Saturday, June 07, 2008

The issue is power

From the June 5 New York Times:

Race and place of residence can have a staggering impact on the course and quality of the medical treatment a patient receives, according to new research showing that blacks with diabetes or vascular disease are nearly five times more likely than whites to have a leg amputated and that women in Mississippi are far less likely to have mammograms than those in Maine.

The study, by researchers at Dartmouth, examined Medicare claims for evidence of racial and geographic disparities and found that on a variety of quality indices, blacks typically were less likely to receive recommended care than whites within a given region. But the most striking disparities were found from place to place.

For instance, the widest racial gaps in mammogram rates within a state were in California and Illinois, with a difference of 12 percentage points between the white rate and the black rate. But the country’s lowest rate for blacks — 48 percent in California — was 24 percentage points below the highest rate — 72 percent in Massachusetts. The statistics were for women ages 65 to 69 who received screening in 2004 or 2005.

I automatically related this to more research showing the degree to which feelings of powerlessness affects health:

Research shows that members of poor communities do not merely experience higher levels of violence; they are also more likely to have high blood pressure and frequent periods of increased heart rate, which contribute to a higher mortality rate. What's more, similar health problems have been shown to afflict the least powerful members of nonhuman primate species. Taken together, these and other findings suggest that the psychology of powerlessness can wreak havoc on people who sit low on the totem pole of any social structure.

"Poverty, and the poor health of the poor, is about much more than simply not having enough money", says Robert M. Sapolsky, professor of neurology at Stanford University. "It's about the stressors caused in a society that tolerates leaving so many of its members so far behind."

Which made me think of this:

According to a study by the Families and Work Institute, a decade ago, 27 percent of employers offered fully, paid six-week maternity leaves. Today, just 16 percent do, which means fewer working mothers can now afford any leave at all.

"I had my son on Thursday and, on Monday, I had to go back to work," said Selena Allen, a 30-year-old mother who was working at a non-profit agency near Seattle when she had a baby five years ago.

No paid maternity leave for Allen meant leaving her premature son, Conor, in the hospital for weeks without being able to care for him.

"I was an emotional wreck, I was devastated, but in order to feed my family, I had no other option," Allen said.

Parental leave is usually framed as an issue of equity and work/life balance, but, ultimately, it's a mental and physical health issue, for both parents and children. It's also an issue of power: If poor and working- and middle-class parents had more of it, you can bet we'd see policies that benefit their health. The evidence is clear: The absence of those policies is harmful.

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