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#is like. the most basic explanation behind gender and its associated roles
ahalliance · 10 months
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learning about semiotics in english this year was great bc it’s like a baby level introduction to gender
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violethowler · 4 years
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The Heroine’s Journey of Sora
I’ve spent the last couple of weeks writing out my thoughts on Kingdom Hearts and the way the series follows the framework of the Heroine’s Journey. Rather than a bunch of drabbles or a single long-winded post, I’ve decided to break up my explanations of the Heroine’s Journey and the way Kingdom Hearts fits into it as a series of ten essays posted weekly. I will put up a masterpost once all of them are finished, and in the meantime I will have all of them on my blog under the tag ‘Kingdom Hearts and the Heroine’s Journey.’
Due to the length of this essay, I will be putting the full thing under a cut. 
What many Kingdom Hearts fans do not realize is that while Tetsuya Nomura does sometimes make up the details as he goes when it comes to the writing of Kingdom Hearts, he does do things with a plan. 
In the KH3 Ultimania [1], he talked about how he’d had the conclusion of the Dark Seeker Saga outlined by the end of Kingdom Hearts II’s development. In an April 2012 interview [2] with Nintendo President Satoru Iwata, he indicated that he’d had a general framework up to Kingdom Hearts II planned out when the original game was first announced. And in a 2004 interview after the original Chain of Memories was released on GameBoy Advance, he mentioned that he’d already come up with the “last scene” that would serve as the definitive ending of the entire series[3]. 
So while some details may be hard to predict because Nomura comes up with lore and backstory details as he goes, he does have a plan in mind where the overall story is going. And the central arc of the series is entirely predictable once you understand the framework that the story fits into. 
Since the late 1800s, scholars have been studying the common patterns that repeat in stories, legends, and myths across different cultures around the world. One of the most well known templates developed from such research is the Hero’s Journey. In his 1949 book The Hero with a Thousand Faces, literature professor Joseph Campbell published a 17 step formula of storytelling. Campbell held up this framework as the monomyth, an ultimate narrative archetype from which all other stories are derived, and in discussion of his work expressed his view of The Hero’s Journey as a universal framework that showed how people grow from youth into adulthood.
However in the 1980s, Maureen Murdock began work on her own narrative framework. Believing that Campbell’s view on the universality of the Hero’s Journey did not encompass the experiences of every identity like he claimed, Murdock developed what she called The Heroine’s Journey as a critique and response to Campbell’s monomyth. Other authors have shared their own variations of the Heroine’s Journey, but for the purposes of this analysis, I will be focusing on Murdock’s model. Hers is both the oldest one I know of, and the one that I personally have the most familiarity with. Though originally conceived as a therapy tool, the core concepts of Murdock’s template have resulted in its use in storytelling for narratives about protagonists overcoming the ingrained biases and preconceptions of society. 
Some notable examples of stories that follow the Heroine’s Journey template, albeit most with different formulas, include 
Beauty and the Beast
The Hunger Games trilogy
The Princess and the Frog
Tangled
Howl’s Moving Castle
Labyrinth 
Star Wars Sequel Trilogy*
Voltron: Legendary Defender*
*Note: Voltron: Legendary Defender and the Star Wars Sequel Trilogy are examples of 3-act narratives that followed the Heroine’s Journey framework in the first 2 acts only for behind-the-scenes conflicts to result in the formula being abandoned in the final act. 
Despite the name, it is possible in theory to have a male protagonist follow the Heroine’s Journey, much like how you can have a female protagonist in a Hero’s Journey.  While nearly every story I know that follows the Heroine’s Journey template has a female protagonist in the lead role, Kingdom Hearts is the first example that I’ve discovered of a male protagonist following this formula. Sora’s arc across the series follows Murdock’s framework so precisely that I was able to correctly predict the broad strokes of how Re:Mind would go three months before the DLC was released. 
Part I: The Beginning
While the Heroine’s Journey mimics the Hero’s Journey in its early stages, it ultimately goes in its own direction. I plan to go into further detail about the differences between the two in a later essay, but for now I will say that while Campbell’s monomyth describes physical plot points and the themes they represent, the Heroine’s Journey formula focuses on the emotional conflict of the narrative and the psychological development of its main characters. The pattern of the Hero’s Journey is fluid and doesn’t have a fixed central theme, while the core element of the Heroine’s Journey is a protagonist coming of age in a society that consciously or not regards them as lesser because they do not fit in with the expectations of the dominant social group. 
I know that some people who decide to read further will be put off by the fact that the names and descriptions of the Heroine’s Journey feature gendered language and focus on discussions of masculinity and femininity, so allow me to explain. The reason for this is that in a Heroine’s Journey, the protagonist is attempting to conform to a set of traits that the audience’s culture values. In pursuing this external validation, the main character has to suppress a vital part of who they are, cutting themselves off from achieving their full potential. The traits they are suppressing are the ones which are often regarded as feminine, while the ones they are trying to conform to are typically associated with masculinity. We see this pattern frequently in movies where the female lead tries to succeed in a male-dominated career field, only to feel lonely and unfulfilled when she finally gets what she wants because she sacrificed the parts of herself that made her who she is along the way. 
Now that I’ve given you a relatively brief summary of the Heroine’s Journey, I can get down to business and walk people through the steps to this template and how it fits with the story of Kingdom Hearts. Note that this is only a basic rundown of the steps of the Heroine’s Journey and how it relates to these games, and I will be posting additional essays shortly which go into greater detail on the themes, character archetypes, and other different layers of the framework that are present in the series. 
Murdock’s version of the Heroine’s Journey begins with the “Separation from the Feminine”. This is the stage where, as mentioned, the protagonist suppresses a core part of themselves in pursuit of external validation. It often takes the form of the protagonist sacrificing their emotional strengths and focuses exclusively on proving themselves in the physical sphere. Sora has demonstrated again and again that his greatest strength is his empathy and his willingness to make connections with others. It makes him a strong unifying force because of how well it complements the people around him. But because this isn’t something tangible in the same way that physical strength is, he doesn’t see the value of it, believing that without the strength of his friends he’s nothing. 
From the way the other kids on Destiny Islands talk about their competitions, Sora’s focus is on trying to prove that he’s just as strong and capable as Riku is. But he’s so focused on proving himself in physical challenges that he doesn’t notice the signs of Riku’s jealousy that lead his friend into the arms of Maleficent. And we see through Anti Form and Rage Form that Sora is still repressing his own negative emotions in Kingdom Hearts III. His narrow focus on external skills has cut him off from achieving the full potential of his internal ones. 
When Sora awakens in Traverse Town after the destruction of Destiny Islands, we come to the second stage of the Heroine’s Journey, “Identification with the Masculine and Gathering of Allies”. This is where the main character chooses to align with the traits and roles that the dominant social group sees as desirable in order to achieve their goal, and where they acquire the allies who will help them in their quest. With the adults around him focusing on his ability to destroy the Heartless, Sora latches onto the Chosen One status that implicitly comes with having a Keyblade. His interactions with Phil and his disappointment with the status of Junior Hero in subsequent games paint Sora as being focused on heroism in the sense of overcoming obstacles with force. Even Donald and Goofy, in the beginning, are focused on Sora’s value as a Keyblade Wielder in terms of how their fight against the Heartless can lead them to King Mickey’s location.
