Does medical humanities matter? The challenge of COVID-19.

Medical humanities has tended first and foremost to be associated with the ways in which the arts and humanities help us to understand health. However, this is not the only or necessarily the primary aim of our field. What the COVID-19 pandemic has revealed above all is what the field of critical medical humanities has insisted on: the deep entanglement of social, cultural, historical life with the biomedical. The pandemic has been a time for reinstating the power of expertise of a particular kind, focusing on epidemiology, scientific modelling of potential outcomes and vaccine development. All of this delivered by science at speed.It has been challenging for medical humanities researchers to find purchase in these debates with insights from our more contemplative, 'slow research' approaches. However, as the height of the crisis passes, our field might now be coming into its own. The pandemic, as well as being productive of scientific expertise, also demonstrated clearly the meaning of culture: that it is not a static entity, but is produced and evolves through interaction and relationship. Taking a longer view, we can see the emergence of a certain 'COVID-19 culture' characterised by entanglements between expert knowledge, social media, the economy, educational progress, risk to health services and people in their socio-economic, political ethnic and religious/spiritual contexts. It is the role of medical humanities to pay attention to those interactions and to examine how they play out in the human experience and potential impact of the pandemic. However, to survive and grow in significance within the field of healthcare research, we need to engage not just to comment. There is a need for medical humanities scholars to assert our expertise in interdisciplinary research, fully engaged with experts by experience, and to work proactively with funders to demonstrate our value.

Menopausal symptoms and work: a narrative review of women's experiences in casual, informal, or precarious jobs.

Governments, employers, and trade unions are increasingly developing "menopause at work" policies for female staff. Many of the world's most marginalised women work, however, in more informal or insecure jobs, beyond the scope of such employment protections. This narrative review focuses upon the health impact of such casual work upon menopausal women, and specifically upon the menopausal symptoms they experience. Casual work, even in less-then-ideal conditions, is not inherently detrimental to the wellbeing of menopausal women; for many, work helps manage the social and emotional challenges of the menopause transition. Whereas women in higher status work tend to regard vasomotor symptoms as their main physical symptom, women in casual work report musculoskeletal pain as more problematic. Menopausal women in casual work describe high levels of anxiety, though tend to attribute this not to their work as much as their broader life stresses of lifelong poverty and ill-health, increasing caring responsibilities, and the intersectionally gendered ageism of the social gaze. Health and wellbeing at menopause is determined less by current working conditions than by the early life experiences (adverse childhood experiences, poor educational opportunities) predisposing women to poverty and casual work in adulthood. Approaches to supporting menopausal women in casual work must therefore also address the lifelong structural and systemic inequalities such women will have faced. In the era of COVID-19, with its devastating economic, social and health effects upon women and vulnerable groups, menopausal women in casual work are likely to face increased marginalisation and stress. Further research is need.

The Color of Breath

[...]the Covid-19 pandemic has generated significant reports of “happy” or “silent” hypoxia: the previously little-known phenomenon of people with dangerously low blood oxygen levels who nonetheless function without shortness of breath.1 These cases highlight a central theme emergent from the Life of Breath project: that there is often a mismatch between objective and subjective measures of health, also known as symptom discordance. The New England Journal of Medicine recently published a list of race-adjusted algorithms to highlight the growing concerns with their uses given the “mounting evidence that race is not a reliable proxy for genetic difference.” Braun’s Breathing Race into the Machine revealed that the practice of “correcting” for race in spirometry, the study of lung function, promoted scientific acceptance of difference between racial groups, without due concern to the racial categories employed to organize this data in the first place, or to the way that social conditions and living conditions affect lung function.10 McGuire’s Measuring Difference, Numbering Normal developed this analysis by demonstrating the use of variable and inconsistent reference classes in spirometry with regard to women and miners. In Britain, data is disaggregated to reflect racial differences so the extent to which Covid-19 was unduly impacting those categorized as “BAME (black and minority ethnic) populations” became quickly visible.11 The patterns suggested by this data have been implemented in workplace safety questionnaires that ask individuals to calculate their “Covid age” according to their sex, age, ethnicity, and various comorbidities before they return to work.12 Though this data is obviously valuable, such initiatives are based on the premise that risk to health originates in the individual rather than in their ways of living as a member of a particular group—ways of living which might include increased exposure to air pollution, decreased access to quality education, greater levels of poverty and stress, and increased levels of discrimination from health professionals.