health

The recent Hobby Lobby, and subsequent Wheaton College, Supreme Court rulings that exclude organizations with “sincere religious objections” from the Affordable Care Act’s birth control mandate have raised a plethora of fears and heated commentary about access to birth control, women’s rights, and the slippery slope of religious exemption. Sociological research, however, suggests that this ruling’s infringement on access to reproductive services and women’s rights is far from straightforward.

The language of birth control mandates varies by state, and the more ambiguously worded the mandate, the less likely there is to be a challenge. Instead, it is the more precisely worded statutes that have prompted court cases, as they allow for less interpretation and compromise.

• Rachel VanSickle-Ward and Amanda Hollis-Brusky. 2013. “An (Un)clear Conscience Clause: The Causes and Consequences of Statutory Ambiguity in State Contraceptive Mandates.” Journal of Health Politics, Policy and Law 38(4).

The moral framing of religious exemption cases is key to making them effective. When actors frame an issue in moral terms, as opposed to scientific or technical, their arguments are usually too divisive to be completely adopted, however, they are often able to thwart their opponents by defining an issue in ways that make it difficult for legislators to support progressive causes.

• Gene Burns. 2005. The Moral Veto: Framing Contraception, Abortion, and Cultural Pluralism in the United States. Cambridge University Press.

A woman’s access to birth control is not only influenced by her insurance policy or the religion of her employer. Race, class, and cultural understandings of what it means to be a “responsible reproductive subject” all play a role in why women seek reproductive services such as birth control, infertility treatment, and abortion, as well as which services they are more likely to have access to.

• Leslie King and Madonna Harrington Meyer. 1997. “The Politics of Reproductive Benefits: U.S. Insurance Coverage of Contraceptive and Infertility Treatments.” Gender and Society 11(1).
• Kara Granzow. 2007. “De-Constructing ‘Choice’: The Social Imperative and Women’s Use of the Birth Control Pill.” Culture, Health & Sexuality 9(1).

For more on the Hobby Lobby decision and the history of birth control in the U.S., check out these great pieces by fellow sociology bloggers families as they really are and Girl w/ Pen.

Eric Shinseki resigned last Friday as head of the Department of Veterans Affairs, stating that “the VA needs new leadership”. This comes in the wake of scheduling issues at VA medical centers leading to extended delays for veterans’ healthcare—issues he now recognizes as a “systemic lack of integrity” involving a widespread cover-up. According to a new VA audit report prompted by a series of CNN investigations, deadly delays in care were being suppressed by clinics driven to meet performance targets. The VA report concluded that the 14-day wait time performance target was “simply not attainable,” and it called for a “long-term, comprehensive reset” of the broken system. While  Shinseki acknowledges these problems, how reasonable is it to expect his successor to fix them? Research shows that scheduling issues are only one barrier among many to veterans’ accessing care.

When predicting which people will seek care, sociologists take into account patients’ prior experiences with the system such as health outcomes and customer satisfaction. Poor service doesn’t just hurt the veterans who seek care—it may keep them from seeking care in the first place!

• Ronald M. Andersen, 1995.  “Revisiting the behavioral model and access to medical care: does it matter?.” Journal of health and social behavior 36(1): 1-10.

Some veterans are eligible for both Medicaid and VA services. The largest group of these vets relies on Medicaid rather than VA care or a combination of the two.

• Denise M. Hynes, Kristin Koelling, Kevin Stroupe, et al. 2007. Veterans’ access to and use of Medicare and Veterans Affairs health care. Medical care, 45(3): 214-223.

Issues with gender in the military also have an effect. Female veterans have less access to VA healthcare relative to males, with 19% of women reporting delayed health care or unmet needs. Knowledge gaps about VA care, perceptions that providers are not gender-sensitive, and a history of military sexual assault predicted women’s likelihood to delay or forgo treatment.

• Donna L. Washington, Bevanne Bean-Mayberry, Deborah Riopelle, and Elizabeth M. Yano. 2011. “Access to care for women veterans: delayed healthcare and unmet need.”Journal of general internal medicine 26(2): 655-661.

