Praying to win this battle: Cancer Metaphors in Latina and Spanish Women’s Narratives

ABSTRACT

This study closely examines 51 breast cancer narratives Latina and Spanish women wrote for other patients to illuminate how they conceptualize their health, with insights for addressing health disparities. Using discourse analysis of the role of language and culture in health care communication, this study focuses on the use of metaphors in the narratives. This provides revelations about the cultural and linguistic aspects of how the writers conceptualize their disease. Building on past research on metaphor use in cancer discourse in the English language, this study reveals the prevalence of metaphors comparing cancer to combat, or more generally, violence (e.g., “my battle against cancer”), or a journey (e.g., “my path with cancer”). Writers used this metaphorical language to offer advice to others with cancer and to mark their membership in a larger community of people with cancer. We also find that Spanish women use metaphors more frequently than Latinas and that they differed in their metaphorical portrayals of cancer. This research uncovers culturally embedded themes that are central to how women with cancer think about the disease, such as the prominence of spirituality in Latinas’ metaphorical constructions, a pattern not evident in Spanish women’s narratives.     

Practitioner and Client Explanations for Disparities in Health Care Use Between Migrant and Non-migrant Groups in Sweden: A Qualitative Study

To investigate variations in explanations given for disparities in health care use between migrant and non-migrant groups, by clients and care providers in Sweden. Qualitative evidence collected during in-depth interviews with five ‘migrant’ health service clients and five physicians. The interview data generated three categories which were perceived by respondents to produce ethnic differences in health service use: “Communication issues”, “Cultural differences in approaches to medical consultations” and “Effects of perceptions of inequalities in care quality and discrimination”. Explanations for disparities in health care use in Sweden can be categorized into those reflecting social/structural conditions and the presence/absence of power and those using cultural/behavioural explanations. The negative perceptions of ‘migrant’ clients held by some Swedish physicians place the onus for addressing their poor health with the clients themselves and risks perpetuating their health disadvantage. The power disparity between doctors and ‘migrant’ patients encourages a sense of powerlessness and mistreatment among patients.     

What is Health Equity: And How Does a Life-Course Approach Take Us Further Toward It?

Although the terms “health equity” and “health disparities” have become increasingly familiar to health professionals in the United States over the past two decades, they are rarely defined. Federal agencies have often defined “health disparities” in ways that encompass all health differences between any groups. Lack of clarity about the concepts of health disparities and health equity can have serious consequences for how resources are allocated, by removing social justice as an explicit consideration from policy agendas. This paper aims to make explicit what these concepts mean and to discuss what a life-course perspective can contribute to efforts to achieve health equity and eliminate health disparities. Equity means justice. Health equity is the principle or goal that motivates efforts to eliminate disparities in health between groups of people who are economically or socially worse-off and their better-off counterparts—such as different racial/ethnic or socioeconomic groups or groups defined by disability status, sexual orientation, or gender identity—by making special efforts to improve the health of those who are economically or socially disadvantaged. Health disparities are the metric by which we measure progress toward health equity. The basis for these definitions in ethical and human rights principles is discussed, along with the relevance of a life-course perspective for moving toward greater health equity     

Racial and Ethnic Makeup in Hospital’s Social Media and Online Platforms: Visual Representation of Diversity in Images and Videos of Washington,D.C. Hospitals

While hospitals’ health promotion via social media has the potential to be a critical source of health information, research shows racial and ethnic disparities exist in health-related knowledge that may be, in part, related to media representation. The purpose of this study is to examine the racial and ethnic representation of people featured in Washington, D.C. hospitals’ social media platforms to understand how hospitals embed cultural competency into their health communication. By comparing the diversity of images on hospitals’ social media platforms with the demographics of hospitals’ neighboring communities, the researchers intend to highlight opportunities to improve targeted health messaging to underserved communities, particularly Black and Hispanic communities. By analyzing the images and videos posted on the three most popular social media platforms – Facebook, Twitter, and YouTube – for a one-month period, the researchers found that Whites and Asians were over-represented while Hispanics were severely under-represented in hospitals’ social media representation as compared to the community demographics. Increasing the diversity of minority representation on hospitals’ social media-based health promotion may contribute to addressing the social disparities in healthcare.     

