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What do a bus, a water fountain, and a bathroom all have in common?

The Trump Administration rescinded President Obama’s Guidance regarding the rights of transgender children to use school restrooms of their choice; many are wondering if this truly is just about a bathroom. Many civil rights and child advocacy organizations are in opposition with the Trump position due to violation of the protections guaranteed in Title IX and the Fourteenth Amendment of the Constitution. Title IX prohibits discrimination based upon sex in federally funded activities or education, however discourse continues surrounding the interpretation gender within the language of federal law. The issue of transgender youth and public school restroom use will be explored by the US Supreme Court this march, however many states have already opted to support transgender youth through local legislation.

Rescinding these guidelines places transgender youth at risk for bullying, violence, and discrimination. Both the American Academy of Pediatrics and the National Association of Pediatric Nurse Practitioners  have issued statements about the hazards involved in marginalizing children: Policies that exclude transgender children from existing within their gender identity will have detrimental effects upon health and well-being. When children experience adversity and lack of acceptance, they become increasingly susceptible to a host of challenges across their life course.

Data from  Williams Institute at the UCLA School of Law estimates that there are approximately 150,000 transgender youth and 206,000 transgender young adults in the United States. Despite the growing numbers of transgender Americans, misunderstanding persists. Curious? Tune into Healthcetera Radio as Senior Fellow Kristi Westphaln delves into the experiences of transgender youth with Dr. Kimberly Aquaviva. Dr. Aquaviva is an authority on lesbian, gay, bisexual, transgender, queer and/or questioning (LGBTQ) aging and end-of-life issues for the George Washington University School of Nursing.

 

 

[audio mp3="http://www.healthmediapolicy.com/wp-content/uploads/2017/03/Westphaln.Acquaviva.3.23.17.mp3"][/audio] What do a bus, a water

Where and how is health created and promoted? If you think it’s in hospitals, you would be terribly wrong. Medical errors are the third leading cause of death in the United States; and yet, we have a health care system that spends billions of dollars every year to provide acute care. It’s costly and our health outcomes are worse than in other peer nations.

Today, there is a growing recognition that we have to move our attention and resources upstream to promote health of people where they live, work, learn and play. The Robert Wood Johnson Foundation has invested significant resources into exploring how to improve the health of communities and create a culture of health among all. The New York State Health Foundation is advancing this work in New York State and other foundations around the nation are investing in projects that build healthier communities through initiatives that will improve access to healthy, affordable foods; create safe places to exercise; bring jobs into the community; improve education; reduce pollution; and other aspects of what are called social determinants of health.

But why has it taken us so long to recognize and act on the connection between the health of a community and the health of people? In the 1960s, physician Jack Geiger had orchestrated a federal grant from the Office of Economic Opportunity as part of a major community development initiative begun by President Lyndon Johnson that represented the nation’s new “War on Poverty.” The grant went to Tufts University to build the Tufts-Delta Health Center in rural Mississippi. The Center was the nation’s first community health center that was the forerunner of the Federally Qualified Health Centers located across the nation to ensure that vulnerable populations have access to primary care. Geiger and his colleagues encountered significant resistance from both the white and black communities in Mississippi but prevailed, with the help of John Hatch, a community organizer.

What they soon discovered was that the Center would treat infected babies or malnourished and sick adults, only to have them return with the same health problems time after time. The local people in this poor community were grateful that they had access to this wonderful health center but noted that they wouldn’t need it so much if they could feed their families or had clean water, jobs, and adequate sanitation. Geiger and his colleagues worked with the community to launch major initiatives to address these concerns, empowering the community in the process and developing a generation of community and political activists.

This story has been detailed in a new book entitled Out in the Rural: A Mississippi Health Center and Its War on Poverty, by Thomas J. Ward, Jr., Chair of the History Department at Spring hill College in Mobile, Alabama. With a foreword by Jack Geiger, the book provides us with an exemplar of how to engage communities to promote healthier lives.

Today on HealthCetera, producers Kenya Beard, EdD, ANP, RN, and Diana J. Mason, PhD, RN, interview Tom Ward about this story. Tune in at 1:00 to WBAI, 99.5 FM in New York City or streaming online at www.wbai.org. Or you can listen to the program anytime by clicking here:

An overview of the story is also shared in this documentary that was made in 2010 (the story starts 30 seconds into the video) :

HealthCetera is sponsored by the Center for Health Policy and Media Engagement at the George Washington University School of Nursing.