Mila Kunis recently announced that she will be giving birth naturally, saying “I did this to myself – I might as well do it right.” By “natural,” Kunis means that she will be using a midwife when she gives birth and opting out of the hospitalized, medically-induced birthing experience that dominates in American society today. Kunis is just one, albeit highly publicized, instance in a larger move away from the hospitalized birthing experience to “home birth.” However, this shift is not without its conflicts, and Kunis’ statement that natural birth is “doing it right” points to deeper societal perceptions of the right way to give birth and how those perceptions of what is “natural” might be changing.

The media often frames this increase in home births as potentially dangerous and problematic, but women were giving birth at home long before they started going to hospitals. The medicalized model of childbirth is a fairly recent product of a larger shift in societal acceptance of professional science over local knowledge.

• Charlotte Borst. 1995. Catching Babies: The Professionalization of Childbirth, 1870-1920. Cambridge, MA: Harvard University Press.
• Robbie E. Davis-Floyd. 2003. Birth as an American Rite of Passage. 2nd ed. Berkeley, CA: University of California Press.

This “medicalization of childbirth” has huge impacts on how society, and women themselves, see women’s bodies and safety. Sociologists argue that this increased medical monitoring during pregnancy is a form of social control that constrains women both physically and emotionally.

• Katherine Beckett and Bruce Hoffman. 2005. “Challenging Medicine: Law, Resistance, and the Cultural Politics of Childbirth.” Law and Society Review 39(1): 125-170
• Kerreen Reiger and Rhea Dempsey. 2006. “Performing Birth in a Culture of Fear: An Embodied Crisis of Late Modernity.” Health Sociology Review 15(4).
• Karin Martin. 2003. “Giving Birth Like a Girl.” Gender and Society 17(1): 54-72.

For a great history of homebirth and the reproductive rights movement, check out Christa Craven’s 2010 book Pushing for Midwives: Homebirth Mothers and the Reproductive Rights Movement.

The Food and Drug Administration recently proposed a slew of changes to the nutrition labels on packaged foods. The first to be made in over 20 years, these changes will include placing a bigger emphasis on total calories and added sugars as well as highlighting certain nutrients, such as Vitamin D and potassium. They are also proposing to make changes to the serving size requirements, making them more “realistic” about what portions of a product people actually consume in a single sitting. The purported goal of these changes is to help consumers “make healthy food choices”, but sociologists show that these choices are not necessarily available to everyone.

The media, as well as most consumers, see diet and eating habits as a personal choice. However, research shows that not all consumers are financially, or even geographically, able to make conscientious decisions about the calories they consume.

• Flis Henwood, Roma Harris, and Philippa Spoel. 2011. “Informing Health? Negotiating the Logics of Choice and Care in Everyday Practices of ‘Healthy Living.’” Social Science & Medicine 72(12): 2026-2032
• Mark Winne. 2008. Closing the Food Gap: Resetting the Table in the Land of Plenty. Beacon Press.

The choices made at the federal level about dietary guidelines and labeling are not just about making sure we all get the right amount of Vitamin D. The food industry is a profit-making business just like any other, and its influence on government nutrition policies runs deep.

• Marion Nestle. 2003. Food Politics: How the Food Industry Influences Nutrition and Health. Berkeley: University Of California Press.

The media coverage of this proposal is largely positive, framing it as a step towards curbing America’s “obesity epidemic”. This kind of media coverage furthers the intense stigmatization of obese people and reinforces norms that equate thinness with moral virtue and social worthiness.

• Abigail Saguy and Kjerstin Gruys. 2010. “Morality and Health: News Media Constructions of Overweight and Eating Disorders.” Social Problems 57(2): 231-250.
• Margaret Mead. 1971. “Why Do We Overeat?” in Food and Culture: A Reader. 2013. Carole Counihan and Penny Van Esterik (eds). Routledge.

For more on culture and obesity, check out Abigail Saguy’s “Office Hours” interview where she discusses her book What’s Wrong with Fat?

As e-cigarettes are fairly new to the market, there is little research on their long-term effects, but their recent popularity has sparked debates about their use and regulation—are they healthier than combustible tobacco, should they have the same restrictions in terms of age and public use, and are they a “gateway” to real tobacco for teen smokers? While a majority of the e-cigarette conversation focuses on whether they are better for you, the desire for healthy lungs is not the only factor contributing to these debates. The e-cigarette debates are the newest chapter in a long history of substance use regulation that is as much about social stigma as public health.