Physician Assimilation in Medical Schools: Dualisms of Biomedical and Biopsychosocial Ideologies in the Discourse of Physician Educators

Although health communication research and popular literature on physicians have heightened awareness of the dualisms physicians face, research is yet to focus on the discourse of physician educators who assimilate students into medicine for dualisms of the biomedical (BMD) and biopsychosocial (BPS) ideologies. The study drew on a dualism-centered model to analyze the discourse of 19 behavioral science course directors at 10 medical schools for the emergence of dualisms in instantiations of BPS ideologies and for the management of dualism in discourse that instantiated both BMD and BPS ideologies as part of the curriculum. Dualism emerged in the BPS ideologies of “patient-centeredness” and “cultural competence.” While a dualism between “patients’ data” and “patients’ stories” emerged in the patient-centeredness ideology, a dualism between enhancing “interaction skill” and “understanding” emerged in the cultural competence ideology. Moreover, the study found educator discourse managing dualism between BMD and BPS ideologies through the strategies of “connection” and “separation.” The study concludes with a discussion and the implications for theory and research.     

Exploring issues relating to disability cultural competence among practicing physicians

BackgroundMany factors contribute to the well-recognized health care disparities experienced by persons with disability, including failure of physicians to understand the lives of individuals with disability. Disability cultural competence considers physicians’ ability to meet the social, cultural, and linguistic needs of this population.ObjectivesTo assess physicians’ understanding of disability cultural competence and attitudes towards patients with disability.MethodsQualitative analyses of open-ended individual interviews averaging 41 min with 20 Massachusetts physicians from 5 different subspecialties, in practice for 8–51 years. Interview recordings were transcribed verbatim for conventional content analysis.ResultsMost participants defined disability using medically-focused concepts rather than concepts that recognize how social factors contribute to disability. All participants used disability culturally-competent language, such as “person-first language,” at some points throughout their interviews. However, most participants also employed language that is now considered unacceptable or archaic, such as variations on the word “handicap,” “wheelchair-bound,” describing persons with disability as “suffering,” and calling persons by their health condition (e.g., “COPDer”). Participants mentioned persons with mental illness and intellectual disability as particularly challenging, especially around communication and performing even routine tests or examinations. Recommendations for improving care included better listening to patients with disability and seeking their views about their care.ConclusionsIn this exploratory study, most participants used language that is considered disability culturally competent at times but also employed many terms and concepts that are considered outdated and may be troubling to some persons with disability.     

“Judging a Body by Its Cover”: Young Lebanese-Canadian Women’s Discursive Constructions of the “Healthy” Body and “Health” Practices

Our interest stems from the dramatic increase in the number of obesity studies, which expose Canadian women to a huge amount of information that links health to weight. Using feminist poststructuralist and postcolonial lenses, this paper investigates young Lebanese-Canadian women’s constructions of the body and “health” practices within the context of the dominant obesity discourse. Participant-centered conversations were held with 20 young Christian Lebanese-Canadian women. A thematic analysis was first conducted and was followed by a poststructuralist discourse analysis to further our understanding of how the participants construct themselves as subjects within various discourses surrounding health, obesity, and the body. Our findings reveal that most participants conflate the “healthy” body and the “ideal” body, both of which they ultimately portray as thin. The young women construct the “healthy”/“ideal” body as a solely individual responsibility, thus reinforcing the idea of “docile bodies.” The majority of participants report their frequent involvement in disciplinary practices such as rigorous physical activity and dietary restrictions, and a few young women mention the use of other extreme forms of bodily monitoring such as detoxes, dieting pills, and compulsive exercise. We discuss the language employed by participants to construct their multiple and shifting subjectivities. For instance, many of these Lebanese-Canadian women use the term “us” to dissociate themselves from Lebanese women (“them”), whom they portray as overly focused on thinness and beauty and engaged in physical activity and other bodily practices for “superficial” purposes. The participants also use the “us/them” trope to distance themselves from “Canadian” women (read: white Euro-Canadian women), whom they portray as very physically active for purposes beyond the improvement of the physical appearance of the body. We discuss the impacts of the young Christian Lebanese-Canadian women’s hybrid cultural identities and diasporic spaces on their discursive constructions of the body and “health” practices. Finally, we examine the participants’ fluid subject-positions: On one hand, they construct themselves as neoliberal subjects re-citing elements of dominant neoliberal discourses (self-responsibility for health, traditional femininity, and obesity) but, on the other hand, they at times construct themselves as “timid” poststructuralist subjects expressing awareness of, and “micro-resistance” to such discourses.     

Metropolitan Fragmentation and Health Disparities: Is There a Link?

