Community Health Narratives

A Reader

Hannah Adams Burque, Emily Mendenhall, B01

• Publisher: University of New Mexico Press
• Year: 2015
• ISBN:
  9780826355607
• Topic: Medicine
• Subtopic: Public Health, Administration & Care

Mark struggled at school and became depressed because he was bullied. Ana Maria feared leaving her home after dark due to gun violence. Mario and his family benefited from an intervention to prevent the spread of avian flu in his village.

Health problems like these affect not only individuals but also families and communities. These examples suggest how community health is realized in peoples' lives and affects people living in the same place who share similar beliefs and values. For example, feeling safe within one's community is an essential part of living a healthy life.

The narratives in this book explore a wide range of topics—social ties, gender and sexuality, mental illness, violence, prevention, and health-care access—that shape community health. Featuring "Communities in Action" sketches describing good community health programming as well as a guide for teachers, this book, along with its companions Global Health Narratives: A Reader for Youth and Environmental Health Narratives: A Reader for Youth (UNM Press), provides a comprehensive curriculum that examines people's health experiences across cultures and nations.

Section I

Social Ties

The communities we live in and people who surround us influence our health. This section focuses on social ties, which are the relationships we have with family members, friends, neighbors, members of groups (such as at church or school), and even acquaintances. Social ties influence where we live, where and how we learn, what we do for work, what we eat, how we spend our time, and the types of experiences we encounter every day. These relationships can have a major impact on a person’s well-being, both mentally and physically. In fact, even having one close friend, relative, or companion you feel understands you can have a direct impact on your health. In contrast, a negative relationship, or a series of difficult social and interpersonal situations, can have a very negative effect on a person’s health. Therefore, social ties can affect people’s ability not only to cope with disease but also to maintain a healthy life.

Our world is very different from the world of previous generations, and the changes in our world, such as advances in technology, have transformed our social ties. Interactions move at a fast pace, exchanging ideas in minutes, even seconds. Instead of pen pals, which were common among past generations, many people connect through social networking sites like Facebook and Twitter. While in some ways the Internet allows us to be closer to people with whom we wouldn’t otherwise be able to communicate, it also means we may be spending more time with technology than building in-person relationships. It is important to recognize the social ties that we build—and how we build them—in our everyday lives.

Most of us try to spend time with people who share common interests, hobbies, or goals and enrich our lives in some way. It’s easy to forget that in fact these relationships can profoundly influence our health, as they affect our happiness, our self-esteem, and the choices we make. While the support of one or more friends can affect our health, so can a formalized social network. For example, Alcoholics Anonymous succeeds in helping people stay sober from alcohol because it provides social support to individuals trying to live sober lives. This goes for food choices and exercise routines as well. Eating behaviors play a major role in how healthy you are because if you overeat or eat unhealthy foods, you can become overweight, which can create many long-lasting challenges for your health. Where and with whom you eat can also influence your health. Spending time eating slowly and enjoying healthy foods can improve not only your nutrition but also your emotional well-being.

Social ties are very important for people with chronic illness. Being left alone to care for a disease can be very isolating, but having someone support you, to help you take your medicines, attend health-care appointments, and maintain a healthy lifestyle, can be fundamental to living a healthy life. This support person might be a family member or friend, but it also could be a teacher or social worker. In some cases, young people might fill this role for a parent or grandparent. This can be especially important if the family member does not speak the same language as the health-care provider as a young person might be able to communicate important health information in settings where a formal interpreter is not readily available.

But some social relationships can have a negative impact on an individual’s health. For example, when someone decides to quit smoking, one of the most common challenges is to avoid spending time with other people who smoke. We develop relationships around our shared behaviors, and because our friends are often likely to behave as we do, changing one’s behavior without breaking social ties can be a struggle. The difficulty of breaking away from unhealthy relationships is one reason why changing behaviors such as overeating or substance use can be a very long, challenging process.

This section describes the ways in which social ties influence health, from eating and activity patterns to emotional well-being and disease management. The section begins with “Seeking SUCCESS,” a story that demonstrates the complex ways a difficult home situation and an under-resourced school can affect a young girl’s education and a family’s health. “The Big Fat Truth” illustrates how bullying can affect one’s emotions, self-esteem, and health through direct and indirect ways. In “Dadi’s Chart,” Anjali helps her grandmother manage her diabetes by believing in her ability to make the changes her doctor recommends for her. “Mai’suka, My Island” describes how social relationships can have a negative impact on health and illustrates the important role of community-level interventions for behavior changes. Finally, “Thiago and the Beach” demonstrates how a strong friendship can have a positive impact on a person’s well-being.

As you read through this section, think about the following questions:

• Are there people in your life who have a positive or negative impact on your health? How so?

• Can you transform a relationship from a difficult to a positive one? How might you do that, and what positive change could it bring to your life?

• If you have or were to have a chronic illness, who is or would be the person you depend upon? Do you play the role of the support person to a family member or friend?

1

Seeking SUCCESS

Lauren Slubowski Keenan-Devlin

“Seeking SUCCESS” highlights how family and teachers can limit or transform young people’s lives and ultimately their health. Taylor is a ten-year-old girl growing up in a low-income urban neighborhood in the United States. Her mother and father use drugs and alcohol, and her grandmother has cancer. Additionally, Taylor is struggling in school. Like many children growing up in poor city neighborhoods, Taylor attends a school that has too many students and too few resources. She has not learned to read by the fourth grade, and she may be held back. Children like Taylor are at high risk for dropping out of school before graduation and are often trapped in a cycle of poverty because they cannot land a high-paying job without a high school diploma. Differences in access to education or quality of education are a huge driver of racial differences in health outcomes and illuminate the need for better educational and social support services in neighborhoods like Taylor’s.

