As Obama eases into office for his second term, and the economy seems to take a turn for the better, there’s still one thing that’s hanging over our heads.
Debt, debt, debt.
I’ve lived my life pretty simply. I have no desire to be rich, just happy. I don’t pine after a bigger house or nicer clothes, I don’t want a new car or a new iPhone. I just want a stellar life. I want experiences, travel, and time with friends, family. I want time to think and read and putter around. I want to write and bake cakes and watch weird movies, and lie on the beach and take road trips.
And mostly, I’ve been able to do this. I drive an old car. I buy my clothes at thrift shops. I cook dinner from scratch every night, and we eat a lot lentils and sweet potatoes. We don’t have cable or smartphones or new computers. Our television is ten years old, I have a prepaid Tracfone, and I can’t remember the last time I saw a movie in the theater. I get my CDs, DVDs and reading material from the library, and buy my son’s toys at garage sales. It’s a simple life, but it’s a very good one.
But there’s always this nasty thing hanging over my head. Debt, debt, debt.
I have $40,000 in student loans, racked up when I was a graduate student. And if I do say so myself, I was a great student. I got excellent grades, I won three awards and I finished two graduate degrees in five years. I taught ten undergraduate classes, was busy every minute of the day. But somehow, I still came out drowning in debt.It just doesn’t seem right that I have these loans hanging over my head for my education. It’s not like I went out and bought thousands of dollars of shoes, or a car I couldn’t afford, or went out to fancy restaurants every night.
I’ve decided to not let it stop me from living the life I want, but it’s still there, this nagging feeling in the back of my mind. Debt, debt, debt.
So when I read that about the Strike Debt movement, I was intrigued. The movement attempts to organize people as debtors. According to Jodi Dean, a professor of political science at Hobart and William Smith Colleges:
“Debilitating medical and student debt are the result of a market approach to medicine and education. So if Strike Debt grows, we could see demands for free healthcare and free universities. Once people stop thinking of banks as entitled to interest and fees, then we may also decide as a society that public sector workers, pensions and basic infrastructures are more important than playing the bankers’ game.”
What does this have to do with health? Everything.
I don’t have any medical debt, but my student debt obligations gobble up a distressingly large portion of my fairly measly income, making it financially impossible for me to purchase my own health insurance. I’m self-employed, so no one is going to provide it for me. I’ve been lucky so far, no major medical catastrophes since I’ve been uninsured, but really I’m just one bad pap test or car accident away from medical bills that could push me into financial ruin.
What about you? Do you have medical or student debt? Is it affecting your health? Have you heard about the Strike Debt movement? Let me know!
Oh, occasionally a women’s health blog/fair/publication/clinic will include information about heart disease, or nutrition, or even chronic illness. For the novelty factor, it might include something about HIV. But most of the time the term “women’s health” is about getting knocked up, not getting knocked up, and boobies.
I’m as guilty as the next person when it comes to limiting my scope: I wrote a dissertation on breast cancer, a master’s thesis on breast feeding, and worked for an organization that focused on reproductive health.
Unlike womb health and boob health, mental health isn’t typically classified as a women’s health issue. That’s unfortunate, because mental health could possibly be the most important topic when it comes to women’s health. After all, if you don’t have your (mental) health, nothing else matters.
Whether it’s post-traumatic stress disorder, postpartum depression, bi-polar disorder, depression and anxiety, or even loneliness, mental health is something that is shaped by gender.
According to the World Federation on Mental Health, depression is not only a worldwide crisis that affects 350 million people a year, it is also a highly gendered affliction:
While depression is the leading cause of disability for both males and females, the burden of depression is 50% higher for females than males (WHO,2008). In fact, depression is the leading cause of disease burden for women in both high-income and low- and middle-income countries (WHO, 2008). Research in developing countries suggests that maternal depression may be a risk factor for poor growth in young children (Rahman et al, 2008).
This risk factor could mean that maternal mental health in low-income countries may have a substantial influence on growth during childhood, with the effects of depression affecting not only this generation but also the next.
Treatment is different for women too. We’re more likely to be diagnosed with depression than men, even if we both give the same list of symptoms. And women are more likely to be prescribed mood altering psychotropic drugs.
Furthermore, there are significant health disparities when it comes to women’s mental health, and not just having to do with unipolar depression:
- Women experience twice as much serious mental illness as men
- Women have a life-time prevalence of alcohol dependance that is more than twice as high as that for men
- Postpartum depression and anxiety are common, but poorly diagnosed and treated. That means many (if not most) women suffer through this alone.
- Women and girls are at least twice as likely to have an eating disorder than are men or boys.
What’s the reason for these disparities?
It’s complicated, but the inequalities inherent in patriarchal societies bear some of the responsibility.
Eating disorders emerge because of an unrealistic image of the female body that is presented in the media. Postpartum depression goes untreated, and can lead to further mental health problems. Women experience more poverty, more workplace harrassment, and do more caregiving for family members than do men.
