health

We have unions to thank for the “invention” of the weekend in the U.S., and most of us look forward to the end of our work week so we can sleep in, make plans with friends and family, and catch up on our favorite tv shows. But would we enjoy that time away from work as much if we had no one to share it with? Research by Young and Lim finds that the structure of the standard work week influences our social and emotional life on a much deeper level than we realize.

In a study comparing the happiness of workers and the unemployed on weekends versus weekdays, Young and Lim find that not all time off is valued equally. Participants in their study did not simply value time off for time off’s sake – instead, the value of time off depends on the ability to coordinate it with others. While the unemployed are less happy overall, both workers and the unemployed see a significant rise in positive emotions and decrease in negative emotions on weekends as compared to weekdays. Further, compared to the employed, the unemployed experienced little to no benefit from their time off when the work week starts.

The results reinforce the argument that most unemployed people are not enjoying their time away from paid work in a way that would outweigh the downsides of being unemployed. This research also has potential implications for the happiness of those who work increasingly common “non-standard” work schedules, meaning they also miss out on time with their families and friends on weekends.

A good doctor is hard to find—and for those with Medicaid or without health insurance at all, finding a new primary care doctor is almost impossible. According to an audit study headed by physician Karin Rhodes, the difference in access to primary care is even more extreme than we might expect. New patients with Medicaid were far less likely to obtain a doctor’s appointment than their privately insured peers, and uninsured patients had it hardest of all: only 15.4% could obtain an appointment without paying more than $75 at the time of service.

One reason this disparity has gone undetected until now is that physicians overestimate how many Medicaid patients they treat by up to 40%. In order to get a true read, Rhodes uses an audit study, which is perhaps the most powerful tool social scientists can use to measure discrimination. In Rhodes’ simulated patient study, a team of 10 field staff members was selected for diversity in race and age based on the sound of their voices in a phone audition. After being trained to pose as new patients, they made 11,347 calls to doctors’ offices in 10 states to assess “business as usual”. On each attempt to make an appointment with a primary care physician, a caller was prompted to adopt the persona of a patient with one of three insurance types: private, Medicaid, or no insurance. In this way, two otherwise identical “patients” were presented in the real-world situation of making an appointment, and the only characteristic that varied was their insurance type, which was experimentally manipulated by the researcher. As a result, using the audit method allowed Rhodes’ team to test exactly how much of the difference in outcomes was due solely to insurance type.

Overall, 87.4% of privately insured callers were able to schedule an appointment, compared to 57.9% of Medicaid callers. Among uninsured patients, 78.8% were able to see the doctor, but only if they could pay a fee of $75 or more in full at the time of service. The median out-of-pocket cost for a primary care visit was $120, and fewer than one-fifth of practices allowed flexible payment arrangements.

Rhodes’ study assessed the capacity of the primary care system before the Affordable Care Act’s 2014 coverage expansion. The ACA is projected to cover 25 million formerly uninsured Americans. Because access to primary care is considered vital to improving population health outcomes, system that is already strained may make the ACA’s goals harder to achieve. This means that the system of providers accepting Medicaid needs to be strengthened before coverage increases will translate into gains in access to primary care.

The United States slaughters approximately 34 million beef cattle annually, yet consumers know very little about beef production. This is largely by design. In a recent article (and podcast), sociologist Colter Ellis exposes the incredible role of emotional boundaries and boundary labor in beef production. Previous research has focused on the detachments necessary between consumers and the exploitation of commodities, ignoring the producers.

For most consumers, our feelings about cows, pigs, chickens, and other animals that we eat are very different from the feelings about our dogs, cats, and other animals that we keep as pets. Ellis demonstrates how this is not the case for cattle ranchers, who often see cattle as sentient, social beings with individual personalities (as illustrated by Pete the social beast and Cupcake the “teaser” steer). Through daily interactions with their cattle, ranchers develop emotional relationships, yet they have also developed narratives and emotional boundaries that allow them to treat these animals as economic assets and, eventually, as commodities.

The labor of cattle ranchers produces more than just beef. Their boundary labor creates a separation between animal-based commodities and the physical bodies these products come from. It creates a separation between consumers and the industrial practices that transforms sentient beings into emotionless commodities. Ultimately, Ellis finds, it allows consumers the privilege to disengage animal from meal.

According to a popular real estate saying, “Three things matter for property: location, location, location.” Turns out, location can be as important to mental health as it is to property value. In a recent study, Kristin Turney, Rebecca Kissane, and Kathryn Edin demonstrate that mental health benefits abound for African American women who move into low-poverty neighborhoods as compared to others who remain living in disadvantaged neighborhoods.

