to the hazard ratio they reported for people.  This comparison is between people who are “overweight” (BMI = 25-29.9) and people who are “normal weight” (BMI = 18.5-24.9).  Studies that fall below the line marked 1.0 found a lower rate of premature death and studies above the line found a higher rate.

25-29

Just by eyeballing it, you can confirm that there is not a strong correlation between weight and premature death, at least in this population. When the scientists ran statistical analyses, the math showed that there is a statistically significant relationship between being “overweight” and a lower risk of death.

Here’s the same data, but comparing the risk of premature death among people who are “normal weight” (BMI = 18.5-24.9) and people who are somewhat “obese” (BMI = 30-34.9).  Again, eyeballing the results suggest that there’s not much correlation and, in fact, statistical analysis found none.

30-34.9

Finally, here are the results comparing “normal weight” (BMI = 18.5-24.9) and people who are quite “obese” (BMI = 35 or higher). In this case, we do see a relationship between risk of premature death in body weight.

35

It’s almost funny that the National Institutes of Health use the word normal when talking about BMI. It’s certainly not the norm – the average BMI in the U.S. falls slightly into the “overweight” category (26.6 for adult men and 25.5 for adult women) — and it’s not related to health. It’s clearly simply normative. It’s related to a socially constructed physical ideal that has little relationship to what physicians and public health advocates are supposed to be concerned with.  Normal is judgmental, but if they changed the word to healthy, they have to entirely rejigger their prescriptions.

So, do we even have an obesity epidemic? Perhaps not if we use health as a marker instead of some arbitrary decision to hate fat.  Paul Campos, covering this story for the New York Times, points out:

If the government were to redefine normal weight as one that does not increase the risk of death, then about 130 million of the 165 million American adults currently categorized as overweight and obese would be re-categorized as normal weight instead.

That’s 79%.

It’s worth saying again: if we are measuring by the risk of premature death, then 79% of the people we currently shame for being overweight or obese would be recategorized as perfectly fine. Ideal, even. Pleased to be plump, let’s say, knowing that a body that is a happy balance of soft and strong is the kind of body that will carry them through a lifetime.

Lisa Wade is a professor of sociology at Occidental College and the co-author of Gender: Ideas, Interactions, Institutions. You can follow her on Twitter and Facebook.

A Simple Lesson on the Social Construction of Race

Flashback Friday.

The images below are all screen shots from the fantastic American Anthropological Association website on race.  They are designed to show how we take what is in reality a nuanced spectrum of skin color and turn it into racial categories.  In this first image, they show how we could, conceivably, separate human beings into short, medium, and tall based on height:

In this second image, they show how, by adding two additional figures, both taller than the tallest in the previous image, the way in which we designate people can easily change.

And this third image demonstrates how, when we actually consider all potential heights, where we draw the line between short and medium and medium and tall is arbitrary and, ultimately, not very useful.

Skin color is like height.  If we just look at three groups with very different skin colors, there appears to be a significant and categorical difference between those three groups of people.

But, if we consider a wide range of people, it becomes clear that skin color comes in a spectrum, not in categories (such as the five from which U.S. citizens are forced to choose on the census).

Much more on the social construction of race at our Pinterest board.

This post originally appeared in 2008.

Lisa Wade is a professor of sociology at Occidental College and the co-author of Gender: Ideas, Interactions, Institutions. You can follow her on Twitter and Facebook.

“Dude, You Need to Get into Nursing”: How Organizations Recruit Men to Nursing

While there has been significant attention to recruiting women into STEM fields, what about the converse – recruiting men to female-dominated fields?  My recent article in Gender & Society analyzes the recruitment strategies of key health care players, examining themes of masculinity in text, speech, and images.

