Health & Society

Prescribing kindness in modern medicine

Anonymous — Tue, 23 Jul 2024 21:43:30 +0000

Prescribing kindness in modern medicine Anonymous (not verified) Tue, 07/23/2024 - 15:43

Doug McPherson

In her new book, Microaggressions in Medicine, CU �鶹ӰԺ alum and bioethicist Heather Stewart writes that some healthcare professionals are causing emotional and psychological harm

Contrary to what is sworn in the Hippocratic Oath, a new book co-written by �鶹ӰԺ alumna Heather Stewart (MPhil'17) argues, those who vow to first do no harm are, in fact, causing harm regularly via microaggressions.

In the recently published Microaggressions in Medicine, Stewart defines microaggressions as “comments, actions, bodily gestures or even features of physical spaces” that subtly communicate bias or hostility toward those in marginalized groups.

In a newly published book, CU �鶹ӰԺ alumna and bioethicist Heather Stewart (MPhil'17) argues that the effects of microaggressions in medicine may compound over time.

“Microaggressions are particularly pernicious forms of bias or discrimination precisely because they’re frequent and subtle, and so they’re often disregarded as insignificant,” says Stewart, now an assistant professor of philosophy at Oklahoma State University. “From the perspective of those on the receiving end of microaggressions, however, they can be incredibly harmful, especially as their effects compound over time.”

A common example of microaggression, Stewart says, is misgendering a person who is trans or non-binary, referring to a person who is transmasculine with feminine identifiers such as “ma’am,” “Miss” or “Mrs.”

“When done unintentionally, the person committing the microaggression often doesn’t realize why it’s harmful, but it’s also likely that they assume their mistake is a one-off occurrence, and they fail to consider that trans and non-binary people may face misgendering regularly,” Stewart explains.

Stewart, who earned her master’s in philosophy from CU �鶹ӰԺ in 2017, adds that being misgendered, especially routinely, can be “incredibly harmful” to trans and non-binary people’s senses of who they are and how they want to be perceived and treated in the world. “From that perspective, microaggressions and their consequences really aren’t micro at all, but touch on core aspects of identity, belongingness and self-respect.”

Feeling unseen

In the book, Stewart and her co-writer, Lauren Freeman, describe several short- and long-term consequences of microaggressions. After a microaggression, they note, the person on the receiving end might feel confused, shocked, disrespected or unwelcomed.

“They might feel as if they’re not being seen, heard, recognized or respected,” Stewart says. “Over time, as microaggressions add up and wear on a person, they can cause real harm to one emotionally, psychologically and more. They can cause one to doubt themselves and question how others see them.

“The goal is to better understand the nature of this distrust so that we can work to form better relations between these communities and the important institutions which govern our lives,” says Heather Stewart.

“In medical contexts, the stakes can be incredibly high. Frequent microaggressions can cause marginalized patients to lose trust in their healthcare providers, which makes them less likely to communicate openly, and can even lead them to delay or avoid seeking medical care. This obviously has serious consequences for the health and wellbeing of marginalized people and communities.”

While she doesn’t share details of her personal healthcare experiences in the book, Stewart does say she’s had “first-hand experience” in not being taken seriously by a healthcare provider and that she’s faced “harmful consequences” such as misdiagnoses and delayed diagnoses.

“I’ve certainly been on the receiving end of microaggressions, including being doubted and dismissed when making claims of pain,” she says. “A long-term consequence of these experiences has been that my trust in healthcare has been shaken. It takes a lot for me to allow myself to be fully open and vulnerable in healthcare settings.”

But her own experiences aside, Stewart says she sees the book as a way to “amplify the voices” of others and their experiences navigating healthcare, and to think about how healthcare can and must do better by them.

A key in solving the problem, Stewart says, is to improve “structural and background conditions.”

“For example, when healthcare professionals are under intense time pressures and constraints, it can be harder to be fully thoughtful, deliberative and empathetic with patients,” she says. “And when healthcare workers haven’t been given adequate education and training about diverse identities and experiences, they might not realize how their words or actions can be harmful. This points to the need for more robust and inclusive training throughout medical education as well as continuing education.”

In a similar vein, Stewart also is studying marginalized groups’ distrust in institutions, specifically distrust that LGBTQ+ communities often have in healthcare institutions.

“The goal is to better understand the nature of this distrust,” Stewart says, “so that we can work to form better relations between these communities and the important institutions which govern our lives.”

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In her new book, Microaggressions in Medicine, CU �鶹ӰԺ alum and bioethicist Heather Stewart writes that some healthcare professionals are causing emotional and psychological harm.

