Examining Health Through a Determines Lens

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The title of my blog is actually a quote taken from Healey and Meadow’s review of the health of Inuit women in Nunavut. Similar to the people in South Side Chicago, they experience the repercussions of health inequities daily. I thought it was a perfect title for this blog, which discusses health inequities, based on the work by photographer, Jon Lowenstein.

Before reading my blog, watch this short film directed by Jon Lowenstein about the South Side of Chicago.

You can read a short synopsis about the video here.

This film, although short, is very moving. It’s almost a panorama of what life is really like in South Side, the true spirit and atmosphere is captured. Lowenstein is known for his work photographing the daily lives of others. However, he isn’t usually photographing people in suburban shopping malls or people at the local Starbucks going for their morning coffee. His photographs usually portray the lives of people living with violence, or drug abuse, the mayhem that occurs in places not so far from our homes. This particular video is a part of Lowenstein’s projects documenting his hometown and current place of residence, the South Side of Chicago.

In an interview with Lowenstein, he talks about his Chicago Project along with others. Some of his photographs are presented, and you can see they really capture the emotion that was present. One in particular resonated with me, where “Uncle Al” is holding up his niece. This shows the sense of community, and family that exists here. Just like any other community, the people care about each other, and I believe they may have stronger bond than a lot of the communities we belong to.

Read the full interview here.

Most of us have heard of Chicago, but I know when I think of the city, the Magnificent Mile and deep-dish pizza first comes to mind. However, like any other city, Chicago has a population of people who are below the poverty line. Answering why the South Side is particularly worse off than other areas is not an easy task. Lowenstein states, it shifted from a predominantly “white” neighbourhood to a mostly “black” neighbourhood over the last 50 years. To be specific, the South Side of Chicago has a 72% black population, compared to a 14% white population (Miller, 2011). The closing down of many factories has led to a high unemployment rate, and influenced a widespread use of crack cocaine. The question is, how do you take an area like this and improve the conditions for these people without intruding or displacing them? Getting to know them on a more intimate level is a place to start in my opinion. According to Miller, the “South Side residents disproportionately suffer from high rates of; Diabetes, Asthma, Hypertension and other chronic diseases” (2011). Although these health inequalities can be described by individual choices to a certain extent, I believe they are much better classified as health inequities, and they can’t truly be explained without the social context.

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An Urban Health Initiative aimed at promoting health in South Side Chicago (Miller, 2009).

Judging by the diagram above, it would seem the social areas needed improvement are being addressed and considered in a plan to help the residents of South Side. However, similar to Canada, the United States is behind compared to some European nations in considering the broader determinants (Raphael, 2008). As I have learned in class, despite the abundance of research affirming the importance of the social aspects of health, data such as the “Epp Report” tells us the majority of policy and funding is still focused on lifestyle. It is communities such as this that suffer the most from the lack of policy and inclusive societal structures. As Lowenstein says, “the United States continues to ignore our most impoverished people” (2013).

“There are lots of ways to find stories, but most important is to keep your eyes, ears and heart open.”  – Lowenstein 2013

I feel this particular quote summarizes Lowenstein’s approach to his work. He is constantly practicing cultural humility. Get asks about people’s opinions, and asks for their perspective about the violence and suffering going on in their front yards. An excellent approach to gain knowledge about how an individuals health is affected socially. This is exactly the attitude needed to promote health in communities such as South Side, or any community for that matter. You must ask questions, and try to understand the history of a place (Tervalon, 1988). One can’t simply implement a broad health care program without acknowledging the diverse characteristics of a community. Similar to promoting health in a place like Iqaluit, Nunavut, aspects such as gender, and the social and physical environment cannot be excluded from the research (Healey & Meadows, 2007). Just as people in South Side have higher rates of chronic disease, the women in Iqaluit suffer higher rates of Chlamydia, Cervical Cancer, and premature delivery compared to the rest of Canada (Healey & Meadows, 2007). The data demonstrates these people are suffering; yet, the research being conducted still ignores the contextual circumstances influencing the determinants of health. “Research must be conducted WITH communities instead of ON them”(Healey & Meadows, 2007). This is why I believe Lowenstein’s work is much more than a form of documentation, he is sincerely trying to understand groups of people too often isolated by society.

Lastly, I want to share with you a different documentary that applies to the topic of health inequalities and impoverished communities.

“Lost Angels: Skid Row is my Home”, is a very moving documentary directed by Thomas Napper. The term “Skid Row” is usually referred to as “grungy” areas of a town, but in this film, Skid Row is referring to an area in Los Angeles, California. In this film, the lives of different individuals living on Skid Row are recorded, but the film doesn’t merely show how they live, rather, it shows why they live. It demonstrates how what is on the surface is not always the whole story. Words such as: drugs, poverty, violence, and mental illness come to mind when describing Skid Row. In reality, these words only touch on what characterizes the residents. Although in the film people share how they first came to live on Skid Row, the true reasons become muffled on a string of socially determined events.

Reasons outsiders might otherwise unconsciously judge inhabitants of Skid Row are challenged. The film allows you to gain a whole new perspective of what it means to be homeless. Living in complete poverty, the people there make lasting bonds with each other. All coming from very diverse backgrounds (even a former Olympian athlete), their stories are uncovered and they can be seen in new light.

Watch the trailer for Skid Row here:

I highly recommend this film to everyone.

What I want readers to take from this entry is the importance of cultural humility. I strongly believe that without cultural humility, health promotion efforts cannot truly metamorphose.

Resources:

Healey, K. Gwen., Meadows, M. Lynn. (2007). Inuit Women’s Health in Nunavut, Canada International Journal of Circumpolar Health 66:3 199-214

K Eng. (2013, December 6). Why I document the often violent and traumatic daily lives of others: Fellows Friday with photographer Jon Lowenstein. Retrieved from

http://blog.ted.com/2013/12/06/q-and-a-with-photographer-jon-lowenstein/

Miller, C. Doriane. (Feburary 26, 2011). Health Care on the South Side of Chicago: Science and Service to the Community. University of Chicago Medical Center: Civic Knowledge Project. Retrieved from: http://povertyinitiative.uchicago.edu/events/Health%20Care%20on%20the%20South%20Side%20of%20Chicago.pdf

Raphael, D. (2008). Grasping at straws: a recent history of health promotion in Canada. Critical Public Health, 18(4):483-495.

Tervalon, M., Murray-García, J. (1998). Cultural Humility Versus Cultural Competence: A Critical Distinction in Defining Physician Training Outcomes in Multicultural Education. Journal of Health Care for the Poor and Underserved, 9: 2, 117-125

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