Case Study

1 9 7H e a l t h a n d W e l l n e s s

a l lows p r a c t i t i o n e r s ? a n d th rough t h e m

tails about thehealth and condition of the fetus, it F a e e e poviences of pregnancy and childbirth and may undermine their knowledge of andconfidence

in theif bodily processes. Writers and researchers involved in Black Women Birthin ystice emphasize the importance of maternal health and care during pregnancy and

childbirth, as well as sterilization abuse and high death rates among Black mothers and infants (Oparah and Bonaparte 2015; Oparah et al. 2017)

.infant Mo r ta l i t y

this refers to babies who die before their first birthday. Although rates of infant mor-

tality havesteadi ly decreased in the United States, Black infants continue to die at more than twice the rate o f white infants. For babies born in 2016, Asian babies had the lowest infantm o r t a l i t y rate (at 3.6 deaths per 1,000 births), followed by white

(4.9 deaths),H i s p a n i c (5.0 deaths), Native Hawaiian and Pacific Islander (7.4 deaths), American Indian or Native Alaskan (9.4 deaths), and African American babies (11.4

deaths per 1,000 births) (Centers for Disease Control and Prevention 2018b). Infant

mortality is l inked to individual factors such as smoking during pregnancy and macro- level factors l ike poverty. Morta l i ty rates were higher for infants whose mothers did not

have prenatal care in the first trimester, and more common among Native American, Mexican American, and African American women, compared w i th Asian American

and white women as these data show.

HEALTH A N D WELLNESS Everyone needs nourishing food, clean water, adequate exercise, and freedom f rom stress in order to mainta in health and vitality. Wellness is partly l inked to genetics,

physical environment, and socio-economic factors such as race, class, dis/ability,

gender expression, and aging. In Box 5.2 we present data from the World Health Orga-

nization to show that, worldwide, the deadliest disease is poverty.

Health Dispari t ies Disparities in health among different groups are due to a mix o f overlapping causes,

including income level, educational attainment, occupation, access to health services, and environmental condit ions?factors l inked to race, class, dis/ability, and gender ex-

pression. People w i t h disabilities and trans people may have diff iculty in f inding d o c tors who are sensitive to their bodies and their health needs, and they may have l imi ted

en as a whole, the health o f white women and medical insurance to cover t he i r care. Tak Asian A m e r i c a n w o m e n is s ign i f i cant ly bet ter t han that o f A f r i can Amer ican , La t inx ,

a n d N a t i v e A m e r i c a n w o m e n . ? W e n o t e a f e w e x a m p l e s here .

1 Most US government data are analyzed according to race/ethnicity in three categories: white,

Black, and H i s p a n i c ? w h i c h includes Puerto Ricans, Cubans,Mex i can Americans, and people f r om Central and South America. Some reports give details for Native Americans and Native Alaskans, or

for Asians and Pacific Is landers?another very heterogeneous group. Data on social issues are rarely

analyzed according to socioeconomic class. Bear th is in m ind dur ing this discussion o f heal th dis-

parities, wh i ch suffers f r om l imi ta t ions o f the data available.

498 BODIES, HEALTH, AND WELLNESS

T h e W o r l d ? s D e a d l i e s t D i s e a s e Is P o v e r t y

- , .

e In 2017, worldwide, 5.4 millionch i ld ren died before

their fifth birthday, mainly from malnutrition, malaria,

acute respiratory infections, diarrhea, and prenatal com-

plications. Nearly half of these deaths were newborns.

¢ Children in sub-Saharan Africa are over 15 times more likely to die before their fifth birthday than are those

in high-income countries. ° Most of these conditions can be prevented oFcured

itati lies with improvements in

:

sanitation, clean water supples,

better housing, adequate food, and general hygiene.

