Minority Women’s Health Summit
Women of Color: Addressing Disparities,
Affirming Resilience, and Developing
Strategies for Success
August 23–26, 2007
Washington, District of Columbia
Summary and Report of Plenary Sessions
This document summarizes the views and issues addressed by invited speakers and discussants at the Minority
Women’s Health Summit. The views expressed in this Summary Report reflect the opinions of the individual
participants at the Summit and do not necessarily reflect the official position of the Office on Women’s Health, the
Department of Health and Human Services, or other Federal entities.
2007 Minority Women’s Health Summit
Women of Color: Addressing Disparities, Affirming
Resilience, and Developing Strategies for Success
Executive Summary
The 2007 Minority Women’s Health Summit brought together physicians, patients, researchers,
community advocates, public health officers, representatives of the private sector, and other
interested parties to discuss health issues disproportionately affecting women of color in the
United States and to share strategies to address them. It was co-sponsored by the National
Hispanic Medical Association, the National Medical Association, Verizon, United Health Group,
the Baylor College of Medicine/Intercultural Cancer Council, and the Lupus Foundation of
America, with contributions from the Department of Health and Human Services Office of
Women’s Health, the Department of Health and Human Services Office of Minority Health, the
Health Resources and Services Administration Office of Women’s Health, the Substance Abuse
and Mental Health Services Administration, and the Administration on Aging. Wyeth
Pharmaceuticals and AstraZeneca contributed to the efforts of the National Hispanic Medical
Association. The Summit aimed for participants to build on knowledge gained from two previous
Summits and to highlight successful models of health promotion and prevention that could be
replicated in various communities.
An Institute on Violence Against Women was held before the Summit to focus on unrecognized
threats to minority women’s health, to identify strategies for intervention and prevention, and to
foster opportunities for skills building. Topics discussed at this institute included sexualization
and exploitation of children, violence during pregnancy, teen violence, and cultural sensitivity in
addressing domestic violence.
The Summit itself opened with a presentation of the colors, the singing of the national anthem,
and remarks from leaders of the Department of Health and Human Services Office on Women’s
Health, the National Hispanic Medical Association, the National Medical Association, and the
Administration on Aging. Dr. Wanda K. Jones, Deputy Assistant Secretary for Health and
Director of the Office on Women’s Health, acknowledged Dr. Janet Mitchell, a founding
member of the Office on Women’s Health Minority Women’s Health Panel of Experts. Dr.
Mitchell was acknowledged for her lifetime commitment to improving the health status of
women, including women of color, and for her work in treating substance-using pregnant
women. Dr. Jones presented a plaque to Dr. Mitchell’s nieces, as Dr. Mitchell has Alzheimer’s
disease and was unable to attend the summit.
The presentation was followed by a session on response, recovery, and resilience in the wake of
Hurricane Katrina, which highlighted both the known and unknown stories of this disaster.
Participants heard perspectives on response, recovery, and resilience before, during, and after the
storm from Ms. Morning Dove Verrett Hopkins, of the United Houma Nation; Ms. Tram
Nguyen, a representative of the Gulf Coast Vietnamese community; Dr Cheryll BowersStephens, an African American wife, mother, and mental health advisor; and Reverend Joan
2007 Minority Women’s Health Summit
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Harrell, a member of the clergy. Ms. Tamara Yang Demko, a public official from Florida,
provided participants with tools to aid in their own preparations for disaster.
Throughout the conference, participants discussed health issues, identified strategies, and began
community partnerships through skills-building workshops, federally sponsored symposia, poster
presentations, and luncheon presentations. The Summit also included a wellness center and
opportunities for exercise and meditation. A luncheon on Friday, August 24, featured
presentations on systemic lupus erythematosus by Dr. Graciela S. Alarcón, and overcoming
health disparities by Dr. Marilyn Hughes-Gaston. A luncheon presentation on Saturday, August
25, focused on efforts by United Health Group to address health disparities. Later, on the evening
of August 25, participants also had the opportunity to attend “Sometimes I Cry,” a one-woman
show written and performed by actress Sheryl Lee Ralph, who has appeared on Broadway,
television, and film and is known best as the original Deena Jones in Broadway’s Dreamgirls
and as Dee in television’s Moesha.
The Summit closed with a session in which women of color shared strategies for maximizing
potential in one’s own community. African American, Asian, Latina, and Native American
women discussed their perspectives and suggested strategies for maximizing one’s potential in
her own community. Dr. Adrienne Smith provided closing remarks.
Several themes arose throughout these activities.
•
Take care of yourself. Several speakers emphasized that women could not adequately take
care of their families or communities if they themselves were sick. These speakers addressed
historical and cultural mores by which women focused so much on taking care of others that
they themselves were of last priority.
•
Recognize women are the caregivers in a family and community and therefore
responsible for everyone’s health. Speakers underscored and illustrated this theme with
quotes and proverbs, and emphasized the importance of recognizing a woman’s role in the
health of a community.
•
Incorporate cultural sensitivity when providing interventions. Providers should be
cognizant of the sociocultural background not only of the person seeking assistance but also
of themselves. Providers should examine their own assumptions and prejudices about culture
to avoid appearing condescending or arrogant, which can place more distance between
themselves and the people they want to help. In addition, providers should understand that
cultural sensitivity should address not only minority groups but also the differences among
subgroups within those groups.
•
Consider how to ask the question. Particularly in terms of interventions against violence,
questions should be asked as part of routine care, repeatedly, in a setting that maximizes the
client’s comfort and is a safe space, and in a way that does not minimize a person’s
experience or history.
2007 Minority Women’s Health Summit
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•
Engage the community in research and education. Communities should be involved in the
design, implementation, and interpretation of research studies, as well as the development,
implementation, and evaluation of educational programs and interventions.
•
Care for the whole person. Throughout the Summit, speakers and participants called on
women of color to take care of not only their physical health but also their mental, emotional,
and spiritual health.
•
The importance of social factors. The societal factors contributing to health disparities must
also be addressed. Participants were encouraged to form partnerships not only within the
health sector but also across the education, banking, corporate, housing, and community
sectors. In addition, efforts to address health disparities should consider the social, racial,
economic, historical, and political complexities of women’s lives.
•
Guard against divide-and-conquer strategies. Speakers pointed out that the media and
many in power often foster animosity and division among groups of color, as well as between
men and women in each group. Participants were encouraged to unite and to overcome these
strategies.
2007 Minority Women’s Health Summit
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Minority Women’s Health Summit
Women of Color: Addressing Disparities, Affirming
Resilience, and Developing Strategies for Success
Pre-Summit Institute on Violence Against Women
Purpose
The Institute on Violence Against Women was held to focus on unrecognized threats to the
health experience of women of color, to highlight strategies for prevention and intervention, and
to foster skills-building opportunities.
Welcome and Opening Remarks
Wanda K. Jones, Dr.P.H., Deputy Assistant for Health, Office on Women’s Health, DHHS,
welcomed participants to the Pre-Summit Institute on Violence Against Women. She emphasized
that the Institute was not intended to demonize men. Women are often victimized and need
healing, hope, and the assurance they will never face violence again, but men also need healing.
Dr. Jones noted that addressing the problems of men is critical to solving the problem of violence
against women. She also expressed her hope that participants would take away from the Institute
a toolkit of ideas, strategies, hopes, and dreams, because they can change the world.
Sexualization/Exploitation of Children
Gail Wyatt, Ph.D., Director, Psychiatry and Biobehavioral Sciences, University of
California, Los Angeles, began her presentation by calling for women to stand up in “righteous
indignation,” because the country is not stepping up when it comes to the care and protection of
children. She cautioned that the studies she would discuss were retrospective studies, which
relied on women recalling events they would rather forget. Dr. Wyatt emphasized, however, the
importance of knowing the long-term effects of sexual abuse.
Child sexual abuse is defined clinically as incidents in childhood and adolescence involving
unwanted sexual contact with a family or non-family member. These incidents can be pleasant or
painful experiences; in some cases the perpetrator convinces the child that the experience is good
for her. Dr. Wyatt noted that the clinical definition of child sexual abuse differs from the legal
definition, which is based solely on reported incidents. However, the majority of participants in
her studies have never reported their experiences. Dr. Wyatt also noted that she had not started
her career investigating the effects of sexual abuse but that it continued to appear. The
experience “oozes out of people,” even if they refuse to talk about it.
Dr. Wyatt reviewed psychosexual development landmarks and emphasized that children should
learn to respect and control their own bodies. Yet sex is often viewed as an expected or
2007 Minority Women’s Health Summit
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developmental inevitability. On average, sexual intercourse begins at age 14 for boys and age 16
for girls. Among children of lower socioeconomic status (SES), it begins at age 11 or 12 for boys
and age 13 for girls. Most often this is related to the fact that people do not want to talk about
sex, even as the media and society promote sex. Dr. Wyatt noted that 80% of abstinence-only
education programs are not effective because of the inordinate amount of pressure on children
and youth to look and act sexy and to engage in sexual activity. These processes sometimes
involve abusive or exploitative experiences for which youth are not prepared.
•
By age 2, children should know the names of all body parts. Dr. Wyatt pointed out that the
use of cute nicknames educates children to be confused about their bodies. Saying nothing at
all is also a type of education.
•
Children should understand sexual development and secondary sex characteristics. Because
of various factors, including the presence of hormones in foods, puberty begins, on average,
at age 9 for girls. African American and Latina girls reach puberty at an even earlier age. Dr.
Wyatt noted that the more developed a girl is, the more she calls attention to herself.
•
Children should understand body image and the social etiquette of sexual behavior, including
what to wear and how to sit. This understanding often is affected by a societal emphasis on
cleavage and looking sexy or “hot.”
•
Children should understand body comfort. Most children engage in touching and stimulation
by 3 years of age.
•
Children should have some knowledge of where babies come from by the time they reach
kindergarten. They should understand their bodies, how they work, how boys and girls differ,
and how that produces babies. Dr. Wyatt warned that if parents did not talk about this in the
home, children would be open to misinformation in school.
•
Children should understand the social protocol for relationships: common interests, trust,
respect, compassion, and interconnectedness.
•
Children should understand their feelings. They should know pleasurable areas of the body
and areas of arousal. They also should know about body pain and discomfort. Just as children
know what to do or say if they have a stuffy nose, girls should know, for example, what to do
or say if they feel pain in or notice strange odors from their vaginas. All children should learn
to express their feelings and their intensity. Dr. Wyatt noted many reports among her patients
of conservative attitudes about human sexuality, and she emphasized the importance of
acknowledging positive feelings. Although parents tell their children what not to do, the
media is telling them what to do.
Dr. Wyatt went on to discuss traumatic, terrorizing, or unwanted experiences where children are
unable to say no. These experiences have effects on brain development. Slowed or confused
cognitive processes,1 problems with attention and concentration, daydreaming, or hyperactivity
1
Putnam FW. Dissociative disorders in children: behavioral profiles and problems. Child Abuse Negl 1993;17:3945.
2007 Minority Women’s Health Summit
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can all be manifestations of traumatic experiences. Child sexual abuse also can accelerate the
appearance of secondary sex characteristics such as breasts or the onset of menses. Finkelhor and
Browne2 proposed the Traumagenic Dynamics Model of Child Sexual Abuse, which identified
four effects:
•
Traumatic sexualization: inappropriate knowledge and behaviors.
•
Betrayal: current or past feelings that someone has betrayed them.
•
Stigmatization: negative messages victims perceive about themselves.
•
Powerlessness: losing control to partners.
Many minority children have these experiences. Some are stigmatized because of their darker
skin color, whereas others live in high-crime areas but are left alone and unsupervised.
Compounding the trauma are stereotypes held by many teachers, principals, and health
professionals that children are sexualized because they want to be. In some cases, children are
punished for talking about their experiences, because the parents are poorly prepared to talk
about them. The fear of blame and retaliation is so strong children will not tell anyone what has
happened to them.
Research studies from 1985 to the present have revealed the following risk factors associated
with child sexual abuse:
•
Excessive touching and masturbatory behaviors;
•
High rates of unintended pregnancy, elective abortions, and sexually transmitted infections;
•
Less condom or contraceptive use;
•
Sexual dysfunction;
•
Difficulties with body image and sexual boundaries;
•
Greater likelihood of having sex with same and opposite sex;
•
Greater range of sexual experience;
•
Difficulties with self-regulation and depressive symptoms;
•
Histories of domestic violence;
•
HIV; and
•
Histories of re-victimization.
2
Finkelhor D, Browne A. The traumatic impact of child sexual abuse: a conceptualization. Am J Orthopsychiatry
1985;55:530-41.
2007 Minority Women’s Health Summit
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Although short-term effects might be mild, the long-term effects come into play as young adults
make decisions about their bodies and sexuality. Victims might exhibit sexual dysfunction
ranging from an aversion to sex to hypersexuality. They might have difficulty trusting others
because they often have been abused by people they know. They might have difficulties with
self-regulation. They might have more negative general outcomes, be more critical of others, and
exhibit few positive responses to sexual advances.3 Some victims of child sexual abuse might
drink or use drugs to alleviate anxiety, depression, or upsetting memories.4,5,6 Women with a
history of child sex abuse also experience more pelvic symptoms and gynecological surgeries.
Moreover, victims of child sexual abuse experience strained marriages, if they are able to marry
at all.
Dr. Wyatt pointed out that in many cases, these people are identified for interventions or
treatments, but these approaches treat only the current problem, without taking into account the
history of child sex abuse. She also discussed several sociocultural contradictions in terms of
HIV risks.
•
Externalized sexual ownership, or the sense that someone else owns your body. The African
American culture reinforces this concept, emphasizing that women should be connected to
someone and that they should trust and let someone have their way with them.
•
Secretism, where children are taught not to divulge “family business.” A “don’t ask, don’t
tell” policy often applies to experiences people are uncomfortable addressing.
•
Avoidance of body symptoms, where women without health care insurance will try to
address their symptoms themselves or douche, without going to a doctor. The absence of
health problems is viewed as a sign of strength.
•
Mind-body disconnect, which served as a coping and survival strategy during slavery, can be
detrimental now, and women of color should unlearn the pieces that cannot help them today.
•
Triggers reinforcing behaviors, where certain people, places, behaviors, smells, or tastes
create anxiety, fear, and sexual arousal and push people to go back to the abusive situation
they left. These triggers must be identified within the environment and controlled.
•
Psychological distress, anxiety, depression, or posttraumatic stress disorder (PTSD) is
experienced by victims of child sexual abuse. However, the culture tells them to get over it,
or it stigmatizes the problem.
3
Gold SN, Lucenko BA, Elhai JD, Swingle JM, Sellers AH. A comparison of psychological/psychiatric
symptomatology of women and men sexually abused as children. Child Abuse Negl 1999; 23:683-92.
4
Perez B, Kennedy G, Fullilove MT. Childhood sexual abuse and AIDS: issues and interventions. In O’Leary A,
Jemmott LS (eds.) Women at Risk: Issues in the Primary Prevention of AIDS. AIDS Prevention and Mental Health.
New York NY: Plenum Press, pp. 83-101, 1995.
5
Waller G. Perceived control in eating disorders: relationship with reported sexual abuse. Int J Eat Disord
1998;23:213-6.
6
Miller M, Paone D. Social network characteristics as mediators in the relationship between sexual abuse and HIV
risk. Soc Sci Med 1998;47:765-77.
2007 Minority Women’s Health Summit
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•
Stress, which can be measured objectively through hormone levels. An evaluation of what is
happening to the body must also consider the biopsychosocial aspects of stress and trauma.
•
Precocious physical development must be addressed. Girls who develop early receive catcalls
and unwanted advances, when in fact they should be protected. Cultural definitions that give
girls permission to be overweight and develop too early should be addressed.
Dr. Wyatt discussed the ESHI intervention, which was funded in part by the National Institute of
Mental Health and enrolled HIV-infected African American and Latina women with a history of
incest. The intervention targeted drug use and sexual risk behaviors. As women started to talk
and connect, they learned about the experiences needed for a healthy childhood, how to control
sexuality and disease transmission, and how to ultimately take responsibility for their own
bodies. This intervention successfully reduced symptoms of PTSD, depression, and trauma. This
approach is now called secondary prevention. Dr. Wyatt called for women to be given the right
to receive mental health services even in these types of interventions, because therapy is not
affordable to all. She further emphasized that HIV interventions should expand beyond condom
education.
Dr. Wyatt made the following recommendations for protecting children:
•
Improve family life. The family unit must be preserved at all costs, and women need to
demand this.
•
Address the environmental factors of crime, drugs, and poor supervision while at the same
time teaching children how to make their own decisions.
•
Improve education to help children make better decisions.
•
Improve and conduct mental health assessments of troubled youth. Understand that
many children in detentions or on suspension are there for a reason. Often children are tried
as adults and incarcerated, and their history has never been addressed.
Dr. Wyatt ended by noting that women of color endure incidents every day that say they are not
important or treat them as less than they are. She called for women to understand that these
incidents are terrorizing and can trigger things they do not expect. She pointed out that women of
color can be depressed but go to work every day and that depression is expressed in different
ways, and when the cumulative traumatic effects overwhelm a woman, people simply say she
went crazy or lost her mind. She noted also that the clothing industry and the media reinforces
stereotypes, and she called not only for women to demand that sexualization of children be
stopped, but also for boys to be socialized against it.
Discussion
A Summit participant noted the lack of resources and the dearth of male health professionals to
deal with issues of sexualization and exploitation. The participant noted that doctors should be
able to refer people to someone. Dr. Wyatt responded that interventions are under development
for women but that children need interventions as well. She encouraged participants to write and
demand more funding in this area. She added that the literature is reporting a decrease in sexual
2007 Minority Women’s Health Summit
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abuse, because it is based on reported cases. However, in her practice, sexual abuse appears to be
increasing.
Pregnancy and Violence
Phyllis Sharps, Ph.D., Associate Professor, Johns Hopkins University School of Nursing,
noted that the problem of intimate partner violence (IPV) contributes significantly to health
disparities in the women who are abused. IPV can occur during pregnancy, and it is associated
with poor maternal, fetal, and infant outcomes. Dr. Sharps added that participants should think of
IPV occurring during the childbearing year, which includes that occurring before, around,
during, and up to 6 weeks after pregnancy.
Dr. Sharps defined battering as “repeated physical and/or sexual assault within a context of
coercive control.”7 She emphasized the factor of coercive control: because the abuse is forced
upon the victim, the victim has no power or ability to negotiate what happens to her. Although
abuse is not a disease or a syndrome, it is a risk factor for behavioral, psychological, and motherchild outcomes. Common themes of IPV include a pattern of physical, sexual, or emotional
threats; unwanted contact; coercive control; a context of power and control; repeated patterns; a
fear of the perpetrator; and the fact that the perpetrator is an intimate partner or former intimate
partner of the victim. According to research studies, men are abusers and women are victims in
95% of cases. However, IPV also occurs in same-sex or same-gender relationships, and the
dynamics of the abuse are the same.
