Author: hbill

Can too much health be a virus?

Examining the impact of the early stages of COVID-19 on health autonomy and ideals

The heart of the COVID-19 pandemic is over. Due to low infection and mortality rates, the pandemic is no longer deemed a public health emergency by the Department of Health and Human Services. Though much of this success is attributed to effective vaccines and treatments, personal efforts like isolation and mask-wearing also mitigated the impacts of the virus. These actions were once espoused before medical interventions were widely available, and they emphasized personal responsibility over health. This messaging regarding COVID-19 safety underscored health autonomy, but this mentality became a slippery slope in terms of excessive health consciousness and unrealistic ideals promoted via social media. 

Increasing Health Autonomy

In the advent of COVID-19, the primary messaging from health authorities such as the Centers for Disease Control (CDC) and the World Health Organization indicated that each person was in control of their own virus prevention. You had the power to protect yourself by social distancing and washing your hands, and if you contracted the virus, that was due to a failure on your part to follow the safety measures. It followed that this sentiment of responsibility over one’s personal health expanded into avenues beyond COVID prevention. A hyper-awareness of individual health and wellness grew early in the pandemic, exacerbated by the lack of access to outside medical services. With an inability to seek professional care, we became our own doctors. Crawford’s claim that “personal responsibility for health is widely considered the sine qua non of individual autonomy and good citizenship”  applies to our widespread focus on how we could best protect ourselves and those around us by adopting the most healthy practices (Crawford, 2006, 402).

“Today, the common assumption is that health must be achieved.”

Robert Crawford (Crawford, 2006, 402)

These practices manifested themselves in numerous ways. From at-home workouts to wearable technology use, methods of improving and tracking physical health became predominant. Acknowledging that quarantine could lead to a sedentary lifestyle, governmental organizations heavily promoted the importance of physical activity, further intertwining the political and private sphere via health consciousness (Crawford, 2006, 403). Regular exercise was also advertised for its mental health benefits in combatting the isolation associated with social distancing, along with practices like mindfulness activities and meditation. These actions were highlighted as things that one can do without risking contact with COVID, underscoring solitary actions that one can take over their health. 

Social Media and Self-Improvement

In addition to the push from governmental and health organizations for an increased health focus, social media was also a significant promoter of self-care throughout the pandemic. When I think of social media during the first month of lockdown, I am immediately reminded of the rampant TikTok health trends, particularly the exercise challenges like those from fitness influencer Chloe Ting. Teenage girls would participate in Ting’s exercise videos, like “Get Abs in 2 WEEKS” and “Do This Everyday To Lose Weight ” and post their body composition results. These videos about lifestyles centered around exercise and nutrition encouraged at-home healthy behaviors among millions. However, they also promoted unrealistic body expectations and the attitude that anyone can make their body look like Chloe Ting’s as long as they have the discipline to do so. Similar to Barbara Ehrenreich’s analysis of 1970s exercise culture, social media during COVID heavily promoted physique as  “a status symbol” and fitness as a “culture that inflicts ‘steep penalties for being overweight’” (Winant & Gallagher, 2018).

The promotion of these activities, however, was by those who could afford the time to focus on their self-care. When these social media videos went viral, it created the illusion that everyone was using their quarantine as the opportunity to be productive in self-improvement. In reality, COVID-19 took away many’s abilities to focus on their health. This was especially true for at-home care workers, as “over one in ten women report[ed] that they [had] new caregiving responsibilities as a result of the pandemic” (Ranji et al., 2021). Many of these caregivers were not able to seek outside forms of stress relief and social support, causing physical and mental health repercussions (Harmon, 2021). In fact, a CDC survey found that “40 percent of caregivers for adults reported anxiety or depression symptoms” throughout the pandemic (Harmon, 2021). While social media advertised quarantine as free time allotted for self-care, only those with privilege could use it as so. This further contributed to social media as a source of unrealistic expectations and lifestyles related to health during the pandemic. 

“It is only the wealthy who have the resources to maintain the illusion of an integral and bounded self, capable of responsible self-care and thus worthy of social status.” 

