health

Black Women and Health Disparities

Amy August and De Andre’ T. Beadle on April 18, 2019
Photo of a Black mother cuddling her newborn baby
Photo by Bonnie U. Gruenberg, Wikimedia CC

“When the medical profession systematically denies the existence of black women’s pain, underdiagnoses our pain, refuses to alleviate or treat our pain, healthcare marks us as incompetent bureaucratic subjects. Then it serves us accordingly.”

So writes sociologist Tressie McMillan Cottom, reflecting on her experiences of medical neglect during pregnancy that ultimately led to the loss of her child. Thick, Cottom’s recently published collection of essays, brings to life intimate portraits and sociological analyses of black women’s issues. It has been widely acclaimed by the Chicago Tribune, The New York Times, NPR, The Daily Show, and has set Black Twitter and Academic Twitter abuzz. With Black women’s health in the spotlight, it’s helpful to reflect on what sociologists already know about medicine and wellness at the intersections of race and gender.

In the United States, racial disparities in health are severe. Black mortality is higher than white mortality, and nationally, there has been no sustained decrease in black-white inequalities in mortality or life expectancy at birth since 1945.
Racism is itself a public health concern. Those who experience racism are more likely to suffer from chronic conditions and disability and to rate their physical health as poor. Racism is linked to poorer mental health as well, with conditions like depression and anxiety more common among those experiencing discrimination. This is particularly problematic for members of racial-ethnic minority groups who have mental health problems as they are likely to suffer discrimination effects on the basis of both characteristics. As discrimination may lead to poverty and social isolation, it can negatively impact help seeking, service use and treatment outcomes. Yet these adverse consequences are thoroughly preventable. In order to identify, anticipate, prevent, manage, and remedy such adverse outcomes, it is important for health service providers to understand racism as an ethical issue. By framing racism as the cause of preventable harmful consequences, many hope to reframe racism as an ethical issue for health service providers to address.
Black Americans tend to experience poorer health outcomes than whites when factors such as age and socioeconomic status are taken into account, but the race gap is even wider among women. For example, according to the Centers for Disease Control, black women are more than three times as likely to die while pregnant or within a year of pregnancy due to causes related to pregnancy or its management. The shockingly high maternal mortality rate for black women is the primary reason that the overall U.S. rate has risen by 250% in the past quarter century.  
Race, class, and gender are interlocking systems of oppression that help explain maternal health inequalities. While other groups may experience some of these dimensions of oppression — for instance white women are penalized by their gender, but privileged because of their race — black women experience oppression on all three of these dimensions.

Autism Across Cultures

Isabel Arriagada and Amy August on April 2, 2019
Photo of two hands holding a paper that says "I Like Being Autistic Because"
Photo by Walk InRed, Flickr CC

In 2007, the United Nations General Assembly designated April 2nd as World Autism Awareness Day. This community-wide event promotes the recognition and raises awareness about Autism Spectrum Disorder (ASD). The celebration brings individuals with autism and grassroots organizations together to connect and to promote appreciation for people with autism. Despite increasing awareness, the causes of ASD remain a puzzle. While scientific approaches consider it to be a developmental disorder associated with genetic or environmental factors, recent studies in social science illustrate how cultures themselves vary in their perception of both autism and other neurological differences.

The prevalence of autism has grown in past decades in North America.  Explanations of this trend point out to an increase in the prevalence of ASD, a broadening spectrum of autism diagnoses, and declining stigma that promotes recognition and acceptance of the condition. Sociologists have also suggested that this may be because parents, psychologists, and therapists have created alliances, using their expertise to develop a new system of institutions for approaching autism.
Regarding the causes of ASD per se, early scientific theories indicated that the condition was associated with genetic alterations, but social science studies have emphasized the role of environmental factors. Further, cultural factors across the world can also shape how people understand autism in the first place.
Both the description and diagnosis of the ASD depend on historical factors and vary across nations. In Korea, children with autism and their families experience profound stigma, especially the mother — who is considered to be responsible for her child’s condition. Since in Korea parents gain social respect based on the behavior of their children, having a child with autism constitutes a signal of defective parenting. On the other hand, in Nicaragua, there is an emergent culture around autism that encourages teachers and communities to create a supportive environment. However, both cultures still see autistic children as suffering with a disability. Both stances contrast with new ideas about neurodiversity that strive to create a new place for autism in larger socio-cultural contexts.
Somali immigrants call autism the “Western disease” because there is no word for autism in the Somali language and because many believe it does not exist in Somalia. Somali parents accuse the Western diet and medical environment in North America for the condition of their children. Their testimonies have not only opened possibilities to explore new scientific hypotheses regarding the environmental causes of autism, but also to reveal the power dynamics and struggles involved in validating different perspectives and narratives about the condition.  