Furthermore, according to the World Health Organization, the high prevalence of sexual violence to which women are exposed and the correspondingly high rate of Post Traumatic Stress Disorder (PTSD) following such violence, means that women are the largest group of people affected by this disorder.
We don’t like to talk about mental illness in this country, and we don’t do a great job of treating it. We throw drugs at it (there’s been a gigantic increase in the number of Americans on anti-depressants, but are we mentally healthy?) We pay lip service to it. But more often than not, we ignore it.
In the US, even if you are lucky enough to have insurance, chances are that it doesn’t offer mental health parity.
For once, the US is not the only country doing a shabby job of providing healthcare. According to the WHO:
Mental, neurological, and substance use disorders are common in all regions of the world, affecting every community and age group across all income countries. While 14% of the global burden of disease is attributed to these disorders, most of the people affected – 75% in many low-income countries – do not have access to the treatment they need.
Reading this onslaught of bad news may not make you feel very mentally healthy, whether or not you’re a woman. But it’s important to share this information as a reminder that mental health is a major health issue for women and that it should be addressed under the umbrella of women’s health.
It’s easy to focus on babies and boobies, but looking at other health issues through a gendered lens may help decrease women’s morbidity and increase quality of life.
What do you think? Do you know any women’s health organizations that are working on this issue? What does the research show about mental health disparities? Are there things that clinicians can do to better protect the mental health of their female patients?
It’s been an amazing week. I wrote an article for Bitch Magazine’s website. I gave at talk about breast cancer advocacy at my local library. I tweeted with Breast Cancer Action during the presidential debates.
There’s been a lot of interesting stories in health news this week, like most weeks. Here’s my round up!
- Looks like free birth control leads to fewer abortions and fewer teen births.
- Bayer is reducing the cost of their contraceptive implants to distribute to women in poor countries. What do you think? Is this a good thing?
- California makes it illegal for psychiatrists to offer young people a cure for homosexuality. Definitely a good thing.
- The NYT Motherlode published an interesting first-person perspective on post-partum depression.
- Mitt Romney told a lot of lies about his healthcare plan during the debate.
- I like this research because it blames racial discrimination for causing health disparities instead of reporting that health disparities exist between white folks and racial minorities. The study is particularly close to my heart since it is about low-birth weight babies (my son was just under 3 pounds when he was born).
- Hobby Lobby doesn’t want it’s employees to be able to get emergency contraception, so they’re fighting tooth and nail to be allowed to ban coverage of Plan B from their health plan. I wonder if they cover Viagara?
That’s all for now. Thanks for reading, and see you next week!
Did you tune into the first presidential debate last night? It was less than riveting. As many astute observers noted, neither candidate mentioned women, gay rights or poverty. There are two more debates, so maybe next time, right?
What they did mention was taxes. They spent 30 minutes talking about taxes.
I don’t know about you, but from where I sit –mother, freelance writer, homeowner, lesbian, with an annual income below $40,000—this is not really a burning issue. As far as I can tell, the only people who are that concerned with taxes are people with a lot of money that could be taxed.
I don’t think that taxes matter that much to my mother-in-law, who works as a home health aide and who is covered on her husband’s dental insurance but not on his medical insurance because the premium is too high.
I don’t think that taxes matter that much to my 22 year old niece who is taking out thousands of dollars in student loans to cover her tuition and rent.
And I’m pretty sure that taxes are not the most important issue to my friend who was laid off a year ago and is struggling to pay her mortgage and her Cobra premiums so that she can get medical care she needs for several chronic health conditions.
I think you can see where I’m going with this.
Unlike taxes, health insurance matters to everybody.
Unfortunately, the discussion about healthcare was frustrating. Obama is now in the position of explaining why the
tepid piece of legislation that is the Affordable Care Act should not be repealed, blandly repeating all the same stuff about getting rid of preexisting condition clauses and letting all those lucky people with private insurance stay on their current plan
Mittens Romney, on the other hand, spent the whole time waxing poetic about state rights and individual responsibility.
One of the magnificent things about this country is the whole idea that states are the laboratories of democracy. Don’t have the federal government tell everybody […]what kind of Medicaid they have to have. Let states do this.
Actually, the let-the-states-decide approach is just magnificent at creating health disparities. It’s an excellent recipe for inequality. Let’s not make things more complicated than they have to be. At the end of the day, everyone really needs the same thing: to be able to get medical treatment for themselves and their children when they need it. It’s not rocket science.
But Mittens persisted. Oh yes he did.
I know my own view is I’d rather have a private plan. I’d just as soon not have the government telling me what kind of health care I get. I’d rather be able to have an insurance company. If I don’t like them, I can get rid of them and find a different insurance company. But people make their own choice.
This is clearly coming from someone who has never tried to buy health insurance.
I have tried, and let me tell you, all the companies are pretty much the same. They’re expensive. The plans that aren’t that expensive don’t really cover much. And if, god forbid, I am diagnosed with breast cancer or multiple sclerosis or a brain tumor, I really don’t care who the fuck is paying, as long as I’m covered.
And then Mittens made a series of confusing statements. Here’s a sample:
Small businesses […] are saying they’re dropping insurance because they can’t afford it, the cost of health care is just prohibitive. We’ve got to deal with cost.
