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Category: Diversity, Inclusion, & Accessibility

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Logo with the words IndigenousSIPIN and a blue wave graphic
Logo for IndigenousSIPIN intervention, shared with author permission from Haozous, E., Yeary, K., Maybee, W., Porter, C., Zoellner, J., John, B., Henry, W. A. E., & Haring, R. C. (2024). Indigenous knowledge and sugar sweetened beverages: Qualitative adaptations towards chronic disease prevention and intervention. Explore (New York, N.Y.), 20(6), 103066. Advance online publication. https://doi.org/10.1016/j.explore.2024.103066

November is Native American Heritage Month. To observe it, The Rotation spoke with Dr. Emily A. Haozous, PhD, RN, FAAN (Chiricahua Fort Sill Apache). 

Dr. Haozous is a nurse and research scientist with the Pacific Institute for Research and Evaluation - Southwest Center, based in Albuquerque, New Mexico. Dr. Haozous conducts community-based and community-guided research and evaluation in collaboration with Native American partners, including urban tribal centers, reservation-based tribal organizations, and tribal governments. Her work is focused on issues of access to care, health equity, cancer and non-cancer pain management, cultural tailoring, and national trends in premature mortality. Dr. Haozous has a clinical background in oncology, hospice, and palliative care nursing. She is a breast cancer survivor and has co-facilitated a women’s cancer support group continuously since 2007. Dr. Haozous received her undergraduate degree in music from the University of California, Santa Cruz, and her MSN and PhD in nursing from Yale University. Most recently, she participated in the authorship of the National Academy of Medicine’s special publication, Systems’ Impact on Historically and Currently Marginalized Populations (expected publication date 2025).

Dr. Haozous is first author of the recent publication, “Indigenous knowledge and sugar sweetened beverages: Qualitative adaptations towards chronic disease prevention and intervention.” The focus of this publication is the adaptation for one Indigenous population of an evidence-based curriculum (SIPsmartER) to reduce consumption of sugar-sweetened beverages (SSB). The study reports on the successful adaptation of the curriculum resulting in a curriculum called IndigenousSIPIN, and also provides valuable insights into the practice of cultural tailoring

The Rotation: Thanks for taking time to talk with me today. I wanted to speak about your most recent publication, and discuss some concepts related to research and Native populations that it introduced me to. I noticed quite a few co-authors on this paper.

EH: It was a really big team. We had people from all over the country and different disciplines… The one thing we didn’t have were any MDs. That wasn’t a conscious decision, just how it worked out. People think about medical research, or health research, and they think about doctors. Here we have nutritionists, we have nurses, we have a social worker… We have people from all across the healthcare spectrum.

The Rotation: I was intrigued by the use of the concept of the Good Mind, a concept familiar to Indigenous people from the community that was addressed by this adaptation, in the modification of the SSB curriculum, which also introduced the metaphor of the Clean and Dirty River as a framework for the curriculum. These worked for the specific Indigenous group the intervention was tested on, who were male athletes in the Northeastern U.S. Would these metaphors be understood to all Indigenous people?

EH: What you’re asking me about is Native Science. That’s kind of the core of cultural tailoring. The old mainstream perspective on cultural tailoring of health literature is “Well, let’s just change the color scheme and maybe add some photos. If they speak a different language, we’ll change the language. Or maybe we’ll make the font size bigger.”

The Rotation: Sort of like when someone doesn’t understand English, so the other person just speaks louder?

EH: That’s a good way to think about it. Think about how that feels, if you’ve ever been to another country and people have done that to you… But when we’re talking about actual cultural tailoring, you really want to think about, Who are the people you’re trying to communicate with, How do they think? What’s important to them? What is their culture? And so, when you do that… it stops being about changing the color scheme – well, actually, maybe the color scheme is important. A lot of Native tribes – I’m not going to say all, because that would be disrespectful, [since] there are 574 recognized tribes in this country right now, and that number’s changing all the time, and we’re all different – color is important to us. When I go and spend time with my tribe, I can tell who’s Apache because of the colors they’re wearing. And I can tell who’s Comanche because of the colors they’re wearing. So color’s important.

The Rotation: That’s why I was wondering, when you are culturally tailoring an intervention or instrument, are there terms that transcend differences between the tribes? I’m asking whether the ways that you modified the tool are fundamentally, across the board, things that would be understood, regardless of tribe.

EH: I don’t think I could say that. I’d have to talk to each person and say, “Does this make sense to you?” Until I had talked to someone from every single tribe or community – and even within tribes there’s differences – I’d have to really do a scan to be able to confidently say yes or no. 

So getting back to [cultural tailoring] – we have to get to what is meaningful for people. So it’s not just about color and not just about pictures, but what is meaningful for those people.”

The Rotation: I look at many studies that aren’t designed like this. Is this research practice of culturally tailoring instruments or interventions something fairly new?

EH: Yes. The practice of really digging deep into a community and finding out what is meaningful to you. And it is not just using an algorithm, but going in and saying, “Is this color aesthetically pleasing to you? Are there colors that we shouldn’t be using? Are there pictures that we shouldn’t be using?” You know, in some communities you don’t include pictures of people who have passed on. Which is challenging, because – people die. And so you have to be very careful with that. And in other communities they really want that, to celebrate people who have been important to them.