Some recruitment items, like this early poster from the Virginia Partnership for Nursing, asked viewers “Are you man enough to be a nurse?” Aspects of hegemonic masculinity — characteristics associated with being the culturally defined “ideal man” — are common themes in the poster, including sports, military service, risk-taking, and an emotionally-reserved demeanor:

1 (3)

Since the “Are You Man Enough?” campaign in the early 2000’s, nurse leaders have tried to make recruitment messages less ostensibly gendered. In discussing the American Assembly for Men in Nursing’s (AAMN) new campaign, Don Anderson notes:

Nursing recruitment efforts needed to evolve from asking men if they were masculine enough to be a nurse to something less gender specific

Despite the effort to “de-genderify” nursing (Anderson’s word), masculinity is still front and center. Though the slogan is different, materials continue to emphasize culturally idealized forms of masculinity. One of the AAMN’s newest posters, “Adrenaline Rush,” avoids the “man enough” rhetoric, but maintains the theme of a stoic, emotionally-detached masculinity through visual cues.  Most of the nurse’s face is covered – limiting emotional expression—while risk-taking is emphasized.

1 (2) - Copy

But not all recruitment materials employ a macho form of masculinity. Johnson & Johnson’s 30-second clip “Name Game” portrays a caring and emotionally competent nurse:

Key health care players, including an international organization (Johnson & Johnson), urban hospital systems, nursing programs, and organizations like the American Assembly for Men in Nursing (AAMN) have devoted resources to recruiting men into nursing. Analyzing their recruitment strategies reveals as much about contemporary tensions within masculinity as it does about the profession’s push for gender diversity.

Check out more of the recruitment materials and a more in-depth analysis in the article, “Recruiting Men, Constructing Manhood: How Health Care Organizations Mobilize Masculinities as Nursing Recruitment Strategy.”  For a free copy, contact me at cottingham@unc.edu.

Marci Cottingham is a postdoctoral fellow in the department of Social Medicine at the University of North Carolina – Chapel Hill. She received her Ph.D. in sociology from the University of Akron. Her research spans issues of gender, emotion, health, and healthcare. For more on her work, visit her site.

Cross-posted at Pacific Standard.

Insurance Companies and the Cost of Health Care

When my primary care physician, a wonderful doctor, told me he was retiring, he said, “I just can’t practice medicine anymore the way I want to.” It wasn’t the government or malpractice lawyers. It was the insurance companies.

This was long before Obamacare.  It was back when President W was telling us that “America has the best health care system in the world”; back when “the best” meant spending twice as much as other developed countries and getting health outcomes that were no better and by some measures worse. (That’s still true).

Many critics then blamed the insurance companies, whose administrative costs were so much higher than those of public health care, including our own Medicare. Some of that money went to employees whose job it was to increase insurers’ profits by not paying claims.  Back then we learned the word “rescission”  – finding a pretext for cancelling the coverage of people whose medical bills were too high.   Insurance company executives, summoned to Congressional hearings, stood their ground and offered some misleading statistics

None of the Congressional representatives on the committee asked the execs how much they were getting paid. Maybe they should have.

Health care in the U.S. is a $2.7 trillion dollar business, and the New York Times has an article about who’s getting the big bucks.  Not the doctors, it turns out.  And certainly not the people who have the most contact with sick people – nurses, EMTs, and those further down the chain.  Here’s the chart from the article, with an inset showing those administrative costs.

1

As fine print at the top of the chart says, these are just salaries – walking-around money an exec gets for showing up.  The real money is in the options and incentives.

In a deal that is not unusual in the industry, Mark T. Bertolini, the chief executive of Aetna, earned a salary of about $977,000 in 2012 but a total compensation package of over $36 million, the bulk of it from stocks vested and options he exercised that year.

The anti-Obamacare rhetoric has railed against a “government takeover” of medicine. It is, of course, no such thing. Obama had to remove the “public option”; Republicans prevented the government from fielding a team and getting into the game. Instead, we have had an insurance company takeover of medicine. It’s not the government that’s coming between doctor and patient, it’s the insurance companies. Those dreaded “bureaucrats” aren’t working for the government of the people, by the people, and for the people. They’ve working for Aetna and Well-Point.

