public policy

Health posts are my thing, and today I cannot stop thinking about the health of the Gulf Coast…which clearly impacts the health of more living creatures than we can fathom.  News coverage may talk about bodies of water like they are distinct things, but ‘the Gulf’ is merely a cartographer’s distinction.  It’s hard to watch the live feed of the endless spray of oil shooting into the ocean.  It feels like watching a massacre, like a spray of machine-gun bullets ending life after life.  Calling this catastrophe a “spill” is like calling an amputation a “boo-boo.”    And, frankly, I can think of nothing more important to write about for this month’s column. 

So, allow me to compare our planet to a patient, a very ill patient who has suffered a severe injury and is receiving really crappy medical care.  Or, let’s take it to a more intimate-level: we can anthropomorphize one affected area, the Mississippi Spillway, as the vulva of the U.S.  One of my favorite sociologist bloggers, Mimi Schippers, Ph.D. (a.k.a. Marx in Drag), did just that in a post where she calls British Petroleum (BP) a pimp — and not the MTV/”pimp my ride”/bling-bling/Snoop Dogg kind of pimp.  No, we’re talking a stone cold, cruel, exploitative, abusive, criminal.  In the words of Dr. Schippers:

 BP and the rest of the oil industry are the johns and the federal government is the pimp.  Federal, state, and local politicians pimp us out to put money and power in their own pockets while, by paying the right price, Big Oil gets to take what it wants and needs.  And they-the pimp and the johns, do so with absolutely no regard for the needs or well-being of the body they use.  The body—the living environment, including the people—is, however, a breathing entity.  And though it appears as if it is just an object to be used, the people know what they are doing.  They strike a bargain that, for the moment, benefits themselves but sacrifices the rest.  You give me jobs, and I’ll give you whatever you want.  Invoking the vulva as metaphor suggests there is something feminine or female about this place and that masculine or male power is the problem.  But don’t let that confuse the issue.  This is about class and economics. 

Whether you prefer to see the U.S. government as an incompetent physician (allowing a patient to inch towards death) or as a corrupt police officer (being too kind to a felon), we have got to ramp up our demands for swift, safe, effective action.  And, perhaps, we need to think seriously about how to safely shut-down all of the deep-water drilling before the next tragedy.  All the money in the world cannot buy a healthy ocean.  Even if this torrent of BP oil is the last one we ever have to deal with, don’t think that we’re close to knowing how bad things really are..in the words of that 70’s BTO classic:

Here’s somethin’ that you’re never gonna forget. B-, b-, b-, baby, you just ain’t seen na, na, nothin’ yet!

Recently, I had the pleasure of corresponding with sociologists Chloe Bird and Pat Rieker about their book Gender and Health: Constrained Choices and Social Policies (Cambridge University Press, 2008), credited as the “first book to examine how men’s and women’s lives and their physiology contribute to differences in their health.” I was curious how the authors see their research relating to some of the health topics that have made headlines in recent months.

Nack: Starting off with the topic of mental, health, you’ve written about sex-based differences.  Reflecting on recent articles, like NYT’s In Anxious Times, Medical Help for the Mind as Well as the Body, how does your book add to our understanding of and concern for policies like the Mental Health Parity Act?

Rieker:  Our book provides concrete data for why the Mental Health Parity Act is such a strategic and critical addition to general health care policy.  We focus on gender differences in mental health, particularly depression and substance abuse disorders.  Although the overall rates of mental illness are similar between men and women, if you look at it by specific disease, then you see large gender differences.  Women’s depression and anxiety rates are double that of men’s; while men’s rates of substance abuse and impulse control disorders are double that of women’s. Available research shows that individuals with serious mental health problems also have more physical health issues, including a lower life span. Both social and medical interventions are needed to prevent and treat these socially and financially costly conditions which create enormous health burdens on individuals, who may become unable to perform work and other social roles, and their families, Employers and society, as a whole, bear additional costs. 

Bird:  Also, differences in men’s and women’s lives can affect their utilization of mental health care and the effectiveness of specific interventions. We need systematic assessments of the effectiveness of treatments/approaches for both men and women, which can ultimately lead to better physical and mental health outcomes. The US has fallen behind Canada and other countries which require this approach in federally-funded research. 

Nack: How are the differences between men’s and women’s mental health problems particularly relevant as we consider the impact of the economic downturn, in general, and, with regard to healthcare coverage, the rising numbers of uninsured and underinsured Americans?

Rieker:  In the current poor economic climate, many men and women are experiencing increased stress/anxiety when losing jobs which may have provided dependable incomes and health insurance. Constant worry, itself, leads to ill health and exacerbates existing underlying conditions (e.g., cardiovascular and respiratory conditions).  Our framework of constrained choice illustrates how social and economic policy can reduce or enhance the options and opportunities for individuals to engage in healthy behaviors such as not smoking, not drinking to excess, eating well, and exercising.  While some individuals respond to economic downturns by temporarily limiting costly habits of smoking or drinking, we argue that more could be done at different policy levels to encourage positive health behaviors and coping strategies that improve physical and mental health. more...