Our second interview is with Professor Emily Mendenhall, Assistant Professor of Global Health in the Science, Technology, and International Affairs (STIA) Program in the School of Foreign Service. Professor Mendenhall has conducted cross-cultural research on the syndemics of poverty, depression, and diabetes in vulnerable populations in the United States, India, and South Africa. She recently published a book on this research entitled “Syndemic Suffering: Social Distress, Depression, and Diabetes among Mexican Immigrant Women”. Additionally, she is the founder of a non-profit that develops global health curriculum for youth. It was a pleasure to sit down with Professor Mendenhall to learn about her work and we thank her for taking the time to speak with us!
Why did you go into research? Have you always wanted to pursue a career in academia?
When I was in college, I had the opportunity to spend some time abroad and I did a couple little research projects. One was done during a summer spent in a small village in Zambia called Mwandi and another during a semester in Chile on a Mapuche reservation doing a small exploratory, comparative ethnography. I asked the same questions to these two communities, resulting in a comparative analysis of the experience of women’s power over their reproductive health. So that was pretty powerful – I thought I wanted to go to medical school, but after doing that research I realized that I really loved it. So I got a master’s in global public health. Then I moved to Guatemala to work for the Pan-American Health Organization for four months. After, I started working at the county hospital in Chicago and also applied to do my Ph.D in medical anthropology, and was accepted. I kind of knew I wanted to be a medical anthropologist because for me, public health didn’t ask the depth of questions that I wanted answered. I felt medical anthropology gave me the ability to kind of look deeper, the opportunity to really dig into the complex political, economic, and social factors that surrounded health problems, which I felt public health didn’t do a good job of answering, so I felt that it was a really good orientation for me.
What is the central question or theme of your research that you are trying to shed light upon?
I have been working on women’s health questions for a really long time, ever since college. When I was doing my master’s work I looked at HIV serodiscordant couples – how women negotiated pregnancy when one partner was positive and one was negative, which creates a lot of complexities in the relationship. For my dissertation, I ended up looking at the relationship of domestic violence and sexual trauma in chronic poverty and how that shaped women’s health. I called it distress in the mind and body. I saw depression as a marker of stress in the mind and diabetes as a marker of stress in the body, and looked at how all these stress factors in the world from poverty to early experiences of abuse to immigration affected Mexican women’s health in Chicago. Then I began looking at how these stress factors were negotiated in different contexts in Delhi India, where I studied how social factors were influencing people’s experiences with depression and diabetes. I then did a comparative study in Johannesburg, South Africa. So I’ve been focusing on women, how they negotiate power, and how they experience health and inequality.
Your research culminated in a book entitled “Syndemic Suffering: Social Distress, Depression, and Diabetes among Mexican Immigrant Women.” Can you talk about this book, the process of creating it, and what inspired you to write it?
Book making is hard work. My book comes out of about five years of field work at the hospital in Chicago where I was working while getting my PhD. I spent a lot of time sitting with people and listening to their problems and life stories. I would ask them to tell me how they understand their lives and how they view their experiences with health and childhood. From all of this listening, I developed research questions. I also worked on a big epidemiological survey that let me look at the health problems among these women from a population perspective, across the community of Mexican women in Chicago who went to the public hospital. I combined that with the women’s life stories in order to demonstrate the complexity of social and health problems together. After doing that exploratory research, I wrote grants and then I did very in-depth interviews. I interviewed 120 women for about 4 hours each and from those I took historical narrative interviews coupled with survey interviews and I took blood samples, I did psychiatric inventories. After doing these lengthy interviews I synthesized them and did analyses on them which became part of my book.
What issues do you think the global health research community should be focusing on more closely in the coming years?
Every few years, something takes center stage. For a long time it was HIV/AIDS, more recently, noncommunicable diseases and mental health issues. Most recently, the new emergent field is health systems, which is really important. As the Millenium Development Goals come to an end in 2015, people are talking about where do we go from here? In 1978 they proposed this idea of the Alma Ata, which is basically health care for all, with a focus on primary health care. The new push in global health is looking at things from a systemic perspective. We are trying to understand health problems from a holistic perspective, by having primary health care professionals that think about the whole body, not just parts of the body, and by having systems that finance health access so that everyone can access health, not just wealthy people.
I agree with a more systemic approach in global health. In my work I look very much at systems by looking at how inequality shapes health at the individual and population level. A lot of countries are undergoing national level change in how health is accessible to populations, specifically the poor. The new movement within global health itself is to develop systems that improve access by changing governance, finance, and health delivery.
You mentioned you look at how inequality shapes health. Can you elaborate on that research and what you found?
So inequality is kind of a messy word because it’s used in a lot of ways and it means a lot of things. The way that I look at it is basically poor and wealthy people have different experiences. If you live in a very poor household, you have different stresses that your family may experience, from chronic poverty, to household issues, access to education, maybe social problems. These experiences shape your life chances and also your exposure to certain things that may shape your health. From a very early age, inequality can make you sick, and this can manifest in various ways from birth to adult mortality.
What would you say are the key skills that you should develop to do research in this field?
When you’re thinking about a problem, one of the main things to do first is to do a lot of reading and do a lot of listening. Anthropological work is always a bit exploratory in the way that we let people tell us about their stories and life experiences and from that, we try to understand the cultural and social nuances of their situation, how they experience life, and what that means. So, if I was a clinician, I might make a survey that says what caused you to be sick? Stress diabetes, depression, or falling in the lake? I provide four options and then they would pick A, B, C, or D. An anthropologist would approach the question in a completely different way and say, tell me about how you came to feel this way. Name what this feels like. What caused it? Where did it come from? How have you dealt with it? Is anyone caring for you? Who? You ask very open questions, which helps you to understand people’s experiences in a different and more nuanced way because the individual can create and describe their experience – rather than the researcher just telling them what is happening when they might be experiencing something else. And on the other hand, people’s perceptions of how they’re experiencing life, might be different than they actually are because they don’t understand the biology. But in many ways, it’s the interaction between the biological problem and the social problem that shapes how people experience illness.
You are the founding director of a non-profit committed to developing global health curricula for youth. Can you tell us more about this non-profit, what it does and what inspired you to start it?
We published two books – Global Health Narratives and Environmental Health Narratives, and we have a third one that’s forthcoming called Community Health Narratives. The stories are written by my friends and colleagues from around the world who work in global health. Some are academics, some are activists, some are practitioners, some are doctors, some are nurses, and some work for Save the Children. These narratives are based on their diverse work and experiences about challenges that young people face in global health. The stories are written from the perspective of 12-16 year olds. They have actually been really effective at sparking dialogue, exploring complex and deep questions, and inspiring discussion about the complexity of health problems. They cause you to think about political, economic, and social factors that shape disease and suffering and what that means.