Even the doctors now sense that they too are merely working for The Man.

Doctors are beginning to push back: Last month, 75 doctors in northern Wisconsin [demanded] . . . health reforms . . . requiring that 95 percent of insurance premiums be used on medical care. The movement was ignited when a surgeon, Dr. Hans Rechsteiner, discovered that a brief outpatient appendectomy he had performed for a fee of $1,700 generated over $12,000 in hospital bills, including $6,500 for operating room and recovery room charges.

That $12,000 tab, for what it’s worth, is slightly under the U.S. average.

Cross-posted at Pacific Standard.

Jay Livingston is the chair of the Sociology Department at Montclair State University. You can follow him at Montclair SocioBlog or on Twitter.

#InstagrammingAfrica: The Narcissism of Global Voluntourism

An article in The Onion mocks voluntourism, joking that a 6-day visit to a rural African village can “completely change a woman’s facebook profile picture.”  The article quotes “22-year old Angela Fisher” who says:

I don’t think my profile photo will ever be the same, not after the experience of taking such incredible pictures with my arms around those small African children’s shoulders.

It goes on to say that Fisher “has been encouraging every one of her friends to visit Africa, promising that it would change their Facebook profile photos as well.”

I was once Angela Fisher. But I’m not any more.

***

I have participated in not one but three separate, and increasingly disillusioning, international health brigades, short-term visits to developing countries that involve bringing health care to struggling populations.

Such trips – critically called voluntourism — are a booming business, even though they do very little advertising and charge people thousands of dollars to participate.

How do they attract so many paying volunteers?

Photography is a big part of the answer.  Voluntourism organizations don’t have to advertise, because they can crowdsource.  Photography – particularly the habit of taking and posting selfies with local children – is a central component of the voluntourism experience. Hashtags like #InstagrammingAfrica are popular with students on international health brigades, as are #medicalbrigades, #globalhealth, and of course the nostalgic-for-the-good-days hashtag #takemeback.

It was the photographs posted by other students that inspired me to go on my first overseas medical mission. When classmates uploaded the experience of themselves wearing scrubs beside adorable children in developing countries, I believed I was missing out on a pivotal pre-med experience. I took over 200 photos on my first international volunteer mission. I modeled those I had seen on Facebook and even premeditated photo opportunities to acquire the “perfect” image that would receive the most “likes.”

Over time, I felt increasingly uncomfortable with the ethics of those photographs, and ultimately left my camera at home. Now, as an insider, I see three common types of photographs voluntourists share through social media: The Suffering Other, The Self-Directed Samaritan, and The Overseas Selfie.

The Suffering Other

In a photograph taken by a fellow voluntourist in Ghana (not shown), a child stands isolated with her bare feet digging in the dirt. Her hands pull up her shirt to expose an umbilical hernia, distended belly, and a pair of too-big underwear. Her face is uncertain and her scalp shows evidence of dermatological pathology or a nutritional deficiency—maybe both. Behind her, only weeds grow.

Anthropologists Arthur and Joan Kleinman note that images of distant, suffering women and children suggest there are communities incapable of or uninterested in caring for its own people. These photographs justify colonialist, paternalistic attitudes and policies, suggesting that the individual in the photograph…

…must be protected, as well as represented, by others. The image of the subaltern conjures up an almost neocolonial ideology of failure, inadequacy, passivity, fatalism, and inevitability. Something must be done, and it must be done soon, but from outside the local setting. The authorization of action through an appeal for foreign aid, even foreign intervention, begins with an evocation of indigenous absence, an erasure of local voices and acts.

The Self-directed Samaritan

Here we have a smiling young white girl with a French braid, medical scrubs, and a well-intentioned smile. This young lady is the centerpiece of the photo; she is its protagonist. Her scrubs suggest that she is doing important work among those who are so poor, so vulnerable, and so Other.