In science, they want algorithms. In dissemination and implementation research, it’s all about, “What works here should be able to work everywhere else.” And that’s just not the case in Native communities. So, I can’t take the Clean and Dirty River model and use it in the Southwest. Because we just don’t have the same accessibility to water. So I can use the same practice of finding a meaningful metaphor and trying to transform it, but I can’t use Clean and Dirty River.

Chart showing five stages of tailoring the existing SIPsmartER intervention to the Indigenous-focused IndigenousSIPIN.
Figure 1 from Haozous, E., Yeary, K., Maybee, W., Porter, C., Zoellner, J., John, B., Henry, W. A. E., & Haring, R. C. (2024). Indigenous knowledge and sugar sweetened beverages: Qualitative adaptations towards chronic disease prevention and intervention. Explore (New York, N.Y.), 20(6), 103066. Advance online publication. https://doi.org/10.1016/j.explore.2024.103066. Shared with author permission.

The Rotation: I was curious about the graphic in the article, which depicts the stages of cultural tailoring of evidence-based interventions. 

EH: That was just me trying to make something that was usable. Part of it is, we have this whole curriculum for the program that we didn’t want to publish, because we didn’t want it to become mainstream.

The Rotation: You don’t want it to be used like a blunt instrument.

EH: Exactly.

The Rotation: Publication of these findings is intended to demonstrate cultural tailoring in practice, but it is not intended as a product to be posted online or whatever.

EH: If people want to contact my colleagues and see the materials they created, it’s up to them.

The Rotation: Were all the team members Indigenous?

EH: Some people were not. We spent some time with the non-Indigenous team members getting them to understand… Some people were saying, “You’ll never get them to drink water.” Because there’s no precedent in the literature where you could convince people who were basically addicted to drinking SSB to stop drinking sweet things. And so we had to do a lot of teaching within the team to say, Look, a lot of traditional beverages are sweet, they’re just not sugar-sweetened. They’re sweetened with berries, there are teas that you can sweeten. And natural stevia grows in the area where we did this research. And they were like, “They’ll never choose water.” And we were able to prove them wrong.

The Rotation: Part of the work being done here is to dismantle the assumptions people are making.

EH: For one of them, this person had been working in the field for a very long time, and her biggest success was getting people to drink diet sodas. And we were like, maybe we can aim for a different purpose.

The Rotation: How much of your published work has been related to Indigenous people?

EH: I always get called in as the expert on Indigenous research. I’m happy to do that. That’s my mission. I’ve published in a lot of different places, domains, whether it’s large data analysis or qualitative research looking at access to care in different places, whether that’s in Indian Health Service or pain management or telehealth.

The Rotation: Do you have recommendations for those who are new to reading research conducted in Indigenous populations?

EH: The first thing I would suggest is that when people are reading an article, they find articles that are written by Indigenous authors. Usually there’s a disclosure statement if a person [on the team is] Native. You want a team that has Native people on the team. I’m starting to see articles coming from other countries where they’re just slurping up data from American sources, and they don’t have Native authors, and they’re terrible. The American Journal of Public Health is usually very careful about this. You want to make sure that [researchers have] followed data ownership guidelines from the tribes. That is usually included in the disclosure with the article. Usually the top tier journals will follow that, and the peer reviewers will keep track of that. It’s a very small circle, you start to see the same people publishing.

The Rotation: What was your experience working on this project?

EH: It was a great project. I like doing that kind of work, because it really makes me work my Indigenous mind, and I get to work with Native teams, which I really like to do.

The Rotation: How long did the project last, start to finish?

EH: It was a couple years, and it all happened during COVID. We had to do a lot of the interviews online, which was hard. But one of the best parts was talking to these men who really knew a lot about their culture, and a lot about how to encourage young men to drink water, and what was important to them.

The Rotation: I was struck by the quote in the article from a participant in the intervention who suggested that something that would make others in their community pay attention to reducing SSB consumption was the high cost of dental care, and the prospect of having dental problems, as being more persuasive than health issues which would appear farther down the road.

EH: There’s a lot going on there, like the fact that they don’t have access to good dental care. There’s so much more in there that we couldn’t add.

The Rotation: When we think about barriers to access to care, people are primarily thinking about, say, African American communities or urban versus rural communities. I think it is rare for people to perceive there are Native communities all around us confronting the same or similar issues. Thank you so much for taking the time to speak with me today.

For those interested in learning more about Native Science, Dr. Haozous recommends Gregory Cajete’s Native science : natural laws of interdependence (Clear Light Publishers, 2000.) This book is available to borrow from Georgetown University through Himmelfarb’s WRLC consortial borrowing program.

References

Haozous, E., Yeary, K., Maybee, W., Porter, C., Zoellner, J., John, B., Henry, W. A. E., & Haring, R. C. (2024). Indigenous knowledge and sugar sweetened beverages: Qualitative adaptations towards chronic disease prevention and intervention. Explore (New York, N.Y.), 20(6), 103066. Advance online publication. https://doi.org/10.1016/j.explore.2024.103066

 

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Picture of black hands folded around a rainbow ribbon.
Photo by Anete Lusina

Himmelfarb Library’s Diversity, Equity, and Inclusion Committee (DEI Committee) is proud to announce the release of the new LGBTQ+ Health Research Guide! The guide features resources that address LBGTQ+ healthcare in clinical and research settings and explores sexual orientation and gender identity barriers to accessing healthcare. You’ll also find general resources including links to LGBTQ+ health organizations at GW and in the DC, Maryland, and Virginia area. Relevant books, e-books, and journals from Himmelfarb’s collection, educational resources about pronouns and preferred terminology, and podcasts to help you learn about LGBTQ+ healthcare are showcased in the guide. 