How about we pass something called the Affordable Care Act?
When you look at Obamacare, the Congressional Budget Office has said it will cost $2,500 a year more than traditional insurance. So it’s adding to cost. And as a matter of fact, when the president ran for office, he said that, by this year, he would have brought down the cost of insurance for each family by $2,500 a family. Instead, it’s gone up by that amount. So it’s expensive. Expensive things hurt families. So that’s one reason I don’t want it.
Because expensive things hurt families? Like having to pay massive medical bills because you don’t have insurance? I have a great idea. How about single-payer healthcare?
[Obamacare] cuts $716 billion from Medicare to pay for it. I want to put that money back in Medicare for our seniors.
But don’t you want to cut Medicare? I’m confused.
[Obamacare] puts in place an unelected board that’s going to tell people ultimately what kind of treatments they can have. I don’t like that idea.
But it’s okay for corporate executives at Aetna or Blue Cross and Blue shield to tell you what kind treatments you can have, right? Because they probably do have your best interests at heart. Really. They do. Pinky swear.
There was a survey done of small businesses across the country, that asked what’s been the effect of Obamacare on your hiring plans? And three-quarters of them said it makes us less likely to hire people.
Really? Oh, okay. I bet they said the same damn thing about affirmative action. Wait a minute, we got rid of affirmative action, right? That really helped close the wage gap.
I’ll end this
rant analysis with a choice gem from President Obama:
Private insurers have to make a profit. Nothing wrong with that. That’s what they do.
Am I going crazy? Somebody help me! Can we please please please just agree that actually there is something fundamentally wrong with that? Healthcare should be a right not a privilege. Anyone? Anyone?
Full disclosure: I’m Canadian, I believe in single-payer healthcare, I don’t have any insurance at the moment. And yes, I’m voting for Obama.
Way back when I was a graduate student teaching Women’s Studies classes to undergraduates, one of my favorite texts to assign was Joni Seager’s Atlas of Women in the World. Seager uses maps and charts to illustrate persistent gender disparities around the globe. Her illustrations always made a big impression on students in a way that a journal article just couldn’t do.
Infographics are a great way of communicating complex information, allowing the viewer to make comparisons and see details in a way that is, well, more graphic, than using text alone. So I was excited to learn about the Visualizing Health Policy series (see above), produced by the Journal of American Medicine in partnership with the Kaiser Family Foundation.
The New York Times often presents information this way, and it’s one of my favorite features. Whether it’s mapping happiness or reporting census data, infographics are fun to look at and invite you to understand familiar information in a different way. Cigna, a global health service company, has taken it a step further and recently created an interactive infographic to help people learn more about health care reform and how it impacts their specific situation.
I love seeing data presented this way. This visual approach makes a great teaching tool, but could also add interest to public health education materials, research summaries, newsletters and even journal articles. A good infographic is a wonderful thing.
Have you seen this approach used in innovative ways? Please share!
Today’s New York Times reported that a new study found that breast cancer could be organized into four distinct genetic types. The hope is that the research will lead to more precise treatment for women with breast cancer. Too often, patients are given chemotherapy that doesn’t help or are subjected to other treatments so broad-reaching that their effectiveness is questionable. Targeted therapies are the gold standard.
It’s great news. It’s also refreshing to read about cancer research that doesn’t focus on an imprecise risk factor, or a risk factor that women can’t do anything about (early period, late menopause, number of children, etc). But will this research actually help patients with breast cancer? Of course it takes time for research to be translated into improvements in treatment, and everyone acknowledges this.
What’s less acknowledged is that even ten years from now, it’s easy to assume that this targeted approach to cancer won’t help all patients with the disease. If customized treatment for breast cancer were available tomorrow, who would benefit?
The millions of women without insurance? Women who are being treated under the Breast and Cervical Cancer Prevention and Treatment Act? Women on Medicaid and disability? Women who are cobbling together treatment plans made up of a variety of different charity care, pay per use and high-deductible insurance? The lesbian woman who loses her job because she is sick but who isn’t covered under her partner’s insurance?
Or would the women who benefit from this research be primarily those whose husbands have great insurance?
In international HIV research, scientists are often called upon by community stakeholders to come up with a plan for making potential treatments available to those who need them. For example in a 2010 study of a gel that could be used to prevent HIV, conducted by South African researchers at CAPRISA, activists demanded accountability and a plan for distribution of this medicine if it was shown to be effective.
The company that manufactured the gel granted royalty-free licenses for 1% tenofovir gel to the International Partnership for Microbicides (IPM) and to CONRAD. These licenses grant the holder the right to manufacture and distribute the product without paying additional fees to the company that invented the drug. In turn, CONRAD granted a royalty-free license to the South African Technology Innovation Agency (TIA), meaning that it will be easier for the South African government to produce and distribute the medication at a reasonable cost.
Could breast cancer researchers take the lead from such innovative strides? Could they try to incorporate this approach into the fundamental structure of their research?
Now that would be something to get excited about.