April 30, 2013
By Jocelyn Streid
This essay is a winner in the Duke School of Nursing’s Global Health Essay Contest.
“When most people think about crime, poverty, and hunger, they picture the inner city. They picture dirty streets and gangs and chain link fences. They don’t picture rolling hills or clear brooks or houses nestled in the woods. They don’t think rural. They don’t think about us.”
The words of one of my research mentors has stuck with me three years after I spent a summer with her in a Appalachian town about the size of my high school. I was teaching smoking cessation classes and studying how faith communities might serve as important social networks for preventative health interventions to target, but I was also learning about a culture that was not my own. The town was a hub of extraordinary Appalachian oral history, art, and music, but it was also a place where fast food dominated the restaurant scene. It was a place where many lacked health insurance but everyone knew friends, family members, and neighbors who had died of preventable and treatable illnesses. It was a place where diabetes and lung cancer ran rampant, where hospitals were half a day away, where food stamps didn’t cut it, and where many I knew dreaded the monthly onslaught of bills. In the Appalachian town, I learned that health isn’t just about malignant cells or defunct immune systems or viral invasions – it’s also about food accessibility, whether or not your friends smoke, HIV/AIDS education, and the poverty line. It’s a place that broke my heart, but it’s also a place that taught me I want to be a doctor who will serve the underserved.
Since that summer, I’ve used my college career to explore issues of health equity and fairness in various forms. The summer after my sophomore year, I explored rural health abroad. After interning in a public hospital in middle-of-nowhere South Africa for two months, I learned how the residues of structural racism, combined with crippling poverty and poor government policy, perpetuate conditions that produce HIV/AIDS, tuberculosis, and malnutrition. Healthcare was free to all, but when hospital staff complained about patients as if they weren’t there and the “good” doctors were the ones who had to falsify patients’ CD4 counts to get them the government anti-retroviral medications they needed but didn’t quite yet qualify for, the hospital was an alienating institution for those of low income and little education – one that scared people off as often as it helped them.
Soon after, I spent a semester studying global health disparities in both India and China through the Global Semester Abroad program. By conducting interviews and listening to narratives of villagers in rural Rajasthan and migrant laborers on the outskirts of Beijing, I learned how the nuances of culture can serve as impediments to good health. My research informed the policies of a local health NGO, and my photography helped them publicize their mission. I’m currently working with a Duke professor to share my photo essays with a larger audience.
Unable to forget my experiences in South Africa, I spent last summer in London, conducting research on palliative care in sub-Saharan Africa. Lack of resources has placed the burden of end-of-life care on family members of the dying, who often lack the time, education, money, and emotional strength to bear the strain of their responsibilities. I’m working with King’s College of London to submit my research for publication. Meanwhile, my work in health disparities continues here at Duke, as I write a senior thesis on palliative care in America.
As I become a doctor dedicated to palliative care for the underserved, I’ll move forward with the conviction that neither a good life or a good death ought to be denied to anyone on the basis of geographical location, socioeconomic status, social capital, or education. I suspect that my career will take me to rural areas with few doctors and academic institutions where there are many; wherever I am, I know that my time in the Appalachian town will forever shape the way I think about medicine, community, policy, and equality.
Often the term ‘disparities’ is related to a specific racial or ethnic group of people, many variations of disparities exist in America, mainly in regards to health. If any outcome from health disparities can be ascertained is populations and regions in America.
Healthy People 2020 creates a compilation of reports in an effort to pinpoint area of disparities among populations, demographics and geographical location. ‘In 2008 more than 33% or more than one million people identified themselves as ethnic or minority’ (Healthy People 2000) In 2008 51% of those people were women (Healthy People 2020).
Major disparities continue to exist in spite of America’s ‘Affordable Care Act’, Although minorities suffer disease five times greater than the rest of the nation, minorities represent the majority of the disparity. Infant Mortality has always been America’s indicator as to the state of the countries health status. America is one of the wealthiest and most powerful nations in the world, However, America ranks number 24th in the world for infant mortality. Puerto Rican and Indian women rank highest among ethnic classes with low infant mortality rates. Some researchers have found lack of prenatal access as the key contributing factor to low mortality and birth weights among these two ethnic classes.
In todays society the second leading precursor for American’s is Cancer, Killing more than 600,000 people per year per capita (Healthy People 2020). Early detection, screening and prevention, often times is not provided by mainstream America to support programs that benefit all American’s. Often Minority groups are sometimes five years after preventative screening before tests are available to them.
These mentioned are just some of the Health Disparities facing America today, while not minimizing the need for greater cardiovascular, diabetes and immunizations still remain constant sore thumbs for Health and Human services. The good news is HHS (Human Health Service) is paving the way for new legislation and programs that will deeply impact the poor and disadvantaged communities. Some of the HHS initiatives are decreasing infant mortality by 22% reduce strokes by 40% End Stage Renal Disease by 65% among American Indian and Black communities. (Health and Human Services .gov)
This is awesome, if we can stay focused and not allow our own selfish needs to get in the way of keeping America strong and thrive as a brilliant country worthy or mimicking in the world.
United States Human Health Services, Issues Racial and Ethnic Health Disparities May 26, 1998
Public Health Reports, Eliminating Racial Disparities
Healthy People 2020 online reading