Featured books from Himmelfarb’s Diversity and Disparities in Health Care Collection include:

Highlighted journals on LGBTQ+ health include:

Please note that some resources, such as e-books and journal collections, may require GW credentials to access.

The Researchers tab of the guide provides insight into useful MeSH search terms, links to helpful research-related guides, and information about conducting research. This tab also features published works related to LGBTQ+ health by GW authors in Himmelfarb’s Health Sciences Research Commons (HSRC).

The DEI Committee wants this guide to be a high-quality resource relevant to our community, and we encourage our users to share relevant resources for inclusion in the LGBTQ+ Health Guide through our Resource Suggestion Form. If you are a member of a GW organization and would like your organization to be featured in this guide, or if you’re interested in partnering with the DEI Committee, please contact the current committee chair, Brittany Smith, at bsmith91@gwu.edu. 

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In recent years, there has been an increased awareness of mental health, mental illness stigma, and how it impacts people in all areas of life. While many workplaces offer services and accommodations for employees with mental health or mental illness concerns, people may face structural barriers when attempting to access these services. Additionally, it is difficult engaging in conversations about mental wellness as harmful stereotypes about mental illness impacts the ways people think about or imagine a person with mental illnesses. 

Burns & Green (2019) and Lo & Herman (2017) published research on mental illness and its impacts on academic librarians; their findings illuminated perceptions and misconceptions about mental illness among the study's population and some respondents shared personal stories about their experiences with being open about their mental illness diagnoses with their colleagues. Both articles are excellent ways to learn more about these topics and they serve as introductions to better understanding how people with mental illnesses navigate the workplace. 

In ‘Academic Librarians’ Experiences and Perceptions on Mental Illness Stigma and the Workplace’, Burns & Green focus specifically on how mental illness stigma plays a role in academic librarians’ professional lives. The researchers surveyed hundreds of academic librarians, collecting data about “concerns around discrimination…disclosure…[and] self-esteem as a whole.” (Burns & Green, 2019, pg 641)  Based on quantitative and qualitative data, “the most obvious finding is that there is a fear of disclosing one’s own mental illness in the academic library environment.” (Burns & Green, 2019, pg 653) Survey respondents shared their stories about their decision to disclose their mental illness diagnosis, the support they may or may receive at their individual institutions, and what work they believe needs to be done to address stigma and shame. 

Alternatively,  ‘An Investigation of Factors Impacting the Wellness of Academic Library Employees’ by Lo & Herman looks at the term “wellness”, how workplaces incorporate or fail to incorporate wellness into their settings, and the factors that contribute to academic librarians’ overall sense of wellness. “This study reveals that most academic library employees feel overwhelmed quite frequently. While age and working overtime are factors, the attitude of the individual also has an impact.” (Lo & Herman, 2017, pg. 802) The researchers also found that academic librarians valued other forms of wellness besides physical wellness. They wrote that “Age again seems to be an important factor regarding respondents’ perception of the different dimensions of wellness…Overall, respondents placed higher importance on their spiritual wellness and intellectual wellness than physical wellness.”(Lo & Herman, 2017, pg. 803)

Lo & Herman and Burns & Green’s research shows that addressing mental illness and wellness in the workplace may be complex, but the end results may be highly valued and beneficial to employees. Having conversations with colleagues about wellness in the workplace can gradually change an organization for the better. These two articles are great resources to refer back to when having conversations about the workplace, mental illness, dismantling stigma, and addressing all aspects of wellness among people.  

References:

  • Burns, E., & Green, K. E. C. (2019). Academic Librarians’ Experiences and Perceptions on Mental Illness Stigma and the Workplace. College & Research Libraries, 80(5), 638–657. https://doi.org/10.5860/crl.80.5.638
  • Lo, L. S., & Herman, B. (2017). An Investigation of Factors Impacting the Wellness of Academic Library Employees. College & Research Libraries, 78(6), 789-. https://doi.org/10.5860/crl.78.6.789

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Latino, Hispanic, or of Spanish Origin+ Identified Student Leaders in Medicine

September 15 to October 15 each year is celebrated as Hispanic Heritage Month. In honor of the contributions of Latinx people to the health sciences, we spotlight the open access book, Latino, Hispanic, or of Spanish Origin+ Identified Student Leaders in Medicine. The acronym used to identify this population in the book is LHS+. This book, published under the auspices of the United Nations, traces the 50 year history of LHS+ leadership in the field. The volume was authored by members of the Latino Medical Student Association, a national organization which was formed from five regional associations that were founded in the 1970s and 1980s.

