The Intersection of Poverty and Health

By Linda Evans
March 7, 2016

“I realized that large, systemic issues often prohibited people from having the capability to achieve good health, and that without good health, people couldn’t live a life they valued.”

Kate LeMasters ’15
Edwin A. Morris ’26 Distinguished Research Scholar
Cluj, Romania

By taking advantage of all that Washington and Lee has to offer, Kate LeMasters ’15 forged an educational path that took her from Lexington to the Southwest United States, Western Africa and Romania to tackle issues of poverty and public health.

Back in Romania this year through The Edwin A. Morris ’26 Distinguished Research Grant, a post-graduate grant from W&L, she continues to expand her research on maternal health among disadvantaged and ethnically marginalized women.

LeMasters first explored how societal context shapes peoples’ well-being through the Bonner Scholar and Shepherd Programs, her work with English for Speakers of Other Languages (ESOL) with Ellen Mayock, Ernest Williams II Professor of Spanish, and through courses in global politics and economics of social issues taught by Tyler Dickovick, Grigsby Term Associate Professor of Politics, and Arthur Goldsmith, Jackson T. Stephens Professor of Economics.

“I realized that large, systemic issues often prohibited people from having the capability to achieve good health, and that without good health, people couldn’t live a life they valued,” LeMasters said.

Dickovick, who was LeMasters’ advisor and continues to be her mentor, encouraged her to explore public health and think critically about how institutional and political contexts influenced peoples’ health. The summer after her sophomore year, LeMasters conducted research with the West Africa AIDS Foundation in Accra, Ghana, where she interviewed HIV-positive pregnant women about disclosure of their HIV status to partners and families.

“In many situations, women did not take their medication for fear that loved ones would discover their diagnosis and abandon them,” she said. Throughout that summer, “it became clear that the health of many families, including that of unborn children, was sacrificed by medical establishments and society ignoring the implications of HIV’s stigma.”

Returning to W&L, LeMasters arranged a semester-long study abroad in Geneva, Switzerland, to learn how public health issues in developing areas were being approached at the international level.

At the end of the semester, LeMasters conducted an independent study in Romania, at the suggestion of Anne Wallis, professor of epidemiology and population health at the University of Louisville. Wallis formerly lived in Lexington and had given a lecture on maternal health at W&L, after which LeMasters discussed her research interests with her.

Funded by W&L’s John M. Evans Endowment for International Study, the research in Romania involved studying the social determinants of smoking during pregnancy and strengthened LeMasters’ interests in maternal health, which had been growing since her time in Ghana.

Back in Lexington during the summer before her senior year, she worked with Dickovick and Niels-Hugo Blunch, associate professor of economics as a Summer Research Scholar to analyze how Ghana’s localizing of its institutional structures affected health after the country decentralized from 65 districts to more than 200.

While her international experiences and internationally focused research were invaluable to LeMasters’ growing body of knowledge of public health, she wanted to learn more about marginalized groups domestically. So, through the mentorship and guidance of her global politics thesis advisors Dickovick and Jon Eastwood, Laurent Boetsch Term Associate Professor of Sociology, during winter break of her senior year, she traveled to Arizona to speak with Western and traditional healthcare workers on the Navajo Nations.

Funded through a Mellon grant from the Provost’s Office, the experience “helped shed light on how medical practices often ignore cultural context,” she said.

“While health issues in Navajo Nation, Ghana and Romania are distinct challenges, they are all examples of how health problems are rooted in societies misunderstanding the lives of those suffering, specifically the socially marginalized.”

LeMasters’ collective experiences enabled her to write two honors theses for her majors in global politics and economics and a capstone for her minor in poverty and human capability studies, all of which focused on understanding maternal health risk factors for ethnic minorities across political and cultural contexts and the injustices involved in those risk factors. Howard Pickett, director of the Shepherd Program, advised her capstone and encouraged LeMasters to explore not only risk factors but the ethical issues involved in administering healthcare to ethnic minorities, which greatly expanded the scope of her work.

But she wasn’t finished with her work just yet.

“I was looking for a way to go back to Romania after graduation to research Roma women’s pregnancy experiences,” she said, “because while the health inequalities between Roma and non-Roma women in Romania intensify throughout life, they often begin in utero.”

She says that experiences of Roma women “are best understood by complementing a traditional epidemiologic approach with one that reexamines the boundaries of assumed pregnancy experiences, gathers the life experiences of women, and examines the interplay of Roma women’s lives and their pregnancies.”

LeMasters expressed her desire to return to Romania to faculty, including her economics thesis advisor, Katherine Shester, assistant professor of economics, and Robert Straughan, now dean of the Williams School.

The school offered her the first Edwin A. Morris ’26 Distinguished Research Grant for post-graduate research. She returned to Romania in September 2015 and will conclude her work in summer 2016.

LeMasters is back at the Cluj School of Public Health as an international fellow, where she has the support of a research team, including a translator for field work (although she is learning Romanian), and continues to receive support and guidance from W&L professors and staff. She has interviewed academics, general practitioners, gynecologists, social and community workers, Roma health mediators and others.

The final component of her research now involves collaboration with World Vision for interviews with Roma and non-Roma women who have given birth within the past five years. “I hope that my work will elucidate the determinants of pregnancy-related health among the Roma and will help others better understand this stigmatized population, as they are increasingly scrutinized,” she said.

She’ll return to Lexington next year to give a talk about her experience. LeMasters will enter graduate school next fall for global public health, and hopes eventually to earn a Ph.D. and teach and conduct research at a university.

LeMasters says she is driven by believing that “better understanding the lives of those suffering from poor health is the first step towards ending unjust health inequalities that affect children before they are even born.”

She would like to thank Professors Blunch, Dickovick, Eastwood, Goldsmith, Mayock, Pickett, Shester, Wallis, and Ms. Carol Karsh for their invaluable mentorship and support while at W&L, and their continued guidance today. She would also like to thank Professor Razvan Chereches and Ms. Alexandra Brînzaniuc, Andreea Silaghi, and Andreea Varga for their research support in Romania.

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