issues

How doctors’ bias leads to unfair and unsound medical triage

Photo by Piron Guillaume on Unsplash

Philip Rosoff

When someone is sick or needs the help of a physician, who should decide what is appropriate – what blood tests and imaging studies to order, what medicines to prescribe, what surgeries to perform? Should it be the doctor, the patient or some combination of the two? Most people nowadays (even most physicians) support what is called ‘shared decision-making’, in which the doctor and patient (and often her family or friends) discuss the situation and come up with a joint plan. The doctor’s role is that of experienced guide, whose medical knowledge, skill and expertise help to shape the conversation and whose understanding of the priorities, values and goals of the patients steers the plan in a given direction to the satisfaction of all.

Unfortunately, in the real world, things don’t always work this way. Doctors and patients have a number of masters, both welcomed and uninvited. Insurance companies or other third-party payers often intrude into the decision-making process, limiting the choices of what services and products might be available: a sick patient often must wait for pre-authorisation for expensive diagnostic tests and procedures; pharmacy formularies restrict the kinds of drugs available for prescriptions, and so on. Furthermore, some doctors have personal interests in the interventions they recommend. Many surgeons make more money if they do more surgery, cardiologists earn more if they put in more cardiac stents and pacemakers, and drug companies have better profits if they sell drugs for chronic conditions that never get better and require lifelong medication (such as high cholesterol, hypertension and diabetes). Such practices contribute to the seeming inexorable rise in healthcare costs (and a host of adverse outcomes) in the United States.

Yet controlling cost without sacrificing quality has been a daunting task. One strategy might be to pay more attention to what patients need, and less to what they want, assuming that the two don’t overlap. Another is limiting the excess of doctors who prescribe because of conflicts of interest or acts of ‘defensive medicine’ – in other words, to protect themselves from lawsuits, not aid the patient.

How does one go about rationing care? Will faceless bureaucrats be denying granny her medication or access to an intensive-care unit solely because she’s old, or saying that Billy can’t get his conditions treated because he is disabled? Indeed, dread of rationing – as well as a healthy dose of old-fashioned fear-mongering by crafty politicians – is what inspired the meme of ‘death panels’, an unfounded canard based upon a misinterpretation of a proposed federal rule for Medicare. Nevertheless, the concept of rationing is still of concern because it implies restriction of a resource that could be beneficial.

Therefore, rationing doesn’t apply to interventions that can’t help anyone at any time – for instance, antibacterial antibiotics that won’t work because the patient has a viral infection. A better example of true rationing is the allocation of organs – such as livers, hearts and lungs – for transplantation. Organ transplantation requires rationing because the supply never keeps up with demand. We also ration drugs that can suddenly become scarce (a distressingly common problem).

But there are other forms of rationing that are problematic, too. The most common one, intrinsic to the US healthcare system, involves limiting the kind and amount of healthcare one can obtain based on one’s financial situation. Poorer people get less and worse healthcare than wealthy people. While the most offensive aspects of this arrangement have been mitigated to some extent in those states that expanded Medicaid under the auspices of the Affordable Care Act, there are still alarming numbers of Americans who have limited access to effective medical care. This is one of the chief reasons why the US population as a whole doesn’t get as much bang per buck as citizens of many other nations, and this form of rationing is blatantly unfair.

But there is another form of rationing that is more insidious still. This is the so-called bedside rationing, in which doctors decide, on an individual per-patient basis, what should be available to them, regardless of the range of services that their insurance or finances might otherwise allow. The problem with this is that it is readily susceptible to prejudice and discrimination, both overt and hidden. It is well-known that doctors, like pretty much everyone else, harbour so-called implicit biases that are readily revealed on the implicit-association test (available online).

This does not mean that physicians express overt sexism, racism, or others forms of bigotry – but rather that these unconscious beliefs about others can influence the kinds of treatments that they offer. Thus, bedside rationing can violate one of the cardinal principles of fairness – that clinically similar situations be treated similarly. So doctors could offer one patient (say, a well-off white person) with unstable angina and blocked coronary arteries the standard of care with cardiac catheterisation and stents, while offering just medical therapy to an African-American patient with comparable disease. And there is ample evidence that such differential treatment occurs.