Contemporary educational programs in the United States are now more aware of the importance of highlighting the strengths rather than the deficits of students with autism. They also recognize that accommodation and acceptance of autism is as important as finding its genetic and neurological causes.

“That’s Not Funny!” Social Context and Humor

Allison Nobles on April 1, 2019
Three women laughing side by side
Photo by Marc Kjerland, Flickr CC
It may be April Fools Day, but the sociology of humor is no joke! Social science research demonstrates that humor reflects societal conditions and can be important for social cohesion. For example, “inside jokes” — shared references between members of a group — promote social cohesion and ensure the group continues to exist by reminding members of the group’s shared history and their social ties to each other.
Women tend to use cohesion-building humor — treating the audience as a cohesive unit — and women rarely make jokes when men are present. Men, on the other hand, tend to use differentiating humor — calling out specific members of their audience and building hierarchies. In other words, using differentiating humor challenges the sense that “we’re all in this together” and instead point out distinctions between group members. Thus, humor can be viewed as a wedge or glue depending on who is using it.
Humor can also reveal cultural tensions in particular times and places. For instance, in Malawi “AIDS humor” reflects the huge shadow cast by the disease over everyday life. For instance, many jokes play on the multiple meanings of “to give” — relationships are often a place of expected exchange, but have also become a key location for the spread of HIV. One cartoon includes the picture of a man kneeling beside a woman saying, “well, you asked me for a romantic present — I’ve just given you AIDs, girl.” While many outsiders would not view these jokes as funny, AIDS is sometimes funny to those in Malawi because it touches the lives of those reading and listening to the jokes.

The next time you tell a joke, consider how you’re responding to a particular social context or situation and whether your humor is pointing out distinctions or bringing people together.

Reconstructing Identity after a Brain Injury

Allison Nobles on March 28, 2019
Woman with hand on forehead and eyes closed
Photo by jill, jellidonut… whatever, Flickr CC

We’re hearing more and more about the dangers of brain injuries, especially in sports. While the physical nature of these injuries often take the forefront, brain injury survivors must also deal with the emotional and social repercussions of their injuries. To mark Brain Injury Awareness month, we delve into social science research on how recovery from a brain injury involves changes to identity, social relationships, and everyday routines.

Post-injury, brain injury survivors must learn to adapt to the changes their injury caused — this could mean relearning how to walk or eat, learning to rely on others for help, and taking more breaks during the day. With these changes to daily life, many survivors believe their identities change too — and they must construct or reconstruct a new version of themselves. And while they retain aspects of their old selves, many survivors view their new identities as separate pieces. For example, brain injury survivors may distinguish between their new “brain injured self,” an “old self,” and a self that does “meaningful” activities, like parenting, helping others, paid work, art, or gardening. The process of healing and therefore the process of constructing a new self is not linear — like riding a rollercoaster, survivors get better for a while and then backtrack, then getter better, and so on. Consequently, a large part of accepting a new self also involves accepting an unpredictable future.

The Pervasive Problem of Intimate Partner Violence

Mark Lee on March 11, 2019

Photo of marchers holding a sign that reads, “choose respect.” Photo by Office of Governor Sean Parnell, Flickr CC

Audiences are re-living one of America’s most infamous cases of intimate partner violence (IPV) with Jordan Peele’s recent documentary about Lorena Bobbitt, who retaliated against her husband John after years of alleged abuse. While the Bobbitt case is unique, the issue is common. The Centers for Disease Control and Prevention estimate that 1 in 4 women and 1 in 7 men in the United States have experienced severe physical violence by an intimate partner. Tabloid exposés of such cases highlight personal details of the individuals involved. By contrast, sociological perspectives on IPV uncover the structural conditions that make it such a pervasive problem.

