health/medicine

Inequality by (Interior) Design, a blog by sociologist Tristan Bridges, turned one-year-old last month and it is quickly becoming one of my favorites.  In a recent post, Bridges featured a product that reminds us all why history is awesome: the “portable baby cage”:

As I discussed in a previous post, with industrialization came cities and with cities came crowded, cramped living quarters.  The baby cage kept infants out of harm’s way and gave the family a bit more space.  As Bridges discusses, it also coincided with the idea that babies needed a lot of fresh air to be healthy.  The baby cage seemed like the perfect solution.

Lisa Wade, PhD is an Associate Professor at Tulane University. She is the author of American Hookup, a book about college sexual culture; a textbook about gender; and a forthcoming introductory text: Terrible Magnificent Sociology. You can follow her on Twitter and Instagram.

Cross-posted at Tim Wise’s website.

It’s one of those stories that can leave even the most jaded and cynical critic of racist thinking scratching their head; the kind that manages to shock even those of us for whom acts of bigotry and intolerance seem all-too-typical, and who have, sadly, come to expect them in a culture such as this.

And so it was that in Flint, Michigan recently, a new father — and this is a term he has earned in only the most narrow, biological sense — demanded that when his recently arrived child was sent to the Neonatal Intensive Care Unit of the hospital where she had been born, no African American nurses were to attend to her needs, to care for her, to do what neonatal ICU nurses do, which is to say keep sick babies alive. White hands only for this white, fresh as snow child, whose father, sporting a shiny new swastika tattoo (a Christmas present no doubt from his pathetic skinhead bride) prioritized his own hatreds above and beyond the needs of his precious little girl.  That the future does not bode well for her seems hardly worth saying. To be delivered from an ICU into the arms of one as unhinged as this can only, by reasonable people, be seen as a turn for the worse. Incubators and breathing machines might be preferable to having parents such as she has, through no fault of her own, inherited.

But what is worse, perhaps, than the bigotry of this one neo-Nazi — which is at least to be expected and so, can, despite its irrationality in a case such as this, remain somewhat within the realm of the banal — is that the hospital in question, Hurley Medical Center, actually capitulated to his psychotically racist demands, posting a sign on the little girl’s chart instructing the unit to disallow any black nurses from as much as touching this baby.

Presumably, were Tonya Battle, a black Hurley neonatal nurse since 1988 the only nurse within arms reach of the girl as she entered cardiac arrest or as her kidneys began to shut down — both of which have been known to happen to those in a NIC-U — Battle was to scream loudly for a white nurse to come and save the child’s life. Because God forbid a black woman with 25 years experience do the job. And if she dies, well, at least her precious white skin wouldn’t have been sullied by black hands.

Hurley’s acquiescence to this insanity, in contravention of all ethical responsibility, not to mention legal obligations to treat their employees in a non-discriminatory fashion, is going to cost them no doubt, as they are apt to discover once the lawsuit currently brought against their witless administrators plays out. They are going to pay, and pay big, as they should, for their enabling of overt white supremacy. But that is hardly the most important part of this story. Just as it was not the most important part of the story back in 2000 when a heart specialist at St. Thomas Hospital in Nashville did a similar thing, agreeing to the lunatic ravings of another racist white man, who demanded that his wife, who needed open heart surgery to save her life, not be attended to by any black doctor, because he didn’t want a black man to see his wife naked.

More interesting, I think, is what this story (and the earlier one from Nashville) says about racism in America, and not just of the sort evinced by one bottom-feeder, troglodytic fan of Adolf Hitler. For while we are too quick to presume racism to be merely an individual pathology manifested by individually bad people, much like the father in the story from Flint, the fact is, an incident like this illustrates as well as anything can, the way that racism continues to operate as a systemic force in the United States, civil rights laws and all our vaunted post-raciality notwithstanding.

To understand what I mean by this, consider something I am often asked as I travel the country, speaking about racism, or in reply to one or another column or book that I’ve written: namely, it is queried, why don’t I ever talk about black racism, or, just generally, racism against white people? Why, it is wondered, do I focus on racism only when it’s deployed by whites?

