Provided: Elizabeth Nelson
Provided: Elizabeth Nelson

A Corollary to War

by Laura DeMassa ’21

Ezinwa Osuoha ’22 watched the nightly news as a child. She remembers images of war and disease in faraway lands. At the time, it seemed that war, and the ailments that follow from it, were challenges for other, poorer nations, not the United States.

“We often dissociate in a demeaning manner,” says Osuoha. “We talk about other countries as if our own is perfect. I cannot hold myself to look at other countries and say they are the only ones experiencing these crises.”

Osuoha grew up on the outskirts of Philadelphia, where her parents settled after immigrating from Nigeria.

“Being immigrants, being Black, and being people who are not in the top one percent, I have seen my family struggle and be victimized by the [United States] health-care system,” says Osuoha, who studies Biology and Society.

Structural barriers—such as the distance to health-care facilities, treatment prices, and a lack of resources—restrict marginalized communities’ access to effective health care, contributing to uneven health outcomes in the United States.

Furthermore, a history of scientific racism and medical exploitation of vulnerable communities has caused lasting unease and distrust in the medical system, according to Osuoha.

The United States Public Health Service (USPHS) Syphilis Study at the Tuskegee Institute offers a striking example of that history. In 1932, researchers enrolled Black men with syphilis in a study intended to observe how untreated late-stage syphilis progressed. The researchers concealed the true objective of the study, did not disclose to participants that they had syphilis, and withheld effective treatment when it became available—a spectrum of abuse that lingers in Osuoha’s mind.

“When seeking health care, in the back of our heads, we are asking, ‘Am I being heard? Am I being given correct information? Am I being treated fairly? Am I safe?’” Osuoha says.

Osuoha wants to reduce health-care disparities in the United States and around the globe. As a McNair Scholar, she compares disease outbreaks in different nations, including cholera in Yemen, asthma in Syria, and COVID-19 in the United States. Each of these outbreaks could have been lessened, she argues, with adequate public health resources. Her current project is advised by Julie Carmalt, Associate Director of the Sloan Program in Health Administration and Senior Lecturer in Policy Analysis and Management.

“I’m constantly curious,” says Osuoha. “I’m always trying to figure out answers: why outbreaks happen and how we can predict certain trends.”

Through her research, Osuoha asks how a country’s social and political landscape makes an impact on its citizens’ health. The answers might explain why a disease is prevalent or an outbreak occurs in some contexts and not others.

“I’m constantly curious. I’m always trying to figure out answers: why outbreaks happen and how we can predict certain trends.”

Disease in Yemen and Syria amid Civil War

War and disease are intertwined, Osuoha observes.

In Yemen, the Sunni government of President Abdrabbuh Mansur Hadi and Shi’ite Houthis from Saada province have been embroiled in conflict since 2014. Persistent warfare has engulfed cities, forced millions of Yemenis out of their homes, and devastated health infrastructure. Hospitals have been damaged, physicians displaced, and blockades have precluded access to clean water, food, and medicine—all requisites for a healthy society.

As a result, more than 2.5 million Yemenis have become infected with cholera, a bacterial disease of the small intestine that, if not treated, can be fatal. Yemen is experiencing the largest outbreak of cholera on record while, in the United States, access to clean water, not to mention preventative vaccines and antibiotic treatment, has made cholera exceedingly rare.

In Syria, the Assad government, the Free Syrian Army, and other factions have launched chemical attacks, airstrikes, and other armed offenses across the country, including in major cities, since 2012. Consequently, civilians may inhale lingering chemicals and debris in the air, be forced to seek refuge elsewhere, and suffer from post-traumatic stress disorder and other illnesses. These factors stress individuals’ lungs and nervous systems, increasing the risk of asthma.

Many Syrians with asthma have gone without treatment: the life-saving inhalers, oral steroids, and other medications that can keep a patient’s airways open.

Osuoha argues that in both Yemen and Syria, violence and material destruction have increased the risk of contracting disease as well as hindered access to medical treatment.

War at Home? Formulating a New Idea of War

When thinking of health care for marginalized communities in the United States, Osuoha believes the story may not be all that different. Like Yemen and Syria, social and political factors in the United States create barriers and disparate medical outcomes for marginalized communities. She sees value in recognizing the unrest in the United States as what it might be called elsewhere: war.

“Although there is no physical war within our country’s bounds, there are opposing sides and tensions,” says Osuoha. “The destruction may not be physical but is social and political. That political polarization influences our health-care infrastructure and how our health-care system works for individuals.”

Osuoha is currently exploring this phenomenon, which she provisionally calls sociopolitical war. To Osuoha, sociopolitical war may appear as political polarization, discriminatory policies, disenfranchisement, and racism that result in a wider health gap between white and marginalized communities, as seen during the COVID-19 pandemic.

Osuoha will be investigating what was going on socially and politically in the United States during the COVID-19 pandemic, disentangling the links between these sociopolitical factors and the disproportionate impact of COVID-19 on marginalized communities.

Osuoha is unsure where her work will take her next, and she anticipates some pushback. “It’s both new and controversial,” she says.

Nonetheless, she hopes to challenge how Americans view war and disease, giving us eyes to better see the deep health inequalities at home.