Context: This article explores the relationship between metropolitan fragmentation, as defined by the total number of governmental units within a metropolitan statistical area (local municipalities, special service districts, and school districts), and racial disparities in mortality among blacks and whites in the 1990s. The presence of numerous governmental jurisdictions in large metropolitan areas in the United States can shape the geography of opportunity, with adverse consequences for health. Methods: We conducted a regression analysis using U.S. Census of Government data and Compressed Mortality File data for the country's largest 171 metropolitan statistical areas. Findings: We found a link between increased metropolitan area fragmentation and greater racial differences in mortality between blacks and whites for both children and working‐age adults. Although increasing fragmentation is associated with a higher mortality rate for blacks, it is not associated with a higher mortality rate for whites. These findings suggest that research is needed to understand how governance can positively or negatively influence a population's health and create conditions that generate or exacerbate health disparities. Conclusions: We need to understand the extent to which metropolitan fragmentation contributes to racial segregation, whether racism contributes to both, and the role of poverty and antipoverty policies in reducing or exacerbating the consequences of metropolitan fragmentation. The exact pathways by which metropolitan fragmentation contributes to differences between blacks’ and whites’ mortality rates are unknown. Uncovering how institutions influence the social, economic, and environmental conditions, which in turn contribute to the current racial and ethnic health disparities in the largest metropolitan areas, is key. Understanding these “upstream” determinants of a population's health and the disparities in health between subgroups in the overall population must be at the core of any attempt to reduce disparities in health. Building bridges between urban planning and public health can be critical to these efforts.     

Cultural Dilemmas of Choice: Deconstructing Consumer Choice in Health Communication Between Maternity-Care Providers and Ethnic Chinese Mothers in New Zealand

This article critically analyses the discourse of consumer choice embedded in health communication interactions between maternity-care providers and migrant ethnic Chinese mothers in New Zealand. Findings indicate that Chinese mothers, as the customers of the New Zealand maternity and health care services, are encouraged to “fit in” with the Western discourse of choice. However, the mothers’ cultural predispositions for childbirth and communication have a significant impact on the ways in which they respond to and resist this discourse. Drawing on theoretical insights from postcolonialism and Third World feminism, this article contributes to the study of intercultural health communication by examining cultural dilemmas in the discourse of choice that is often taken for granted in Western health contexts. In doing so, it builds a platform for an inclusive maternity care and health environment in multicultural societies.     

Language and Immigrant Status Effects on Disparities in Hispanic Children’s Health Status and Access to Health Care

The objective of this study is to estimate Hispanic/non-Hispanic (nH)-white health disparities and assess the extent to which disparities can be explained by immigrant status and household primary language. The 2007 National Survey of Children’s Health was funded by the Maternal and Child Health Bureau, and conducted by Centers for Disease Control and Prevention’s National Center for Health Statistics as a module of the State and Local Area Integrated Telephone Survey. We calculated disparities for various health indicators between Hispanic and nH-white children, and used logistic regression to adjust them for socio-economic and demographic characteristics, primary language spoken in the household, and the child’s immigrant status. Controlling for language and immigrant status greatly reduces health disparities, although it does not completely eliminate all disparities showing poorer outcomes for Hispanic children. English-speaking and nonimmigrant Hispanic children are more similar to nH-white children than are Hispanic children in non-English speaking households or immigrant children. Hispanic/nH-white health disparities among children are largely driven by that portion of the Hispanic population that is either newly-arrived to this country or does not speak primarily English in the household.     

The elephant in the room: talking race in medical education

The deaths of black men and women while in police custody, rising anti-immigrant sentiment and rhetoric in high-income countries, and the continued health disparities experienced by Indigenous communities globally have brought race and racism to the forefront of public discourse in recent years. In a context where academic health science centres are increasingly called to be “socially accountable,” ignoring the larger social context of race and racism is something that medical education institutions can little afford to do. However, many such institutions have largely remained silent on the issue of race and racism, both within and outside of healthcare. Most medical education continues to emphasize a primarily biological understanding of race. We argue that a different approach is needed. Highlighting the social construction of race is an essential starting point for educators and trainees to tackle racialized health disparities in our clinics and to challenge racism in our classrooms, educational and research institutions, and communities.     