So how does one ‘choose wisely’ and escape the moral pitfalls of bedside rationing? It turns out that this is an extraordinarily difficult to do, especially in a system such as ours where physicians have such discretionary power about what diagnostic and treatment interventions should be on the ‘menu’ for each patient. This can readily lead to too much and too little offered to patients for reasons that cannot be easily justified.

I think that the solution, at least in the US, might require a wholesale re-engineering of our healthcare system to minimise the financial incentives to overprescribe, and to protect or immunise against the biases that lead to inappropriate rationing at the bedside. The only way to reduce the frequency of these behaviours is to have a single-payer system that controls (to a certain extent) the availability of certain interventions, analogous to the way in which the organ-transplant system regulates who gets transplanted and under what circumstances.

Of course, unlike livers and hearts, what needs to be rationed in the US is money and what it can buy. We could save money by efficiencies of scale and decreasing the waste and administrative costs that contribute at least 25 per cent of the total cost of what we now spend. Can we totally eliminate ‘bad’ rationing? No, of course not. But Americans should do all they can to avoid the moral tragedy of being the wealthiest nation on Earth that chooses dumbly, not wisely, about healthcare. Aeon counter – do not remove

Philip Rosoff is professor of paediatrics and director of the clinical ethics programme at Duke University Hospital in North Carolina. He is the author Drawing the Line: Healthcare Rationing and the Cutoff Problem (2017).

This article was originally published at Aeon and has been republished under Creative Commons.

Gun violence in the US kills more black people and urban dwellers

A man changes a flag to half-staff near the First Baptist Church of Sutherland Springs.
AP Photo/Eric Gay

Molly Pahn, Boston University; Anita Knopov, Boston University, and Michael Siegel, Boston University

On Nov. 5, just 35 days after the deadly Las Vegas shooting, a man walked into a church in a small Texas town and murdered 26 people with an assault rifle. The coverage dominated the news.

But the day before, even more people – 43 – were shot to death in cities and towns around the country. And nobody really seemed to notice.

Shootings kill more than 36,000 Americans each year. Every day, 90 deaths and 200 injuries are caused by gun violence. Unlike terrorist acts, the everyday gun violence that impacts our communities is accepted as a way of life.

Of all firearm homicides in the world, 82 percent occurs in the United States. An American is 25 times more likely to be fatally shot than a resident of other high-income nations.

As public health scholars who study firearm violence, we believe that our country is unique in its acceptance of gun violence. Although death by firearms in America is a public health crisis, it is a crisis that legislators accept as a societal norm. Some have suggested it is due to the fact that it is blacks and not whites who are the predominant victims, and our data support this striking disparity.

Urban and racial disparities

Within the United States, the odds of dying from firearm homicide are much higher for Americans who reside in cities. Twenty percent of all firearm homicides in the U.S. occur in the country’s 25 largest cities, even though they contain just over one-tenth of the U.S. population. Data from the Centers for Disease Control and Prevention show that of the 12,979 firearm homicides in 2015, 81 percent occurred in urban areas.

There is even more to the story: CDC data also show that within our nation’s cities, black Americans are, on average, eight times more likely to be killed by firearms than those who are white. The rate of death by gun homicide for black people exceeds those among whites in all 50 states, but there is tremendous variation in the magnitude of this disparity. In 2015, a black person living in Wisconsin was 26 times more likely to be fatally shot than a white person in that state. At the same time, a black person in Arizona was “only” 3.2 times more likely than a white person to be killed by a gun. The combination of being black and living in an urban area is even more deadly. In 2015, the black homicide rate for urban areas in Missouri was higher than the total death rate from any cause in New York state.

These differences across states occur primarily because the gap between levels of disadvantage among white and black Americans differs sharply by state. For example, Wisconsin – the state with the highest disparity between black and white firearm homicide rates – has the second-highest gap of any state between black and white incarceration rates, and the second-highest gap between black and white unemployment rates. Racial disparities in advantage translate into racial disparities in firearm violence victimization.