Dr. Sharps discussed a study in which women who survived murder attempts or family members
of slain women were interviewed. In this study, 70% of the women had been abused before the
murder or murder attempt. Moreover, women who had been abused before pregnancy were more
likely to be abused during pregnancy. In a study of patterns of abuse, before, during, and around
pregnancy, Saltzman and colleagues8 found that IPV was the most common form of
victimization women experienced. Eight to 22% of pregnant women reported abuse during the
childbearing year, compared with 7% experiencing preeclampsia or hypertension, and the most
significant risk factor was abuse before pregnancy. Dr. Sharps pointed out that this finding was
contrary to the media perception in which women are more likely to be endangered by street
violence.
Several issues affect the ability to accurately assess the prevalence of IPV during pregnancy.
Although IPV differs from family abuse, some studies lump all types of perpetrators together.
Some studies have not accounted for the timing of IPV relative to pregnancy. The time at which
women are asked about abuse, how the question is asked, and who asks the questions are also
factors.9 Sometimes women are asked during pregnancy, although these women often minimize
or refuse to talk about their experiences. Other times, women are asked at the end of pregnancy,
in which case the study must contend with recall bias. In some cases, women might be asked
7
Campbell JC, Humphreys J (eds). Nursing Care of Survivors of FamilyViolence. St Louis, MO: CV Mosby Co,
1993.
8
Saltzman LE, Johnson CH, Gilbert BC, Goodwin MM. Physical abuse around the time of pregnancy: an
examination of prevalence and risk factors in 16 states. Matern Child Health J 2003;7:31-43.
9
McFarlane J, Parker S, Soeken K, Bullock L. Assessing for abuse during pregnancy. Severity and frequency of
injuries and associated entry into prenatal care. JAMA 1992;267:3176-8.
2007 Minority Women’s Health Summit
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only during a particular trimester. However, as Dr. Sharps pointed out, abuse might start after
that woman has been asked about it.
At least three patterns of IPV related to pregnancy have been identified.10 In 30% of cases in one
study, pregnancy was a protective period, where abuse occurred before and after pregnancy, but
not during. In 24% of cases in that study, pregnancy was a risk period, where abuse started
during pregnancy, especially if this was a woman’s first pregnancy. For 75% of women in other
studies, however, the pattern of IPV did not change.11, 12 In other studies, physical abuse stopped,
but the emotional and psychological abuse increased.13 Several studies found that teens or
adolescent mothers were at the highest risk for partner abuse during pregnancy. Many appeared
to suffer a “double whammy” of family abuse and IPV, because family members were angry
about the girl becoming pregnant.14, 15
Comparisons among ethnic groups have shown that the prevalence of IPV during pregnancy is
significantly lower in Hispanic couples, about 14% compared with a 16% prevalence rate in
African American and Anglo couples.16 However, Dr. Sharps cautioned against combining all
categories of a race or ethnicity. For example, the lower prevalence rate observed in the
McFarlane study was observed among Mexican American couples. Other studies have shown the
highest rates of IPV during pregnancy among Puerto Rican and African American couples and
lower rates among Central Americans, Cubans, and Mexicans.17 Again, the prevalence depended
on how the questions were asked, when they were asked, and who asked them. In studies by
Campbell and colleagues and Torres and colleagues,18 the prevalence of physical and emotional
abuse was fairly high, but in 19% of cases, abuse was identified on women’s charts. Dr. Sharps
noted thus that screening does not appear to take place when women come in for care.
10
Ballard TJ, Saltzman LE, Gazmarian JA, Spitz AM, Lazorick S, Marks JS. Violence during pregnancy:
measurement issues. Am J Public Health 1998;88:274-6.
11
Martin SL, Mackie L, Kupper LL, Buescher PA, Moracco KE. Physical abuse of women before, during, and after
pregnancy. JAMA 2001;285:1581-4.
12
Saltzman LE, Johnson CH, Gilbert BC, Goodwin MM. Physical abuse around the time of pregnancy: an
examination of prevalence and risk factors in 16 states. Matern Child Health J 2003;7:31-43.
13
Castro R, Peek-Asa C, Garcia L, Ruiz A, Kraus JF. Risks for abuse against pregnant Hispanic women: Morelos,
Mexico and Los Angeles County, California. Am J Prev Med 2003;25:323-32. Castro R, Peek-Asa C, Ruiz A.
Violence against women in Mexico: a study of abuse before and during pregnancy. Am J Public Health
2003;93:1110-6.
14
Martin SL, Mackie L, Kupper LL, Buescher PA, Moracco KE. Physical abuse of women before, during, and after
pregnancy. JAMA 2001;285:1581-4.
15
Parker B, McFarlane J, Soeken K, Torres S, Campbell D. Physical and emotional abuse in pregnancy: a
comparison of adult and teenage women. Nurs Res 1993;42:173-8.
16
Parker B, McFarlane J, Soeken K, Torres S, Campbell D. Physical and emotional abuse in pregnancy: a
comparison of adult and teenage women. Nurs Res 1993;42:173-8.
17
Campbell J, Torres S, Ryan J, King C, Campbell DW, Stalling RY, Fuchs SC. Physical and nonphysical partner
abuse and other risk factors for low birthweight among full-term and preterm babies: a multiethnic case-control
study. Am J Epidemiol 1999;150:714-26.
18
Campbell J, Torres S, Ryan J, King C, Campbell DW, Stalling RY, Fuchs SC. Physical and nonphysical partner
abuse and other risk factors for low birthweight among full-term and preterm babies: a multiethnic case-control
study. Am J Epidemiol 1999;150:714-26.
Torres S, Campbell J, Campbell DW, Ryan J, King C, Price P, Stallings RY, Fuchs SC, Laude M. Abuse during and
before pregnancy: prevalence and cultural correlates. Violence Vict 200;15:308-21.
2007 Minority Women’s Health Summit
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Almost half the women in focus groups cited jealousy of the infant as a reason for IPV during
pregnancy.19 During pregnancy, women would be more likely to think about the baby, which
would threaten the partner’s perspective of control. Seventeen percent of women thought their
partners were angry about the pregnancy itself, whereas another 17% thought their partners were
angry at the baby. However, this focus group data revealed a significant percentage of women
for whom abuse was just “business as usual.”
Several studies have found correlations between IPV during pregnancy and negative maternal
health outcomes such as depression, substance abuse, low social support, spontaneous abortion,
smoking, and risk for homicide.20,21 The rate of infant mortality is highest among African
American women and other women of color, and the rate of IPV and infanticide are also high
among these groups. In addition, IPV has been connected with low birth weight, particularly
among low-income women,22 women who smoke, and women who abuse substances.23 It should
be noted that physical abuse is a risk factor for low birth weight in term infants, but not in
preterm infants.24 IPV during pregnancy also has been linked to poor maternal weight gain,
increased risk for preterm delivery, higher miscarriage rates, and poor adherence to medications.
These outcomes can be explained in part by abusers preventing their partners from entering
prenatal care.25 IPV during pregnancy has also been correlated with child abuse, with the most
severe abuse occurring by nonbiological fathers. In some cases, the abused woman is at risk for
hurting her own children. The presence of a stepchild in the home also increases a woman’s risk
for enduring IPV during pregnancy.
Acculturation is a risk factor for abuse among Latina women. Rates increase among women who
have become acculturated to the United States, whereas first generation immigrants are less
likely to experience IPV during pregnancy. Dr. Sharps noted that abuse during pregnancy is
related to cultural values regarding wife beating and the protection of women during pregnancy.
Dr. Sharps pointed out that death from any cause during pregnancy is considered a maternal
death. At one time maternal deaths occurred primarily from bleeding or infection. However, Dr.
19
Campbell JC, Oliver CE, Bullock LF. Empowering survivors of abuse: healthcare for battered women and their
children. In Campbell JC (ed). Sage Series on Violence Against Women. Thousand Oaks, CA: Sage Publications,
Inc., 1998, pp.81-9.
20
Gielen AC, O’Campo PJ, Faden RR, Kass NE, Xue X. Interpersonal conflict and physical violence among a
cohort of low-income pregnant women. Womens Health Issues 1994;4:29-37.
21
Campbell JC, Poland ML, Walter JB, Ager J. Correlates of battering during pregnancy. Res Nurs Health
1992;15:219-26.
22
Bullock LF, McFarlane J. The birthweight/battering connection. Am J Nurs 1989;89:1153-5.
23
Curry MA. The interrelationships between abuse, substance use, and psychosocial stress during pregnancy. J
Obstet Gynecol Neonatal Nurs 1998;27:692-9.
24
Campbell J, Torres S, Ryan J, King C, Campbell DW, Stalling RY, Fuchs SC. Physical and nonphysical partner
abuse and other risk factors for low birthweight among full-term and preterm babies: a multiethnic case-control
study. Am J Epidemiol 1999;150:714-26.
Torres S, Campbell J, Campbell DW, Ryan J, King C, Price P, Stallings RY, Fuchs SC, Laude M. Abuse during and
before pregnancy: prevalence and cultural correlates. Violence Vict 200;15:308-21.
25
Campbell J, Torres S, Ryan J, King C, Campbell DW, Stalling RY, Fuchs SC. Physical and nonphysical partner
abuse and other risk factors for low birthweight among full-term and preterm babies: a multiethnic case-control
study. Am J Epidemiol 1999;150:714-26.
Torres S, Campbell J, Campbell DW, Ryan J, King C, Price P, Stallings RY, Fuchs SC, Laude M. Abuse during and
before pregnancy: prevalence and cultural correlates. Violence Vict 200;15:308-21.
2007 Minority Women’s Health Summit
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Sharps noted that medical science has done well in addressing these problems, and now
homicide is the leading cause of maternal death. This has been shown in metropolitan areas such
as New York, Washington, D.C., and Chicago,26 as well as in the state of Maryland.27 A
December 19, 2004, article by Donna St. George28 in the Washington Post noted domestic
violence as a factor in 88 maternal deaths per year since 1990. Dr. Sharps found it compelling
that homicide was a leading cause of death during what most consider as a woman’s happiest
time. She also noted that historically, homicide has been neglected in maternal death reviews.
However, more and more reviewers are looking at possible histories of IPV.
Dr. Sharps outlined several strategies for addressing IPV and pregnancy:
•
Universal screening. Providers should ask all patients about IPV, and they should ask more
than once. Dr. Sharps recommended asking women every time they come in for family
planning, prenatal care, well-child appointments, etc. She cautioned Summit participants not
to make assumptions about who is abused.
•
Referrals. Providers should know where social workers, shelters, legal assistants, and other
resources are in the community. They should find out the patient’s concerns and make the
appropriate connections. Dr. Sharps pointed out that not all women will want to go to
shelters.
•
Danger assessment and safety planning. Providers should help women understand how
dangerous their situations are. Dr. Sharps displayed a tool available on the Johns Hopkins
University Web site and described how women start to understand their risk as they go
through this tool. Providers are then in a position to help women with safety planning.
•
Empowering women. Providers should listen to women’s stories, increase their awareness,
and acknowledge that these women do not deserve the treatment they receive. Dr. Sharps
added that providers should let women know how concerned they are.
Dr. Sharps summarized the provider’s role in conducting routine assessment at each prenatal care
visit,29 being alert for child abuse if IPV during pregnancy is noted, understanding the particular
tendency for hope in a relationship during pregnancy (that is, many women hope the pregnancy
will make a difference, and some will continue to try to make it work), and conducting routine
assessments during postpartum visits. Dr. Sharps also emphasized the need to include men. She
pointed out that most efforts to improve maternal and child health have excluded men, which
might further aggravate relationship and abuse issues. Many men might have been abused
26
Dannenberg AL, Carter DM, Lawson HW, Ashton DM, Dorfman SF, Graham EH. Homicide and other injuries as
causes of maternal death in New York City, 1987 through 1991. Am J Obstet Gynecol 1995;172:1557-64.
Krulewitch CJ, Pierre-Louis ML, de Leon-Gomez R, Guy R, Green R. Hidden from view: violent deaths among
pregnant women in the District of Columbia, 1988–1996. J Midwifery Women’s Health 2001;46:4-10.
27
Horon IL, Cheng D. Enhanced surveillance or pregnancy-associated mortality—Maryland, 1993–1998. JAMA
2001;285:1455-9.
28
St. George D. Researchers stunned by scope of slayings. Washington Post 12/19/2004, p. A21.
29
McFarlane J, Parker S, Soeken K, Bullock L. Assessing for abuse during pregnancy. Severity and frequency of
injuries and associated entry into prenatal care. JAMA 1992;267:3176-8.
2007 Minority Women’s Health Summit
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themselves or are hurting in other kinds of ways. Dr. Sharps cited initiatives on the Family
Violence Prevention Web site that address ways to safely engage men.
Dr. Sharps then provided more information about assessments. She focused first on how to ask
questions. Women should be asked about IPV in private, away from their partners, family,
children, and friends. If interpreters are needed, professional interpreters and not family or
friends should be used. Questions should be asked as part of routine care, at every visit, so that
women do not feel singled out. Questions should be direct. Providers should listen and be
sensitive, taking care not to minimize a woman’s experience. Dr. Sharps reminded the audience
that women suffering IPV have endured unimaginable situations, and most often no one has told
them how important it is that they survived or made decisions to protect themselves. In this way
providers can build on resilience and strength, rather than victimizing women further.
Dr. Sharps then highlighted assessment tools. One is the Abuse Assessment Screen, which asks
whether a woman has ever been emotionally or physically abused by her partner or someone
important to her; whether she has been slapped, kicked, hit, pushed, shoved, or otherwise
physically hurt by her partner or ex-partner (and by whom and the number of times); whether her
partner ever forces her into sex; and whether she is afraid of her partner or ex-partner.30 Dr.
Sharps encouraged Summit participants to remember RADAR: Remember to ask; Ask directly;
Document findings; Assess for safety; Review options and refer; and follow up. She also
encouraged them to remember ASSERT: Ask, Sympathize, Safety, Educate, Refer, and Treat.
Dr. Sharps also described interventions. The Tested Ten-Minute Nursing Intervention,31 funded
by the Centers for Disease Control and Prevention (CDC), enrolled 132 poor pregnant women
from urban and rural communities. This population was 36% African American, 34% Latina or
Hispanic, and 30% Anglo. The intervention was longitudinal and consisted of three intervention
visits and three follow-up visits at 0, 6, and 12 months. The intervention taught women safety
behaviors and empowered them to interact with their abusers differently. Significantly more
safety behaviors were used by women in the intervention group, and the amount of abuse
decreased.32 Another intervention is the Domestic Violence Enhanced Home Visitation Program
(DOVE), for which Dr. Sharps serves as the principal investigator. This program is testing the
Ten-Minute Nursing Intervention with a nurse home visitor program administered by public
health departments in urban and rural settings, and it will follow mothers and babies for 2 years.
Dr. Sharps emphasized the importance of involving community, integrating systems, and taking
every opportunity to ask questions. She closed by recommending the domestic violence content
or interventions be included in Healthy Start programs, father’s programs, child protective
services, and postpartum visits. She also recommended that handguns be impounded if an order
of protection or indictment is issued for domestic violence or stalking, and that childbirth
education include assessments for primary prevention of domestic violence.
30
McFarlane J, Anderson J, Helton A. Response to battering during pregnancy: an educational program. Response
to Victimization of Women and Children 1987;10:25-6.
31
McFarlane J, Parker B, Soeken K, Silve C, Reel S. Safety behaviors of abused women after an intervention during
pregnancy. J Obstet Gynecol Neonatal Nurs 1998;27:64-9.
32
Parker B, McFarlane J, Soeken K, Silva C, Reel S. Testing an intervention to prevent further abuse to pregnant
women. Res Nurs Health 1999;22:59-66.
2007 Minority Women’s Health Summit
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Intimate Partner Violence Resources:
National Domestic Violence Hotline
1-800-799-SAFE
Nursing Network on Violence Against Women International (NNVAWI)
1-888-909-9993
NNVAWI.org
National Domestic Violence Health Resource Center (FVPF)
1-800-537-2238
ENDABUSE.org
Phyllis W. Sharps, Ph.D., R.N., CNE, FAAN
410-614-5312
[email protected]
Teen Dating Violence
Rhondra O. Willis, M.B.A., Ph.D. (c), recalled a South Carolina representative who, when
asked about teen dating violence or IPV, said it was the woman’s own fault because she should
leave. She then reminded Summit participants that children take their cues from adults, and she
invited comments and discussion throughout her presentation.
Ms. Willis reviewed quick facts about teens and violence. Twenty-six percent of teens are
concerned about dating violence, and 31% report that they or a friend have experienced dating
violence. Teens identifying as gay, lesbian, or bisexual are just as likely to experience dating
violence as those identifying as heterosexual. The rates of dating violence are highest among
young women aged 16 to 24. A Summit participant noted that the media and music videos
promote attitudes condoning dating violence, and another referred to Dr. Wyatt’s presentation
about the sexualization and exploitation of children. Ms. Willis added that mothers often do not
talk to their children about dating violence and that, although teens are eager to talk about it
when they get to college, steps should be taken to reach them before college.
Like adult IPV, teen dating violence can involve physical, verbal, emotional, sexual, or
financial/emotional abuse. Key factors include humiliation, intimidation, and physical injury, and
anyone can be a victim. In some cases, when a teen tries to end the relationship, the abuser will
not accept the termination. Teens are more likely to hide the abuse not only because they are
embarrassed or ashamed, but also because in some cases, their parents might not allow them to
date so they fear punishment. Although Summit participants noted a few examples of mandated
programs addressing teen dating violence, these examples are in the minority. Ms. Willis noted
that no such program exists in South Carolina, and she called for advocacy to address this need.
Ms. Willis and participants discussed stalking as an aspect of teen dating violence. Stalkers
employ several threatening tactics, including:
•
Repeated phone calls, sometimes with hang-ups;
2007 Minority Women’s Health Summit
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•
Following or tracking the victim, possibly with a global position tracking device;
•
Sending unwanted packages, cards, gifts, or letters;
•
Monitoring the victim’s phone calls or computer use;
•
Watching the victim with hidden cameras;
•
Contacting friends, family, coworkers, or neighbors for information about the victim;
•
Using public records, online searching, or paid investigators to find their victim;
•
Threatening to hurt the victim or the victim’s family, friends, or pets;
•
Going through the victim’s possessions or garbage; and
•
Damaging the victim’s home, car, or other property.
With new online meeting places and social avenues such as MySpace and FaceBook, incidents
of cyberstalking, in which teens are stalked by faceless admirers, are increasing in number. The
effects of cyberstalking can include changes in sleeping and eating patterns, nightmares,
hypervigilance, anxiety, helplessness, fear for safety, and shock and disbelief. Ms. Willis
suggested that parents or caregivers pay close attention to potential effects.