Taylor gently patted her grandmother’s arm before she swung her backpack over one shoulder. “Have a good appointment today, Maw Maw. I love you.”

The old woman strained to nod at her granddaughter. The cancer seemed to be causing her a lot of pain today. It had already claimed her breast and was now spreading through her bones. She was only sixty-three but looked a lifetime older.

Taylor glanced at her tiny brother as she walked out the door. At four years old, he was a handful for Maw Maw—she wished her mother would stay off drugs long enough to see that. It was her mother’s fault that Maw Maw was falling apart. Maw Maw spent so much time picking up the pieces from her daughter’s mistakes that she didn’t have the time to go to the doctor when the pain began, when her breast started turning purple and puckered from the tumor. Maybe if she hadn’t been so run down from all of the worry that her junkie daughter had caused her, the cancer would never have started.

With a slam of the door, Taylor set off down the sidewalk toward Horatio Elementary. A gust of wind caused the candy wrappers, chip bags, and crushed soda bottles that littered the sidewalk to dance across her path. If she closed her eyes, she could imagine them as fallen leaves crunching beneath her feet.

Taylor slid into her seat just as the school bell rang. Slumping down low and propping her feet on the back of the desk in front of her, she heaved a sigh and let her mind wander, as usual, far away from the classroom. Today Taylor thought about her grandmother and was only reminded of Ms. Hamlin’s presence when the teacher’s voice sharpened to call order to the unruly, overcrowded classroom. Ms. Hamlin scratched letters on the board, but to Taylor they were nonsense; she had never learned to read properly. Books and worksheets looked like word-search puzzles. She didn’t even bother to put her homework in her backpack these days, since her time at home was spent watching her brother, Little Man, so Maw Maw could rest. Rest. That sounded nice right about now. Taylor let her heavy eyelids droop closed.

“Markus, go to the disciplinarian’s office!” Ms. Hamlin bellowed. Taylor’s eyes popped open. “Now, it’s time for science. Get out your books. Princess, put the phone away or it’s mine!”

Taylor adjusted herself in her seat and switched her pencil between hands, staring out the window in preparation for the next lesson.

“Who can tell me what a ‘hypothesis’ is?” asked Ms. Hamlin. A girl at the front of the classroom answered. “Right,” Ms. Hamlin said, “so it’s an idea that you think is right. For example, I could say, my hypothesis is ‘only people with bad behaviors, like people who smoke, get cancer.’”

Taylor jolted in her seat. “That’s not true!” she cried, now sharply tuned in.

“Don’t yell out in my class, Taylor!” warned Ms. Hamlin. “That’s my hypothesis. Now how could I go about testing this hypothesis?”

“It’s a stupid hypothesis!” hollered Taylor, her face burning with rage.

“That’s enough! Taylor, go join Markus in the disciplinarian’s office,” said Ms. Hamlin.

“I don’t care if you’re the teacher,” Taylor mumbled under her breath as she rose from her seat, eyes fixed on her instructor’s outstretched arm and pointed finger. “You don’t know what you’re talking about.” Dragging her backpack by one strap, Taylor stormed angrily out of the room.

Taylor couldn’t wait to get home to check on Maw Maw. Scurrying up the path, she found the front door wide open, but her grandmother wasn’t in her easy chair. Instead, she found her mother in the bedroom dumping armfuls of clothing into boxes.

“What’s going on, Mom?”

“Maw Maw’s dying. She went in for a checkup, and they won’t let her leave, darn hospital. You kids got to go to your dad’s house.”

Taylor’s stomach dropped. “For how long?”

“We ain’t coming back here, OK? Even if she comes home by some miracle, she can’t watch Little Man. What the heck am I supposed to do with him?” Her mother shoved her frail frame against the top of an overfilled box, attempting to close it with a force she didn’t have. “Be useful! Go feed your brother or help me pack.”

Taylor was never allowed to be emotional—crying got you beat, and it never solved anything, anyway. Sturdily, Taylor walked out into the living room where Little Man sat on the floor, staring at the television. “Ya hungry, Little Man?”

Her dad was propped on the couch, feet on the coffee table, surrounded by discarded beer cans when the family of three dragged their boxes through the front door that night. “Hey, kids,” he offered, obviously buzzed from his drinks. There were a few other adults in the room as well, all in similar states of drunkenness. “Y’all are in the downstairs room. Tay Tay, leave Little Man with us and take your things down there.”

“Yeah, you do that, Tay Tay,” echoed her mother, dropping a half-opened box on the floor. “I’m going out.”

The next morning, Taylor woke with the sun glinting through the basement glass block window. It took her forever to find a clock in the house. She finally spotted one on the crusty oven in the basement kitchen and saw she was already ten minutes late for school. Taylor threw on her uniform, sweeping her short, textured hair under a beanie cap, and headed upstairs. Little Man was asleep on the sofa next to his father. A couple of the other adults were still in place, too, heads rolled back, breathing loudly. Her father was not very reliable, but he was more reliable than her mother. Taylor knew Little Man would still be alive when she came home, s...

Table of contents

• Cover
• Half title
• Title
• Copyright
• Contents
• Foreword
• Acknowledgments
• Introduction
• Section I: Social Ties
• Section II: Gender & Sexuality
• Section III: Mental Health
• Section IV: Violence
• Section V: Prevention
• Section VI: Health-Care Access
• Postscript
• Teaching Guide
• Contributors
• Index