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If a Dartmouth faculty member or student is suddenly diagnosed with hypertension, he or she can take all the necessary steps to prevent progression to cardiovascular disease by using the Alumni Gym, buying fresh fruits and vegetables from the Hanover Co-op, obtaining Lisinopril from Dick's House, or using the internet to find answers to questions. In an underserved community, the environmental and social scenarios are very different. Last summer, I worked with the World Health Organization in Cairo to investigate the social determinants of and barriers to hypertension management in underserved communities in greater depth.
During our field-work, Arab women particularly interested me throughout the study. Living in the Arab world for some time, I had frequently witnessed the condition of many subordinated women. It was no longer surprising to see the clear difference in roles, privileges, education, salary, and responsibility between genders.
It appeared to me that women continued to bear a disproportionate share of the burden of poverty—a burden that jeopardized their own health and mental well-being. Among many women, the prevalence of myth, mystery, and misinformation on healthcare options and on the conditions that require medical assistance often proved to be detrimental. With many women not being high school graduates, any available information was also usually inaccessible due to the high reading levels required for the material.
Cultural and family influences also affected the rate of healthcare access. The women in this study traditionally placed the health needs of their families at the forefront and put less emphasis on individual needs. Traditions such as these make it difficult to establish the importance of preventive health behaviors.
From this experience, I came to realize that it is often not the enhancement of health facilities and technologies that is paramount, but the implementation of approaches that empower people in underserved communities to take control over their health choices. Culturally appropriate health education that is tailored to be tradition-inclusive could not only help prevent the onset and progression of cardiovascular and respiratory diseases, but also enable women of underserved communities to take more control over their bodies and to have influence over the care provided to them.