Participants discussed stalking, differences in perceptions between adults and teens, and resulting
difficulties in talking to teens about stalking.
•
One participant noted an incident when one girl’s name was posted with “my bitch” on a
MySpace page. The participant observed that this girl was flattered by the phrase and that
many teens view such words as cool or a term of endearment.
•
Another participant noted an incident where a young girl’s boyfriend wanted to harm her
father, who objected to the relationship, and the girl expressed her boyfriend’s values in
inappropriate terms (“friend with benefits”). This participant emphasized the need for adult
women to engage teenagers and guide them on what is and is not appropriate dating
behavior.
•
Yet another participant pointed out that teens do not define stalking as adults might. She cited
as an example where a young girl reported that her boyfriend picked her up from school,
dropped her off at school, and did not allow her time alone or with friends. This participant
cautioned that adults must be careful in how they ask about stalking and the kind of language
they use, because the teen might assume the adult is jealous or putting the teen down. Ms.
Willis noted that stalking often starts with control and isolation.
•
Another participant noted that defining stalking can be difficult because of cultural
differences in how men should act in dating. For example, Latino men are very persistent, so
2007 Minority Women’s Health Summit
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it is hard for Latina girls to identify stalking. This participant cautioned that in terms of
stalking, one size might not fit all across cultures.
•
A participant suggested that stalking be viewed in terms of the fear and the obsessive or
unwanted aspect of it.
Ms. Willis and Summit participants discussed the importance of cultural competency in
addressing stalking or other issues of teen dating violence. Some participants questioned how
cultural competency is defined; how it can be integrated into practice, particularly among
different racial and ethnic groups, and how to draw boundaries for acceptable and unacceptable
behavior. Ms. Willis responded that in South Carolina, she and her colleagues talked to the target
population and asked what did or did not work, what got their attention, and how best to talk to
them. She agreed on the importance of acknowledging differences between adult and teen
perceptions.
In addition to cultural competency, sex and sexuality should be addressed. Moreover, parents and
families should talk about dating, sex, and dating violence. One participant noted that “it starts at
home”; today’s teens have influences that older generations did not have, and parents should
explain what a good partner is. Another participant shared that her friend’s pregnant, 18-year-old
daughter had been found murdered in a hotel room. She had been killed by the father of her
child. This participant stressed that parents are so busy they do not address the issue until later,
when in fact they should stop everything and address it right now. Ms. Willis shared a case
where a ninth-grade boy was stalked by an 18-year-old girl.
Teen dating violence can morph into adult violence as victims continue to have relationships
where they are abused or devalued. Ms. Willis added out that girls can be just as aggressive as
boys.
Adolescents at most risk for perpetrating dating violence have a history of sustained abuse or
maltreatment as children, abuse of alcohol and drugs, and exposure to community violence. A
history of witnessing violence between parents is also a risk factor, because it encourages an
abuser’s belief that dating violence is acceptable. Signs of a violent partner include jealousy,
possessiveness, refusal to accept the end of relationships, and attempts to control the teen. The
partner might scare or threaten the teen or put her down in front of friends, make the teen worry
about the partner’s reaction to what the teen says, or use of own guns or other weapons. Victims
of teen dating violence might feel that they are at fault, or they might feel sad, angry, lonely, or
depressed. They also might feel helpless to stop the abuse, threatened or humiliated, anxious,
afraid of getting hurt more seriously, or unable to talk to family and friends. Some victims act
out in school.
Ms. Willis discussed ways to engage teen males in discussions about teen dating violence. For
example, programs such as the University of South Carolina’s Changing Carolina provides peer
training for college-age males and educates them to change their attitudes about dating violence.
Dr. Suzanne Swan, who leads the Changing Carolina program, also offers courses on
relationship violence. These courses cover such topics as biological factors of aggression;
reactions to victimization; stalking victimization; battered women and intimate terrorism; sexual
assault; child abuse, incest, and learning to be violent; IPV in lesbian, gay, and bisexual
2007 Minority Women’s Health Summit
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relationships; and forensic assessment of defendant’s family violence history in capital
sentencing mitigation.
Ms. Willis then suggested the following strategies for addressing teen dating violence:
•
Advocate for courses on teen dating violence, beginning in middle school.
•
Advocate for laws that protect teens from dating violence.
•
Advocate for employers that hire teens to provide literature on teen dating violence.
•
Provide training to teachers and school administrators to recognize the signs of teen
dating violence.
•
Work with males to educate them about appropriate attitudes toward dating and
domestic violence.
•
Train law enforcement officers and attorneys to successfully build cases to prosecute
offenders.
•
Provide bilingual advocates for victims and their families to accommodate immigrant
populations.
•
Include conflict resolution in the school curriculum and mentoring programs, and work
directly with nonprofits that serve youth.
Ms. Willis closed her presentation by encouraging participants to seek help, record incidents,
seek orders of protection, notify school officials (including resource officers), and develop safety
plans if they see a teen being abused.
In response to questions about ways to encourage girls to protect themselves legally, Ms. Willis
suggested restraining orders, making school officials aware, and enrolling girls in self-defense
courses. Another participant asked about providing teens with ways to describe dating violence,
similar to teaching children the names of their body parts to help them describe sexual abuse.
Although Ms. Willis did not know of any, she noted that she uses role-play in her work and
suggested that a tool be developed.
A participant who lives in a primarily Hispanic area near the border described a generational
shift, such that men no longer call girls, ask for dates, or speak with their parents. Instead, only
girls who are willing to have sex are the ones with boyfriends. The participant noted the
difficulty in encouraging positive relationships when faced with that type of peer pressure. Ms.
Willis had also noticed such a shift. The factors for this shift are not known, but Ms. Willis
speculated that the decreased pool of eligible partners and an implied message that women have
to accept this type of treatment might play roles.
Another participant pointed out the connection between violence and HIV/AIDS; according to
the CDC, 90% of HIV-infected women are in or have been in violent situations. The participant
2007 Minority Women’s Health Summit
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suggested that information about HIV/AIDS be incorporated into programs or interventions
addressing dating violence.
A physician who focuses on prevention asked about population-wide activities that State, county,
and other agencies could do to help adults and adolescents in recognizing when they are in
potentially violent relationships. The physician also asked what could be done at a personal level,
how individuals could be advised. Ms. Willis reiterated her call to develop training methods and
work with law enforcement providers and attorneys and to incorporate cultural competency and
develop peer training in the schools. She also emphasized the importance of accommodating the
person’s cultural background, as one size does not fit all.
Teen Dating Violence Resources:
Love Is Not Abuse
www.loveisnotabuse.com
Break the Cycle
310-286-3366
1-888-988-TEEN
www.breakthecycle.org
[email protected]
Teen Outreach Program
www.teenrelationships.org
Jane’s Due Process (JDP)
www.janesdueprocess.org
Promote Truth
www.promotetruth.org
U Have the Right
www.uhavetheright.net
Safe Youth
www.safeyouth.org/scripts/index.asp
The Quiet Storm Project
www.thequietstormproject.com/tgsp.html
Love Doesn’t Have to Hurt
www.apa.org/pii/teen
Cool Nurse
www.coolnurse.com/teen_dating_violence.htm
2007 Minority Women’s Health Summit
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Teen Dating Violence References:
Womenslaw.org
NYC Government
Applied Research and Consortium LLC for Liz Claiborne, Inc.
Helpguide.org
National Centers for Victims of Crime
http://ohioline.osu.edu/flm01/FS07.html
Teen Advocacy Education Programs
Cultural Competency and Domestic Violence
Sujata Warrier, Ph.D., Director, New York Program, New York State Office on the
Prevention of Domestic Violence, posed a scenario from Young,33 asking participants to
imagine facing the Old Royal Observatory in Greenwich, England. She described a walk around
its walls leading to a brass strip set in the pavement. The smooth, gold band on the ground marks
the Prime Meridian, or Longitude Zero. If one were to stand to the left, Dr. Warrier noted, one
would be in the Western Hemisphere. If that same person were to stand to the right, however,
they would be in the East. No matter who that person is, he or she would have been translated
from a European into an Oriental.
Dr. Warrier pointed out that much of what many think about culture centers on dividing lines of
difference. However, these lines hinder one’s ability to understand who someone is, what groups
that person belongs to, and where that person comes from. Many know that culture shapes an
individual’s experience of violence, how a perpetrator will accept responsibility for his or her
actions, what kinds of interventions are undertaken, and how one obtains access to services. Dr.
Warrier noted that when people think of culture, they are often curious about the culture of the
other person. They look on the Internet, go through diversity training with a “rainbow panel,”
and come to a point where they think they understand an individual based on their understanding
of that individual’s culture. People rely on stereotypes because these images make life easier. Dr.
Warrier warned that in reality, not only is the culture of that person important. The cultural
background of the person providing services, where that person works, and where that person is
in terms of knowledge and understanding is just as important. “Who you are” and “where you
work” are often ignored, because it is so much easier to zero in on who the other person is.
The historical and anthropological process by which many have come to understand culture is
problematic. This process would have one think that culture is a stable pattern of values, beliefs,
and traditions that are passed down from generation to generation for successfully adapting to
other group members and their environment. Historically, people have been curious as to why a
33
Young, RC. Colonial Desire: Hybridity in Theory, Culture and Race. London, England: Routledge, 1995, p. 1.
2007 Minority Women’s Health Summit
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population does things a certain way, and that curiosity has led people to ask questions and
driven understanding. Yet most of the historical definitions of culture were established by
Europeans as they went through the world observing different people. Dr. Warrier pointed out
that when one observes another, that person must remember that he or she observes through a
particular lens based on his or her own experience and background. Thus, historical cultural
definitions tell more about the Europeans than about the culture being observed. Slavery, the
Holocaust, treatment of women, and other phenomena were based on the initial definitions of
culture and the perception that a group needed to be “civilized.”
Culture is about shared experiences and commonality, but nothing is fixed. Politics, economics,
situations, and settings change. Yet culture has been viewed, and historical oppression
perpetrated, in terms of race, ethnicity, national origin, sexuality, gender, religion, age, class,
disability status, immigration status, education, geography, rural versus urban, time, or other axes
of identification. Each category by itself is problematic. How these categories intersect, as well
as the history of oppression and power, matters most. Thus culture is more complicated and
nuanced then one would like to think.
Discussions about violence against women often pay more attention to gender and create a
hierarchy of oppression. But this is not how women experience the violence. They experience it
along all axes. The perception of a hierarchy of oppression can sometimes impede one’s access
to services. Dr. Warrier cited as an example the case of an African American woman she had
worked with. This woman did everything she had to do to get help in leaving an abusive
situation, but her mother thought the ex-husband was the best thing to happen to the daughter.
Thus, whenever the woman moved and called her mother, the mother would call the ex-husband.
The woman eventually decided to move away from New York City, and after a 6-month process,
she had moved to a new community, had found a good job, and had placed her kids in a good
school. Eight months later, however, the woman called Dr. Warrier to say she had returned to
New York City. She’d gone grocery shopping one day and encountered two White men who had
spat at her, used racial slurs, and told her to go back to where she had come from. Dr. Warrier
now noted that focusing on race or gender is not enough. Everyone lives a multilayered life, and
the totality of those layers must be understood.
Dr. Warrier pointed out that privilege and access lie in every axis of social context. In the United
States, the dominant attributes are White, male, English, Christian, and heterosexual. Each of
those axes involves control or power over someone else. Dr. Warrier noted that some have more
privilege than others, but all have some privilege, which means that all can dominate in some
kind of way. No one holds a crown of oppression. Dr. Warrier further noted that domination
begins with a large amount of misinformation and that that type of colonization still exists today.
Violence against women occurs on a continuum, which includes female infanticide, incest,
sexual harassment, poverty, domestic violence, and the murder of women. Violence against
women also can be understood as occurring on a tightening spiral or coil or as a corkscrew. In
looking at violence against women, one must look at the totality of what happens in those
women’s lives. When a provider sees a woman about an incident, he or she must understand that
this incident is only part of a totality of the woman’s experience. The provider must understand
how that woman understands her experience on the basis of various categories, and the provider
must understand that all of these axes, as well as past access, will shape how the woman
2007 Minority Women’s Health Summit
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responds to intervention. Thus, providers must keep a broad framework in mind. Sexism
intersects with racism, which intersects with classism. Dr. Warrier emphasized that all of these
forms of oppression go together and that providers must stop looking at one slice of it.
Dr. Warrier outlined some culturally competent assumptions:
•
All cultures are contradictory in that there are both widespread acceptance of domestic
violence (as part of society) and traditions of resistance.
•
Each victim is not only a member of his/her community, but a unique individual with his or
her own response. The complexity of a person’s response to domestic violence is shaped by
multiple factors.
•
Each individual comes into any encounter with cultural experiences and perspectives that
might differ from those present in the system.
•
All institutions have to develop specific policies and procedures to systematically build
cultural competence.
Dr. Warrier noted reports from the United Nations Secretary General and the World Health
Organization (WHO) stated that violence against women occurs everywhere in the world. She
further stressed that there should be no room for negotiation when it comes to abuse, violence, or
trafficking, that providers must be clear that violence against women is unacceptable, and that
relativism—saying “Oh, it’s okay in their culture”—is unacceptable. How providers work with
women will differ because each woman’s understanding will differ.
Dr. Warrier outlined the following strategies in developing cultural competency:
•
Know your own stuff. Providers must be aware of their own biases, prejudices, and
knowledge about a victim. For example, they must challenge their assumptions, use
appropriate language, and be aware about assumptions of family.
•
Recognize your professional power. In so doing, providers must avoid the imposition of
their own values. For example, they should ask non-judgmental questions.
•
Listen to the victim. For example, providers should let victims narrate their own stories, and
they should not assume that people have resources.
•
Gather information about the victim’s interpretation of her culture. For example,
providers can ask who the victim has talked to, what that person’s response was, or what it is
like to talk about her experience in her community.
•
Validate the victim’s strengths. For example, in an intervention, providers can thank the
victim for sharing and acknowledge existing support systems and efforts to keep the victim
safe.
•
Ensure victim safety and self-determination. For example, the provider should develop
safety plans that account for culturally specific needs.
2007 Minority Women’s Health Summit
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•
Negotiate acceptance of a different set of values. Providers should remember that it takes
time for people to accept new systems and ideas. Patience is critical.
•
Develop linkages with the community. Providers should give culturally appropriate
referrals and work with community-based agencies.
Dr. Warrier also presented a World Traveling Method of Cultural Competency,34 which
acknowledges that culturally challenging practices require a vision of independence and
connectedness. She noted problems with the term “cultural competence,” which implies that one
can simply receive formal training and be competent. Instead, cultural competency is an ongoing,
lifelong process in which people understand themselves in their own historical context, with an
emphasis on the overlaps, influences, and conditions they observe in others. People must also
understand their historical relationship to others, seeing themselves as others see them, and they
must see others in their own contexts. Otherwise, they will present themselves as arrogant, which
will create distance between themselves and “the Other.”
Dr. Warrier noted how easy it is to say, “Oh, you poor barbaric people” or “those people”
without asking how different that person’s culture is from one’s own. She closed by quoting
lyrics from an old Berber song:
“So vast the prison crushing me,
Release, where will you come from?”
Discussion
Discussion of this presentation began with a woman whose mother came from Africa. This
woman noted the common perception of Africans as ignorant, barbaric, dark, and “running
around naked.” The woman agreed that color does not determine who a person is, and she
challenged others to question the media’s role in a community and who that role serves.
In response to questions about what exactly to call the process, if not “cultural competency,” Dr.
Warrier reiterated that “competency” and “proficiency” do not adequately represent what needs
to be done. She suggested that the combination of sensitivity, curiosity, and challenging and
interrogating one’s own perception and attitudes is more self-reflection. In response to another
participant’s question about the usefulness of having people from different cultures serve as
resources, Dr. Warrier cautioned that one cannot just say, for example, that they have an Asian to
deal with Asian issues. Differences along several categories must still be taken into account to
help one understand someone else’s background. Dr. Warrier noted that trainings are useful, but
they are only a starting point.
One participant asked about ways to bring these ideas into the realm of policy. Dr. Warrier
acknowledged the difficulty in doing so. She emphasized that when people develop policy, they
should not believe, for example, that all African Americans or Latinos think the same way.
Instead, those crafting policy should attempt to get many different points of view. Policies must
34
Gunning I. Female genital surgeries. Columbia Human Rights Law Review 1992;23:189-248.
2007 Minority Women’s Health Summit
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accommodate a larger population, but caveats can be written in to address the views of
individuals for whom the policy might not work.
Cultural Competency and Domestic Violence Resource:
Sujata Warrier, Ph.D.
212-417-4477
[email protected]
Closing Remarks
Frances Ashe-Goins, R.N., M.P.H., Deputy Director, Office on Women’s Health, DHHS,
acknowledged the richness of experience represented by the women presenting during this
Institute. She noted common thoughts of people on the outside of a situation: “That’s in someone
else’s house,” “those other people,” “that would never occur in my family.” She noted that
violence against women should not be greeted by silence. It occurs in homes, families,
community, and society. Ms. Ashe-Goins informed participants that a friend of hers could not
attend the Summit because that friend’s daughter had been stabbed to death by her partner. She
emphasized that women can no longer choose not to become involved or hope that someone else
will take care of it. Ms. Ashe-Goins expressed the hope that participants at this Institute would
commit to doing something, rather than allowing abuse to happen to girls and boys.
2007 Minority Women’s Health Summit
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Minority Women’s Health Summit
Women of Color: Addressing Disparities, Affirming
Resilience, and Developing Strategies for Success
Introduction and Purpose of the Summit
The Department of Health and Human Services (DHHS) Office on Women’s Health (OWH),
with contributions from the DHHS Office on Minority Health (OMH), the Administration on
Aging (AOA), the Substance Abuse and Mental Health Services Administration (SAMHSA),
and the Health Resources and Services Administration (HRSA), convened the third summit to
address health disparities among women of color living in the United States. The summit, titled
Women of Color: Addressing Disparities, Affirming Resilience, and Developing Strategies for
Success, was co-sponsored by the National Hispanic Medical Association (NHMA) and the
National Medical Association (NMA). Other co-sponsors included Verizon, United Health
Group, Baylor College of Medicine/Intercultural Cancer Council, and the Lupus Foundation of
America.
Wyeth Pharmaceuticals and AstraZeneca contributed to the efforts of the National Hispanic
Medical Association.
Previous Minority Women’s Health Summits had been held in 1997 and 2004. The 2007 Summit
aimed first for participants to build on the knowledge gained in these Summits and to identify
distinct health issues that disproportionately affect minority women, which would facilitate the
improvement of existing programs. Participants discussed health issues that could be
incorporated into national, State, and local health policy agendas and identified action-oriented
strategies to increase positive health outcomes for women of color across the lifespan, from both
rural and urban communities. The second goal of the 2007 Summit was for participants to
highlight successful models of health promotion and prevention that could be replicated in the
community. Skills-building workshops explored existing prevention strategies, including
strength-based approaches that worked in various rural and urban communities. Also toward this
second goal, the Summit fostered community partnerships to identify and implement best
practices targeting prevention, diagnosis, and treatment of diseases that disproportionately affect
women of color.