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Early childhood health interventions have ‘big, multi-generation impacts,’ research finds

Anonymous — Wed, 06 Mar 2024 16:01:04 +0000

Early childhood health interventions have ‘big, multi-generation impacts,’ research finds Anonymous (not verified) Wed, 03/06/2024 - 09:01

Daniel Long

Tania Barham’s research suggests that it doesn’t take much to give impoverished people a better start to life

It was the late ‘90s, and Tania Barham, future associate professor of economics at the �鶹ӰԺ, was in Yemen, working as an economist for the World Bank, which had teamed up with UNICEF to improve that country’s health, education and water.

Like the World Bank and UNICEF, Barham believed she was helping people, making a positive difference in their lives. But something was missing.

Much of CU �鶹ӰԺ researcher Tania Barham's work draws on data from Bangladesh.

“I had a moment where I’m like, ‘There’s almost no evidence,’” Barham recalls. “There was little data to understand if a project was successful or not in terms of development.”

It was a life-changing realization, one that convinced Barham to go back to school, earn her PhD and research how to bring people out of poverty over the long term.

Unique data

Much of Barham’s work draws upon data from Bangladesh.

In the ‘70s, Barham explains, the Bangladeshi government rolled out the Maternal and Child Health and Family Planning Programme (MCH-FP) in the Matlab area, a rural pocket of land just east of the Meghna River.

The purpose of this program was twofold: to provide a basic health care package for impoverished families—including family planning, nutritional rehabilitation and vaccinations—and to do so in a way that allowed researchers to study the program’s effectiveness.

“They wanted to see if this thing worked,” says Barham.

One way the program designers did this was by setting up a control area and a treatment area, so that different health outcomes between the two could be traced back to the interventions. Another was by keeping detailed records of the specific individuals and families who received the treatments.

“They kept regular demographic surveillance data, and then they would do census of the study areas every so often,” says Barham.

This surveillance data shows a number of things: if someone migrated or married, if someone died, if over time there have been any changes in household structure. And it goes deep.

“We could link everybody back to their original household from before the project began,” says Barham.

Residents of Kashadaha village, Bangladesh, visit the Kashadaha Anando school Oct. 12, 2016. (Photo: Dominic Chavez/World Bank)

So rich is this data that Barham and fellow researchers were able to conduct follow-up surveys of the treatment subjects starting in 2012, decades after MCH-FP began.

Barham wanted evidence, but this was more than she could have ever hoped for.

“This data doesn’t exist almost anywhere else.”

The effects

In a paper now under review, Barham and coauthors Brachel Champion, Gisella Kagy and Jena Hamadani explore the effects of MCH-FP on human capital.

Human capital, says Barham, refers to how equipped a person is to be successful in life. “It’s a person’s education. It’s their health. It’s their cognition. It’s their ability to solve problems. It can be social-emotional skills too.”

In other words, to improve a person’s human capital means to improve that person’s chances of escaping poverty or avoiding it in the first place.

Barham and her colleagues found that those in the Matlab area who received treatments showed increased height, a sign of improved health. They also found that kids in the treatment area exhibited improvements in cognition and, among the males, higher education and higher math scores.

But the most important finding, says Barham, was that these effects spanned generations. The second generation benefitted as much as the first. The human-capital gains were ongoing.

In another paper, this one published in December 2023, Barham and coauthors Randall Kuhn and Patrick S. Turner describe how MCH-FP affected migration.

Traditionally, many men in the Matlab region have migrated to Chittagong or Dhaka for work, or sometimes farther afield to countries like Qatar, where the higher-paying jobs are. But MCH-FP interrupted this narrative.

Students participate in school activities at the Sahabatpur Daspara Ananda school in Sahabatpur village, Bangladesh, Oct.12, 2016. (Photo: Dominic Chavez/World Bank)

“We thought we would find some traditional thing—you improve people’s education, and they go and get better jobs, and they still migrate to get them,” says Barham. “But that wasn’t the story we found at all. It was actually, I think, a more exciting story.”

Barham, Kuhn and Turner found that, instead of migrating, the Bangladeshi men were getting better jobs at home and therefore staying with their families.

“This is so important,” says Barham. “We see so much migration happening in the world right now, and here is an example which you almost never see of a program where people decided to stay.”

The big takeaway from both papers, says Barham, is that even a modest health package can have “big, multi-generation impacts.”

The big picture

Barham’s ultimate goal is to help those living in poverty, especially children.

“I care about people having the best start to life. Because if you don’t have a good start to life, it’s just that much harder to be successful later on.”

Now, propped up on decades of data and research, she hopes to spread the word and encourage investment in programs similar to MCH-FP.