There are many things I could say, and do, when asked something like this. But for now, let it suffice to say that this story, from Michigan, involving a white institution as respected as a hospital bending to the whims of a fucking Nazi, is more than enough of a reason for my selective attention. And this is true for multiple reasons.

First, what the story demonstrates is how much more potent white racism is than any potentially parallel version practiced by peoples of color. Simply put, there is no way that any bigoted black person, or Latino, or Asian American, or indigenous person, could possibly have made a similar demand in the reverse direction — that no white nurses attend to their newborn — and expect to have that insistence met with approval and acquiescence. Anyone who thinks a hospital would have agreed to such a thing — to actually deny opportunity to white nurses or doctors, and to limit the care of such a child to same-race caregivers because of the expressed bigotry of a patient — is either so overly medicated or mentally damaged as to make further discussion impossible. In other words, even when a white racist who is likely not of substantial economic means makes a racist demand, his desires can get ratified, and in ways that not even the wealthiest person of color could expect to have happen.*

And this is because — and this is what is especially pertinent to the matter of institutional racism — even if a hospital was willing to go along with the ridiculous and bigoted demands of a hateful person of color, that no whites be allowed to touch their black or brown baby, it would be virtually impossible to fulfill such a request. And why? Simple. Because given the history of unequal opportunity in medical professions, from doctoring to nursing — and also just given the demographic and power dynamics within pretty much any institution you can name — to work around white professionals, even if one wanted to, is almost impossible.

Bottom line: the hospital in this case went along with the demand to exclude blacks from attending to this child because they could. Given the history of discrimination in access to the medical profession, including nursing, and the barriers to professional practice faced by too many people of color, there exists today a more limited number of such professionals from which to draw. As such, excluding them from a particular hospital unit or assignment is hardly a huge burden for the institution in question.

But imagine what would happen if the situation were reversed, and a racist black man had demanded the exclusion of whites from caring for his child. Even if there were a doctor willing to agree to such conditions, it would be virtually impossible for him or her to follow through, because whites — having received the opportunities needed to enter the nursing profession in larger numbers — are hard to work around. “No whites” policies would result in a lot of empty NIC-Us, whereas “No blacks” policies require only a small administrative headache at best, so fewer are such professionals in the first place. And so, given the history of racial inequity, the consequences of which we still experience, white bigotry of the individual type is operationalized and activated if you will, by the institutional injustices that have resulted in the over-represantaion of whites and under-representation of black and brown folks in certain jobs to begin with.

In other words, institutional racism is akin to the gasoline, allowing the otherwise stationary combustion engine of individual racism to function: the former gives the latter life, and the ability to impact others in a meaningful and detrimental way. Without the power to enforce one’s racism, or expect it to be enforced or enforceable by others, that racism is largely sterile. Which is why white racism is simply more worthy of our attention and concern than any other form.

Much the same would be true in other realms of life, beyond medical and hospital settings. Blacks who wish to avoid whites in their neighborhoods will typically find themselves limited to the poorest, most crowded areas of town — places whites long ago abandoned — since finding Caucasian-free zones in more prosperous suburbs can be a tough task. Whites can more or less live wherever we wish. If we are not to be found in a particular census tract you can bet it’s because we’ve chosen to be absent. Such cannot be said for why blacks are often absent from more affluent areas, however. Money or no money, good credit or bad, millions face discriminatory barriers in residential opportunity every year.

Once again, even if people of color despise whites and seek to avoid us, their ability to do so will be directly constrained by the larger opportunity structure that has skewed power and resources in our direction. Whites seeking to avoid blacks and Latinos on the other hand, can do so readily, with the help of mortgage discrimination, redlining, zoning laws and so-called “market forces” pricing many blacks out of the better housing markets (even though we only got into those markets because of government subsidies and preferences, both private and public).

