Old Enough to Know: The Impact of Health Values on Self-Care among Elderly Black Men and Women

Article excerpt

Introduction

This article presents a comparative analysis of elderly Black women's and men's decisions to use self-care. Self-care is defined as activities "performed by the individual ... to achieve, maintain, or promote maximum health" (Bakken Henry and Holzemer, 1997, NS34). The research evolves from the premise that healthcare attitudes and trends are shaped by our health values, which are defined as our desirability for certain health conditions (Tsevat, et al. 1996). Given the rapidly graying population of the United States, the care of senior citizens is becoming an increasingly important social issue. The U.S. Census Bureau reports that the over-65-years-old population increased elevenfold between 1900 and 2000, compared to a threefold increase in the nonelderly population (Hobbs, 2001). Gerontologists believe that the "new-old demographic," that is, members of the population who will enter the older Americans cohort in the next few decades, will inject changing value systems into healthcare decision making (Binstock, Janigen, and Post, 1994). Increasingly, these value systems can be equated to a "new health morality" that demands that we all take personal responsibility for our health (Conrad, 2005; Hacker, 2008).

This "new health morality" has been termed healthicization. Healthicization, or wellness promotion, proposes behavioral or lifestyle prescriptives for previously biomedically defined events, such as agerelated illnesses (Conrad, 1994; Westfall and Benoit, 2004). Implicit in this value system or morality is the suggestion that self-care methodologies should be a pivotal part of the life of every responsible adult. Dill, Brown, and Ciambrone (1995) define self-care as the range of methodologies employed by the individual to first recognize and evaluate symptoms and then either treat those symptoms or seek advice about treatment. Specifically, this paper will examine self-care as it is defined and measured on three distinct points: (1) changing one's behavior, (2) equipment use, and (3) modifying one's environment. This tripartite self-care definition was partially adopted from the National Survey of Self-care and Aging (Kincade Norburn, Bernard, Konrad, et al., 1995). The promoters of healthicization practices such as self-care believe that there are beneficial outcomes for adopting such practices, which range from reduction in healthcare costs to healthier bodies (Conrad, 2005).

Two structural phenomena of aging--the increasing dependence of the aged on the state for economic support and the transformation of retirement into a period of leisure--shape how seniors are viewed today (Uhlenberg, 1992). Over the last three decades, seniors' concerns have become more prominent in the public discourse, as the proportion of public funds expended on the elderly increases (Cain, 1974). Increasingly, the public views senior citizens as a large and active voting bloc with political power, so much so that their advocacy has been labeled "the third rail of politics" (Campbell, 2003).

The current study focuses on the social realities of elderly Black people, analyzing their healthcare choices within an intersectional framework. The study targets elderly Blacks because they face double discrimination based on age and racial identity.

This paper advances the idea that healthicization trends are not only present among elderly Black people but also that these trends are driven by health values. In light of this, the larger theoretical questions to be answered by this analysis are: (1) How do health values manifest themselves in the healthcare decisions of elderly Black people? (2) Do health values affect Black women and men differently? And (3) are there any manifest outcomes for the elderly Blacks from practicing self-care methods?

Literature Review

Bakken Henry, and Holzemer (1997) identify self-care as those activities "performed by the individual, or their families or communities, to achieve, maintain, or promote maximum health. …