So I've gotten into a few little skirmishes recently with folks I'm partnering with on projects, both of which had me saying "but that is health" somewhere along the way. Got me thinking about how "health" is defined by various people and how that definition leads us to do certain things, and to do those things in certain ways.
The first incident involved advertising a community health fair event. We were at a meeting of partner organizations, sitting around trying to design the flyer that would advertise the health fair, putting together language that we thought could appeal to community members, and that would cover the comprehensive array of services that this event would be offering.
Without giving it a second thought, I blurted out, "oh, and legal services..." in response to the question, "so what else should the flyer say?" This was especially considering that this community health fair would include not just medical screenings but also booths with community based organizations offering what are typically referred to with the catch-all umbrella phrase of "social services" - and that those services are not only in great demand, they are much needed by members of our community.
To me, telling folks that they could come to our community health fair event and also have legal questions answered - whether its about if they would be labeled 'public charge' if they used Medicaid, or how long it'll take for them to sponsor their mother from Bangladesh - made a whole lot of sense. So much so, that I was frankly stunned when another person at the table retorted,
"but that's not health! This is a health fair."
I'm not sure whether it was her insisting on distinguishing 'health' from 'legal' services, compartmentalizing and not wanting these two to mix (nor understanding why I insisted that they overlap quite a bit), or it was my own (relatively) newfound stubborness in seeing practically every aspect of life (social, political, legal, educational, spiritual, psychological, sexual, etc. etc.) as tied up and intricately connected to that thing we call 'health' that rendered the third person in this conversation essentially tongue-tied.
All she wanted to do was finish with the darn flyer. But this simple point - whether or not to advertise 'legal services' as part of a health fair, had struck a deeper chord in me, and I was not about to let it go. This was of course further complicated by the fact that organizations that organize and therefore advertise their health fairs have at least two aims: 1. to glorify their organization, at the same time protecting it from any liability and/or responsibility and 2. to let community members know about as many different services as exist out there, even if their organization doesn't offer that service, and even if the individual that sees the flyer for that health fair doesn't come out that day - at least they know its 'out there' if and and when they need it.
The thing is, legal services, especially immigration services, are a huge part of what I think health should be defined as. I will never forget this experience I had leading a workshop on cervical cancer for Pakistani immigrant women here in NYC. I was so proud of myself, having gone through a role play in Urdu, discussed with them what pap smears are, explained why its important to get one, and answered all their questions. So, at the end of the workshop, when I asked, “so what health topic should I take up next time?” and they said, “baji, can you please talk about immigration?” it was a completely humbling moment. Of course immigration is a part of health – one can’t think of getting a pap smear if they are afraid they will be deported tomorrow!
Likewise, other social services, like housing, child support, adolescent development, domestic violence, parenting, etc. that many amazing South Asian organizations out here in NYC (and beyond, of course) provide, to me fit under that umbrella definition of health which I am keen to promote. Just this past weekend, I was asked by the organizer of a large community event to arrange for a “Health Fair” portion. Since she put this job into my hands, I decided to invite organizations that I we work with, all not necessarily “health-defined organizations” for many reasons, but important, nonetheless, in my eyes as offering services that are part and parcel of what a “Health Fair” event reaching thousands of South Asian immigrants should be. The day before the event, I get a call from this organizer, to whom I had just emailed the final list of attendees (i.e. organizations taking part). She was upset about two things: HIV/AIDS education and Youth Services. Now the HIV/AIDS education piece she thought was “inappropriate” while I thought it was totally important and therefore more than appropriate for a large gathering of a community whose HIV testing rates are abysmal (a topic I hope to discuss in a separate post). The Youth Services bit though…you won’t imagine the response I got:
“this is supposed to be strictly a health fair.”
That was her objection. Imagine, that somehow making sure that South Asian youth are given healthy, supportive environments to grow up in is not somehow part of our community’s health – I couldn’t even describe what they do without using the word “health”! What she should have said is that she was looking for a “medical fair” – even though I suppose some of those in the medical profession may also argue that 'allied social services’ are essential to their diagnosis and full professional treatment of patients.
There is another aspect that I think many in public health would agree is a part of that definition of health, although I have somehow come across problems recently. In planning this same health fair event this past weekend, I was speaking with a dietician about providing handouts on Diabetes in about 4-5 different South Asian languages, based on the languages commonly spoken at our events and the proportion of those language speakers who are limited in their English ability. Her response, after insisting that:
“everyone who lives here can either speak Hindi or English,”
was
“information without education is dangerous.”
This shocked me on so many levels.
Firstly, of course she is incorrect in saying everyone here can speak either English or Hindi. We have a large South Asian immigrant population that speaks neither, and those are the individuals attending our events – of course Urdu & Hindi are essentially the same spoken, so the folks I’m considering are most commonly Bangla, Punjabi, Nepali, Gujarati, and Telugu speakers. Not to mention that even IF she was correct, it still doesn’t account for the high prevalance of illiteracy, especially health illiteracy, in our communities. So giving a handout on Diabetes to a Bangla speaker that you think can ‘speak enough Hindi to understand’ is not going to be very useful – 1, if they don’t read Hindi, or 2, if they don’t read.
Which brings me to her ‘information without education’ point – she’d rather that people not get information if they are – as she calls them, “uneducated.” In other words, if they can’t read at all, or they don’t know Hindi or English, they are uneducated, and therefore don’t deserve the handout on Diabetes anyways. I realize she may have a fear about self-diagnosis, which I also share, but isn’t giving information – whether spoken or written – actually a way to create a more educated society, especially for those that didn’t have the privilege of receiving a formal education?
This whole altercation made me think of a couple other things I would throw in to what belongs under that fabulous health umbrella: Language Access, Literacy, Legal & Immigration services, Youth Services, Women's Rights, Intimate Partner Violence, LGBTQ Rights, Education, etc. etc. Many of these are also essentially surrogates for, or somehow associated with, Socio-Economic CLASS, something I plan to explore much more in future blog postings.