So for those seeking to understand what racism is — and the difference between the merely individual as opposed to institutional forms of it — and why white racism is more potent and problematic than any other potential form, you need look no further than the recent headlines. When institutions can and will collaborate with and directly empower the racism of even the most deranged of bigots, you know that we have yet to arrive at that place of racial ecumenism claimed for us by those who would rather gloss over the ongoing injustices we face, and pretend to have attained, as a people, a perch to which we have no ethical right to lay claim.

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*Please note, I wish to differentiate here between those patients whose desire for same-race/ethnic nurses or doctors is motivated by apparent bigotry, on the one hand, and those whose desire for such a thing might be motivated by such things as linguistic familiarity, on the other. So, for instance, a Spanish-speaking, or for that matter, German or Russian-speaking mother-to-be might request a nurse, or anesthesiologist who speaks their language, for reasons of comfort and communication. Additionally, it is possible that given the history of difficulties in cross-cultural communication between authority figures who are white and patients/clients who are persons of color (which has been studied and documented for years), a black patient might prefer, if possible, to have a black nurse or anesthesiologist to wait on them. Although even these cases are likely rare, they would not be remotely comparable to a blatant bigot demanding same-race care for reasons comparable to the facts in this story, or the 2000 story from Nashville.

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Tim Wise is among the most prominent anti-racist writers and educators in the United States.  The author of six books on race in America, he has spoken on over 800 college and high school campuses and to community groups across the nation.  His new book, The Culture of Cruelty, will be released in the Fall of 2013.

Cross-posted at Montclair SocioBlog.

The Wall Street Journal had an op-ed this week by Donald Boudreaux and Mark Perry claiming that things are great for the middle class.  Here’s why:

No single measure of well-being is more informative or important than life expectancy. Happily, an American born today can expect to live approximately 79 years — a full five years longer than in 1980 and more than a decade longer than in 1950.

Yes, but.  If life-expectancy is the all-important measure of well-being, then we Americans are less well off than are people in many other countries, including Cuba.

The authors also claim that we’re better off because things are cheaper:

…spending by households on many of modern life’s “basics” — food at home, automobiles, clothing and footwear, household furnishings and equipment, and housing and utilities — fell from 53% of disposable income in 1950 to 44% in 1970 to 32% today.

Globalization probably has much to do with these lower costs.  But when I reread the list of “basics,” I noticed that a couple of items were missing, items less likely to be imported or outsourced, like housing and health care.  So, we’re spending less on food and clothes, but more on health care and houses. Take housing.  The median home values for childless couples increased by 26% between just 1984 and 2001 (inflation-adjusted); for married couples with children, who are competing to get into good school districts, median home value ballooned by 78% (source).

The authors also make the argument that technology reduces the consuming gap between the rich and the middle class.  There’s not much difference between the iPhone that I can buy and the one that Mitt Romney has.  True, but it says only that products filter down through the economic strata just as they always have.  The first ball-point pens cost as much as dinner for two in a fine restaurant.  But if we look forward, not back, we know that tomorrow the wealthy will be playing with some new toy most of us cannot afford. Then, in a few years, prices will come down, everyone will have one, and by that time the wealthy will have moved on to something else for us to envy.

The readers and editors of the Wall Street Journal may find comfort in hearing Boudreaux and Perry’s good news about the middle class.  Middle-class people themselves, however, may be a bit skeptical on being told that they’ve never had it so good (source).

Some of the people in the Gallup sample are not middle class, and they may contribute disproportionately to the pessimistic side.  But Boudreaux and Perry do not specify who they include as middle class.  But it’s the trend in the lines that is important.  Despite the iPhones, airline tickets, laptops and other consumer goods the authors mention, fewer people feel that they have enough money to live comfortably.

Boudreaux and Perry insist that the middle-class stagnation is a myth, though they also say that

The average hourly wage in real dollars has remained largely unchanged from at least 1964—when the Bureau of Labor Statistics (BLS) started reporting it.

Apparently“largely unchanged” is completely different from “stagnation.”  But, as even the mainstream media have reported, some incomes have changed quite a bit (source).

