Tailoring Healthcare: Understanding and Surpassing Hierarchies

Former UN Secretary-General Ban Ki-moon
[Photo: Flickr user The Official CTBTO Photostream]

United States health outcomes are lagging in comparison to the rest of the developed world: but why is this the case?

It has always been a problem, but is now center stage to the public and global eye: in a time of political supremacy and educational hierarchies, the evidence of poor foundations in healthcare is more evident than ever before. 

Former U.N. Secretary-General Ban Ki-moon allows an outside perspective on U.S. health care systems in an interview with the guardian,  discussing how poor people are lacking support largely due to the failures within the healthcare system and healthcare law. Kin-moon commented on the inability of U.S. officials to move toward universal healthcare, mainly due to inclusion of hierarchies, such as pharmaceutical companies, hospitals, and doctors, in healthcare law and decision-making.

Source: Sara R. Collins et al., “First Look at Health Insurance Coverage in 2018 Finds ACA Gains Beginning to Reverse: Findings from the Commonwealth Fund Affordable Care Act Tracking Survey, Feb.–Mar. 2018,” To the Point (blog), Commonwealth Fund, May 1, 2018.

Since the Trump administration has taken office, healthcare law has weakened, and as a result, around 4 million people within the United States have lost coverage since 2016, increasing total unisured people from 12.7% to 15.5%. This is a problem, especially within the United States, given the fact that we have the highest healthcare costs in comparison to any other industrialized nation, despite education and literacy rates, and innovations in technology.  

If we look at specific health outcomes, the maternal mortality rate within the U.S. is also much higher than any other industrialized nation. Women and maternal death rates show similar patterns; numbers declined during the latter half of the 20th century, but are now seeing the reverse effect--a steady incline since 2000. Maternal deaths associated to chronic disease has increased by alarming numbers.

 Data: Centers for Disease Control

As a recent CDC study supports, this is largely due to systemic errors in the healthcare system. About 12% of U.S. women of child-bearing age (roughly 15 to 44) do not have healthcare. Often, many mothers on Medicaid or living without insurance choose to see a doctor only in the later stages of their pregnancy. By these end stages, it is too difficult to diagnosis and treat any severe medical conditions. Women of child bearing age are dying more frequently from chronic illness, likely due to the discounting of women throughout the healthcare system.

Even when a women is able to choose to see a doctor, there is a fear of the possibilities and the end results. Often, people not only fear the use of medical jargon, but also the degrading and condescending attitude of a doctor. The patient-provider relationship has always been viewed in a paternalistic manner. Ideally, the provider recognizes a health issue, and as a result, directs the patient towards the proper treatment path that they believe is best for the patient. This view stems from the belief that since the doctor has an education and experience that can better mitigate a medical decision. 50% to 70% of the general population voiced concerns in addressing mistakes, confusion, lack of quality of care, or did not want to appear to be a "troublemaker."  A survey done on women in Australia found that nearly 40% of women worried about being perceived as a "hypochondriac" or "drama queen" if they were to speak up if something did not feel right.

Though the U.S. leads in healthcare costs among other industrialized countries, the hierarchies in healthcare exists globally, and are a contributing factor to inferior health outcomes. Not only do these viewpoints foster an environment where patients are uncomfortable to speak, but also an environment where patient safety is not placed as a priority. Power hierarchies in patient-doctor relationships must be diminished and eliminated in order to promote healthcare models that encourages proper moral and value-based patient care. There needs to be a maintained focus on the overall healthcare system, and implemented plans to address individualistic issues in specific areas around the globe.

There is also vital importance in continuing to ask questions; we should be consistently challenging health care and working to break down these hierarchies to provide equal opportunity and outcome to all. Davis explains the ways that Our Body, Ourselves does this. By tailoring different versions of the book to include narratives and questions of women's health specific to areas around the globe, authors allow distinguished analysis. This allows populations to ask the correct questions to direct the attention of healthcare systems toward being more inclusive and diverse, yet specifically tailored to the needs of an individual population.

Equity is crucial to providing quality healthcare and treatments that result in positive health outcomes. By addressing the needs of healthcare systems on a individualistic basis, we will recognize improvements in outcomes and healthcare quality. Surely, these advancements will not happen overnight, but long-lasting change takes time and constant attention.  Despite some steps backwards from current administration, it is time to build awareness, and surpass the implemented hierarchies in healthcare.

Women’s Health: An Umbrella term we use to only Cover our Heads

When the topic of women’s health is discussed, the dominant narrative surrounding the subject is restricted to topics within the realm of reproductive services. Although incredibly vital, a woman’s body is not simply constructed around reproductive organs including the vagina, ovaries, uterus, etc. In today’s political agenda, it is not uncommon to associate women’s health, a very broad and encompassing term, with strictly reproductive health care services such as abortion and birth control access. In turn, this insinuates a diverse, political climate associated to the subject of women’s health due to the current polarized issues within reproductive health care.

Reproductive Health plays a role IN Women’s Health

Vanity Fair, 2017

The Trump Administration has made their positions on abortion, accessible birth control, and other reproductive services incredibly clear-- they are either against it or lack the care to make change, and I am not sure entirely sure which of the two is worse. President Trump continuously nominates people in high power who are against reproductive freedom such as Attorney General, Jeff Sessions, and Supreme Court nominee, Neil Gorsuch. As if these nominations did not prove his intentions clearly enough, he once stated that there “should be some sort of punishment” for women who seek abortions (NARAL, 2018). He even went as far to say that Planned Parenthood, a nonprofit organization dedicated to research and health counseling on a plethora of women’s health related issues regardless of a woman’s socioeconomic status, race, religion, etc., “is like an abortion factory, frankly” (NARAL, 2018). Frankly, I believe President Trump’s anti-woman agenda is once again another instance in which systematic oppression plays yet another role in health care policies and education.

