health

Rural, White Women Getting Sicker, Dying Quicker

Sarah Catherine Billups on April 21, 2016
Graphic via Washington Post. Click for original and animation.
Graphic via Washington Post. Click for original and animation.

The Washington Post highlights the growing morbidity and mortality rates of rural white women. The rates of sickness and death for white women have climbed steadily over the past couple of decades, but the most dramatic increase is in rural areas. Sociologists and demographers have long investigated these trends. Poverty, stress, and timing of childbirth all matter for mortality, but the combination of these factors have stronger effects on rural, white women—surprising, because poverty confounds our typical understandings of race and inequality.

Mortality rates have decreased overall since the latter half of the 20th century, though several factors, many related to poverty and education, contribute to the increasing death rates of certain groups. Those with less education tend to have higher mortality rates and rates of heart disease and lung cancer.
Less education tends to correlate with lower socioeconomic status and difficulty finding employment. Sociologists Link and Phelan point to poverty as a “fundamental cause” of mortality and morbidity. Low socioeconomic status means difficulty is accessing resources: not only do poor people have trouble obtaining the means to maintain a healthy life, they also tend to lack the time, transportation, social networks, and money to help them recover from sickness.
Some of the health issues tied to poverty affect women more than men. Women with high stress levels are more likely than men to die from cancer-related illnesses. Other health patterns related to social class, such as the timing of childbirth, matter, too. Poorer women are more likely to have children before age 20, which correlates with increased risk of death, heart and lung disease, and cancer.

Bringing Harm Reduction to America’s Heroin Problem

Austin Jenkins and Allison Nobles on April 12, 2016
Urban Seed, an Australian organization, considers harm reduction programs part of their mission to help disadvantaged communities. Flickr CC.
Urban Seed, an Australian organization, considers harm reduction programs part of their mission to help disadvantaged communities. Flickr CC.

The mayor of Ithaca, New York recently proposed a facility for people to use heroin and other injected drugs safely. It’s part of a larger plan to focus on prevention and treatment of drug use, and the facility’s trained medical staff would provide clean needles, referrals to treatment programs, and naloxone, an opioid overdose antidote. Today’s opioid epidemic—which kills an estimated 78 Americans every day—has shocked many, given that other forms of illicit drug use have generally declined in prevalence and mortality during recent decades. Ithaca’s plan falls under the umbrella of “harm reduction” approaches, which attempt to mitigate personal and societal harm from drug and alcohol use. Social science shows us how and why these programs work.

Supervised injection facilities are relatively recent, originating in the Dutch and Swiss harm reduction movements of the 1970s and ‘80s. The first site in North America opened in Vancouver in 2003 and is linked to drastic declines in public injection and overdose deaths. Today a number of supervised drug consumption rooms operate throughout northern Europe, Canada, and Australia. Ithaca’s would be the first in the U.S.
Substance use was once a popular element of social events, like election day, but by the 20th century, “drug scares” stigmatized drug use, associating it with racial stereotypes, immigration, and crime. Smoking opium was first outlawed in the U.S. in the 1870s, for instance, as a result of anti-Chinese sentiments in California. Non-smoking opioid use remained popular among the white middle class—for supposed medical reasons, but by the turn of the century though, users who preferred injection became the stigmatized face of opiate addiction.
Stigma remains a critical issue in drug treatment, preventing users from accessing clean injection tools, uncontaminated opiates, information about safe injection practices, and life-saving overdose antidotes. Harm reduction efforts, like needle exchanges, have the potential to restore self-respect and autonomy to populations generally believed to lack these characteristics. Programs that provide work to formerly incarcerated individuals who have undergone drug treatment has been shown to reduce certain crimes, like robberies. Harm reduction communities also offer a space for drug users to empathize with and support each other, creating networks that bolster success.

Colorism and Divisions Among Black Women

Amber Joy Powell on April 3, 2016
Zoe Saldana, left, and Nine Simone, right. Image via ABC News Entertainment.
Zoe Saldana, left, and Nine Simone, right. Image via ABC News Entertainment.

Zoe Saldana’s portrayal of singer and activist Nina Simone in an upcoming biopic has proven controversial, even before the film’s premiere. In press photos, Saldana, a light-skinned woman of color, is clearly wearing dark makeup and a prosthetic nose to appear more like the late singer. Some argue using “blackface” in order to cast Saldana is particularly troubling considering Nina Simone’s own life-long dedication to encouraging the acceptance and embrace of dark skin tones. It also ignores the realities of colorism, which reproduces social inequalities and hierarchies among people of color.