The top 10% and especially the top 1% have done well in this century.  The 90%, not so much. You don’t have to be too much of a Marxist to think that maybe the Wall Street Journal crowd has some ulterior motive in telling the middle class that all is well and getting better all the time.

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

The Institute of Medicine and the National Research Council released some damaging numbers this month: Americans ranks startlingly low in life expectancy, compared to 16 other similarly developed countries.  This is especially true for younger Americans. Indeed, among people 55 and under, we rank dead last.  Among those 50-80 years old, our life expectancy is 3rd or 2nd to last.

Sabrina Tavernise at the New York Times reports that the “major contributors” to low life expectancy among younger Americans are high rates of death from guns, car accidents, and drug overdoses.  We also have the highest rate of diabetes and the second-highest death rate from lung and heart disease.

Americans had “the lowest probability over all of surviving to the age of 50.”  The numbers for American men were slightly worse than those for women. Overall, life expectancy for men was 17 out of 17; women came in 16th.  Education and poverty made a difference too, as did the more generous social services provided by the other countries in the study.

What isn’t making a difference?  Apparently our incredible rate of health care spending.

Via Citings and Sightings.

Lisa Wade, PhD is an Associate Professor at Tulane University. She is the author of American Hookup, a book about college sexual culture; a textbook about gender; and a forthcoming introductory text: Terrible Magnificent Sociology. You can follow her on Twitter and Instagram.

As politicians negotiated regarding the fiscal cliff, they debated whether to cut social programs aimed at alleviating poverty and deprivation.  Most of us imagine that these programs help a minority of the population.  In fact, the Pew Research Center reports that more than half of the population has received government benefits from one of the six most well-known programs:

This isn’t the so-called 47% that Romney claimed would vote for a Democrat no matter what.  In fact, people who received one of these six benefits were only slightly more likely to vote Democratic:

In fact, receiving benefits is pretty well spread out among the population. Except for people over 65, there seems to be significant consistency in the receipt of at least one benefit:

Notably, these programs also go to help the poor, women (largely because they end up single with young children), and people in rural areas.

Interestingly, many of us who have benefited from targeted government programs (“targeted” because we all benefit from programs like, oh, transportation initiatives and environmental protection and [insert dozens more here]) don’t know that we do.  In a previous post, we showed that large proportions of people who’ve benefited from social programs don’t recognize that they have unless their thinking is sparked by asking them about specific programs.  (It’s kind of like responding “No I don’t do drugs” and then being asked specifically about marijuana and saying, “Oh yeah, well that one I guess!”).

Since it is indeed the majority of Americans who benefit from targeted programs, it shouldn’t be too hard for politicians to find it in their hearts to support these programs.  That 57% of conservatives and 52% of Republicans have used them suggests that the political right is more interested in purporting an ideology than serving its constituency.

Alternatively, they realize that a certain proportion of benefit recipients also believe that the government “does not have the responsibility to care for those who cannot care or themselves.” About a third of people who hold onto this principle have used benefits:

It seems that data like this might be very useful for what we really need: an educational campaign designed to help Americans understand what social programs do and who benefits from them.   Maybe then we could have sensible policy discussions.

Lisa Wade, PhD is an Associate Professor at Tulane University. She is the author of American Hookup, a book about college sexual culture; a textbook about gender; and a forthcoming introductory text: Terrible Magnificent Sociology. You can follow her on Twitter and Instagram.

Cross-posted at Family Inequality and The Atlantic.

The problem of income inequality often gets forgotten in conversations about biological clocks.

The dilemma that couples face as they consider having children at older ages is worth dwelling on, and I wouldn’t take that away from Judith Shulevitz’s essay in the New Republic, “How Older Parenthood Will Upend American Society,” which has sparked commentary from Katie Roiphe, Hanna Rosin, Ross Douthat, and Parade, among many others.

The story is an old one — about the health risks of older parenting and the implications of falling fertility rates for an aging population — even though some of the facts are new. But two points need more attention. First, the overall consequences of the trend toward older parenting are on balance positive, both for women’s equality and for children’s health. And second, social-class inequality is a pressing — and growing — problem in children’s health, and one that is too easily lost in the biological-clock debate.