Americans are 128 times more likely to be killed in everyday gun violence than by any act of international terrorism. And a black person living in an urban area is almost 500 times more likely to be killed by everyday gun violence than by terrorism. From a public health perspective, efforts to combat firearm violence need to be every bit as strong as those to fight terrorism.

The ConversationThe first step in treating the epidemic of firearm violence is declaring that the everyday gun violence that is devastating the nation is unacceptable. Mass shootings and terrorist attacks should not be the only incidents of violence that awaken Americans to the threats to our freedom and spur politicians to action.

Molly Pahn, Research Manager, Boston University; Anita Knopov, Research fellow, Boston University, and Michael Siegel, Professor of Community Health Sciences, Boston University

This article was originally published on The Conversation. Read the original article.

I’m a librarian in Puerto Rico, and this is my Hurricane Maria survival story

Condado, San Juan, Puerto Rico.(Photo by Sgt. Jose Ahiram Diaz-Ramos/PRNG-PAO)

Evelyn Milagros Rodriguez, University of Puerto Rico – Humacao

I’ve always been fascinated by storms, particularly Puerto Rico’s own history of them. I think it’s because I was born in September 1960 during Hurricane Donna. In its wake, that storm left more than 100 dead in Humacao, the city where I am now a special collections librarian at the University of Puerto Rico.

In 1990, Israel Matos, the National Weather Service Forecast Officer in San Juan, told me that, “The tropics are unpredictable.” That comment only increased my interest in storms. Now, with the people of Puerto Rico still reeling from Hurricane Maria more than a month after it hit the island, his words seem prescient.

Today I have – if not the honor, then the duty – to describe, firsthand, what it is to live through the aftermath of the worst storm of this brutal hurricane season.

Academic crisis

Since the storm I haven’t been able to go to work at the library on the Humacao campus. At 88,000 square feet and three stories, the biblioteca is the biggest building on campus, and it’s among the worst damaged by Maria.

The library at the University of Puerto Rico, Humacao.
Evelyn M. Rodríguez, Author provided

It’s mold-infested and the roof is leaking, so there’s a lot of work to be done in both repairs and cleaning before students can use it. The mold has gotten into our collection – from books and papers to magazines – and most of the furniture and computers will have to be replaced.

According to the general damage report for the University of Puerto Rico, the infrastructure in all 11 campuses of the university system suffered severe losses.

Héctor Rios Maury, chancellor of the University of Puerto Rico’s Humacao campus, speaks to staff and students after the storm.
Evelyn M. Rodríguez, Author provided

The Humacao campus, located on the island’s eastern side, was the hardest hit, with damages calculated at more than US$35 million. Classes will start again on Oct. 31.

Students at the Río Piedras campus, which has been partially closed since Hurricane Irma skirted Puerto Rico on Sept. 6, have had only a week of class so far this year.

Five weeks after Hurricane Maria, all the campuses have now reissued their academic calendars and classes are resuming, though in some places the first semester will run through January to make up for lost time.

A culture of catastrophe

Starting on Sept. 20, 2017, Hurricane Maria swamped Puerto Rico with 20 inches of rain and battered it with 150 mph winds for over 30 hours.

The resulting humanitarian crisis has been widely reported worldwide: 80 percent of the island is still without electricity and there is not enough drinking water.

Communications – radio, television, telephones and internet – are now recovering slowly, after weeks of near nonexistence. Having said that, it took me more than two weeks just to write this article, between finding somewhere to charge my laptop and locating an internet connection strong enough to research the data and send a file by email. Eventually I discovered a Starbucks near my house with both electricity and Wi-Fi. Nothing is easy.

What outsiders are unable to see, perhaps, is that an entire culture has arisen around the catastrophe caused by Hurricane Maria – one with typically catastrophic traits: material scarcity, emotional trauma, economic catastrophe, environmental devastation.

