health

For the first time since 2006, the Census finds a .5 percentage drop in the poverty rate, with children and Hispanics seeing the biggest declines. Before taking these encouraging statistics at face value, it is important to put them into context. Briefs produced by the Stanford Center on Poverty and Equality and the Center for American Progress outline important factors that often get ignored when focusing on the poverty rate alone, including the consistent struggle for young adults and minorities to find work and the ever-increasing working poor that often get left out of the poverty conversation entirely.

The high poverty rate among young adults is cause for concern. Experiencing poverty in early adulthood has been found to hinder future earnings, especially within minority populations. Young people may stay hungry if our definition of poverty doesn’t grow up with them.

• Andre Mizell. 2000. “Racial and Gender Variations in the Process Shaping Earnings’ Potential: The Consequences of Poverty in Early Adulthood.” Sociology & Social Welfare 27(2).

While the poverty rate may have dropped slightly, this is largely due to the increase in the working poor. Millions of families are trapped in the middle, earning just enough to be considered above the poverty line but making far from enough to be considered economically secure. Poverty among working adults is linked to a broader decline in labor unions.

• David Brady, Regina S. Baker, and Ryan Finnigan. 2013. “When Unionizations Disappears: State-Level Unionization and Working Poverty in the United States.” American Sociological Review 78(5).

Most of the discussion around the poverty rate centers on what David Cotter calls “person poverty” as opposed to “place poverty.” In his analysis of Census data, Cotter finds that, regardless of any individual characteristic, households in rural America are more likely to experience poverty than their metropolitan counterparts.

• David Cotter. 2002. “Poor People in Poor Places: Local Opportunity Structures and Household Poverty.” Rural Sociology 67(4).

Our partner Scholars Strategy Network has tons of great briefs on this issue, including this one on the need for a more comprehensive measure of poverty.

Flipping burgers at McDonald’s is the iconic dead-end job of the U.S. service economy with low-wages, few benefits and certainly no labor unions. But now a national movement of fast-food and other low-paid workers is growing and organizing to improve working conditions. In the past two years there have been seven national fast-food strikes, which reflect a broader resurgence in the U.S. labor movement and new forms of social mobilization from Occupy Wall Street to the Walmart Black Friday strikes. These recent protests have mobilized often marginalized communities in ways that question the service economy model based on cheap non-unionized labor.

Service work, and fast-food in particular, is a growing sector of employment that is indicative of larger trends in the U.S. economy towards contingent, temporary employment and low wages. Violations of workplace laws like mandatory overtime and minimum wage are part of corporate cost-cutting and common in low-wage industries, and unionization could help give workers power to resist these practices.

• Annette Bernhardt, Michael W. Spiller, and Diana Polson. 2013. “All Work and No Pay: Violations of Employment and Labor Laws in Chicago, Los Angeles and New York City.” Social Forces 91(3):725–46.

This revitalized labor movement is also mobilizing women, people of color and immigrants who were largely left out of the traditional craft and industrial unions.

• Ruth Milkman. 2006. L.A. Story : Immigrant Workers and the Future of the U.S. Labor Movement. New York: Russell Sage Foundation.

Broader decline of unionization and decrease in the minimum wage has contributed to rising income inequality, and so attempts to organize low-wage workers could help all U.S. workers and reduce this inequality. Union membership provides a wage boost for workers, especially women, people of color and those with less education.

• Bruce Western and Jake Rosenfeld. 2011. “Unions, Norms, and the Rise in U.S. Wage Inequality.” American Sociological Review 76(4):513–37.
• Jake Rosenfeld and Meredith Kleykamp. 2012. “Organized Labor and Racial Wage Inequality in the United States.” American Journal of Sociology 117(5):1460–1502.

For more on the inclusive power of unions, check out this Girl w/Pen! post.

While President Obama is hosting an economic summit with African leaders this week, the Ebola outbreak is overshadowing major economic news. Experts argue that the epidemic can be curbed, but note rampant distrust toward aid organizations in rural communities makes treatment and prevention difficult. Social scientific research helps explain how media and governments shape the way citizens respond to outbreaks.

We usually think media fans the flames of mass panic, but research on previous Ebola shows media sources actually turn toward a “containment” narrative, emphasizing that it’s hard to catch Ebola and the outbreak is “somewhere else.”

• Sheldon Ungar. 1998. “Hot Crises and Media Reassurance: A Comparison of Emerging Diseases and Ebola Zaire.” The British Journal of Sociology. 49(1): 36-56

It isn’t that local communities “don’t understand” that aid workers are there to help. Epidemics often manufacture misunderstandings and mass panic. Recently, in New York City’s Chinatown, Asians were “stigmatized during the SARS epidemic despite having no SARS cases.”

• Laura Eichelberger. 2007. “SARS and New York’s Chinatown: The Politics of Risk and Blame During an Epidemic of Fear.” Social Science and Medicine. 65(6): 1284–1295

Political context also matters, including the actions of national governments and international NGOs. Comparative work on Uganda and South Africa’s approaches to HIV/AIDS has shown top-down strategies don’t calm the infection rate. Bottom-up approaches, like changing hygiene behaviors, are more effective at the local level. However, this tactic requires an environment of “representation and democratic participation” that governments and international organizations have to build and frame.

• Justin O. Parkhurst and Louisiana Lush. 2004. “The Political Environment of HIV: Lessons from a Comparison of Uganda and South Africa.” Social Science and Medicine. 59(9): 1913–1924
• Yu-Ju Chien. 2013. “How Did International Agencies Perceive the Avian Influenza Problem? The adoption and manufacture of the ‘One World, One Health’ framework.” Sociology of Health and Illness. 35(2): 213–226

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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