Sociologists began studying violence between spouses in the 1970s, particularly violence against women. Feminist scholars, drawing from interviews with victims in women’s shelters, focused on women’s experiences as targets or victims. They believed that IPV’s root causes were the patriarchal norms and laws that defined wives as their husbands’ property. Other survey researchers found that men were also likely to be targets of IPV — sometimes at rates as high as those for women.  They considered IPV a special case of violence in the home, but similar to child or elder abuse in its determinants: stress, social isolation, and intergenerational histories of family violence. Although the question of gender differences in IPV remains controversial, contemporary research does not necessarily see these perspectives as competing, but rather as describing two or more different types of IPV, such as “patriarchal terrorism” versus “common couple violence.”
Victims of IPV often suffer severe consequences. Violence damages physical and mental health, leading to injury, chronic pain, depression, sexually transmitted disease, and post traumatic stress disorder. Beyond these individual effects, the negative impact of abuse spills over into other areas. In some cities, landlords are penalized if the police are called to their property too often. Because of this, female renters who report domestic violence are considered a liability and often face eviction. Trouble at home also follows many women to work in the form of stalking and harassment. IPV victims miss work more frequently than their peers because of injury and distress, which results in lower productivity and higher job turnover.
Eradicating IPV across the world is a major focus of human rights organizations, but a big obstacle to changing behaviors remains: the continuing social acceptance of physical violence against wives in some areas. A recent international survey found that support for a husband hitting his wife varies widely across countries, but tends to be greatest in places where gender inequality is relatively high. Within a given country, the most marginalized people (rural, lowest wealth quintile, least education) are generally the most likely to support IPV. The good news is that these attitudes are changing. In nearly every country where data are available, support for IPV has declined since the 1990s. This trend parallels an increasing number of policies banning violence against women in recent decades.

This research shows how intimate partner violence affects both men and women, though women tend to experience more severe and persistent abuse in the United States and internationally. Undoing this social problem will require structural change in the way societies construct gender norms and how institutions respond to victims. In the meantime, some resources for abuse victims can be found here.

Bias and Transgender Personnel in the U.S. Military

Lucas Lynch on March 8, 2019

Photo by Ted Eytan, Flickr CC

In 2016, the Obama administration began to allow transgender military personnel to openly affirm their gender identity without fear of being separated, discharged, or denied reenlistment. Recently, however, President Trump and the United States Supreme Court instituted a ban on openly transgender personnel serving in the military. Among these are troops that have multiple deployments, extensive combat experience, and are highly decorated. Though President Trump asserted that transgender personnel affect military readiness, top military leaders did not support this determination. Additionally, projected healthcare costs for these personnel — another reason stated by Trump for the ban — have been found to be minimal, given the small size of this population. Sociological research sheds light on troops’ attitudes towards transgender personnel, and addresses misconceptions about the effects of transgender personnel on military readiness.

One study at a premier military academy revealed that most concerns about the integration of transgender personnel in the military included items such as privacy (bathrooms, showers, living arrangements), how to gauge male and female physical fitness standards for transgender personnel, and costs of hormones or surgeries for transitioning soldiers. Another study suggests that overall, cadets (both ROTC and military academy) and civilian undergraduates do not believe working with transgender people would affect their ability to do their jobs. However, nearly half of academy cadets agree with barring transgender people from military service, while smaller percentages of undergraduates and ROTC cadets hold this opinion.
In another study, survey responses of active and veteran military students revealed relative support for transgender men and women in the military. Both deployment to a combat zone and being in an infantry combat position led to supportive attitudes towards transgender military personnel. However, a noteworthy number of participants also expressed stark bias and prejudice towards transgender individuals in the military.
President Trump tweeted once that “our military . . . cannot be burdened with the tremendous medical costs and disruption that transgender in the military would entail.” As scholars have shown, however, the effects on both health costs and military readiness would be indeed negligible.

Best of 2019: Unearthing Black Women’s Early Contributions to Sociology

Amber Joy Powell and Caity Curry on February 28, 2019

Photo of a plaque commemorating Ida B. Wells. Photo by Adam Jones, Flickr CC

As Black History month draws to a close, it’s important to celebrate the work of Black scholars that contributed to social science research. Although the discipline has begun to recognize the foundational work of scholars like W.E.B. DuBois, academia largely excluded Black women from public intellectual space until the mid-20th century. Yet, as Patricia Hill Collins reminds us, they leave contemporary sociologists with a a long and rich intellectual legacy. This week we celebrate the (often forgotten) Black women who continue to inspire sociological studies regarding Black feminist thought, critical race theory, and methodology.

