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Archive for May, 2006

Well, last week I talked about women's sexuality. The gist of that post is that women's sexuality is not defined by women, but by men, and as such is defined as being in relation to, or largely for the benefit of, men. Women are responsible for male sexual pleasure; we are expected to know what to do and how to do it, with the end goal being male orgasm and ejaculation. This has led to all sorts of problems for women, from sexual harrassment to rape to general misogyny as a result of a culture obsessed with the female body and that commodifies female sexuality for male profit. Feminists have been working against this conception of female sexuality, first and foremost to allow women to define our own sexuality on our own terms, but also to break down the heterosexual ideology about women's sexuality that oppresses lesbian and bisexual women.Along with discussions of sexuality naturally come discussions of reproduction. If women's sexuality has been defined in terms of male pleasure, then reproduction has been defined in terms of continuing the male bloodline, and women are responsible for both producing a (healthy) child and raising that child. To this end, the greatest value a woman has in a patriarchal society is to become a wife and mother. Feminists have long fought for women's reproductive autonomy, in order that women who do not wish to become mothers or cannot become mothers are valued, and in order that women who do wish to become mothers are not tied completely to either the role of mother or the role of belonging to a man.

Pregnancy and Childbirth have long been thought to be "the most natural thing in the world." Not that you'd know it, since both have been so highly medicalized. Pregnant women used to be left alone to gestate, and to take their chances with whatever child results. Today, pregnant women are subjected to a slew of tests and monitering procedures to ensure, primarily, the health of the fetuses they carry (the health of the mother is important, of course, as well, but mostly as a means to the end of a healthy child – or future healthy children). The most common prenatal test is, of course, the ultrasound, a technology orginally intended to track submarines. Ultrasound technology allows the doctor a look inside the mother's womb to see if the fetus is developing properly. If you have ever seen an ultrasound picture of a fetus, it's pretty tough to tell what's what… but now they have advanced technology that gives a 3D image of the fetus in great detail. Ultrasounds are standard procedure for pregnant women. But, did you know that ultrasound was used widely before the long-term effects of such a procedure were known, and that no standardized study of the safety of ultrasound in pregnancy has ever been done? Who knows – maybe ultrasound is the reason for the increase in cervical and uterine cancer in women. We do know that ultrasound has resulted in the abortion of millions of female fetuses. The real prize for a woman is to deliver a healthy baby boy.

Women are routinely encouraged to have more invasive tests, such as amniocentesis and maternal serum testing, to determine the disability status of the fetus. Women over 40 years of age are encouraged to undergo amnio testing, in which a large, long needle is inserted into the womb and some of the amniotic fluid is extracted and then tested. This procedure carries a risk to the fetus of puncture, and is painful for the pregnant woman. Increasingly, women whose fetuses test positive for disability – whether cognitive or physical – are encouraged to abort. this decision is often portrayed as "the right thing to do" because raising a disabled child is "so hard" and disabled people have a lessened "quality of life". Of course, some women refuse to abort for various reasons, but this practice is disturbing for three reasons. First, the woman is being treated as a mere vessel whose purpose is to produce a healthy child; she is first pressured into undergoing the testing, and then to abort unwanted "defective" fetuses – all in relation to propagating the father's seed. All this testing creates an invasion of pregnant women's bodies to "see" inside in order to ensure the successful production of a healthy fetus. Producing a healthy child is extremely valued – and producing an unhealthy or disabled child is then cast in opposition as a failure on the woman's part, since she is responsible for gestation. Second, this practice is deeply offensive to disabled people. Abled people have a deep misconception that life as a disabled person is not worth living. This is, of course, not at all true. Life may be more challenging, but life is more challenging if one is born a woman, or nonwhite, or homosexual. Do not mistake what I am saying: being a woman or nonwhite or homosexual is not a challenge in the same way as not being able to walk is a disability, or being in a constant state of physical pain. What I am saying is that disability is overblown by abled people as being the absolute worst state of being possible, so much so that many believe they would prefer to be dead. The truth about most disability is that disability is not really biological, but is environmental – if every environment were suitable to every person, there would be no such thing as disability. Imagine yourself born with a congential condition that prevents you from being able to walk. Now, imagine you have jsut turned on the TV to the news story that because of selective abortion and prenatal testing, your particular condition has been completely eliminated from the population of newborns – it has been effectively bred out of human genetics. How might you feel? Might you feel that you, and your life, was not valued by society? Third, all these prenatal tests are presented as increasing women's autonomy is terms of choosing what sort of child to have. But in truth, these choices are set up within a framework that is predetermined, primarily by men. Perhaps if mothers of disabled children were better supported by our society and government, more women would see raising a disabled child as a feasible option. It seems to me it is the framework that needs to change, not women.

The medicalization of pregnancy does not end with labour. Epidurals, which freeze the woman from the waist down, carry a risk of paralysis. Episiotomies, which surgically cut the woman's perinium toward the anus to reduce pushing time, have been found to be unnecessary and difficult to heal properly. Heart-rate moniters, which moniter the heart rate of the fetus during delivery, are uncomfortable for the woman and make her labour experience more difficult. Caesarian sections take a long time to heal. Infant newborns are immediately snatched from the mother to be checked by the doctor in order to be deemed healthy, thus validating the woman as a successful gestator. I could go on, but I have more to say on other topics.

