Introduction to Health Culture and Community

1. Introduction to Health Culture and Community Public Health, Race and Citizenship

2. Sovereignty • Bare Life (zoe) – simple fact of living common to all living beings. • Political Life (bios) - manner of living of a particular group qualified by the capacity for speech (logos).

3. Biopower • Builds from Greek understandings of democratic citizenship, and refers to the political organization of life. • Biopower is a contested terrain that is informed by race, class, gender and nationality in the political organization of lives that are included and excludedin the national community.

4. The bound corpses of two Italian immigrants, CastenegoFicarrotta and Angelo Albano, handcuffed together, hanging in a Florida swamp.  One with note affixed to feet, the other with pipe in mouth.  September 9, 1910.

5. Charred corpse of Jesse Washington suspended from utility pole. May 16, 1916, Robinson, Texas.

6. The barefoot corpse of Laura Nelson. May 25, 1911, Okemah, Oklahoma. Gelatin silver print. Real photo postcard. 3 1/2 x 5 1/2"

7. The lynching of Laura Nelson and her son, several dozen onlookers. May 25, 1911, Okemah, Oklahoma. Gelatin silver print. Real photo postcard. 5 1/2 x 3 1/2"

8. Shah – Reforming Chinatown • Construction of Chinatown as byproduct of housing discrimination. • Increased density in housing increased rate of tuberculosis infection and high mortality rates. • Classifications of racial danger, difference and subordination are reinforced. • Racially coded languages of hygiene and health reinforced cultural concepts of health and nation that reinforced exclusion of Chinese from the nation (1882 Chinese Exclusion Act)

9. Group Exercise: • What strategies did Chinese American’s use to be recognized as “healthy” citizens? • How did constructions of gender and domesticity shape perceptions of the Chinese?

10. What is the Possessive Investment in Whiteness? • Advantages gained from the legacy of colonialism, slavery, segregation, immigrant exclusion and “Indian” exclusion. • Race neutral and conscious policies that exacerbate inequalities (i.e. exclusionary New Deal Policies in 1930s or contemporary attacks toward Affirmative Action).

11. Housing & Urbanization • Federal Housing Act (FHA) provides credit from Federal government via private lenders to promote home ownership. • Confidential surveys and appraisers channeled most of money to whites. • General Services Administration (GSA) channeled government’s rental and leasing business to realtors engaged in racial discrimination. • “Urban Development” or “Renewal” reduced limited supply of housing for communities of color. • Government financed $120 billion worth of new housing bet. 1934-1962, but 2 percent of real estate available to non-white families.

12. Urban Renewal and Racial Formation • Migration of Ethnic Europeans to suburbs constructed new “white” identity (bet. 1960-77: 22 million whites move to suburbs) • Concentration of communities of color in urban centers reinforced racial hierarchy (bet. 1960-77: 6 million blacks move to inner city) • 1968 Housing & Urban Development Act compounded inequality by allowing private lenders to shift risk of financing low-income housing to government. Promoted white “flight” from inner-city and inflated price of homes to minorities.

13. Health Impacts of Urban Renewal & Ongoing Segregation • Displaced communities of color faced profound alienation and traumatic stress described by Clinical Psychiatrist Fullilove as “Root Shock”. • Greater concentration of toxic incinerators and highways in communities of color, increase rates of asthma and other respiratory diseases. • Native Americans are targeted for storage of nuclear waste storage; due to exposure, teens face reproductive organ cancer rates that are 17% above national average. • Due to poor housing, communities of color face double the rate of lead poising than whites (among families with incomes under $6,000: 68% vs. 36%; above 15,000: 12% vs. 38%).

14. Health Impacts of Urban Renewal & Ongoing Segregation (cont.) • Due to structural inequalities that promote illness, African Americans face a life expectancy that is 6 years shorter than non-Hispanic whites. • In Virginia, as of 2009, black women are 2 ½ times more likely than women of other races to experience infant mortality. • Nationally, infant mortality rates among blacks in 2000 was 14.1 deaths per 1,000 live births. The national average is 6.9 deaths per 1,000 live births. • Police surveillance target black and Latino communities for drug offenses and receive more time in jail than whites.