Ida B. Wells (1862-1931) was a pioneering social analyst and activist who wrote and protested against many forms of racism and sexism during the late 19th and early 20th century. She protested Jim Crow segregation laws, founded a Black women’s suffrage movement, and became one of the founding members of the NAACP. But Wells is best-known for her work on lynchings and her international anti-lynching campaign. While Wells is most commonly envisioned as a journalist by trade, much of her work has inspired sociological research. This is especially true for her most famous works on lynchings, Southern Horrors (1892) and The Red Record (1895).
In Southern Horrors (1892), Wells challenged the common justification for lynchings of Black men for rape and other crimes involving white women. She adamantly criticized white newspaper coverage of lynchings that induced fear-mongering around interracial sex and framed Black men as criminals deserving of this form of mob violence. Using reports and media coverage of lynchings – including a lynching of three of her close friends – she demonstrated that lynchings were not responses to crime, but rather tools of political and economic control by white elites to maintain their dominance. In The Red Record (1895), she used lynching statistics from the Chicago Tribune to debunk rape myths, and demonstrated how the pillars of democratic society, such as right to a fair trial and equality before the law, did not extend to African American men and women.
Anna Julia Cooper (1858-1964) was an avid educator and public speaker. In 1982, her first book was published, A Voice from the South: By A Black Woman of the South. It was one of the first texts to highlight the race- and gender-specific conditions Black women encountered in the aftermath of Reconstruction. Cooper argued that Black women’s and girls’ educational attainment was vital for the overall progress of Black Americans. In doing so, she challenged notions that Black Americans’ plight was synonymous with Black men’s struggle. While Cooper’s work has been criticized for its emphasis on racial uplift and respectability politics, several Black feminists credit her work as crucial for understanding intersectionality, a fundamentally important idea in sociological scholarship today.
As one of the first Black editors for an American Sociological Association journal, Jacquelyn Mary Johnson Jackson (1932-2004) made significant advances in medical sociology. Her work focused on the process of aging in Black communities. Jackson dismantled assumptions that aging occurs in a vacuum. Instead, her scholarship linked Black aging to broader social conditions of inequality such as housing and transportation. But beyond scholarly research, Jackson sought to develop socially relevant research that could reach the populations of interest. As such, she identified as both a scholar and activist and sought to use her work as a tool for liberation.

Together, these Black women scholars challenged leading assumptions regarding biological and cultural inferiority, Black criminality, and patriarchy from both white and Black men. Their work and commitment to scholarship demonstrates how sociology may be used as a tool for social justice. Recent developments such as the #CiteBlackWomen campaign draw long-overdue attention to their work, encouraging the scholarly community to cite Wells, Cooper, Jackson, and other Black women scholars in our research and syllabi.

Food and Sports Beyond the Couch Potato

Jean Marie Maier on February 1, 2019

Photo of a Steelers fan watching the Superbowl from a couch. Photo by daveynin, Flickr CC

Each year we are reminded of research on how many calories the average American eats on Super Bowl Sunday (hint: it’s more than Thanksgiving). Other research finds that fans of NFL teams that lose eat more saturated fat the next day than fans of teams that win. News outlets ranging from Men’s Health to Runner’s World to Healthy Women publish guides on how to stay healthy on game day. But sitting on the couch isn’t the only activity that is linked to both sports and food. As plan your healthy (or unhealthy) Super Bowl weekend, take a look at the research on how athletics can affect the eating habits of athletes ranging from body builders to youth basketball players.

Among female athletes, eating disorders are a prevalent issue. However, the research on whether female athletes are significantly different from their non-athlete peers regarding prevalence of eating disorders is mixed. Sport-specific factors such as performance pressure contribute to disordered eating, especially in sports that encourage leanness. The combination of disordered eating, amenorrhea, and osteoporosis is called the “female athlete triad.”
Male athletes are not immune from concerns over eating. Wrestlers may be at particular risk of disordered eating due to the intense emphasis on weight. Other sports encourage weight gain, and specific positions, such as linemen in American football, often achieve weight gain through stomach fat that puts them at risk for health complications like diabetes and cardiovascular disease. Athletes and non-athletes may turn to steroid use to achieve a more muscular body, which can include intense cycles of 6,000+ calories per day followed by weeks of a stringent, low-calorie diet.
Proponents of youth sports expect that these activities instill healthy food and exercise habits. However, one study found that many youth sports events provide participants with unhealthy food and lack healthier options. Although youth involved in sports are more likely to eat fruits, vegetables, and milk than those not involved in sports, they also consume more calories overall and are more likely to eat fast food and drink sugar-sweetened beverages. Parents and organizers of youth activities need to be aware of the food options and information available to young athletes in order to make youth athletics a net positive in the health of children.