By setting off with Donald, and Goofy, Sora embarks on the “Road of Trials” stage of the Heroine’s Journey. This is one of the few points of similarity between the Heroine’s Journey and the Hero’s, corresponding to Campbell’s “Tests, Allies, and Enemies” stage. This is where the main character faces the initial obstacles and challenges of their quest. In the first few Kingdom Hearts games we have Sora face off against Maleficent, Ansem, and the Organization, before reuniting with Riku and Kairi in The World That Never Was. The final stages of Kingdom Hearts II correspond to the “Finding the Boon of Success” stage of both the Hero and Heroine’s Journeys. 
Part II: Interlude
In a Hero’s Journey, the Boon of Success is the end of the story. They slay the dragon, save the princess, and go home to live happily ever after. I suspect this is one reason why a lot of gamers in the KH fanbase tend to think of Kingdom Hearts 2 as the best game of the series - because in their minds Sora’s quest had been completed now that he had found Riku and Kairi like he set out to do in the first game. His journey, as far as they were concerned, was done. 
(This may also have an affect on how some fans reacted to Kingdom Hearts III, expecting it to be a grand epic finale that wrapped everything up with a bow and left a completely blank slate for the future of the series)
But in a Heroine’s Journey, the Boon of Success is not the end of the main character’s story. They have achieved their external goal, but they have not addressed their internal motivations for seeking that goal in the first place. And as their story continues, they find themselves facing challenges that their attitude thus far has failed to prepare them for. Finding The Boon of Success typically occurs early during the second act of the story. Usually it is achieved in the second half of Act II, but can sometimes happen as early as the end of the first act. For Sora, this was of course finding Riku and Kairi so that they could all go home to the Destiny Islands together.
But because the protagonist of a Heroine’s Journey has not addressed the underlying insecurities which set them on their current path, they “Awaken to Feelings of Spiritual Aridity”. 
They begin to learn that the conflict they find themselves involved in is not as clear cut as they previously believed, and the challenges that come with this new knowledge are ones that their current way of doing things has failed to prepare them for. They may have found their boon of success, but things quickly begin to go wrong until they are ultimately forced to sacrifice their reward. 
The first game already showed through Riku and Mickey that Sora was not the only person able to wield a Keyblade, but because of his heroic deeds the story still framed him as the Keyblade Master and treated him as having a more significant role to play in important events than anyone else. It’s only after he hears from Mickey of the Keyblade Wielders who came before him that it begins to sink in for him that being a Keyblade Master is not a special Chosen One status. He thinks that because of all that he’s accomplished, he doesn’t need the recognition that comes with the official title, and because of that he’s careless and almost gets himself Norted at the end of DDD. 
His failure in the exam is a blow to his self confidence and shows that despite what he had said at the start of the test, deep down he really does want that kind of external validation. His insecurities and doubts continue to eat at him over the course of KH3, culminating in his breakdown at the Keyblade Graveyard. Outside of battle, we see him bottle up his doubts and other negative emotions because his friends (Except for Riku. More on him later) brush his concerns and problems aside. It is very much like Joy from Inside Out doing everything to keep Rylee happy and refusing to let Sadness take the controls. 
When their current way of doing things ultimately costs them their boon, the protagonist tries to go back to the way things used to be. To return to a simpler time and avoid the pain of the present. When literally going back to where their journey began isn’t possible, a Heroine’s Journey story will use this stage symbolically. The main character will cling to a person, object, or relationship that they associate with a simpler time. But as comfortable as the sense of familiarity they get from that is, it ultimately cannot truly address their inner pain in the long run.
This is reflected in the Re:Mind DLC, where Sora goes back in time in order to find the pieces of Kairi’s heart and bring her back. One of Kairi’s most consistent character traits is her fear of change and desire for things to remain the way they were. 
At the end of the DLC, Sora compares his connection with Kairi to the bond between Ventus and Chirithy, a friendship explicitly strained by distance, time, and Ven’s amnesia. In an interview at E3 2018 [4], Nomura commented about Kingdom Hearts III tying into a theme of childhood friendships changing as one gets older, a plotline that Merlin calls attention to after Sora’s visit to the 100 Acre Wood. And in a 2006 book titled Character’s Report Vol. 1, Nomura specifically calls attention to Kairi’s anxiety about growing apart from Sora and Riku as they get older. [5] All of these details combined frame Sora’s quest to save Kairi as an attempt to symbolically recover the innocence he lost when he began his journey.
But while he is able to find a way to renew his connection to Kairi, it can never be the same as it was before, and attempting to go back to how things used to be is ultimately doomed to failure. By the time he brings her to The Final World at the end of Re:Mind, Sora has realized that he and Kairi cannot stay on the same plan of existence anymore as a consequence of his actions. So he takes her on a tour of the worlds to re-establish their connection before fading away at the end of KH3. Thus, we come to the final act of the Kingdom Hearts narrative. 
Part III: The Future Story 
It is at this point that the protagonist of a Heroine’s Journey begins the “Initiation and Descent to the Goddess” stage. Having failed to achieve meaningful success through their old way of doing things, they must look inward and examine the cause of their insecurities and accept that in order to move forward they need to heal themselves. In this step, the main character travels to either a dream world or a physical location that is closed off and forbidden to them, like the West Wing of Beast’s Castle in Beauty and the Beast. In Jungian psychology, this metaphorical dark cave represents the main character’s subconscious, and entering it triggers a dark night of the soul for our protagonist as they are forced to confront the parts of themselves they’ve been keeping locked away.
While Sora knows in his head that darkness is not inherently bad, he continues to rely entirely exclusively on light, on his connections to others, and has not properly accepted it in his heart. In order to truly finish his coming of age narrative, Sora must learn to balance his inner light and darkness the same way that Riku has. And to do that, he needs to look inside himself and figure out why he feels so badly that he needs his connections to others in order to be strong. And in order to achieve that level of understanding of himself, he needs to understand his Animus. 
Derived from the psychological theories of Carl Jung, the Animus in a Heroine’s Journey is an external representation of the protagonist’s masculine-coded traits in physical form. While not every Heroine’s Journey features an Animus, many of the stories I’ve seen that follow the formula do. Usually the Animus appears in the form of a deuteragonist who often functions as the protagonist’s Shadow, an archetypal character that embodies the aspects of the main character’s personality that due to their immaturity they either aren’t aware or don’t want to acknowledge that they have. 
In order to complete their character arc, the protagonist must symbolically integrate with their Shadow by learning to embrace the parts of their psyche that the Shadow represents. In many stories the protagonist has more than one Shadow figure, all of whom challenge the protagonist by forcing them to become faster or smarter to stay one step ahead, giving their interactions with the main character a push-and-pull dynamic as they drive the main character to grow. Shadow figures who fill the role of the Animus also challenge the protagonist to look inside themselves and examine their own emotional needs. With an Animus, the push to grow runs in both directions, with the main character motivating their Animus’ growth just as much as the other way around. 