15. “Roll-back” of Civil Rights Victories • 1964 Civil Rights Act - made racial discrimination in public places illegal. Established equal standards for the right to vote. • In the late 70s, due to deindustrialization, seniority based lay-offs, disproportionately impacted minority workers. • Ongoing bi-partisan opposition to school desegration. • Opposition by conservative right wing groups target civil rights gains as cause of loss of “blue collar” white jobs and constructs “moral panics” about families, crime, and welfare to erode social safety net.

16. “Roll-back” of Civil Rights Victories • Liberals and conservatives have also supported seemingly race-neutral policies in 1980s that reinforce value of whiteness through changes in tax laws that advantage those with wealth. • At present, Obama extended George W. Bush tax breaks for wealthy (with earnings in excess of 250,000 a year) for 2 years, increasing the deficit another $801 billion.

17. Possessive Investment in Whiteness & Consumer Citizenship • Encourages individuals and groups to view every action of the state in oppositional consumer terms, to seek profit at the expense of others. • Utilizes collective political campaigns that identify harm toward white interests due to enforcement of civil rights laws framed as “reverse racism”. • Frames elites as oppressed by bloated government bureaucracy and racial minorities, migrants, and targets social welfare programs as cause of unemployment and recession (i.e. Tea Party and Minuteman Project). • Prevents examination of contradictions embedded in capitalism (crisis of overproduction).

18. What Theoretic Models Can We Use to Understand Hierarchies of Health & Illness Across Communities?

19. Biomedical & Feminist Intersectional Paradigms

20. Biobehavior Paradigm • Is considered the mainstream acceptable approach to the study of health disparities. • Majority of national funding (National Institutes of Health and Centers for Disease) support biomedical approaches. • Majority of publications on health disparities utilize biomedical paradigm. • Emphasizes measurement and quantification of independent and proximate causes of social inequality. • Methodologically, emphasizes distance and value neutrality in research.

21. From Biomedical to Genomic Research • How unbiased is the study of Human Genomic Research? • How has the Human Genome Project reinforced the Possessive Investment in whiteness?

22. Limitations of Biomedical Paradigm • Legacy of individualizing illness and disease in the body. • History of Euro and androcentric bias in research

23. Recent Example of Bias in Biomedical Research • HIV/AIDS – victims were stigmatized and diagnosis, prevention, and care were impeded for these and other groups. • Bias resulted in underdiagnosis, lack of care and treatement, and increased death and burden of disease among less powerful

24. As with hypotheses, human values cannot be eliminated from science, and they can subtly influence scientific investigations…. Social and personal values unrelated to epistemological criteria—including philosophical, religious, cultural, political and economic values—can shape scientific judgment in fundamental ways…. The obvious question is whether holding such values can harm a person’s science. In many cases the answer has to be yes. National Academy of Sciences, 1989

25. Feminist Intersectional Paradigm • Emerged primarily among women of color inside and outside the academy. • Arose as a critique of mainstream scholarship and exclusionary practices in emerging interdisciplinary and critical movements (women’s studies and ethnic studies) • Aims to understand the multiple dimensions of social inequality (class, race, ethnicity, nation, sexuality, and gender) at the macrolevel of institutions micolevel of individual women. • Motivated by a desire for social justice through social change

26. Example of Feminist Intersectional Research • Perceptions of smoking are shaped by ideology and political power. • White mothers are significantly more likely to smoke than black mothers. • Surveillance of poor (via Medicaid and family social services) increases power of state interventions to determine when women are fit for mothering. • Reasons for smoking are linked less to uncontrollable addiction, but institutional and power relationships: unequal gender dynamics, increased double burden of formal and informal labor, and involved with partners that smoke.

27. Feminist Intersectional Approach & Health Interventions to Promote Smoking Cessation • Improvement of living wage • Shifts in workplace control • Universal, affordable, quality health care • Accessible public transportation • Safe and affordable housing • Equal access to quality education