A Place at the (Global Development) Table

Brooke Chambers on January 29, 2019

Photo of country flags on a building for the 2018 World Economic Forum meeting. Photo by GovernmentZA, Flickr CC

Each year in January, the World Economic Forum hosts its annual meeting in the Swiss resort town of Davos. The event brings together state leaders, business tycoons, and philanthropists who cultivate relationships between governments and businesses, all with the hope of guiding global progress. This year, the annual meeting made headlines for featuring a Somalian refugee, Mohammed Hassan Mohamud, as one of the event’s seven co-chairs. This inclusion marks another stage of a contested history of international business, development, and intervention in the Global South.

Throughout the Global South, colonialism altered or destroyed local systems, such as food production. Agriculture was restructured to serve colonial powers, which often forced farmers to produce cash crops (like coffee or cotton) instead of food for their own consumption. Over time, knowledge about cultivating local crops was lost. In the aftermath of colonialism, many countries have faced challenges in remaking their agricultural sectors. Businesses and governments from the Global North have sought to have a role in this restructuring. Investors and technological innovators partner to develop new foods, often suggesting genetically modified crops as a solution to hunger. Many scholars, however, raise concerns about the cultural loss of replacing local produce with imported goods that look and taste different. Others assert that such approaches do not address the power inequities that lead to hunger.
Large international development organizations that use technology as a tool of development, such as the Gates Foundation, are organized to create and implement “best practice systems.” Often, this means that corporations develop solutions that treat recipients of their products as new customers. Rachel Schurman argues that this structure separates institutions and their employees from the needs of farmers and strategists from the Global South. From this vantage point, events like the annual World Economic Forum meeting serve as opportunities for international businesses to strategize the best ways to find new consumers.
Activist scholars have built on these critiques with tangible suggestions for more equitable practices. Many argue that development actors must treat communities in the Global South as partners in progress, rather than as beneficiaries. This can be done by including local leaders at every stage of the decision making process. More broadly, activist scholars advocate for the role of social science in industry decision making, particularly in instances of post-conflict investment, as social scientists can provide insight into both power inequities and the long-term effects of economic intervention.

The tension between economic expansion and philanthropy has always been an aspect of development. These power hierarchies continue, but scholars are offering new avenues for more equitable involvement of the Global South. While the inclusion of a refugee in a leadership position in Davos could be a step in the right direction, involvement from the Global South must be inclusive, genuine, and sustained to truly make a difference. In Mohamud‘s own words, “We are not asking for too much, just equal opportunity.”

Government Shutdown

TSP Editors on January 25, 2019

Photo of a closed sign outside Saguaro National Park during the 2013 U.S. federal shutdown. Photo by NPCA Photos, Flickr CC

Originally posted October 15, 2013.

Government shutdowns are (thankfully) rare and tend to lead to a lot of calls to economists: what happens to the dollar on the international market? How do military towns and towns that rely on National Park tourism survive? Will companies screech to a halt while they wait for the FDA to get back to business? In the meantime, we might take this opportunity to remember the myriad ways in which all Americans are dependent upon the government.

Most people don’t realize they benefit from government programs.

In 2012, Mettler asserted 96% of Americans benefit from 21 specific government programs (not including those that affect all people equally, like road maintenance). These include “submerged” benefits (like tax breaks for mortgage interest) and direct benefits (like Medicaid). In Table 3 of the second citation, she shows that even some 44.1% of those receiving Social Security benefits answer “no” when asked if they “have used a government program.”

The government is instrumental in innovation.

Fred Block and Matthew Keller sum up some of their research in a Scholars’ Strategy Network brief on government as the main driver of innovation. Using data from R&D‘s annual top 100 breakthroughs list, in 2006 they identified 88 winners with some government support, 77 of which relied on federal dollars and 42 of which came directly out of federally-sponsored labs. They also focus on a program started by Ronald Regan’s Administration that, today, provides up to 6,000 loans ($2 billion or so) annually to small businesses trying to commercialize new tech.