 

Where and how is health created and

Story is an important part of healing. An entire sub-discipline in the health humanities referred to as narrative medicine has developed in the past thirty years in an attempt to understand, explore, and expand the use of story in health and healing. Sociologist Arthur Frank writes in his book Letting Stories Breathe: A Socio-narratology that our stories about our bodies and their troubles can actually care for us, by helping us formulate the courage to continue to desire from life, by helping to externalize our fears, and by helping us imagine our next viable selves, with and post illness.

 

Though both care givers and receivers alike can benefit from telling and hearing stories that help us heal, sometimes articulating our stories can be a challenge. Making and reading comics can be a terrific method for accessing our stories. (I’m defining ‘comics’ here as sequential art that conveys a narrative, often including text.) Based on a traditional panel framing, comics build one box at a time, helping us to focus and organize our thoughts and feelings. Comics combine word and image, and we know that different parts of our brains are in use as we do this, forging unique connections and pathways. Finally, comics can be fun – even when difficult topics are discussed.

 

Comics are an expressive medium, containing many genre. One of the genre to emerge quite prominently in the past ten years has been that of “Graphic Medicine.” This term was coined in 2011 by U.K. physician Ian Williams (author of The Bad Doctor) to refer to the interface between comics and the discourse of health. Three stellar examples of the variety and range of the genre are Peter Dunlop Shohl’s My Degeneration: A Journey Through Parkinson’s, Sarah Leavitt’s Tangles: A Story about Alzheimer’s My Mother and Me, and Brian Fies’s Mom’s Cancer. Fies has said of creating this book, “Comics were the right medium for the story I wanted to tell. They meld words and pictures to convey an idea with more economy and grace than either could alone.”

 

In Graphic Medicine, most often the works used in teaching are non-fiction memoir created by those living with illness and/or caregiving. Who better to represent the challenges illness can bring to lives, families, and communities? But those of us familiar with the history of medicine know that these voices are precisely the ones that have most often been marginalized. Physicians and other “experts” have traditionally defined and represented states of health, illness, and deviations from expected norms of the body. The underground history of comics is one that has created a space for bearing witness to stigmatized realities and amplifying the voice of the marginalized. Often these are our most vulnerable citizens, most in need of our health services, most at risk with proposed cuts to the Affordable Care Act. The new genre of comics known as Graphic Medicine can help by bearing witness to the stories of the impact of the ACA, those who will face the devastation its loss will bring to their lives. A series of four comics were posted last week on a website called The Nib, a website featuring political cartoons and non-fiction comics. The ACA comics were each individually titled, and the group was called “What Will Happen to Us? Four Cartoonists on A Life Without the Affordable Care Act.” The following example is by cartoonist Lucy Bellwood.Bellwood wrote on her blog about this comic, “I don’t talk about politics often. I like keeping my work accessible to a wide range of people. I’m also, if I’m honest, conflict-averse. But this so immediately and directly impacts my life and the lives of so many people that I love, that it seems like a good time to use the creative skills I’ve been cultivating to try and push for more awareness, more compassion, and more action.”

 

Those who work in the public health domain know that comics are great educational tools when we face a high density of information to communicate, there is a high importance to communicating the information, and the learner is in a high-stress situation. Next time you are on a flight, take a look at the informational card in the seat pocket before you. Odds are it’s a comic. They work.

 

Medical anthropologist Dana Walrath wrote in the introduction to her graphic memoir, Aliceheimer’s that, “Around the world, comic artists, caretakers, parents, and assorted onlookers are taking up their drawing tools, pens, papers, scissors, and computers to depict illness and ways of being human that have been stigmatized. This is Graphic Medicine.” If you are interested in Graphic Medicine and the potential uses of comics in health and health policy, visit www.graphicmedicine.org. If you are in the Seattle area, consider attending some of the public events of our annual international conference this coming week which will be held at the Seattle Public Library Main Branch Thursday June 15 through through Saturday June 18th. More information is available here. Let’s get drawing, reading, and sharing more comics about the impact of health policy that aims to benefit the already advantaged and leaves the most vulnerable lacking basic care. No experience necessary.

 

MK Czerwiec, RN, MA is a Senior Fellow of the George Washington University Center for Health Policy and Media Engagement. She is also Artist-in-Residence at the Northwestern Feinberg Medical School. Her graphic memoir, Taking Turns: Stories from HIV/AIDS Care Unit 371 was recently published by Penn State University Press. She is also a co-author of the Graphic Medicine Manifesto and with Dr. Ian Williams co-runs GraphicMedicine.org 

Story is an important part of healing.