Fertility is not something all women posess equally. Some women are not able to produce children. Since a woman's primary value in society is to produce (healthy) children, infertility is a major failure. Luckily, modern medicine has stepped in to find all sorts of ways to increase the chances of a successful impregnation. All of these methods are invasive to the woman – even in cases where the infertility is her partner's – and involve hormone injections (which produce mood swings, hot flashes, and excessive hair growth) in order to create an overproduction of ova. In vitro fertilization (IVF) involves extracting ova with a long needle inserted into the vagina and through the cervical opening, and artificial insemination (AI) involves injecting sperm into the uterus, again with a long needle. With IVF, the ova are fertilized outside the body and re-inserted. In both IVF and AI, since multiple ova are produced thanks to the horomone therapy, the risk of a multiple pregnancy is higher than normal. If this happens, the woman then has to decide whether to carry all the fetuses to term, which carries health risks for the fetuses and for herself, or to abort one or more of her prized fetuses. How sad this decision must be, especially knowing that it is possible the fetus(es) she does decide to carry may miscarry. So what is the responsiblity and contribution of the man in all of this? Ejaculation into a cup.

Again, what is at issue is that these fertility options are presented as ways to increase women's autonomy. However, if the value of women was placed differently, more women would be free to choose NOT to undergo these invasive and expensive treatments. All women would be valued intrinsically, rather than valued only as relational to men and as a means to men's interests.

Abortion is the last topic I will tackle, but briefly, in relation to women's reproductive freedom. I've posted on abortion before, but I'll recap here. In order to truly enjoy sexual freedom, abortion must be an option. It has been deemed a human right of women to determine the number and spacing of their children, by the UN and WHO, no less. Without going into the ins and outs of the debate over when life begins, I will state that my opinion is that it doesn't matter when life begins. The woman's rights, as a fully developed human moral agent capable of reason and emotion and autonomy, are more important than the rights of a fetus, a nonperson, a potential person, or whatever you want to call it. (For a more detailed argument on this line, see Judith Jarvis Thomson's A Defence of Abortion.) If abortion is not an option for women, then the "rights" of an unborn person, a nonperson, are placed higher than the rights of a fully developed person, namely the woman in question. But then, what else is new? The interests of the male power block – in this case, perpetuating the family name and bloodline – outweigh those of women. The main opposers of abortion are, surprise surprise, the big C Church, the original oppressors of women.

Abortion is coming under fire again. In the US, famously now, South Dakota has passed legislation preventing women from accessing abortions – EVEN in cases of rape and incest. In New Brunswick, the only hospital providing abortions has just announced it will no longer provide the service, leaving the provincial government to scramble to find another facility to offer abortions. In Canada, abortion is not prohibited in any way; medical guidelines are the only ones in place to determine when the cut-off for abortions is, and in cases of grave risk to the mother, late term abortions are performed. I have heard rumblings about the new conservative government wanting to challenge abortion law in Canada. I can't tell you how upsetting this is. Abortion is absolutely necessary for reproductive – and sexual – freedom.

In countries where abortion is not legal or accessible, women who are raped are forced to carry the resulting fetuses to term – if they are physically able, or are not beaten or murdered by male relatives trying to preserve the family's honour. This is used to advantage by warlords, who sanction the mass rape of hundreds of thousands of women in order to ethnically cleanse the population of their enemy. How can women in these circumstances ever achieve sexual freedom? They have no control over their own reproduction, their own bodily integrity, their own autonomy to choose with whom to have a family. Abortion is aboslutely necessary in order to preserve women's rights.

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Okay, this is the last post about TV. I promise. For now. :)The season finale of LOST was on last night, and boy, did it leave me speechless! That ol' JJ Abrams, he really knows how to leave you wanting more – each answer you get only raises more and more questions! So everyone knows the premise of the show, right? – plane crash on a deserted tropical island in the south Pacific somewhere. Only the island isn't so deserted after all. It's got polar bears, and sharks with funny symbols on their tails, and crazy French women, and hillbillies dressed in grubby clothing and no shoes, and hatches with people inside them who've been isolated for years thinking they're in quarantine, and on the other side of the island is a whole group from the back end of the plane. I've been waiting the whole season long to find out about the button, and the hatch, and what the heck is the deal with the Dharma Initiative, and the Others, and why JJ Abrams names his characters after famous philosophers. Slowly, things have been coming together, but holy christ! I won't say much about it in case you haven't seen it yet, but let me tell you, this is some mysterious shit. And, of course, just as some major questions have been answered, a dozen more crop up in their place. The more you know, the more you know you don't know. The more you want to know, wish you could know. And now, I won't know until the fall! And even then, it's highly unlikely that I'll really get to know anything! I love it!

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Well, my very favourite show ended last night. After 5 years of ass-kicking, conspiracy, and outrageously cool disguises, Sydney Bristow, super-spy extraordinaire, has retired.




