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At the initial encounter: Laura was very low risk from the biological point of view. Pregnancy expected changes in Body Functions and Structures. b.134 sleep functions b.152 emotional functions b.156 perception functions b.420 blood pressure functions b.515 digestive functions (tolerance)
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At the initial encounter: Laura was very low risk from the biological point of view Pregnancy expected changes in Body Functions and Structures b.134 sleep functions b.152 emotional functions b.156 perception functions b.420 blood pressure functions b.515 digestive functions (tolerance) b. 535 digestive sensations (nausea) b.545 water balance functions (retention) b.620 urination functions (frequency) b.660 procreation functions b.670 reproductive sensations s. 620 structures of pelvic floor Young healthy Latina pregnant woman
But she had many risks coming from the environment Environmental Factors e.130 prod/tech for education e.225 climate e.315 support from immediate family e.430 individual attitudes of people in position of authority e.450, 455 individual attitudes of health professionals, other professionals (dis.) e.465 social norms, practices and ideologies (cultural barriers) e.550 legal services, systems, policies e.580 health services, systems, policies e.590 labor/employment services, systems, policies e. 595 political services, systems and policies Isolation Insecurity Exclusion Illegal status Poverty Migration
Which resulted in poor functionality Environmental factors as barriers to performance! d.175 solving complex problems d.230 carrying out a daily routine d.240 handling stress d.310,d.330 communicating d.470 using transportation d.570 looking after one’s health d.590 employment systems, policy d.630 preparing meals d.760 family relationships d.770 intimate relationships d.839 education about pregnancy d.870 economic self-sufficiency d.950 political life and citizenship Poor functionality Body functions and structures with full capacity
Adding the Activity Setting’s dynamic perspective Input The environment Participation Output Process FUNCTIONALITY? Activities Laura Input
Non accepting community Health System Home in Mexico Home in Wisconsin Laura had multiple activity settings
Activity settings influence each other….. Non-accepting community Health System Home in Mexico Home in Wisconsin
Activity setting evolve. It has some stable qualities and some changing qualities as it propagates through time. new new new same same same Home yesterday Home today Home tomorrow WHAT IS DRIVING CHANGE?
Home in Mexico CAPITALISM IS THE UNDERLYING FORCE DRIVING UNHEALTHY CHANGE IN ALL THE ACTIVITY SETTINGS Home in Wisconsin Non- accepting Community Health System
Without her family’s approval, she and her boyfriend used the money saved for their wedding to pay the “coyote” to cross the border Home in Mexico Good for capitalism Bad for health
The baby’s dad depended on a friend to get to work so he was saving to buy a car, the baby was an unexpected expense, she waited to tell him about the pregnancy Home in Wisconsin Good for capitalism Bad for health
She wanted to wait until she could send money to contact her family so they could see the benefit of her leaving, and she didn’t call her mother or sister for advise about the baby Home in Wisconsin Good for capitalism Bad for health
Non-accepting community • They considered it too risky to ask the employer for a poof of (low) income, a requirement to receive the coverage Good for capitalism Bad for health
Non-accepting community • She knew she had no rights to services and was afraid that any institution would deport her if she ask for help Good for capitalism Bad for health
Non-accepting community • She knew LHO, as many other non-profits, is struggling for resources and that only gave health education, not health care so she didn’t call us Good for capitalism Bad for health
Health System • Someone told her that the clinic was sending collection agents to people that did not pay for care Good for capitalism Bad for health
Health System • Coverage rationale was not the women but that prenatal care was cost-effective ($1 saves $3 of post-natal care) Good for capitalism Bad for health
QUESTIONS: • Is capitalism a trickle-down of well-being or a “sucking up” of the health of populations? Have we become the means of its ends? • Can a small advocacy organization have an impact against such a tremendous force? • What should the Latino Health Organization do? Please suggest….