Puerto Ricans are now facing a dramatically different way of life, which means our relatives and friends in the diaspora are, too.

Nothing about life resembles anything close to normal. An estimated 100,000 homes and buildings were demolished in the storm, and 90 percent of the island’s infrastructure is damaged or destroyed. Not only are there shortages of water and electricity but also of food, highways, bridges, security forces and medical facilities.

It’s dangerous to venture outside at night. An island-wide curfew was lifted last week, but without streetlights, stoplights or police, driving and walking are dangerous after dark.

The official tally of missing people varies, with police tallies ranging from 60 to 80 right now. Considering Puerto Rico’s hazardous conditions and limited health care services, that number is sure to rise. We are well aware that epidemic diseases, including leptospirosis and cholera, could come next. Health concerns are further stoked by the delays and disarray of the various federal agencies tasked with handling this emergency.

A deep uncertainty looms over our futures. There is post-traumatic stress involved in surviving in an overwhelming situation like this, so as a people we’re now waking up to that psychological pain, too.

The outlook from here

In short, Hurricane Maria has changed the modern history of Puerto Rico. For those who, like me, are curious about such things, the last storm of this caliber was San Felipe II, in 1928.

Known in the U.S. as the Great Okeechobee Hurricane, that massive storm was so destructive that it basically plunged Puerto Rico and Florida into the Great Depression a year before the rest of the country.

The aftermath of the Great Okeechobee Hurricane in Florida, 1928.
NOAA

In some ways, though, Puerto Ricans are well prepared for these challenges, for the history of the island is one of uncertainty and trouble.

Puerto Rico has never had a sovereign government. Instead, it has always been bound to some other larger and more powerful state. First it was Spain, which colonized our territory in 1508.

Then, since the 1898 invasion, it’s been the United States, a country with which Puerto Rico enjoys a tricky political relationship. That’s very clear right now, as the Trump administration wavers in coming to our aid.

Mired in uncertainty

Even before the hurricane arrived, Puerto Rico was facing uncertainty around another major challenge: bankruptcy. Considering lost pensions, jobs and savings, the real financial costs surely exceed by billions the official sum of $123 billion in unpaid government debt.

Hurricane Maria has deepened this economic crisis, creating a ripple effect that touches everyone across all levels of society.

Everyone is mired in uncertainty. What is the solution to this cascading set of problems? How long will recovery take? What could actually make life better for us? What will we miss? Will anything ever be the same?

Among all this concern and confusion, though, some things have become clearer since the storm. On this once-green island, the hurricane blew down and shredded thousands and thousands of trees.

The sky is more visible now. Houses once hidden are exposed, and we discern entire communities that that we rarely saw before.

A graffiti-scrawled reminder in Puerto Rico: ‘Behind the trees live a lot of people.’
Evelyn M. Rodríguez, Author provided

There’s graffiti popping up across the island, written by someone identified as “JC,” who reminds Puerto Ricans, as a kind of consolation, that “Behind the trees live a lot of people.”

Just as new environments are created in areas opened up by the hurricane, with trees and plants sprouting afresh, over time we’ll find that our current uncertainties also fade and transform. A brand new way of life is emerging among all Puerto Ricans – those who stayed, those who left, their relatives and their friends.

The ConversationLeer en español.

Evelyn Milagros Rodriguez, Research, Reference and Special Collections Librarian, University of Puerto Rico – Humacao

This article was originally published on The Conversation. Read the original article.

Exclusive Interview: “Charcoal” writer/director Francesca Andre talks colorism

Francesca Andre has a message for everyone with her short film, Charcoal. The main theme of her film is about colorism and its damaging effects on the black diaspora. Her two main characters go through a journey of self-acceptance and self-awareness, and that journey is something Andre hopes is replicated in her viewers.

I’ve had the chance to speak with Andre recently about her film (which you can learn more about in a previous article and the trailer below) as well as her opinions on how colorism affects us. I also asked about the Dove ad that sparked controversy, and how we can heal as a people from our societal wounds. Andre offers clear insight into her own journey towards healing and how we can continue the process of healing in our own lives. Here are highlights from that conversation.

