Thursday, March 29, 2012

Healthcare and ideology really don't belong together

The USA never ceases to amaze me. At this moment, a political battle is playing out in the Supreme Court that essentially pits the political right against Obama's health care plan. The biggest irony is that the 'socialized medicine' against which the right is fighting so hard is based on a conservative plan, proposed in the 1990s by a conservative think tank, and subsequently adopted by at least one conservative governor (Mitt Romney) in his state.

Perhaps history will prove me wrong, but I think this will turn out to be one of the biggest miscalculations of the political right. Inasmuch as "Obamacare" is not perfect, it is a vast improvement over what existed before. It gives more Americans access to affordable health care. Those who have not had the experience of being locked out of every possible insurance plan because they suffer from chronic disease or terminal disease may not realize just how revolutionary this is. The pre-"Obamacare" trend is not sustainable, especially since America has some of the worst health indicators in the industrial world, and these are getting progressively worse. As Americans become sicker, affordable health care is going to become increasingly necessary.

If 'true American values' continue to move towards the right, as they have been doing for the past 50 or so years, then Americans will wake up in a dystopian society some decades from today. Basic health care (including vaccination, prenatal and antenatal care) will be out of reach for the average person. Perhaps only 10% of the population will have access to fresh fruit, vegetables, meat and dairy products. The rest will have to make do on heavily-sugared and salted food products. It sounds very much like the USA is trending towards "third world" status. Those of us from the "third world" who have seen what zero access to affordable health care for the majority of the population means in practical terms know that there's nothing ideal about it. The strangest thing of all is that the American public will have voluntarily taken itself in that direction  because of its ideological investments.

I think the political right would have done better to embrace "Obamacare" as their original idea. After all, it did grow out of a conservative vision for expanded health care coverage. By contrast, a vision originated by the political left would have pushed private insurance companies out of the market and replaced them with a single insurer: the government. Seen from this perspective, many on the left could (and do) argue that "Obamacare" is too huge a compromise by the Obama administration to the right.

If the right had taken credit for "Obamacare" they would have had a more coherent platform to run on. They would have been able to paint "Romneycare," not as a blemish on Romney's record, but as a superior plan to "Obamacare." I have to wonder what lies ahead for American politics and American health care.

The best-thought out piece I have read on the American health care system lately comes from Fareed Zakaria: "Health insurance is for everyone". Its valuable for its comparative assessment of health care and insurance in different national contexts. David Paul's piece on the Supreme Court and the insurance mandate is also a good read.

This work is licensed to Rose Kahendi under a Creative Commons Attribution-Noncommercial 3.0 Unported License.

Friday, March 23, 2012

Changing our attitudes towards homosexuality

When they think about what it means to be gay, many East Africans focus on its physical implications: they think about gay people as those who have physical relationships with members of the same sex. Because sex is a physical act that one chooses to engage in, they figure that one can choose whether or not to be gay. This perspective fails to take into consideration the fact that, for many gay people, being gay precedes the act of sex. To them, being gay means feeling attracted to people of the same sex. Even if they never act on these feelings and choose to live a life of celibacy or one of heterosexuality instead, they know deep down inside that they feel attracted to members of the same sex and that they have felt that way for as long as they have been sexually aware.

I have read narratives by gay people who speak about becoming teenagers and realizing that, unlike their age mates, they felt absolutely no attraction to members of the opposite sex. They grew older and the status quo held: the heterosexual attraction that other people took for granted was never a part of their experience. Instead, they remember their first experience of feeling romantic love for another as involving somebody of the same sex.

I notice that most discussions of homosexuality in the East African media have not evolved beyond the expression of horror or disgust at the possibility that two men or two women can be physically intimate. Very few East African writers set aside the focus on the sexual angle to ask what it is that makes it possible for a man to feel attracted to a man or for a woman to feel attracted to a woman. Very few even ponder over what it is that makes them heterosexual. They just assume that they are heterosexual because that is the natural state of things. They don’t think about the biological and environmental factors that influence their sexuality. Nor do they realize that if a few factors in their lives had been different, they could possibly have been gay.

The truth of the matter is that there is no single definitive factor that makes a person gay or straight. Rather, a variety of factors interact to influence a person’s sexuality. They include genetic heritage, the hormones to which a fetus is exposed while in the womb, the structure of the brain, family influences, birth order and other factors.

Over the years, I have read of studies where it was shown that there were demonstrably distinct differences between people who self-identify as homosexual, and those who self-identify as heterosexual. These include physiological differences, e.g. differences in the sizes of specific parts of the brain, different brain responses to certain chemicals, and different ways of processing certain forms of information. One study I read about in a science magazine a few years ago (unfortunately, I can’t remember which one now) looked into the family structures of gay and straight men. It found that the gay men’s maternal female relatives tended to have more offspring than their paternal female relatives. The conclusion was that the X-chromosome, which was passed to these men by their mothers, was involved in some way. The scientists speculated that this chromosome was carrying genes that increased female fertility and the likelihood that male offspring would be homosexual.

I remember reading another article which indicated that more gay men tended to experience rejection from their fathers than straight men. Gay men also tended to have closer relationships with their mothers than straight men. The conclusions were not clear cut in this one. It could be argued that the fathers rejected their offspring because they sensed that they were somehow different from the norm and that the mothers tried to compensate. It could also be argued that the rejection by the fathers played a role in influencing their sons’ psychosexual development.

I can think of many more studies that focus on different biological and environmental factors, and show them to have some kind of influence on an individual’s sexuality. The conclusion I am bound to draw from all of this is that sexuality is complex, and that there are no easy explanations for the way it manifests in individuals. Thus, being gay or straight is not about simply deciding to feel a certain way.

Given that homosexuality is complex, and is determined by a variety of factors, our attitudes towards it need to change. We are living in the age of information. With access to the internet, many people really have no excuse for holding on to superstitious beliefs about sexuality.

This work is licensed to Rose Kahendi under a Creative Commons Attribution-Noncommercial 3.0 Unported License.

Friday, March 9, 2012

How cultural norms contribute to malnutrition

This week, I have been reading Richard K'Okul's book, Maternal and Child Health in Kenya. The book explores the different factors that contribute to malnutrition in the community. These range from bad policies to poverty, ignorance and cultural factors that influence maternal nutrition.

One of the factors that I found unnecessary and sad was the cultural norm in Western Kenya, whereby a young married woman is not allowed to cook for her family. Instead, she has to comply with her mother-in-law's wishes. If her mother-in-law doesn't feel like cooking, then even small babies are condemned to remain hungry until she is ready to cook.

To make matters worse, the food cooked may not necessarily be suitable for small children. In parts of Nyanza Province where polygyny is common, it is the senior wives who control the cooking. It is common to see very young women who are married to elderly men carrying small children with kwashiokor. When asked why they can't feed their child better, they give answers like, ' I have not been given food'.

The point of this little story is to point out that  the time has come for Africans to reexamine and restructure their cultures in order to survive. It doesn't matter how many highly educated specialists Africa produces, if we don't take care of the basic anomalies in our family dynamics: Malnutrition, disease and death will remain common among African children. Young African men must therefore play their part in condemning these practices, and African mothers must advocate more for the welfare of their children. Then Africa will take one step closer to joining the global community.