The book brings together personal narratives from LHS+ medical students and regional perspectives from organizations across the United States which led to the formation of the national body. The chapter "Tu Lucha es Mi Lucha" (Your Struggle is My Struggle) examines the development of a health policy initiative led by LHS+ medical students. Other chapters focus on the role of faculty/physician advisors who are partners in the success of LHS+ students, as well as the support roles of Student Affairs offices, and the role of Medical Education offices in training future practitioners to care for LHS+ individuals. The book also covers faculty development and advancement of LHS+ faculty in graduate medical education, which touches on topics such as culturally relevant faculty mentoring.

For those interested and engaged in medical education, or those wishing to gain more detailed insight into the history of LHS+ people in the graduate medical education field, this book is a unique and comprehensive resource.

References

Sánchez, J. P., & Rodriguez, D. (2023). Latino, Hispanic, or of Spanish Origin+ Identified Student Leaders in Medicine : Recognizing More Than 50 Years of Presence, Activism, and Leadership. (1st ed.). Springer International Publishing AG.

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Picture of a large group of people with two blue, pink, and white trans flags being held above the crowd.
Photo by Oriel Frankie Ashcroft

In honor of August being Transgender History Month, we bring you a reading list that highlights transgender history and elevates transgender voices. Are you interested in learning more about transgender history? Consider adding one of the following titles to your reading list.

  1. Before We Were Trans: A New History of Gender by Kit Heyman, Ph.D.: This book explores academic research and cultural writing focused on transgender and gender-nonconforming people and examines gender norms perpetuated by society. Before We Were Trans highlights stories of trans people worldwide, throughout human history and chronicles often overlooked trans experiences. Request this title through our Consortium Loan Service (CLS).
  2. Transgender Warriors: Making History From Joan of Arc to Dennis Rodman by Leslie Feinberg: Transgender people have existed for as long as people have. Part memoir, part history, and part gender studies text, this book explores the lives of transgender history-makers from around the globe. A print copy of this title will soon be available at GW’s Gelman Library.
  3. Others of My Kind: Transatlantic Transgender Histories by Alex Bakker: In the 1950s, a group of transgender people from both sides of the Atlantic created communities that profoundly shaped the history and study of sexuality and gender. They created private networks of affirmation and trust by exchanging letters and pictures among themselves and submitted their stories and photographs to medical journals and popular magazines to educate doctors and the public alike. Others of My Kind celebrates the faces, lives, and personal networks of those who drove 20th-century transgender history. Click the link above to read an e-book version of this title.
  4. Black on Both Sides: A Racial History of Trans Identity by C. Riley Snorton: This exceptional book explores the intersectionality of transgender history and Black history through a multi-faceted lens. This is the story of Christine Jorgensen, America’s first publicly known transgender figure. Click the link above to read an e-book version of this title.
  5. Trans Medicine: The Emergence and Practice of Treating Gender by Stef M. Shuster: Transgender medicine is a rapidly growing medical field. This book explores the history of trans medicine and current practices through interviews with medical providers, and ethnographic and archival research. Trans Medicine provides a rare look inside how providers make decisions when providing care to trans people. An e-book version of this title is available through Himmelfarb, or you can request a print copy through our CLS service.
  6. The Two Revolutions: A History of the Transgender Internet by Avery Dame-Griff: This book explores how the rise of the internet has shaped transgender identity and activism from the 1980s through today. This book combines a largely ignored period within the history of computing and the poorly understood role of technology in queer and trans social movements and offers a new understanding of both. Click on the link above to read the e-book version of this book.
  7. From This Day Forward by Bullfrog Films: While this one isn’t a book, it is an interesting look at trans experience. This film follows filmmaker Sharon Shattuck as she returns home before her wedding to explore the mystery of her upbringing: How her transgender father Trisha and her straight-identified mother Marcia stayed together against all odds. This moving portrayal of an American family coping with intimate transformation is available in Himmelfarb’s streaming video collection and in our third-floor audiovisual collection (call number: HQ77.9 .F76 2015). A print book companion is available in the stacks (call number: HQ77.9 .F76 2015). 

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Image of a diverse group of teenagers talking. Text: National Minority Mental Health Awareness Month.
Image from https://minorityhealth.hhs.gov/national-minority-mental-health-awareness-month-2024-toolkit

July is National Minority Mental Health Awareness Month! This important yearly observance aims to raise awareness about the unique challenges that impact the mental health of racial and ethnic minority populations. This year’s theme is Be the Source for Better Health: Improving Health Outcomes Through Our Cultures, Communities, and Connections, which emphasizes how the unique social determinants of health of racial and ethnic minority populations impact overall health, including mental health.

Social determinants of health have a profound impact on both physical and mental health. The Centers for Disease Control (CDC) defines social determinants of health (SDOH) as “non-medical factors that affect health outcomes” and can include “the conditions in which people are born, grow, work, live, and age” (CDC, 2024). Five key social determinants of health highlighted in Healthy People 2030 include education access and quality, health care and quality, the neighborhood and built environment, social and community context, and economic stability.

Image of icons used by the CDC for the 5 key social determinates of health.
(CDC, 2024)

Economic stability is a key determinant of mental health. According to Alegria et al. “unemployment, precarious employment, and employment conditions” are linked to “increased psychological distress, even in countries with universal healthcare, where employer-provided health insurance is less essential to accessing services” (Alegria et al., 2018). Economic stability, neighborhood, and the built environment play a role in food security. Lower-income people are more likely to live in food deserts (areas with limited access to plentiful, affordable, or nutritious food). According to a 2020 National Public Radio article, 19 million Americans, about 6% of Americans lived in a food desert in 2015 (Silva, 2020). Black and Hispanic Americans are disproportionately impacted by food insecurity, with 19.1% of Black households and 15.6% of Hispanic households experiencing food insecurity in 2019, compared to only 7.9% of White households (Silva, 2020). 