In these types of stories, every aspect of the character is tailored to make the Animus and the protagonist fit together like Yin and Yang. In visual stories such as film, television, and video games, the Animus’ entire look is designed to complement the main character and they are framed in the narrative as the protagonist’s equal physically, intellectually, and spiritually. This serves to emphasize that despite their surface differences, much of the conflict between the protagonist and their Animus comes from the ways in which they are fundamentally similar. While their circumstances may have led them to drastically different lives, the characters are ultimately two sides of the same coin, and their character development is driven by learning to balance their contrasting traits.
And within the structure of the Kingdom Hearts series, there is only one character who fulfills all of these qualities in relation to Sora’s journey. 
The same character who Testuya Nomura said in the KH1 Ultimania was designed to balance Sora; [6]
Who series producer Shinji Hasimoto said was part of the core of the series alongside Sora [7], as has been repeatedly emphasized by the number of games where he is given a major focus and is a playable character alongside Sora. 
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[Image Description: Riku walking towards a door to light in the opening of Kingdom Hearts III. End Description]
While Sora and Riku have addressed some of the latter’s behavior in the first game during their conversation on the dark beach at the end of Kingdom Hearts II, they have yet to truly dig deep into why Riku felt the way he did in the first game. Riku has not told Sora about how he felt like he was being left behind and forgotten. And since that conversation, Riku has gone to the opposite extreme, dealing with his emotional problems on his own instead of lashing out at others like he had done at the start. Likewise while Sora has accepted that darkness is not inherently evil he has yet to apply this to his own negative emotions, as seen in Kingdom Hearts III. Neither character has truly achieved an ideal balance yet, and they cannot until Sora completes his journey. 
After the protagonist returns from their spiritual journey, they experience an “Urgent Yearning to Reconnect with the Feminine.” As the main character recovers from their period of soul searching, they embrace the parts of themselves that they had neglected in their pursuit of outside approval. Their Descent allowed them to recognize their value as a person and an individual outside of their ability to fulfill the role that they were expected to fill. Following this realization, they go about “Healing the Mother/Daughter split”. Reclaiming the aspects of their personality they’ve been repressing gives the protagonist the clarity necessary to gain a different perspective on their old way of thinking. This new understanding is what will allow them to find the inner balance needed to truly complete their journey. 
The Japanese version of the “My friends are my power” mantra often repeated across the series is “Connected hearts are my power.” For Sora, who has long relied on his connections to others as a source of strength, he should come to realize that these connections go both ways: that his friends draw strength from him just as much as he draws strength from them. This should help him come to accept that he is still strong and worthy all by himself. Ven’s version of the mantra from the English version of BBS summarizes it best: “My friends are my power. And I am theirs.” After he accepts this, Sora will finally be able to use the full extent of his emotional abilities.
After achieving that new perspective, the protagonist’s next step is “Healing the Wounded Masculine Within”. This is the stage of the Heroine’s Journey where the main character, having come to understand themselves, reconciles with their Animus, thereby symbolically integrating the aspects of their psyche that the Animus represents and permanently healing the rift between the two characters. This will be where Sora and Riku need to have a longer, more in-depth conversation than the one they had on the Dark Magin at the end of KH2. Where they talk about why Riku acted the way he did and finally address the underlying reason for why he was so jealous of Sora in the original game. 
The final stage of the Heroine’s Journey is the “Integration of Masculine and Feminine”. This is the point at which the main character and their Animus finally achieve a perfect balance between them. They are united both internally and externally. There are no more secrets between them, and they are now free to move forward and overcome the main antagonist together. 
Part IV: Conclusion: 
While there’s too many different possibilities to completely predict every twist and turn of the series’ lore in future games, once you understand how Kingdom Hearts fits into the framework of the Heroine’s Journey, the broad strokes of how the story will go in terms of Sora’s growth and character development are entirely predictable. When Re:Mind first released and the rest of the fandom was reacting on Twitter, I was sitting back with a smug smile on my face thinking:
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[Image Description: Emperor Palpatine in Star Wars: Episode VI: Return of the Jedi sitting aboard the Death Star II with the caption ‘Good, Good. Everything is going according to plan.’ End Description.]
While I didn’t expect the precise mechanics of how Sora went about saving Kairi, Re:Mind was exactly what I expected it to be in terms of themes and its place in the Heroine’s Journey framework, and then the Secret Episode came along to reinforce that the next game is going to be Sora’s Descent.
While there isn’t a complete guarantee that the series will continue to follow the formula, I find it extremely unlikely that it won’t. Kingdom Hearts follows the stages of this framework too precisely for me to ever believe it happened by accident. So as long as there is no corporate interference from Disney like what happened to Voltron, I’m confident that Nomura’s plan for the finale of the series will be exactly what the Heroine’s Journey predicts it should be, no matter how unexpected future additions to the lore may be.
Special thanks to @dragonofyang and the rest of Team Purple Lion for everything I know about the Heroine’s Journey. I wouldn’t be as enthusiastic about analyzing the story of Kingdom Hearts if they hadn’t taught me the vocabulary to realize the kind of story that Nomura has been telling right under my nose for the last 18 years.
Sources:
[1] “Kingdom Hearts III Ultimania interview with Tetsuya Nomura”; March 12, 2019
https://www.khinsider.com/news/Kingdom-Hearts-3-Ultimania-Main-Nomura-Interview-Translated-14763
[2] “Iwata Asks: Nintendo 3DS: Third Party Game Developers, Volume 12: Kingdom Hearts 3D [Dream Drop Distance], Part 3: Square’s Intentions”; April 2012.
https://iwataasks.nintendo.com/interviews/#/3ds/creators/11/2
[3] “2004 GMR Nomura Interview 2004!”; Translation by Kingdom Hearts Insider posted May 5, 2012. 
https://www.khinsider.com/news/GMR-Nomura-Interview-2004-2563
[4] “E3 2018: Tetsuya Nomura on If Kingdom Hearts 3 Is the End of Sora's Story”; June 14, 2018.
https://www.ign.com/articles/2018/06/14/e3-2018-tetsuya-nomura-on-if-kingdom-hearts-3-is-the-end-of-soras-story
[5] “Character’s Report Vol. 1 Translations”; Jul 16, 2014
https://www.khinsider.com/forums/index.php?threads/characters-report-vol-1-translations.195560/\
[6] “A Look Back: Kingdom Hearts Ultimania Gallery Comments Part 1″; August 30, 2019;
https://www.khinsider.com/news/A-Look-Back-KINGDOM-HEARTS-Ultimania-Gallery-Comments-Part-1-15519
[7] “How Kingdom Hearts III Will Grow Up With Its Players.” September 24, 2013
https://www.ign.com/articles/2013/09/25/how-kingdom-hearts-iii-will-grow-up-with-its-players
[X] “The Heroine with a Thousand Faces”; June 13, 2019;
https://www.teampurplelion.com/heroine-with-a-thousand-faces/
[X] Murdock, Maureen. The Heroine’s Journey. 1990.