The authors analyze data from interviews with 67 Baltimore adults participating in the Moving-to-Opportunity social experiment, a project that randomly gave 4,608 families living in public housing developments the chance to move into low-poverty neighborhoods. Of those interviewed, 33 received MTO’s move to low-poverty neighborhoods, while 34 had not been selected. All interviewed were female and the head of their household; 66 were African American and one was multiracial.

The authors found that both groups reported experiencing traumatic and stressful life experiences and mental health challenges. Many who moved endured additional challenges in transitioning from public to private housing, managing utility bills, securing transportation, and living farther from friends and family. However, the stresses of relocation were counteracted by improvements in neighborhood and home aesthetics, neighborhood collective efficacy and pride, lower violence and criminal activity, and better environments for raising children. On the whole, the improvements in physical and social environments positively impacted mental health of those who moved. The link between location and opportunity remains tenuous, but the link with quality of mental health is now better understood.

If money can’t buy happiness, can redistributive social policies do the trick? In their research on state intervention in various socially democratic welfare states, Hiroshi Ono and Kristen Schultz Lee examine how welfare expenditures and taxes affect the happiness of citizens. Writing in Social Forces, Ono and Schultz not only report that money does buy happiness, but also that using public social expenditures to protect populations from social risk is a wise investment.

Using data from the 2002 International Social Survey Program’s (ISSP) “Family and Changing Gender Roles” module, the authors use individual-level factors including gender, marital status, and income to predict reports of happiness in Eastern European countries.  Countries are classified as either low- or high-PSE (Public Social Expenditure) depending on levels of social welfare funding.

Among their findings, women and men are equally happy regardless of the size of the welfare state. The happiness gap between married couples and non-married persons is greater in high-PSE countries, suggesting that countries with higher social expenditures are home to happier marriages. Cohabiters, too, are also nearly three times happier than non-married, non-cohabiting individuals in high-PSE countries. And even low-income people are happier in high-PSE countries compared to their counterparts in low-PSE countries.  Social welfare programs seem to help both the economic security and the subjective wellbeing of the poor. Still, the authors emphasize that public social expenditures do not invoke happiness among all citizens.

The redistribution of income reduces the happiness gap between the rich and the poor:  The happiness of the poor is lifted, and the happiness of the rich is lowered.

Countries attempting to mitigate various forms of “happiness inequality” through investments in safety nets may learn that achieving a state of happiness may not be as expensive as they thought. It just might lead to a few grumpy 1%’ers.

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Community health centers provide care to over 20 million people nationwide. As they primarily serve low-income and minority populations, they are intended to be culturally sensitive, but  a recent study by Emily Mann shows otherwise. In her findings, these centers often promote white, middle-class ideals about how to be a good “sexual citizen”. The clinics encourage clients to be in monogamous, heterosexual, preferably married, relationships, implicitly signaling that this is the only acceptable and respectable way to be a sexual citizen. Further, these health providers push expectations of the “right” trajectory to adulthood; deviations from the “school, then work, then baby” path are seen as negative.

Through in-depth interviews with care providers, Mann found many centers focused on teenage pregnancy among low-income Latina youth as a social problem, concentrating on pregnancy prevention. Mann, however, argues the “abstinence until after school, work, and marriage” agenda severely limits sexual education. Latina women are getting the abstinence message, but missing out on vital information about safe sex, reproduction, and alternative sexualities. Providers also seem to ignore the limitations to work and education in their clients’ communities; the “normal” path to adulthood may not be accessible for these patients.

By framing the sexual and reproductive practices of Latina youth as deviant and problematic, Mann argues that community health providers are unintentionally questioning the legitimacy of girls’ sexual citizenship. What health providers think their clients need and what their clients actually need simply do not fit. When doctors and nurse practitioners serve as ambassadors, how can they simultaneously treat their patients, interrupt social inequality with increased education, and create culturally respectful clinic environments? The sexual citizenship test is harder than we thought.
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Autism is today’s hot topic in the middle of medicine and society, sparking conversations on everything from parents and public health to new theories of social interaction and technological innovation. But how did this once-obscure condition become an “epidemic”?

