Introduction: The Critical Cure
Issue #39, September 1998
When a recent US report cited that lesbians are more likely than heterosexual or bisexual women to have hearing problems, it was tempting to joke that this was merely the medical establishment's attempt to account for women who can't hear the call of heterosexuality. The idea that a person's sexuality might affect their inner ear seemed at best absurd, and at worst a little too close to the idea of a "gay gene." But no matter how problematic such links can be, the fact is that a person's sexuality, race, gender, class, and immigrant status can directly affect their health.
Indeed, a recent article in the Washington Post reported that "immigrant children's health deteriorates the longer they remain in the US and assimilate into American life." Living in the US, in other words, can be bad for your health. While the report aimed to expose the "negative effects of assimilation," it also went on to say that it is not simply the fact of living in the US which is unhealthy, but rather that first and second generation Americans are more likely to "adapt" to the "lifestyle of a poor American 'underclass.'" In a remarkable instance of journalistic understatement, the article suggests that "the McDonaldization of the world is not necessarily progress when it comes to nutritious diets." According to this report, then, it is not poverty per se which leads to bad health, but rather the "lifestyle" of poverty.
In rerouting the relationship between health and class through notions of "lifestyle," responsibility and blame quickly become subsumed under notions of choice and volition. While "choosing" to consume McDonald's burgers everyday might not provide all the nutrients and food groups our bodies allegedly need, decisions about where and what to eat cannot be understood outside of larger questions of access to money, time, and transportation. Neither poverty nor unhealth are "lifestyles."
How can we understand the relationship between individual responsibility for one's health and larger social forces? In actuarial terms, a person's health can be predicted according to their class, race, and gender. A few examples from within the US: Vietnamese-American women have five times the risk of cervical cancer and Latinas have two times the risk compared to white women. Native Americans are more likely to get diabetes than other Americans. Latinos and Latinas are more likely to get stomach cancer. African-American men have heart disease at twice the rate of white men. Across race, male prison populations and men in high-density housing have a higher chance of contracting TB. Women of all races who never get pregnant are more likely to get breast cancer. Lesbians, therefore, are statistically more likely to contract breast cancer than straight or bisexual women. And while white women have the highest incidence of breast cancer, African-American women and Latinas have a much higher mortality rate.
What do such figures tell us? Clearly, "health" is not a monolithic category. Also, treatment, research, and prevention need to be targeted to specific groups with specific needs. Which already happens, but as yet only in ways that reinforce inequality. For example, the long-term contraceptives Depo-Provera and Norplant are still widely used and prescribed in the US for African-American women and Latinas despite WHO reports that these methods increase the chance of contracting breast cancer. Some family planning clinics go so far as having pamphlets on Norplant in Spanish only, with other forms of birth control described in English.
But while race, ethnicity, gender, and sexuality can determine health, these are not "lifestyle" issues. Furthermore, having access to insurance can be a prime determinant of access to health care. While one-seventh of whites in the US have no health insurance, one-fifth of African-Americans and one-third of all Latinos/as are uninsured.
These are some of the hard facts about contemporary health care in the United States. In this issue of Bad Subjects, we offer some personal perspectives on those hard realities. Confronted with the mundane aspects of everyday life, Joel Schalit and Steven Rubio find their thoughts moving beyond the personal to the darker side of public health. Schalit's search for a decent public bathroom leads to a recognition that personal psychology is informed by public policy, while Rubio bonds with Dostoevsky in the laundromat. In both cases, the authors realize they have more in common with the victims of modern society than with the so-called victors. Annalee Newitz and Brock Craft are less concerned with public spaces and more concerned with the body itself. Newitz' graphic description of urinary tract infections forces the reader to experience the helplessness that often accompanies our interaction with the modern health system, while Craft's attempts to get a vasectomy also reflect the difficulty of maintaining personal control over our bodies amidst a moralistic mainstream that wants to keep that control for itself. For both writers, the desire to preserve a personal relationship with their bodies goes against the status quo.
John Brady looks at the use of body and health metaphors for our national well-being, examining the positive and dangerous aspects in this usage. He identifies concrete threats to our political health not only in metaphor but more specifically in neo-liberal capitalism. Sandra Teresa Hyde's essay on AIDS medical practices in China sees threats to political health in an entirely different society. Again, the language used by state medical officials works to obscure reality, rather than to enlighten the populace. Finally, Mike Mosher and Shih Chang examine popular artifacts with implications beyond simple health concerns. Mosher's participatory account of a conference devoted to Elvis combines a description of papers on the King's dysfunctional family life with his thoughts on Elvis as unifying icon of America. Chang goes to the supermarket and finds evil coincidence in the production and marketing of Brita water filters and Clorox bleach. For both writers, the connection between culture and health is complex and inescapably tied to the marketplace.
Our personal health is crucially connected to our socio-cultural situation. As always, the interaction between personal and political is complex and multi-directional. There is no escaping this interaction; our very health depends on an intelligent, critical analysis of the unequal distribution of resources in contemporary society.1998 by Bad Subjects