These debates are also influenced by social factors such as unemployment, youth populations, political battles for and against government regulation, and a much broader, but more subtle, process of stigmatization when cigarette smoking— which was once perfectly acceptable in society—slowly slides out of favor.

• Randall Collins. 2004. “Tobacco Ritual and Anti-Ritual” in Interaction Ritual Chains. Princeton: Princeton University Press
• Mike Vuolo. 2012. “Placing Deviance in a Legal and Local Context: A Multilevel Analysis of Cigarette Use in the European Union.” Social Forces Vol.90(4), p.1377-1402

As smoking loses favor in public opinion, so do smokers. While these debates are about health on the surface, the underlying message to smokers is that they are deviant. Research has found that smoking, and substance use in general, occurs in higher numbers among lower income and minority groups, revealing much deeper power dynamics influencing smoking policy and the public image of smokers.

• Justin Tuggle and Malcolm Holmes. 1997. “Blowing Smoke: Status Politics and the Shasta County Smoking Ban.” Deviant Behavior Vol.18(1), p.77-93
• Kellie Barr et al. 1993. “Race, Class, and Gender Differences in Substance Abuse: Evidence of Middle-class/Underclass Polarization among Black Males.” Social Problems Vol.40(3), pp.314-327

Controversy continues to rage over the alleged “job-killing” effects of the Affordable Care Act and potential increases in the federal minimum wage. Kathleen Sebelius recently weighed in on the Congressional Budget Office’s report about the ACA, reminding us that the CBO’s “2 million jobs lost by 2017” figure comes from Americans cutting their work hours, not employers cutting their jobs to cover healthcare costs. With a new poll showing Americans think the job market is the number-one problem today, however, why would we see these trends? The ACA and a higher minimum wage may not be a job-killers—instead they remind us that employees can demand better working conditions.

We shouldn’t necessarily think of coverage programs in terms of “jobs lost.” Instead, giving employees affordable health coverage may actually free them from “job lock.” Economic research shows that benefit programs can give low-income workers the security and potential mobility to seek out better jobs.

• Cynthia Bansak and Steven Raphael. 2008. “The state children’s health insurance program and job mobility: Identifying job lock among working parents in near-poor households.” Industrial and Labor Relations Review 61(4): 564-579

While benefits can give employees the opportunity to quit, organizational characteristics like group job satisfaction and flexibility in the workplace also affect the likelihood that employees will want to quit.

• Phyllis Moen, Erin Kelly, and Rachelle Hill. 2011. “Does enhancing work-time control and flexibility reduce turnover? A naturally occurring experiment.” Social problems 58(1): 69-98.
• Kimberly Jinnett and Jeffrey Alan Alexander. 1999. “The influence of organizational context on quitting intention an examination of treatment staff in long-term mental health care settings.” Research on Aging 21(2): 176-204.

The recent death of Philip Seymour Hoffman has highlighted the resurgence of heroin use and overdoses in the US. Heroin use doubled between 2007 and 2012. Between 2006 and 2010, there was also a 45% increase in lethal overdoses, up to more than 3,000 deaths per year. The death toll continues to grow, and includes more than 80 deaths over the past few weeks as a result of heroin laced with fentanyl.

The rise in heroin use may be linked with the prevalent use of oxycontin and other opiate-based prescription drugs. The crackdown on illicit use of prescription opiates makes them more expensive, and more users have turned to heroin.

• Pradip K. Muhuri, Joseph C. Gfroerer, and M. Christine Davies. 2013. “Associations of Nonmedical Pain Reliever Use and Initiation of Heroin Use in the United States.” Center for Behavioral Health Statistics and Quality. Rockville, MD: Substance Abuse and Mental Health Services Administration.
• April Young and Jennifer Havens. 2012. “Transition from first illicit drug use to first injection drug use among rural Appalachian drug users: a cross-sectional comparison and retrospective survival analysis.” Addiction 107(3): 587-596.