[X] “Maureen Murdock’s Heroine’s Journey Arc”. The Heroine Journeys Project. https://heroinejourneys.com/heroines-journey/
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ghinanotlinetti · 4 years
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A Review of ‘Feminsm for the 99%: A Manifesto’ by Cinzia Arruzza, Tithi Bhattacharya & Nancy Fraser
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Feminism for the 99%: A Manifesto is a book published by Verso Books, and is essentially a manifesto for feminist rooted in socialism. As I read this book in its entirety, I found myself agreeing with most if not all of the points that were made by the authors. Throughout the manifesto, the contributing authors make it clear that the rise of capitalism is greatly responsible for enabling exploitation, oppression and discrimination. There are also other factors which play into widening the gap of inequality such as race, class, and gender. I connected with this manifesto a great deal largely because I myself cannot comprehend neo-liberal values, and yet these values were seen as the norm and/or the ideal. I remember the time when Hilary Clinton’s vow to ‘break the glass ceiling’ for women pursuing a political career gained popularity; although there have been many women who’ve praised her and portray women like her as an icon, I found myself rather intimidated and disturbed by women such as Clinton and the women that would rally behind due to the fact that there would be a pattern or commonality that I, and many other women, could see in this group of women. For starters, I and other women look nothing like these women (they’re white most of the time), and secondly these women would have access to a plethora of resources from a system which favours this type of women (i.e. they had money, wealth that many women only dream of possessing). I mention Clinton and her glass ceiling because the book references this in the statement: “We have no interest in breaking the glass ceiling while leaving the vast majority to clean up the shards.” I read this statement over and over again, because these words are the exact the words I’ve been dying to say but could never piece out during the rise of white liberal feminism. White neo-liberal feminism seemed to have become the golden standard for women’s liberation, and yet I found it quite odd how easy it was for this ideology to exclude a large population of women in the global society whilst claiming to be “universal”. The moment I was confronted with just how much white women dictated the grounds for gender development, I was an exchange student in a Scottish university studying Gender and Development. From being cut off when I tried to speak up in the class group discussions to saying and idea but from an Eastern perspective and have it be questioned shortly after that idea was repeated but used in a Western perspective and then applauded by the white girls in this class gave me much to think about when class was over and I made my way in the snow from the university grounds to my flat. I do want to mention that the professor was a white woman and she was well aware of imbalances of power especially in gender and development studies, so she was a wonderful woman and I appreciate her very, very much, her classes were the best. But it was very clear to me that the white girls who came to this class were very much trained into thinking in neo-liberal and “Caucasian” trains of thought. It’s not that I’m disturbingly shocked because of how surprised I was, if anything I wasn’t even the slightest bit surprised and this gave me clarity in really and truly having every intention in fighting for my rights and every other woman’s rights to speak their narrative and voice their story with power and confidence.
This manifesto, along with my memories and teachings as a student of international studies, has given me clarity in voicing my principles and what I believe in. Just as any twenty-something-year-old I’m still learning, but I’m also at that stage where I’m able to ground myself in my core believes and search for what truly speaks to me and that won’t be what everyone believes. I also want to mention the post-face because there was a point which I felt really hit the nail and this is on women and labour. The authors speak about labour in terms of sustenance, survival and consequence. Generally speaking, it’s implied that men pursue hard labour to have a right in taking on the role of breadwinner of the family, they strive and work-hard for glory and praise, whereas women who are committed to childcare and other labour that is associated with maintaining the household are typically seen someone who’s just doing what they’re suppose to be doing, nothing praise-worthy, they simply do labour (which is most often unpaid) out of “love”. Many aunts who are caring for more than three children come to my mind when I read this explanation of labour in the post-face; women in our society are told that it is our purpose to be a mother typically by men (and I know this because it happened to me) and I strongly disagree. A woman's purpose shouldn't be reduced to giving love and receiving basically nothing in return; we are our own person, we have dreams, desires, hopes, fears, and ambitions beyond our capacity to give love.
100000000/10! This is a book I’ll be recommending to all my fellow social justice warriors, let’s fight together and be radical together for our society! Reading this during quarantine made me all in my feelings but this is exactly why social justice matters. We all matter. After this book I made a conscious effort to read a fiction book because I’m trying to avoid entering an existential crisis in these tough times 😅 my next review will be on a fiction book that I’ve recently read, it’s a best-selling novel and has been adapted into a miniseries and here’s an emoji for the hint: 🔥 (if you guessed Little Fires Everywhere then you’re absolutely right!) Happy reading my dudes!
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hina-akatsuki · 5 years
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PINK for girls BLUE for boys
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During our childhood, I am sure most of us had heard this statement," pink is for girls and blue is for boys". Obviously, it did not make sense in our young minds then, so most of us complied without giving it much thought. I was no exception. It was much later that I came to realize that this idea is one of the many stereotypes that segregates the sexes.
It is curious how something as impartial as color became a distinguishing factor between the sexes. But why only pink and blue from the vast color spectrum? Is there some biological theory behind it or is it a norm structured by culture and society?
Digging into history, this color-gender norm came into being only during the 20th century, probably becoming more prominent after World War 2. In fact, girls and boys were dressed in white and that too dresses till the previous century. With the emergence of pastels(pink and blue were widely used), children were adorned in colors other than white. The earliest reference to this color scheme appeared in a June 1918 edition of the Trade publication Earnshaw's Infant's Department:
" The generally accepted rule is pink for boys and blue for girls. The reason is that pink, being a more decided and stronger color, is more suitable for the boy while blue which is more delicate and dainty, is prettier for the girl."
The idea stuck around for a couple of years, with some contemporary publications also emphasizing that colors should not be decided based on the baby's gender, but based on eye and hair color.
Pretty smart!
However, over time the clothing manufacturers sought to reject this statement and promoted the idea "pink for girls, blue for boys". The practice escalated after World war 2, as corporate marketers promoted color-based distinction between boys' and girls' clothing. The motivation? It prevents parents from handing down clothes between siblings of different sexes, hence increasing the profits for designers and manufacturers. As an explanation of this divide, manufacturers simply stated that girls liked pink while boys liked blue.
A turning point in the history of gender-color norms came during the Women's liberation movement of the 1960s and 1970s which emphasized gender neutral clothing. In an upsurge of feminism, the fashion industry went through dramatic changes- from bloomers to bobbed hair to unisex wear to gender-neutral color.
But as we rolled into the 1980s, making money ruled over all existing perspectives at the time and marketing teams managed to flip the paradigm yet again.
Moving into the 21st Century, color preferences take an interesting turn. The youth of the present day provides us with a mixed opinion when asked about their favorite color. A recent study indicates vast majority prefer blue to pink and that pink is actually one of adult world's least favorite color.
So how did this shift in the spectrum occur? As it turns out, defining gender-specific colors has been a tug of war over the years with the end result being more or less a tie. Both colors( pink and blue) along with their hues are equally favored, regardless of gender.