The 2007 Women’s Health Summit began with a presentation of the colors and the singing of the
national anthem by Emmett Nixon.
Welcome and Opening Remarks
From the DHHS Office on Women’s Health
Frances Ashe-Goins, R.N., M.P.H., Deputy Director, OWH, DHHS, welcomed participants
to the opening session of the 2007 Minority Women’s Health Summit. She noted that this was
the third such summit and acknowledged members of the planning committee.
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Wanda K. Jones, Dr.P.H., Deputy Assistant Secretary for Health, Office on Women’s
Health, DHHS, acknowledged co-sponsors and other partners or contributors, then introduced
the speakers for the opening session.
From the National Hispanic Medical Association (NHMA)
Elena Rios, M.D., President and CEO, NHMA, expressed appreciation for the amount of
enthusiasm she observed for the 2007 Women’s Health Summit. She recognized the importance
of women’s health to the future of the United States. She noted past efforts, history, and the
importance of knowing where we have come from, but she also acknowledged the dawn of a
new age in which more women are in leadership positions throughout the health care system and
serving as trailblazers for women and women’s health.
Dr. Rios expressed that the NHMA and its Latino colleagues could not do what they do without
other minority groups in the Washington, D.C., area. She emphasized the importance of
collaboration in moving an agenda forward. Minority organizations in Washington know that by
the year 2050, more than 50% of the U.S. population will be people of color. The country’s
leadership will need to be prepared for this eventuality. Dr. Rios stressed that participants should
continue to document their innovations and evidence for new programs and evaluate these
programs, particularly those reaching women and their families. For example, the prevention of
obesity and associated chronic diseases will become more and more important. Dr. Rios also
called on participants to continue to build their communities. For example, the NHMA works
with national Hispanic leadership and the National Coalition of Hispanic Health to address
health disparities.
Dr. Rios encouraged participants to call their representatives in Congress and offered NHMA
assistance in doing so. She also mentioned two bills making their way through Congress. The
Senate bill, the Minority Health Improvement and Health Disparities Elimination Act, was
introduced in June 2007 by Senator Ted Kennedy (D-Massachusetts) and Thad Cochran (RMississippi). The House bill, the Equitability and Accountability Act, was introduced in July
2007. Both bills aim to allow more recruitment to build culturally competent students and
faculty, to develop research and data collection, and to expand the ability of OWH to establish
more programs in minority women’s health and grants to places such as American Indian
reservations and the United States-Mexico border. Although many are hopeful about the bills,
Dr. Rios called on participants to contact their representatives.
She closed by sharing NHMA’s excitement about the Summit and participants’
recommendations for the future.
From the National Medical Association (NMA)
Nelson L. Adams, M.D., President and CEO, NMA, extended greetings from the Association.
He noted that the NMA had been founded in 1895, but that many of the issues affecting the
United States in 1895 were still present in 1995 and are still present today. Thus meetings like
this Summit remain important. The NMA represents 30,000 African American physicians and
other health care providers. Health and wellness, the elimination of health disparities, the
2007 Minority Women’s Health Summit
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sustenance of physician viability, and operational excellence are the Association’s goals. The
2007 Minority Women’s Health Summit covers two of these strategic goals.
As an obstetrician-gynecologist, Dr. Adams was aware of issues affecting women, particularly
women of color. He noted however, that he is a son, a husband, a father, and a brother, and he
has seen the impact of women of color. He became an obstetrician-gynecologist partly because
he understood that to produce change in communities, he would have to be in touch with those
who have the power to influence communities. Dr. Adams stressed that women are the ones who
determine values, diet, family activities, first aid, preventative or acute health care. In short,
women establish who we are.
Dr. Adams noted that although access to the health community is important, and though genetics
and environment play their roles in health, about 50% of health outcomes are related to personal
choices. As Henry Louis Gates said, “We can’t talk about the choices we have until we talk
about the choices we make.”
He called on participants to be encouraged, inspired, and motivated, but he noted that the true
secret, “the secret sauce,” was education. He was proud to say that among 24 scientific sections
of NMA, two focus exclusively on issues concerning women and particularly minority women.
Historically, women and minorities have been excluded from clinical trials. Dr. Adams
mentioned the NMA’s Project IMPACT program, which trains physicians to become clinical
investigators. He also described TeaTalk, a program that brings African American women
together in a relaxed, supportive environment to discuss the importance of wellness practices.
TeaTalk participants feel empowered to turn health education into action.
Dr. Adams suggested that as Summit participants pursue the secret sauce of education, they use
the four Cs: competence, commitment, compassion, and collaboration. He encouraged
participants to do their best in everything they do and say. He closed with a quote that serves as
his personal philosophy:
“Good, better, best, never let it rest. Our good becomes our better, and our better becomes our
best.”
From the Administration on Aging (AOA)
The Honorable Josefina Carbonell, Assistant Secretary for Aging, AOA, expressed greetings
from Mike Leavitt, Secretary, DHHS, who was in Africa with a delegation from the Department.
She also welcomed 25 young leaders who were attending the Summit. She noted that the AOA is
produce to be a partner in the Summit, which is a perfect example of successful partnerships
between the Federal Government and national minority organizations to improve the health of
Americans of all ages, with a particular emphasis on women of color. She acknowledged the
grandparents struggling to find treatment and health care options for themselves and the
grandchildren they are raising, and she mentioned the National Caregiver Support program,
which will be launched in 2008.
The value of working in collaboration with families was impressed upon Ms. Carbonell early on,
and it has guided her work at AOA. As Assistant Secretary for Aging, she seeks to enhance the
Secretary’s efforts to improve the health of the nation by building, strengthening, and leveraging
2007 Minority Women’s Health Summit
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relationships across communities, particularly to modernize health and long-term care. DHHS
works to address racial and ethnic health disparities and improve overall access to medical and
public health care through value-driven health care initiatives. The Department also aims for
consumers to gain control of their health care and to be informed so they can make decisions for
themselves and their families. Ms. Carbonell stressed that information and education are
important components of empowerment. She pointed out that disease can be reduced by adopting
healthier lifestyles. DHHS is committed to helping people build a foundation of wellness, which
comprises physical activity, healthy foods, medical screenings, vaccinations, and avoidance of
risky behaviors. Prevention helps people to make themselves and their families better. These
priorities have a great impact on women because of the roles they play in family and community
life. Women are the heartbeat of families and communities and represent the backbone of
caregiving in the United States.
The impact of chronic disease is pronounced among American racial and ethnic minorities. Heart
disease, cancers, cerebrovascular disease, and diabetes are among the leading causes of death for
African American, Latina, American Indian/Alaska Native, and Asian/Pacific Islander women.
These diseases threaten the independence and dignity of all people. Unintentional injuries are
also among the top causes of death for American Indians, Alaska Natives, Asians, and Pacific
Islander. However, all of these can be prevented or managed by behavioral lifestyle changes.
Efforts to prevent falls and ensure access to drugs for hypertension and diabetes make a
difference. To reduce the impact of chronic disease for all, preventive services must be made a
priority, as quickly as possible. DHHS is focused on including preventive services in programs
such as Medicare, and it has worked hard to promote these services in communities across the
country, so that people can receive health education and services in places where they live, work,
and play.
One such program is the Healthier U.S. Starts Here campaign, which has traveled to 21
metropolitan areas and rural towns, 45 states, and Washington, D.C., to reach out to beneficiaries
who are not obtaining free vaccinations and screenings. Ms. Carbonell also mentioned Healthy
People 2010, which outlined a set of health objectives for the first decade of the new century and
aimed to close gaps in the health experiences of various racial and ethnic communities. These
objectives have been used by many States, communities, and individuals to develop programs to
improve health. Ms. Carbonell encouraged other groups to integrate these objectives into events,
education, publications, and meetings. Schools, colleges, civic organizations, and faith-based
organizations can take advantage of these objectives, and health care providers can use them to
help their patients pursue healthier lifestyles.
Ms. Carbonell stressed that it was never too early or too late to start living a healthy life,
regardless of age, race, or ethnicity. She noted that many minority women come from close
families that spend a large amount of time together, and asked what better way there was to
promote good health across the lifespan by education and example? She also emphasized that
women often form the fabric sustaining the family during a crisis. They hold the family together,
are resilient, and respond to disaster. Ms. Carbonell called on participants to help older women to
plan.
Ms. Carbonell noted that in 2005, there were approximately 3.3 million older Hispanics in the
United States. By 2028, Hispanic elders will form the largest minority population in the United
2007 Minority Women’s Health Summit
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States. A 2006 report by the Agency for Healthcare Research and Quality on health disparities
affirmed persistent and growing health disparities and a higher incidence of chronic conditions,
including heart disease, diabetes, and arthritis, among Hispanic elders. Secretary Leavitt has thus
launched a Hispanic Elders Community Partnership Initiative. This initiative will help elders
take advantage of services available to them through the Older Americans Act and Medicare.
Metropolitan areas have formed teams across health and organizational needs, and these teams
will address chronic illnesses and health screening accessibility. The teams will join together to
form a national learning network, with a plan to address one or more health disparities concern
over the next 15 months. Ms. Carbonell announced that the following communities had been
selected to participate in this initiative: Chicago, Illinois; Houston, Texas; Los Angeles,
California; McAllen, Texas; Miami, Florida; New York City, New York; San Antonio, Texas;
and San Diego, California. Ms. Carbonell noted that the work of these partnerships would
provide opportunities for all and had the potential to help millions of Hispanic families and their
loved ones.
In closing, Ms. Carbonell commended Summit participants on all the work they do every day.
She challenged them to stay engaged, to learn and seek out something to take back, and to work
for change, competence, and action. She stressed that participants were the leaders and strengths
of their communities.
Other Remarks
Dr. Jones cited Ms. Carbonell’s mention of Secretary Leavitt’s trip to Africa, which he has taken
as part of the President’s Emergency Plan for AIDS Relief. Dr. Jones referred Summit
participants to the Secretary’s blog on his experiences during this trip. The blog is available on
the HHS Web site.
Ms. Ashe-Goins recognized Sharon Golden and Debra Mitchell-Golden, nieces of Janet
Mitchell, M.D., M.P.H., who had long worked to improving the health status of women,
including those of color. She had worked to address such issues as infant mortality, adolescence,
HIV/AIDS, and substance abuse, published several articles and book chapters, chaired the panel
that wrote the original treatment improvement protocols for substance-using pregnant women,
and directed the largest prenatal program for substance-using pregnant women. Dr. Mitchell was
a founding member of OWH’s Minority Women’s Health Panel of Expert. Ms. Ashe-Goins
noted that Dr. Mitchell now has Alzheimer’s disease and was therefore unable to attend the
Summit. She presented a plaque to Dr. Mitchell’s nieces in recognition of all Dr. Mitchell’s work
in minority women’s health.
From the Eyes of Women: Disaster Response, Recovery, and
Resilience
This session, moderated by Vicki Mays, Ph.D., UCLA, focused on various women’s
experiences in response, recovery, and resilience in the wake of Hurricane Katrina. During this
crisis, the media presented several faces, as well as its interpretations of behavior, to the public.
Yet many faces and many stories were missed and remained invisible, despite the devastation
they too faced from Hurricanes Katrina, Rita, and Wilma. The impact on women also was
downplayed or ignored. According to a recent report of the Women’s Foundation Network, for
2007 Minority Women’s Health Summit
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example, Mississippi lost 94% of its public housing, or 25,000 homes. Of the 180,000 jobs lost,
many had been held by women in industries specific to women. Many women were sexually
assaulted. Many women who had owned homes before Hurricane Katrina lost them during the
storm.
During this session, speakers addressed those studies, told their stories, shed light on populations
and problems ignored by the media, and offered insights on ways to prepare for disaster. The
lessons learned, and the illustrations of response, recovery, and resilience, can be applied,
regardless of issue, type of disaster, or geographic location.
From the Perspective of the Houma Nation of Louisiana
Morning Dove Verrett Hopkins, of the Houma Nation of Louisiana, began her remarks with
a prayer. She then pointed out that the hurricane did not hit just New Orleans. Nor was it
prejudiced. It also hit everyone in the lower lands of Louisiana. Ms. Hopkins showed pictures of
Plaquemines, St. Bernard, and Jefferson Parishes, all of which were devastated by the storm. The
Houma Nation, which is based in Plaquemines Parish and includes 18,000 people, lost 8,000
homes. The media showed the French Quarter, and public officials expressed a desire for people
and tourists to return to New Orleans. However, Ms. Hopkins stressed that her people wanted to
come back, too. Many are still living in Federal Emergency Management Administration
(FEMA) trailers, some with their children or grandchildren. Homes have not been repaired, and
in many cases, homes are beyond repair.
Ms. Hopkins showed pictures of and described that United Houma Nation Hurricane Relief
Center. She addressed the common misconception that Native Americans receive a large amount
of money from the Federal government, by pointing out that her chief, Brenda Dardar
Robichaux, does not receive compensation for her work in tribal government. In the wake of
Hurricane Katrina, however, she opened her father-in-law’s store as a hurricane relief center.
Donations from several individuals and organizations were stored here, and doctors arrived to
donate tetanus and flu shots. Chief Dardar Robichaux also put out food for hurricane relief
volunteers and set up tents in her yard. Ms. Hopkins pointed out, however, that because
thousands of people had lost everything, the stocks did not last long. She also pointed out that
many people had packed for 2 or 3 days, as is usually instructed when one evacuates for a
hurricane, but that in this case, evacuees could not go home.
Ms. Hopkins stressed that out of something terrible came a lot of good. The disaster brought
awareness of the Houma Nation. She did point out, however, the ironies of how Houma Indians
are treated. The Houma Nation is a large tribe with State recognition, but the Federal
Government has yet to recognize it. Ms. Hopkins noted that she still had to have a card with a
number to prove who she was, what tribe she belonged to, and who she was. She recalled her
childhood in Terrebonne Parish. Her father trapped fish and hunted for a living and raised 10
children. Ms. Hopkins went to a missionary school, but the Federal Government then determined
she had to attend an Indian school. She noted the irony in being told to go to an Indian school by
an entity that did not recognize her Indian heritage.
Ms. Hopkins went on to describe her community, which accepts everyone. For example,
throughout its history, the Houma Nation welcomed African Americans coming to their tribe,
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many of whom were running from slavery, and treated them as family. The Houma are a proud
people who live off the land. Ms. Hopkins also noted the loss of wetlands and islands at the
Louisiana coast and the importance of building up these natural resources to curb future impacts
on the Houma people.
In closing, Ms. Hopkins told of Miss Marie Dean, a Houma woman who lives on $300 a month
and makes dolls and baskets. Ms. Hopkins showed pictures of Miss Marie’s new home, which
volunteers had helped to rebuild and repair.
For More Information:
United Houma Nation Hurricane Relief
20986 Highway 1
Golden Meadow, LA, 70357
www.unitedhoumanation.org
From the Perspective of the Vietnamese Community
Tram Nguyen, Boat People SOS, noted that the Vietnamese community also was invisible in
the aftermath of Hurricane Katrina. She recalled that in the first few days following the storm,
many Vietnamese Americans throughout the nation were talking. Word of mouth, which remains
this community’ primary means for conveying news, said, “It’s 1975 all over again.” Ms.
Nguyen recalled that in September 2005, when she arrived in Houston, she realized what this
meant, and she started to think about her own family in refugee camps in Thailand, Cambodia,
and other Southeast Asian countries. As had been the case in 1975, the sense of loss following
Hurricane Katrina had been great.
Following the fall of Saigon in 1975, and through the 1980s and early 1990s, Vietnamese came
to the United States in waves. They had no money and little education. They faced cultural
barriers and could not speak to anyone. Yet they made a life for themselves. Thirty years later,
Hurricane Katrina destroyed all they had built, and many Vietnamese again went through the
trauma of having to start over from nothing. Ms. Nguyen pointed out that the community
persevered and was resilient before, and it will do so again. But she repeated that many felt like it
was 1975 all over again.
In the days before Hurricane Katrina made landfall on the Gulf Coast, the Vietnamese
community faced many barriers. Women, who had been overburdened with domestic
responsibilities, had had no opportunities and could not speak English. Yet all warnings and
evacuation orders were broadcast in English. Even though these women had their televisions on,
they could not understand what was being said and therefore could not understand the severity of
what was coming. Moreover, because of their caregiving responsibilities, they were not mobile.
Eventually, by word of mouth, those who were mobile knew to leave, but they did not have time
to gather important documents such as their legal/immigration papers or health information. Nor
did they know where to go. They learned by word of mouth to go to Houston, and as they
approached Houston, Vietnamese radio stations instructed them to go to Hong Kong City Mall.
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Once they arrived, however, they found a site that did not know they were coming. Even so, the
community started to rally around itself, and staff at Hong Kong Mall scrambled to provide for
the evacuees.
The Vietnamese who could not leave found themselves in megashelters such as the Superdome
and the Convention Center. Ms. Nguyen recalled the horror stories the public heard about these
shelters, and she acknowledged that although some of these stories were exaggerated, some were
not. She told the story of a Vietnamese family who evacuated to the Superdome because they did
not know what else to do. They felt as if they had been forced to go there. A 9-year-old girl in
this family was raped and killed. Ms Nguyen quoted a Louisiana caseworker who noted that had
this community been given different services from the beginning and had they known their
options, this tragedy would not have occurred. Had there been education, or if language had been
addressed, the community would have better understood what was coming.
Ms. Nguyen emphasized the importance of ensuring access to information, particularly among
the women of the community. Women are the caregivers, and they understand the needs of their
families and communities. She also stressed the need to address language barriers and to
understand the cultural context of these communities. For example, one barrier in the postKatrina response and recovery has been a cultural belief in keeping one’s personal problems
private. Ms. Nguyen noted that many in the Vietnamese community are proud and stubborn and
that they do not ask for help. This is especially an issue for women, who are less apt to voice
concerns or speak out against their elders or husbands. However, the presence of organizations
and staff who can relate to them has resulted in shifts among Vietnamese women from the
coastal communities on the Gulf. These women are starting to believe they can change things.
They have taken on the roles of community organizers, in addition to their traditional roles as
caregivers.
One example of this change can be seen with the battle against the City of New Orleans over the
Chef Menteur Landfill. The city decided to ship all Hurricane Katrina debris to this landfill,
which lies 2 miles from the largest Vietnamese community and the largest wildlife reserve in the
area. The Department of Environmental Quality designated this landfill as a site to store
hurricane debris without the Vietnamese community’s input. Moreover, there was already
evidence of negative health outcomes from prolonged exposure to this landfill. The Vietnamese
community, with the help of the Louisiana Environmental Action Network and other
organizations, sued for an injunction. At first, the U.S. District Court judge rejected the
injunction based on the defending lawyer’s argument that such an injunction would prolong
clean-up efforts. Such a decision signaled that the public health of this community was not
important. However, the community continued to fight, and the landfill was finally closed in
August 2006.
