Category: Right to Health and Public Health

We Beretta Do Something: Gun Violence, Public Health & Their Discontents

 

doctor-gun. Source: spacecoastdaily.com, Creative Commons

Continuing the Institute for Human Rights’ blog series on gun violence, this contribution illuminates a public health lens, offering an evidence-based analysis and pragmatic solutions to the U.S. gun violence epidemic.

Following the February mass shooting at Marjory Stoneman Douglas High School (Parkland, FL) that resulted in 17 fatalities, mainstream fervor on U.S. gun violence has, once again, returned. Parkland Students have utilized their recent tragedy as a platform to demand an end to gun violence and mass shootings, stressing why their lives matter. According to Amnesty International, the world’s largest grassroots human rights organization, U.S. gun violence is a human rights crisis. Human rights are protected and enforced by international and national policy, and with the U.S. government marshalling many of these treaties and laws, it is, too, culpable of upholding such rights.

The nation’s leading science-based voice for the public health profession, the American Public Health Association (APHA), claims gun violence is one of the leading causes of premature death in the U.S., killing over 38,000 people and injuring nearly 85,000 annually. Gun violence can not only affect people of all backgrounds but disproportionately impacts young adults, men and racial/ethnic minority groups. Recently, Parkland Students teamed with students in Chicago to address inner-city gun violence, a phenomenon commonly overlooked by the media while addressing its threat on young lives. Though most gun violence is not an agent to mass shootings, the APHA claims, in 2017, there were 346 mass shootings in the U.S., killing 437 as well as injuring 1,802.

Furthermore, the American Medical Association (AMA), who leads innovation for improving the U.S. health care system, labeled gun violence “A Public Health Crisis”. At their 2016 Annual Meeting of House Delegates, the AMA actively lobbied Congress to overturn legislation that averts the Centers for Disease Control and Prevention (CDC) from researching gun violence. The CDC is one of the leading institutions of the Department of Health Human Services (DHHS), working 24/7 to protect Americans from foreign and native health threats, whether they be chronic, acute, curable or preventable, accidental or intentional. Ultimately, the CDC protects U.S. national security and critical science is imperative to addressing health threats.

According to the Union of Concerned Scientists, a 1993 CDC-funded study published by the New England Journal of Medicine found that firearms in the home increased the risk of homicide in the household, as opposed to home protection. This galvanized the National Rifle Association (NRA), a major force in U.S. gun rights and education, to campaign against the CDC and its “anti-gun propaganda”.

In response to this 1993 publication and the NRA’s support, Congress in 1996 passed an appropriations bill known as the Dickey Amendment, named after former Arkansas congressman and NRA member Jay Dickey, which states, “none of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention may be used to advocate or promote gun control.” Almost two decades and thousands of tragedies later, Dickey renounced these restrictions in 2015 by claiming, “Research could have been continued on gun violence without infringing on the rights of gun owners, in the same fashion that the highway industry continued research without eliminating the automobile.” Despite this humility, the Dickey Amendment persists, curtailing efforts to address gun violence in the U.S.

a picture of a Beretta handgun
Beretta 9000S. Source: James Case, Creative Commons

In the U.S., a common method to circumvent the argument that guns extrapolate acts of violence is to scapegoat people with mental illness. The American Psychiatric Association (APA), the leading voice and conscience of modern psychiatry in the U.S., recently published a book on gun violence and mental health. Specifically, they address the topic of mass shootings and mental illness.

Some popular misperceptions are:

  • Mass shootings by people with serious mental illness represent the most significant relationship between gun violence and mental illness.
  • People with serious mental illness should be considered dangerous.
  • Mass shooting will be effectively prevented with gun laws focusing on people with mental illness.
  • Gun laws focusing on people with mental illness, or a psychiatric diagnosis, are reasonable, even if they perpetuate current mental illness stigma.

On the other hand, it is evidence-based that:

  • Mass shootings by people with serious mental illness represent less than 1% of all annual gun-related homicides.
  • People with serious mental illness contribute to an overall 3% of violent crimes. An even smaller percentage of them are found to involve firearms.
  • Laws for reducing gun violence that focus on the previously mentioned 3% will be extremely low yield, ineffective, and wasteful of resources.
  • The myth that mental illness leads to violence is perpetuated by gun restriction laws focusing on people with mental illness, as well as the misunderstanding that gun violence and mental illness are strongly linked.

However, a significant caveat related to mental illness and gun violence is suicide. The American Foundation for Suicide Prevention (AFSP), who funds research and offers education on suicide, claims depression is one of the most treatable psychiatric illnesses yet is seen in over 50% of people who die by suicide. Suicide lays in the shadow of repetitive, media-frenzied mass shootings, while representing nearly two-thirds of gun-related deaths in the U.S. Harvard University T.H. Chan School of Public Health indicate a number of factors that define lethality of suicide methods, including inherent deadliness, ease of use, accessibility, ability to abort mid-attempt and acceptability — all attributable to gun ownership and usage, specifically in the U.S.  To strengthen civil discourse on gun-related deaths and injuries, we must uphold a national platform for suicide prevention, too. If you or a loved one is experiencing a suicidal crisis or emotional distress, the National Suicide Prevention Lifeline is 1-800-273-8255 (available 24/7).

Last year, researchers at Johns Hopkins University School of Medicine analyzed data from the Nationwide Emergency Department (ER) sample between 2006-2014 and concluded the U.S. accumulates an annual $2.8 billion in hospitals bills from gunshot wounds, with an average ER cost of $5,254 and approximately $96,000 in follow up care per patient. This study was limited because data was only used for gunshot victims who arrived at the hospital alive; people who did not seek medical treatment or were dead on arrival were not counted. Furthermore, after accounting for lost earnings, rehabilitative treatment, security costs, investigations, funerals, etc., a 2015 Mother Jones report estimated gun violence cost Americans $229 billion annually.

The APHA insists gun violence is not inevitable but preventable, and suggests core public health activities are capable of interrupting the transmission of gun violence. Notable ways to curb gun violence are:

  1. Better Surveillance
    • Increased congressional funding of The National Violent Death Reporting System which is currently employed in 40 U.S. states, D.C. and Puerto Rico.
  2. More Research
    • Lifting restrictions on federal funding for research on gun violence. There is barely any credible evidence on the effect of right-to-carry laws.
  3. Common-Sense Gun Policies
    • Criminal background check on all firearms purchases. This includes gun show and internet purchases.
  4. Expanded Access to Mental Health Services
    • Funding for mental health services has declined, so increased financial support for the Substance Abuse and Mental Health Services Administration (SAMHSA) is advised.
  5. Resources for School and Community-Based Prevention
    • Intervention and preparedness programming to prevent gun violence and other emergencies in communities, namely schools.
  6. Gun Safety Technology
    • Innovation that prevents illegitimate gun access and misuse such as unintentional injuries.

If the above prescriptions are not followed, the tragedies will likely continue. So, it is imperative we support leaders who will encourage gun policy that protects public health and our right to life. Tomorrow, March 24, 2018, people across the world will March For Our Lives, demanding the lives of kids and families, amidst the controversy circling around gun violence, become prioritized.

A march for our lives, your life and mine is exactly what the doctor ordered.

The Responsibility to Protect, Revisited: Gun Ownership in the United States

Tennessee, Tennessee, Ain’t No Place I’d Rather Be

I grew up in rural Northeastern Tennessee, situated 30 minutes from both the Virginia and North Carolina state borders. In my hometown of Kingsport, itself a part of the Tri-Cities, I inherited many traditional Southern cultural mannerisms and beliefs as a growing kid. True to form, I can whip up banana pudding and biscuits and gravy, I sometimes use the word “ain’t”, and I will always hold the door open for others. Southern culture can be a simple one; try sitting on your front porch for the entire weekend – something we in Tennessee consider high entertainment. Tennessee made me a fan of great music (I’m an avid Bonnaroovian), a taste for delicious foods (ever tried Pal’s Sudden Service?), and a reverence of nature. My family, tried-and-true Southern kinsfolk, embody many Southern ideals. Most of these traditions, such as saying, “yes ma’am” and “no sir” are benign. These mannerisms just are – part of the charm of hailing from the South. Tradition is quintessentially Southern.

A photo of the author's family farm in Tennessee.
“Tennessee.” Photo by: Nicholas R. Sherwood

Part of a traditional Southern rearing is a respect for and knowledge of firearms. Almost all members of my extended family know how to operate these weapons using proper gun safety measures. I recall many afternoons as a child refining my marksmanship. This often involved setting up targets (nothing fancy, soda cans would do) across long pastures in the various farms my family owns. All the cousins and our parents would gather ‘round, grilling ribs, searing vegetables, and baking buttery breads. We swam in muddy ponds and hightailed across our properties in four-wheelers. All the while, the children, teenagers, and adults would take turns practice shooting a variety of revolvers, magnums, bolt-action rifles, and muzzleloaders.

