Dr. Leah Adams is an Associate Professor in the Women and Gender Studies Department here at Mason. I sat down with her (over Zoom, we are COVID safe over here at HC) at the end of Black History Month and the near beginning of Women’s History Month to discuss COVID and its impact on marginalized women. This pandemic will obviously go down in history, but there are disparate outcomes across groups that must be accounted for and inquired about. Dr. Adams graciously provided me with detailed insight from her careers as both a clinical psychologist and a researcher of women’s health.
Blythe Dellinger (BD): I know your experience with researching women’s health because I researched you, but if you could explain a little bit of what you’ve done researching women’s health I think that would be great for our readers to know.
Leah Adams (LA): My research really focuses on how psychological, social and structural factors play a role in people’s health. Mostly in their physical health, I am a clinical psychologist but I identify as a rehab psychologist, which, it’s not the clearest terminology. Because, I think when people hear rehabilitation they think substance use disorders, but rehabilitation psychologists really are folks who focus on how people cope with and adapt to chronic illnesses and disabilities. I tend to focus on how psychological, social and structural factors affect people’s physical health status and their physical health behaviors and how they cope and adapt to illness and injuries.
I don’t exclusively focus on women’s health, but I have developed a special interest.
Given some of the ways that women’s experiences, particularly in medical settings have been minimized or not attended to, at times.
After finishing my PhD I completed a two year postdoctoral fellowship that was funded by the National Institute of Aging and that fellowship was specifically focused on women’s health and aging. That time is when I started to get more involved clinically and didn’t research and in understanding people’s experience with chronic pain and the gendered aspect of chronic pain and when I’m saying the gendered aspect, I mean how pain is received.
It’s one that certainly crosses the gamut like all people experience pain, but there’s a unique history in terms of women’s pain and that gendered aspect is also racialized as well. Such as, Black women’s pain not being perceived as significant or serious or real.
And so now, a lot of my work that focuses on women’s health is in that pain sphere, not only because women report pain at higher rates, but also just because I think it is really important to contextualize those experiences.
BD: That is so fascinating, thank you for explaining. How would you define the disproportionate impact this pandemic has had on marginalized groups?
LA: That’s a big question. I think the disproportionate impact has been felt by marginalized communities in every way and in every sector that you might imagine would be hit by a pandemic. Which again, I think, is all of the ways and all of the sectors. And I think it’s playing out exactly like we might expect it to. Given where our historical, social and political makeup is in our country, right? I am reminded that there’s this old saying and I don’t know who to attribute it to, but it’s something I’ve heard a lot in my life.
Which is, “when white America catches a cold Black America gets pneumonia.” I think that saying really encapsulates what we see with COVID and what we see with, you know, big negative events that have a significant health or economic impact in the country. It’s extended beyond just this Black and white divide here, I think it extends to other communities of color, I think it extends to other marginalized, minoritized groups.
When a tragedy like a pandemic hits, the people who are hit the hardest are the ones who are structurally in the most precarious position. Because they don’t have the safety net, or the resources and tools to kind of weather the storm in the way that other folks might be able to. Weather the storm really is, you know, health care coverage, sick time childcare, food supply. When we think back to last March, almost a year ago, at this point, and you remember how so many people were stockpiling food and trying to get beans and pasta and flour. And, I kept thinking during that time, “wow like this is really another example on display of what a luxury it is to have the money to buy in bulk and to buy a lot of things for the long run.”
And that if you don’t have that, and you have to spread this thing out over a longer period of time and risk being in public more frequently. Going to the store more regularly because you have to see what you can get, and the shelves are now empty. There are all of these things that come into play, and so I really think that that impact has been felt on just every possible level.
BD: How do you think the psychosocial impacts that marginalized women have faced during this pandemic will impact, for instance, my generation or generations as they age? How do you think that will play out, especially with people who have had COVID and experienced what it is like?
LA: So, that’s a really interesting question and I think we will start to see more of that, of course, as time goes on. Exactly how people are affected by it.
I just published a study with some co-authors in Seattle, and the primary study is actually an intervention for older adults who have knee osteoarthritis. The study was in the middle of its trial, and as you might imagine a group based exercise of people who are all 70 years or older in Seattle, it was one of the very first studies to get shut down for good reason.
