Tag Archives: Public Health Adoption

Why adoptee rights advocacy should use a public health lens

When I wrote my memoir and critical study of the U.S. adoption experience, I deleted a chapter where I highlighted divisions among many of the millions of adoptees, notably those who want to focus mainly on their personal feelings about this experience and those who focus more on making systemic changes to end inequities to many.

This is a long debate, and I strategically dropped this section because I thought it would become a distraction. There are many ways this plays out, and I am choosing not to amplify works and ideas that I do not think will lead to change. Nor do I want to tell others how to navigate meaning in their lives. Those decisions remain with the individual, and no one but the person has the ability to confront those realities.

Resurrection River Alaska

Making systemic change requires a focus on upstream advocacy, to fix the root issues and problems.

Since publishing my book, I have had some modest successes, including calling attention to how the United States fails to even count adoptees, which would be one step forward. This ongoing and intentional failure by the U.S. Census reveals larger issues of bias to adoptees and how the power dynamics of the interconnected institutions and interests co-mingle with sustaining modern adoption while not reforming it.

I would love to see more fellow adoptees, especially among those who advocate for systemic changes—what public health folks call upstream advocacy—talk about the intersection of public health, adoption, and adoptee rights issues.

Adoption is and will remain a public health concern, since the public health systems at the local, state and federal level in this country helped build this system and sustain it, for domestic and inter-country adoptions.

I am fortunate that I have a background in public health, so I can make these connections much more easily. As I wrote in what I call my first of its kind public health memoir on adoption: “I use public health concepts that focus on laws and systems that have an impact on large groups of people. A public health lens lets one look at outcomes, including the health of adoptees and those born illegitimately. This approach points out flaws that can be fixed, particularly if we look at evidence and science as well as how adoption systems work best.”

The Centers for Disease Control and Prevention provide this model to explain how a public health approach addresses problems and promotes population health.

Unfortunately, I have found few adoptees with this formal education, and that may be one reason why this method and lens have not been widely shared by them as a means to highlight the root issues and show a path to change with institutions that wield unhealthy power over the lives of millions of adoptees because of laws and policies.

As I have written before, health and public health groups have a moral obligation to advocate for the wellbeing of all adopted Americans as a population. Both also have a responsibility to correct their past historic roles creating a system that denies adoptees rights and also health information that could potentially be life-saving for some.

I am still confident that the approach I outlined in my book will gain traction, among journalists who continue to ignore root issues and also among adoptees themselves.

I also know this journey will be long. I have not given up hope because the goal remains to fix the larger problems, and changing laws and systems will help the greatest number of people who continue to be denied basic legal rights and knowledge of who they are.

Why adoption and the rights of adoptees must be seen as public health issues

The Centers for Disease Control and Prevention provide this model to explain how a public health approach addresses problems and promotes population health.

My memoir, You Don’t Know How Lucky You Are: An Adoptee’s Journey Through the American Adoption Experience, stands apart from most books and memoirs that focus on adoption and adoptees’ stories.

Unlike other works in this field, You Don’t Know How Lucky You Are describes the American adoption experience through a public health lens, and it is written as a “public health memoir.” Please see the CDC Foundation’s definition of public health if you are not sure what public health means or how it approaches health issues.

In terms of policy, You Don’t Know How Lucky You Are shows how the institution—past and present—and the status of being adopted both constitute legitimate public health areas of interest that can be improved by changing outdated and discriminatory laws and policies. This will require the active collaboration of health and public health groups. Both have a moral obligation to advocate for the well-being of all adopted Americans as a population. Both also have a responsibility to correct their past historic roles creating a system that denies adoptees rights and also health information that could potentially be life-saving for some.

These are some of the public health issues my memoir addresses:

  • It shows that being adopted can be measured in long-term health impacts (there are anywhere from 5 million to 9 million U.S. adoptees, and that imprecision is part of the larger problem of counting them, and thus ensuring they count in all public-health decision-making).
  • It shows how and why health and public health professionals need to be involved in policy changes that improve the health for this diverse but large group of Americans, including advocating for legal changes to harmful adoption-records-secrecy laws now used in most U.S. states. Giving more adoptees access to their records will allow them to know their health and family ancestry—something recommended by nearly every leading health and scientific expert.
  • It shows how public health professionals today, namely in state vital records offices, contribute to legal inequality in the treatment of adopted persons seeking equal treatment by law and their family ancestry and medical history.
  • It shows how implicit bias against illegitimately born people—adoptees are viewed that way, even if that is not acknowledged—is seen in longitudinal health outcomes. There are tragic and meticulous historic and current data on mortality and morbidity of those born outside of marriage, which should be of interest to anyone in public health and health who thinks that bias matters in the treatment of people/groups.
  • It shows how doctors and social work professionals from the late 1940s through the 1970s promoted practices that separated infants and their birth families without any peer-reviewed or demonstrable evidence documenting how this would provide a long-term benefit to millions of Americans, namely the relinquished infants and their mothers/birth families. Those impacted were usually vulnerable, young, and powerless women who had few advocates for maintaining family relationships.
  • It shows how the United States’ state-level adoption records laws promoting records secrecy are out of alignment with most developed nations that allow adoptees to access birth records, and all without any evidence of harm. This discussion also highlights how this represents another form of “American exceptionalism” in health issues, such as the United States’ lack universal health care, and how the GOP in promoting adoption as a Christian/moral “alternative to abortion” has promoted this exceptionalism that harms adoptees as a population.

(Published Jan. 16, 2018; updated July 27, 2019)