It's hard to describe my feelings about this tragic turn of events. (I must not speak about the details of the final episode, as I have friends who will not be able to see it for some time and I don't want to ruin anything.) The final episode aside, I am just plain sad that I won't be seeing my favourite show anymore. I came to love Sydney, and her boyfriend Agent Michael Vaughn, and kooky Marshall, loyal Dixon, sexy bad guy Julian Sark, and even cold-fish papa Jack Bristow. I loved the adventure, the outlandish storylines, the implausible technology, the fight scenes, the breath-taking cliff-hangers (remember the finale of season two? I think that was the most compelling and shocking surprise twist in TV history! Including "Who Shot J.R.?"). It was the best part of my TV watching for the week. I think the end came via a slew of coinciding missteps on the part of the network and the creator, JJ Abrams (but why should he care? he's directing Mission Impossible movies now, the turncoat!). The show suffered a double whammy of a time-slot change and a new show from Abrams (Lost – have you seen it, or do you live under a ROCK?). Then, Jenny Garner went and got pregnant (I'm sure she's very happy), which completely ruined the shooting schedule. Then, Agent Michael Vaughn was killed off this season, a move that so infuriated loyal viewers (I think perhaps the most loyal viewers of any current show) that they boycotted en masse. Alas, the network couldn't figure out a way to save ALIAS.So, now I am left, alone and sad, without really understanding why it had to end. I wish Sydney – I mean, Jennifer Garner – and all her friends all the very best. I'll be keeping my eyes peeled for all of you. Please don't keep me waiting. I'll be watching ALIAS on DVD until then.

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So sorry for the extreme tardiness of this post. I am feeling much better now, so I feel like I can concentrate.

One of the main points and aims of feminism in the 20th and 21st centuries has been reproductive freedom. This is a complicated topic that is closely related to women's sexual freedom. I'd like to write about both, but I think it best to start at the beginning and discuss women's sexuality first. Next week, I'll talk about reproductive freedom. Ready?

Historically, in western society women’s sexuality has been suppressed and controlled by male power. Women's sexuality before the Victorian age was seen as a volatile, all-consuming, dangerous phenomenon, a wild and destructive force that must be tamed (by threat of rape/violence and by actual rape/violence), all of which preserves patriarchy. The idea of vaginatis dentata was popular, which portrayed the vagina as having teeth, representing the dangers of the sexually irrepressible vagina as consuming male flesh. It was commonly held that women's sexual appetite was insatiable, and that men could not keep up. This made men fearful that their women would be unfaithful; women were at this time considered property, after all, little more than chattle whores. Marriage in ancient Greece was seen as a form of prostitution or sexual slavery, where wives were expected to provide sexual favours to their husbands in return for being taken care of. Wives were often kept away from other men as a result, and eventually this led to women rooming together, in cloistered fashion, when men were gone.

Through the Victorian age, female sexuality became completely repressed, and the common view was that women's sexual appetite was smaller than that of men. The picture of the cold and frigid, virginal and pure woman became the norm. Everything about the culture was repressive, and women's bodies and sexuality was the ultimate site of inscription for this. This was also the time when women's clothing was most restrictive and punishing, with corsets and heavy layers of material piled high enough to cause fainting spells from lack of oxygen. Thanks, Queen Victoria!

Sexual relationships between women were condemned historically, although simultaneously encouraged by seclusion practices. Since men dominated women, sex between women did not present such a threat as did sex with other men (which threatened paternity). Because sex was associated with reproduction, phallic penetration defined sex. Therefore, sex between women was not ‘real’ sex and was tacitly tolerated by patriarchal systems, so long as patriarchal marriage commitments to reproduce were upheld. As a result, a silence about sexual relationships between women developed.

Sexuality became more important as separation of sex from reproduction became the Western norm. As access to contraception grew, an increased focus on sexual pleasure as a justification for intercourse developed, even in a marital context. Once sex was not tied to reproduction, homosexuality strengthened socially, and homosexuals became more visible. Subcultures developed, although gay male subcultures were more tolerable than their lesbian counterparts. Lesbians were seen to threaten male supremacy because they did not participate in patriarchal marriage situations. Lesbians were persecuted by law and deemed pathological and neurologically ill. As a result, lesbians often did not identify as such despite co-habiting and carrying on sexual relationships with other women over several years.

By the 1960s, feminists had a difficult task on their hands. Feminists had to advocate for women’s sexual freedom while also advocating for the end of male domination, definition, and exploitation of women and their sexuality. Trying to achieve sexual equality when women lacked economic and political equality was a a difficult task for feminists advocating amidst a political climate rife with tension. Feminists were seen as lesbians regardless of their personal sexual practices because they trespassed on what was traditionally male space politically.

Feminists had two separate ideals regarding sexuality: the idea of purity of women and the right to say no to unwanted sexual advances, and the idea of sexuality as being separate from reproduction. These ideals were not always complementary. Sexually liberated women of the 1960s often found their taste of sexual liberation unfulfilling. With increased risk of pregnancy and no economic equality or security, women ended up bearing the costs associated with pregnancy, motherhood, and abortion, and often were forced to turn to welfare to support their families. Women also felt they had lost the right to say no by being sexually liberated, and media and pornographic images perpetuated the notion that women were sexually available and perpetually eager to have sex. The sex industry proliferated during the second wave of feminism and the commercialization of sex through marketing became common. Sexuality, especially women’s sexuality, is being used and reinforced by capitalist commercialism today more than ever. This contributes to an idea of women’s sexuality that is primarily heterosexual, and damaging to women as we try to negotiate a more secure economic and political footing in society.