Ms. Nguyen stressed that clean-up standards should not be weakened or minimized for minority
communities simply because a disaster had occurred. Otherwise, the harm from the disaster
would be compounded. Ms. Nguyen called for equal standards and equal protection of public
health across communities, and she suggested that agencies charged with cleanup should ensure
that minority and low-income communities do not receive disparate treatment.
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Although the Vietnamese community was successful in this regard, it is still plagued with many
long-term challenges including unstable housing, displaced support systems, and financial stress.
Many government systems are designed for nuclear families with one head of household. Yet
many households in the Vietnamese community include many family members, and now family
members are fighting over who will be the primary applicant for an address. Families are able to
obtain assistance and FEMA trailers, but 300 square feet is not enough to accommodate nontraditional families of eight to ten people. Those in FEMA trailers are threatened with eviction,
suffering negative health effects from the formaldehyde in these trailers, and living in cramped
conditions, which exacerbates problems with domestic violence. Women who are suffering
abuse are afraid to leave because they have lost their immigration papers.
Moreover, stress on the community is heightened by the clear fact that they are not included in
the rebuilding plans for many cities. Ms. Nguyen cited as an example East Biloxi, in which landgrabbing to build casinos is rampant. The Vietnamese community is slow to return to their
homes on the Gulf because of lack of resources and information. The State of Mississippi
legislated that anyone who had not returned within a certain amount of time would lose their
land, leaving the way open for casinos to take the land from the Vietnamese, without input from
that community. Ms. Nguyen pointed out that officials finally agreed to a town meeting, and
even thought to issue Vietnamese-language fliers advertising the meeting. However, there were
no translators present at the meeting itself. Ms. Nguyen noted the record profit of $97.3 million
by casinos in July 2007. She pointed out that public officials in East Biloxi tout these profits as a
sign that the community is rebuilding, when in reality many are still living in FEMA trailers and
on empty lots. She noted that the community is also blamed for being slow to recover because
they visit casinos, and she asked what could be expected when people have nothing else and
casinos are built in their backyards. She closed by noting that without the help of local city
officials, without inclusion in these cities’ plans, there was nothing they could do.
From the Perspective of a Spiritual Leader
Reverend Joan R. Harrell, M.S., M.Div., Director of Strategic Development, Chicago
Theological Seminary, told participants that although she is an ordained woman of God and
called to ministry, she has worked as an international broadcast journalist. She is now in a Ph.D.
program examining how the intersection of religion, media, and politics leads to oppression of
women. Reverend Harrell also is Director of Strategic Development for the Samuel Dewitt
Proctor Conference, which is the largest African American social justice network for African
American female clergy. This group was the first to minister throughout the Gulf Coast
following Hurricane Katrina, regardless of victims’ religious preferences.
Reverend Harrell noted that she was speaking on behalf of women and children who gave her
permission to speak for them. Some of these people have died in the 2 years since the storm.
She spoke of Susie Parks, mother of a 10-year-old fifth grader. Ms. Parks, her husband, and her
son all died on August 30, 2005, a day after the storm struck the Gulf Coast.
She spoke of Shanai Gray, a 3-year-old girl who was slated to begin Head Start the week after
Katrina. However, Shanai died, and her body was not found until October 2005, even though the
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family told everyone where they could find her. Two months after Shanai was found, her
grandmother was found dead in her home.
Reverend Harrell spoke of a mother who watched as her children and her own mother were
swept away by rising water. She noted the televangelists implying she had done something
wrong, and she wanted to know whether God was punishing her because she is poor.
This is a disaster- and tragedy-ridden era, Reverend Harrell said. She pointed out that for many
of the sisters who had died during Hurricane Katrina, it was not the storm that had killed them. It
was the levees built by human hands and placed in the lower socioeconomic communities.
People of political power and material wealth did not care about these communities. They did not
consider them valid because they were filled with people of color.
Reverend Harrell spoke of Reverend Arnise Moses, a mother, grandmother, and pastor of two
churches. One of her churches is in the Lower Ninth Ward, and the other is near the airport.
When the levees broke, Reverend Moses had to take care of her family, look for parishioners
from her two churches, and try to take care of herself. When interviewed by Reverend Harrell’s
mentor, Dr. Carolyn McQueary, Reverend Moses said, “I never thought about taking care of
myself until I experienced Katrina.”
Reverend Harrell spoke of Pastor Rose (not her real name), who still lives in the car she drove
from Houston, 2 years later. Pastor Rose still leads a Pentecostal church she started in her
apartment, when she was called to minister to the people of a housing project 5 years before
Katrina struck. She and her church lost everything in the storm. She was able to reach the
nursing home where her mother lived, and she and her mother were pulled from the roof of the
nursing home. She was taken to Houston, but her mother was in Chicago. Yet Pastor Rose felt
called to get back to her parishioners. She borrowed money and drove back to New Orleans. She
has high blood pressure and admits she should take better care of herself, but she feels that she
needs to take care of other people first. She and Reverend Harrell prayed together for Pastor
Rose to receive strength, wisdom, and money for medication.
The Samuel Dewitt Proctor Conference is working to help women and men who no longer
receive support from their denominations. Some of these denominations have decided that New
Orleans or the Gulf Coast region will be there no longer, and they are no longer providing clergy
with the resources to help their people. Reverend Harrell pointed out that the Black church has
always been a survival station. She noted also that many women are shunned and discriminated
against in their denominations, simply because they are women. Yet these women are out at the
forefront, taking care of all.
Reverend Harrell called for sisters of poverty, sisters of various SES, and sisters of all colors to
recognize that they all allow the media to separate them. She noted how all had come together
for the betterment of collective health, and she questioned why the media and religious
organizations are allowed to separate them. In this tragedy, people are beginning to realize that
as long as religion, the media, and public policy are allowed to polarize them, they will never
join together. So long as such polarization is allowed—the -isms and phobias that keep people
from helping each other and make people internalize their pain and suffering—holistic healing
will not be possible, and people will continue to be mentally, psychologically, socially, and
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physically ill. Reverend Harrell pointed to the many women living with diabetes, high blood
pressure, and HIV/AIDS and asked why women were killing themselves, allowing the media,
conservative religion, and discriminatory public policy to keep them in individual and collective
pain. She read a poem, “What Makes You Cry Black Woman,” which was written by the
Reverend Linda Faye Matthews, who also is a writer and a member of the law enforcement
division in New Orleans. Reverend Harrell also quoted Reverend Dr. Emilie Townes, a professor
at Harvard University: “As long as there is no individual or community lament, there will be evil
and sickness.”
Reverend Harrell noted that women of faith are tired of victimization and the oppressive
polarization keeping women in so much pain. She asked Summit participants to intently bond
together as women of color, as women, and as human beings, to help heal society and the world.
She noted that the people of New Orleans weep with an expectation of joy in the morning. She
quoted Reverend Linda Faye Matthews’ response of disbelief, loss, and grief when asked about
the amount of money spent in Iraq when so many homes and communities on the Gulf Coast
have not been rebuilt. Reverend Harrell added that what makes women cry could one day make
an entire people cry, and she closed by quoting Toni Morrison: “The bird is in our hands.”
From the Perspective of a Mother, Wife of a Health Officer, and Mental Health
Advisor
Cheryll Bowers-Stephens, M.D., M.B.A., Office of Mental Health, State of Louisiana,
discussed how the potential threat of Hurricane Dean over the past week and a half had many
thinking about what they were doing 2 years ago, as Hurricane Katrina approached. At that time
she was Commissioner of Mental Health for the State of Louisiana, and her husband was Health
Director of New Orleans. They had three sons: one starting his senior year in high school, one
starting sixth grade, and one starting first grade. Dr. Bowers-Stephens recalled her struggle,
because she, like many women, was responsible for the disaster plan for the family. She had to
make sure that her family had what they needed, but she also had a responsibility to the citizens
of the State of Louisiana.
On the Friday before Katrina struck, Dr. Bowers-Stephens was at a strategic planning session on
reforming health care in Louisiana. A health officer told them that a hurricane was in the Gulf
and instructed them to keep their cell phones on. Emergency preparedness procedures were
implemented on Saturday morning. Dr. Bowers-Stephens had to get her children together and see
about extended family. Her oldest son, who had traveled to work with his father from time to
time, remembered things that been said about the roof of the Superdome. As they evacuated, he
suggested things Dr. Bowers-Stephens had not thought about. She took her children to stay with
their grandparents, and by Monday evening, the levees had broken and all was in chaos.
With her children safe at their grandparents’ home, she went to work in the aftermath. Her oldest
son called to ask where he and his brothers would be going to school, and that was when Dr.
Bowers-Stephens realized how serious this situation was and how life-changing it was going to
be. She recognized that things would have to change in life and within families. Never again
would she be in the position where she had not even considered the basic needs of her children,
such as their education. In the wake of Katrina, she scrambled to get her children enrolled into
new schools, and she resigned from her position once she returned to New Orleans. Recently, as
2007 Minority Women’s Health Summit
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the family tracked Hurricane Dean, Dr. Bowers-Stephens’ youngest son asked whether they had
a family plan. This time they were prepared.
Dr. Bowers-Stephens pointed out that these are the types of issues people struggle with in New
Orleans. Now the arrival of any hurricane can mean picking up, leaving, and never coming back.
Now residents not only think about where they will go. They also think about what kind of jobs
are there, what kind of schools are there. They now understand that evacuating might mean
setting down roots in a new place. There has been slow but steady progress with recovery in New
Orleans, but there is still a long road ahead. Dr. Bowers-Stephens emphasized the significance of
social policy issues. Both the educational and health care systems were destroyed by Hurricane
Katrina, and as a result, the community died.
She noted that when natural disaster strikes, women are more vulnerable to its strains because of
traditional, social, economic, and cultural roles that marginalize and discriminate against them.
These strains cut across educational and economic lines. Women also are vulnerable because
they are responsible for themselves and their families. Dr. Bowers-Stephens highlighted the
following ways to help women cope:
•
Disaster-reduction policies and measures should enable societies to be resilient to
natural hazards, while ensuring the development decreases vulnerability to these
hazards. Many policies are not designed for the people who are responsible for
implementing them. Women and minorities should be involved in policy discussions.
•
Recognize that gender relations structures are part of the societal and cultural context
that shapes the community’s ability to anticipate, prepare for, survive, cope with, and
recover from disasters. Before disaster strikes, people should be educated as far as what the
plans are and what will happen.
•
Recognize that increased violence against women is a secondary effect of post-disaster
stress all over the world. Disaster recovery plans often do not incorporate measures to
address this effect.
•
Recognize that the proactive role of women after a disaster should improve their
standing in society. Gender equality in disaster-reduction policies and measures will require
the promotion of women such that they have increasing roles in leadership, management, and
decision making. The position of women in the community and within larger society should
be recognized.
•
View functional associations with disaster reduction not as an expense but as an
investment in society’s future. The consideration of the needs and roles of women is crucial
in this context. Dr. Bowers-Stephens reminded Summit participants of the many people
writing New Orleans off. She also pointed to the Army Corps of Engineers’ call for $17
billion or more to shore up levees by 2011, which some view as a discouragement for
rebuilding.
Dr. Bowers-Stephens emphasized that the plight of women during disasters is a social justice
issue.
2007 Minority Women’s Health Summit
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She also listed three documents that can be used when crafting or developing policies. Hurricane
Katrina: Social-Demographic Characteristics in Impacted Areas (Congressional Research
Service, 2005) focuses on the disparities that affect women, particularly those who are poor. The
areas affected by Hurricane Katrina are two of the three poorest regions in the United States. The
disparities were already there; Hurricane Katrina simple revealed them. Impact Disparity:
Women Caught in the Storm (Global Fund for Women, 2005) offers simple facts that can be used
in policy papers and policy development. The Calm in the Storm: Women Leaders in Gulf Coast
Recovery (Ms. Foundation for Women, 2006) arose from a grant of $1.3 million by the Kellogg
Foundation for groups focused on women’s issues to examine policy development. Dr. BowersStephens highlighted that several sexual assaults had occurred after Hurricane Katrina; that half
of the workforce who had lost their jobs were women; and that in New Orleans, men’s salaries
had increased whereas women’s salaries had decreased.
She also noted that in terms of housing policy, what was happening in New Orleans was a tale of
two cities. In places like the French Quarter, one can hardly tell that anything had happened.
Residents either have a lot of money or none; the middle class is eroding or leaving because it
cannot afford the housing. Both Time and National Geographic have suggested that the French
Quarter will be left intact and that New Orleans will become a small, cosmopolitan city for
people who can afford to live that way. However, the people who built New Orleans and made
the city what it was, the people for whom New Orleans was home, are no longer included. Dr.
Bowers-Stephens noted that the dynamic of the city is quickly shifting.
Dr. Bowers-Stephens closed by pointing out that FEMA is now putting safeguards in place to
prevent the separation of children from their families. She also warned that the mental health
aftermath she and her colleagues had predicted, based on the dynamics of the storm and the
disaster response, is now starting to appear. The Kessler Group has noted increased rates of
PTSD, suicide, and drug and alcohol abuse in the Gulf Coast. Experiences of Hurricane Katrina
figure into these presentations.
Lessons Learned from Florida
Tamara Yang Demko, Esq., Assistant Deputy Secretary of the Florida Department of
Health and Human Services, recalled growing up in Kansas, where tornadoes are the
predominant natural disasters. She remembered going downstairs and playing games with her
family when a tornado struck, and she remembered that she had never associated tornadoes with
danger. Now that she is a public health official, her outlook has changed.
Florida has a population of 18 million; 4 million of those are elderly, and more than 500,000 are
migrant workers. Its population includes 90 different races and ethnicities. Approximately $4.5
billion is tied into the space industry, and many of the homes in the State are manufactured.
Florida is the most vulnerable State to hurricanes and has the highest predicted storm surges,
exceeded only by those experienced in Bangladesh. Within the past few years, Florida
experienced the 2004 and 2005 hurricane seasons, tornadoes, wildfires, and the 2001 anthrax
scare. Thus, this State has had to be resilient again and again.
In response to its increased vulnerability to disaster, Florida has undertaken several initiatives.
Governor Charlie Crist has implemented two health care initiatives. One promotes healthy
2007 Minority Women’s Health Summit
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lifestyles and prevention to prepare minds, bodies, and spirits for disaster. This type of
preparation can improve resiliency. In another, Governor Crist has appointed the first State
Surgeon General, Ana Viamonte Ros, M.D., M.P.H., who focuses on prevention, personal
responsibility, and preparedness. Florida also has an Office on Women’s Health and an Office on
Minority Health, which are developing strategic plans to include disaster preparedness.
Ms. Demko pointed out that preparedness is an ongoing cycle of planning, equipping, training,
and rehearsing. She pointed to a national preparedness goal issued by the United States
Department of Homeland Security in 2005 for the entire nation to be prepared to prevent, protect
against, respond to, and recover from all hazards in a way that balances risks with benefits. Ms.
Demko also noted that preparedness must occur at the individual, family, community, State, and
Federal levels. Moreover, preparedness should occur as both top-down and bottom-up processes.
The medical system should be prepared to meet the needs of various categories of victims. Some
will be exposed and injured, others will die, and yet others will not be exposed but concerned.
Too often emergency rooms are flooded and overcrowded, and the providers people trust might
not be reliable. Disaster preparedness must meet the needs of the system itself by providing
supplies and equipment, locations, and pharmacies. It must meet the needs of responders by
offering protection, countermeasures, and behavioral health services. Thus preparing medical
systems for disaster requires a comprehensive approach.
Some of the barriers highlighted by Ms. Demko included language barriers and lack of cultural
competency, financial barriers, and cultural taboos. She called for an increase of awareness in
communities and the provision of cultural awareness training. She also noted the increasing
number of women of color in health and emergency response professions.
Ms. Demko had participants stand and take a preparedness quiz of 10 questions. She then
referred them to floridadisaster.org, a Web site that provides information on diseases and hazards
in as many as 14 languages. This site also offers a feature to assist individuals in creating family
or business disaster plans. Florida residents can input their address and the numbers of people in
their households, identify contact people out of state, and obtain directions to that person. In
addition, the site provides information on the type of food residents will need, how much water
to keep on hand, and special considerations.
Ms. Demko highlighted the following actions to take.
Before a Disaster
•
Create a family disaster plan.
•
Know your local disaster response points.
•
Know your neighborhood (for example, whether it lies in a flood plain).
•
Discuss your plans.
•
Have a first aid kit and a disaster supply kit in place.
2007 Minority Women’s Health Summit
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•
Get cash, as credit cards and automatic teller machines are inoperable without electricity.
•
Locate gas and water shut-off valves.
•
Take pictures or home videos of your home.
•
Fill your gas tank, as gas pumps will be inoperable without electricity.
•
Place important documents in waterproof containers.
•
Listen to emergency announcements and follow directions.
•
Prepare for pet safety.
•
Have a 3-day supply of drinking water, 1 gallon per person per day.
•
Have a 3-day supply of water for cooking and hygiene, 1 gallon per person per day.
•
Have ice.
•
Have cooking implements and a 3-day supply of nonperishable food. Food should have
nutrients, such as protein, to keep up your energy.
•
Consider the needs of special populations:
o Infants: what will happen if the baby is separated from the mother.
o Children: include them in the planning, pack things that will make them feel safe.
o Pregnant women: pack a 2-week supply of medications, increase stored water to keep
them hydrated, have medical records, records of immunization, and Healthy Start contact
information.
o Elderly: arrange for transportation, disability assistance, medications, and special medical
equipment. Have contact information and medical records, and know the locations of
special needs shelters.
o Arrange for the needs of people with health conditions such as HIV/AIDS, cancer,
diabetes, kidney disease (dialysis), asthma, or Alzheimer’s disease or cognitive
impairment, as well as for those who are physically or developmentally challenged.
•
Note special considerations for minority women. Many are either single mothers or primary
caretakers, and many are involved in the care of their elders or extended family. Some have
difficulty in accessing care and transportation, and some health conditions are more prevalent
in certain racial or ethnic populations.
After a Disaster
2007 Minority Women’s Health Summit
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•
Listen and wait for local authorities to announce the all-clear.
•
Check for damage. Use flashlights. Do not light matches or turn on electric switches.
•
Check on your neighbors.
•
Stay away from downed power lines.
•
Call out-of-town contact and family members.
•
Gauge both mental and physical health needs. Lingering stress following a disaster should be
addressed. Keep in mind that many accidents and fatalities occur after the disaster.
Ms. Demko also listed things that are often overlooked. If electricity is out, people will have to
contend with communication problems, lack of water, and in some cases, extreme temperatures.
