Health officials are in general agreement that the United States has a health care problem. More Americans are dying younger and of preventable causes than our peer nations who spend less on health care.
This weekend, medical doctors from across the country took to the stages of the New Orleans Book Festival at Tulane University to speak on the state of women’s health care and public health in prisons.
On Friday afternoon, Dr. Homer Ventersformer chief medical officer of the New York City jail system and current court-appointed monitor of health services in jails and prisons, discussed the most pressing ethical and medical issues in prison health care.
Venters spoke alongside Dean Thomas LaVeist of the Tulane University Celia Scott Weatherhead School of Public Health and Tropical Medicine.
“Most physicians work in a system that’s built for health care, whereas most correctional health [workers] work in a box that was built for custody or control,” Venters said.
In many correctional facilities, Venters said the health team is managed by the facility’s security team, introducing pressure on the health team to treat patients and report findings differently to accommodate administrative preferences.
This is what Venters terms the ubiquitous but rarely-discussed “dual loyalty” that health care workers face in carceral settings, as they are stuck between addressing the needs of their patients and answering to the “paramilitary” control of prison administration.
He noted that one well-executed aspect of carceral health care is disease outbreak responses, and that these can be a catalyst for addressing and preventing other systemic health issues that incarcerated people face.
vendors’ most recent book“Outbreak Behind Bars: Spider Bites, Human Rights, and the Unseen Danger to Public Health,” is about the rapid, dangerous spread of communicable diseases in overcrowded correctional facilities.
“That’s an area where everybody cares. Correctional officers get sick, their families get sick, the people around jails and prisons get sick,” Venters said. “Even in states that are poorly resourced for public health … there’s a good understanding these are legitimate issues.”
Saturday’s Book Festival programming featured a conversation on women’s health care with Dr. Veronica Gillispie-Bell, Heddwen Brooks, Sara Reardon and Dr. Jennifer Avegno, Tulane researcher and director of the health department for the City of New Orleans.
Women often stay silent about health issues in their everyday lives, “white-knuckling” through pain and discomfort because they don’t know about the resources available to help them, Reardon said.
“You did nothing wrong; the systems just were not in place to support you,” Reardon said. Reardon is a pelvic floor physical therapist and a prominent social media presence.
A main theme of the panel was the underrepresentation of women’s health in research.
In 2020, 5% of global research funding was allocated to women’s health research. In the National Institute of Health, diseases affecting primarily males received disproportionately more funding, despite having less disease burden than those affecting mostly women. Most clinical trials for medical treatments also underrepresent women and minorities or fail to disaggregate by factors like sex and race.
Gillispie-Bell, who is an obstetrician-gynecologist at Ochsner Health, said that equality in every facet of health: research, conversations surrounding it and representation in leadership would define success in women’s health care.
In Louisiana, women’s health care is ranked among the worst in the nation. For Gillispie-Bell, “that means I have a responsibility,” she said. She noted the importance of policy as a cornerstone for improving women’s health care, and the opportunities she has had to advocate for policy improvements in maternal care at congressional briefings and through other federal programs.
“We don’t talk enough about those social factors [that determine health outcomes],” Gillispie-Bell said. “We also don’t invest enough in public policy to address those social factors.”
A common sentiment of both events was hope for the future of health care.
Brooks, who is the chair of the physiology department at the Tulane School of Medicine, focuses on researching physiological sex differences. She reminded the audience that many people remain passionate about studying topics like women’s health despite disparities in resources.
In light of recent massive federal funding cuts to research, Brooks said, “I tell my faculty, just keep doing what you’re doing, ignore the noise. We know we’re doing the right thing. We’re studying things that are super important.”
On carceral health care, Venters spoke about cases involving patients in Texas in non-air-conditioned, high-heat settings, but noted that “advocacy by families and local journalism has really pushed the state legislature” to improve their conditions.