However, we still tend to associate the color pink with femininity and blue with masculinity in some aspect or the other. Especially, while deciding clothing and types of toys for little ones.
The pink-blue color divide may seem like a trivial distinction between the sexes, but in reality, it paves way for other gender biases and forms the root of gender discrimination. Deciding on what a child should wear or what he or she should play with in order to conform to the so-called societal norms restricts it from exploring and having a mind of its own. Surveys show that children are not born into choosing a gender-specific color or toy, rather they are groomed into making such specific choices.
Be it wearing corsets in the Victorian era or being at home, women are groomed to look the part of what is considered as “feminine”. And it starts from a young, impressionable age when a child is getting to know its surroundings. The quote holds true," One is not born a woman. One becomes a woman".
But we shall not exclude the male party from this issue of gender discrimination for they are affected equally. The need to "be a man" as defined by our society puts pressure on the individual. Boys are told to be aggressive, that they cannot shed tears, that they need to indulge themselves into sports that involve physical strength. Basically don't do anything that is considered to be "girly"( for example- play with dolls, learn dance, etc). Any male indulging themselves in activities that are "girly" are often looked down upon or labeled as "gay".
Boys placing themselves on the pink side of the spectrum are assumed to be hinting at their homosexuality with the well-known logic of " boys who like boys are basically girls." Nazi concentration camp badges included a pink triangle for gay men, while lesbians were lumped into an ‘asocial elements’ group with a black triangle.
However, in the late 60s, with the rise of the LGBT movement, the balance shifted from the color of shame to that of pride. This brought in a new mindset-" Pink and Blue make purple". Purple covers everything between red (pink) and blue, and challenges fixed and extreme gender roles. Instead of just two labels-male and female, we have many, as portrayed by the LGBT rainbow flag.
In the end, we shouldn't associate our sexuality or behavior with the colors we choose. We are free to choose between pink and blue, unguided by society. And this openness comes from a young age, with good parenting. It is crucial for a parent to understand that a child can be whatever it chooses to be. We live in a time where traditional roles are questioned more often than before. A girl can like shades of blue and can love playing with cars and a boy can indulge in cooking and like hues of red or pink. Who knows, that girl grows up to be an F1 racer and that boy becomes a Michelin star chef in the future.
So, choose any color you like, irrespective of gender, society or culture. For, choice of color doesn’t define who we are, it’s our thoughts and actions that do.
Links for reference:
https://www.thelist.com/32342/real-reasons-behind-blue-boys-pink-girls/
https://munsell.com/color-blog/why-that-color-gender/
http://www.todayifoundout.com/index.php/2014/10/pink-used-common-color-boys-blue-girls/
NOTE- I wanted to write on this topic for a very long time and I realized that there is a lot to talk about.. so I decided to provide some links which I referred to for this piece. Opinions would be appreciated on this discussion! Thanks!
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jesseneufeld · 6 years
Text
Patient Empowerment: The Path to Better-Informed Health Decisions?
Patient empowerment. There’s no single, agreed-upon definition of what it is or how to get to it.
But, patient empowerment is generally seen as leading to collaborative, coordinated care. It supports an approach to care that honors the patient’s preferences, values, cultural traditions, and socioeconomic conditions. All of these characteristics are cornerstones of patient-centered healthcare, which is seen as fostering high-quality care for all.
  What is patient empowerment?
Patient empowerment requires the active participation of patients, providers, and policymakers – Source
  How you define patient empowerment depends on who you ask. It’s been described as a process, a set of actions, a skill, and a value.
  A process
The World Health Organization (WHO) defines patient empowerment as a process. Specifically, “a process through which people gain greater control over decisions and actions affecting their health.”
Both the individual and the community play a part in this process, which the WHO says has four requirements:
The patient understands their role
The patient acquires enough knowledge to be able to engage with their healthcare provider
The patient has the skills needed to manage their health
The healthcare environment and community facilitate the patient’s health-related activities and efforts
When these requirements are met, a process can take place “in which patients…are given the knowledge and skills by their healthcare provider to perform a task in an environment that recognizes community and cultural differences and encourages patient participation.”
This definition comes across as paternalistic. It keeps the healthcare provider as the driver of the process, “giving” knowledge and skills to the patient who performs the health-related task.
  A set of actions
The Center for Advancing Health (CFAH), describes patient empowerment as “the actions we (i.e., patients) take to support our health and to benefit from health care.”
In its Engagement Behavior Framework, CFAH identified 42 actions that patients and/or their caregivers must take to maximize the benefit received from their available healthcare.
Organized around ten themes, these actions include:
Finding healthcare providers who satisfy the patient’s personal criteria
Finding providers who are accepting new patients and the patient’s health insurance
Preparing questions in advance of doctor appointments
Gathering additional expert opinions before starting a new course of treatment for a serious illness
Changing behavior to maximize health and wellbeing
Discussing end-of-life wishes and values with healthcare providers, caregivers, and family members
Putting advance directives and a power of attorney in place
Here, the patient is the driving force behind the actions taken. The patient’s whole life, not just instances of illness or health concerns, is considered or managed in this empowerment framework.
  A skill
Emil Chiauzzi, PhD, the principal scientist at Patients Like Me, characterizes patient empowerment as “a finely-tuned skill providers and patients develop together.”
The skill is made up of:
Problem solving
Communications
Ability to seek out resources
Understanding of the disease
Understanding of the associated treatments
This definition of patient empowerment suggests an active partnership between patients and providers. It calls on providers to make educational resources available and to allot the time needed to work with patients in order to meet their needs. It also calls on patients to become empowered through their own learning and understanding of their health and disease.
  A value
The Patient Empowerment Network (PEN) articulates a collaborative approach to patient empowerment that focuses on “the value of having patients assert greater control over their health and healthcare.”
PEN identifies seven essential components for patient empowerment:
Information
Health literacy
Digital literacy
Self-efficacy
Mutual respect
Shared decision-making
A facilitating environment
PEN points to the rise of technology and apps as being largely responsible for changing the dynamic between patients and providers. These changes are key to the growth in patient empowerment.
  Empowerment is not the same as engagement
With engagement, patients are no longer the target of actions taken by others – Source
  The goal of patient empowerment is to have patients make informed decisions and take actions that support their overall health.
Unlike patient engagement, which is primarily aimed at getting patients to be more adherent and compliant, patient empowerment aims to create the conditions needed to help patients follow through on better health decisions they themselves make.
The notion of empowerment comes from the patient being the primary decision-maker, based on their own understanding of their health, their aspirations, and their healthcare provider’s expertise. What it means to be “better” is relative to the patient’s own values and desires for their overall health and quality of life.
  Patient empowerment supports patient-centered care
Patients who are empowered tend to seek out more than one source of information about their condition. Patients and providers engage in more shared decision-making. And, patients collaborate with their provider to pursue care that aligns with their values, culture, preferences, and socioeconomic conditions.
No longer is the patient the passive recipient of the provider’s expertise and instructions. Nor is the provider the authority making care decisions regardless of the patient’s values and circumstances.