“Food insecurity and poor diet quality have also been linked to poorer mental health in the United States and Canada” (Alegria et al., 2018). Poor mental health outcomes associated with food insecurity include depression and anxiety. According to Morrison and Frank, there is “a dose-response relationship between the severity of food insecurity and the prevalence of depressive symptoms” (Morrison & Frank, 2023). Food insecurity can also lead to psychological stress responses including “higher levels of anxiety, frustration, and a sense of powerlessness” (Morrison & Frank, 2023). 

Social and community contexts also play a vital role in the social determinants of mental health. Violence within the community can have a large impact on mental health. “Direct and indirect experiences of community violence in adolescence have been significantly associated with elevated depressive, anxiety, and PTSD symptoms” (Alegria et al., 2018). Additionally, living in areas with high incarceration rates is associated with an increased risk of a major depressive or generalized anxiety disorder (Alegria et al., 2018). 

Some unchangeable, fixed characteristics, such as race/ethnicity, nationality, gender, and sexual orientation, also play an important role in mental health. The intersectionality between minority status of race, sexual orientation, and gender identity is an important consideration (Morrison & Frank, 2023). LGBT adults who are also racial/ethnic minorities reported poorer mental health than white respondents (Alegria et al., 2018). Higher rates of suicide have been reported among minority youth who were also marginalized due to sexual orientation and gender identity (Morrison & Frank, 2023). 

It’s important to understand the relationship between social determinants and mental health. “Poor mental health can aggravate personal choices and affect living conditions that limit opportunities” (Alegria et al., 2018). A focus on improving social determinants of health will help improve mental health for minorities who are often disproportionately impacted. “Multilevel interventions aimed at eliminating systemic social inequalities - such as access to educational and employment opportunities, healthy food, secure housing, and safe neighborhoods - are crucial” (Alegria et al., 2018). Primary care physicians can use validated screening tools such as the Social Needs Screening Tool developed by the American Academy of Family Physicians (Morrison & Frank, 2023). Social prescribing, linking patients to appropriate social and community services, is another option for physicians. By addressing the social determinants of health that impact minority mental health through a comprehensive approach, we can work to “advance health equity, reduce health disparities, and Be the Source for Better Health for racial and ethnic minority and American Indian and Alaska Native populations” (HHS, 2024).

References:

Alegría, M., NeMoyer, A., Falgàs Bagué, I., Wang, Y., & Alvarez, K. (2018). Social Determinants of Mental Health: Where We Are and Where We Need to Go. Current psychiatry reports, 20(11), 95. https://doi.org/10.1007/s11920-018-0969-9 

Centers for Disease Control (CDC). (2024). Social Determinants of Health. https://www.cdc.gov/public-health-gateway/php/about/social-determinants-of-health.html

U.S. Department of Health & Human Services Office of Minority Health (HHS). (2024). National Minority Mental Health Awareness Month 2024 Toolkit. https://minorityhealth.hhs.gov/national-minority-mental-health-awareness-month-2024-toolkit

Morrison, L., & Frank, C. J. (2023). Social Determinants of Mental and Behavioral Health. Primary care, 50(4), 679–688. https://doi.org/10.1016/j.pop.2023.04.003

Silva, C. (September 27, 2020). Food insecurity in the U.S. by the numbers. National Public Radio (NPR). https://www.npr.org/2020/09/27/912486921/food-insecurity-in-the-u-s-by-the-numbers

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Aubrey Gordon is the creator of Your Fat Friend, the co-host for the Maintenance Phase podcast and the author of two books, “You Just Need to Lose Weight” and 19 Other Myths about Fat People and What We Don’t Talk About When We Talk About Fat. Gordon’s writing critically examines the messaging around health, wellness and weight, particularly in the social and cultural environment in the United States. She writes in the introduction of What We Don’t Talk About When We Talk About Fat, “...fat people face overwhelming discrimination in employment, healthcare, transit, the treatment of eating disorders, and more.” (Gordon, pg. 5, 2020)

Gordon describes her body of work as fat justice which is distinct from body positivity. She acknowledges the benefits of the body positivity movement, but also notes that like many mainstream movements, it leaves the more marginalized members behind. “Acceptance is a step forward, but it’s a far cry from centering fat people’s humanity in our cruel and ceaseless conversations about fat bodies.”(Gordon, pg. 7, 2020)

What We Don’t Talk About When We Talk About Fat is a text that is accessible to many readers. Gordon uses a strong personal voice in each chapter. By drawing on her memories and experiences as a fat person, she shows the cruelty she and others face because of their weight. From those anecdotes, she extrapolates broader messages around weight and fatness and how those messages harm people in larger bodies. 