Barbara Ehrenreich in “Natural Causes” (Winant & Gallagher, 2018)

The Lasting Influence

At the beginning of lockdown, COVID considerably impacted our perception of health autonomy, and the effects persist today. Speaking from personal experience, I am much more cognizant of my efforts to avoid sickness than before the pandemic. I have always attempted to prioritize sleep and minimize stress levels, but I am now aware of how these efforts aid my immune system in warding off disease. Additionally, plagued by the aforementioned motivational lifestyle videos on my social media feed, I adopted a rigid exercise regimen to keep myself in shape at the beginning of quarantine. This contributed to a hyper-awareness of my body’s conditions. I know of many that have had similar experiences, and I have attempted to let go of this self-consciousness since coming to college. Though the stress of individual responsibility over healthy behaviors did wonders in reducing the viral impacts of COVID-19, the long-lasting effects in terms of health consciousness and unrealistic ideals persist today.

References

Crawford, R. (2006). Health as a meaningful social practice. health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine, 10(4), 401-420. 10.1177/1363459306067310

Harmon, K. (2021, August 4). America isn’t taking care of caregivers. Vox. Retrieved March 26, 2023, from https://www.vox.com/22442407/care-for-caregivers-mental-health-covid

Ranji, U., Fredericksen, B., Salganicoff, A., & Long, M. (2021, March 22). Women, Work, and Family During COVID-19: Findings from the KFF Women’s Health Survey. KFF. Retrieved March 26, 2023, from https://www.kff.org/womens-health-policy/issue-brief/women-work-and-family-during-covid-19-findings-from-the-kff-womens-health-survey/

Winant, G., & Gallagher, S. (2018, May 23). Barbara Ehrenreich’s Radical Critique of Wellness Culture. The New Republic. Retrieved March 26, 2023, from https://newrepublic.com/article/148296/barbara-ehrenreich-radical-crtique-wellness-culture

Lack of Language

Communication Challenges to Health in Rural America

My hometown of Harrisonburg, Virginia is a hub for the world’s nationalities and ethnicities in the heart of the rural Shenandoah Valley. In our public school system, 53 birth countries and 57 foreign languages are represented (Harrisonburg City Public Schools, 2017). From my experiences with first- and second-generation immigrants, I’ve learned how vital language is in everyday life. Fundamental activities like running errands and ordering at restaurants require communication that I would not give a second thought. However, for those that lack English fluency, these can create difficult and anxiety-provoking situations. Furthermore, when the non-native English speaker becomes a patient, these language barriers become especially challenging.

Keezletown Road runs just behind my neighborhood, connecting hundreds of acres of farmland in Harrisonburg and its surrounding area. (Photo by Holly Bill)

There are a multitude of factors that impede effective communication regarding healthcare. Individuals that are not fluent in English may have difficulty grasping the complicated syntax used to convey serious medical information, even if they are knowledgeable about health-related concepts. These subsequent language barriers are heightened in rural areas, causing their extension into spheres outside of direct physician-patient interactions. 

Language in the Rural

According to the U.S. Department of Health, limited English proficiency can prevent access to health care services, clearly indicating language as a social determinant of health (Healthy People 2030, n.d.). This is generally tied to health literacy, defined as “the degree to which patients understand basic health information,” which has lower rates in rural areas (Rural Health Information Hub, 2022). However, after reflecting upon this definition and its use of the word “understand,” I feel as though there is a distinction between language and health literacy as social determinants of health. An immigrant patient may have a strong perception of their health based on information they received in their first language. However, the patient may struggle with language barriers if they reside in an area that lacks access to interpreters, like in rural communities (Rural Health Information Hub, 2022). This can result in poor health outcomes, such as improper medication use or health screening misunderstandings. While closely related to health literacy, language differences result in more of a fundamental miscommunication barrier, especially in rural areas where there are limited resources to overcome the challenges they create. 

Silver Lake Mill, a farm located just west of Harrisonburg in the rural town of Dayton, VA. (Photo by Holly Bill)

Taking the case of Harrisonburg in particular, those in my town fall victim to the underlying language divide, despite the area’s diversity. There is a shortage of interpreters and multilingual physicians, and offering translated medical documents is not common practice (Kraska, 2016, 18). This reminded me of the Nature article’s meat-packing vignette in the rural San Joaquin Valley. Despite the poultry plant’s employees speaking strictly Spanish, Hmong, and Punjabi, all of the signs in the building about coronavirus safety and statistics were in English (Maxmen, 2021, 680). The lack of accessible COVID-19 information for the workers posed a serious health hazard. Even in rural communities where those fluent in English are the minority, language barriers to health persist. 

