Wednesday, December 14, 2005

Neoliberal Health Concepts

The front page of the Sudbury Star yesterday featured a story with the title, "Aboriginal Cancer Rates Skyrocket". The article is a prime example of how health in this neoliberal world is regarded as something privatized, both in how we as a society take action to improve it and, as a consequence, in how we think and write about it. The focus of the article is a particular set of health outcomes for a particular grouping of people -- Aboriginal peoples -- which is constructed through shared patterns of experience and history, yet the article does almost nothing to explore the social and historical questions for which the facts presented in the article cry out for explanations.

The article begins:

The rate of cancer among Aboriginals in Canada is rising quickly and may soon surpass that of other Canadians, research released Monday show.

To reverse the trend, Aboriginals need education so they can make better lifestyle choices, native leaders and cancer-care experts said in Sudbury while launching the Lets Take a Stand Against Cancer NOW! campaign.

The overall cancer incidence rate in First Nations people, while still below the rate for the general population, is rising more quickly, Carmen Jones, director of the Aboriginal Cancer Care Unit, said in a release.

The most interesting content from farther down in the article is a quite long quote from an Assembly of First Nations official:

Angus Toulouse, Assembly of First Nations Ontario Regional Chief, said cancer is devastating for anyone. But for native people, it is even more difficult because many must leave their home communities to get treatment.

"I would hate to see more of our people suffer through this disease and I hate to see more of our people get separated from their families, especially in the North," Toulouse said.

"It is really hard on the individual and hard on the family to see their loved ones leave their community, in one aspect physically and then some of them not getting the treatment early enough leaving this place we call Earth sooner than later in a lot of cases."

Additional medical resources in native communities could bring earlier detection of the disease, Toulouse also said.

"I dont think there are sufficient resources available, as was identified recently in the first ministers meeting that took place. There is a serious gap where First Nations health is at and where the general population health is at.

"We really need to close that gap and find ways and means of addressing those things that cause the health and quality of life of people in First Nations to be much lower than that of the Canadian public," he said.

So what you have here is a situation where health outcomes for a specific social group are distinct from health outcomes in the broader society. Isn't "why" the logical first question to ask? Yet the article does not tackle this question head on, but rather leaves hints from which the readers might draw conclusions about what is different in the experiences of these groups that leads to different health outcomes.

One of the possible explanations readers might draw from the article is from the comments by Toulouse, who indicates that health system resources are not sufficient in Aboriginal communities. This is a very important point and an injustice that needs to be addressed. It is also a social factor, but only one among many that could conceivably be relevant. As well, it is presented in as weak a way as possible in the article -- buried in the later paragraphs, on an inside page; supported only by the words of a member of the group impacted, which should be enough but often isn't for many people; and with no corroborating statistics from the journalist, which would probably be easy to find.

The other possible explanation comes in the second paragraph of the article, which gives it more weight because of how newspaper articles are structured and because most people read only the first few paragraphs of a given article. Also, it is attributed to both Aboriginal leaders and "experts," which would give it more authority for many readers. I am talking about the phrase, "Aboriginals need education so they can make better lifestyle choices." It is intended specifically with respect to the cancer issue, but I would imagine many readers would take it to heart more generally. This is particularly true since it reinforces racist stereotypes that are widely held. Everyone can benefit from a better understanding of health issues, but the way this is phrased gives the impression that personal failings related to racial background are the principle factor at play in poor health outcomes.

"Why" remains substantially unanswered.

I cannot answer the various "whys" that might occur to a reader of this article, nor talk with authority about the specific social factors involved. But I can speculate.

First, on the issue of low cancer rates historically and rapidly increasing rates now. I can't help but seek explanations in the history of colonization, and the ways in which Aboriginal communities have adapted to and struggled against that reality at different times. How does the spatial distribution of Aboriginal peoples in Canada play out in all of this? How does the steady degradation of even the most remote pieces of wilderness by resource extraction industries and mobile industrial pollutants in air and water factor in? Does the rapid increase now have to do with details of the current stage of the colonial project by the Canadian state? In other words, are the factors in the dominant society's ways of living that are personally carcinogenic penetrating Aboriginal lives to a greater extent in this generation than before? Why is this the case? How might decolonization struggle be part of how Aboriginal people "Take a Stand Against Cancer NOW!"?

In any case, before blaming Aboriginal peoples for needing "education so they can make better lifestyle choices" about cancer we should maybe appreciate that the disruption of traditional Aboriginal ways of being, the destruction and decentring from the lives of many communities of traditional Aboriginal teachings on health and wellness, and the terms under which Aboriginal communities deal with the dangerous aspects of the settler society have been determined much more by white people, settler state institutions, and their affiliated economic institutions than Native peoples themselves.

And it would have been nice to see even one paragraph and a couple of summary statistics from the journalist corroborating Toulouse's assertion of disproportionately negative health outcomes for Aboriginal peoples more generally. Another couple of paragraphs talking about social reasons for this would've been even nicer. Again, the article leaves nothing more than the lack of health system resources in Aboriginal communities (which is true and important) and the need for "education" as explanations for any readers that wonder about this point based on Toulouse's words.

But even a short search of peer reviewed (Western) medical literature can raise other factors that are very relevant to health:

It is possible to go into more detail -- things like incidence of depression amongst oppressed people and the impact of depression on immune function, or the incidence of experience of acute trauma amongst oppressed people and the impact that trauma has on immune function -- but the references above are at least a start in laying out the social landscape that is likely playing a role in determining differential health outcomes between Aboriginal peoples in northern North America and the Canadian population as a whole.

In other words, the provincial Liberals have managed to get some good ink from one small educational program making public health information more accessible to Aboriginal peoples (which should have been happening all along). This isn't a bad thing, as far as it goes. What is bad is the credit they can take for "doing something" about Aboriginal health issues, when in fact they are doing no more than any other settler state government to achieve the basic factors that are really necessary for Aboriginal health: decolonization and justice.

And though this post is in response to an article that is about Aboriginal health, the points that I've made about looking beyond individualistic, privatized blaming and to the social factors that create the landscape for individual choice is relevent to everyone's health -- real social justice could improve health for all of us.


andrew said...

wow. wonderful job "thinking globally, acting locally," in a different sort of way. i mean taking something mainstream and everyday like an article in the local daily and showing how it shapes our (mis)understandings of stuff beyond the article's immediate content, and beyond a limited politics. i mean not just leaving it at the fact that aboriginal communities are under resourced (which neocons can easily twist into "let's givem' a hand up, not a hand out" rhetoric), but deepening the analysis to show that any quick, typical response (like evacuation and new water infrastructure) on its own is so deprived of understanding.

you know i'm never going to be able to bring myself to vote in january if you keep writing stuff like this.

Scott said...

Well, I'm not sure that discouraging voting is exactly what I intended, however particularly odious that civic act might be this time around, but thanks for your kind words about the post! 8)

opit said...

Scandals about water quality on reserves come to mind. Carcinogenic or not, definitely a health issue. Waterton proved that it's not necessarily a native problem (possibly a rural one)

Scott said...

True, opit, though from what I understand the proportion of reserve communities with "boil water" orders is much higher than the proportion of white-majority rural communities across the country.

opit said...

Checking back on my bookmarks, I ran into this again. At second look, I note the incidence of cancer in aboriginals is less than that of the general population. The question of who should be emulating whom occurs to me.