This is a Sherwood tradition- we all know how to responsibly fire a weapon.

In my family, gun ownership is a serious endeavor. I vividly remember my uncle and my dad explaining to my sister and me that guns can and do often kill other human beings. To own and operate a gun is to have access to an awesome power, and we only used this power under the strict supervision of properly-trained adults. Firing a gun required two things: every person on the property was safely accounted for and our parents knew beyond the shadow of a doubt that we were mature enough to grapple with the destructive power in our still-growing hands. Today, I am thankful for being desensitized to firearms. I can watch someone shooting a gun and know if they have good or poor form, how to properly handle the weapon, and have the maturity to wield it. Most of the Sherwoods have taken at least one, if not several, Tennessee Hunter’s Safety Courses. This too was crucial to our firearm education. Additionally, many of us have Conceal & Carry permits. This is not to say the Sherwood clan only buys guns just to keep them; we have several avid hunters in our ranks. For us, hunting is a sacred tradition with specific rules we abide by. I was taught never to overhunt in an area – disrupting animal populations would wreck local ecosystems. Thankfully for us, East Tennessee has an overpopulation of deer, meaning local hunters can bag and tag a regulated amount of these animals without destroying the Tennessee natural ecology. In fact, by hunting excess deer, wild apex predators are kept in check and the vegetation deer overconsume is conserved. Descending from a long line of Cherokee Native Americans, instilled in every Sherwood is an understanding that we, like our ancestors, have a responsibility to care for the land around us. Hunting is part of that responsibility.

A Portrait of the Responsible Gun Owner

With this upbringing in mind, when acts of mass gun violence rip through the social fabric of America, I am thrust into a dissonant space. How do I reconcile my upbringing of responsible gun ownership with the dire need to regulate these weapons – for the safety of all Americans? Parsing through these issues, the Institute for Human Rights is currently running a series on gun control in response to the horrific massacres of school-children throughout the United States. It is my intention to show that responsible gun owners do exist, and they too must be a part of this conversation. Moving towards reconciliation of these two issues, public safety and private liberty, I have these questions:

  • What is responsible gun ownership?
  • Is it a regulatory process that educates the general population on gun safety protocols or an ethos of responsibility? Is it both?
  • Does gun control involve federal law, perhaps barring ownership from individuals with moderate to severe psychopathologies, histories of criminality, or a lack of maturity to handle weapons?
  • Is gun control a responsibility to protect the gun owner from his or her own mistakes in handling the weapon, or is gun control a responsibility to protect society at large from individuals with the sole intent to do as much damage in the least amount of time?
  • How do we reconcile the responsibility to protect the most defenseless members of society with the responsibility to protect freedom of thought and behavior?
  • What institutions bar authentic and transformative debates from occurring in the American public sphere and within global civil society at large?

What is undeniable is this: no productive and sustainable progress in gun control will take place without the inclusion of responsible gun owners within the conversation. And all gun owners must accept that governmental limitations on gun ownership is not an existential threat to one’s personal liberty. This limitation is a recognition that an individual’s participation in society requires a widening of responsibility to protect not only one’s immediate family and friends but also the protection of all members in a society. What we are facing here is a tension between individual liberty and the need for a cosmopolitan protection of all members within a society. To resolve this tension, we must first acknowledge that a solution is indeed possible, and that we already have the necessary tools to move towards successful resolution.

Towards this end, we must first define an oft-nebulous construct: responsible gun ownership. I propose a “responsible gun owner” possesses the following qualities:

  1. a working knowledge of local, regional, and national laws that dictate the possession and usage of any and all types of firearms,
  2. a vetting by official state authorities (such as the local police and / or military personnel) on said knowledge of gun possession and usage,
  3. is of sound mental health (yes, this advocates for universal mental health background checks upon purchase of any firearm),
  4. constant usage of a locked gun safe that prevents children and other unqualified persons from accessing firearms,
  5. has undergone a rigorous criminal background check, with a waiting period before firearms can be purchased, requiring an utter absence of violent and harassment-based crimes, such as stalking and intimate partner violence,
  6. an acceptance that gun ownership will always be a contested issue that must be resolved through constant dialogue between all invested parties with concessions on all sides,
  7. a commitment to solution-focused resolution rather than a problem-focused resistance to negotiating gun ownership.

This last point is especially salient. Any meaningful conversation on gun control must arise from a negotiation between second amendment advocates and gun control advocates.

Too often (on both sides of the spectrum) the prevailing narrative of this discourse is a blanket denial of the rights, responsibilities, and needs of all involved parties.

Specific institutions promote this denial and antagonism, thereby promoting a particularly insidious form of structural violence and resistance to civil dialogue. I speak specifically of the National Rifle Association.

A man photographs the National Rifle Association logo.
“NRA” by Bart, Creative Commons.

The National Rifle Association’s Culpability

In the aftermath of the massacre at Marjory Stoneman Douglas High School, the National Rifle Association (NRA) participated in a town hall on gun policy in America. In attendance were survivors from the high school, Senator Marco Rubio, local politicians, and the NRA’s spokeswoman, Dana Loesch. Ms. Loesch, a one-time contributor for Breitbart News and Glenn Beck’s The Blaze, relied heavily on her familiar stumping strategy: invoking the maternal instinct as an emotional appeal to advocate for gun ownership. She and other members of the NRA assert a broad dissemination of guns throughout American society (their opinion of who deserves such weaponry is inconsistent, to say the least) is one of the most promising methods to protect children and other marginalized groups in America from the “people who are crazy” who possess guns. Essentially, the NRA argues more guns in society increase the chances that “good guys with guns” will deter or kill the “bad guys with guns”. This is, of course, tautological.

Flooding the market with guns would increase the likelihood that these “crazy” people get ahold of a firearm. After all, the NRA has made no serious attempt to advocate for mental health reform in response to calls for tightened gun control. The ‘mental health’ argument has long been a smokescreen of the NRA, a method of distraction to bait the normally health-promoting left a fight on mental health care reform. This bait-and-switch technique is a political gambit used by an inherently political institution, and it does a disservice to responsible gun owners throughout the United States.

Furthermore, it duplicitously reduces individuals with mental health issues to be political pawns; this reduction is utterly dehumanizing and offers no solution to the massive structural issues facing access to mental health care in America.

These theatrics add to the antagonism on both sides of the issue. Of course, a critical question remains regarding why such controversy exists: who stands to benefit from these bitter feuds? The answer is overwhelmingly politicians.

Millions of dollars of contributions from the NRA have fundamentally altered how politicians are able to fundraise, which politicians receive adequate funding to mount serious campaigns, and (this is most concerning) when or if a given politician will advocate for common-sense, widely-supported gun control policies in the face of unspeakable tragedy. This puppeteering is, by its very nature, anti-democratic and antithetical of American ideals. This ability to openly buy politicians, including Presidents of the United States, is an existential threat to American democracy. Add in the suspected ties to Russia and the political jockeying on display during CNN’s Town Hall, and you have a political institution that effectively and openly operates as a site of political nepotism and deception. Topping it all, the National Rifle Association has been linked to white supremacy ideology and it’s spokeswoman, Ms. Loesch, accused of encouraging violence as an acceptable form of response for critiquing the NRA. This dimension of intentional structural violence transforms the NRA from an institution not only engaging in political bribery, but also one that reflects tendencies of homegrown terrorism.

In my opinion and personal experience as a responsibly-trained gun user, the National Rifle Association functions a terrorist organization stoking fear and tribalism, thereby driving responsible gun owners away from the debate table on this issue.

Support for the NRA is a moral failure to denounce election-buying, white nationalism, and foreign meddling in the American political system. This support is an abject failure to protect American society from treacherous forces undermining a functional society, and this failure is far beneath the maturity and discipline typically shouldered by responsible gun owners throughout their mastery of weapons capable of both indiscriminately murdering and responsibly nourishing.

Conclusion

As I have stated, responsible gun owners do exist. These individuals see the inherent danger and power in firearms and acknowledge that controlling this power requires specialized education, careful observation, and highly specific locations where guns may be appropriately used. Responsible gun owners must hold other gun owners responsible, whether leading by example or calling out inappropriate practices as they occur. This responsibility extends not only to other gun owners, but to the American public as well. The conversation on gun control requires an intentional suspension of disbelief from both camps in order to find a middle ground in the issue.