In the chapter ‘First, Do No Harm’ Gordon opens with a story about a negative medical appointment, one of many such disappointing appointments she experienced whenever she sought medical care. The chapter starts with the line “I was twenty-six years old the last time I saw a doctor.”(Gordon, pg. 139, 2020) From there, Gordon lays out what brought her to the doctor, the anxiety she experiences prior to her appointment and the defense mechanisms she relies on to endure the encounter. Near the end of the visit, Gordon describes a terse exchange where the doctor suggested she lose weight in response to her diagnosis of an ear infection. “He glared for a moment, heaved another sigh, then left, his door slam thwarted by the muted, slow work of the door’s quiet hinge. We were both frustrated, and neither of us got what we were looking for.”(Gordon, pg. 140, 2020) To contrast this opening story, she ends the chapter with a more recent appointment that was both cathartic and revelatory. “All the years of effort, all the machinations to avoid humiliation and erasure, and someone had finally noticed. Later that day, I realized that despite years of trying, no one had ever told me that I cared about my health. And I did. I do.” (Gordon, pg. 153, 2020)

Gordon also cites extensive research to support her claims in the book. She cites academic journals such as BMC Medicine, Journal of the American Academy of Nurse Practitioners and the American Journal of Preventive Medicine. She also pulls information from mainstream news and media outlets such as pop culture shows like Law & Order, The New York Times, Allure Magazine and the Chicago Tribune. As Gordon writes in the opening chapter, this book is “a mix of memoir, research, and cultural criticism…” (Gordon, pg. 4, 2020) The analysis in the book provides a much more complex portrayal of weight, dieting and weight stigma than what is often presented in mainstream media or in virtual spaces. 

What We Don’t Talk About When We Talk About Fat is a challenging, but worthwhile read. Gordon confronts common and harmful myths about weight and people living in larger bodies. She ties her work with the broader theme of body autonomy and her book ends on a hopeful note as she imagines a world that is not obsessed with weight loss or harmful dieting messaging. “I also believe that my life is worth living, worth embracing, worth loving, and celebrating. And it’s worth all of that now–not two hundred pounds from now.” (Gordon, pg. 161, 2020) For some readers, this book may be an introduction to concepts such as Health At Every Size, fat liberation, universal design and other ideas. For other readers, Gordon’s book may be an affirmation of their own lived experiences and a source they can rely on when engaging in these conversations with the people in their lives. Though this book is short, it is packed with information that will encourage you to reflect on the impacts of diet culture and how we can build a more holistically healthier society.

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Intersex-Inclusive Progress Pride Flag
Image by Neo_Artemis from Pixabay

As Pride Month 2024 draws to a close, we want to take this opportunity to look back at some of our favorite LGBTQ+ blog posts. Whether you’re new to Himmelfarb Library or have been following our blog for years, this retrospective look at Himmelfarb’s Pride posts can serve as an opportunity to reflect on the history of Pride, celebrate the progress that’s been made towards LGBTQ+ equality and those who have fought for this progress, and recommit to the work that still needs to be done.

LGBTQ+ History

Most people don’t associate October with Pride Month, but October is LGBTQ History Month. In an October 2023 post titled The History Behind LGBTQ History Month, we took a look at the history behind LGBTQ History Month starting from its origins in 1994 when high school history teacher, Rodney Wilson addressed a lack of LGBTQ representation in school curriculum and worked with organizations such as the Human Rights Campain to have LGBTQ History Month recognized at the national level. October has additional significance within the LGBTQ community as the first March on Washington for Lesbian and Gay Rights took place in October of 1979, and a second March on Washington took place on October 11, 1987. In 1988, October 11th was recognized as National Coming Out Day. If you’d like to learn more about the 1979 and 1987 March on Washington for Lesbian and Gay Rights, read the full post!

LGBTQ+ Profiles

At GW, we are lucky to have many influential members of the LGBTQ+ community who have been members of our faculty for many years! We’ve profiled some prominent GW faculty and one prominent national figure on our blog.

Picture of Dr. Deyton and Dr. Fauci standing in front of a GW Medicine & Health Sciences logo.
(GW SMHS Facebook Page, 2017)

In June 2021, we posted a piece titled “Just Speak:” Lawrence “Bopper” Deyton. This in-depth profile of Dr. Deyton explores an influential experience Dr. Deyton had as a patient that would have a profound impact on the course of his career and inspire him to work to be a positive influence for change within the field of medicine and healthcare for his entire career. In 1978, Dr. Deyton co-founded what is now Whitman-Walker Health as “a health clinic for gay men and lesbians before AIDS redefined everything and the clinic became a hub for HIV treatment” (Sullivan, 2011). After attending medical school at GW and completing his residency at the University of Southern California Los Angeles County Medical Center, Dr. Deyton began working at the NIH, where he became friends with Dr. Anthony Fauci, and together they would play a crucial role in HIV/AIDS research during the early 1990s epidemic. Dr. Deyton was instrumental in overseeing the “clinical research on the development and approval of antiretroviral drugs and treatment strategies, including the first trials of combination therapies, the cornerstone of current HIV treatments” (GW SMHS, 2017). Read the full post to learn more about Dr. Deyton’s fascinating and impactful career!

Picture of Dr. Carlos Rodriguez-Diaz.

In September of 2021, we posted a profile titled Dr. Carlos Rodriguez-Diaz: Aim for What You’re Passionate About. In this post, Dr. Rodriguez-Diaz discusses what inspired him to go into public health and get involved with HIV care and prevention. He discusses the privilege of being a “young Latino gay man and to have access to education and contribute to my community by engaging in public health training, practice, and research” (Puro, 2021).