“Hard copies of consent forms, aftercare instructions, any of those
things, all of the brochures…I just don’t think they’re out there in all the possible languages that they can just pick up.”

Danielle, a Harrisonburg-based Spanish interpreter in reference to the lack of written medical information in more than one language (Kraska, 2016, 19-20).

A Barrier Beyond Healthcare

Communication differences can also play a role in scenarios tangentially related to healthcare access, such as those within the legal system. Rural areas have been hit particularly hard by the drug epidemic and have high rates of substance use disorders (Dickman et al., 2017, 1434). My mother is a psychiatrist at a state hospital, and she deals with the repercussions of  these crises not only on her ward but also in court. She speaks about the hardships faced by non-native English speakers because they have difficulty understanding the jargon of judicial proceedings. Without confidence in their English proficiency, these individuals are often frightened to stand trial. 

Medical-legal partnerships are valuable for residents of rural communities concerning issues like family law and insurance benefits, and these improve health outcomes (Rural Health Information Hub, 2022). However, if a patient doesn’t speak fluent English and lacks an interpreter, they cannot advocate for themselves in the midst of legal scenarios. 

We discussed the importance of addressing the underlying social determinants of health in confronting rural healthcare inequalities, and legal assistance is an example that does so beneficially. Yet, my mother’s experiences with many immigrants show that the efficacy of these solutions is limited. Individuals that do not speak the same language as the professionals offering assistance cannot reap the full benefits of these interventions. 

Modes of Action

After relating what we’ve learned in class regarding social determinants of health to the experiences of immigrants in my hometown, I have found that language significantly influences health outcomes. The barriers that arise from language differences are especially prevalent in rural areas and are so foundational to everyday life that they expand into realms outside of health. Thus, efforts to address these barriers are essential for tackling health disparities. These could include increased educational initiatives for both English learners (to increase their understanding of medical language) and providers (to train them to work with patients that are not fluent English speakers). Additionally, perhaps investing in translation technology and hiring more multilingual medical staff and interpreters would prove beneficial. 

“You shall love every foreigner as yourself.”

A Bible verse displayed outside of a refugee church in San Joaquin Valley, CA (Maxmen, 2021, 677).

Harrisonburg calls itself “the Friendly City” because of our supportive, welcoming nature to people from across the world. I am proud to be from such a diverse town, but I know work is necessary to ensure that every resident, especially those suffering from language barriers, can live a healthy life.  

References

Dickman, S. L., Himmelstein, D. U., & Woolhandler, S. (2017, April 8). Inequality and the health-care system in the USA. Lancet, 389(10077), 1431-1441. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)30398-7/fulltext

Harrisonburg City Public Schools. (2017, September 10). Enrollment of English Learners – September 29, 2017. Harrisonburg City Public Schools Enrollment Statistics. Retrieved February 30, 2023, from https://harrisonburg.k12.va.us/files/user/1/file/9-29-17-EL-Birth-Countries-and-Languages.pdf

Healthy People 2030. (n.d.). Social Determinants of Health. Office of Disease Prevention and Health Promotion. Retrieved February 15, 2023, from https://health.gov/healthypeople/priority-areas/social-determinants-health/literature-summaries/language-and-literacy

Kraska, S. J. (2016, May). Examination of the effects of language and cultural barriers on Spanish-speaking patients in health settings as observed by medical Spanish interpreters. Senior Honors Projects, 185, 1-44. https://commons.lib.jmu.edu/honors201019/185

Maxmen, A. (2021, April 29). Inequality’s Deadly Toll. Nature, 592, 674-680. https://www.nature.com/immersive/d41586-021-00943-x/index.html

Public School Review. (2023). Harrisonburg High School (2023 Ranking) – Harrisonburg, VA. Public School Review. Retrieved February 15, 2023, from https://www.publicschoolreview.com/harrisonburg-high-school-profile/22801

Rural Health Information Hub. (2022, June 6). Social Determinants of Health for Rural People Overview. Rural Health Information Hub. Retrieved February 16, 2023, from https://www.ruralhealthinfo.org/topics/social-determinants-of-health