Necessary Health Care and Basic Needs: Health Insurance Plans and Essential Benefits

According to HealthCare.gov, by improving access to quality health for all Americans, the Affordable Care Act (ACA) will reduce disparities in health insurance coverage. One way this will happen under the provisions of the ACA is by creating a new health insurance marketplace (a health insurance exchange) by 2014 in which “all people will have a choice for quality, affordable health insurance even if a job loss, job switch, move or illness occurs”. This does not mean that everyone will have whatever insurance coverage he or she wants. The provisions of the ACA require that each of the four benefit categories of plans (known as bronze, silver, gold and platinum) provides no less than the benefits available in an “essential health benefits package”. However, without a clear understanding of what criteria must be satisfied for health care to be essential, the ACA’s requirement is much too vague and open to multiple, potentially conflicting interpretations. Indeed, without such understanding, in the rush to provide health insurance coverage to as many people as is economically feasible, we may replace one kind of disparity (lack of health insurance) with another kind of disparity (lack of adequate health insurance). Thus, this paper explores the concept of “essential benefits”, arguing that the “essential health benefits package” in the ACA should be one that optimally satisfies the basic needs of the people covered.     

Perceptions of Secondhand and Thirdhand Smoke Among Hispanic Residents of Multiunit Housing

Despite the progressive adoption of smoking bans in public spaces, children living in multi-unit housing remain at risk of exposure to secondhand smoke (SHS) and thirdhand smoke (THS). Hispanic populations in California are particularly vulnerable to the harmful effects of SHS and THS because a large proportion of Hispanics live in multi-unit housing. Three focus groups were conducted in the fall of 2012 (in Spanish and English, N = 24) to understand Hispanics’ knowledge of and experiences with SHS and THS, including barriers to avoiding smoke exposure and strategies for protecting their homes from smoke. Hispanic residents reported unpleasant experiences with SHS and THS and were generally knowledgeable about the adverse health effects, although they were not familiar with the term “thirdhand smoke.” Some participants also mentioned marijuana smoke as a potential health hazard. Hispanic cultural values made participants reluctant to confront their neighbors but also motivated them to find ways to protect their families from smoke. Potential solutions included working with the smokers to designate a smoking area and gaining support from the building owners. Broad smoking policies should be implemented to help Hispanic residents overcome cultural and social barriers to smoke free air.     

Hispanic Immigrant Father Involvement with Young Children in the United States: A Comparison with US-Born Hispanic and White non-Hispanic Fathers

Objectives Fathering is known to foster child development and health, yet evidence on Hispanic immigrant fathers’ involvement with their young children is sparse. This study assessed disparities in pregnancy intendedness and father involvement with children ages 0–4 among Hispanic immigrant co-resident fathers versus two reference groups: US-born Hispanic and US-born White fathers. We hypothesized that differentials in involvement were associated with socioeconomic and cultural factors. Methods Using 2011–2013 data from the National Survey of Family Growth (N?=?598), we performed bivariate, logistic and linear regression analyses to assess disparities in pregnancy intendedness and five father involvement outcomes (physical care, warmth, outings, reading and discipline). The models controlled for socio-economic, structural, health and cultural covariates. Results Pregnancy intendedness did not differ significantly between Hispanic immigrant fathers and the two reference groups. Compared with US-born Hispanics, unadjusted models showed that immigrant fathers were less likely to engage in physical care, warmth and reading, (p?≤?0.05) though the differences were attenuated when controlling for covariates. Hispanic immigrant fathers were less likely than US-born White fathers to engage in each of the father involvement outcomes (p?≤?0.05), with the disparity in reading to their child persisting even after controlling for all covariates. Conclusions for Practice We found marked socio-economic and cultural differences between Hispanic immigrant and US-born Hispanic and White fathers which contribute to disparities in father involvement with their young children. Hispanic immigrant status is an important determinant of involved fathering and should be taken into account when planning public health policies and programs.     

Does Selective Migration Explain the Hispanic Paradox? A Comparative Analysis of Mexicans in the U.S. and Mexico

Latino immigrants, particularly Mexican, have some health advantages over U.S.-born Mexicans and Whites. Because of their lower socioeconomic status, this phenomenon has been called the epidemiologic “Hispanic Paradox.” While cultural theories have dominated explanations for the Paradox, the role of selective migration has been inadequately addressed. This study is among the few to combine Mexican and U.S. data to examine health selectivity in activity limitation, self-rated health, and chronic conditions among Mexican immigrants, ages 18 and over. Drawing on theories of selective migration, this study tested the “healthy migrant” and “salmon-bias” hypotheses by comparing the health of Mexican immigrants in the U.S. to non-migrants in Mexico, and to return migrants in Mexico. Results suggest that there are both healthy migrant and salmon-bias effects in activity limitation, but not other health aspects. In fact, consistent with prior research, immigrants are negatively selected on self-rated health. Future research should consider the complexities of migrants’ health profiles and examine selection mechanisms alongside other factors such as acculturation.     