“Good interventions help, and they accumulate,” she says. “We have to tell that story.”

Top image: Rozina (far left), comforts her nephew, Tanvir (center left), along with her mother, Shefali, in Dhaka, Bangladesh on Oct. 11, 2016. (Photo: Dominic Chavez/World Bank)

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Tania Barham’s research suggests that it doesn’t take much to give impoverished people a better start to life.

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Study: High crime raises diabetes risk

Anonymous — Mon, 06 Mar 2023 15:07:41 +0000

Study: High crime raises diabetes risk Anonymous (not verified) Mon, 03/06/2023 - 08:07

Daniel Long

Genes matter, says CU �鶹ӰԺ’s Jason Boardman, but so does the environment

Young adults living in high-crime areas have an increased genetic risk for Type 2 diabetes, according to a recently published study co-authored by Jason Boardman, �鶹ӰԺ professor of sociology and director of the Institute of Behavioral Science’s Health and Society Program.

Boardman and his co-authors published their paper, “Does Crime Trigger Genetic Risk for Type 2 Diabetes in Young Adults? A G x E Interaction Study Using National Data,” in Social Science & Medicine in November.

A key takeaway is that genes are not an irrefutable crystal ball predicting people’s health future. The environment plays a significant role as well.

Jason Boardman teaches undergraduate and graduate-level courses in statistics, social demography, and the sociology of race and ethnicity.

“Genes matter,” says Boardman, “but how they are linked to your health depends on where you live.”

Key to understanding why, says Boardman, who studies the social determinants of health, is the notion of environmental triggering, a phenomenon by which the environment elicits certain genetic responses.

It’s a bit like planting a flower, Boardman says, with the seed being people’s genes and the soil, water and sunlight being the environment. The seed may be planted, but without the right environmental conditions, it won’t sprout.

Something similar happens with Type 2 diabetes.

“Genetic risk for Type 2 diabetes does not manifest as a risk absent environmental triggers—in this case, local area crime rate,” Boardman explains. “Indeed, we find that the polygenic risk for Type 2 diabetes is non-existent among residents of communities with little to no crime.”

In other words, genetic variants linked to Type 2 diabetes are not enough to give someone the disease. What counts is how those genes interact with the environment.

Boardman and his colleagues’ findings recast what many consider the primary driver of Type 2 diabetes: obesity, which Boardman says plays not so much a causal role as a mediating one.

To understand how this works, Boardman explains, imagine the same person in two scenarios.

In the first scenario, this person lives in an area with a low crime rate. He or she therefore experiences little stress and has access to healthy coping mechanisms, such as walking or riding a bike outside. This person is consequently unlikely to become obese and develop diabetes.

In the second scenario, however, this same person lives in a high-crime area and has elevated stress levels and limited access to healthy coping mechanisms. This person is therefore more likely to internalize stress, adopt an unhealthy dietary pattern, gain weight and become diabetic.

Same person, same genes, opposite outcomes. The only difference between the two scenarios is the environment.

“Thus,” says Boardman, “what appears to be a biological process is in large part a social process.”

Boardman began studying the social influences of health several decades ago.

“I was fortunate to be part of the Social Environment Working Group of the National Children’s Study in the early 2000s,” he says.

While working with this group, Boardman witnessed the scientific community placing “a great deal of emphasis on collecting and summarizing rich biological measures of population health” while overlooking “comparably rich measures of the social and physical communities in which people live, go to school and play.”

But rather than criticize the field of statistical genetics, Boardman decided to gain training in it. He received a career development award from the Eunice Kenney Shriver National Institute of Child Health and Development and, as a tenure-track professor, enrolled in the graduate-training program at CU’s Institute for Behavioral Genetics.

Boardman says that research exploring gene-environment interactions provides a more nuanced understanding of what causes Type 2 diabetes than does the nature-nurture argument.

“The nature-nurture dichotomy gets us nowhere in terms of understanding complex phenomena like the increase in obesity in recent years,” says Boardman, adding that it’s not either nature or nurture that people should be focusing on, but both.

“Nurture fundamentally affects nature, and nature fundamentally affects nurture.”

Boardman also hopes his research will provide a counterpoint to what he considers a worrying trend.

“I am most concerned about the routine practice among researchers utilizing genome-wide data and related summary scores to limit their analyses to individuals who identify with a similar socially defined racial group,” he says.

“My hope is to contribute to methods that provide summary genetic scores that belie the unnecessary need to run models separately by racial and ethnic group.”

Genes matter, says CU �鶹ӰԺ’s Jason Boardman, but so does the environment.

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