People also forget special medical considerations, alternative evacuation routes, and the
importance of filling up their gas tanks. In some cases disasters consist of multiple events, and
conditions and paths can change quickly.
Ms. Demko closed by saying that all can empower themselves through preparation and
knowledge, which will give them the tools to be resilient and minimize adverse effects, among
other things. She called for all to be involved in planning so they can be resilient and better
prepared for the next disaster.
Disaster Response Resource:
www.floridadisaster.org
Discussion
Dr. Bowers-Stephens was asked about mental health status both in the aftermath of Hurricane
Katrina and 2 years later. She responded that people react and recover in different phases
because there is so much loss. The levels of grief vary and encompass denial, anger, anxiety, and
depression. In some cases there are clinical effects requiring medication. Dr. Bowers-Stephens
added that those directly affected by the storm are experiencing various stages of PTSD, even
acute PTSD in cases where recovery or rebuilding has been slow.
A participant from Washington, D.C., asked about resources or information on the number of
women displaced to various areas and how to serve these women’s needs. Dr. Bowers-Stephens
noted that groups such as Columbia University and the Kaiser network are following the
numbers and providing periodic updates on status. She also referred the participant to the Center
for Mental Health Services, Substance Abuse and Mental Health Services Administration
(SAMHSA) Web site, as well as 1-800-273-TALK. She highlighted the need for nonprofits to
partner with other organizations to overcome gaps in resources. Session Moderator Vicki Mays,
2007 Minority Women’s Health Summit
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Ph.D., added that the study by the Kessler group, which was centered at Harvard University and
funded by Federal tax dollars, has some data about displaced people across the country. She also
encouraged the participant to contact foundations such as the Kaiser Family Foundation and the
Kellogg Foundation, who are interested in helping at the level the participant sought.
A woman who lived in Washington but had come from New Orleans and still had family there
thanked Ms. Nguyen for discussing the experiences of the Vietnamese community. She
acknowledged that no one had ever talked about this community. She went on to ask about the
psychological and mental effects of the way the media portrays people of all groups. She also
asked how the media could be held accountable for the images they release. She added that
during coverage of Hurricane Katrina and the aftermath, she was able to talk to her family, who
had managed to leave, and they were able to watch the media coverage knowing that not
everyone in the Superdome were criminals or killers, as the media portrayed them to be. She did
not know what was worse: portraying African Americans falsely, or not talking about the
Vietnamese or American Indian populations at all.
In response to this question, Reverend Harrell encouraged this woman and other participants to
address the media. She pointed out that the media is supposed to be a voice for the people, but
this voice is compromised because of globalization and the increasing centralization of
ownership among a select few with specific agendas. Reverend Harrell discussed efforts to train
young people how to create their own media. Because of technology today, people can create
their own newspapers, television and radio stations, among other things, and they can get their
messages out. Reverend Harrell and colleagues are also teaching people to complain, to call and
protest their stations. She reminded participants that these few groups make money off continued
polarization, and the mainstream press has not covered many people’s stories. To address the
needs of the whole person, people should create their own media and take advantage of the
community press, the ethnic press, and the alternative press, among others.
Ms. Hopkins was asked to discuss more about the costs and difficulties of rebuilding in the
Houma communities. She explained that regardless of where one lives in the region, the cost to
lift the house off the ground is $30,000 on average. Once utilities were turned off following the
storm, the companies refused to turn them back on, and insurance companies refused to cover
these properties until houses were raised off the ground by at least 10 feet. Thus, many Houma
Indians have been unable to come home. Ms. Hopkins reminded participants that some areas in
this region had more than 37 feet of water during the storm. Yet the levees under construction by
the Morganza to the Gulf Hurricane Protection Project stand 9 to 15 feet in some areas and as
low as 4 ft in others. Ms. Hopkins further noted that efforts by the Federal Government and the
Red Cross had been minimal.
A participant cited examples in which fire departments distribute free smoke detectors after a
fire. She asked about the feasibility of having agencies donate fire- and waterproof containers to
families who couldn’t afford them. This would allow them to store their important documents so
they would have the necessary information as they sought to rebuild. Ms. Demko thought this
was a good idea, and she further pointed out the importance of building partnerships for any
policy.
2007 Minority Women’s Health Summit
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A woman offered her perspectives as a mother and an immigrant and mentioned manmade
disasters such as the shootings that had occurred at Virginia Tech. She pointed out that the
mental health needs of immigrants had not been addressed. She further noted that program
planning and development should take into account the experiences of immigrant mothers. In
many cases, their roles in the families are reversed when they come to the United States. Their
children go to school and encounter situations the mothers have never faced. She called for
assistance for immigrant mothers struggling to make a new life for their families, and she
expressed her feeling that the school system and mental health system had failed them. Ms.
Nguyen agreed with these remarks and noted that in many Asian communities, as with other
communities of color, mental health is a taboo subject. She mentioned lessons learned in the
wake of Hurricane Katrina and the Virginia Tech tragedy. For example, peer-based support and a
community-based approach to mental health were more successful. These approaches do not
address issues as “mental health” but as factors affecting the family as a whole. Through these
approaches, women have been able to talk about what affects them. Dr. Mays added that a recent
Surgeon General Report on Mental Health had addressed mental health parity and minority and
immigrant issues, but was lying fallow. Dr. Mays encouraged participants to contact their
legislators about taking action on this report.
A woman from OWH Region 2 in New York noted that healing comes in part from hearing the
voices of those affected by disaster. She acknowledged the increasing amount of information on
ways to address mental health and trauma, but she noted the lack of an easy central place from
which to obtain that information. She noted similarities in stories among those affected by
Hurricanes Katrina, Rita, and Wilma; the 2004 tsunami; and the terrorist attacks of September
11, 2001. She suggested that these experiences should be shared and used to inform preparedness
for future disasters.
Another participant thanked the organizers for putting this session together, and she especially
thanked the panel for putting faces to the numbers. She acknowledged that many are
overwhelmed by the numbers or hear only about Black and White, but this session had left her
with a different perspective. She cited an issue of Essence focusing on four women of different
colors, races, or ethnicities, who had different businesses. In the aftermath of Hurricane Katrina,
these women worked together to rebuild each other’s businesses.
A woman from the Haitian community in Boston noted the rich media outlet this community has
in radio and television. She cautioned that addressing language barriers meant more than
addressing Spanish-speaking populations. Ms. Nguyen cited new guidance issued by the
Department of Homeland Security on special needs populations; this guidance is now
incorporating language considerations. Ethnic media outlets have been involved in the drafting
of this guidance. Reverend Harrell added that the Federal Communications Commission was
changing the rules so that less money is needed to own radio stations. Groups, particularly those
representing marginalized groups, can apply on the FCC Web site and receive help in starting
their own stations.
A participant noted the spike in the incidence of sexual assault following Hurricane Katrina, and
she asked whether there had been any verification of the number of people assaulted the
Superdome and whether response teams were in place to deal with these issues. Dr. BoyerStephens cited a registry on the Internet, as well as two or three commissions on women, but she
2007 Minority Women’s Health Summit
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had not heard of a concentrated, organized approach to this issue. Dr. Mays cited secondhand
knowledge of reports filed, cases documented, and in some instances, verification of claims. She
added that she had heard discussion of how shelters should be arranged, but she invited
suggestions or recommendations from Summit participants. Other panelists agreed that there
should be a focus, and one cited a list of recommendations a group had cited to prevent violence
against women, including sexual assault, following a crisis. Another panelist noted that some
domestic violence shelters were not being rebuilt, so that the effects of increased violence were
compounded by a limited number of places to go.
Ms. Nguyen agreed with Dr. Bowers-Stephen’s comment about “a tale of two cities.” She
commented on having visited the French Quarter and the Garden District and seeing pristine
communities. The Vietnamese communities, however, are still severely damaged, and living
conditions are unacceptable. Ms. Nguyen pointed out that this might be “old news,” but
communities still need help in rebuilding.
Suggestions for Disaster Preparedness—Policy Level
Provide fire- and waterproof containers for families to store important documents.
Consider and involve immigrant mothers in planning and development.
Contact legislators about actions taken on the Surgeon General’s report on mental health.
Be aware of other language minorities, not just of Spanish-speaking minorities.
Acknowledge the threat of increased violence against women following a disaster and incorporate
measures to address it in disaster recovery plans.
Final Remarks from the Speakers
Ms. Demko reminded participants that often people feel passionately about an issue for a time,
then forget about it. She encouraged those who now felt passionate about what they heard to
communicate about it, break taboos, and keep talking about it so that each participant can be a
champion for women’s health.
Ms. Hopkins had worried that people would not want to hear any more about this because of all
the media coverage. But what has been presented is what others want the public to see. The
Houma Nation is still in mourning. They choose to live in Louisiana; it is their home and their
tradition, and they still live off the land. They do not want to go somewhere else. Ms. Hopkins
asked participants not to forget about them.
Reverend Harrell noted that many are still burying their children, and bodies are still being
found, so the story is not old. If one looks at New Orleans as a microcosm, it is the “isms” that
have caused the most damage. Politicians and people of faith should work together to stop the
violence that was going on even before Hurricane Katrina struck. Reverend Harrell
acknowledged that some might be tired of hearing about Black people, but she stress that many
are still victimized simply because they are Black.
2007 Minority Women’s Health Summit
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Ms. Nguyen noted the theme of resilience throughout the session and the way the session ended
on emergency preparedness and looking forward. She noted that Vietnamese community leaders
are now receiving Computer Emergency Readiness Team training and working with local
officials so they will know what the evacuation routes are, where the shelters will be, and how to
run drills.
Dr. Bowers-Stephens acknowledged the natural, technological, and manmade aspects of this
disaster, which unmasked the ills of our society, such as poverty, inequity, marginalization, and
disenfranchisement. She emphasized that these were issues of social justice. She warned that any
vulnerable community hit by a disaster will experience the same types of things.
Dr. Mays closed the session by expressing the hope that participants would educate themselves
to take care of themselves and their families, participate in their communities, and talk about
next steps. She was glad that many now understood the extent to which groups were made
invisible, as well as the complexities of the disaster. Women should ensure that when disaster
strikes again, they are responding, recovering, and resilient.
Luncheon Presentations: Overcoming Challenges Through Education
and Commitment
Sabrina Matoff-Stepp, M.A., Director, Office of Women’s Health, HRSA, informed Summit
participants that Dr. Edward Brandt, Jr., who had made many contributions to women’s health,
was dying.35 Dr. Brandt had been a pioneer in women’s health research and a longtime member
of the Advisory Committee on Research on Women’s Health. He had served as Assistant
Secretary, DHHS, and as Acting Surgeon General from 1981 to 1984, when HIV/AIDS was first
discovered, and he had promoted awareness of the growing HIV/AIDS epidemic during the early
years. Dr. Brandt had moved on to work as an educator at the University of Texas-Medical
Branch, the University of Maryland, Baltimore County, and the University of Oklahoma, and he
had served as a representative to the World Health Organization. He also had mentored many
students.
Following Ms. Matoff-Stepp’s announcement, moderator Sharon Barrett, M.S., of the
Association of Clinicians for the Underserved, introduced the luncheon speakers.
Systemic Lupus Erythematosus
Graciela S. Alarcón, M.D., M.P.H., Jane Knight Lowe Chair of Medicine in Rheumatology,
University of Alabama at Birmingham, provided participants with an overview of systemic
lupus erythematosus (SLE), a multisystemic autoimmune disease. Although the cause of SLE is
unknown, biological and environmental factors have been identified. SLE is fairly rare, but it is
more common among women and minority populations. Among women, SLE occurs
predominantly during the reproductive years, suggesting a role for female hormones in the
development and course of the disease. SLE also sometimes affects infants and children, and
now that the general population is living longer, more cases are seen in the elderly. Although
SLE is more serious in younger individuals, older individuals might suffer more dire
35
Dr. Brandt died on August 25, 2007.
2007 Minority Women’s Health Summit
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consequences from it. The impact of SLE can be measured through disease activity, damage
accrual, functioning and health-related quality of life, and mortality and survival. Disease
activity and damage accrual occur over time, and after many flares or, in some cases, treatments,
damage becomes irreversible.
SLE varies from person to person in clinical presentation, course, and outcome. Thus, no single
test can confirm diagnosis of it. Before the 1950s, SLE was diagnosed only in its latest stages,
when it was too late to do anything about it. Following the 1948 discovery of LE cells in the
blood of patients with lupus and of cortisone as a potent anti-inflammatory compound,
diagnosing and treating the disease became somewhat easier. SLE could be diagnosed based on
the presence of multisystemic disorder and a positive LE test, and the ability to diagnose the
disease was improved further in the 1960s with the advent of an anti-nuclear antibody test.
Moreover, chances for survival have improved. In a 1950s study of 94 patients from Johns
Hopkins University, half the patients died within 4 years.36 A more recent study in a cohort of
1,387 patients from Hopkins (1987–2004) found the majority of patients living after 5 years.37
Mortality was still increased among these individuals, but not to the degree seen in the 1940s and
1950s. Yet mortality has not improved for everyone. It has actually increased for African
American women, particularly those of middle age.38 In addition, SLE still affects patients’
quality of life, as assessed by Dr. Alarcón and her colleagues.39 Racial and ethnic disparities also
remain in disease frequency and disease manifestations.
Dr. Alarcón described Lupus in Minorities: Nature versus Nurture (LUMINA), a multiethnic,
longitudinal study of lupus outcomes, with sites at the University of Alabama at Birmingham, the
University of Texas-Houston, and the University of Puerto Rico. LUMINA participants have had
SLE, as defined by the American College of Rheumatology, for 5 years or fewer. Following a
baseline visit, they undergo semiannual, then annual visits. Eighty-five percent of Caucasian
participants and 89% of African American participants are women, whereas 93% of Hispanics in
Texas and 95% of Hispanics in Puerto Rico are women. Even at baseline, disparities are
apparent: the mean number of years in school is lower for Hispanic and African American
women, and more of these participants are living below poverty and less likely to have health
insurance. Disease prevalence is comparable among Hispanics in Texas and African Americans,
and early data shows that these groups have a much higher probability of damage accrual and a
steeper drop in survival, compared with Caucasians and Puerto Rican Hispanics. Yet when these
data are adjusted for SES and clinical factors, poverty is the major factor in outcome. Thus SLE
outcomes can be determined by genetic and non-genetic factors.
Dr. Alarcón then discussed ways to empower minority women to better deal with diseases like
lupus and achieve better outcomes. Women must believe that they can actively participate in
health care decisions by moving from a traditional model to a proactive one. For example,
Salutogenesis, a concept coined in 1979 by Dr. Aaron Antonovsky, focuses on two components.
36
Merrell M, Shulman LE. Determination of prognosis in chronic disease, illustrated by systemic lupus
erythematosus. J Chron Dis 1955;1:12-32.
37
Kasitanon N, Magder LS, Petri M. Predictors of survival in systemic lupus erythematosus. Medicine (Baltimore)
2006;85:147-56.
38
Sacks J et al. Trends in deaths from systemic lupus erythematosus—United States, 1979-1998. MMWR Morb
Mortal Wkly Rep 2002;51:371-4.
39
Alarcón GS, McGwin G Jr, Uribe A, Friedman AW, Roseman JM, Fessler BJ, Bastian HM
2007 Minority Women’s Health Summit
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One is the use of Generalized Resistance Resources to help individuals resist the daily stresses of
life. These resources include those related to SES, knowledge, ego strength, social support, and
cultural beliefs. The second is a Sense of Coherence, in which individuals use their Generalized
Resistance Resources when confronting a health crisis or setting goals for positive health.
Interventions would build on this coherence at the societal level by addressing SES, at the
community level through the work of community advocacy groups, and at the individual level by
helping women to understand the disease and its consequences, strengthening their social
support, and using the positive aspects of their culture. Minority women also can empower
themselves through lifestyle modifications in smoking, drinking, and physical activity.
Discussion
In response to questions about admixture, Dr. Alarcón acknowledged the breadth of that subject.
She noted that the United States Census has historically catalogues its citizens as belonging to
one racial or ethnic group, when in fact most Americans are of mixed heritage. Studying diseases
by race or ethnicity should more precisely consider admixture, as well as the fact that other genes
not linked to ancestral genes might be important.
A Summit participant asked whether SLE had been included in the CDC’s Adverse Childhood
Experiences (ACE) study, which assesses the relationships between early trauma and later
outcomes. Dr. Alarcón did not know whether ACE had included lupus, and she was unsure
whether any other study had addressed that issue when so much about the disease is still
understood.
In response to questions about the exclusion of American Indians, Alaska Natives, Pacific
Islanders, or Asians with SLE, Dr. Alarcón explained that LUMINA had not included these
groups because of the extremely small numbers of these populations in the areas of study.
However, studies in California, the western part of Canada, and Asian countries have examined
SLE in Asian groups and found that intermediate outcomes are not as bad for Asians as they are
for African Americans. However, they are not as good as those for Caucasians. She also knew of
some studies on Native Americans with lupus.
Overcoming Health Disparities
Marilyn Hughes-Gaston, M.D., Gaston & Porter Health Improvement Center, referred to
the Webster definition of revolution as “a radical change in situation.” She called for a radical
change in the situation of health for women of color, communities of color, and the health care
system. She noted the multiple challenges to be overcome through education and commitment,
particularly the disparities in health outcomes, including mortality rates. African American
women are dying at higher rates than any other group of women. However, heart disease, cancer,
stroke, and diabetes are leading causes of death for all women of color. Dr. Hughes-Gaston
pointed out that most of these deaths are preventable. She also expressed outrage at CDC
statistics showing that women in the United States are 26th in the world, and minority women in
the United States 33rd, when it comes to life expectancy. Dr. Hughes-Gaston pointed out that the
United States spends $1.9 trillion on health, and thus more than any country in the world, to
achieve these results. She also noted that only 3% of the $1.9 trillion is spent on prevention. Thus
what is called a health care system is actually a “sick care system.”
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The mental and emotional health of women of color is also a challenge. Dr. Hughes-Gaston read
a passage from Prime Time, which she had written with Gayle Porter, M.D., and described the
stress many women of color endure from being exploited, called ugly, and placed at the bottom.
Women of color face psychological distress in the form of stress, anxiety, depression, and a
feeling of being overwhelmed. By CDC estimates, African American women 18 to 44 are the
most distressed, but at older ages Latinas become the most distressed. Dr. Hughes-Gaston noted
that CDC had not provided data for Native American or Asian populations, saying they were too
small. However, she stressed the need to include everyone, including subgroups within Asian,
Latina, and African American populations. Dr. Hughes-Gaston noted how many in the
community talk about holistic health and the mind-body connection, but do not practice it.
Instead, the spirit, the body, and the mind are often compartmentalized. Meanwhile,
psychological distress continues to kill women of color. For example, data from a study done at
Johns Hopkins University revealed links between depression and the risk of dying from a heart
attack.