Older mothers

First, we need to distinguish between the average age of birth parents on the one hand versus the number born at advanced parental ages on the other. As Shulevitz notes, the average age of a first-time mother in the U.S. is now 25. Health-wise, assuming she births the rest of her (small) brood before about age 35, that’s perfect.

Consider two measures of child well-being according to their mothers’ age at birth. First, infant mortality:

Health prospects for children improve as women (and their partners) increase their education and incomes, and improve their health behaviors, into their 30s. Beyond that, the health risks start accumulating, weighing against the socioeconomic factors, and the danger increases.

Second, here is the rate of cognitive disability among children according to the age of their mothers at birth, showing a very similar pattern:

Again, the lowest risks are to those born when their parents are in their early 30s, a pattern that holds when I control for education, income, race/ethnicity, gender, and child’s age.

When mothers older than age 40 give birth, which accounted for 3 percent of births in 2011, the risks clearly are increased, and Shulevitz’s story is highly relevant. But, at least in terms of mortality and cognitive disability, an average parental age in the late 20s and early 30s is not only not a problem, it’s ideal.

Unequal health

But the second figure above hints at another problem — inequality in the health of parents and children. On that purple chart, a college graduate in her early 40s has the same risk as a non-graduate in her late 20s. And the social-class gap increases with age. Why is the rate of cognitive disabilities so much higher for the children of older mothers who did not finish college? It’s not because of their biological clocks or genetic mutations, but because of the health of the women giving birth.

For healthy, wealthy older women, the issue of aging eggs and genetic mutations from fathers’ run-down sperm factories are more pressing than it is for the majority of parents, who have not graduated college.

If you look at the distribution of women having babies by age and education, it’s clear that the older-parent phenomenon is disproportionately about more-educated women. (I calculated these from the American Community Survey, because age-by-education is not available in the CDC numbers, so they are a little different.)

Most of the less-educated mothers are giving birth in their 20s, and a bigger share of the high-age births are to women who’ve graduated college — most of them married and financially better off. But women without college degrees still make up more than half of those having babies after age 35, and the risks their children face have more to do with high blood pressure, obesity, diabetes, and other health conditions than with genetic or epigenetic mutations. Preterm births, low birth-weight, and birth complications are major causes of developmental disabilities, and they occur most often among mothers with their own health problems.

Most distressing, the effects of educational (and income) inequality on children’s health have been increasing. Here are the relative odds of infant mortality by maternal education, from 1986 to 2001, from a study in Pediatrics. (This compares the odds to college graduates within each year, so anything over 1.0 means the group has a higher risk than college graduates.)

This inequality is absent from Shulevitz’s essay and most of the commentary about it. She writes, of the social pressure mothers like her feel as they age, “Once again, technology has given us the chance to lead our lives in the proper sequence: education, then work, then financial stability, then children” — with no consideration of the 66 percent of people who have reached their early 30s with less than a four-year college degree. For the vast majority of that group, the sequence Shulevitz describes is not relevant.

In fact, if Shulevitz had considered economic inequality, she might not have been quite as worried about advancing parental age. When she worries that a 35-year-old mother has a life expectancy of just 46 more years — years to be a mother to her child — the table she consulted applies to the whole population. She should breathe a little bit easier: Among 40-year-old white college graduates women are expected to live an average extra five years compared with those who have a high school education only.

When it comes to parents’ age versus social class, the challenges are not either/or. We should be concerned about both. But addressing the health problems of parents — especially mothers — with less than a college degree and below-average incomes is the more pressing issue — both for potential lives saved or improved and for social equality.

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.

Cross-posted at Reports from the Economic Front.

One of the subthemes of current discussions about how best to reduce our national debt is that we must rein in out-of-control spending on federal safety net programs.   The reality is quite different.