Planned Parenthood, 2018

Due to defunding for nonprofit organizations such as Planned Parenthood, it is becoming increasingly more difficult for women to access birth control, specifically women of color and women of lower socioeconomic status. The Trump administration recently rolled back on the birth control mandate, which now grants employers the right to deny women insurance coverage for contraception (Pear, 2017) and offers religious freedom as a way to deny coverage to certain groups, which may insinuate direct restrictions on the civil rights of the LGBTQPAI+ community.

These topics are very important within the discourse of women’s health, however it is important to note that women’s health is not simply reproductive health. In fact, according to the CDC the leading causes of death of females in the United States are heart disease (22.3%), cancer (21.1%), chronic lower respiratory diseases (6.2%), stroke (6.1%), and Alzheimer’s disease (5.7%) (2015). Among the top 10 reasons, none of them are directly associated with reproductive organs or services. These issues are not commonly associated with the narrative of Women’s Health, and yet they are what is killing women in the United States. Unfortunately, if you were to Google the definition of “women’s health” is it very difficult to come to a consensus of a standard definition. So I decided to define “health” instead, which according to the Merriam-Webster dictionary is “the condition of being sound in body, mind, and spirit”, ”the general condition of the body”, and “a condition in which someone or something is thriving or doing well” (2018). Nowhere in the definition of “health” do we specify bodily organs or parts, instead it is the general state of the body. What is difficult to understand is why when “women” are added to create our topic of discussion, women’s health, we typically focus on women’s reproductive organs and little else. By restricting the definition of women’s health to strictly reproductive health, it leaves women susceptible to other poor health outcomes, while putting an emphasis on the politicization and standardization of the woman body.

Why is knowing Women’s Health is more than just reproductive health important?

It is extremely important to recognize how systematic oppression plays a large role in the health care system and its education of their doctors. The health care system was created as an institution stemming from the patriarchal system. In turn, medicine and science orbits around the standard of the white, male body. In the United States, “women are less likely than men to survive the years after a heart attack, even after accounting for age” (Yong, 2018). Women’s heart attack symptoms present differently from the standard symptoms we all think of when we hear “heart attack”. Typically, we think of severe pain in the left arm, tightness in your jaw, neck, and chest, and severe shortness of breath-- all symptoms usually associated with a male having a heart attack. We have created a standard of symptoms such as this, where we do not take into account the effects of gender on different medical disorders, and instead idealize the male reaction. Due to this, the leading cause of death in women in the United States is due to heart disease (CDC, 2015). Moreover, another interesting study showed that women are more likely to survive a heart attack if they are being treated by a female doctor (Yong, 2018). Yong addressed this subject by also adding on that “overall, the team found that female physicians outperformed their male colleagues, and that their patients were, on the whole, more likely to live” (2018). Is this because female doctors have to prove themselves more so than men do in medical school and on the job? Is this because there are, overall, fewer practicing female doctors than men? Or is this because females feel the need to downplay their pain in front of male doctors? Regardless of the answer, it is something incredibly important in the discourse of Women’s health, however it is often overlooked.

Overall, the need to integrate gender perspective into medicine is becoming increasingly more necessary. When people think of a female’s doctors, they are automatically drawn to the gynecologists and obstetricians because of this emphasis in women’s health on the reproductive system. However, a female’s doctor is not just a doctor that specializes in medicine in respect to the reproductive system. If you were a woman suffering from chest pains, you definitely would not want to call your gynecologist. A female’s doctor is going to include primary care physicians, emergency room doctors, neurologists, cardiologist, etc. Instead of focusing on a standard of care that perpetuates the idealization of the male body, physicians and medical students should be introduced to all types of bodies-- female, transgender, transsexual, intersex, etc., in order to provide equal care across all bodies.

“Women’s health” and “reproductive health” are not interchangeable terms. Women’s health is a term that encompasses mental and physical well being among all individuals who identify as female. Reproductive health is extremely important in women’s health, but to focus solely on reproductive health is dangerous especially when the white, male body is a standard of education and care within the medical system. We created umbrella terms such as these to be able to cover the whole body, not just the reproductive organs.

Referred to the following readings from class:

Yong, Ed. “Women More Likely to Survive Heart Attacks If Treated by Female Doctors.” The Atlantic, Atlantic Media Company, 6 Aug. 2018. 

DUSENBERY, MAYA. DOING HARM: the Truth about How Bad Medicine and Lazy Science Leave Women Dismissed,... Misdiagnosed, and Sick. HARPERONE, 2019.

Additional Material:

“Donald Trump on Reproductive Freedom.” NARAL Pro-Choice America, 2018, www.prochoiceamerica.org/laws-policy/federal-government/donald-trump-abortion/.

“Health Equity.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 10 Apr. 2018, www.cdc.gov/women/lcod/2015/index.htm#modalIdString_CDCTable_0.

Pear, Robert, et al. “Trump Administration Rolls Back Birth Control Mandate.” The New York Times, The New York Times, 6 Oct. 2017, www.nytimes.com/2017/10/06/us/politics/trump-contraception-birth-control.html.