The majority of deaths from infectious diseases can d with existing, cost-effective measures,

be prevented with existing,including childhood vaccinations, bed nets and other

melarie-prevention treatments, oral rehydration ther apy, and antibiotics.

x R e e e

7 - ,

e Poor nutrition and being underweight under age five at increased risk n o n a i g

arthea and pneumonia. Being inden tions ~

ervasive problem in countries of ght ems

h e r e poverty causes household f , soba Su,

mothers? inadequate nutrition, unks t h n c e , nents, and poor health care. y ening

inable Development G

T e d Netione in 2015 were d e v e l ? eedbyte ©

?hei Il children. Goal 3; well peng c a i n e and chilhen e a d Prevent,

deaths o lorated progress is n e c d n SF age five

2030. Accelerated? progress | ed to achieve

especially in sub-Saharan Africa and South ESt Aa

Source: World Health Organization (2018).

.

Tuberculosis, an infectious disease associated w i t h p o o r l i v i n g cond i t i ons , was

all but eradicated in the United States du r i ng the twen t i e th century . C o m p a r e d w i th

the rest o f the population, Native Americans are f o u r t imes as l i k e l y t o have tuber-

culosis. Hypertension, a major risk factor for heart disease a n d stroke, is m u c h more

prevalent among African American women t han a m o n g w h i t e w o m e n . P u b l i c health

researchers have attributed this difference, in part, to stress related to rac ism and pov- erty (American Psychological Associat ion 2016).

Women with HIV/AIDS have not been diagnosed as early as men because their

symptoms are not so clear-cut and doctors were less l ikely to look for HIV/AIDS in

women. Also, negative stereotypes o f HIV-positive women (as drug users and people with multiple sex partners) have affected their visibi l i ty and care. Far more women than men contract HIV through heterosexual contact. O f women in the United States

who were living with HIV/AIDS in 2016, 59 percent were Black, 19 percent were Latinx,

and 17 Percent were white (Centers for Disease Control and Prevention 2018a). Toxic workplaces are a health hazard, especially for low- income women. Some

to cover Mammograms to detect breast cancer,

€t. 1 c o m e women to have insurance

is djLate diagnosisSis 1s direct ly related to Cancer is more common in African

merican women are more l ikely to

1can women have a lower r isk o f CeL.org 2018).

1 9 9 Health and Wellness

| a n d E m o t i o n a l H e a l t h enta 5 ways: h is tor ica l ly oppressed and marginal;

ani terized as somehow less emoti *ginalized people have been stereotyped .charac 1onally and mentally healthy th

inant group. Phi losopher Denise Russell y healthy than those in the o m " . al Europe, where i t was th (1995) traced definit ions of madness from mediev venteenth century, eco ought o f as a combination of error and sin.

puring the © bu i l d ?h ry, economic crises and rising unemployment prompted j officials to bul ouses o f confinement? for be d

Joca d those considered mad. L ?BBars, runks, vagabonds, pet ty .criminals, an ater, as psychiatry developed, doctors headed

jums in Europe and the Un i ted States and theorized th iasy. due to thei ; a t much mental distress ex-

enced by e o n h t t o b ear sexuality and reproductive capacities. p e r i Hyster ia, thoug t t o be due to a disturbance o f the womb, became a catch-all cat-

egory tO describe women's mental illness. The English word hysterical comes f rom the

Greek hysterikos, m e a n i n g ?of the womb." Writer and l i terary cr i t ic Elaine Showalter (1987) and psychotherapist Phyll is Chesler (1972) showed how def in i t ions o fm a d - ness were used to suppress women?s creativity, education, and pol i t ical involvement.

Nineteenth-century wh i t e upper- and middle-class women who wanted to write, paint, travel, OT speak ou t on issues o f the day were often assumed by their husbands?and b y

sychiatr is ts?to be insane. Charlotte Perkins Gilman?s powerful f ic t ional work, The

yellow Wallpaper (2000), describes this experience from having l ived th rough it. More recently, ?depression? and ?premenstrual syndrome? (or ?PMS?) have replaced ?hyste-

ria? as catch-all terms used i n describing mental illness in women. In 1973, the American Psychiatric Association removed homosexuality from its

Diagnostic and Statistical Manual of Mental Disorders (DSM). Currently, they include

gender dysphoria in the most recent edition, the DSM-5 (American Psychiatric Asso- ciation 2013). The American Psychiatric Association's website (2018) describes this as

