public health

Disease Exposes Discrimination

Allison Nobles on March 10, 2020
Flyers at Hartsfield-Jackson Atlanta International Airport wearing facemasks. Photo by Chad Davis, Flickr CC

During times of crisis, existing prejudices often become heightened. Fears about the current coronavirus, or COVID-19, have revealed rampant racism and xenophobia against Asians. Anti-Asian discrimination ranges from avoiding Chinese businesses to direct bullying and assaults of people perceived to be Asian. This discriminatory behavior is nothing new. The United States has a long history of blaming marginalized groups when it comes to infectious disease, from Irish immigrants blamed for carrying typhus to “promiscuous women” for spreading sexually transmitted infections. 

Historically, the Chinese faced blame time and again. In the 19th century, public health officials depicted Chinese immigrants as “filthy,” carriers of disease. These views influenced Anti-Chinese policies and practices, including humiliating medical examinations at Angel Island — the entry port for many Chinese immigrants coming to America — and the violent quarantine and disinfection of San Francisco’s Chinatown in the early 20th century when a case of the Bubonic plague was confirmed there. 
An advertisement for "Rough on Rats" rat poison. On the flyer there is an image of a stereotypically drawn "china man" eating a rat.
Late 19th century racist advertisement for rat poison

Discrimination against the Chinese is one example among many. Such discrimination had nothing to do with their actual hygiene and health, and everything to do with their social position relative to other racial groups. It’s easy to look back on the xenophobic U.S. policies and behavior in earlier times. Let’s not fall into the same patterns today.

For more on xenophobia and coronavirus, listen to Erika Lee on a recent episode of NPR’s podcast, Code Switch.

Contagion and Panic in the Media

Allison J. Steinke on February 27, 2020
Photo by photologic, Flickr CC

This post was created in collaboration with the Minnesota Journalism Center. 

Coronavirus — also known as COVID-19 — has taken the global media world by storm. Over 2,000 have died and more than 79,000 are infected globally. The World Health Organization has been criticized for not declaring a public health emergency earlier than they did, but doctors including Dr. Emily Landon at the University of Chicago are saying that “people shouldn’t panic.” 

In cases of public health epidemics, whether people panic depends in part on how journalists cover the issue and which experts they cite. Journalists tend to quote official sources like government officials and public health officials to inform the public about outbreaks of illness including influenza, swine flu, Zika, Ebola, and more recently, coronavirus. Being quoted in news articles gives public health officials the opportunity to share their expertise on said topics to help inform readers about how to protect themselves and avoid infection. From a sociological perspective, focusing on the spread of information about pandemics and infectious diseases provides opportunities for scholars to comment on evolving social structures and processes in a way that will influence the biomedical sciences’ public and policy agenda.

As epidemiologist Adam Kucharski wrote in The Guardian, “stories sparking fear seem to have overtaken the outbreak in real life” and misinformation (a topic The Society Pages has written about here) seems to be more contagious than the virus itself. The “need for speed” in publishing journalistic updates about the virus as well as scholarly work has resulted in several retractions, including the retraction of a preprint of a scholarly paper after its analysis was found to be faulty. 

Further, the spread of information — and misinformation, including conspiracy theories — about health crises often occurs on social media platforms including Twitter and Instagram. Scholars found that false information spread especially quickly during Ebola outbreaks in West Africa and in the Zika outbreak in Brazil, which led to the formation of counterproductive policies passed by public health officials who struggled to combat false claims. In recent years, Instagram was found to be the most effective platform for health organizations including Centers for Disease Control, the World Health Organization, and Doctors without Borders to engage followers during global health crises.
Scholars, including Dr. Anita Varma, recently published five tips for journalists on covering coronavirus. These include paying attention to the frames used and including quotes from official sources like government officials as well as the people directly affected by the health concern. Dr. Karin Wahl-Jorgensen published an article on the role that fear plays in narratives about public health crises. The bottom line is: The way stories are told matters and affects the management of pandemics and policy responses.

Revictimization after Sexual Assault

Amber Joy Powell on December 3, 2019

Infographic by snipergirl via Flickr CC.
Infographic by snipergirl via Flickr CC.

Originally posted March 12, 2016.

Last week, a civil judge ruled that singer Kesha must fulfill her music contract despite allegations that her producer sexually assaulted her. While Kesha received an outpouring of support from fellow artists and fans creating the hashtag #FreeKesha, entertainment show host Wendy Williams critiqued the singer for not disclosing the “alleged” rape earlier. The media frequently questions the credibility of women like Kesha and the accusers of famous men like Mike Tyson and Bill Cosby because their stories deviate from what are perceived as “real rape” experiences (those committed by strangers and with a deadly weapon). Social science research helps us sort out how and why institutions risk “revictimizing” survivors as they navigate the criminal justice process.

