Health Care Politics in the US South

by Emma Sandoe

Courtesy of Vanderbilt Center for Medicine, Health, and Society

This month I attended the Politics of Health Care in the US South conference held at Vanderbilt. This conference was cosponsored by the Anna Julia Cooper Center at Wake Forest. Instead of a lengthy conference summary, I’ll attempt to capture some of the key lessons I learned to better understand the politics of the South.

What is the South?

There is no other region of the country with such a strong personal identification and complex emotional reaction as the South. Californians don’t identify as “Westerners;” “New Englander” inspires connotations of sleepy scenes of snow and hot chocolate; and while you may get a rare character that strongly identifies as a “Midwesterner,” there is a clear difference in the passion that a Minnesotan speaks of their homeland compared to a Tennessean. But despite the fact that the words “the South” strikes passion in its residents, historical and modern important moments in our nations conversation on race, and a specific cultural identity, there is really no common definition of the geographic South. Modern politics make the inclusion of Maryland and DC counter to our understanding of the deep red political vote. Texas and Florida have their own unique identities and their vast populations often skew any analysis of the region. Each unique issue in the South first requires a definition of what geographic region you are discussing.

Beyond a geographic nature, there is little agreement on what defines the region culturally. One key cultural center of the region is the food. Food policy in the South illustrates some of the region’s key problems. The region’s high poverty has led to food deserts and a proliferation of poor nutritional food options. The cultural Southern diet of high fat and few vegetable options has only added to this obesity epidemic. The efforts to educate and change behavior have been met with resistance because of the perception of an attack on the Southern culture. But efforts have been creative using churches and other key aspects of Southern culture to redefine health in a Southern context.

Politics are deeply rooted in decades or centuries of history and profoundly local. To make an impact in the South first requires knowing the place, the culture and the tradition of the specific state or locality. Unlike Washington where a change in the administration can cause a sea change in the politics, the state legislatures’ connections to the local industries, media, and public actors means there is a greater sense of consistency through political change in the region.

The Role of Race

Race continues to be one of the dominant issues facing Southern politics. Regardless of the health care issue under discussion, issues of justice and the history of the treatment of African Americans were present in the conversation. Policies to increase health coverage and change the delivery system cannot begin without first understanding the history of a lack of trust in the medical system and state policies to redirect medical services from black populations. Whether it was HIV or training medical professional, scholars looked to the history of racial justice to better understand the current landscape of the health issue in the South.

Melissa Harris Perry gave a wonderful keynote in which she discussed the stress that women of color undergo throughout their lives. This is a stress not unique to the South but stronger there than any other region of the country. It is a stress that should be considered by scholars when analyzing health policies and health outcomes. The human experience and health extends far beyond treating pathogens, but a person’s experience can greatly impact their mental health and in turn their physical health.

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