Lesbians grasped hold of the idea of female sexual self-determination. Lesbians lived outside of heterosexual institutions, and were seen as naturally challenging patriarchy. Also, lesbians were seen as “natural” feminists because they are free from emotional dependence on men. Heterosexual feminists risked losing privilege by associating with lesbians, felt excluded by lesbianism and felt “not feminist enough” because of their intimate relationships with men. The popular slogan of radical lesbian feminists, who encouraged a complete detachment from male society and formed a lifestyle that did not involve men in any way, was "Feminism is the theory. Lesbianism is the practice."

The picture of female sexuality in our society is certainly one of heterosexuality. Young girls now are subjected to extremely high expectations to have sex with boys, and teenage pregnancy and the rate of STIs in teens is rising: the group most at-risk for new HIV infections is 18-24 year old women. Sex is everything, yet it is nothing. It is everything because there is such a major emphasis on sex in our culture – yet it is nothing because it is "no big deal", "everyone's doing it", etc. More and more, this is true. The danger of this is for young girls more than young boys, because our culture seems to be sexualizing our young girls so much earlier. The pornography industry does nothing but feed this trend, picturing women with tiny little vulvas and no pubic hair, slender hips and thighs – but, paradoxically, huge round breasts, which signify the breasts of motherhood, full with milk. Young girls are paraded around in completely inappropriate clothing for their age, and are exposed to not just the damaging effects of Barbie, but very adult TV shows, movies, magazines, etc. Mothers don't seem to know where to draw the line with their children, perhaps because they went through this hyper-sexualization themselves, who knows? Fathers seem not to care. After all, a girl/woman's best chances of survival and economic prosperity lay with finding a husband. Sex is nothing, yet it is everything.

In her great book Promiscuities, Naomi Wolf writes about the coming of age for young girls during her generation, the 60s and 70s in San Fransisco, City of Love. Her story and that of her friends could jsut as easily be any girl's story; the feelings and rituals she describes are so scripted. Of course, coming of age for young girls means sex. Wolf talks about how in other cultures, women's sexuality has been celebrated and respected, and how in our culture, women's sexuality is degraded and repressed. When girls in some cultures begin to menstruate, they are seen as coming of age, and this is celebrated with rituals as the young girl enters into womanhood. She is taught about sex and her own sexuality by elder women in the group, and often go on adventures, either with other young girls or solo, in order to reflect on and experience her own power as a woman. In our culture, menstruation is seen as an inconvenience, an embarrassment – an inconvenience for men who cannot have sex with women at this time (which of course is totally untrue, but many men do freak out when see blood on their penises), or at least cannot have sex in order to procreate at this time; and an embarrassment because a woman's purpose, use, reason for being in a patriarchal society is to provide these things – sex and babies – for men. In some cultures, women seclude themselves during menstruation as a ritual, to celebrate their womanhood. It is well-known that when women live together, their cycles align naturally. This was convenient for these seclusions. In some cultures, women are sent away during menstruation. Or is that just how anthropologists viewing the situation with a patriarchal lens see this practice?

In our culture, this type of celebration of female sexuality for young girls is completely absent. Officially, our young girls are taught that sex is bad, it will make them pregnant, it will hurt, it will make them damaged goods, they will get STIs, and that any kind of sex is morally wrong. However, young girls are also exposed to the unofficial news about sex – it is fun, boys will like you, it feels good, that you can't get pregnant from anal or oral sex, that STIs are not that common and condoms will protect you – some of which is true and some of which is not. Kids are surrounded by images of what female and male sexuality is/should be, yet officially they are told a completely different story. Kids have hormones that race wildly, but they are taught that any kind of sexual touching – even touching their own body – is impermissible, because it will lead to more sexual contact. As a result, we have taken away the sexual learning ground for children – whatever happened to "petting"? (as much as I hate that term… kids are not animals to "pet"!) I say, bring back petting, allow kids – especially young girls – to develop some knowledge about sex that doesn't involve the risks of intercourse. Let young girls learn to enjoy their bodies through masterbation. Let young girls learn to express their feelings about sex, to ask questions, to find answers that are honest, in a safe environment. Let young girls learn what feels good and what doesn't, and that it's okay to share that with someone else, and not to accept sexual treatment that doesn't make them feel good, either physically or emotionally. The virgin/whore dichotomoy is old and tired. We need to let it go, move on from it, and stop letting it rule our sexual identities.

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I've been feeling a bit under the weather the past few days, I have a touch of malaise, so I am tardy with my FF post this week. Sorry! I'll post it as soon as I feel up to being in front of the computer for more than 15 minutes at a time. I'm thinking maybe tonight or sometime tomorrow. Wish me well – I feel so exhausted and depleted I can use all the well-wishing I can get!