Dr. Rodriguez-Diaz talks about how he ended up at GW, what lessons scientists can learn from the spread of misinformation related to the COVID-19 vaccine, and how to make research more transparent and accessible. Included in his answer, he explains that “we should facilitate those scientists from minority populations (e.g. Latinos, Black, LGBTQ, Native Americans) to have access to mass media and platforms to reach out to their communities. No one else can speak to a community like a community member” (Puro, 2021). Read the full article to learn more about Dr. Rodriguez-Diaz.

In June of 2021, our post titled PRIDE: Dr. Rachel Levine: Physician and LGBTQ+ Health Advocate profiled Dr. Rachel Levine, the first openly transgender woman to be confirmed for federal office by the United States Senate in 2021. Dr. Levine is still serving as the 17th Assistant Secretary for Health (ASH) at the Department of Health and Human Services. Dr. Levine served as the Pennslyvania Physician General from 2015 to 2018, during which time she was responsible for an initiative that allowed law enforcement agents to carry Naloxone, an anti-overdose drug, and also allowed Pennsylvanians to purchase Naloxone from a pharmacy without a prescription. Levine has used her platform to highlight health inequality issues impacting marginalized communities, including the LGBTQ+ community. In a 2020 interview with Philadelphia magazine, Dr. Levine said “One of my goals, being a state health official…is that people will see me. … it’s about letting people put a face to something they might not understand, so they aren’t fearful, so that they don’t get angry, so that it doesn’t lead to hate.” 

Picture of Dr. Rachel Levine standing in front of a podium and US flag.

Resources

We’ve also posted about LGBTQ+ resources and local organizations. A 2023 post titled Celebrate Pride: LGBTQ+ Healthcare Resources highlighted selected books, journals, and streaming videos that are part of Himmelfarb’s collection. A more recent post from earlier this month titled Pride in the Collection shared more books from our Diversity and Disparities in Health Care collection relevant to the LGBTQ+ community. 

References:

George Washington University School of Medicine & Health Sciences. (June, 12, 2017). Lawrence “Bopper” Deyton installed as Murdock Head Professor of Medicine and Health Policy. SMHS News. https://smhs.gwu.edu/news/lawrence-%E2%80%9Cbopper%E2%80%9D-deyton-installed-murdock-head-professor-medicine-and-health-policy

Puro, A. (2021, September 29). Dr. Carlos Rodriguez-Diaz: Aim for what you’re passionate about. Himmelfarb Library Blog. https://blogs.gwu.edu/himmelfarb/2021/09/29/dr-carlos-rodriguez-diaz-aim-for-what-youre-passionate-about/

Sullivan, P. (2011, September 7). Lawrence Deyton, award nominee, heads FDA campaign against smoking. The Washington Post, https://go.openathens.net/redirector/gwu.edu?url=https%3A%2F%2Fwww.washingtonpost.com%2Flocal%2Flawrence-deyton-award-nominee-heads-fda-campaign-against-smoking%2F2011%2F08%2F15%2FgIQABsMYAK_story.html

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Background with a red, black, and green stripe. The word "Juneteenth" in the center.
Image by Wynn Pointaux from Pixabay

June 19th is Juneteenth, also known as “Black Independence Day,” “Freedom Day,” or “Emancipation Day.” Although President Abraham Lincoln issued the Emancipation Proclamation in 1863, enslaved people living in Confederate states, specifically Texas, would not learn of their freedom until two months after the Civil War ended in April of 1965. On June 19, 1865, Union General Gordon Granger and his soldiers arrived in Galveston, Texas, and informed the state’s residents that slavery had been abolished and that enslaved people were now free. Mary Elliot, Curator of American Slavery at the National Museum of African American History and Culture stated that “although there were enslavers who were aware of the implementation of the Emancipation Proclamation, it wasn’t until June 19th, 1865 that it was enforced with the Union Army” (Smithsonian Institution, n.d.).

While Juneteenth has long been a celebration of hope and freedom within the African American community, Juneteenth did not become a federally recognized holiday until 2021 when President Joe Biden signed the Juneteenth National Independence Day Act. If you’re interested in learning more about the history of Juneteenth, read our Understanding and Honoring Juneteenth post from last year.

Juneteenth and the Health Sciences

So how is Juneteenth related to medicine, the health sciences, and public health? In many ways, Juneteenth is more relevant than ever considering the focus in recent years on confronting health inequities and the structural racism that is at the root of those health inequities. In 2020, The American Medical Association (AMA) declared that racism threatens public health and created a strategic plan to advance health equity. The 2020 statement recognizes that “when race is described as a risk factor, it is more likely to be a proxy for influences including structural racism than a proxy for genetics” (O’Reilly, 2020). Race has long been considered a risk factor for many conditions and “is present in numerous clinical guidelines and algorithms” and “can impact medical decision-making that potentially worsens health disparities” (The Oregon Clinic, 2021). 

Juneteenth has many lessons that medical, nursing, and public health professionals and students can apply to further the cause of health equity and provide high-quality care to patients. Practicing critical reflection, “the process of identifying, questioning, and assessing deep-seated assumptions upon which our beliefs are built”  can help us “better recognize and arrest our biases that can manifest in our interpersonal encounters with patients, colleagues, and trainees” (Opara, et al., 2021). Participating in “transformational conversations” can help “raise the consciousness within the spaces we occupy” and bring important issues to light so they can be addressed (Opara, et al., 2021). 