The majority of victims do not report assaults to police, often because they don’t think they’ll be believed. Unsurprisingly, the cases most reported to police are those perpetrated by strangers and/or involving a weapon—what victims (and police) believe best constitute criminal, “authentic rapes.” Further, police treat victims perceived as “professional” as more credible than prostitutes.
Victims can also be revictimized if they opt to undergo a physical examination. Forensic nurse examiners often prioritize the preservation of forensic evidence while unintentionally neglecting the emotional care of the victim in service to the criminal investigation.
The court process is distinctly difficult for victims, too. They must attempt to satisfy the expectations of prosecutors and withstand cross-examination by defense attorneys. Prosecutors may prepare victims for testimony by encouraging them to use certain vocabulary, dress in a way that suggests they did not “ask for it,” and show emotion to convey the specific feelings expected of a rape survivor. Despite rape shield laws that prohibit attorneys from disclosing a victim’s sexual history, defense attorneys may still question the victim’s morality, interrupt victims, ask confusing questions, and limit their responses in an effort to transform sexual violence into mutual consent in the eyes of a judge and jury.

The Politics of Pink

Sarah Catherine Billups on October 2, 2019

Ben Ostrowsky//Flickr CC
Ben Ostrowsky//Flickr CC

Originally posted October 13, 2015.

October brings cozy sweaters, Pumpkin Spice Lattes, and lots of pink for Breast Cancer Awareness Month. It’s a worthy campaign: approximately 1 in 8 women will receive a breast cancer diagnosis in her lifetime. But how has breast cancer gained such visibility when others—even other forms of cancer—plague the population at even higher numbers?

Breast cancer awareness campaigns have branded breast cancer through pink ribbons and other merchandise, making the disease not only highly visible, but also a commodity. The signature pink color connects breast cancer to traditional ideas of femininity, beauty, and morality, and allows family and friends to show support.  Color aside, merchandise and freebies like cosmetics and small home appliances reinforce breast cancer’s symbolic ties to beautiful, domestic, heterosexual women as the primary sufferers. This is breast cancer’s “disease regime,” a system of institutional practices and styles of speech that shapes how patients experience it (Klawiter 2004, 851).  
Large-scale organizations like the Susan G. Komen foundation raise awareness, but often leave out marginalized identities that don’t fit a traditional feminine image. Groups like the Women & Cancer Walk provide spaces for those who don’t fit the mainstream definition of a “breast cancer patient.”
The specific image of the breast cancer patient affects who participates in activism and how they view their work for the cause. Many women volunteer for organizations like Komen as a way to connect with other survivors. Often this means that much of their work goes unnoticed, in part because they downplay their activism as trivial volunteering or “just being fair,” further reinforcing the gendered construction of the disease.

For more on breast cancer awareness, check out posts at Feminist Reflections, Sociological Images, and two of our recent Discoveries.

Housing Security and Health

Allison Nobles on May 6, 2019
Photo of a sign that read "Apartment for Rent" on a glass door. You can see stairs through the door and there is a phone number written below the sign.
Photo by Simon Law, Flickr CC

Sociologist Matthew Desmond’s popular book, Evicted brought to light just how precarious housing can be for someone living in poverty in the United States, but there’s far more to the challenges than money alone. One important and under-appreciated aspect of housing insecurity involves health, and sociologists have shown that the relationships between health and housing are more complicated than you might imagine.

On the one hand, a health crisis can propel a whole family into housing hardship. For instance, one study found that when one member of a household experiences a drastic change in health, the household is much more likely to miss a utility payment. And once they miss that payment, they are less likely to be able to recover the next year, pushing the household further into economic disadvantage.

But the relationship also goes the other way around: Health often suffers following housing precarity. People who have experienced some kind of housing insecurity — getting behind on rent payments, moving for cost of housing, experiencing homelessness — were more likely to report anxiety and depression than those who had not experienced housing insecurity. One particular study showed that evicted mothers were more likely to report depression and poor health for themselves and their children when compared to mothers who were not evicted.

More positively, getting access to housing while already experiencing housing insecurity can have health benefits. For instance, children who lived in public housing had better mental health outcomes than those who were still on the waiting list.

Policy makers and community organizations can utilize social science research on health and housing to improve housing security in the future.