I assert responsible gun owners have the moral responsibility to inclusively and adroitly address the legitimate calls for disarmament in the face of such abject horrors and losses exemplified by the recent school shootings throughout America. Without genuine participation in this exchange, gun owners lose the opportunity to educate the public on successful encounters between liberty and responsibility, and they may well lose their firearms as a result. An unwillingness to come to the discussion table with open ears and clear heads will result in the marginalization of responsible gun owners unless they are willing to make strident concessions in the ongoing debate of gun control. Similarly, gun control advocates must accept that responsible gun owners do exist, and these individuals have a constitutional right to bear arms.

The only way the mayhem will stop, the only way lives can be saved, is if both sides accept the only way towards a meaningful and equitable solution for all involved parties will require an intentional partnership to confront and transform the meaningless violence that currently terrorizes the safety of many Americans – most notably schoolchildren.

The first step in this partnership must be a resounding denunciation and deconstruction of the practices and ideologies of the National Rifle Association. You are not a responsible gun owner if you support the NRA in its current form. Only once the NRA has been disbanded, its latent ideology of political radicalism reconciled, can authentic encounters between gun control advocates and responsible gun owners reshape the horrifying trends of gun violence currently annihilating the safety and wellbeing of schoolchildren and marginalized groups throughout the Unites States.

Human Rights and Guns

**Due to the continuing tragedies of gun violence, especially in schools, and stalled legislation, our series on guns and gun control (from two months ago) will repost over this week.  

a picture of the end of a gun tied in a know
pistola floreada. Source: Edith Soto, Creative Commons

The gun rights vs. gun control debate is again at the forefront of our national discourse after 17 people lost their lives in a school shooting in Florida last month. School shootings hit close to home for all of us, and especially those of us engaged in education or with school-aged children. As an educator and mother, this is very personal. We need this public discussion on what our children’s lives are worth to us, on guns, and laws and policies that will help protect us in cases of gun violence.

I have noticed that both sides invoke human rights when they advocate for either gun rights or gun control. The human rights case for gun control is pretty clear and straightforward. Gun control advocates base their claims on the most fundamental human right: the right to life and security of the person (Articles 6 and 9, International Covenant on Civil and Political Rights (ICCPR) and Article 3, Universal Declaration of Human Rights). Article 6 ICCPR very clearly states that “no one shall be arbitrarily deprived of his life” and that states have an obligation to ensure the security of all persons. School shootings fall within the realm of arbitrary taking of life, and therefore need to be addressed by the government. The government has a duty to protect people from these types of events. When the government fails to do so, we speak of a human rights crisis, which is what the Amnesty International has called gun violence in the United States.

The “other side”, namely the gun lobby and gun rights advocates, has used human rights language mostly in terms of “right to own a gun”. Gun control has been said to “be the ultimate human rights violation.” However, this rhetoric is highly problematic.

Let me be very clear:

There is no human right to gun ownership.

Human rights are essentially the opposite of guns. Here is why.

According to the preamble to the International Covenant on Civil and Political Rights (ICCPR), human rights “derive from the inherent dignity of the human person’ and are aimed at achieving ‘freedom from fear and want.” Human rights are moral rights with legal implications. They are about the value of each human life, and about people’s most basic needs. Access to food, water, housing, for example, or equal treatment before and under the law and not to endure discrimination on grounds of race, religion, ethnicity, sex or gender, national or social origin, and disability status. These rights are codified in international human rights treaties or part of customary international law.

The right to own a gun is not mentioned in any human rights document.

It is not part of customary international law or a general principle of law as recognized by the international community. It is not general state practice, which is what you would think following the debates in our own country. In fact, the United States is one of three countries in the world that has included the right to bear arms to their constitution, so it is quite an outlier.Therefore, the fact that the right to own guns is a constitutional right (although there is some debate over how to interpret the Second Amendment) does not mean it is a human right.

The reason the gun lobby is proposing a human right to gun ownership is easy to see. First, human rights are “sexy”, they are “in”. Their proposition reflects an overall trend to construct more and more issues in the language of human rights. Second, calling gun ownership a human right also strengthens their argument – who would not want their position to be supported by an inalienable right? But again, this is not what human rights are. You cannot simply take any individual right and call it a human right. As discussed above, human rights carry greater moral weight than individual rights by themselves. This might be splitting hairs to some, but it is an important distinction. It makes all the difference. Third, gun rights advocates often argue that not only is gun ownership is a human right, but also that the government cannot legally limit this right. That is not how rights work, regardless of whether we are talking about a human right or any other right.

No rights are absolute – they are limited by the rights of others. Governments can certainly limit rights, for national security reasons, for example, or to uphold public order, or to confront a health threat. Take freedom of speech as an example: You cannot say anything you want. You cannot incite murder, leak government secrets, or distribute child pornography. The idea that there is a human right to own guns and that this right is unlimited is incorrect.

But what about self-defense? Isn’t there a human right to individual self-defense from which the right to own guns would follow? This is where things get a bit more complicated. The academic literature contests whether self-defense is a human right. No international human rights treaties or resolutions mention the right to individual self-defense, which leads me to conclude that individual self-defense is not recognized by international law (unlike collective self-defense, which is the right of the state under Article 51 of the UN Charter). The right to life and physical security might imply that states must recognize an individual right to self-defense since states will never be able to defend all individuals from being harmed at all times. However,

the entitlements that flow from a human right are not the same as the human right itself.

For example, the right to work does not include a specific right to conclude a contract for employment. Or the right to freedom of movement does not liberate you from rush-hour traffic.

In short, the assertion that there is a human right to individual self-defense has dubious legal and moral foundations, and scant empirical support. The conclusion that this means there is a right to gun ownership for private citizens is clearly false. A conclusion like this would imply that guns are only be used in self-defense. However, studies have shown that guns are not used in self-defense as often as people claim. A recent study by the FBI showed that in 2012, only 259 homicides were justifiable (in self-defense), but 8,342 criminal gun homicides. In other words, for every one (1) justifiable homicide in the U.S. involving a gun, 32 criminal homicides occurred. This ratio does not take into account gun-induced suicides or fatal accidents involving guns. In other words, the assessment of gun rights cannot depend solely on their positive or negative impact on the right to self-defense, since no gun is inherently limited to defensive use.

Studies have clearly demonstrated that more guns mean more homicides (see here, here, and here). Individuals who have a gun are almost 5 times as likely to be shot in assaults than those who don’t have a gun. Other studies show that living in a home with guns is less safe than living in a home without guns (see here and here). Gun proliferation has a negative impact on the right to life and physical security and can lead to human rights violations. It is, therefore, important for the government to take action and regulate and hinder the proliferation of guns as part of its obligation to protect the right to life, as I explained above.

Human rights and guns do not go together. Using human rights to justify gun rights is not only wrong but it is dangerous. Human rights are about the lives of human beings, about freedom, liberty, and the betterment of these lives. Guns or “gun rights” have no place in human rights discourse; countering gun violence, engaging in public discussion, and instituting gun control do, however.

This is the mission of the March for Our Lives, which is scheduled for this Saturday, March 24, to raise awareness of the gun violence in schools. The March’s mission statement reads: “Not one more.  We cannot allow one more child to be shot at school. We cannot allow one more teacher to make a choice to jump in front of a firing assault rifle to save the lives of students. We cannot allow one more family to wait for a call or text that never comes. Our schools are unsafe. Our children and teachers are dying. We must make it our top priority to save these lives.”

 

When You Are Ready for the Baby Carriage: Black Maternal Health and Disparities

by MARTINIQUE PERKINS WATERS, Ph.D. 

a maternity shoot
Source: Ariane Hunter, Creative Commons

I did something very interesting in my mid-twenties. I asked a few of my family members if they would be willing to be a surrogate if I could not have children. Now, let me preface this by saying I never had any kind of health issues and most women in my family conceived with no problem. My OB/GYN never mentioned irregularities, fibroids, or cysts. My graduate school research had nothing to do with women’s health so I was not inundated with facts and figures. Yet, here I was already concerned and worried (with no discussion of even a long-term future with my partner at the time might I add). My wonderful family, including my mother, tentatively agreed but I am sure were thinking “she has to be joking”. I had never been more serious; I wanted to have options. I did not know what would happen when my womanhood was called out on stage. As women, that is how so many of us define ourselves, right? This is what famed Developmental Psychologist Erik Erikson called generativity: deciding how we will contribute to future generations. In his theory, however, he felt that people usually did not start worrying about this legacy until middle age (or at the very least until a partner was on board), but here I was already thinking about my grandchildren.

About 5 years later, while I was teaching Public Health and Medical Issues in African American Communities, I discovered the documentary series, “Unnatural Causes.” Unnatural Causes delves into the relationship between social conditions and population health. When it came time to discuss health disparities as related to women’s issues, the episode “When the Bough Breaks” was perfect. One statement in the video astounded me: Black women with advanced degrees have worse birth outcomes than White women without a high school diploma. I nearly cried in front of my class. It not only took me back to my concerns in my 20s, but I had just found out I was pregnant with my first child. Would I, a Black woman with a PhD in her early 30s, not be able to carry full-term? Infertility issues, low birthweight babies, and high-risk pregnancies can absolutely influence any woman and family. However, research has uncovered unique circumstances that impact the maternal health of Black women.