Further Reading

Educating yourself on racial health disparities is always a great first step. Here are titles from our Diversity and Disparities in Health Care Collection that may be of interest:

References: 

Smithsonian Institution. (n.d.). What is Juneteenth? National Museum of African American History and Culture. https://nmaahc.si.edu/explore/stories/what-juneteenth

Opara, I.N., Lewis, C., Kasozi, R.N., Givens, R. (2021). Lessons from 1865: What clinicians can learn from Juneteenth. Passion in the Medical Profession. https://closler.org/passion-in-the-medical-profession/lessons-from-1865-what-clinicians-can-learn-from-juneteenth

O’Reilly, K.B. (November 16, 2020). AMA: Racism is a threat to public health. American Medical Association website. https://www.ama-assn.org/delivering-care/health-equity/ama-racism-threat-public-health

The Oregon Clinic. (June 18, 2021). Juneteenth and healthcare. The Oregon Clinic Newsroom. https://www.oregonclinic.com/newsroom/juneteenth-and-healthcare/

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one person's hand holding another person's hand

June is Cancer Survivors Month. Any cancer diagnosis induces feelings of anxiety, uncertainty and fear in patients. While novel approaches to and treatments for cancer are improving survival rates, social determinants of health continue to exert significant impact on patients’ ability to experience positive outcomes to treatment. Let’s look at one of these determinants, economic stability, in the context of cancer survival.

The term “cancer-related financial toxicity” was introduced in 2013 by Zafar and Abernethy, and described as, “the patient-level impact of the cost of cancer care” (Zafar and Abernethy, 2013). Even those patients who are privately insured are not protected from financial toxicity, as a 2022 study published in the Journal of the National Cancer Institute found. Out-of-pocket expenditures by privately-insured cancer patients in the United States have increased, due to the rise in high-deductible insurance plans and greater expected patient contribution to medical expenses (Shih et al, 2022).

How best, then, to help patients navigate the potential financial burdens of a cancer diagnosis, and thereby improve their potential treatment outcomes? A 2023 scoping review in Critical Reviews in Oncology/Hematology examined interventions for financial toxicity among cancer survivors. The interventions discussed include: financial navigation, which includes identifying patients at high risk for financial toxicity, offering guidance on out-of-pocket costs, and facilitating access to programs to alleviate financial stress. Financial counseling helps patients access advice and guidance on managing financial toxicity caused by cancer treatment. Insurance education entails providing patients a structured way to develop insurance literacy and assistance in choosing a plan. Other types of interventions examined included multidisciplinary psychosocial supports, intensive symptom assessments, and supportive care (Yuan et al, 2023).

The effectiveness of the interventions, researchers found, were closely tied to the causes of the cancer-related financial toxicity, with socioeconomic and employment status, cancer stage, and type of treatment, type of insurance, as well as coping skills all having a direct impact on how effective financial interventions could be. Looking closely at just one of the interventions mentioned above, engaging with financial navigation helped cancer patients save significant dollar amounts annually by facilitating the procurement of free medication, and insurance premium and co-pay assistance.

The financial interventions described in the evidence reviewed differed greatly, but more generally, the recent focus in the literature on finding ways to alleviate financial toxicity frequently faced by cancer patients is one promising step towards improving outcomes for all patients dealing with cancer.

References

Debela, D. T., Muzazu, S. G., Heraro, K. D., Ndalama, M. T., Mesele, B. W., Haile, D. C., Kitui, S. K., & Manyazewal, T. (2021). New approaches and procedures for cancer treatment: Current perspectives. SAGE open medicine, 9, 20503121211034366. https://doi.org/10.1177/20503121211034366

Lau, L. M. S., Khuong-Quang, D. A., Mayoh, C., Wong, M., Barahona, P., Ajuyah, P., Senapati, A., Nagabushan, S., Sherstyuk, A., Altekoester, A. K., Fuentes-Bolanos, N. A., Yeung, V., Sullivan, A., Omer, N., Diamond, Y., Jessop, S., Battaglia, L., Zhukova, N., Cui, L., Lin, A., … Ziegler, D. S. (2024). Precision-guided treatment in high-risk pediatric cancers. Nature medicine, 10.1038/s41591-024-03044-0. Advance online publication. https://doi.org/10.1038/s41591-024-03044-0

Shih, Y. T., Xu, Y., Bradley, C., Giordano, S. H., Yao, J., & Yabroff, K. R. (2022). Costs Around the First Year of Diagnosis for 4 Common Cancers Among the Privately Insured. Journal of the National Cancer Institute, 114(10), 1392–1399. https://doi.org/10.1093/jnci/djac141

Yuan, X., Zhang, X., He, J., & Xing, W. (2023). Interventions for financial toxicity among cancer survivors: A scoping review. Critical reviews in oncology/hematology, 192, 104140. https://doi.org/10.1016/j.critrevonc.2023.104140

Zafar SY, Abernethy AP. Financial toxicity, Part I: a new name for a growing problem. Oncology (Williston Park, NY). 2013;27(2):80-149.

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