1 (2) - Copy

The girl is me. And the photograph was taken on my first trip to Ghana during a 10 day medical brigade. I’m beaming in the photograph, half towering and half hovering over these children. I do not know their names, they do not know my name, but I directed a friend to capture this moment with my own camera. Why?

This photograph is less about doing actual work and more about retrospectively appearing to have had a positive impact overseas. Photographs like these represent the overseas experience in accordance with what writer Teju Cole calls the “White Savior Industrial Complex.”

Moreover, in directing, capturing, and performing in photos such as these, voluntourists prevent themselves from actually engaging with the others in the photo. In On Photography, Susan Sontag reminds us:

Photography has become almost as widely practiced an amusement as sex and dancing – which means that…it is mainly a social rite, a defense against anxiety, and a tool of power.

On these trips, we hide behind the lens, consuming the world around us with our powerful gazes and the clicking of camera shutters. When I directed this photo opportunity and starred in it, I used my privilege to capture a photograph that made me feel as though I was engaging with the community. Only now do I realize that what I was actually doing was making myself the hero/star in a story about “suffering Africa.”

The Overseas Selfie


[Photo removed in response to a request from Global Brigades.]

In his New York Times Op-Ed, that modern champion of the selfie James Franco wrote:

Selfies are avatars: Mini-Me’s that we send out to give others a sense of who we are … In our age of social networking, the selfie is the new way to look someone right in the eye and say, “Hello, this is me.”

Although related to the Self-Directed Samaritan shot, there’s something extra-insidious about this type of super-close range photo. “Hello, this is me” takes on new meaning – there is only one subject in this photo, the white subject. Capturing this image and posting it on the internet is to understand the Other not as a separate person who exists in the context of their own family or community but rather, as a prop, an extra, someone only intelligible in relation to the Western volunteer.

***

Voluntourism is ultimately about the fulfillment of the volunteers themselves, not necessarily what they bring to the communities they visit. In fact, medical volunteerism often breaks down existing local health systems. In Ghana, I realized that that local people weren’t purchasing health insurance, since they knew there would be free foreign health care and medications available every few months. This left them vulnerable in the intervening times, not to mention when the organization would leave the community.

In the end, the Africa we voluntourists photograph isn’t a real place at all. It is an imaginary geography whose landscapes are forged by colonialism, as well as a good deal of narcissism. I hope my fellow students think critically about what they are doing and why before they sign up for a short-term global volunteer experience. And if they do go, it is my hope that they might think with some degree of narrative humility about how to de-center themselves from the Western savior narrative. Most importantly, I hope they leave their iphones at home.

Cross-posted at Pacific Standard and at Mondiaal Nieuws in Dutch.

Lauren Kascak is a graduate of the Masters Program in Narrative Medicine at Columbia University, where Sayantani DasGupta is a faculty member.  DasGupta is the editor of Stories of Illness and Healing and the author of The Demon Slayers and Other Stories and Her Own Medicine.

Majority of “Stay-at-Home Dads” Aren’t There to Care for Family

At Pew Social Trends, Gretchen Livingston has a new report on fathers staying at home with their kids. They define stay at home fathers as any father ages 18-69 living with his children who did not work for pay in the previous year (regardless of marital status or the employment status of others in the household). That produces this trend:

1 (2) - Copy

At least for the 1990s and early-2000s recessions, the figure very nicely shows spikes upward of stay-at-home dads during recessions, followed by declines that don’t wipe out the whole gain — we don’t know what will happen in the current decline as men’s employment rates rise.

In Pew’s numbers 21% of the stay at home fathers report their reason for being out of the labor force was caring for their home and family; 23% couldn’t find work, 35% couldn’t work because of health problems, and 22% were in school or retired.