Physical Factors

The 2006-2010 National Survey on Family Growth interviewed over 20,000 men and women about family life, pregnancy, infertility, general health, and reproductive health. Chandra and colleagues found non-Hispanic Black women were 1.8 times more likely to report fertility issues compared to non-Hispanic White women. This finding was true among married women as well.  It is possible that uterine fibroids, benign tumors in the uterus, affect fertility. Reproductive Science is a relatively young field (compared to Obstetrics and Gynecology which date back to the 19th century), therefore the relationship between uterine fibroids and infertility is far from definitive. However, race/ethnicity is a well-established risk factor for uterine fibroids with Black women developing uterine fibroids at an earlier age than White women. A recent analysis of couples in a reproductive medicine clinical trial found that Black women with uterine fibroids were more likely to miscarry before 12 weeks compared to White women with uterine fibroids. Researchers are trying to identify genetic causes but that will not help the thousands of Black women trying to conceive now.

Psycho-social Factors

Were you ever told babies do not grow in a hostile womb? I heard that at some point in life. During my first trimester, I learned this new information about health disparities in pregnancy outcomes and I was going through a career transition. I was stressed out. Stressors cause the body to release cortisol, which is a necessary hormone when you need to react during intense situations. However, long term exposure to cortisol weakens your immune system and puts you at risk for disease. There is a significant amount of data to support that high levels of cortisol (from continual exposure to stressors) throughout pregnancy can impact the development of your baby. At the same time stress, as a psychological and emotional reaction, is at the center of two of the most common psychological disorders: anxiety and mood.

Anxiety disorders often include fear, tension, nervousness, and dizziness whereas mood disorders often include a sense of hopelessness, fatigue, depression, and an inability to concentrate. Although pregnancy does not increase the likelihood that you will develop either disorder, whether stressed or not, undiagnosed psychological disorders prior to pregnancy can advance further because the symptoms go undetected due to similarities with the normal experience of pregnancy. Dealing with the stigma of mental health issues in the Black community will have to be for another time, different blog! What should a Black woman dealing with certain psychological and emotional symptoms, particularly as stressors, do? Best solutions to deal with stress: walk, yoga, cut out unnecessary activities, watch TV, journal, eat well, and countless other suggestions from books and websites about de-stressing your life. I will admit that I failed miserably in completely de-stressing but I did manage to incorporate a few suggestions over my pregnancy.

a pregnant Black woman sitting on a windowsill
maternity 5. Source: Ariane Hunter, Creative Commons

How can Black women deal with cultural, historical, and intergenerational stress…the kind of cumulative stress that comes from 400 years of slavery, racism, and discrimination? The pervasive stress that has entrenched itself in the Black psyche? Yes, it is absolutely in there, but it has not just remained in our minds as simple negative thoughts. If that were the case, we could have some sessions of cognitive therapy, learn to counteract those aversive thoughts, and stop perceiving the world as a threat. When one examines racial differences in health outcomes with all things being equal across the racial groups, for example money, education, health care access, and family life, health disparities are still present. Scholars have offered the historical trauma of Blacks throughout the course of US history as an explanation. Could racism not be another explanation for infertility? According to Prather and colleagues, it is the perfect explanation for the social conditions endured by Black women that ultimately influence sexual and reproductive health outcomes.

This is just the tip of the iceberg. There is additional research on the impact of lack of quality healthcare for Black women experiencing fertility issues. Differences in healthcare options affect the recommended treatment and patient understanding of alternatives. There are also observed racial differences in In Vitro Fertilization usage, with money most often the biggest deterrent.  Low-income families are very likely unaware that there are grants available to assist with infertility treatment. These are macro-level factors that require changes in resource distribution, medical training, and public policy. And I ask again, how does it help the Black woman trying to conceive now?

As it turns out, I worried for no reason as I thankfully have two healthy and beautiful little girls. I want to ensure that my outcome continues to be the norm rather than the exception going forward. In my opinion, increased awareness of this problem in the Black community will cause a push for more research on racial disparities in fertility issues. Only then will we begin to see changes that will eventually trickle down to support for another young girl in her 20s wondering “can I conceive?”

 

Dr. Martinique Perkins Waters is an Assistant Professor in the Department of Behavior Sciences at the University of West Alabama. She obtained a PhD in Lifespan Developmental Psychology from UAB in 2010 and since then has taught a variety of courses for Psychology, African American Studies, and Public Health. For over 10 years, Dr. Waters’ research has broadly related to gerontology with specific interest in the social role of caregiving and how that impacts physical, mental, and emotional health.

Sustainable Blazers

Green Life… Source: Julie Rutherford1, Creative Commons

On Wednesday, April 11th at UAB Edge of Chaos, dozens of Blazers met, in the spirit of Earth Month and Earth Day (4/22), to hold a discussion titled A Conversation about Sustainability. The event centered on a faculty panel, consisting of Dr. Hessam Taherian (School of Engineering), Dr. Suzanne Judd (School of Public Health), Dr. James McClintock (Department of Biology), Dr. Tina Reuter (Institute for Human Rights), Dr. Josh Robinson (Collat School of Business), and, moderator, Dr. Shauntice Allen (School of Public Health), alongside an inspired, and vocal, student body.

Conversation began with a simple question: Why should we care about sustainability?

The conversation began as far from Birmingham as possible, in Antarctica, where Dr. McClintock conducts research, inspiring him to mention risks to the continent’s biodiversity and its resources that enable pharmaceutical innovation. Dr. Taherian asserts that with almost 7.5 billion people on this planet and counting, so it is imperative we think about our actions, especially as finite resources dissipate. Dr. Judd mentioned how she just came back from Paris, where, in recent years, often rises, and threatens to flood the heart of Paris.

Discussion then turned to Alabama, where raining has increased, resulting in river erosion. Although the effects in Birmingham are minimal, as hurricanes travel through warm water, their strength compounds and influences greater threats to our environment and communities.

When discussing resource distribution, the tragedy of the commons became an immediate talking point — a scenario where individual actors are capable of taking a resource with no clear owner, leading to its depletion. This concept was then related to big hunting in Africa because no one owns the wildlife; therefore, excessive hunting practices have guided many species to their endangerment. Since human behavior was addressed, conversation quickly shifted toward a human rights perspective, demonstrating sustainability’s impact on conflict and displacement of vulnerable communities, namely poor and indigenous persons. The Universal Declaration of Human Rights, an international document that aims to protect security of the person, was proposed as a framework to protect these communities. However, no legal mechanisms are yet in place to protect “climate refugees”, a growing phenomenon.

Following, concerns from the crowd asked if we’ve reached the point of no return. Without hesitation, it was claimed we have because the Great Barrier Reef has experienced recent catastrophic loss from climate change, serving as a canary in the coalmine for what is to come.

Panelists exclaimed we need to incentive sustainability because it directs responsible behaviors. For example, in France, one is charged if they don’t bring their own grocery bags, while, in Dr. Reuter’s home country of Switzerland, she mentioned trash bags are $2 each, incentivizing sustainable behavior. Inevitable critiques of business practice then emerged, where Dr. Robinson claimed businesses are designed for sustainability, meaning accumulating costs of unsustainability will pressure enterprises to adapt. However, it was insisted major oil companies don’t want to leave their product in the ground because of it investment, pitting money against environment. Strikingly, the same researchers hired to protect the tobacco industry about the harms of smoking now help Big Oil with denying the existence of climate change.

As the topic of taxing the population entered the discussion, audience members suggested such an approach would disproportionately affect society’s poorest. Although, it was insisted taxes are not monolithic and can be tiered by income brackets. In addition, the groundswell of communities pressuring the Chinese government to clean the polluted air was mentioned. This generated conversation about the multi-stakeholder process that has been excluded from many environmental decisions, leading to a strong suggestion for non-state actors to be included in such discussions.

When formal discussion ended, students forwarded more insightful questions to the panel, which many responses resulted in conversation about behaviors such as beef consumption, sustainable transportation, Styrofoam cups and the importance of not being aggressive when discussing sustainable behaviors with others. As the lively dialogue ended, it was clear that UAB is the largest electricity consumer in the state, inside a city with poor transportation, and represents a state with some of the nation’s greatest solar potential, meaning Blazers are in the unique position to participate in a global cause by leading local initiatives that advocate for a greener, more sustainable community.

What is Gender-Based Violence?