Dr. Hughes-Gaston acknowledged Summit participants’ efforts in applying their training and
commitment to create revolutions, initiate change, and establish programs to address disparities,
language barriers, and cultural competence. She acknowledged those who are revising
curriculums to train students and give them skills in cultural competence and health literacy. She
also acknowledged efforts by the mass media to encourage women to make lifestyle changes.
She challenged all participants to learn as much as they can about strategies, models, and
practices and to network with many women doing similar kinds of work. Dr. Hughes-Gaston
encouraged participants to start making plans as they traveled home: plans to reconnect and plans
to mobilize their communities. She emphasized that knowledge becomes powerful when one acts
on it and makes a difference, and she asked participants to think about their efforts at four levels.
The women you serve. All must continue to work for equal access to care for everyone,
regardless of race, ethnicity, or SES. Poverty continues to be a major determinant of health, as
acknowledged by Mahatma Ghandi when he said that the worst form of violence is poverty. Dr.
Hughes-Gaston also encouraged participants to continue fighting for universal health insurance,
as the Institute of Medicine found being uninsured as the fifth leading cause of death. She also
called for equal access in terms of language, information, affordable pharmaceuticals, and
treatment. Two-thirds of disparities and deaths related to breast cancer could be eliminated if all
women had equal treatment. Policy is another area where equal access is needed. It must move
from a focus on illness to one on wellness. Dr. Hughes-Gaston pointed out that lifestyle is a
major determinant in health outcome, and she called for Summit participants to educate,
motivate, and agitate their sisters to understand that it is never too early or too late to work on
wellness.
The staff at your organizations. Many women in the workplace are stressed, overweight, or
diabetic. Participants should work to ensure that their agencies provide or defray costs for weight
loss services, exercise, stress management, and smoking cessation. Employees also should be
encouraged to take vacations, and cafeterias should offer healthy foods.
Your family. Participants should engage in discussions with their family and be proactive about
their health. Families should know their health history and know how to read food labels,
2007 Minority Women’s Health Summit
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particularly the serving size. Dr. Hughes-Gaston cited the example of a woman she had met at
one of the Sister Circles she was holding. This woman was caring for her 9-year-old grandson,
and she told her grandson about the program she was entering and stated a goal to live long
enough to see his grandchildren. They went shopping together one day, and the woman was
enticed by a sale on chips. However, the grandson read the label and told the cashier they would
not buy the chips.
Yourself. Dr. Hughes-Gaston noted this as the most important level. She encouraged participants
to live a life of health promotion and disease prevention, working to eliminate risk factors and
prioritizing themselves and their health first. She pointed out that women will be unable to take
care of others if they have not taken care of themselves. Dr. Hughes-Gaston also challenged
participants to not feel selfish or guilty for taking care of themselves and to place themselves on
their calendars and day planners. She added that taking care of themselves meant having a daily
stress management plan that includes deep breathing, yoga, tai chi, meditation, muscle
relaxation, and positive self statements. Dr. Hughes-Gaston also encouraged participants to fill
their lives with health, positive people and to laugh more. Spiritual health should not be
neglected. Data from Johns Hopkins University, Duke University, and others show that women
who pray every day reduce by a third their risk of dying from all causes.
Sponsored Luncheon Presentation: United Health Group
Marie Y. Philippe, Ph.D., SPHR, Chief Diversity Officer, United Health Group, described
efforts by the United Health Group (UHG) to address minority health and health disparities.
UHG has aligned business interests and social needs to facilitate opportunities to address longterm problems. The company strives to record, understand, respect, and embrace the complexity
of human difference, and it continues to search for creative and sustainable ways to improve
health care. Dr. Philippe noted that accessible, affordable, and high-quality health care should be
available to everyone. In keeping with this core belief, UHG strives to enhance access to health
benefits for all, including minority groups, seniors, low-income customers, and those who are
chronically ill. To help people achieve optimal health outcomes, UHG tailors its products and
services to the specific needs of each person.
UHG works with communities of color to understand needs and to design culturally appropriate
health benefits and programs. As a private organization, UHG has committed to building and
sustaining meaningful and long-term collaborations with medical associations, community
organizations, associations, nonprofits, government agencies, regulators, employers, and other
health plans. Dr. Philippe cited the following examples:
•
African American academic health centers. Historically Black colleges and universities
have struggled to offer affordable and effective health care to their campuses. This is made
more difficult by disparities of health outcomes in their communities. UHG has worked with
these institutions and business groups to design products. This effort marks the first to
incorporate the African American community in the design of products and services.
•
Rainbow/PUSH Coalition. UHG has formed a strategic alliance with this group to work for
better health and disease prevention among African Americans. The merger of communitybased relationships and UHG resources forms a powerful way to support African Americans
2007 Minority Women’s Health Summit
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in making informed health care decisions and in overcoming the health challenges they face.
Through this collaboration, UHG has provided churches, community organizations, and
leaders of the PUSH Coalition with access to tools and technological, clinical, disease
management, and care coordination expertise. It provides assistance with hospice care
workshops to end disparities for African Americans using end-of-life care
Dr. Philippe discussed efforts by UHG to increase access to quality health care services for
people in underserved, underrepresented, and economically challenged communities. She
described work by the United Health Foundation, the charitable arm of UHG, to ensure health
care coverage for all Americans, especially children. The Foundation funds an initiative, Centers
of Excellence, which supports community clinics in economically challenged communities. Dr.
Philippe did note, however, that much more is needed to meet specific health needs. For
example, racial and ethnic minorities are less likely to have access to preventive health services.
Thus, the care they receive is inconsistent with the best evidence, and life expectancy among
these groups is lower. UHG offers insurance products that target minorities where they live and
work.
In some cases, access is not a matter of cost. It is related to the ability to understand how to use
the complicated and multilayered health care system in the United States. UHG offers interactive
tools on the Internet, as well as through employers at their work sites. For example, Hispanic
members receive materials to help them enroll into plans and navigate the system to make the
best use of benefits, and customer service is provided in several languages.
Education is another area of concern for UHG. Dr. Philippe noted efforts to provide targeted
materials and programs focused on health conditions related to specific populations. For
example, UHG provided seminars and community events focused on diabetes in the African
American population. UHG also recognized that many Hispanics do not have sufficient
resources and access to information to care for themselves and their families. The company also
recognized that language barriers can impede care. To address these problems, UHG has a Latino
Health Solutions Department that provides a variety of bilingual educational tools and programs,
including interactive health risk questionnaires, programs to educate members to take action on a
variety of chronic diseases, and photo novellas on diabetes and hypertension, which are prevalent
in the Hispanic community.
Dr. Philippe noted the importance of a diverse and culturally sensitive workforce. She pointed
out that the UHG physician network includes doctors who speak Spanish, Vietnamese, Korean,
Japanese, and several Chinese dialects. She also highlighted the UHG Diverse Scholars Program,
which supports scholarships to racial and ethnic minority students, particularly those pursuing
careers in health care. More than 50 awards of $5,000 each will be awarded in the 2007–8 cycle.
UHG also has formed a partnership with 10 Hispanic organizations to targeted bilingual
Hispanic students either in or entering higher education. Approximately 250 scholarships have
been awarded thus far, ensuring the presence of bilingual and bicultural students in the future
workforce. UHG also is working with OMH to disseminate cultural competency modules to
520,000 contracted providers. These modules provide up to 9 hours of continuing medical
education credit at low cost. Moreover, UHG strives to ensure diversity and cultural sensitivity
among its own employees, and it continues to seek talented individuals who can embrace the
value of diversity and serve all UHG members.
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Seniors also suffer health disparities. Dr. Philippe pointed out that disparities do not end just
because someone becomes eligible for Medicare. She described UHG efforts to serve elder
members and provide choices and solutions that meet their real needs. UHG continually assesses
its products, and even here, it works hard to ensure innovative, robust, and culturally sensitive
products. UHG provides educational and disease management programs for people older than 50
years, for many cultures, and it builds on relationships, a strong local presence, and face-to-face
and grassroots efforts with minority communities. For example, UHG created Show Me guides
in seven languages to help seniors understand Medicare Part D. More than 10 million copies of
these guides have been distributed.
Dr. Philippe closed by pointing out the strength of UHG brands and the importance of using a
variety of distribution channels. She pointed out that UHG efforts represent a step in the right
direction, but significant issues remain. She stated that affordable, quality health care for all can
be a reality if all work together to find creative and sustainable solutions.
Discussion
In response to questions about the Diverse Scholars Program, Dr. Philippe noted that the
deadline for applications was August 31. Web sites for the United Negro College Fund, the Tom
Joyner Foundation, and several Asian groups all link to the site for this program. Dr. Philippe
added that this program supports students at all levels of higher education, including
undergraduate, and that it supports a variety of projects devoted to improving health care,
accessibility, and affordability.
Dr. Philippe added that UHG had also formed partnerships with State pharmaceutical assistance
programs and had implemented a program to include reduced-cost or free drugs in some of its
plans. She invited more community organizations into partnerships.
One Summit participant acknowledged UHG’s efforts at cultural competency and asked about
materials for French-speaking minority communities (for example, Patois and Creole). She
described difficulties in finding brochures or information packets for these communities. Dr.
Philippe responded that she had raised this issue with leadership and that she herself had
translated the Show Me guide into Creole. She also noted partnerships with agencies specializing
in those languages, as well as the employment of specialists who speak the languages of the
Islands.
Dr. Philippe also noted that the Foundation supports community projects and awards grants on a
rolling basis. She invited community groups to apply.
For More Information on United Health Group:
Marie Y. Philippe, Ph.D., SPHR
Chief Diversity Officer
United Health Group
952-936-1300
www.unitedhealthgroup.com
2007 Minority Women’s Health Summit
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Closing Plenary: Maximizing Your Potential in Your Community
Moderator Justine Love, Director of Community and Public Affairs, WPGC-FM, began this
session by inviting Summit participants to discuss their programs and health messages on her
show. She further informed them that every radio station is required by its licenses to air public
service announcements. Many stations are now on the Internet and prefer announcements
national in scope. Ms. Love therefore encouraged Summit participants to tailor their community
program messages to connect with a wider audience.
Ms. Love also described a local group of women who had lost their children to violence. Some
were the mothers of those who had murdered the children of others. She noted that this group
could offer lessons on how to help each other heal.
An Asian-American Perspective
Sonia Aranza, Aranza Communications, began by stating the name of her mother, who
emigrated from the Philippines in 1969. Ms. Aranza shared that when her mother arrived in the
United States, the immigration officer said that her name was too difficult to pronounce and had
her change it to “Annie.” Ms. Aranza stated her mother’s given name again, stressing that
although her father had contributed to the family, she wanted to dedicate this time to the hard
work and sacrifice of her mother. She then invited all Summit participants to state the names of
their mothers.
Ms. Aranza then described taking her son to visit the Philippines for the first time. They stayed
in the Shangri La in Manila, played in the pool, and ordered room service, but one day Ms.
Aranza and her husband decided to show their son the real Philippines. They all rode the public
buses and traveled to the interior of the country. They saw hillsides and mountains but could not
ignore the poverty. Ms. Aranza also discussed a visit to South America on a speaking
engagement. Again she took her family, and again they stayed in a resort. This time she and her
husband took their son by bus to the interior of Colombia and to the UNESCO site in Cartagena.
Again, the poverty could not be ignored. Likewise, in Washington, D.C., homeless shelters sit
mere minutes away from the White House. In 2005, Hurricane Katrina exposed the level of
poverty in New Orleans. Thus, even in this wealthy country, poverty cannot be ignored
According to the World Bank and the International Monetary Fund, 9 in 10 people worldwide
live in poverty. Ms. Aranza pointed out that those in the audience had a 1 in 10 chance of living
the way they do. She reiterated that the mothers of all in the room might have lived in poverty or
navigated areas close to poverty. However, all in the room had benefited from their navigation
and sacrifice. Thus, all in the room were leaders whether they wanted to be or not.
Ms. Aranza also noted that many use their mothers as the model for health care, providing a
blueprint in terms of personal well-being. However, she noted that in her own case, the blueprint
she had been given was not a good one. Her mother often placed the health of her husband,
children, and relatives before hers. Ms. Aranza noted that many Asian and Pacific Islander
women followed a similar blueprint for health as a result of culture, gender, and generation. At
lower SES, women place their own health at even lower priority.
2007 Minority Women’s Health Summit
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Ms. Aranza pointed out that this generation, the 1 in 10 living in privilege, the ones who have
been given so much, have the power to take an inventory of this blueprint and to create
something new, both for self and for daughters. She referred to an often-cited example of
airlines’ instructions to “put your mask on first, then help others.” She stressed that women must
place their own health first. She acknowledged that they already had begun by attending
gatherings such as this Summit, where they could share knowledge, increase awareness, and
embrace skills. Ms. Aranza also noted that every one in the room represented thousands of others
who did not have knowledge or opportunity, and she emphasized that they are the voice for the
voiceless.
She outlined strategies for maximizing one’s potential in the community:
•
Be cognizant of diversity. Ms. Aranza referred to her childhood in Hawaii, where she grew
up thinking all Whites were the same. She went to college on the mainland and realized that
many thought all Asians were the same. Diversity must be considered not only along the
lines of race or ethnicity, but also along many other dimensions, including SES, religion, and
level of assimilation. Ms. Aranza emphasized that the image of a “model minority” was a lie.
•
Recognize the depth, breadth, and complexity of cultural patterns. Each culture involves
several and separate customs, traditions, and beliefs. As Ms. Aranza pointed out, things are
not universal among Asians and Pacific Islanders.
•
Manage your own biases and blind spots. Ms. Aranza pointed out that even educated, welltraveled professionals have biases and blind spots. People must take an inventory of and
manage these blind spots, primarily by taking stock of their own thoughts. She closed with
the following by Frank Outlaw:
Watch your thoughts; they become words.
Watch your words; they become actions.
Watch your actions; they become habits.
Watch your habits; they become character.
Watch your character; it becomes your destiny.
Maximizing Your Potential: An Asian Perspective
Aranza Communications
Notes on presentation available at www.soniaaranza.com
A Native American Perspective
Pamela Iron, M.Ed., Executive Director, National Indian Women Resource Center,
provided her perspective as a member of the Long Hair clan of the Cherokee tribe and the Little
Eagle clan of the Laguna Pueblo tribe. She discussed concepts important to Native American
communities and suggested ways Summit participants could draw on these concepts to be agents
of change in their own communities. Ms. Iron first discussed gadugi, a Cherokee word for
2007 Minority Women’s Health Summit
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working together for the benefit of the entire community. She emphasized the need for
togetherness and pointed out that “tribalism” refers to commonality among all tribes.
Native American culture is founded on symbolism, which transmits values and beliefs. Each
tribe has its own set of symbols. For example, the turtle is a symbol of good health for the
Cherokee, whereas the owl is a negative omen symbolizing death for the Ponca tribe but a
symbol of good health for the Pueblo tribe. Ms. Iron emphasized the importance of symbolism
when naming a program. She also noted that Government program names are often used only on
paper. In practice, the community uses a name it has chosen to describe the project and how the
community operates, emphasizing togetherness and traditional learning styles in group settings.
Ms. Iron described the name of a program as “like a life map, giving understanding, expectation,
and the hope of what the program can become.”
Ms. Irons pointed out that because Native Americans enjoy and work better as a group,
grassroots coalitions work well in these communities. Foundations for these coalitions must be
built over time through training, facilitation, and support, but once they are set, they give rise to a
solid group thinking they can take over the world. In many cases, coalitions start out focusing on
one risk factor, but they expand to involve other projects because of strength, resiliency, and a
sense of group accomplishment.
Programs should incorporate traditional community processes. In Native American
communities, successful programs incorporate mentoring, storytelling, dancing, and traditional
games and skills. These processes can also help a community with healing, tapping into a
community’s history not of trauma, but of strength, spiritual direction, inherent resiliency, and
the discovery of positive identity. In Native American communities, this can mean learning
traditional songs and participating in drum groups.
Spirituality is also important in programming. Native Americans believe that living in harmony
with nature will result in a balanced life. Ms. Iron noted beliefs in the life cycle, in seasons,
directions, and life forces. She pointed out that Native Americans acknowledge that the Creator
and all life forces must be in balance, and without each individual playing a part in a larger
picture, the larger picture is not as it should be. For this reason, Cherokee prayers always include
all races of people, acknowledging that each group adds color and dimensions to the whole.
Programs that incorporate this concept are successful in Native American communities.
Ms. Irons also discussed the concept of a group sustaining life. She pointed out that Native
American peoples historically worked as hunters, gatherers, agrarian, or a combination of the
three. Male or female, young or old, each member plays a certain role, and all roles are viewed as
equally important in sustaining the food supply and in transmitting values, beliefs, and
knowledge from one generation to another. Many tribes still practice traditional roles in their
communities. Ms. Iron applied these roles to community organizations and encouraged Summit
participants to find their own roles in women’s health:
•
In traditional Native American communities, hunters find the meat. For community
organizations, these are the individuals who seek funding, write proposals, shape policy, and
motivate others.
2007 Minority Women’s Health Summit
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•
Gatherers are responsible for collecting berries, roots, and stems. In terms of public health
and community organizations, the gatherers are the epidemiologists, researchers, and people
conducting surveillance.
•
The agrarian members are the keepers of the seeds, the planters, and the harvesters. In
community organizations, the planters develop ideas, see the big picture, and motivate others.
Harvesters serve as project managers, make preparations, and organize public relations. The
keepers of the seeds are the evaluators, who ensure that growth can continue with each
season.
Ms. Iron also encouraged Summit participants to take care of their own health. She challenged
them to set goals and own and defend them and to nurture their minds, bodies, spirits, and
emotions. She also suggested that participants focus on reviving one family tradition or
establishing a new one that is significant. Ms. Iron also encouraged participants to focus on one
project in their communities. For example, she discussed her participation in a women’s health
program that held bimonthly seminars. In so doing, she established long-lasting friendships with
women in the community.
In closing, Ms. Iron presented a Cheyenne quote:
A Nation is not conquered until the hearts of the
women are on the ground, then it is finished no
matter how brave its warriors or how strong
their weapons.
She encouraged Summit participants to keep this quote in their hearts as they work in their own
communities. She closed with an ancient song lyric—Now I make the footprint for the corn to
grow. She expressed her hope that Summit participants would make their own footprints,
enabling the knowledge gained at the Summit to grow in their hearts and to be harvested in their
communities.
Maximizing Your Potential: A Native American Perspective
Presentation available at www.niwhrc.org
A Latina Perspective
Elena M. Alvarado, Founder and CEO, National Latina Health Network, congratulated
Summit participants on sharing their time and brain power and for their continuing commitment
to reduce health disparities. She emphasized two themes of the Summit—strengthening
partnerships and individual lifestyle—and she stressed that women must internalize that they do
come first.