Diet and Acculturation Among Hispanic/Latino Older Adults in the United States: A Review of Literature and Recommendations

Among U.S. and foreign-born Hispanic/Latino older adults living in the United States, associations of dietary acculturation and health outcomes have yielded no consistent findings. The purpose of this review was to present current knowledge and research disparities on acculturation, dietary intake, and health outcomes among the fastest growing minority group in the United States. Fifteen peer-reviewed studies that measured dietary acculturation among Mexican, Puerto Rican, and Dominican older adults living in the United States were identified and examined. This literature review divulged contradictory associations between dietary acculturation and dietary intake, along with nutritional and general health outcomes. Conclusive evidence has yet to be attained due to use of cross-sectional study designs and numerous acculturation measures as well as unique cultural and dietary patterns across diverse Hispanic/Latino populations. Further research is needed to ascertain dietary acculturation among U.S. and foreign-born Hispanic/Latino older adults in the United States and should strive to develop instruments that consider the social, economic, and political environments that influence the dietary acculturation process. Furthermore, longitudinal study designs and qualitative methodologies are warranted.     

Diet and acculturation among Hispanic/Latino older adults in the United States: a review of literature and recommendations

Among U.S. and foreign-born Hispanic/Latino older adults living in the United States, associations of dietary acculturation and health outcomes have yielded no consistent findings. The purpose of this review was to present current knowledge and research disparities on acculturation, dietary intake, and health outcomes among the fastest growing minority group in the United States. Fifteen peer-reviewed studies that measured dietary acculturation among Mexican, Puerto Rican, and Dominican older adults living in the United States were identified and examined. This literature review divulged contradictory associations between dietary acculturation and dietary intake, along with nutritional and general health outcomes. Conclusive evidence has yet to be attained due to use of cross-sectional study designs and numerous acculturation measures as well as unique cultural and dietary patterns across diverse Hispanic/Latino populations. Further research is needed to ascertain dietary acculturation among U.S. and foreign-born Hispanic/Latino older adults in the United States and should strive to develop instruments that consider the social, economic, and political environments that influence the dietary acculturation process. Furthermore, longitudinal study designs and qualitative methodologies are warranted.     

Parent–Child Acculturation Patterns and Substance Use among Hispanic Adolescents: A Longitudinal Analysis

Acculturation discrepancy theory predicts that conflicting cultural preferences between adolescents and their parents will increase the adolescents’ risk for behavior problems such as substance use. This study evaluated this hypothesis in a sample of 1683 Hispanic students in Southern California who completed surveys in 9th and 10th grade. Measures included the students’ own cultural orientations and their perceptions of their parents’ preference for their cultural orientations (“Perceived Parental Cultural Expectations”—PPCE). Hispanic PPCE in 9th grade was a risk factor for lifetime, but not past-month, cigarette, alcohol, and marijuana use in 10th grade. The adolescents’ own Hispanic orientation in 9th grade was protective against lifetime and past-month smoking and marijuana use and lifetime alcohol use in 10th grade. The effects of the acculturation variables did not vary according to generation in the U.S. Change in acculturation between 9th and 10th grade was statistically significant but small in magnitude. Increases in parent–child Hispanic acculturation discrepancy (i.e., the difference between the adolescents’ own cultural orientations and their PPCE, with adolescents perceiving that their parents wanted them to be more Hispanic oriented than they actually were) from 9th to 10th grade were associated with an increased risk of substance use. Family-based interventions for acculturating Hispanic families may be useful in decreasing the likelihood of substance use among Hispanic adolescents.     

Mainstreaming social justice: human rights and public health

Our interest in a human rights and health discourse emerges from our efforts as social scientists to bring a meaningful social justice perspective to the realm of public health. In Canada, as in many countries, "health" is still firmly within the domain of the biomedical and the clinical. While considerable effort has been made to include more social, economic, and cultural perspectives, efforts to frame these issues as political phenomena have tended to be polarized into either a rich body of theoretical literature or case studies of interventions which have in varying degrees incorporated a social justice approach. What is still missing is a framework of discourse that allows various concepts of social justice to inform policy, intervention strategies, evaluation and evidence-based measures of effectiveness. This commentary examines the human rights discourse as conceptual space from which to build this framework.