Growing up, I was resentful of the social freedoms my male friends naturally enjoyed. Unlike the parents of my male friends, my parents were very strict about things like curfews, not being outside at night alone, and avoiding certain neighborhoods. My dad would always say, “We trust you, but we don’t trust the people around you”. Although I was still resentful, I know my father enforced those stringent rules because he was trying his best to protect me from gender based violence (GBV). GBV is defined as violence towards an individual that is motivated based on his or her gender identity, biological gender, “or perceived adherence to socially defined norms of masculinity and femininity”. The term ‘violence’ encompasses physical, sexual, and psychological abuse along with coercion, threats and compromised liberty. Examples of GBV include sexual violence like rape, domestic violence, and human trafficking. Both men and women are affected by GBV; however it is recognized women and girls are at most risk for exposure due to the imbalanced power relations between men and women “which have led to domination over and discrimination against women by men … and that violence against women is one of the crucial social mechanisms by which women are forced into a subordinate position compared with men.”

Violence against women and girls is a prevalent human rights violation resulting in disproportionate negative consequences on females’ physical, mental and sexual and reproductive wellbeing including but limited to including, but not limited to: “i) fatal outcomes; ii) acute and chronic physical injuries and disabilities, iii) serious mental health problems and behavioral deviations increasing the risk of subsequent victimization and iv)  gynecological disorders, unwanted pregnancies, obstetric complications and HIV/AIDS .”

International Womens Day Strike. Source: Molly Adams. Creative Commons

Some troubling statistics on GBV:

  • In 2014, a UNICEF study projected that ~120 million girls (almost 1 in 10) under the age of 20 have been forced to perform sexual intercourse or other sexual acts during some point of their lives.
  • Almost half of the women killed in 2012 were murdered by a family member or intimate partner.
  • Globally, the WHO estimates 35% of women worldwide have experienced either physical and/or sexual intimate partner or non-partner violence or sexual violence. Other national studies have estimated up to 70% of women experience GBV.
  • “Women and girls together account for 71 per cent, with girls representing nearly three out of every four child trafficking victims. Nearly three out of every four trafficked women and girls are trafficked for the purpose of sexual exploitation.”

Although a pressing issue, it wasn’t until 1992 when the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) formally adopted General Recommendation No. 19: Violence against Women (GR 19), which legally categorized violence against women a distinct form of discrimination. Likewise, it wasn’t until 1993 the United Nations General Assembly adopted the Declaration on the Elimination of Violence against Women (DEVAW), forming the first ever internationally-recognized definition of GBV. Both documents explicitly outline how GBV violates basic human rights mentioned throughout the UDHR such as the right to life, dignity, and health.

Health Effects of Exposure to GBV

Sexual and Reproductive Health
GBV is a major public health concern contributing to mass amounts of mortality and morbidity. Specifically, the relationship between GBV and HIV and other STIs has been recognized as an important pathway for the contraction and spread of such diseases. WHO states that, in some regions, women facing sexual partner violence are 1.5x more likely to contract HIV, and 1.6x more likely to contract syphilis. Here’s how:

First, increased vulnerability to HIV and STI’s stems from sexual violence such as rape. “Violence reduces victims’ abilities to influence the timing and circumstances of sex, resulting in more unwanted sex and less condom use, including situations where women are coerced or pressured not to use condoms.” For example, of the estimated minimum 250,000 women brutally raped during the Rwanda Genocide, 70% of those survivors tragically acquired HIV.

Second, another important pathway from GBV to HIV is men who are physically violent are also more likely to be HIV positive. Studies find violent men are more likely to engage in risky sexual behavior such as having multiple sex partners and utilizing transactional sex, increasing their chances of contracting and spreading HIV and other STIs.

Along with the spread of disease, women and girls experience unwanted pregnancies due to GBV. The WHO states that women with previous exposure to GBV are more likely to account having had a self-induced abortion. Globally, “80 million unintended pregnancies each year, at least half are terminated through induced abortion and nearly half of those take place in unsafe conditions.” A study analyzing the relationship between GBV and sexual and reproductive health among low-income youth in three Brazilian cities, supports WHO’s statement that women in abusive relationships are more likely to experience unwanted pregnancies. The study found adolescent females who became pregnant as teenagers were more likely to have been victims of controlling behavior or physical abuse compared to teenage girls whom have never gotten pregnant. Among the girls who got pregnant as a teenager during the study, “20% reported having suffered physical violence from a partner and 10% reported having been subjected to sexual violence from a partner, compared to 5% and 3% respectively of those who did not get pregnant as teenagers.”

Mental Health:

Along with physical harm, studies highlight women and children face serious mental health problems after enduring traumatic experiences with GBV. “Exposures to traumatic events can lead to stress, fear and isolation, which, in turn, may lead to depression and suicidal behavior.” According to the WHO, women abused by a non-partner are 2.3 times more likely to have alcohol use disorders and 2.6 times more likely to have depression or anxiety. A cross-sectional study based on the Australian National Mental Health and Well-being Survey in 2007 found that of the 4,451 female respondents, 1,218 (27.45%) of the women have experienced one of the four types of GBV analyzed in the study (IPV, stalking, sexual assault, and rape). Of the 139 women who experienced at least three types of GBV, the rates for mental disorders were 77.3% for anxiety disorders, 47.1% for substance abuse disorders, 34.7% for attempted suicide, and 56.2% for PTSD.

Right On. Source: Liz Spikel. Creative Commons

Potential Solutions to Address Gender-Based Violence

In light in of April being sexual assault awareness month, itself a form of GBV, it is essential to break through the culture of silence. Our health care system can be more active is addressing the prevention of GBV, and also the aftermath of GBV. First, providing survivors with mental health services such as counseling is critical for these women and girls to address their psychological trauma and progress with their lives. Mental health services are vital in providing survivors a voice to express themselves. Second, our health care system could potentially be a major stakeholder in identifying and stopping GBV.

“GBV is very common, but most health care providers fail to diagnose and register GBV, not only due to socio-cultural and traditional barriers, lack of time, resources and inadequate physical facilities; but even more so due to lack of awareness, knowledge and poor clinical practices with limited direct communication and failure to do a full physical examination, not to mention register and monitor the effectiveness and quality of care.”

Moving forward, there needs to be a systematic change within in the health sector. The World Bank, amongst other NGO’s, have provided approaches on how to address this issue. Some strategies to consider include, but of course not limited to:

1) Requiring GBV screenings during doctor visits to ensure early intervention
2) Train and educate health care personal about GBV to improve provider’s knowledge, medical services and attitudes towards GBV.
3) Providing survivors access to adequate infrastructure within hospitals which includes private counseling and examination rooms.

Women are approximately 50% of our global population, yet gender-based violence is one of the most prevalent and widespread human rights violations. Gender equity is an inalienable right protected in numerous human rights documents, however change will never be achievable until we break this vicious cycle of violence through education and strict policy changes. Ultimately, women have proven they are just as equally capable as men, and gender-based violence and discrimination over an uncontrollable biological factor is simply unjust.

The ‘Invisible’ Killer

Simply because you cannot see air pollution, does not mean air pollution does not exists.  Often, pressing issues such as air pollution and other environmental problems such as soil contamination are dismissed because the effects of pollution are not always tangible until extreme environmental disasters occur. On December 5, 1952 the residents of London, England suffered  five days of devastating toxic clouds known as the Great Smog. Various factors contributed to the creation of the smog, daunting the city of London. First, London, England was a manufacturing city utilizing coal for industrial purposes. Second, residents used coal in household heaters to brace against the December cold. Exacerbated by acrid black smoke from millions of chimneys and manufacturing plants, “a high-pressure weather system had stalled over southern England and caused a temperature inversion, in which a layer of warm air high above the surface trapped the stagnant, cold air at ground level. The temperature inversion prevented London’s sulfurous coal smoke from rising, and with nary a breeze to be found, there was no wind to disperse the soot-laden smog.”

Trafalgar Square. Source: Leonard Bentley, Creative Commons

The consequences of this event were immense, as an estimated 4,000 people died due to health conditions, such as bronchitis and pneumonia which increased more than seven-fold in the immediate aftermath of this environmental disaster.

Outdoor Air Pollution
The Great Smog is one consequence of extreme environmental pollution. In the subsequent 60 years+ since the Great Smog, countries over the world such as China and India continue to bare the effects of both outdoor and indoor air pollution on the health communities. The effects of air pollution on the health of populations is a human rights issue; it essentially affects one’s right to health and life. Numerous epidemiological studies formally recognize the negative effects of air pollution on human health. In 2013, air pollution was officially classified as a cause of lung cancer by World Health Organization’s (WHO) International Agency for Research on Cancer (IARC).  WHO finds “the combined effects of ambient (outdoor) and household air pollution cause about 6.5 million premature deaths every year, largely as a result of increased mortality from stroke, heart disease, chronic obstructive pulmonary disease, lung cancer and acute respiratory infections.” And more specifically, the WHO states ambient air pollution globally causes:

1) 25% of all deaths and diseases from lung cancer,

2) 17% of all deaths and diseases from acute lower respiratory infection,

3) 16% of all deaths from stroke internationally,

4) 15% of all deaths and disease from ischemic heart disease, and

5) 8% of all deaths and disease from chronic obstructive pulmonary disease.