Charcoal can be seen at the Yonkers Film Festival Nov. 3-8.

The inspiration for Charcoal:

Colorism is something that has impacted my life at a very young age. It’s very common in Haiti—it’s not white people versus black people, it’s really lighter skin versus darker skin. At a very young age, I was made aware of that. When I was probably five years old, I received a dark-skinned doll. When I took it home, people started making fun of the doll, saying the doll is ugly. My mother being brown-skinned, my grandmother being lighter-skinned, and my grandfather and my father being darker skinned men, people just made comparisons to the skintones.

Colorism and the lasting effects of racism in the black diaspora:

We’re still dealing with the consequences [of racism] as a people when it comes to economic empowerment, how we are being perceived and anything else—colorism sits right in there. It’s still affecting us, we’re still dealing with it, it’s not a thing of the past. We’re still healing from it. Those of us who are aware and are making a conscious decision to talk about it. You can’t really talk about racism or the advancement of us as a people and not talk about colorism.

Here in America, [the Dove colorism ad] was a mainstream brand that everyone can see, but you have some smaller brands, when you go to Caribbean markets that are selling [similar] products. You have women making skin-bleaching lotion and selling it to other women. I guess for some people here, it’s not as blatant as it is in other cultures—if you go to CVS, you probably won’t be able to find it, right? But it’s happening. It never went away, at least from my experience; as long as I’ve been alive, I’ve always known about these products.

Even thinking about “good” hair,the hair is not closer to our hair texture. It’s something closer to European hair texture. But when you look at our hair and the versatility of our hair, to me it’s like, really good hair! It took me a long time to reprogram myself, my thoughts, and redefine what “good” hair was for me to access [my hair] and accept it, love it, and embrace it…I don’t have any problems with it now.

Francesca Andre

On how to heal from colorism:

I do feel like we need to start having conversations, and an important part of that is the healing part of that. I think you will see that you’ll find more women going natural more than ever. Here’s what’s fascinating: how so many black women did not know their hair period because they just haven’t been dealing with their hair…they did not know how to take care of their hair; it’s been processed. When they find out what products work on our hair and what they can do to make their hair do this and that. Again, it’s knowledge and healing and more women are stepping out. It’s not a strange thing now to see a black woman with natural hair in the workplace. There was a time when this wasn’t a thing. Now, more people are going natural, embracing it and being unapologetic about it. I feel like we’re going forward. Even with skintones, too—[online campaigns and phrases like] “My melanin’s poppin’,” #BlackGirlMagic—we are healing collectively. I hope the men are using those terms as well; I hope the men are healing because they are also victims of colorism. I hope that we as a people stop the vicious cycle.

…First of all, I think [the first step to healing is] knowing what colorism is. Many people don’t even know what colorism means. It really starts the conversation. It’s hard to change beliefs, but one way we can do that as a people is to talk—ask [about it] and dialogue. Increase representation [in the media] to make women more confident in who they are and how they look. As an artist and storyteller, the way I [change] people is including it and showing it, talking about it and not pushing it away…Whenever I see a girl with natural hair, I tell them “I love your hair” or “I love your twists”; I make it my job to remind them because all the messages they are receiving are the opposite.

How Charcoal can start viewers’ journeys toward self-acceptance:

I think there’s a universal aspect to it. I hope people feel inspired and hopeful. I hope people find some sort of healing or be the beginning of that journey. We all can relate to pain, and the characters go through that, but we can see how they overcome that.♦

This interview has been edited and condensed. 

Why America needs Marvel superhero Kamala Khan now more than ever

Katie M. Logan, Virginia Commonwealth University

During the first few weeks of the Trump administration, we’ve seen increased pressure on Muslim and immigrant communities in the United States.

In the face of these threats, which Marvel superhero might be best equipped to defend the people, ideals and institutions under attack? Some comic fans and critics are pointing to Kamala Khan, the new Ms. Marvel.

