Sunday, October 28, 2012

Better Day Than I Expected!

Well, first day at APHA went a lot better than I expected...
Still haven't found the job of my future, but hope springs eternal.

What was a ton of fun was running into a lot of former students, colleagues, and meeting a few social epidemiologists. I was stoked to meet Dr. Camara Jones and chat with the author of the "reactions to race" module I'm writing a paper on at the moment. She was super friendly and sounded excited about my work with it.
Also met Dawn Richardson & Amy Schulz from Detroit whose work I've cited in that same paper, and after chatting about measures of segregation for a few minutes, she slipped it in that she uses one of my papers for her environmental health class. I was floored! I said if she wanted me to swing by her class, I'd fly out on my own dime, and I would!

Had an unexpectedly engrossing conversation with a woman working on injuries among loggers, shared a bunch of ideas about what might be causing the patterns she's seeing - injury rates seem to be coming down over time, a little bit. It brought up fond memories of Joe Masure, the guy who cut the trees that became our house in Vermont. That man was an artist whose canvas was forests. Alas, he would have been one of her statistics. Of all the anazing, technically challenging work he did, he met his demise sitting down for lunch, and having a branch just fall down on him. A great loss.

And to top the day off, chatted with Susan Cochrane about analyzing experiences of discrimination reported before and after the proposition 8 vote, in relation to how their neighbors voted on it.

SECOND DAY
That conversation about loggers and injuries yesterday has got me thinking I really need to spend more time reading up on and thinking about occupational health. Most of my work has been based on exposures based on where people live, but workers are often exposed to very particular things, and often at very high levels, there's a lot of opportunities there.
One study I've been mulling in the back of my head is the exposure of BART employees to dangerous levels of air pollution. You'd think that with the BART trains being electric, there wouldn't be much pollution, but when I carried an air monitor with me to and from work a few times, the pollution levels inside BART terminals, particularly Embarcadero, were much higher than anywhere else along my route, at home, or in my office. So I think it would be really interesting to plunk a few air monitors in various BART stations, or ask the workers to clip one to their belt for a few weeks, to better characterize their overall exposure levels, and also where and when during their day they get the biggest hit. Another thing that would be good to know is what's in that pollution - the monitor I had just detected small particles, but it doesn't say what those particles are made of. For the most part, it's just the size of the particles that matters for health, but what they are made of can help track down the source. Presumably the levels are highest at Embarcadero because of the Transbay Tunnel, but what in the Transbay is causing so much pollution, and what can be done about it?

Alright.... one more poster session this afternoon, then I'm headed home to make pumpkin soup, pumpkin pie, leek & onion sautee, steam-fried greens, rolls, and fruit salad.

THIRD & FOURTH DAYS
Jeez, it's been a bit of a whirlwind. Made a bunch of great connections, including a couple very bright young stars, like John Blosnich at the VA, and Gilbert Gonzales at U Minnesota. Had a brief conversation with Healther Corliss and Sari Reisner thinking about getting different results from relative vs. absolute comparisons when looking for 'intersectionality' - I may need to write an in-depth blog post on the topic, but to be honest, I'm quite vexed (;-)) about how to resolve those differences. I'm not sure that there is a way to resolve them. For a close analogy to what I'm rambling about here, check out an earlier posting about racial disparities in mortality - the very same evidence shows that they are growing in relative terms and declining in absolute terms. So does that mean that we are making progress, or losing ground, on racial disparities? The short answer is "yes".

Saturday, October 27, 2012

Queer Ideas of Health at APHA

The American Public Health Association (APHA) is invading San Francisco this week, and I'm going for the first time in over a decade.
I'm very proud to be an epidemiologist. I'm deeply committed to public health.
And, I can't stand how public health thinks about the public's health these days, the trends that the field has taken lately. Especially in regards to gay health, but really it's much broader than that.

So, I'm trying to gird myself for what I know will be a very frustrating experience - seeing a ton of deeply committed people - deeply committed to doing good in the world - and with a few great exceptions, failing at it.

What I need, from you, is the strength to get through this APHA meeting with grace and charm. I need to listen with open ears, do my little bit to shift how people think about queer health, and most importantly, get a job back East!

Queer health on the agenda

There is a very active LGBT caucus within the APHA, with programming booked from cover to cover in the program. One could easily attend only the LGBT caucus events and never really interact with the thousands of other programs happening simultaneously. So the good news is we're there, we're taken seriously, we're in leadership roles (openly). That's great progress from the last time I went, when the LGBT caucus was insignificant, essentially a support group. Great sex, though.
But taking a closer look at the talks and posters, it becomes very clear that there is a very odd view of LGBT health being explored at APHA's meeting. I say 'odd' and not 'queer' because the view of LGBT health that comes screaming through the program book is one that focuses almost exclusively on disease and negative health outcomes, and even more troublingly, rarely interrogates homophobia / heteronormativity / stereosexism (my neologism for the view that there are but two sexes), at least does not interrogate these fundamental causes directly.
Health disparities rule the day. Not just in LGBT health, but most definitely in LGBT health. That, and individual-level analyses that can just as easily be interpreted to mean that we are inherently sick or sinful as they can be interpreted to mean that homophobia is unhealthy.
And if there is something good going on in gay health, like gay men being less likely to be obese, it must be because of some deep-seated pathology, like lousy body image.
I'm not sure where we went awry. How we came to wear these bizarre prism glasses that only allow us to see such a small fragment of LGBT health. A small fragment? Yes, a small fragment. Because what the average person steeped in LGBT health knows is a laundry list of health outcomes that we do worse on: for gay men: HIV, STD's, depression and suicidality, drugs and alcohol misuse, tobacco dependence, violence victimization, etc. For women, being obese, higher breast cancer risk, drugs and alcohol misuse, tobacco dependence, violence victimization, etc. For trans women, HIV, STD's, lack of access to care, violence victimization, drugs and alcohol misuse, etc. and for trans men, lack of access to care, and probably more, but we forgot to ask who was transmasculine and who was transfeminine, so we can't really say.
If I were then to ask OK, so what about the health advantages that LGBT people enjoy? Most probably would have to think a while before coming up with the fact that gay men are less likely to be obese. And a few might toss off the idea that lesbians, at least "out" lesbians, are less likely to experience an unintended pregnancy. How many would claim that gay men are less likely to perpetrate violence? More likely to volunteer, to provide intimate care for someone not related to them? Less likely to get someone unintentionally pregnant? To enjoy a vibrant, exciting, and life-affirming sex life?

But by far the biggest category is health similarities, and I doubt that anyone could name a single one with confidence. I'd have a lot of trouble with that myself despite thinking about it for a few years now.

At any rate, if you've been reading this blog, you've heard all these arguments before. And I need to make myself cheerful and winsome. Wish me luck.