How collaborations and alliances are built will determine how successful partnerships are. Ms.
Alvarado noted the familiar saying that business is built on relationships. She noted that
successful communities are no different. Bringing together the right mix of partners takes
2007 Minority Women’s Health Summit
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advantage of unique strengths, strengthens capacity, and allows individual groups to accomplish
together what they could not accomplish alone. Ms. Alvarado pointed out that the right mix of
partners results in a group that is more effective, cost-effective, and credible. In addition,
coalitions and partnerships are often required by Federal grantors.
The use of local and national resources also determines the success of partnerships. Ms.
Alvarado noted that often local resources are forgotten or ignored. Yet local health agencies can
help groups disseminate information, local groups can make contributions, help groups, and
perhaps assist with promotions. In addition, community-based organizations can provide
expertise in reaching the intended population. National resources of the OWH, American Heart
Association, and American Diabetes Association are valuable, and they have local chapters
where community organizations can get information.
Building healthy communities is also a measure of successful partnerships. Ms. Alvarado
presented a collaborative partnership model in which business, local and State officials,
policymakers, media advocates, community and professional groups, associations, faith-based
groups, and the education system all contribute to a local network devoted to health. Ms.
Alvarado further noted that each component of the network has its own network, resource base,
and expertise. These components should not duplicate efforts, but work together to build
capacity and infrastructure. Ms. Alvarado also acknowledged that successful partnerships need
not only good planning and the right mix but political will. Many communities have a difficult
time with this.
Ms. Alvarado discussed challenges the National Latina Health Network works to address. One is
the importance of women taking care of themselves, which they often are not socialized to do.
Poverty and lack of health insurance are other challenges. Lack of knowledge is yet another.
•
Ms. Alvarado noted that although heart disease is a leading cause of death among women of
color, and although hypertension is a common chronic disease, Latina women are less likely
to know the signs and symptoms of a heart attack or how to prevent heart disease.
•
Diabetes is the fourth leading cause of death among Latinos and arises from obesity, lack of
exercise, and poor nutrition. Ms. Alvarado informed participants of ongoing research aiming
to identify genetic and environmental factors predisposing individuals to excessive weight
gain.
•
Latina women are particularly at risk for cancers of the breast or cervix, but they are less
likely to get mammograms or Pap smears. Ms. Alvarado discussed an observational study
conducted by the National Institute of Environmental Health Sciences. This study examines
genetic and environmental causes of disease by tracking the cancer-free sisters of women
with breast cancer. Ms. Alvarado informed participants of a large push to recruit women of
color from August 14, 2007, through March 2008.
•
Women of color are the new face of HIV/AIDS, and the major mode of transmission is
heterosexual contact. Ms. Alvarado called on Summit participants to teach young women
about sexual health, the choices they make, and the risks they are taking. She stressed that the
2007 Minority Women’s Health Summit
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next generation will be lost because many women are too embarrasses or ill-equipped to
discuss these matters.
•
As is the case with other communities of color, mental health is often a cause for
stigmatization and isolation in the Latino community. Yet Latino women do suffer from
depression and alcohol or drug abuse. Ms. Alvarado pointed out that not enough mental
centers are family based or designed by women.
Ms. Alvarado commended the organizers of the Summit for including violence against women.
She shared that her sister had had an extremely aggressive husband who always degraded her.
With time Ms. Alvarado and her sister learned that this was a form of dehumanization and that
emotional scars are just as bad as the physical ones. She reiterated calls by other speakers to
speak out if they see abuse.
Women can maximize their potential in their communities to reduce health disparities by:
•
Community outreach, education, screening, and prevention.
•
Promoting policies that support healthy lifestyles.
•
Including Latinas in national and local policymaking bodies.
•
Increasing health coverage and quality of care.
•
Assisting with navigation of the health care system.
•
Consumer education, protection, rights, and advocacy.
•
Creating women-centered prevention and treatment programs.
Ms. Alvarado described a visit to a town in the Netherlands, where cars were not allowed in the
town center. People aged 8 to 80 years were riding bicycles, and bicyclists had the right of way
and lanes that were part of traffic. Ms. Alvarado noted that the Dutch and Germans have made
physical fitness a major priority. She commented that these types of policies create healthier
communities.
Creating healthier communities also means understanding the cultural challenges. Like other
minority groups, Latino groups include many subgroups. Ms. Alvarado described the community
as family based and intergenerational; when someone goes to the doctor, the whole family goes.
Ms. Alvarado also stressed the value of oral history in health practices. She further emphasized
that health practitioners should respect the cultural values that make up their patients’ racial and
ethnic fabric.
She closed by stressing that women of color must increase their knowledge and serve as their
own advocates. They must look closely at the historical, social, economic, and political issues
that brought them to where they are today.
Maximizing Your Potential: A Latina Perspective
2007 Minority Women’s Health Summit
Page 56
National Latina Health Network
Washington Office
202-965-9633
[email protected]
www.nhln.net
New Jersey Office
732-565-0070
[email protected]
An African American Perspective
Marsha Lillie-Blanton, Dr. P.H., Kaiser Family Foundation, noted the new Congress and the
upcoming Presidential elections and commented that now was an important time to discuss
strategies and interventions. She also stated that as a researcher, she understood the importance
of data, but she also acknowledged that putting a human face on an issue is far more effective in
increasing people’s understanding.
She shared a personal story as an example of the many ironies African American women face.
When she was growing up, she had two sets of grandparents who lived into their 80s. Her
paternal grandmother lived until she was 89, but her daughter, Dr. Lillie-Blanton’s aunt, died
when she was 40. The grandmother had an eighth-grade education and had to be strong and
strong-willed to survive the jobs and indignities she faced. The aunt had graduated from college
and worked as an accountant at a university, but still did not live past 40. Dr. Lillie-Blanton
commented that many African American women had moved up the ladder, but they still seem to
lag behind on many health measures.
She also noted that the story of life and death is a complicated one. For African American
women who survive to age 65, the life expectancy does not differ from that for white women.
Yet for African Americans in general, mortality associated with chronic diseases is about twice
that for White women. Thus, African American women are resilient but vulnerable. To develop
strategies to improve health for women of color, one must understand the complexity of the lives
those women have lived.
Dr. Lillie-Blanton shared three lessons to maximize one’s potential in the community:
•
Do not neglect yourself or your family. This has been stressed throughout the Summit. At
her luncheon presentation, Dr. Hughes-Gaston talked about the role of personal lifestyle
choices. Dr. Lillie-Blanton added that women can be their worst enemies. Women must
exercise and manage their stress, and they must work together to eliminate alcohol abuse and
violence. They must focus greater attention on their personal health and the health of their
families. Committed organizers and conscious health care providers should develop viable
strategies to meet these needs, without neglecting their own health.
•
Guard against divide-and-conquer strategies. During the last two decades, more and more
conversations have focused either on African American women or African American men.
2007 Minority Women’s Health Summit
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Some provide data that a quarter of all African American women live in poverty, and about
half are heads of household. Dr. Lillie-Blanton referred to the high rate of infant mortality
and HIV infection and mortality. Others provide data about the high rates of incarceration,
homicide, and unemployment among African American men. Dr. Lillie-Blanton pointed out
that both groups are in the same boat and that the two sets of data are related. The situation of
African American men affects the health and well-being of African American women, and
vice versa, and the situation of both affects families. African American women continue to
shoulder the primary responsibility of raising children. That responsibility is one reason for
the higher rate of poverty among them. Dr. Lillie-Blanton acknowledged the data and spoke
against focusing on one or the other. She pointed out the need to strengthen and redesign
social structures and institutions that nurture opportunities for both men and women.
•
Understand the link between health and larger society. Dr. Lillie-Blanton shared that she
had just returned from Senegal and Gambia, where she had attended a conference organized
by the American Slavery Institute. The conference took place on Glory Island, which had
played a large role in the slave trade. Dr. Lillie-Blanton also shared a Mandinka proverb:
“The same water flows through two rice fields sharing the water.” This proverb stresses that
one can live without friends but not without neighbors. Dr. Lillie-Blanton pointed out that
groups have been separated by unacceptable divisions. Yet even as groups understand their
uniqueness or differences, they should also understand the borders they share. People should
acknowledge the neighbors in schools and workplaces, who affect well-being even though
they have not been invited into others’ lives.
Social disadvantages affect both African American men and women, and they also shape the
lives of other communities of color. Dr. Lillie-Blanton addressed comments that economics,
not race or gender, shape people’s lives. However, these factors are so intertwined that the
effort to separate them might outweigh the benefit gained. Be it social institutions, such as
the school or workplace, social environments, or power relationships, people of color are
immersed in social conditions that do not serve their families well. Dr. Lillie-Blanton
summed by saying that some of what ails African American men and women is the water
flowing through the shared borders. Thus, social structures and institutions serving African
American communities need an overhaul. Most of the changes implemented to make the
health care system more efficient and effective have been surface level and less than
adequate. At the root are social conditions outside of the health domain. Thus those seeking
to improve the health care system must form partnerships with those in education, banking,
corporations, community organizations, and housing.
Dr. Lillie-Blanton acknowledged the enormous challenge in developing and undertaking
interventions to address health disparities. She noted that outrage at the fact of health disparities
in the United States is beginning to resonate in both the public and private sectors. She described
this shift in thinking as good news, but she cautioned that the time of attributing disparities
simply to biology has passed. Dr. Lillie-Blanton noted that with the current economic outlook
and the situation in Iraq, an effort to overhaul the health care system is more difficult. Getting
health disparities higher in priority will require financial resources, technological know-how, and
political will. Dr. Lillie-Blanton closed by saying these goals have not been reached yet, but the
nation is on the right track.
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Discussion
Ms. Love began the discussion by encouraging Summit participants to get out of their own way
and to know their own worth. She repeated a statement she often uses to close her shows: If
nobody told you they love you today, I do. She then announced a DHHS program, Supporting
Caregivers across the Lifespan, which will be broadcast on satellite. Summit participants were
encouraged to contact Debbi Oxenreider, M.P.A. ([email protected]), Centers
for Medicare & Medicaid Services, for more information.
Discussion focused primarily on engaging elected officials. A woman who had survived cervical
cancer and started the Cervical Cancer Coalition of Tennessee commended speakers for
discussing this issue. She described the challenges she had faced in Tennessee, where those in
power dismiss her when she tries to speak to them about health disparities. She suggested
inviting some of these people to the next Summit. In response to her questions about getting
those in power to listen:
•
Dr. Lillie-Blanton suggested going through other organizations focused on communities of
color, then using those connections to get back to those who make policy and law. She
suggested the National Conference of State Legislators as a starting point.
•
Ms. Aranza suggested building relationships with legislators’ staff members and engaging
them at conferences. She noted the amount of work staff members do and suggested that in
many cases, staff will be able to address community needs better than their bosses can.
•
Ms. Love suggested identifying someone who has been affected by the issue. For example,
someone at a radio station might have been affected by cervical cancer, which would make
them more passionate about the issue. That person might then air messages about cervical
cancer. Ms. Love pointed out that on the air, one can gently call out a legislator for what they
have or have not done. Staffers might hear this message. Ms. Love encouraged the
participant to use the media, and she emphasized that the media have to be accessible. She
emphasized that organizations should follow up with the public service director after they
have sent their public service announcement. Ms. Love also encouraged participants to be
engaging on public affairs show and to send the host questions they want to answer.
An educator from California, who had been engaged in community-based research for 6 years,
also discussed this issue. Those working on the ground and engaging the community to respond
at a local level are often hampered by lack of support from elected officials. They know the
processes, but they are bombarded with political agenda at the local, State, and national levels. In
many cases, minority health is not a priority. The participant expressed exhaustion and
frustration and was convinced that those in power kept minorities in dependent position by
design. She asked how organizations could move forward with people who are actively
committed and not with those “representatives” that do not reflect the real issue.
Dr. Lillie-Blanton acknowledged and understood the participant’s frustration. She expressed
optimism, however, because what she has seen in the Washington, D.C., area is a long way from
where it was 20 years ago. This change has resulted primarily from efforts undertaken by people
in local communities. She stressed the importance of forming partnerships across sectors to avoid
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burnout on the part of any one group. She added that people who are elected or appointed can be
influenced. Ms. Aranza also suggested working with the Congressional caucuses, who are
accessible. She pointed out that each woman has a sphere of influence and can therefore educate
others and raise awareness. Ms. Alvarado emphasized the importance of the individual, who
must start with herself, then teach her family and community.
A participant who works with the American Cancer Society in Pennsylvania pointed out that
national American Cancer Society has a political and legislative arm. She also commented that
action will require groups to put a face on the problem, rather than simply say “disparities” or
“inequities.” She reminded Summit participants that all politics are local. Organizations should
work to put a face on the problem at the local level.
A member of the Minority Women’s Health Panel of Experts shared a strategy whereby a
Filipino nursing organization approached legislators as a group. Members worked together to
craft a bill enabling the nursing community to establish a peer program where nurses helped
those coming from poorer countries to pass the Boards and those nurses in turn helped others.
The panel member emphasized that it is not enough to write the bill. The group must exercise
patience and have large numbers of supporters present at every session.
One of the 25 young leaders asked whether policies could be drafted to address preventive health
care in younger women. For example, she pointed out that younger women would like to have
regular checks of their blood pressure and blood sugar levels, but they must pay for these
services unless they are deemed at risk or have been diagnosed with hypertension or diabetes.
Speakers agreed that the system of health insurance did have gaps, particularly for younger
people. Although plenty of legislative attention has focused on extending health insurance to
those who do not have it, few legislators have focused also on the scope of benefits.
Speakers repeated their calls for women, particularly those who are community leaders, to
engage elected officials in discussions of health care.
A participant from Las Vegas, Nevada, discussed the information available about Presidential
candidates on the Internet and in the media. She pointed out that most of it was irrelevant and
that voters needed to know the candidates’ policies on health, immigration, and education,
among other things. The participant summed by saying that women need to know what
candidates stand for, not what they did when they were younger.
A participant from Boston, Massachusetts discussed a report on health disparities, which had
been commissioned by the State legislature. The document is available at www.mass.gov. The
Disparities Action Network Coalition is now attempting to get legislation passed to act on this
report. In terms of lifestyle changes, the participant pointed out that patients’ lives are chaotic
and the food available to them is salty and sugary. Thus, change will require more than personal
responsibility; social interventions are needed as well.
Other discussion points included:
•
Culturally appropriate materials. A participant who works with an organization focused
on fibromyalgia discussed efforts by the organization to inform women of color that they too
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are at risk. The participant described inappropriate materials targeted toward Hispanics and
African Americans, including a brochure with a taco of churchgoer on the cover. In response
to questions about ensuring cultural sensitivity, Ms. Iron pointed out that the National Indian
Women Resource Center and other Native American organizations have staff that can review
materials for cultural appropriateness. She invited the participant to contact her for referrals.
Ms. Alvarado made a similar offer to help the participant create materials accounting for the
various regional and age-related differences in the Latina community. Dr. Lillie-Blanton
pointed out that the mainstream often approaches the one person of color to speak for all
people of color. She encouraged the participant to identify resources in other communities
and form partnerships. OMH can assist with those connections. Dr. Lillie-Blanton
commented that she had once resented being asked to speak for all people of color. However,
she now reaches out to partners.
A physician who has lectured physicians and medical students for 20 years discussed a
compilation of information addressing health disparities among African Americans, Latinas,
and Native Americans. She offered to share these materials with others.
•
Diversity in the health care workforce. A health care provider pointed out that women
must play a part in improving diversity in the health care workforce. They must do whatever
they can to advocate for opportunities for minorities, to mentor young people, and to
encourage them to go into health care field.
•
Silent epidemics. Ms. Oxenreider raised traumatic brain injury as a health issue needing
more attention. She mentioned a walk that will take place on September 9 to raise awareness.
An independent consultant who works with the Black Women’s Health Alliance reiterated Ms.
Love’s call for women of color to know their own worth. She asked who participants could
contact and how they could continue these discussions with and support of each other. Ms. Iron
pointed out that OWH has a coordinator in each region. She added that the coordinator for
Region 6 had formed an alliance of local groups, including local Indian tribes. This alliance has
sent representatives to the Summit, and these representatives will share the information and
knowledge they gained with others in the alliance.
Ms. Ashe-Goins also responded to the participant’s question by noting that OWH employs a
coordinated process for every conference it holds. She invited participants to contact OWH and
their regional coordinators, to visit the OWH Web site (www.4woman.gov/owh/index.htm), and
to talk with members of the Minority Women’s Health Panel of Experts. She further noted that
OWH regularly works with OMH, NIH, the NIH Office of Research on Women’s Health, and
other Federal agencies. She also pointed out that the 2007 Summit resulted from a 2-year process
in which regional coordinators held listening sessions in their regions. Input from these sessions
was used in the design of the conference.
Closing Remarks
Adrienne Smith, Ph.D., Senior Public Health Advisor, OWH, thanked participants for
attending, for allowing themselves to be open to new ways of learning, and for sharing their
resources, approaches, and mentoring opportunities with others. She noted that the Summit had
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been organized not as a conference to provide information about diseases and conditions and
how they affect minority women, but as a forum to provide participants with the skills and
resources to better do their jobs and make an impact on their communities. Although the Summit
included many presentations and panels, Dr. Smith pointed out that all participants were experts
in their own right and that as such, these participants had their own spheres of influence. Dr.
Smith also thanked the men who had attended the Summit and reminded participants of the
influence men have on the women in their lives.
In keeping with the emerging theme that women of color should make sure to take care of
themselves, Dr. Smith discussed a conference she had attended. At this conference, Dr. Renee
Harding spoke about knowing yourself and your strength, spending time with yourself, and
allowing yourself to be appreciated. Dr. Harding noted that in the midst of working and caring
for others, women should take at least 2 hours a week for themselves. Dr. Smith thus challenged
Summit participants to take care of themselves physically, mentally, socially, intellectually, and
spiritually.
Dr. Smith commented that big problems often turn into blessings. She noted that the Summit had
more attendees than had been anticipated. However, although this caused logistical problems, Dr.
Smith was happy to see more people learning, extending the reach of the Summit. She discussed
her role in making connections throughout the Summit and encouraged participants to maintain
and extend those connections and to use each other’s resources. To that end, the participant list
will be updated and posted online.
Dr. Smith also discussed the importance of legacy in improving health among women of color.
She acknowledged Ms. Angela Bates, NIH Office of Research on Women’s Health, who
advocated throughout the planning process for the inclusion of young people in the Summit. Dr.
Smith had also brought her daughter to the Summit as a step toward that legacy. She discussed
the importance of instilling healthy behaviors in children at an early age and of encouraging
them to be health leaders. She also emphasized the importance of mentoring. Dr. Smith reiterated
calls for participants to improve and preserve their own health and quality of life, to consider
how they affect families, communities, children, and generations to come. In so doing, women of
color can provide a legacy of good health while improving and preserving their own.
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