J

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I wrote a paper recently, the topic of which was, is there such a thing as a right to health care? I argued that yes, there is a right. Here is the paper:

HEALTH HUMAN RIGHTS

“Physical health is a site of social inequality. Unequal social relations create unequal chances of staying alive, unequal possibilities of health across lifetimes and inequalities in the experience of ill health. Profound, unjust suffering results.”[1]

– Eileen MacLeod and Paul Bywaters

Introduction
Health is said to be the great equalizer. It is of universal interest and importance; no matter who they are or where they come from, everyone thinks about health. Health is ubiquitous; because humans are embodied beings, mental and physical health are unavoidably important. When illness strikes, social privileges seem to matter less – all that matters is becoming well, or as well as possible.

This perspective is clearly a privileged one. Health is certainly not an equalizer: it has been widely acknowledged that health is to a large extent socially determined. Those who are ill but socially privileged may find their privilege matters less to them than their health, but those who are ill and socially disadvantaged are not elevated to the same social status as the privileged during the course of their illness. Social disadvantage doesn’t melt away with illness; in fact, social disadvantage prevents access to health care and contributes to the length and severity of illness.

This paper will argue that health care is a right of all citizens of all societies. First I will present evidence that health is in large part socially determined. Then I will argue that since society has a decisive hand in creating health through social conditions and structures, society has a pursuant moral obligation to provide care for citizens whose health is affected by those conditions and structures.

It is important to note that this paper focuses on population health rather than individual health. Genetics play an important part in the health of individuals, but the largest contributors to the health of populations are environmental and social factors.[2]

Social Determinants of Health
In 1980, a groundbreaking study was released in the UK on the correlation between social inequalities and health. Colloquially known as The Black Report, the study showed that such social classifications such as gender, race, ethnicity, and economic class affected health, and that poor health was directly related to social disadvantage.[3] Further, the report showed surprisingly that even though Britain has (and had at the time) a national publicly administered health care system, access to health services was reduced among the socially disadvantaged.[4] The report states, “In all cases, for an individual to seek medical care, his (or her) perception of his (or her) need for care will have to outweigh the perceived costs (financial and other) both of seeking care and of the regime which may be prescribed. These costs are class related.”[5] The Black Report began an extensive and ongoing sociological project that looked to identify and explain the social determinants of health.

The World Health Organization has comprehensively studied the links between social status and health internationally. In 2003, WHO released the second edition of the report, Social Determinants of Health: The Solid Facts.[6] This report focuses on such social conditions such as work, stress, and social exclusion due to race and economic status as factors affecting population health. The report states, “Poor social and economic circumstances affect health throughout life. People further down the social ladder usually run at least twice the risk of serious illness and premature death as those near the top.”[7] Further, “disadvantages tend to concentrate among the same people, and their effects on health accumulate during life. The longer people live in stressful economic and social circumstances… the less likely they are to enjoy a healthy old age.”[8] So, those people who fall into socially disadvantaged and marginalized groups have an increased risk of illness and death, and the ill effects on their health are cumulative. WHO has also published reports on the specific correlations between poor health and socioeconomic status,[9] and gender and health.[10]

Judith Lorber examines the links between the social construction of gender, race, and class, and population health. She writes, “Many of the risky health behaviours in adulthood, such as drinking and smoking cigarettes, seem to be a matter of individual choice. But a closer look reveals that social factors linked to gender, race and ethnicity, and economic class produce the situational circumstances that influence health-related behaviours.” [11] Studies have shown that poor uneducated black men are more likely to become heavy drinkers than black women or white men or women, and that educated black men have a significantly higher incidence of alcohol-related problems than educated white men: once per month on average as compared to three times a year for educated white men. Lorber notes that educated black men are more likely to feel pressure to maintain a standard of behaviour expected by society in relation to their social standing.[12]

Social inequalities can have both direct and indirect influences on health and health care for members of those groups.[13] Poverty precludes people from providing for themselves healthy living conditions like clean and safe housing, nutritious meals, and warm clothing. More subtly, forms of discrimination can produce psychological barriers to good health by creating stress, causing depression and despair, and preventing certain people from having their concerns listened to and met with realistic solutions.[14] Social exclusion can contribute to isolation and withdrawal from the community and social networks of support that can in turn reduce the likelihood of certain people asking for and receiving help. Poor finances can mean a person who is in poor health may not be able to afford to take time off from working for convalescence, and as a result may allow an illness to progress further before seeking medical help; additionally, such a person might have difficulty communicating across economic class and other socially determined lines, such as race and gender, to a medical professional whose social position is one of relative, yet significant, power. Women have traditionally behaved deferentially to male doctors when seeking medical help, which may adversely affect their health outcome, for example. It is easy to see how “even within relatively prosperous, ‘developed’ economies with apparently comprehensive health care systems supported by ‘scientific’ medicine, health chances are tied to economic, social and environmental factors.”[15]

Society’s Responsibility, Society’s Obligation
Because health is determined by social factors, society has a two-fold obligation: 1. to provide health care for those who become ill, and 2. to reduce social inequalities that result in poor population health. I will discuss each obligation in turn.

Health inequalities are not remedied by providing a comprehensive health care system to the public. Even in countries where health care is publicly funded and access is not restricted, social inequalities still produce inequalities in health: “The primacy of economic, social and environmental factors is reflected in evidence that treatment-oriented health care has relatively little impact on the health chances of populations.”[16] However, this does not excuse governments from providing health care to its citizens; just because comprehensive universal health care doesn’t solve the problem of social inequality, it does not mean governments have no obligation to provide health care to its citizens. Because society has a hand in determining health, it has an obligation to provide care to those who become ill as a result of inequality.