Human activity is a driving force behind air pollution. Human activities contributing to air pollution include industrial facilities such as manufacturing companies, power generation such as coal plants, fuel combustion from motor vehicles, and waste burning.

The morbidity and mortality contact to air pollution causes globally emphasizes how our personal contributions to air pollution not only harms us individually but also affects everybody else on this earth. Air pollution wasn’t caused by one entity, but rather accumulate to dangerous levels due to the actions of people from every single part of the world. Optimistically, there are plentiful habits people can change in their lives to promote cleaner air. On a community level, individuals can participate in carpooling to places such as school or work to reduce toxic emission from transportation, eliminating waste generation by not using plastic materials and recycling to prevent potential waste burning, and even supporting local community groups that address pollution concerns by volunteering. Education is also another tool that is needed to decrease levels of air pollution. Communities may not be aware of the consequences of exposure to air pollution. Educating communities about methods to decrease the production of pollution empowers people to improve and protect the health of their communities. As people, we will need to continue to work together to combat air pollution, educate communities, and implement sustainable life style changes.

Activists gather to demand clean air as Edinburgh Air Pollution Zone to be expanded. Source: Friends of the Earth Scotland, Creative Commons.

Indoor Air Pollution
Even though air pollution impacts the entire global community, lower income communities are at greater risk of exposure to indoor air pollution (IAP). The World Health Organization states “3 billion people cook and heat their homes using solid fuels (i.e. wood, charcoal, coal, dung, crop wastes) on open fires or traditional stoves. Such inefficient cooking and heating practices produce high levels of household (indoor) air pollution which includes a range of health damaging pollutants such as fine particles and carbon monoxide.” As a result, 4.3 million deaths may be accredited to the negative health impacts of household air pollution annually.

Exposure to air pollution is inequitable. Rural and lower socioeconomic communities do not have access to sufficient stoves, energy and indoor ventilation, creating disproportionally exposure to household indoor and potential negative health effects. WHO finds approximately 90% of the 3 million premature deaths due to outdoor air pollution transpired in low- and middle-income countries. Furthermore, the highest burden of outdoor air pollution occurred in the WHO Western Pacific and South-East Asia regions. Additionally, in 2000 60% of IAP induced deaths affected women. Women are at greater risk for exposure to IAP due to being responsible for cooking, and household duties. Finally, young and newborn children are a vulnerable population and at greater risk for exposure to household pollution due to being with their mothers while she cooks and preforms other daily activities.

Disparities in the USA
Air pollution disproportionally effects lower income countries and populations. However, environmental injustice is not a foreign concept for low income minority communities all over the United States of America regardless of policies such as the Clean Air Act. Marginalized Americans continue to bear the consequences of environmental racism – “the racial discrimination in the enactment or enforcement of any policy, practice, or regulation that negatively affects the environment of low-income and/or racially homogeneous communities at a disparate rate than affluent communities.” A nationwide environmental research study highlights black, Hispanic and low income students are at greater risk to exposure to harmful toxins in school. The research found:

1) African American students make up 16% of US public school students, yet, more than 25% of those students attend schools worst affected by air pollution,

2) white school children account for 52% of all US public school attendees, however, only 28% of those white students attend schools worst affected by air pollution,

3) schools with large student of color population are located near busy roads, factories and other major sources of air pollution, and

4) five of the ten worst polluted school counties contain a non-white student populations greater than 20%.

This is just one example of lower income communities experience inequitable consequences of air pollution in the US. Other prominent examples of the negative health impacts of air pollution on minority and low income communities include Cancer Alley in Louisiana and the Anniston Community Health Survey. Epidemiological studies strongly support the relationship between health and air pollution.

Smog Zone. Source: Chris Davies, Creative Commons.

Ultimately, the health and overall quality of life of communities should not be jeopardized based on socioeconomic status, gender, age and race. GASP, a local Birmingham non-profit, is an important stakeholder in keeping our Birmingham communities air clean. GASP is a local advocate for clean air by:

1) monitoring, reporting and documenting air quality issues,

2) raising awareness of the health effects of air pollution on childhood health outcomes,

3) empowering and better educating local community member on advocacy skills for clean air, and

4) promoting environmental justice through policy change. More information such as contact information is available on their website. Protecting and promoting our environmental health is a community effort.

Organizations like GASP are important in ensuring all American citizens have equal rights to health and life without discrimination. As a community we need to continue to supporting community advocacy and education initiatives about air pollution, as they are major stakeholders in the success of environmental improvement. A healthy and clean environment is possible if we continue to work together.

 

Be a Real Man: Toxic Masculinity

Man turning his head to face the camera.
He-Man. Source: Reddy Aprianto, Creative Commons

What does it mean to “be a man”?  The traditional response would involve being dominant, physically strong, and emotionally closed off.  Some might see someone who is tough and intimidating, who never cries in front of others, and say that he is a “real man.”  Men in our society are pressured to fit perfectly into this traditional depiction of masculinity.  If a man fails to be strong enough or shows too many emotions, he is often shamed by others.  When a man’s masculinity is questioned, he might make a point of acting more masculine, which could lead to harmful or even violent behavior.  It can have a negative effect on his mental health, contribute to the occurrence of intimate partner violence, and marginalize certain groups.  When masculinity is forced upon individuals and is significantly harmful, it becomes toxic.

For the purposes of this blog, toxic masculinity refers to masculine traits, attitudes, and behaviors that are harmful, yet continue to be encouraged by much of society.

Impact of Toxic Masculinity on Mental Health

Masculinity is often associated with not sharing one’s feelings with other people. Men are not expected to be emotional individuals.  When they are emotional, they are often chastised.  The suppression of emotions is a negative thing for anyone to do.  Bottling up everything does not make one’s feelings go away and can have long-term consequences.  In a meta-analysis of 48 studies, there seemed to be a relationship between the suppression of emotions and an increase in negative changes in mental health, such as depression and anxiety.  There also seemed to be a relationship between the suppression of emotions and a decrease in positive changes in mental health, such as life satisfaction.

The negative effects of societal expectations of masculinity begin in childhood.  One study, which used a sample of 280 middle schoolers, found that the boys in their study began to conform to traditional expectations of masculinity between the fall and spring of their first year of middle school.  The results of that study also suggest that there is a relationship between the presence of depression and conformity to traditional masculinity.  The study defines traditional masculinity as, “a dominance-oriented ‘bravado’ with which individuals posture for social dominance through fundamentally maladaptive behaviors, such as physical toughness and emotional stoicism, that project social power and invulnerability.”  Many of the behaviors that traditional masculinity supports are “socially dysfunctional,” such as suppressing emotions and being physically aggressive.  Considering the fact that middle school is a critical point of development, one can see that long-term harm can be caused by being held to standards that relate to depression and dysfunctional social behaviors.

Suicide is the third leading cause of death for boys, which suggests that there are serious mental health issues and factors that need to be addressed.  Boys who fail to fit into the norms of traditional masculinity are often bullied by those who adhere to norms well.  Bullying is associated with symptoms of depression, which has the potential to lead to the occurrence of suicide.  One study, which used a sample 236 students, found that individuals who had experienced bullying had more symptoms of depression and suicidality four years after initially being surveyed than those who did not report that they had experienced bullying.  In addition to depression, bullying that relates to failure to meet gender norms can lead to violence against others.

Intimate Partner Violence 

Not only does toxic masculinity harm men themselves, but it also harms the other people in their lives.  One study, using a sample of 570 married men in Bangladesh, suggests that increased norms of gender equity are associated with a decrease in the use of “coercive control” over men’s partners.  The men in the study were presented with a list of coercive behaviors, such as, “when I want sex I expect my partner to agree,” and, “I have more to say than she does about important decisions that affect us.”  The majority of the men reported using most of the behaviors.  On average, the men agreed with 5.7 of the 8 traditional gender attitudes, such as, “a woman should obey her husband,” and, “a woman’s most important role is to take care of and cook for her family.”

Another study, which surveyed 600 men, looked to test the presence of a relationship between “masculine discrepancy stress” and intimate partner violence.  The study defines masculine discrepancy stress as, “a form of stress arising from perceived failure to conform to socially-prescribed masculine gender role norms.  Intimate partner violence is mental, emotional, or physical violence towards an intimate partner.  The results of the study suggest that “masculine discrepancy stress” was significantly effective in predicting a man’s history of committing intimate partner violence.  If a man felt that their masculinity was being questioned, then they felt the need to perform strong acts of masculinity, such as acts of violence.