Several studies address the benefits that accrue to light-skinned women. Employers, for example, often evaluate women applicants on physical attractiveness, regardless of job skills. This includes privileging physical features that suggest lighter-skinned women are friendlier and more intelligent. Lighter skin tones also make their female bearers more likely to marry spouses with higher incomes, report less perceived job discrimination, and earn a higher income. In schools, studies find that teachers expect their lighter-skinned students to display better behavior and higher intelligence than their darker peers, and public health research shows lower rates of mental and physical health problems among lighter-skinned blacks.
Colorism may provide socioeconomic, educational, and health benefits to light-skinned women, but it also challenges their identity as black women. Other blacks may perceive them as not “black enough,” assuming that they are more assimilated into white culture and lack awareness of black struggles. Those with lighter skin may feel isolated as members of their ethic group openly question their authenticity and belonging.

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.

Un-Making a Murderer Still Leaves a Mark

Ryan Larson on February 2, 2016
Innocence Project Stats
Click to visit the Innocence Project.

Netflix made a big splash in “true crime” with its series Making a Murderer, chronicling the investigations and trials of Wisconsin man Steven Avery. Exonerated after 18 years in prison for sexual assault in 2003, Avery was arrested for a new crime—murder—in 2007. Public debate about the documentary revolves around whether Avery’s innocent, potential misconduct in the justice system, and the ethics and consequences of documentary “vigilante justice,” but there is little doubt Avery was wrongfully convicted the first time around, in 1985. Social science helps us understand the more systematic consequences of incarceration and exoneration that cultural phenomena like Making a Murderer, the Serial podcast, and even the upcoming miniseries “The People v. O.J. Simpson: American Crime Story” bring to our attention.

Pop culture tends to focus on errors, like witness misidentification and shoddy forensics, but those are not the only things that lead to wrongful convictions. Sociological research shows blacks and Hispanics are at a higher risk, and these groups are, in fact, overrepresented in samples of exonerees. Black exonerees suffer longer periods of incarceration between their conviction and exoneration than other groups. And exonerations often raise questions about the criminal justice system’s authority and legitimacy in the eyes of the public.
Exonerees, even those who aren’t in a media spotlight, face practical problems after they are released from prison. The stigma of having served time diminishes chances in the employment and housing markets, even for those who are exonerated. Like others experiencing reentry after incarceration, exonerees also face unmet needs with regard to physical, dental, and mental healthcare, as well as the myriad challenges of rebuilding social networks and reintegrating to everyday life.

#MedicatedAndMighty: The Social Construction of Stigmatized Illness

Sarah Catherine Billups on November 26, 2015
Vicodin tablets photographed by frankieleon, Flickr CC.
Vicodin tablets photographed by frankieleon, Flickr CC.

In September, blogger Erin Jones posted a photo on Facebook that would spark a fight against the stigma of mental health and medication for it. Her hashtag #medicatedandmighty has inspired others who take prescription medication for depression, anxiety, and a host of other mental health needs to share their own photos and “come out.”

What makes it possible for the #MedicatedAndMighty to fight back against stigma in mental illness? Since doctors and researchers do not have complete monopoly over medical knowledge, the lay person (non-medical person) plays a role in constructing the meaning of mental illness. Patients’ lived experiences with an illness confirm or challenge expert knowledge, contributing to the continual shaping of the biomedical and cultural understandings of the condition.
Cultural meanings of illness shapes responses to them, making all mental illnesses socially constructed experiences . Claims-makers and interested parties, not just doctors and scientists, create medical knowledge—what makes an illness “real,” and what constitutes its symptoms, diagnosis, and treatment. Often, negative understandings of specific illnesses come from elite moral entrepreneurs whose elite socioeconomic status and moral legitimacy give them framing power.

Prescription Drug Use on the Rise

Caty Taborda on November 11, 2015
Taki Steve, Flickr CC.
Taki Steve, Flickr CC.

A study published earlier this month in the Journal of the American Medical Association (JAMA) reports that over half of adults in the United States use prescription drugs, and as many as 15% of adults report using more than five prescription drugs each month. Recent coverage of these findings at NPR explores how increases in obesity and obesity-related illnesses may contribute to the increase in prescription drug use. Several sociological studies provide other potential explanations, including the increasing influence that pharmaceutical companies have over the doctor-patient relationship.