Furthermore, inequality is so pervasive and ubiquitous, it follows that the most just way of dealing with this obligation so that nobody who becomes ill due to social determinants falls through the cracks is to provide health care universally to everyone, not just to those who are marginalized. It is morally inappropriate to set an acceptable level of social inequality to endure before health care may be accessed. A perfect example is the Medicaid program in the United States. Medicaid is a publicly administered health care program that insures those with limited income. However, not everyone on a limited income is eligible to receive Medicaid; various requirements exist for different groups that are difficult to generalize.[17] For example, the working disabled qualify for Medicaid only if their income is 200% below the poverty line. These eligibility requirements leave 45.8 million American citizens without access to health care.[18] Additionally, a recent Harvard study found that half of all personal bankruptcies in the U. S. are due to medical bills.[19] Chances are many of those 45.8 million uninsured Americans are touched in some way by social marginalization that has an impact upon their health. By refusing to provide universal access to health care, the U.S. government ignores the ways in which it participates in and creates the social inequalities that contribute to or are responsible for the poor health of so many Americans.

Social Justice
Immanuel Kant’s Categorical Imperative, “Act only on that maxim whereby thou canst at the same time will that it should become a universal law,”[20] is seen as the basis for social justice and human rights. Kant’s insistence that all people must be treated as ends in themselves[21] is an expression of the notion of universal and inherent human equality. Modern accounts of social justice, such as the one advanced by John Rawls, declare that social inequalities are tolerable only insofar as those inequalities provide an overall benefit to the least advantaged members of society.[22] This can only be achieved through redistributing wealth from the rich to the poor. In the modern welfare state, this is done through taxation: wealth is collected in the form of taxes and redistributed to the economically disadvantaged through social programs that provide money, food stamps, and housing. On social justice, then, a person who is economically disadvantaged can claim a positive right to goods and services that he or she cannot afford to purchase. Because society supports social inequalities, it has an obligation to provide a basic level of goods and services to all members of that society. This view can be extended globally; because there are economic and social disparities between global communities, economically powerful countries have an obligation under social justice to alleviate some of the effects of those disparities. There may be pragmatic problems with achieving this goal, but that does not remove the obligation.

The current health care situation in the United States is an example of how social inequalities lead to poor health, and where social justice falls short. The wealthy may simply buy health care when they become sick, while the poor bankrupt themselves under the strain of medical bills. The U.S. government allows social inequalities to exist that have a negative impact on health, does nothing to alleviate the root causes of those inequalities, and does not even provide adequate health care to those who become sick due to the social conditions the government creates and supports. This is like putting a band-aid on a gunshot wound. A system in which social inequalities exist that affect the health of some members of the population, and in which health care is not universally accessible but is only available on the basis of ability to pay unjustly favours the wealthy. A system like this does not value each person equally. If social inequalities cause poor population health, governments have a moral obligation to contribute to the treatment of the illness caused by embedded social structures such as racism and poverty. If a government recognizes that individuals who are adversely affected by socio-economic constructs have a right to goods they cannot otherwise access through welfare, that government should also recognize that health care is one of those goods.

Health Care Is Not Enough: Health Human Rights
Providing health care is only half the solution. The other half must come from reducing and eliminating the inequalities that result in poor health. The World Health Organization declares in its constitution that “the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being,”[23] and goes on to say that “governments have a responsibility for the health of their peoples which can be fulfilled only by the provision of adequate health and social measures.”[24] The United Nations has linked human rights to health issues such as HIV/AIDS,[25] sexual and reproductive freedom,[26] and violence against women.[27] The UN believes that humans have a universal right to health and health care.

In its report on the social determinants of health, WHO makes policy recommendations that will have the effect of reducing social inequalities that are contributing factors to poor health. WHO consistently refers to claims of social justice, human rights, and welfare, and the responsibility of governments to reduce the disparities between social groups by increasing education opportunities, encouraging involvement in the community, raising housing standards, and alleviating unemployment.[28] Also, WHO has developed a Commission on the Social Determinants of Health to help find ways to reduce inequalities between social groups that may contribute to better access to health care.[29] Initiatives like these go to the heart of the problem of socially determined health inequalities, and will ultimately be the solution society needs. In the meantime, governments must commit to providing universal free access to health care to treat those who fall victim to the social determinants of poor health.

Conclusion
This paper has shown that health is causally linked to social factors such as race, class, and gender, and that poor population health is due to inequalities between social groups. I have argued that since health is determined by society, society has a moral obligation to provide health care to those who need it, and that the most just way to do this is to provide universal health care. I have further argued that providing universal health care is not enough, and that society has a moral obligation to reduce social inequalities that lead to poor health and suffering. I have argued that health is a human right based on equality, and that societies that do not provide universal health care do not support principles of social justice and equality. I have also argued that the only way healthy populations can be achieved is through a two-pronged approach that aims to provide universal health care while simultaneously reducing and eliminating social inequalities that lead to poor health.