Men standing by a wall and talking to each other.
Men Gathering. Source: Eleni Papaioannou, Creative Commons

The Marginalization of Groups

If a boy or a man is considered to be too feminine, people might call him a girl or say he’s gay in an attempt to make him feel bad about who he is. This depicts being feminine or being gay as being a bad thing, like it is shameful to be anything other than a straight man. Why are entire groups of people being marginalized in order to demean another person?  What is wrong with possessing traditionally feminine qualities?

One might suggest that it is only a problem when someone possessing those qualities breaks traditional gender roles. However, that does not explain it.  Women are frequently supported for displaying certain characteristics, such as being strong, or participating in certain activities that are traditionally masculine, such as enjoying sports, hunting, and fishing.  In other situations, their positive “masculine” characteristics are twisted around into negative “feminine” ones.  For example, if a woman is very confident and has strong leadership skills, she is likely to be called “bossy”.  If a girl is more logical and is not very emotional, then she may be considered cold-hearted and mean.  A man and a woman can act in the exact same way, but they will not receive the same response from other people.

Toxic masculinity also has a significant impact on transgender men.  Violence against the transgender community has been on the rise.  In some situations, trans-men experience “defensive masculinity,” where they conform to traditional ideas about masculinity, whether they identify with them or not, in fear of violence.  Toxic masculinity harms their mental health and puts them at risk of violence if they do not meet traditional gender norms.  It is more than a matter of people not agreeing with non-traditional ideas about gender.  Toxic masculinity has the potential to be an issue of life and death for transgender individuals.

Why Is Toxic Masculinity an Issue of Human Rights?

Ultimately, traditionally masculine traits themselves are not bad, but they become negative when they are expected and forced upon people.  Toxic masculinity has the potential to violate human rights.  It can be harmful to mental health and lead to intimate partner violence, both of which are public health and human rights issues.  According to Article 3 of the Universal Declaration of Human Rights, “Everyone has the right to life, liberty and security of person.”  Toxic masculinity can also act as a barrier to gender equality and harm the LGBTQ community.  Article of the Universal Declaration of Human Rights says that all people are entitled to the rights given in the declaration, “without distinction of any kind, such as race, color, sex, language, religion, political or other opinion, national or social origin, property, birth or other status.”

For years people have tried to explain away toxic masculinity as “boys just being boys” and simply “the way men are,” but that is not fair to anyone.  The way people act is hugely impacted by the way people expect them to.  Societal expectations need to change to support boys and men in being kind and being open with their emotions.  Violence and aggression cannot be accepted as granted parts of masculinity.  Men do not have to be strong and domineering to be men.

Diagnosing ADHD: Mental Health and Human Rights

Playground adventures. Source: BrownZelip, Creative Commons

Mental health is a topic that is becoming increasingly recognized as an important public conversation.  It is usually focused on depression and anxiety and is often overlooked in the context of human rights. It is important to recognize that mental health is a public health issue, and therefore a human rights issue. Mental health has an irrefutable impact on an individual’s physical health and their quality of life.  It can also harm their ability to receive an education. This blog will discuss Attention-Deficit/Hyperactivity Disorder (ADHD) and the issues created by the stereotypes and stigmas related to mental health.

Conditions like ADHD are frequently given a specific popularized depiction. Though the depiction may not be entirely incorrect, it is rarely inclusive of all the individuals experiencing these conditions.  When people think of ADHD for example, they often think of a boy with a lot of behavioral problems and poor grades.  The fact of the matter is that people with ADHD can be any gender and can have any kind of experience in school. Using stereotypes to inform our ideas about the people who have certain conditions impacts if and when people who have these conditions are able to receive a diagnosis and treatment. Because of this, girls with ADHD are frequently unaware of what they are experiencing.

What Is ADHD?

ADHD is a disorder that results from the way the brain develops.  According to the Centers for Disease Control and Prevention, “ADHD is one of the most common neurodevelopmental disorders of childhood.”  It is very important to understand that ADHD is not merely a behavioral issue.  It is a condition that cannot be punished away.  ADHD brains work differently than brains without ADHD.  ADHD brains lack a sufficient amount of dopamine and norepinephrine, two neurotransmitters that transport signals in the brain.  They are like filters for your brain.  Dopamine helps to regulate the reward center of the brain, movement, and emotional responses. Norepinephrine strengthens signals that are relevant and important while blocking information that is unnecessary.  Medicines that treat ADHD typically aim to support the circulation of these neurotransmitters in the brain.  These medicines decrease the frequency of the symptoms of ADHD, though they do not eliminate them.

In addition to the symptoms related to impulsiveness and inattentiveness, the lack of filter ADHD causes in the brain can lead to sensory overload, which can cause a lot of stress and anxiety.  When this occurs, one becomes overwhelmed by all of the noises you hear, the things you see, and the things you feel.  You notice everything around you, including the things that are unimportant.

Depending on an individual’s personal symptoms and experiences, they may have one of three different types of ADHD. One type of ADHD is the “Predominantly Hyperactive-Impulsive Presentation”.  This type can involve a lot of fidgeting, feelings of restlessness, and an unusually large amount of impulsive behavior, such as interrupting people.  Another type of ADHD is the “Predominantly Inattentive Presentation”.  This type often involves forgetfulness and difficulties in fully absorbing new information.  The third and final type is called the “Combined Presentation” and involves experiencing the symptoms of the other types equally.

Differences Between Boys and Girls With ADHD

Girls are significantly less likely to be diagnosed with ADHD than boys are, though they are not less likely to actually have it. One study, using data from the Danish National Birth Cohort, found that children whose parents reported ADHD behaviors and who were undiagnosed were girls more often than boys.  Because of this, girls with ADHD are more likely to go untreated than boys are.  The differences in how boys and girls experience ADHD contribute to the underdiagnoses of girls. Another study, which combined the results of 8 prior studies to have a sample of 772 boys and 325 girls, suggests that boys with ADHD are more likely to display symptoms of impulsivity that girls with ADHD are, based on the children’s performances on “Continuous Performance Tests”. Symptoms of impulsivity are often easier to recognize than inattentiveness and result in behaviors that catch people’s attention.  Inattentiveness, which girls more frequently experience, does not lead to behaviors that are as disruptive as the behaviors of impulsivity.

Children in a classroom reading with their teacher.
students-in-class-with-teacher-reading. Source: Ilmicrofono Oggionom, Creative Commons

Why It Matters

ADHD is highly connected to the issue of mental health. According to one study, girls with ADHD are more likely to experience comorbid disorders such as depression, anxiety, oppositional defiant disorder, and conduct disorder than girls who do not have ADHD. Individuals with ADHD may internalize what they are going through, blaming themselves and feeling like what they are going through is their own fault.  They may externalize what they are going through, impacting the way they interact with other people and their environments.  Internalizing and externalizing behaviors occur in individuals with ADHD regardless of the existence of a diagnosis but being undiagnosed can make the situation more difficult.

The possibility of being diagnosed with ADHD is also impacted by many social determinants. Social determinants are defined as “conditions in which people are born, grow, live, work, and age.” They lead to avoidable health disparities. It is important to recognize social determinants when it comes to mental health and human rights, because they highlight the fact that people of different backgrounds do not have access to the same resources. Factors that are out of an individual’s control impact their ability to access their human rights and maintain a good quality of life. By identifying social determinants, we can begin to identify changes that can be made to diminish injustice in the world. For example, even the country that someone with ADHD lives in can impact the chances that they will be diagnosed.

In France, 0.5% of children are diagnosed with ADHD, while about 12% of children in the United States receive a diagnosis. Different countries around the world have different views of ADHD, affecting their rates of diagnosis and the methods of treatment. The treatment of ADHD in France frequently involves prioritizing methods such as therapy and family counseling over medicines. In Germany, it is likely that students with ADHD benefit from the “outdoor component” of their education, as being outside can be more favorable for them than a traditional classroom. The United States relies more heavily on using medicinal methods to treat ADHD.

Another social determinant that impacts treatment is socioeconomic status. Even if a child in poverty has received a diagnosis, it is still possible that they cannot afford treatment. If they are uninsured, it would be difficult for them to access medication or therapy. Race also acts as a social determinant. The results of one study suggest that there is a large disparity in ADHD diagnosis and treatment that negatively impacts African-American and Latinx children.  According to the study, it is more likely that the disparity is due to African-American and Latinx children being underdiagnosed and undertreated than white children being overdiagnosed and overtreated.