Youth and the Development of “Rave” Culture

Lucas Lynch on August 27, 2018

Photo by Indi Samarajiva, Flickr CC

The word “rave”evokes different responses depending upon one’s generation. For many it symbolizes fun all-night dance parties with friends. While the public may be quick to associate rave culture with youth delinquency, social science explores the broader range of social, spiritual, and cultural elements of raves and electronic dance music (EDM). Raves began in 1980s Britain and quickly spread to the United States. Youth created these anti-establishment and and underground events to celebrate peace, love, unity, and respect — otherwise known as “PLUR.” However, heavy drug consumption resulted in media scrutiny and government crackdowns of these underground locations in the 1990s and early 2000s, pushing raves into more formal spaces like clubs.
Social scientists have explored raves and the electronic dance music scene from two different perspectives. The cultural perspective emphasizes a sense of community and empathy for its members as the roots of the scene. From this perspective, drug use enhances these experiences. The rave has been portrayed as a youth cultural phenomenon, characterized by belonging, self-expression, acceptance, camaraderie, escape, and solidarity, and where drugs — particularly ecstasy or “E” — are often central to the scene or tools in rebellion. From the public health perspective, excessive drug use is the defining feature of rave culture. Here raves and the electronic dance music scene are perceived as dangerous drug subcultures that increased drug-related health problems in the United States. However, some debate these claims and argue that the effects of ecstasy itself are linked to feelings of closeness and solidarity at raves.
While typically not linked to public perceptions of rave culture, some scholars connect raves and electronic dance music culture (EDMC) to religion and spirituality. In particular, scholars point to the non-Christian religiosity of rave’s dance “ritual,” likening it to the non-denominational “new church.” Further, EDM inherits its ritualistic, chanting, and percussive elements from African, Asian, and Indigenous cultures in North America, and African American, Latino, and gay communities in Chicago and New York City in the 1970s and 1980s. Thus, youth promoted raves as place of growth, sacredness, and unity, where youth were not divided through class, ethnicity, and gender.

Though the shape and form of raves and rave culture continues to change, both cultural and public health scholars agree that these events are much more than sporadic, all night dance parties.

Health Minorities and the Hispanic Paradox

Isabel Arriagada on August 20, 2018

Photo by Sara Star NS, Flickr CC

Despite the stressful experiences and the poverty that often accompany immigration, social science research shows that Hispanics as a whole fare better in health outcomes than non-Hispanic Whites. The ‘Hispanic Paradox’ refers to the fact that these good health conditions in Hispanic populations represent a curious puzzle for researchers. This is because Hispanics also exhibit low-income status, disproportionate exposure to stress factors associated with the immigration process such as learning a new language, adapting to an unfamiliar environment, and encountering persistent discrimination — factors associated with poor health outcomes.
Some studies explain the ‘Hispanic Paradox” based on Hispanic culture-specific features that act as protective factors of health and wellbeing. They include the cultural emphasis in the development of social resources, family ties, and religious affiliations. Hispanic mothers in the United States, for example, enjoy favorable birth outcomes due to their close relationships with family, friends, and community members who provide a protective network of informal prenatal care. However, new research has found that Hispanic mothers’ adaptation to the norms of U.S. society — known as acculturation — erode these healthy behaviors.
Notably, the Hispanic Paradox may not remain consistent when researchers consider the specific composition of Hispanic populations living in the United States, compared to Hispanic populations in their places of origin. For instance, Hispanics who migrate may have better health conditions than those who stay in their home countries, known as the ‘healthy migrant effect’. On the other hand, less healthy Hispanics may be more likely to return to their home countries and thus less likely to participate in research studies, what is called ‘the salmon bias’. A study of Hispanics tested both the ‘healthy migrant’ and ‘the salmon bias’ effects among Cubans (for whom returning to their home countries is not feasible), Puerto Ricans, and U.S.-born Hispanics (whose deaths are recorded in the U.S. national statistics). Findings reveal that lower mortality for Hispanics remains constant, even when controlling for these alternative hypotheses.

Alberto Palloni and Elizabeth Arias. 2004. “Paradox Lost: Explaining the Hispanic Adult Mortality Advantage.” Demography 41(3): 385-415.

Ana F. Abraido-Lanza, Bruce P. Dohrenwend, Daisy S. Ng-Mak, and J. Blake Turner. 1999. “The Latino Mortality Paradox: A Test of the” Salmon Bias” and Healthy Migrant Hypotheses.” American Journal of Public Health 89(10): 1543-1548.

Studies on the Hispanic Paradox shine a light on how ethnicity can affect health outcomes. However, concerns about health outcomes among minorities require both strengthening the benefits and preventing potential harmful consequences of being Hispanic in the United States.

Morality and Maybe-Moms

Allison Nobles on May 9, 2016

"Drinking for Two" via Edmonton Fetal Alcohol Network
“Drinking for Two” via Edmonton Fetal Alcohol Network

Pregnant women are under attack—or so it seems. Actually, according to the Center for Disease Control (CDC), all women who might become pregnant ever are at risk. In February, the CDC released a report estimating that around 3 million women “are at risk of exposing their developing baby to alcohol because they are drinking, sexually active and not using birth control to prevent pregnancy.” Since then, many have bashed the CDC for advising women to live as though they are “pre-pregnant,” abstaining from drinking if they are not on birth control or if they are even considering getting pregnant. Coupled with growing threat of the Zika virus and its links to birth defects, such suggestions have propelled discussions of women’s roles in preventing catastrophic disability. Sociologists suggest that perceptions of women’s behavior are closely tied to ideas about the morality of motherhood. In particular, women who appear to resist common conceptions of what it means to be a “good” mother are subject to greater social control.