Together, the conditions that make up patient empowerment facilitate the patient-provider collaboration that is at the core of patient-centered care and will lead to higher quality care for all.
  Who is the empowered patient?
Empowered patients tend to be assertive, making healthcare decisions for themselves – Source
  Patients Like Me (PLM) surveyed members of their patient research network in an effort to characterize empowered patients.
In terms of behavior, PLM found that empowered patients ask more questions. They seek more detailed explanations about their conditions and related issues. To feel comfortable asking questions of healthcare providers, patients need to feel confident in their level of education and understanding of health and medicine. They also must be confident that their provider will remain available and engaged for as long as it takes to build patient understanding.
PLM also found that not all patient groups across all health conditions demonstrated the same level of empowerment. Patients with conditions that are more easily diagnosed and more visible (like Parkinson’s and Multiple Sclerosis) self-reported a higher level of empowerment than patients with conditions that are more difficult to diagnose or less visible (like chronic fatigue syndrome and fibromyalgia).
One possible explanation for this disparity is that the stigma attached to less visible conditions undermines patients feeling empowered. Patients with stigmatized conditions often find that providers and caregivers doubt or, in some cases, dismiss their reported symptoms and health experiences.
In characterizing the demographics of empowered patients, PLM reported that patients who self-identified as empowered tended to be more educated, with a higher level of insurance, and male. To some degree these results are not surprising since educational achievement, insurance coverage, and male gender are perceived to be social advantages.
  How can we encourage more patients to become empowered?
Addressing social determinants of health can provide significant leverage to improve health outcomes – Source
  For the benefits of patient empowerment to be fully realized, empowerment needs to reach beyond the privileged few and those with the most visible illnesses. Engagement tactics alone (like enabling knowledge and encouraging shared decision-making) won’t be effective in spreading empowerment because they don’t reach all patients.
The formula for widespread patient empowerment, and the benefits of patient-centric care that come along with it, lie in addressing social determinants of health. By addressing social determinants, all patients have the opportunity to gain the literacy and skills needed to actively manage their health and make better-informed decisions.
There are nearly thirty widely-accepted social determinants of health. Out of this complex web of factors, three have been identified as creating the most favorable conditions for expanding patient empowerment.
Surprisingly, these three factors go beyond the clinical setting. They are:
Making health insurance accessible to all
Addressing language barriers in care
Addressing basic needs (i.e., food, housing, and financial insecurity)
  Insurance accessibility
Having health insurance has a direct effect on access to healthcare. Those without insurance are substantially less likely to access healthcare recently or regularly. This often means that those without insurance don’t seek care until they are experiencing a health crisis, making their treatment more complex and expensive.
  Language and communication barriers
Language barriers undermine communication between patients and providers with serious consequences. Patients with limited English proficiency are twice as likely to experience adverse medical consequences as English-speakers.
English proficiency is not the only barrier that must be addressed. People with hearing impairments or deafness also need interpreters. And disparities between patients’ and providers’ level of health literacy can also get in the way of understanding and communication needed to get to better-informed health decisions.
  Addressing basic needs
It’s widely-accepted that when people live in poverty or in under-resourced communities, their health suffers, and life expectancy is shortened. Community-wide action is needed to provide people with their basic needs for food, housing, and security.
Additionally, to ensure that basic needs are met across social and economic lines, a “health is in all policies” approach needs to be adopted. Governmental actions and decisions made outside of “purely health” policy will often have an effect on health. Actions and decisions made in one neighborhood can affect others. These effects need to be recognized and consciously managed to build healthy communities for everyone – not just some.
  Patient empowerment doesn’t happen in a vacuum
Much is made of the concept of patient empowerment. Empowerment is held up as the key to better healthcare decisions and better health. And while the decision-making power rests with the patient, that patient cannot make those decisions in a vacuum. A host of skills, actions, processes, and values are needed to inform patients and their decisions for true empowerment to be realized.
  In my next article, I’ll discuss how the patient is being transformed into a health consumer as one model for patient empowerment. 
The post Patient Empowerment: The Path to Better-Informed Health Decisions? appeared first on WEGO Health.
Patient Empowerment: The Path to Better-Informed Health Decisions? published first on https://drugaddictionsrehab.tumblr.com/
0 notes
jesseneufeld · 6 years
Text
Patient Empowerment: The Path to Better-Informed Health Decisions?
Patient empowerment. There’s no single, agreed-upon definition of what it is or how to get to it.
But, patient empowerment is generally seen as leading to collaborative, coordinated care. It supports an approach to care that honors the patient’s preferences, values, cultural traditions, and socioeconomic conditions. All of these characteristics are cornerstones of patient-centered healthcare, which is seen as fostering high-quality care for all.
  What is patient empowerment?
Patient empowerment requires the active participation of patients, providers, and policymakers – Source
  How you define patient empowerment depends on who you ask. It’s been described as a process, a set of actions, a skill, and a value.
  A process
The World Health Organization (WHO) defines patient empowerment as a process. Specifically, “a process through which people gain greater control over decisions and actions affecting their health.”
Both the individual and the community play a part in this process, which the WHO says has four requirements:
The patient understands their role
The patient acquires enough knowledge to be able to engage with their healthcare provider
The patient has the skills needed to manage their health
The healthcare environment and community facilitate the patient’s health-related activities and efforts
When these requirements are met, a process can take place “in which patients…are given the knowledge and skills by their healthcare provider to perform a task in an environment that recognizes community and cultural differences and encourages patient participation.”
This definition comes across as paternalistic. It keeps the healthcare provider as the driver of the process, “giving” knowledge and skills to the patient who performs the health-related task.
  A set of actions
The Center for Advancing Health (CFAH), describes patient empowerment as “the actions we (i.e., patients) take to support our health and to benefit from health care.”
In its Engagement Behavior Framework, CFAH identified 42 actions that patients and/or their caregivers must take to maximize the benefit received from their available healthcare.
Organized around ten themes, these actions include:
Finding healthcare providers who satisfy the patient’s personal criteria
Finding providers who are accepting new patients and the patient’s health insurance
Preparing questions in advance of doctor appointments
Gathering additional expert opinions before starting a new course of treatment for a serious illness
Changing behavior to maximize health and wellbeing
Discussing end-of-life wishes and values with healthcare providers, caregivers, and family members
Putting advance directives and a power of attorney in place
Here, the patient is the driving force behind the actions taken. The patient’s whole life, not just instances of illness or health concerns, is considered or managed in this empowerment framework.
  A skill
Emil Chiauzzi, PhD, the principal scientist at Patients Like Me, characterizes patient empowerment as “a finely-tuned skill providers and patients develop together.”
The skill is made up of:
Problem solving
Communications
Ability to seek out resources
Understanding of the disease
Understanding of the associated treatments
This definition of patient empowerment suggests an active partnership between patients and providers. It calls on providers to make educational resources available and to allot the time needed to work with patients in order to meet their needs. It also calls on patients to become empowered through their own learning and understanding of their health and disease.
