I was asked recently to talk at a prominent gathering on women’s heart health. Let me be clear, I’m a doctor of ideas and not bodies. My Ph.D. is in the humanities, not internal medicine. But the event was by/for/about women’s health and I have lots of things to say about gender so I said, sure.
But what I found out in my quick research surprised me. We know that statistics related to women’s heart health are grim: heart disease and stroke kill 8.6 million women worldwide annually which accounts for one in three deaths among women generally. Black women “suffer rates of heart disease that are twice as high as those among white women,” meaning one in two women of color in the U.S. will die of heart disease.
It’s bad. So what’s to be done? After reading personal accounts of women’s heart disease and looking for any analysis that grappled with high rates of women’s heart disease, one thing became clear. While there are a few critiques of medicine’s gender bias in diagnosing how and when women have heart attacks, there is almost no analysis on how women’s understanding and under-reporting of heart disease is directly related to sexism and internalized oppression. These “scary” words—sexism and oppression—are never used for what is a scarier health reality: women’s heart health needs feminism to make sense.
On women’s heart health websites, articles, and, in person, at fundraisers—shocking stories abound about women who a) did not realize they had heart disease and/or were having a heart attack and b) how other women should learn from their story and, well, not die. At the American Heart Association’s “Go Red for Women” website, the most prominent U.S. organization on women’s heart health, an entire section is devoted to women’s stories of heart disease and recovery. Take any example and you’ll see the above two-fold narrative—I didn’t know I had heart disease and I changed some habits and am still alive.
There’s Aimee Rodriguez-Zepeda who was diagnosed at 39 with congestive heart failure much to her shock. “I’m still trying to find my new normal,” says Rodriguez-Zepeda; she “changed her diet and tries to get exercise when she has the energy for it, even if it’s just walking around her house.” It’s clear from the rest of the narrative, like most heart disease survivor stories, these women are everyone’s primary: caregiver, mom, partner, spouse, kin-keeper, house cleaner. In other words, in none of these women’s heart disease narratives is there an understanding that women aren’t just dying of heart disease, they are killing themselves by working and caring for others to death—literally.
There’s the story of a single mom taking her kids to the bus stop though she’s having a heart attack—because who else will get her kids there? The story of a daughter coordinating the care-giving for elderly family members while ignoring heart attack warning signs—because who else will take care of her parents? The story of a wife working a demanding job while planning family events and having heart palpitations but she doesn’t stop—because who else will organize the family event? In all these stories, each woman thinks she’s the one person holding her family and community together. If she doesn’t fulfill her commitment—who will?
The stories of women’s heart disease rely solely on women’s individual efforts—if I go to the doctor, prioritize my sleep, exercise more, try to take my health just a bit more seriously then I won’t die. Sure, all these individual acts are critical but they are incomplete. What’s unstated is a harder reality: many women are dying from structural inequality which means they’re not paid enough, aren’t co-parenting, aren’t sharing domestic chores, aren’t always able to acknowledge the debilitating health effects of, say, racism and homophobia. Feminist analysis means that we need to change systems to work better for women: families, work, schools, child-care to support women’s flourishing. Women are dying from broken hearts because systems are broken not necessarily because the women themselves aren’t doing enough.
Another way to understand this phenomenon of women’s heart health epidemic which is more structural than individual is through the concept of “the second shift.” Feminist sociologist Arlie Hochshild famously researched and coined “the second shift” or the work shift women do at home on top of work outside the home. Hochshild argues that this second shift also includes “invisibilized labor” or all the “emotional labor” women do to keep families functioning. It takes a toll. What if it also takes your health? At what point do women stop saying “I’ll fix myself” and say instead “this structure—family, work, culture—needs to change to support me and help me live a full life?”
If we understand feminism as theorist bell hooks defines it, “feminism is a movement to end sexism, sexist exploitation, and oppression,” then we grasp the unequal ways women are doing unequal amounts of care-taking and work that hurts their health. We know women are socialized into being care-takers, putting others before themselves which leads to women frequently ignore health warning signs because they are so focused on taking care of others. Last year a headline stopped me in my tracks, “Women die more of heart attacks than men because they don’t want to be a bother to anyone.” Let me repeat that: they don’t want to be a bother to anyone. The American Heart Association 2015 study has a direct quotation from a woman who said she waited to report her heart attack because, “I didn’t want to be a bother.”
What is called “self-care” for women is not selfish but hard to do as I watch many of my female friends “not want to be a bother” as they work a “second shift” at home doing domestic work after a day’s work, do the main care-taking of sick children, and the kin-keeping or organizing all the family holidays, get-togethers, and gifts.
I sometimes ask: who is the designated present wrapper in your family? Naturally, there’s great joy in something like present wrapping—I’m not some mean gender studies professor who’s against present wrapping. I can see headline now—Rabid Feminist Kills Joy Of Present Wrapping. No. I’m asking: given all the ways that women take care of others, how do we take care of ourselves to the point where we don’t die. There is a correlation between caring primarily for others and not caring for ourselves.
If we really want to understand why women’s heart disease keeps going under-reported, we need better analytical tools to diagnose the problem. I would argue that feminism is good for your heart. If prescribed, more women might live.