Gil Eyal answers this question by tracing the social history of autism, arguing that we can learn more about why it is common today by asking why it used to be rare. His work highlights three key changes in the mental health system. First, treatment for autism shifted from clinics and institutions to special education at home and in the community. Second, specialists stopped looking for complete “bundles” of symptoms to diagnose autism, turning instead to a checklist of individual behaviors, identified by parents and falling across a wide spectrum. Finally, these changes in practice taught parents and doctors to look for progress in small steps through treatment, rather than a complete “cure” for autism; it is now seen as a lifelong condition.

Eyal argues that these changes didn’t create new knowledge or skills among the experts, but instead made a new kind of autism expertise by changing the social relationships among parents, therapists, researchers, and activists. Now parents are encouraged to actively participate in the diagnosis and treatment of their children, with their observations taken more seriously by doctors. Thus, autism diagnoses have been supported by a broader social network and increased over time, while other conditions that required specific clinical treatments without the parents—like childhood schizophrenia—have decreased. While autism now occurs more frequently, at least part of the epidemic lies in the way our society sees mental health.

Both women’s labor force participation and breast cancer incidence have increased substantially since the 1970s. That seems like a coincidence, but for women in positions of authority, recent research by Tetyana Pudrovska links the two.

Pudrovska shows that women who graduated from Wisconsin high schools in 1957 and had the authority to influence pay and hire and fire employees (“job authority”) in 1975 had a 70% higher risk of a breast cancer diagnosis by 2011 than those without such authority (controlling for a variety of known biological and social breast cancer risk factors). This greatly increased risk was specific and increased among women with job authority who spent a large portion of their time at work dealing with people.  Some of this increased risk may be due to the particularly stressful environment women faced in the 1970s labor force, but Pudrovska observes similarly increased breast cancer risk (through 2011) for women who held such job authority in 1993.

Pudrovska argues that the established health benefits of having a job can be counteracted by unfavorable working conditions—such as the significant stress of being a woman in a position of authority when that violates social norms. To the extent that a woman in charge is less countercultural today than in the ‘70s, job authority may pose a lower health risk to today’s women.

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Let’s get down to business: unemployment has been linked to increases in debt, poverty, homelessness, crime, depression, and family breakdown. According to a recent article by Montez and Zajacova, unemployment is also partially responsible for the growing difference in mortality rates of low-educated white women compared to their more highly educated peers.

Between 1997 and 2001, low-educated women 45-86 years old were 1.37 times more likely to die than high-educated women. Compared to mortality data from 2002 to 2006, the gap between groups widened by 21%. To find out why, the authors use complex statistical modeling to investigate the influence of socio-psychological, economic, and health factors on the increasing difference in mortality rates. Along with smoking, unemployment is identified as the factor most strongly linked to this change. The authors speculate that the Internet and the “digital divide” may be playing a larger role in the unemployment of low-educated women, and that the information taught in schools may be becoming more relevant to health.

Having identified unemployment as one of the causes of the growing education gap in mortality, Montez and Zajacova call for social-protection policies geared toward helping low-educated women remain in the workforce. They believe that work-family policies allowing more flexible hours and protected leave will contribute to stemming the divergence.  Their hope is that giving women the opportunity to punch the clock will—in the long-run—give them more time to unwind.

In nearly half of all U.S. states, it is a felony for HIV-positive people to have sex without disclosing their status to their partners. In some places, this law, meant to promote public health, has become a tool of social control. Those who have—or are suspected of having—HIV or AIDS are essentially kept under surveillance and can be criminally sanctioned for various violations.

Trevor Hoppe (Social Problems, February 2013) interviewed 25 health officials responsible for managing “health threat” cases in Michigan, where the laws are particularly strenuous. When new HIV-positive individuals are identified, officials do extensive contact tracing. While surveillance technologies are officially about disease prevention, they are also used to aid law enforcement and to regulate the client’s sexual practices. If an individual is labeled a “health threat,” they may be forced to undergo testing, counseling, treatment, or be quarantined. HIV-positive individuals may not be allowed to have any unprotected sex, even if they have disclosed their status to their partner (and if they test positive for a secondary STI, that is taken as evidence of unprotected sex). The law also treats all types of sex as equally risky, criminalizing even those sexual acts that carry no risk of transmission.

The criminal punishment for non-disclosure also provides impetus for local rumor mills, often setting in motion a “witch hunt.” Community members can call in confidential third party reports accusing individuals they suspect are HIV positive of not disclosing. These accusations often come against already-stigmatized individuals and may be false reports, but they set investigations in motion.

The additional stigma and social costs attached to an HIV diagnosis in states with such legislation may now be reducing people’s willingness to be tested for STIs at all, thus rendering a public health effort bad for public health.