We ended up going back and doing a bit of quantitative surveys, but also qualitative interviews with them to see how the early days of the pandemic were affecting them. There’s a quote in there from one of the women talking about her fears for her grandchildren and her fears for younger generations and things about what this has done socially to all of us to not necessarily be able to have those same connections. Fears about what this might mean long term and in terms of how we connect with each other.
I think we’re going to be in a really tough spot for quite some time, because I think there’s a lot of grieving that we have to do. We’ve lost a lot and we haven’t been able to stop and slow down to kind of look around and see that loss. There are still thousands of people dying all the time because of COVID. I think there’s going to be a prolonged rollout of what this might be like in terms of the effect that it’s going to have on generations that have lived through it. I think that we will be okay, in the long run, I think history has shown us that we can experience significant hardship and continue to rebuild and be okay, but I do think that we’re in for some significant challenges related to all that we’ve lost. I mean that for people, I mean that for time, I mean that for relationships, I mean that for connections.
There’s concern, particularly for women that we’re seeing, particularly for women who have children. A lot of women have made the choice, I say choice, and I think for some women it is a choice and for other women it is the choice that they have to make, the choice to leave the workforce.
In certain kinds of sectors, and so I wonder what that’s going to do long term and thinking about continued parody for women in the workforce and in their ability to continue to move up the ranks, seeing that so many have had to fall out of the workforce. I worry about the long term implications that it is largely women falling out. I wonder what effect that will have on parity for women in the workforce.
BD: How do you think this specific experience has applied to women’s health, specifically Black and Latino women, within the pandemic?
LA: Yeah, so I will start with women broadly. While the pandemic is hard on everybody, there are certainly gendered dynamics that come into play and all of these gendered dynamics have certain valleys for minoritized women.
In home settings, women tend to be caregivers at higher rates as well right and shoulder so many of the daily household tasks. We are all at home and so all those tasks are you know multiplying in terms of what there is to do. Women are also disproportionately in low wage positions and so they are some of the first ones to be laid off.
So now, everything that I just said about the challenges that women are experiencing multiply that add that up for women who are racially or ethnically marginalized. I talked about the economic downturn and women being in low wage jobs, Black women and Latina women are at low wage jobs at even higher rates.
I think in September, just over a million people dropped out of the Labor force and of that million like 200,000 were men and like 800,000 were women who fell out. When you look at that even further, it was mostly Black and Latino women who were falling out of the Labor force, and you know some dropping out and some being pushed out of the Labor force.
If we take a racialized and gendered perspective to it, the unemployment rate was about 7 to 8% for all women, but 11% or higher for Black and Latina women, so I think those highlight just how different that experience has been. Between November and December, almost all of the job loss that was recorded was essentially black and Latino women.
And then you also throw in that minoritized women also tend to have higher comorbidities, so their health problems may be exacerbated by COVID. Less access to health care. less access to the kinds of jobs that provide stable healthcare that’s affordable for folks means that they are more at risk due to access issues as well.
So I think that that is, that is a piece, and even as we move forward to vaccines which is fantastic, we are still like that gendered and racialized aspect with reluctance about having a vaccine.
This kind of reluctance is steeped in valid mistrust right, so the mistrust is not you know, out of nowhere there’s reasons. Historical reasons that are founded for why people Black folks in particular and Latinx people, in particular, would be skeptical of a rollout.
The gendered aspect of it, I think, is also tied into there being so much mixed communication earlier about the potential impact of the vaccine on reproductive health. These questions about whether or not it was going to harm your ability to have a child if that’s what you wanted to do, or if it was safe for people who are pregnant or thinking about becoming pregnant.
So I think, just like at every stage, risking the ways in which what I’ve said about women broadly is just amplified for women who are in marginalized communities.
BD: What do you think can be done to improve the negative psychosocial implications we’re seeing with marginalized women?
LA: Like I said I think we’re in for a long haul around when we’re able to kind of stop and breathe and really sit and reflect on what has happened in this last year. I mean I don’t know about you, but it is tough to sit and really consider the number of people that have died, and the people who are left behind and have experienced that loss and had to try to manage it, while also still living in this strange pandemic state.I think when we get to a place, hopefully soon, of the after times it’s going to be a real kind of personal reckoning and thinking about what this has all been.