Anti-drug campaigns and moral panics in the media may actually have the unintended effect of promoting, not reducing, substance abuse. In fact, a minority of interviewed users reported seeking out the stronger batches of heroin reported in the media.

• Craig Reinarman and Harry Levine. 1997. “The Crack Attack: Politics and Media in the Crack Scare.” In Crack in America. Berkeley, CA: University of California Press.
• Thomas Kerr, Will Small, Elaine Hyshka, Lisa Maher, and Kate Shannon. 2013. “’It’s more about the heroin’: injection drug users’ response to an overdose warning campaign in a Canadian setting.” Addiction 108(7): 1270-1276.
• Peter Miller. 2007. “Media reports of heroin overdose spates: Public health messages, moral panics or risk advertisements?” Critical Public Health 17(2): 113-121.

Solutions to these problems often focus more on treatment and harm-reduction than tough enforcement of drug laws.

• Teresa Gowan, Sarah Whetstone, and Tanja Andic. 2012. “Addiction, agency, and the politics of self-control: Doing harm reduction in a heroin users’ group.” Social Science & Medicine. 74(8): 1251-1260.

For more on harm-reduction approaches, see this recent Public Criminology post.

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In an ongoing effort to decrease HIV and AIDS globally, The Gates Foundation recently announced 11 winners of $100,000 grants meant to innovate a “new generation of condom”—to create a product that is more effective in preventing disease and pregnancy, as well as more enjoyable to promote its use. However, what may get lost in the shuffle of competition and punny condom names is the fact that bad condoms are not the only factor contributing to unprotected sex and the spread of STDs.

A focus on the individual behavior of condom use often misses the social conditions which make individuals vulnerable to disease.

• Bruce Link and Jo Phelan. 1995. “Social Conditions as Fundamental Causes of Disease”. Journal of Health and Social Behavior. 35: 80-94.

While there is a shortage of condom availability in the global south, unprotected sex is not just a result of low supply; low demand plays a role as well.

• Jacqueline Papo et al. 2011. “Exploring the Condom Gap: Is Supply or Demand the Limiting Factor – Condom Access and Use in an Urban and a Rural Setting in Kilifi District, Kenya”. AIDS. 25(2): 247-255.

Relying solely on condom use for STD prevention also fails to consider gender roles and sexual power dynamics in different cultures. Often, women are not able to negotiate the terms of sex – or sex in general – and face unequal access to care.

• Campbell, Carol. 1999. Women, Families and HIV/AIDS: A Sociological Perspective on the Epidemic in America. Cambridge: Cambridge University Press
• F. Nii-Amoo Dodoo and Maria Tempenis. 2002. “Gender, Power, and Reproduction: Rural‐Urban Differences in the Relationship Between Fertility Goals and Contraceptive Use in Kenya” Rural Sociology. 67(1):46-70.

Why would people experiencing homelessness refuse shelters in some cases? They are often trapped between policies which treat them as criminals for making their own shelter and sick if they seek help.

After rising steadily over the past decade, suicides across the military have dropped by more than 22% this year. Military suicides began rising in 2006, reaching their highest record in 2009 before leveling off for two years. Defense officials have launched increased efforts to eliminate the stigma of getting help, but are still unsure about what exactly prompts soldiers to take their own lives. While this drop in suicide will be a relief to some, there is no indication whether this is a trend or a one-year anomaly.

Suicidal thoughts among Iraq and Afghanistan war veterans have been associated with a range of family concerns, strains of leaving for deployment, depression, and direct effects of war such as post traumatic stress disorder (PTSD). However, perceived social support can help with these effects.

• Martha Bruce. 2010. “Suicide risk and prevention in veteran populations.” Annals of the New York Academy of Sciences 1208(1):98-103.

However, the socio-cultural environment is also a crucial element in understanding military suicide. It can act as a cause through the military’s fatalistic masculinity ideology by internalizing individual problems, but also as a solution when soldiers perceive social support for dealing with their strain.

• Chad Lemaire and David Graham. 2011. “Factors associated with suicidal ideation in OEF/OIF veterans.” Journal of Affective Disorders 130(1):231-238.
• Harold Braswell and Howard Kushner. 2012. “Suicide, social integration, and masculinity in the US military.” Social Science & Medicine 74(4):530-536.