Good health is more than a personal matter. Good health is a matter of concern for society. Healthy populations are productive populations, and productive populations contribute to successful economies that support democratic rights and freedoms. I’ll end this paper with a quote that elucidates the political importance of health, and encapsulates nicely my belief in the ultimate international result of good population health: “The health of all peoples is fundamental to the attainment of peace and security and is dependent upon the fullest co-operation of individuals and states.”[30]


[1] McLeod, Eileen and Bywaters, Paul. 2000. Social Work, Health, and Equality, pp 1. London: Routledge.

[2] The Social Determinants of Health: The Solid Facts. Second Edition. Wilkinson, R., and Marmot, M., editors, pp 7. © 2003 World Health Organization. Accessed April 6, 2006 at http://www.who.dk/document/e81384.pdf

[3] Inequalities in Health: Report of a Research Working Group. 1980. DHSS. Chapter 2, Section 2.66, 2.67, 2.68.

[4] Ibid, Chapter 4, Section 4.42-4.49. Accessed April 6, 2006 at http://www.sochealth.co.uk/history/black4.htm

[5] Ibid, Section 4.48

[6] The Social Determinants of Health: The Solid Facts. Second Edition. Wilkinson, R., and Marmot, M., editors. © 2003 World Health Organization. Accessed April 6, 2006 at http://www.who.dk/document/e81384.pdf

[7] Ibid, pp 10.

[8] Ibid, pp 10.

[9] Blakely T, Hales S, Woodward A. Poverty : assessing the distribution of health risks by socioeconomic position at national and local levels. Geneva, World Health Organization, 2004. (WHO Environmental Burden of Disease Series, No. 10). Accessed April 6, 2006 at http://www.who.int/quantifying_ehimpacts/publications/en/ebd10.pdf

[10] Gender, Women and Health. WHO website. Accessed April 7, 2006 at http://www.who.int/gender/other_health/en/, http://www.who.int/gender/documents/en/

[11] Lorber, Judith. 1997. Gender and the Social Construction of Illness, pp 26. Thousand Oaks: Sage Publications, Inc.

[12] Ibid, pp 26-27.

[13] McLeod, Eileen and Bywaters, Paul. 2000. Social Work, Health, and Equality, pp15. London: Routledge.

[14] Ibid, McLeod and Bywaters, pp 15.

[15] Ibid, pp 15

[16] Ibid, McLeod and Bywaters, pp 15.

[17] Medicaid at a Glance 2005: A Medicaid Information Source. United States Department of Health and Human Services. Accessed April 7, 2006 at http://www.cms.hhs.gov/MedicaidEligibility/downloads/MedGlance05.pdf

[18] Centre on Budget and Policy Priorities website. Accessed April 7, 2006 at http://www.cbpp.org/8-30-05health.htm

[19] “Medical Bills Leading Cause of Bankruptcy, Harvard Study Finds.” Consumer Affairs website. Accessed April 7, 2006 at http://www.consumeraffairs.com/news04/2005/bankruptcy_study.html

[20] Kant, Immanuel. “The Categorical Imperative,” Contemporary Moral Issues Fifth Edition (Cragg, W. and Koggel, C., editors), pp 592. ©2005, Canada: McGraw-Hill Ryerson Ltd.

[21] Ibid, pp 595.

[22] Rawls, John. “A Theory of Justice,” in Moral Issues in Globla Perspective (Koggel, C., editor), pp 46. © 1999, Peterborough: Broadview Press.

[23] Preamble to The Constitution of the World Health Organization, pp 2. Accessed April 7, 2006 at http://w3.whosea.org/LinkFiles/About_SEARO_const.pdf

[24] Ibid. pp 2.

[25] Declaration of Commitment on HIV/AIDS, “Global Crisis, Global Action,” Section 16, pp 10 & Sections 58-61, pp 24-25. Accessed April 7, 2006 at http://data.unaids.org/publications/irc-pub03/aidsdeclaration_en.pdf

[26] Convention on the Elimination of All Forms of Discrimination Against Women, Article 16(e). Accessed April 7, 2006 at http://www.un.org/womenwatch/daw/cedaw/text/econvention.htm#article16

[27] UNIFEM website, “Facts and Figures on VAW [Violence Against Women].” Accessed April 7, 2006 at http://www.unifem.org/gender_issues/violence_against_women/facts_figures.php

[28] Ibid, pp 10, 11, 13, 17, 21, 23

[29] Commission on the Social Determinants of Health. WHO website. Accessed April 7, 2006 at http://www.who.int/social_determinants/en/

[30] Preamble to The Constitution of the World Health Organization, pp 2. Accessed April 7, 2006 at http://w3.whosea.org/LinkFiles/About_SEARO_const.pdf

*please note: this paper may not be used in full or in part in any form without the express permission of the author*