I think I would like to see more investment in mental health and to have mental health, be a foregrounded thing in the response. You know, obviously physical health is critical like we have to try to keep people from getting COVID. We have to roll out the vaccine in an equitable and expedient manner.I think we also just have to really recognize the psychosocial impact that this has had, and I think that you know, there are things I would really love to see us do.
There’s been a significant rollout of telemental health and demonstrating that we can support people through distance therapy. It is possible to do some of these things in a more accessible way, not everybody has a life setup where they can go to an appointment every week physically.
I would love to see us kind of foreground mental health in our overall response and thinking about marginalized communities, and you know Black, Latinx folks and other marginalized groups. I’d like to see more investment in community based efforts and ways to link folks who are on the ground to professionals.
BD: We’ve seen in Denver how they have brought in mental health counselors to deal with mental health crises within what would normally be responded to by police officers and the police force. This has been a shift that is in recognition of the structural racism and violence of the police force.
Do you think we could kind of see that shift within the medical community where there’s more sort of an emphasis on cultural competence in the wake of the pandemic just because of the sheer amount of like Black people we’ve seen die in this pandemic?
LA: I mean, I think, and to me this is particularly important in the context of any kind of vaccine is you do not get the outcomes that you want by just saying the same things.
Like people are like Black communities don’t trust the vaccine let’s provide more information and it’s like yes and you’ve got to actually address what the mistrust is.
Right? Like you, can’t pretend that it doesn’t happen.
I think that people are really trying to do what they can do and aren’t necessarily thinking about some of the historical ramifications. I wish that we, as a country, had a better understanding of our history and the histories of people within the country.
Because those histories are not lost by individuals who are going through the world. I think they feel like they get lost among us as a cultural group right, and so I think movements for the medical field movement for mental health to right like we are not perfect and not without problems.
But I think I think what all of us need to do better, is to acknowledge why things are the way they are, why people’s reactions are the way they are, why mistrust is the way that it is.
And then that is the only way, in my opinion, to actually move forward, because you have to address the concerns, as they are you don’t get to just make up new things, “Oh, I guess, I guess they’re afraid of the side effects.” Well, why don’t…
BD: Why don’t you ask? I think that there’s so much more value in actually speaking to the people who are affected and asking the questions. How can we make this vaccine more accessible to you? What are ways that would make you feel more comfortable? While also doing that self-education and doing that work.
LA: Yeah no I think that’s so important, it’s such a good point and I think it really is about the mindset of partnering with people. As a provider, whether it’s a physician, a psychologist like me, or anybody else you don’t give somebody health, like “Here’s your mental health today”. That’s not what happens if you have to partner with people because they have a lot of individual behaviors and choices that are constrained by these larger structures. Just across the board anybody in health care, we would do much better for ourselves by remembering that we are not the arbiters and providers of health, even though we say that.
I feel like I’d be remiss if I didn’t mention that, like right now Asian women, Asian people, are experiencing a different kind of challenge associated with COVID. Xenophobia, stigma and prejudice all of these kinds of things.
People with disabilities are having to listen to conversations, not only are they at increased risk physically, but are having to listen to conversations about whether or not their lives are valid if they do get COVID if they should get the ventilator. Like all of these kinds of things really are challenging. We talked about psychosocial stressors and everybody being at home, you’ve got folks who identify as LGBTQIA+ in situations where they cannot authentically be themselves in a safe way.
So I think it’s important to consider how those pieces and elements can also just shape the experience in a different way and provide a kind of different challenges and obstacles in the context of COVID.
It goes back to what we’ve talked about. Actually ask and consider. I think a lot of times we don’t consider the larger macro pieces that are going on, that are affecting people. I think it would be a failure to just pretend that everybody’s coping and experience has been exactly the same. But I think what we’re learning.
And I say learning, but, to be fair, there are people who are like this is how it should have been for a really long time, and then there are people who are like oh I didn’t know that.
These bigger macro issues affect people, and so we have to be thinking about that we have to be proactively thinking about that and responsive to people when they talk about these issues coming into their everyday lives.