Social determinants like nationality, socioeconomic status, and race can be barriers to a child’s diagnosis and treatment for conditions like ADHD. These factors are out of the child’s control and create disparities that cause further harm.  Even if an individual knows what a problem is, they cannot work towards alleviating it if they do not have the resources they need. If a black girl is born is born into a New York family in poverty, she may lack the ability to spend time outside, receive certain medications, or go to therapy. She would not have access to the same resources as children from families with higher incomes or different geographical locations. This injustice feeds into comorbid disorders and has a negative impact mental and public health, as emotional issues can develop from being able to understand the injustice.

The Universal Declaration of Human Rights includes the right to education (Article 26) and the right to an environment that promotes health and wellbeing (Article 25), along with many others.  Access to these rights is limited when individuals with conditions like ADHD are unable to seek treatment, whether that treatment be medicinal or a form of counseling.  The effect that these conditions have on one’s mental health makes a significant difference. Education is one of the human rights that is fundamental to growth and flourishing in life.

We, as a global society, must recognize the relationships between mental health, public health, and human rights. They are not isolated issues. The way we approach one impacts the outcomes of the others.  Mental health is a part of public health, impacting an individual’s physical health and their quality of life. Both mental health on its own and public health as a whole are largely influential in one’s ability to access their human rights. Everything is connected.

“Wonder”: Bullying Redefined

a picture of boxing gloves
Boxing gloves. Source: Franz Kohler, Creative Commons

“Sticks and stones may break my bones but words will never hurt me.” Saying and repeating this mantra is a daily occurrence on some playgrounds and households. The harsh reality is words do hurt because the bruises and wounds they inflict remain in the core of the psyche and being. A video of Keaton Jones set the world of social media ablaze on his behalf late last year. Jones, a middle-schooler from Tennessee, tearfully retold his experience with bullies during the day. There is a temptation to turn Jones into a “poster child for inspiration porn”; thereby negating the reality that being different remains a negative within some societies, including America. Siblings bully each other by calling one another names, coworkers often haze the newbies, jocks put nerds in lockers, and presidential candidates mock journalists with disabilities. In other words, we are in the midst of a bullying epidemic.

Epidemic is generally used to describe the spread of an infectious disease, one that is seemingly out of control. Society fails to view the unintended consequences of words as part of an epidemic that spans the public and mental health sphere, and reaches into the realm of human rights. The ultimate issue with this bullying epidemic is that it infringes on the individual’s (or group’s) right to a peaceful environment. Humiliation and marginalization, fueled by a desire for control, are the ultimate effects projected onto countless targets. These effects, often times, cause targets to make irreversible and life changing decisions like 10-year-old Ashawnty Davis and 13-year-old Rosalie Avila who both committed suicide after copious amounts of schoolyard and online bullying they endured. Their deaths speak to a direct need for awareness and prevention tactics in the classroom, family, and society. The words bully and bullying have a stereotype and stigma that leads many individuals to make assumptions that seek to label the bully rather than their actual behavior. The misapplication of labels, placed on a bully, dehumanizes their personhood rather than their behavior. This blog examines the interplay between the assumptions and realities of the bullying persona.

R.J. Palacio wrote Wonder following an encounter with her child and another in an ice cream shop. Wonder tells the story of August “Auggie” Pullman, a 10-year old boy, who is blighted by a severe facial deformity. Because of his deformity, his peers and often times other adults are cruel to him. As Auggie starts middle school, his peers find his appearance off-putting so they choose to isolate him. The school culture created an environment where ostracism is the result of not fitting in. The bullying behavior begins with isolation and badmouthing by his peers. The story begins to take a turn when one of Auggie’s friends, Jack, is caught making fun of him. Jack so desperately wants to fit in that his lack of self-confidence influences his courage and willingness to defend Auggie when others are badmouthing him. Jack is a classic example of the bystander role. Many of us find ourselves witnessing a bullying situation and we, more than not, choose to ignore the situation or join in on the bullying. Jack’s betrayal of Auggie cuts so deeply that he holes himself up in the bathroom in tears.

Auggie’s reaction is common. Much like Keaton Jones, those on the other end of a bully’s action and/or words do not understand why others are so cruel. Ultimately, in the book, Jack and the others in Auggie’s grade realize that it is better to choose kindness. They rally around Auggie and accept him as one of their own. They see all of the values he possesses and admire him for his courage and perseverance. This story is an example of what bullying awareness can bring; unfortunately, bullying situations do not always end so positively.

a face that is angry
anger. Source: Shaun Chin, Creative Commons

Bullying is a multi-faceted phenomenon, influenced by many factors that not easily explained. It is a unique and complex form of interpersonal aggression. Aggression takes many forms and manifests in different patterns of relationships; it is a show of oppression in an attempt to gain power over another individual. Coincidentally, bullying behavior is not just the result of individual characteristics, but influenced by multiple relationships with peers, families, teachers, neighbors, and various other interactions with societal influences. It is important to note this distinction in order to equate a bully’s actions to be a result of their personal psychology and their interactions with the environment.

Bullying can be broken down into two categories. The first form of bullying occurs when the bully and their target are in the presence of one another. This is direct bullying and observable when a bully physically or verbally harasses their target directly. Spreading rumors is a method of indirect bullying because the aggressive behavior occurs ‘around’ the target. Under those two umbrella terms, there are four types of bullying: physical, verbal, relational, and damage to property. Physical bullying encompasses hitting, biting, kicking, or punching. Verbal bullying occurs when the bully chooses to use words to hurt and harass their targets. Relational bullying involves efforts to harm the reputation or relationships of the targeted targets. Lastly, damaging one’s property is its own form of bullying because it not only involves a target’s personhood, but their property as well.

Bullying can happen in any number of places, contexts, and locations. It is not isolated to the stereotypical shove in a locker or thrown in the trashcan after school. The more digitized society becomes, the more complex and viral the bullying. Electronic bullying, or cyberbullying, involves the oppression and assertion of power over an individual through social media and other digital outlets. Cyberbullying focuses on context or location versus an actual type of bullying because it happens over the internet. Although this form of bullying occurs through the internet, its consequences are just as detrimental to its targets. Depression, suicide, and anxiety are just a few ways that cyberbullying can affect its targets. School, the workplace, the mall, online, and the bar are all places where bullying can be perpetrated. In the case of Ashawnty Davis, the viral sharing of the altercation she experienced at school proved too much for her to overcome.

When thinking about bullying and its perpetrators, it is important to note that it is fluid in its nature and involvement. Studies show that frequent targets and frequent perpetrators assume different roles in bullying across school years as well as young adulthood. Thus, individuals can observe bullying, experience bullying, and perpetrate bullying across different situations over time. Across contexts, for instance, a student may be targeted by classmates at school but bully his or her siblings at home.

Jack, who starts as August’s friend, later finds himself in the position of a bully. He badmouths August in order to gain notoriety with his classmates. Eventually, his role shifts from being a bully and a bystander, to becoming an “upstander.” An upstander is a person who acts for positive change. Jack does this by sticking up for August when others attempt to bully him. However, by standing up for August, he finds himself now being bullied as well, thus falling into the targets role.

Research shows that being involved as both a perpetrator and targets seems to compound the impact of bullying. Bully-targets find themselves at greater risk for anxiety, depression, low self-esteem, self-harm, suicidal thoughts, suicide, substance abuse, and a host of other psychoanalytic disruptions. The misconception that bullies bully because they themselves have been targets is an overgeneralization to the psychoanalytic aspects at play when an individual sets out to bully someone else. We cannot simply equate their actions as retaliation.

What makes an individual more susceptible to becoming a bully? A variety of factors including the association with callous-unemotional traits like psychopathic tendencies, endorsement of masculine traits, conduct problems, and antisocial traits may contribute to exhibiting bullying behavior. In children, being the target of a bully can manifest in depression, anxiety, truancy and poor performance, loneliness and withdrawal. Bullies targets those who tend to less well liked, less accepted, and more rejected by peers. The relationship between perpetrator and targets is a power struggle in allowance for the superior party to oppress and marginalize their targets. The consequences of bullying and targetization is complex in its nature. Studies show that bullies are also at risk for many of the same adverse side effects as their targets. Bullying perpetration often leads to anxiety and depression, social withdrawal, delinquent behavior, and adult diagnosis of antisocial personality disorder.

We, as a society, must assist in implementing intervention and prevention tactics to combat bullying behavior. Education and awareness are essential. Begin by recognizing the many forms that bullying takes – beyond simple name calling in a second grade classroom. Bullying transcends the classroom into adulthood. At the end of Wonder, the revelation that Auggie’s bully experiences bullying brings the story full circle. Summer, along with Jack, help to balance out this narrative by offering their friendship and support to August when no one else will. Once we recognize the many facets of bullying, we can begin to have those tough conversations about choosing kindness.