In American culture, motherhood is inextricably tied to morality. Moral arguments against abortion often rely on particular conceptions of sexual behavior, family life, and care for children. The ideology of “intensive mothering” demands that women be self-sacrificing and devote extensive time and energy to their children’s wants and needs — time and energy that many working women cannot afford.
This emphasis on mothers’ devotion to their children places them under considerable scrutiny, not only while raising children, but also during pregnancy. For instance, the “discovery” of Fetal Alcohol Syndrome heightened concerns over drinking during pregnancy. This made pregnant women the individual bearers of responsibility for the well-being of future children, and made them susceptible to moral outrage for behaviors like drinking. (Bucking the trend, the New York City Human Rights Commission has just recommended that visibly pregnant women cannot be discriminated against if, for instance, they order a glass of wine in a bar.)
Poor women, especially poor women of color, face a greater burden under dealized conceptions about what it means to be a “good” or “fit” mother. Not only are they regularly depicted as immoral or unfit, they are also criminalized and sanctioned at higher rates. Historical analyses show pregnant women are arrested for stillbirths, miscarriages, using drugs while pregnant, as well as incarcerated to prevent abortion. Poor women labeled “high risk” are prosecuted for failing to comply with medical advice when their fetus or baby dies, thus they are ironically discouraged from seeking care during pregnancy. Just as the “crack baby” became a symbol of the irresponsibility of poor, black women in the 1980s and ‘90s, Zika exposure and alcohol use are invoked today to place mothers and potential mothers under continued scrutiny.

Safer Sex for Male Inmates

Sara Anderson on March 1, 2016

Robert Elyov, Flickr CC https://flic.kr/p/8RUdpc
Robert Elyov, Flickr CC

In July 2015, four California state prisons began supplying condoms to prisoners, and more will follow suit in the next next five years. California, however, is only the second state to address infectious diseases in prisons. Prison officials are skeptical of the new law, though its ability to slow the spread of HIV and other sexually transmitted diseases among inmates may prove significant.

Sexual contact amongst U.S. prisoners is a complex issue emanating from societal expectations of sexuality and masculinity. Many of those who are incarcerated are young, unmarried, working-class men who are effectively cut off from the outside world and heterosexual encounters. As a result, many who identify as straight engage in male-to-male sex behind bars. This “institutional homosexuality” separates sexual behavior from sexual orientation.

Preventing the spread of sexually transmitted diseases in prison populations is a complicated matter. In the past, condom distribution was refused for two main reasons: the denial that male-to-male sex occurred in prison, and the illegal status of such encounters. To slow the spread of sexually transmitted diseases in prison and when inmates are released, both facts must be acknowledged.

U.S. prisoners are guaranteed access to health care. Unfortunately, rather than receiving cost effective, preventive measures to combat STIs, inmates usually only receive treatment after contracting one—and that’s costly in terms of money and health.

Sara Anderson will graduate from University of the Pacific in May 2016 with a degree in social sciences. She will attend law school in the fall.

There’s Something in the Water

Sarah Catherine Billups and Caty Taborda on February 24, 2016

Photo by Keoni Cabral, Flickr CC.
Photo by www.liveoncelivewild.com, Flickr CC.

To cut costs, the city of Flint, Michigan moved its residents from the Detroit city water system to water sourced from the Flint River. It was a temporary fix until Flint could access Great Lakes water directly. Now, as the world knows, there’s something in the water: lead. In Flint, more than 40% of residents live below the poverty line, and the high lead levels (10 times higher than originally estimated) have caused skin lesions, hair loss, vision loss, memory loss, depression and anxiety, and Legionnaires’ disease. According to sociologists, it’s no fluke that a disenfranchised community pays the ultimate price for environmental damage.

Nature is a battleground where the privileges of wealth and whiteness prevail. Race and class inequalities perpetuate practices that harm the environment, and the poor, immigrants, and minorities are most likely to live in areas with environmental damage (some 60% of African Americans and Latino/a people live in in places with uncontrolled toxic waste sites). This is largely due to the ways that bureaucracies and the state exercise power over resources in a capitalist economy. Flint, MI is just one of many examples of wealthy governments and corporations exporting hazardous material to poor communities of color.  
Poor communities of color also receive lower government response and assistance in environmental emergencies. From Hurricane Katrina to the Flint water crisis, African Americans tend to lack the economic resources and transportation necessary to evacuate an environmental danger zone, exacerbating its impacts on minority communities.