1. Young healthy Latina pregnant woman b.134 sleep functions b.152 emotional functions b.156 perception functions b.420 blood pressure functions b.515 digestive functions (tolerance) b. 535 digestive sensations (nausea) b.545 water balance functions (retention) b.620 urination functions (frequency) b.660 procreation functions b.670 reproductive sensations s. 620 structures of pelvic floor Pregnancy expected changes in Body Functions and Structures At the initial encounter: Laura was very low risk from the biological point of view

2. But she had many risks coming from the environment e.130 prod/tech for education e.225 climate e.315 support from immediate family e.430 individual attitudes of people in position of authority e.450, 455 individual attitudes of health professionals, other professionals (dis.) e.465 social norms, practices and ideologies (cultural barriers) e.550 legal services, systems, policies e.580 health services, systems, policies e.590 labor/employment services, systems, policies e. 595 political services, systems and policies Environmental Factors Isolation Insecurity Exclusion Illegal status Poverty Migration

3. d.175 solving complex problems d.230 carrying out a daily routine d.240 handling stress d.310,d.330 communicating d.470 using transportation d.570 looking after one’s health d.590 employment systems, policy d.630 preparing meals d.760 family relationships d.770 intimate relationships d.839 education about pregnancy d.870 economic self-sufficiency d.950 political life and citizenship Environmental factors as barriers to performance! Body functions and structures with full capacity Poor functionality Which resulted in poor functionality

4. Adding the Activity Setting’s dynamic perspective FUNCTIONALITY? Activities Participation Laura The environment Input Output Process

5. Home in Mexico Non accepting community Home in Wisconsin Laura had multiple activity settings Health System

6. Home in Mexico Non- accepting community Home in Wisconsin Activity settings influence each other….. Health System

7. Activity setting evolve. It has some stable qualities and some changing qualities as it propagates through time. same new Home yesterday Home today Home tomorrow WHAT IS DRIVING CHANGE?

8. Home in Mexico Non- accepting Community Home in Wisconsin Health System CAPITALISM IS THE UNDERLYING FORCE DRIVING UNHEALTHY CHANGE IN ALL THE ACTIVITY SETTINGS

9. Good for capitalism Without her family’s approval, she and her boyfriend used the money saved for their wedding to pay the “coyote” to cross the border Home in Mexico Bad for health

10. Good for capitalism The baby’s dad depended on a friend to get to work so he was saving to buy a car, the baby was an unexpected expense, she waited to tell him about the pregnancy Home in Wisconsin Bad for health

11. Good for capitalism Home in Wisconsin Bad for health She wanted to wait until she could send money to contact her family so they could see the benefit of her leaving, and she didn’t call her mother or sister for advise about the baby

12. Good for capitalism They considered it too risky to ask the employer for a poof of (low) income, a requirement to receive the coverage Non- accepting community Bad for health

13. Good for capitalism She knew she had no rights to services and was afraid that any institution would deport her if she ask for help Non- accepting community Bad for health

14. Good for capitalism She knew LHO, as many other non-profits, is struggling for resources and that only gave health education, not health care so she didn’t call us Non- accepting community Bad for health

15. Good for capitalism Someone told her that the clinic was sending collection agents to people that did not pay for care Health System Bad for health

16. Good for capitalism Coverage rationale was not the women but that prenatal care was cost- effective ($1 saves $3 of post-natal care) Health System Bad for health

17. QUESTIONS: Is capitalism a trickle-down of well- being or a “sucking up” of the health of populations? Have we become the means of its ends? Can a small advocacy organization have an impact against such a tremendous force? What should the Latino Health Organization do? Please suggest….