Though physicians are the ultimate gatekeepers for prescription drugs, the pharmaceutical industry drastically shapes prescription drug use. Through internal research studies and trials, pharmaceutical companies produce new knowledge about illnesses and treatment options. Pharmaceutical companies can even play an increasing role in medicalization—the process of constructing issues as specifically medical problems. By promoting the idea that something is a medical problem, pharmaceutical companies then offer a solution. Pharmaceutical salespeople aggressively promote their wares to clinicians, even promoting the off-label use of drugs to increase distribution.
Direct-to-consumer advertising may also lead to increase prescription drug use. Patients who see such ads may be more likely to self-diagnose and directly request drugs, and patients who request medication (whether a specific drug or just drug treatment in general) are more likely to be prescribed medication. Despite the potential for over-prescribing, direct-to-consumer advertising also encourages positive interactions between patients and physicians by providing patients with more information about current and undiagnosed conditions.

Fantasy Sports and the Culture of Fandom

Evan Stewart and Alex Snidarich on October 29, 2015
Fantasy sports have gained coverage as a sport of their own.
Fantasy sports have gained coverage as a sport of their own.

You’ve probably seen more than an ad or two this fall for DraftKings or FanDuel, two massive online fantasy sports websites valued at over $1 billion each. Since 2009, the number of fantasy sports players has doubled, and, as of August, 56.8 million participated in the United States and Canada (according to the Fantasy Sports Trade Association). It’s not all fun and games, though. The New York Attorney general launched an investigation into these sites, and a recent feature in The New York Times highlights how deep the rabbit hole goes for illegal online gambling on fantasy sports. It is easy to focus on scandalous stories of crime rings, big winnings, and crushing losses, but these sites are not just about gaming the system. Sociologists emphasize that they are also powerful social communities driven by cultures of masculinity and fandom.

Eric Leifer argues that the history of sports fandom in the U.S. is place- and team-based—fans supported the team in their town or region as a marker of community membership. Fantasy leagues and social media challenged this by shifting the focus from entire teams to individual athletes’ performance.
Sociologists, especially, focus on the racialized and gendered nature of sport-based communities. Members often forge strong social ties in male-dominated spaces that emphasize knowledge and expertise, and the groups can privilege racial stereotypes and racialized assumptions about athletic performance.
Fantasy sites (and the betting that ensues on them) are in line with other case studies that show how online socialization is not “less real” or consequential than offline social interaction—both teach everything from harmless play to deviant behavior. We see the power of online interaction in everything from hackers developing their own open-source political theory to online peers teaching others how to download music for free and sport message boards reinforcing racial stereotypes.
Of course, gambling is tied up in these social structures. While American society has “medicalized” compulsive gambling, treating it as an individual and treatable problem, more recent work shows how social environments create what gamblers want most: a chance to be in the “zone” and play for long periods of time. The strong communal aspect of fantasy sports websites makes them a perfect space for sustained play.

#ShoutYourAbortion Shouts Back at Stigma

Amber Powell and Jacqui Frost on October 26, 2015
Twitter screenshot.
Twitter screenshot.

In the ongoing battles around whether to defund Planned Parenthood, Lindy West and Amelia Bonow created the Twitter hashtag #ShoutYourAbortion to encourage women to share their abortion stories, express their experiences, and recognize the stigma that often silences women who have an abortion. Consequently, many have criticized the hashtag and attacked the women involved. Supporters of #ShoutYourAbortion argue that sharing real women’s stories on social media produces cultural change around an issue surrounded by legal rhetoric. Sociological research details why women have generally felt compelled to stay silent about having abortions and the potential benefits of speaking up.

Many women believe that disclosing their abortion experiences will lead to negative responses from relatives and friends, due to widely held norms of femininity and motherhood that assert women are “natural nurturers” and the idea that having an abortion negates those qualities. In a classic study of pro-life and pro-choice activists, Kristin Luker notes that abortion is often seen as a “referendum on the place and meaning of motherhood.” For pro-life activists, terminating a pregnancy may be the ultimate example of being a “bad mother.” Rather than face anticipated judgment and condemnation around moral codes of appropriate feminine behavior, women then choose to conceal their procedures.
A major source of stress and frustration women experience centers on the gendered imbalance of responsibility for contraception and abortion decisions. Research finds that women are often expected be responsible for providing or taking contraception, but are heavily criticized when they take responsibility by choosing to have an abortion. Thus, Sally Brown argues, where women are held responsible for reproductive decisions, “decision making, if ‘decisions’ happen at all, is bound up with notions of hegemonic masculine and feminine roles.”
Stigma, however, does not reduce the likelihood that a woman will have an abortion. Cockrill and Nack write that even women who “believe abortion is morally wrong and that women who have abortions are careless and irresponsible will still have abortions.” Instead, the primary consequences of abortion stigma are decreased mental and physical health, strained relationships, and loss of social status. Spaces of affirmation and support like the #ShoutYourAbortion campaign allow women to engage in “collective stigma management,” offering a supportive network where their public presence can work to change social attitudes and shatter the silence surrounding abortion experiences.