  A value
The Patient Empowerment Network (PEN) articulates a collaborative approach to patient empowerment that focuses on “the value of having patients assert greater control over their health and healthcare.”
PEN identifies seven essential components for patient empowerment:
Information
Health literacy
Digital literacy
Self-efficacy
Mutual respect
Shared decision-making
A facilitating environment
PEN points to the rise of technology and apps as being largely responsible for changing the dynamic between patients and providers. These changes are key to the growth in patient empowerment.
  Empowerment is not the same as engagement
With engagement, patients are no longer the target of actions taken by others – Source
  The goal of patient empowerment is to have patients make informed decisions and take actions that support their overall health.
Unlike patient engagement, which is primarily aimed at getting patients to be more adherent and compliant, patient empowerment aims to create the conditions needed to help patients follow through on better health decisions they themselves make.
The notion of empowerment comes from the patient being the primary decision-maker, based on their own understanding of their health, their aspirations, and their healthcare provider’s expertise. What it means to be “better” is relative to the patient’s own values and desires for their overall health and quality of life.
  Patient empowerment supports patient-centered care
Patients who are empowered tend to seek out more than one source of information about their condition. Patients and providers engage in more shared decision-making. And, patients collaborate with their provider to pursue care that aligns with their values, culture, preferences, and socioeconomic conditions.
No longer is the patient the passive recipient of the provider’s expertise and instructions. Nor is the provider the authority making care decisions regardless of the patient’s values and circumstances.
Together, the conditions that make up patient empowerment facilitate the patient-provider collaboration that is at the core of patient-centered care and will lead to higher quality care for all.
  Who is the empowered patient?
Empowered patients tend to be assertive, making healthcare decisions for themselves – Source
  Patients Like Me (PLM) surveyed members of their patient research network in an effort to characterize empowered patients.
In terms of behavior, PLM found that empowered patients ask more questions. They seek more detailed explanations about their conditions and related issues. To feel comfortable asking questions of healthcare providers, patients need to feel confident in their level of education and understanding of health and medicine. They also must be confident that their provider will remain available and engaged for as long as it takes to build patient understanding.
PLM also found that not all patient groups across all health conditions demonstrated the same level of empowerment. Patients with conditions that are more easily diagnosed and more visible (like Parkinson’s and Multiple Sclerosis) self-reported a higher level of empowerment than patients with conditions that are more difficult to diagnose or less visible (like chronic fatigue syndrome and fibromyalgia).
One possible explanation for this disparity is that the stigma attached to less visible conditions undermines patients feeling empowered. Patients with stigmatized conditions often find that providers and caregivers doubt or, in some cases, dismiss their reported symptoms and health experiences.
In characterizing the demographics of empowered patients, PLM reported that patients who self-identified as empowered tended to be more educated, with a higher level of insurance, and male. To some degree these results are not surprising since educational achievement, insurance coverage, and male gender are perceived to be social advantages.
  How can we encourage more patients to become empowered?
Addressing social determinants of health can provide significant leverage to improve health outcomes – Source
  For the benefits of patient empowerment to be fully realized, empowerment needs to reach beyond the privileged few and those with the most visible illnesses. Engagement tactics alone (like enabling knowledge and encouraging shared decision-making) won’t be effective in spreading empowerment because they don’t reach all patients.
The formula for widespread patient empowerment, and the benefits of patient-centric care that come along with it, lie in addressing social determinants of health. By addressing social determinants, all patients have the opportunity to gain the literacy and skills needed to actively manage their health and make better-informed decisions.
There are nearly thirty widely-accepted social determinants of health. Out of this complex web of factors, three have been identified as creating the most favorable conditions for expanding patient empowerment.
Surprisingly, these three factors go beyond the clinical setting. They are:
Making health insurance accessible to all
Addressing language barriers in care
Addressing basic needs (i.e., food, housing, and financial insecurity)
  Insurance accessibility
Having health insurance has a direct effect on access to healthcare. Those without insurance are substantially less likely to access healthcare recently or regularly. This often means that those without insurance don’t seek care until they are experiencing a health crisis, making their treatment more complex and expensive.
  Language and communication barriers
Language barriers undermine communication between patients and providers with serious consequences. Patients with limited English proficiency are twice as likely to experience adverse medical consequences as English-speakers.
English proficiency is not the only barrier that must be addressed. People with hearing impairments or deafness also need interpreters. And disparities between patients’ and providers’ level of health literacy can also get in the way of understanding and communication needed to get to better-informed health decisions.
  Addressing basic needs
It’s widely-accepted that when people live in poverty or in under-resourced communities, their health suffers, and life expectancy is shortened. Community-wide action is needed to provide people with their basic needs for food, housing, and security.
Additionally, to ensure that basic needs are met across social and economic lines, a “health is in all policies” approach needs to be adopted. Governmental actions and decisions made outside of “purely health” policy will often have an effect on health. Actions and decisions made in one neighborhood can affect others. These effects need to be recognized and consciously managed to build healthy communities for everyone – not just some.
  Patient empowerment doesn’t happen in a vacuum
Much is made of the concept of patient empowerment. Empowerment is held up as the key to better healthcare decisions and better health. And while the decision-making power rests with the patient, that patient cannot make those decisions in a vacuum. A host of skills, actions, processes, and values are needed to inform patients and their decisions for true empowerment to be realized.
  In my next article, I’ll discuss how the patient is being transformed into a health consumer as one model for patient empowerment. 
The post Patient Empowerment: The Path to Better-Informed Health Decisions? appeared first on WEGO Health.
Patient Empowerment: The Path to Better-Informed Health Decisions? published first on https://drugaddictionsrehab.tumblr.com/
0 notes
jesseneufeld · 6 years
Text
Patient Empowerment: The Path to Better-Informed Health Decisions?
Patient empowerment. There’s no single, agreed-upon definition of what it is or how to get to it.
But, patient empowerment is generally seen as leading to collaborative, coordinated care. It supports an approach to care that honors the patient’s preferences, values, cultural traditions, and socioeconomic conditions. All of these characteristics are cornerstones of patient-centered healthcare, which is seen as fostering high-quality care for all.
  What is patient empowerment?
Patient empowerment requires the active participation of patients, providers, and policymakers – Source
  How you define patient empowerment depends on who you ask. It’s been described as a process, a set of actions, a skill, and a value.
  A process
The World Health Organization (WHO) defines patient empowerment as a process. Specifically, “a process through which people gain greater control over decisions and actions affecting their health.”
Both the individual and the community play a part in this process, which the WHO says has four requirements:
The patient understands their role
The patient acquires enough knowledge to be able to engage with their healthcare provider
The patient has the skills needed to manage their health
The healthcare environment and community facilitate the patient’s health-related activities and efforts
When these requirements are met, a process can take place “in which patients…are given the knowledge and skills by their healthcare provider to perform a task in an environment that recognizes community and cultural differences and encourages patient participation.”
This definition comes across as paternalistic. It keeps the healthcare provider as the driver of the process, “giving” knowledge and skills to the patient who performs the health-related task.