?a conflict between a person?s physical or assigned gender and the gender wi th which

he/she/they identify,? which leads to ?significant distress and/or problems function- ing?. Although careful to include societal factors and to separate gender dysphoria from gender nonconformity in discussing ?challenges and complications? associated with the condition, this language and the fact of being included in the DSM reinforce

a medicalized and stigmatizing approach. Alongside the negative attitudes described above, there are serious mental health

concerns among marginalized peoples, and studies have shown the relationship be-

tween oppression and mental distress (see, €.8-, Fernando 2010). For instance, many more women are diagnosed as having some sort of mental illness, especially depres-

sion, compared to men. Adult African Americans are 20 percent more likely to report serious psychological distress than white people. People who identify as transgender experience mental health issues at a higher rate than cisgender women or men (Sch-

reiber 2016). Seeking and getting help is another aspect of theissue. Seeking help is shaped by cultural attitudes to mental health treatment, while getting help is linked to one?s ability to pay and f inding a suitable therapist or other mental health provider. It is more socially acceptable for women as a BrOUP to seekhelp f o r mentalhea l t h concerns compared to men. However, not everyone who ?seekshelp does so voluntarily. Some-

times seeing a counselor or therapist is required bya social service agency or is a condi-

tion of probation. Patients in mental hospitals represent a relatively small proportion

of those who are suffering mental ly and emotionally. In general, women are a m i t ted

to mental hospitals as inpatients in roughly the same numbers as men.

2 0 0 B O D I E S , H E A L T H , A N D W E L L N E S S

Denise Russell (1995) pointed to many external factors affecting women?s Menta)

health, inc luding sexual abuse, rape, int imate partner violence, restricted educationa} or economic opportunit ies, racism, and pressure to look beauti ful , to be th in, an

to be compl iant wives and long-suffering mo the rs?any o f which, she argued, could

reasonably make women depressed or ?crazy.? Hopelessness and anger at such circum.

Stances are not i r rat ional reactions. Women?s symptoms may seem vague to doctors. even when understood, such traumas and problems are not easy to alleviate.

Women have wr i t ten powerful f ict ional and autobiographical accounts o fMenta l i l lness (see, e.g, Danquah 1998; Kaysen 1994; M i l l e t 1990; Plath 1971; Shannonhousge

2003; Slater 1998). I n Reading 25, cul tural cr i t ic bell hooks refers to the severe long. term effects o f racism and internal ized oppression on Af r ican Americans? mental] and

emot iona l health. She notes that slave narratives often emphasized the importance of

Black people's capacity to tepress feelings as a key to the i r survival, and that this habit has been passed on through fam i l y experiences. As a result, ?many black females have

learned to deny o u r inner needs whi le we develop our capacity t o cope and confront in

Publ ic life.? Sociologist Tamara Beauboeuf-Lafontant (2007, 2009) argued that ?being

strong? is o f ten taken as a sign o f emot ional health for whi te women. However, ?being strong? is a ?cul tural ly specific expectation placed o n Black women,? w h i c h ?normal-

izes struggle, selflessness, and in terna l iza t ion strategies? that compromise Black wom-

en's hea l th (2007, p. 46; also see Evans, Bell and Bur ton 2017; Parks 2010).

Accord ing to a repo r t pub l ished in Psychology Today, the h igh rate o f ?distress and

i m p a i r m e n t , considered essential characteristics o f mental disorders? among transgen-

der i n d i v i d u a l s is l i nked p r i m a r i l y to the d iscr iminat ion, stigma, non-acceptance, and

phys ica l a n d psycho log ica l abuse they face regular ly and consistently as a socialg r o u p (Schre iber 2016). Th is f i n d i n g is consistent w i t h studies over the past decades, wh ich s h o w t h a t

f o r m a n y adults, dea l ing w i t h d i sc r im ina t i on results in a state o f heightened v ig i lance

a n d changes in behavior , w h i c h i n i tsel f can t r igger stress responses? tha t is, even

the an t i c i pa t i on o f d i s c r i m i n a t i o n is suf f ic ient to cause people t o become stressed.