It is reasonable to call a father staying at home with his kids a stay at home father, regardless of his reason. We never needed stay at home mothers to pass some motive-based criteria before we defined them as staying at home. And yet there is a tendency (not evidenced in this report) to read into this a bigger change in gender dynamics than there is. The Census Bureau has for years calculated a much more rigid definition that only applied to married parents of kids under 15: those out of the labor force all year, whose spouse was in the labor force all year, and who specified their reason as taking care of home and family. You can think of this as the hardcore stay at home parents, the ones who do it long term, and have a carework motivation for doing it. When you do it that way, stay at home mothers outnumber stay at home fathers 100-to-1.

I updated a figure from an earlier post for Bryce Covert at Think Progress, who wrote a nice piece with a lot of links on the gender division of labor. This shows the percentage of all married-couple families with kids under 15 who have one of the hardcore stay at home parents:

SHP-1. PARENTS AND CHILDREN IN STAY-AT-HOME PARENT FAMILY GROUPS

That is a real upward trend for stay at home fathers, but that pattern remains very rare.

See the Census spreadsheet for yourself here.  Cross-posted at Pacific Standard.

Philip N. Cohen is a professor of sociology at the University of Maryland, College Park, and writes the blog Family Inequality. You can follow him on Twitter or Facebook.

Saturday Stat: Smoking Keeps Its Hold on the Poor

At the New York Times, Sabrina Tavernise and Robert Gebeloff discuss the tenaciousness of tobacco in low-income areas.  Smoking rates are declining, but much more slowly in some counties than others.  Local residents suggest that smoking is the least of their worries:

“Just sit and watch the parking lot for a day,” Mrs. Bowling said. “If smoking is the worst thing that’s happening, praise the Lord.”

Smoking rates, 1996:1a

Smoking rates, 2013:1

Lisa Wade is a professor of sociology at Occidental College and the co-author of Gender: Ideas, Interactions, Institutions. You can follow her on Twitter and Facebook.

Liberation and the Sanitary Napkin: One Man’s Journey

1A touching BBC story describes a new documentary, Menstrual Man, that chronicles the trials and tribulations of a humble man in India who sought to offer his wife a sanitary napkin.  After marrying, he discovered that his wife kept from him a secret: the rags she used and re-used to collect menstrual blood.

Only 12% of women in India used pads; they were simply too expensive for most to buy. Nearly three-quarters of all reproductive diseases were caused by poor menstrual hygiene.  A combination of high cost and embarrassment kept women from developing a safe method of managing menstruation.  Nearly a quarter of girls dropped out of school when they started their periods.

Arunachalam Muruganantham was driven to offer women a solution.  He was going to design a machine that would produce low cost menstrual pads.  He asked his wife to serve as an experimental subject, but one woman menstruating once a month wasn’t enough of a sample.  He asked medical students to participate, but the responses were slim.  He fashioned a fake uterus and collected goat blood, trying to experiment himself.

“Everyone thought he’d gone mad.”

His wife left, his mother left, his friends avoided him; it was suspected he was some kind of diseased or possessed sexual pervert, collecting menstrual blood to do god-knows-what.

Figuring out how to make highly absorptive cotton was a significant challenge.  He finally tricked a  multinational company into sending him samples of the raw material: cellulose from the bark of the tree.  Now he just had to design a cheap machine that would turn the raw material into pads.

Four-and-a-half years later, he was producing affordable menstrual pads for Indian women on a cheaply made machine.  He won an award.  His wife came back.

He built 250 machines, which he then took to the poorest areas of Northern India.  He gave them to women, at no profit, who could then produce the pads and sell them to local women.  Each woman now runs her own business.  “Over time the machines spread to 1,300 villages in 23 states.”

8

He is now looking to expand to 106 more countries.

About his success, Muruganantham said:

Anyone with an MBA would immediately accumulate the maximum money. But I did not want to. Why? Because from childhood I know no human being died because of poverty — everything happens because of ignorance…. I have accumulated no money but I accumulate a lot of happiness.

Watch the trailer here.

Cross-posted at Pacific Standard.

Lisa Wade is a professor of sociology at Occidental College and the co-author of Gender: Ideas, Interactions, Institutions. You can follow her on Twitter and Facebook.