  A set of actions
The Center for Advancing Health (CFAH), describes patient empowerment as “the actions we (i.e., patients) take to support our health and to benefit from health care.”
In its Engagement Behavior Framework, CFAH identified 42 actions that patients and/or their caregivers must take to maximize the benefit received from their available healthcare.
Organized around ten themes, these actions include:
Finding healthcare providers who satisfy the patient’s personal criteria
Finding providers who are accepting new patients and the patient’s health insurance
Preparing questions in advance of doctor appointments
Gathering additional expert opinions before starting a new course of treatment for a serious illness
Changing behavior to maximize health and wellbeing
Discussing end-of-life wishes and values with healthcare providers, caregivers, and family members
Putting advance directives and a power of attorney in place
Here, the patient is the driving force behind the actions taken. The patient’s whole life, not just instances of illness or health concerns, is considered or managed in this empowerment framework.
  A skill
Emil Chiauzzi, PhD, the principal scientist at Patients Like Me, characterizes patient empowerment as “a finely-tuned skill providers and patients develop together.”
The skill is made up of:
Problem solving
Communications
Ability to seek out resources
Understanding of the disease
Understanding of the associated treatments
This definition of patient empowerment suggests an active partnership between patients and providers. It calls on providers to make educational resources available and to allot the time needed to work with patients in order to meet their needs. It also calls on patients to become empowered through their own learning and understanding of their health and disease.
  A value
The Patient Empowerment Network (PEN) articulates a collaborative approach to patient empowerment that focuses on “the value of having patients assert greater control over their health and healthcare.”
PEN identifies seven essential components for patient empowerment:
Information
Health literacy
Digital literacy
Self-efficacy
Mutual respect
Shared decision-making
A facilitating environment
PEN points to the rise of technology and apps as being largely responsible for changing the dynamic between patients and providers. These changes are key to the growth in patient empowerment.
  Empowerment is not the same as engagement
With engagement, patients are no longer the target of actions taken by others – Source
  The goal of patient empowerment is to have patients make informed decisions and take actions that support their overall health.
Unlike patient engagement, which is primarily aimed at getting patients to be more adherent and compliant, patient empowerment aims to create the conditions needed to help patients follow through on better health decisions they themselves make.
The notion of empowerment comes from the patient being the primary decision-maker, based on their own understanding of their health, their aspirations, and their healthcare provider’s expertise. What it means to be “better” is relative to the patient’s own values and desires for their overall health and quality of life.
  Patient empowerment supports patient-centered care
Patients who are empowered tend to seek out more than one source of information about their condition. Patients and providers engage in more shared decision-making. And, patients collaborate with their provider to pursue care that aligns with their values, culture, preferences, and socioeconomic conditions.
No longer is the patient the passive recipient of the provider’s expertise and instructions. Nor is the provider the authority making care decisions regardless of the patient’s values and circumstances.
Together, the conditions that make up patient empowerment facilitate the patient-provider collaboration that is at the core of patient-centered care and will lead to higher quality care for all.
  Who is the empowered patient?
Empowered patients tend to be assertive, making healthcare decisions for themselves – Source
  Patients Like Me (PLM) surveyed members of their patient research network in an effort to characterize empowered patients.
In terms of behavior, PLM found that empowered patients ask more questions. They seek more detailed explanations about their conditions and related issues. To feel comfortable asking questions of healthcare providers, patients need to feel confident in their level of education and understanding of health and medicine. They also must be confident that their provider will remain available and engaged for as long as it takes to build patient understanding.
PLM also found that not all patient groups across all health conditions demonstrated the same level of empowerment. Patients with conditions that are more easily diagnosed and more visible (like Parkinson’s and Multiple Sclerosis) self-reported a higher level of empowerment than patients with conditions that are more difficult to diagnose or less visible (like chronic fatigue syndrome and fibromyalgia).
One possible explanation for this disparity is that the stigma attached to less visible conditions undermines patients feeling empowered. Patients with stigmatized conditions often find that providers and caregivers doubt or, in some cases, dismiss their reported symptoms and health experiences.
In characterizing the demographics of empowered patients, PLM reported that patients who self-identified as empowered tended to be more educated, with a higher level of insurance, and male. To some degree these results are not surprising since educational achievement, insurance coverage, and male gender are perceived to be social advantages.
  How can we encourage more patients to become empowered?
Addressing social determinants of health can provide significant leverage to improve health outcomes – Source
  For the benefits of patient empowerment to be fully realized, empowerment needs to reach beyond the privileged few and those with the most visible illnesses. Engagement tactics alone (like enabling knowledge and encouraging shared decision-making) won’t be effective in spreading empowerment because they don’t reach all patients.
The formula for widespread patient empowerment, and the benefits of patient-centric care that come along with it, lie in addressing social determinants of health. By addressing social determinants, all patients have the opportunity to gain the literacy and skills needed to actively manage their health and make better-informed decisions.
There are nearly thirty widely-accepted social determinants of health. Out of this complex web of factors, three have been identified as creating the most favorable conditions for expanding patient empowerment.
Surprisingly, these three factors go beyond the clinical setting. They are:
Making health insurance accessible to all
Addressing language barriers in care
Addressing basic needs (i.e., food, housing, and financial insecurity)
  Insurance accessibility
Having health insurance has a direct effect on access to healthcare. Those without insurance are substantially less likely to access healthcare recently or regularly. This often means that those without insurance don’t seek care until they are experiencing a health crisis, making their treatment more complex and expensive.
  Language and communication barriers
Language barriers undermine communication between patients and providers with serious consequences. Patients with limited English proficiency are twice as likely to experience adverse medical consequences as English-speakers.
English proficiency is not the only barrier that must be addressed. People with hearing impairments or deafness also need interpreters. And disparities between patients’ and providers’ level of health literacy can also get in the way of understanding and communication needed to get to better-informed health decisions.
  Addressing basic needs
It’s widely-accepted that when people live in poverty or in under-resourced communities, their health suffers, and life expectancy is shortened. Community-wide action is needed to provide people with their basic needs for food, housing, and security.
Additionally, to ensure that basic needs are met across social and economic lines, a “health is in all policies” approach needs to be adopted. Governmental actions and decisions made outside of “purely health” policy will often have an effect on health. Actions and decisions made in one neighborhood can affect others. These effects need to be recognized and consciously managed to build healthy communities for everyone – not just some.
  Patient empowerment doesn’t happen in a vacuum
Much is made of the concept of patient empowerment. Empowerment is held up as the key to better healthcare decisions and better health. And while the decision-making power rests with the patient, that patient cannot make those decisions in a vacuum. A host of skills, actions, processes, and values are needed to inform patients and their decisions for true empowerment to be realized.
  In my next article, I’ll discuss how the patient is being transformed into a health consumer as one model for patient empowerment. 
The post Patient Empowerment: The Path to Better-Informed Health Decisions? appeared first on WEGO Health.
Patient Empowerment: The Path to Better-Informed Health Decisions? published first on https://drugaddictionsrehab.tumblr.com/
0 notes