(Amer i can Psycholog ica l Assoc iat ion 2016, p. 8)

Moreover, other studies have suggested similar experiences among refugees and asylum seekers, also due to the stress of marginalization and discrimination (see, e.g., Kastrup 2016; Volkan 2017).

People o f all classes and racial groups may attempt to deal w i th the pain and dif-

f icul ty o f their lives through drugs and alcohol. In the United States, drug addiction

has been considered a crime rather than a health issue. In recent years, highly addic

tive medications prescribed for chronic pain have been responsible for an increasing

number o f deaths, especially among white people. There are far fewer drug-treatment

programs than required, and fewer for women and transgender people than for men.

A g i n g and Heal th

The health of women in middle age and later life is partly linked to how healthy they were when they were younger. The effects o f poor nutr i t ion, smoking, stress, or lack

o f exercise bu i ld up over time. Many older women have felt pressure to conform to

2 0 1 H e a l t h a n d W e l l n e s s

ideals and gend jnant beauty! gender expectation etaking others throughout their quilt jives. AS they age, they have to face theiro f ca r

anging looks, physical limitations, am410s o f independence and loved ones, patia eligi which calls for we q religious faith. Shevy Healey (1997) argued that confrontingageler optimism,sm in society

a| as one?s own negative feelings ab as Wesearchers MargaretMorganrothC u l l e r ing is must for mental health. Femi-a

n 3) and Ashton Applewhite (2016) all . (2004, 2011), Margaret Cruickshank of aging.(201 k (2003) critiqued th emphasize the social construction

n oFcruickshan qued thef i e l d of gerontology fo ; aging f aging and proposed an approach that emphasizes I i accepuing a medicalm o d e l

andolder women?s needs, and includes research conduced by embraces life chane? anti and Slevin (2006) countered the cultural insistence° nY e t womena )

ncehe ways ?the anti-aging indust on successful aging? (Pp. 3) andt dy? industry operates to reinscribe gendered ageist stereo- rypes onto the body (quoted in Winterich 2007, p. 784). In general women live longer than men 1D all racial Broups, but white and Asian Americanwomen live longer than

patinx oF Black women. To live well in older age, women need financial security famil and friends, and support for conditions like arthritis, Alzheimer?s, diabetes oF ofoess,

proken bones, digestive conditions, and osteoporosis that typicallyaffect women and

w o r s e n w i t h age. feminis ts have organized health projects since the early 1970s. Examples inc lude

college courses in women?s health; in fo rmal self-health groups l ike the B looming ton Women?s Hea l th Col lect ive (Bloomington, IN); women?s health centers (e.g., Equal-

i t y Heal th Center in Concord, NH); campaigns for reproductive rights (e.g., NARAL

pro-Choice Amer ica and regional affiliates) or for breast cancer research and treat- ment (€.8-, Women?s C o m m u n i t y Cancer Project, Cambridge, MA); c o m m u n i t y

health campaigns for LGBTQ people (e.g., FORGE, Milwaukee, WI; Gender Diver-

sity, Seattle, WA; GLBT Hea l th Access Project, MA); and national organizat ions l ike Black Women?s Hea l t h Imperat ive (Washington, DC),, the Nat ional Latina H e a l t h

Organization (Oakland, CA), the Nat ional Women?s Health Network (Washington,

DC), and the Native Amer ican Women?s Health and Education Resource Center (Lake Andes, SD). The Boston Women?s Health Book Collective's groundbreaking book Our Bodies, Ourselves, wh ich inspired the t i t le for Part I l o f this book, f i r s t

started as m imeographed notes for a course in women?s health and was later devel-

oped for publ icat ion. It has gone through many editions and is an essential resource on women?s hea l th and sexuality, translated and adapted for use in many countr ies

(K. Davis 2007).

QUESTIONS FOR REFLECTION As you read a n d d i s c u s s t h i s chap te r , t h i n k a b o u t these ques t ions : 1. How do you feel about your own body? What makes you feel good about your body?

.How do you know when youTe healthy? Sick? 2. What are the m a i n body and health issues for women in your fami ly or on your

campus? ing person, what specific health and 3. I f you are transgender or a gender nonconform

wellness concerns do you face?