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So, with my week off of Feminism Friday (which happened to coincide with Feminism Friday's 3 month birthday!), I have a couple of ideas for posts welling up inside my head. So, I have enough fodder for a couple of posts now! Today, I'm writing about a theory of identity that pops up frequently in philosophical discussion, and in particular, is a criticism of first-wave feminism, namely, intersectionality.Until about the 1960s, feminism was predominantly a white woman's theory. (this time period is referred to as first-wave feminism.) Not only a white woman's theory, but a white, middle-class, able-bodied, heterosexual, christian woman's theory. Basically, feminism benefitted the wives of men who had the most social and economic power in society. During the 1960s, a second wave of feminism began to emerge, which identified the problems with a theory for "women as a group" when "women as a group" was a fractured and heterogenous collective. (Second-wave feminism also focussed strongly on socio-economic and legal equality for women.) It turns out that not all women have the same experience, thus making it impossible to universalize the experiences of women under one group title "woman". This criticism was largely levelled against feminism by black feminists, such as bell hooks, Audre Lorde, Kimberle Crenshaw, Patricia Hill Collins, Angela Davis, Alice Walker, and Barbara Smith, but also included criticisms from lesbian feminists and feminists from economically disadvantaged backgrounds, such as Dorothy Allison and Minnie Bruce Pratt.

These women argued that the picture of women that feminism had painted was incomplete and racist, classist, able-ist, and heterosexist/homophobic. Instead, they presented a picture of identity that involved many factors, including race, sexual orientation, disability, and economic status as well as gender. Kimberle Crenshaw makes a great analogy of identity as the intersection of so many streets: each street is a part of one's identity, so in my case, my streets would be white, female, heterosexual, middle-class, able-bodied, and so on, and my identity is the point where all those streets intersect. So, if I should be involved in an accident at my intersection (be subjected to oppression or prejudice), the source could come from any of several directions, and the severity of the accident (or prejudice) could be compounded by any number of factors because of the traffic coming through my intersection. Hence, this theory of identity is often referred to as Intersectionality. For myself, my privilege is apparent. But for a black female lesbian of poor economic status, the collision is far more serious. Crenshaw also uses an analogy she calls the "Basement Analogy". Imagine a room in which the most well-off members of society reside. Below is is a basement, filled with all the people whose identity prevents them from being able to access the room. There is a trap-door in the floor of the room, and the people in the basement are scrambling for access. Those on top, or most likely to be granted access to the room, are those who only have one factor of their identity working against them: white women, disabled white men, non-white men, white non-christian men, white poor men, and so on. These people are standing on the shoulders of those who have two factors against them: black women, gay non-white men, poor white women, disabled women, etc. And so on, and so on. These analogies, while perhaps not perfect, provide a great visual, yes?

Audre Lorde wrote beautifully about how she was often asked to speak for all black women when she was invited to speak at feminist events, but to leave out speaking about her experiences as a lesbian, or as being part of an interracial couple, or as an economically disadvantaged single mother. She refused to do so, saying, "My fullest concentration of energy is available to me only when I integrate all the parts of who I am, openly, allowing power from particular sources of my living to flow back and forth freely through all my different selves, without the restriction of externally imposed definition." This is one of my favourite quotes.

Because we are not just one thing, but a compilation of many facets that make up a whole person, it is next to impossible to talk about women as if we are a homogenous group. I talk a lot about women here, and I am a feminist who believes that women get a raw deal and deserve equality, but I also acknowledge that women are a variegated group and include all sorts of different identities, and if women are to be equal in society, we must also eliminate racism, classism, able-ism, heterosexism, ageism, anti-Semitism, and other forms of discrimination. It does no good for women to achieve equality when black women and disabled women and lesbian women and others are still discriminated against. As a feminist, I am also committed to ending other forms of discrimination and injustice and oppression. I've used this quote before, but I'll use it again here: "I am not free while any woman is unfree, even when her shackles are very different from my own." (Audre Lorde)

The theory of intersectionality is a theory of knowledge, or an epistemology. It is related to the "Situated Knower" theory of identity and knowledge, which holds that it is impossible to shed one's own contextual reality. This argument is often used in moral theory, and stands in contrast to Thomas Nagel's argument that it is possible to stand back and assume a "God's eye view", or a View From Nowhere when it comes to making moral judgments. As brilliant as Nagel is, I have to side with the Situated Knower and the Intersectionality arguments. Not only is it impossible to shed one's contextual reality, it should not be asked of a person to do so. (Stay tuned for a feminist critique of ethical theory!)

More recently, in the 1990s, a third wave of feminism emerged, which focusses on redefining sexuality and gender, but also includes post-colonial discourse, queer theory, critical theory (including critical race theory), Marxist and socialist discourse, transnationalism, ecofeminism, and post-modern discourse about embodiment. This is a diverse and interesting body of work and theory, and I'm excited to find out where it will go from here.

References:
Kimberele Crenshaw, "Demarginalizing the Intersection of Race and Sex", Living With Contradictions: Controversies in Feminist Social Ethics. (Ed. Allison Jaggar) (C) 1994, San Fransisco: Westview Press Inc. 39-52.
Audre Lorde, "Age, Race, Class, and Sex: Women Redefining Difference" and "The Uses of Anger: Women Responding to Racism", Sister Outsider: Essays & Speeches by Audre Lorde. (C) 1984, Berkeley: Crossing Press. 114-133.
Thomas Nagel, "The View From Nowhere", Ethical Theory: Classical and Contemporary Readings, Fourth Edition (Ed. Louis Pojman) (C) 2002, Belmont: Wadsworth Group, Thomson Learning Inc. 141-150.

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