Khan, the brainchild of comic writer G. Willow Wilson and editor Sana Amanat, is a revamp of the classic Ms. Marvel character (originally named Carol Danvers and created in 1968). First introduced in early 2014, Khan is a Muslim, Pakistani-American teenager who fights crime in Jersey City and occasionally teams up with the Avengers.

Since Donald Trump’s inauguration, fans have created images of Khan tearing up a photo of the president, punching him (evoking a famous 1941 cover of Captain America punching Hitler) and grieving in her room. But the new Ms. Marvel’s significance extends beyond symbolism.

In Kamala Khan, Wilson and Amanat have created a superhero whose patriotism and contributions to Jersey City emerge because of her Muslim heritage, not despite it. She challenges the assumptions many Americans have about Muslims and is a radical departure from how the media tend to depict Muslim-Americans. She shows how Muslim-Americans and immigrants are not forces that threaten communities – as some would argue – but are people who can strengthen and preserve them.

Superhero-in-training

After inhaling a mysterious gas, Kamala Khan discovers she can stretch, enlarge, shrink and otherwise manipulate her body. Like many superheroes, she chooses to keep her identity a secret. She selects the Ms. Marvel moniker in homage to the first Ms. Marvel, Carol Danvers, who has since given up the name in favor of becoming Captain Marvel. Khan cites her family’s safety and her desire to lead a normal life, while also fearing that “the NSA will wiretap our mosque or something.”

As she wrestles with her newfound powers, her parents grow concerned about broken curfews and send her to the local imam for counseling. Rather than reinforcing her parents’ curfew or prying the truth from Khan, though, Sheikh Abdullah says, “I am asking you for something more difficult. If you insist on pursuing this thing you will not tell me about, do it with the qualities benefiting an upright young woman: courage, strength, honesty, compassion and self-respect.”

Her experience at the mosque becomes an important step on her journey to superheroism. Sheikh Abdullah contributes to her education, as does Wolverine. Islam is not a restrictive force in her story. Instead, the religion models for Khan many of the traits she needs in order to become an effective superhero. When her mother learns the truth about why her daughter is sneaking out, she “thank[s] God for having raised a righteous child.”

The comics paint an accurate portrait of Jersey City. Her brother Aamir is a committed Salafi (a conservative and sometimes controversial branch of Sunni Islam) and member of his university’s Muslim Student Association. Her best friend and occasional love interest, Bruno, works at a corner store and comes from Italian roots. The city’s diversity helps Kamala as she learns to be a more effective superhero. But it also rescues her from being a stand-in for all Muslim-American or Jersey City experiences.

Fighting a ‘war on terror culture’

Kamala’s brown skin and costume – self-fashioned from an old burkini – point to Marvel Comics’ desire to diversify its roster of superheroes (as well as writers and artists). As creator Sana Amanat explained on “Late Night With Seth Meyers” last month, representation is a powerful thing, especially in comics. It matters when readers who feel marginalized can see people like themselves performing heroic acts.

As one of 3.3 million Muslim-Americans, Khan flips the script on what Moustafa Bayoumi, author of “This Muslim American Life,” calls a “war on terror culture” that sees Muslim-Americans “not as complex human being[s] but only as purveyor[s] of possible future violence.”

Bayoumi’s book echoes other studies that detail the heightened suspicion and racial profiling Muslim-Americans have faced since 9/11, whether it’s in the workplace or interactions with the police. Each time there’s been a high-profile terrorist attack, these experiences, coupled with hate crimes and speech, intensify. Political rhetoric – like Donald Trump’s proposal to have a Muslim registry or his lie that thousands of Muslims cheered from Jersey City rooftops after the Twin Towers fell – only fans the flames.

Scholars of media psychology see this suspicion fostered, in part, by negative representations of Muslims in both news media outlets and popular culture, where they are depicted as bloodthirsty terrorists or slavish informants to a non-Muslim hero.

These stereotypes are so entrenched that a single positive Muslim character cannot counteract their effects. In fact, some point to the dangers of “balanced” representations, arguing that confronting stereotypes with wholly positive images only enforces a simplistic division between “good” and “bad” Muslims.