The chart below shows spending trends in terms of GDP for the ten major needs-tested benefit programs that make-up our federal social safety net. The programs, in the order listed on the chart, are:

• The refundable portion of the health insurance tax credit enacted in the 2010 health care reform law
• Medicaid and the Children’s Health Insurance Program (CHIP)
• The Supplemental Nutrition Assistance Program (SNAP)
• Financial assistance for post-secondary students (Pell Grants)
• Compensatory Education Grants to school districts
• Assisted Housing
• The Earned Income Tax Credit (EITC)
• The Additional Child Tax Credit (ACTC)
• Supplemental Security Income (SSI)
• Family Support Payments

As Jared Bernstein explains:

…for all the popular wisdom that programs to help low-income people are swallowing the economy, the truth is that like so much else that plagues our fiscal future, it’s all about health care spending.  The figure shows that as a share of GDP, prior to the Great Recession, non-health care spending was cruising along at around 1.5% for decades.  It was Medicaid/CHIP (Medicaid expansion for kids) that did most of the growing.

The takeaway from this: we need a new health care system (think single payer).

Regardless, the recent explosion in the ratio of Medicare/CHIP spending to GDP is largely due to the severity of the Great Recession, not the generosity of the programs. The recession increased poverty and thus eligibility for the programs, thereby pushing up the numerator, while simultaneously lowering GDP, the denominator.   Moreover, spending on all non-health care safety net programs is on course to dramatically decline as a share of GDP. Even Medicare/Chip spending is projected to stabilize as a share of GDP.

These programs are essential given the poor performance of the economy, and in most cases poorly-funded. Cutting their budgets will not only deny people access to health care, housing, education, and food, it will also further weaken the economy, in both the short and long run.

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Martin Hart-Landsberg is a professor of Economics and Director of the Political Economy Program at Lewis and Clark College.  You can follow him at Reports from the Economic Front.

For the last week of December, we’re re-posting some of our favorite posts from 2012. Cross-posted at The Huffington Post.

If you live in the U.S. you are absolutely bombarded with the idea that being overweight is bad for your health.  This repetition leaves one with the idea that being overweight is the same thing as being unhealthy, something that is simply not true.  In fact, people of all weights can be either healthy or unhealthy; overweight people (defined by BMI) may actually have a lower risk of premature death than “normal” weight people.  Being fat is simply not the same thing as being unhealthy.

The Health At Every Size (HAES) movement attempts to interrupt the conflation of health and thinness by arguing that, instead of using one’s girth as an indicator of one’s health, we should be focusing on eating/exercising habits and more direct health measures (like blood pressure and cholesterol).

A recent study offered the HAES movement some interesting ammunition in this battle. The study recruited almost 12,000 people of varying BMIs and followed them for 170 months as they adopted healthier habits.  Their conclusion? ” Healthy lifestyle habits are associated with a significant decrease in mortality regardless of baseline body mass index.”

Take a look.  The “hazard ratio” refers to the risk of dying early, with 1 being the baseline.  The “habits” along the bottom count how many healthy habits a person reported.  The shaded bars represent people of different BMIs from “healthy weight” (18.5-24.9) to “overweight” (25-29.9), to “obese” (over 30).

The three bars on the far left show the relative risk of premature death for people with zero healthy habits. It suggests that being overweight increases that risk, and being obese much more so.  The three bars on the far right show the relative risk for people with four healthy habits; the differential risk among them is essentially zero; for people with healthy habits, then, being fatter is not correlated with an increased relative risk of premature death.  For everyone else in between, we more-or-less see the expected reduction in mortality risk given those two poles.

This data doesn’t refute the idea that fat matters.  In fact, it shows clearly that thinness is protective if people are doing absolutely nothing to enhance their health.  It also suggests, though, that healthy habits can make all the difference.  Overweight and obese people can have the same mortality risk as “normal” weight people; therefore, we should reject the idea that fat people are “killing themselves” with their extra pounds.  It’s simply not true.

h/t to BigFatBlog.

Lisa Wade, PhD is an Associate Professor at Tulane University. She is the author of American Hookup, a book about college sexual culture; a textbook about gender; and a forthcoming introductory text: Terrible Magnificent Sociology. You can follow her on Twitter and Instagram.