Unbreakable

Kamala Khan, however, signals an important development in cultural representations of Muslim-Americans. It’s not just because she is a powerful superhero instead of a terrorist. It’s because she is, at the same time, a clumsy teenager who makes a mountain of mistakes while trying to balance her abilities, school, friends and family. And it’s because Wilson surrounds Kamala with a diverse assortment of characters who demonstrate the array of heroic (and not-so-heroic) actions people can take.

For example, in one of Ms. Marvel’s most powerful narrative arcs, a planet attacks New York, leading to destruction eerily reminiscent of 9/11. Kamala works to protect Jersey City while realizing that her world has changed – and will change – irrevocably.

Carol Danvers appears to fill Kamala in on the gravity of the situation, telling her, “The fate of the world is out of your hands. It always was. But your fate – what you decide to do right now – is still up to you … Today is the day you stand up.” Kamala connects the talk with Sheikh Abdullah’s lectures about the value of one’s deeds, once again linking her superhero and religious training to rise to the occasion. In both cases, the lectures teach Kamala to take a stand to protect her community.

Arriving at the high school gym now serving as a safe haven for Jersey City residents, Kamala realizes her friends and classmates have been inspired by her heroism. They safely transport their neighbors to the gym while outfitting the space with water, food, dance parties and even a “non-denominational, non-judgmental prayer area.” The community response prompts Kamala to realize that “even if things are profoundly not okay, at least we’re not okay together. And even if we don’t always get along, we’re still connected by something you can’t break. Something there isn’t even a word for. Something … beautiful.”

The ConversationKamala Khan is precisely the hero America needs today, but not because of a bat sign in the sky or any single definitive image. She is, above all, committed to the idea that every member of her faith, her generation, and her city has value and that their lives should be respected and protected. She demonstrates that the most heroic action is to face even the most despair-inducing challenges of the world head on while standing up for – and empowering – every vulnerable neighbor, classmate or stranger. She shows us how diverse representation can transform into action and organization that connect whole communities “by something you can’t break.”

Katie M. Logan, Assistant Professor of Focused Inquiry, Virginia Commonwealth University

This article was originally published on The Conversation. Read the original article.

How media sexism demeans women and fuels abuse by men like Weinstein

File 20171016 31008 59fzv3.jpg?ixlib=rb 1.1
Advertising continues to portray women as charming keepers of the home, making it harder to succeed at work.
Andrea44/flickr, CC BY-SA

Virginia García Beaudoux, University of Buenos Aires

The sexual abuse scandal currently embroiling media mogul Harvey Weinstein has stunned the United States, with Hollywood and the fashion industry declaring that “this way of treating women ends now.”

As an Argentinean woman who studies gender in the media, I find it hard to be surprised by Weinstein’s misdeeds. Machismo remains deeply ingrained in Latin American society, yes, but even female political leaders in supposedly gender-equal paradises like Holland and Sweden have told me that they are criticized more in the press and held to a higher standard than their male counterparts.

How could they not be? Across the world, the film and TV industry – Weinstein’s domain – continues to foist outdated gender roles upon viewers.

Women’s work

Television commercials are particularly guilty, frequently casting women in subservient domestic roles.

Take this 2015 ad for the Argentine cleaning product Cif, which is still running today. It explains how its concentrated cleaning capsules “made Sleeping Beauty shine.”

The prince could help clean up, but why bother when women can do it all?

In it, a princess eager to receive her prince remembers that – gasp – the floors in her castle tower are a total mess. Thanks to Cif’s magic scouring fluid, she has time not only to clean but also to get dolled up for the prince – who, in case you were wondering, has no physical challenges preventing him from helping her tidy up.

But why should he, when it’s a woman’s job to be both housekeeper and pretty princess?

Somewhat paradoxically, advertisements may also cast men as domestic superheroes. Often, characters like Mr. Muscle will mansplain to women about the best product and how to use it – though they don’t actually do any cleaning themselves.

Mansplaining domestic chores.

More recently, there’s been a shift – perhaps an awkward attempt at political correctness – in which women are still the masters of the home, but their partners are shown “helping out” with the chores. In exchange, the men earn sex object status.

Thanks for ‘helping out,’ hubby.

We’ve come a little way, baby

Various studies on gender stereotypes in commercials indicate that although the advertising industry is slowly changing for the better, marketing continues to target specific products to certain customers based on traditional gender roles.

Women are pitched hygiene and cleaning products, whereas men get ads for banks, credit cards, housing, cars and other significant financial investments.

This year, U.N. Women teamed up with Unilever and other industry leaders like Facebook, Google, Mars and Microsoft to launch the Unstereotype Alliance. The aim of this global campaign is to end stereotypical and sexist portrayals of gender in advertising.

As part of the #Unstereotype campaign, Unilever also undertook research on gender in advertising. It found that only 3 percent of advertising shows women as leaders and just 2 percent conveys them as intelligent. In ads, women come off as interesting people just 1 percent of the time.

Britain paves a path

Even before it was forced to reckon with allegations that Harvey Weinstein had also harassed women in London, the United Kingdom was making political progress on the issue of women’s portrayal in the media.

In July, the United Kingdom’s Advertising Standards Authority announced that the U.K. will soon prohibit commercials that promote gender stereotypes.

“While advertising is only one of many factors that contribute to unequal gender outcomes,” its press release stated, “tougher advertising standards can play an important role in tackling inequalities and improving outcomes for individuals, the economy and society as a whole.”

As of 2018, the agency says, advertisements in which women are shown as solely responsible for household cleaning or men appear useless around kitchen appliances and unable to handle taking care of their children and dependents will not pass muster in the U.K. Commercials that differentiate between girls’ and boys’ toys based on gender stereotypes will be banned as well.

Sticky floors

The U.K.‘s move is a heartening public recognition that gender stereotypes in the media both reflect and further the very real inequalities women face at home and at work.

Worldwide, the International Labor Organization reports, women still bear the burden of household chores and caretaking responsibilities, which often either excludes them from pay work or leaves them relegated to ill-paid part-time jobs.

In the U.K., men spend on average 16 hours per week on domestic tasks, while women spend 26. The European Union average is worse, with women dedicating an average of 26 weekly hours to men’s nine hours on caretaking and household tasks.

In Argentina, my home country, fully 40 percent of men report doing no household work at all, even if they’re unemployed. Among those who do pitch in, it’s 24 hours a week on caretaking and domestic chores for men. Argentinean women put in 45 hours.

You can do the math: On average, Argentinean women use up two days of their week and some 100 days annually – nearly one-third of their year – on unpaid household labor.

Real-world consequences

These inequalities, combined with advertising that reinforces them, generate what’s called the “sticky floors” problem. Women – whether would-be investment bankers or, I dare say, aspiring Hollywood stars – don’t just face glass ceilings to advancement, they also are also “stuck” to domestic life by endless chores.

The cultural powers that be produce content that represents private spaces as “naturally” imbued with female qualities, gluing women to traditional caregiving roles.

This hampers their professional development and helps keep them at the bottom of the economy pyramid because women must pull off a balancing act between their jobs inside and outside of the domestic sphere. And they must excel at both, all while competing against male colleagues who likely confront no such challenges.

Former U.S. president Barack Obama once pointed out this double standard in homage to his then-competitor Hillary Clinton. She, he reminded an audience in 2008, “was doing everything I was doing, but just like Ginger Rogers, it was backwards in heels.”

The ConversationThe sticky floor problem puts women in a position to be exploited by men like Weinstein, who tout their ability to help female aspirants to get unstuck. Until society – and, with it, the media we create – comprehend that neither professional success nor domesticity has a gender, these pernicious powerful dynamics will endure.

Virginia García Beaudoux, Professor of Political Communication and Public Opinion, University of Buenos Aires

This article was originally published on The Conversation. Read the original article.