Tagged: health disparities

How to Start an Epidemic

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A cholera epidemic was just one of the unnintended consequences of UN health workers

In 2010 there was a terrible earthquake in Haiti that caused unprecedented destruction. Thousands of people died, homes were destroyed, and what infrastructure existed was decimated.

Shortly after the earthquake, the country experienced a devastating cholera outbreak. There had never been a case of cholera on the island before.

Cholera is a nasty disease that can kill a healthy adult in as little as three hours. It is easy to treat, but thousands of people in Haiti died before health workers were able to control the  epidemic.

How can this be?

Yes, Haiti is poor and the infrastructure was in disarray. But surely the people who planned the response knew that cholera was a possibility?

It bears repeating that although infectious disease is spread from bacteria and viruses, there is always, always a social component to disease. As Charles and Clara Briggs wrote in their excellent ethnography about a cholera outbreak in Venezuela,  Stories in the Time of Cholera: Racial Profiling During a Medical Nightmare: 

Epidemics are ‘mirrors held up to society,’ revealing differences of ideology and power as well as the special terrors that haunt different populations[…]

Cholera created a charged, high-stakes debate about the lives of the people it infected, and competing stories bore quite different policy implications.

So what stories were being told about the cholera outbreak?

At first, the international aid community including the UN tried to blame poor infrastructure.  Health workers stepped up education campaigns about clean water use (which is kind of a joke in a country that was completely ravaged by the earthquake). The response tended to emphasize   existing problems with the water delivery system, poverty, poor hygiene, and living conditions that were ripe for this type of epidemic. The UN launched a major cholera aid package that some say was just repackaging an aid effort that already existed.

But in the end, they had to own up.  It turns out that UN aid workers brought it with them. Not on purpose. But still. They were actually the vectors.

It’s fitting, I suppose, that this is the conclusion. After all, the history of Haiti is an endless story of outsiders bring poverty, violence, disease, devastation.

So how do you create an epidemic? Act first, think later. Don’t ask for advice. Don’t consult an anthropologist. Hope for the best. Rely on old worn-out narratives. Emphasize feeling and emotion. Charge  in to save the day.

Cholera was the most vivid example of the latest tragedy visited on Haiti, but surely there were more. What about the American aid workers who went to save the day, like this guy, but came back feeling disappointed when people on the street just wouldn’t stop begging for money:

It’s very frustrating because, again, it’s this strange combination of being dependent, but also expecting it. And that can be very disheartening because the reality is no aid project is going to work if you don’t have people that you’re trying to help bought into it in wanting to help themselves.

Or the  foreign aid that often benefits companies from the US while at the same time undermining local economies.  Or that fact that medical aid organizations can sometime swoop in without trying to integrate themselves into the existing medical system, with the unintended consequence of leaving the local healthcare system in worse shape than they found it.

Haiti is trying to sue the UN for damages. Here’s hoping that they win.

Turning those lemons into lemonade

Lemonade

Don’t you hate these kind of motivational posters? I do. They are corny and cheesy, but sometimes these types of insufferable cliches resonate.

I’ve been in a funk lately, a creative rut.  I work at home, I spend lots of time with a three year old, and as a freelance,  I am responsible for getting my own business. It feels like there are never enough hours in the day, and sometimes I’m like a hamster in a wheel, going around and around and not getting anywhere, coming up with the same unworkable solutions again and again.

So I  love to hear about t innovations or radically different ways of thinking, examples of ahem, turning lemons into lemonade. This article in yesterday’s NYT  provides an excellent example of this approach in action.

Remember how we have this messy, mean, non-existent, non-cohesive healthcare system in this country that refuses to provide federally funded healthcare for all?

The folks that run community health centers interface with this impossible reality every day, and they’ve come up with one way of making a dollar out of fifteen cents: using brownfields — or really polluted land — on which to build health clinics.

It’s not as crazy as it seems. The federal government allocates EPA money to clean up these sites, so it’s a creative way of getting extra government funding to build clinics. Lemonade out of lemons. You get the picture.

According to the New York Times:

[This is] a nationwide trend to replace contaminated tracts in distressed neighborhoods with health centers, in essence taking a potential source of health problems for a community and turning it into a place for health care.

And why is this extra important?

By 2015, the number of Americans who rely on community health centers for care is expected to double to 40 million from the 20 million who relied on the centers in 2010, according to the National Association of Community Health Centers.

It’s just this kind of thinking that’s needed to come up with creative, innovative solutions to the gigantic healthcare coverage in this country.

And personally, I’m inspired to think about my own goals in a new way, and to think about how to make liabilities into possibilities.

What do you think?

 

Silence still equals death

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Did you know that Saturday was World AIDS Day?

I wasn’t paying attention. Like so many Americans, I have the luxury of acting as if the virus doesn’t exist.

But AIDS is still a major problem in the US. I live in the South, the region of the country that experiences the highest rate of the disease. But most of the time (or even all the time) it’s completely off my radar. There are lots of reasons for this, one of which is the fact that people living with HIV/AIDS are largely invisible. For all I know, my neighbor could be HIV positive, but I would have no idea. Unlike breast cancer or even depression, HIV is so stigmatized that people with the disease remain completely hidden.

Remember that old mantra, silence= death? It still does.

When was the last time you saw a “I’m HIV positive” bumper sticker? Or even a red ribbon?

HIV continues to be a disease that highlights social inequality. According to a new report:

  • Black women account for 64% of all new HIV diagnoses in the country
  • Nine of ten of the states with the highest death rate of HIV are in the South
  • Approximately 1 in 16 Black men will be diagnosed with HIV in their lifetime

If these numbers make you shudder, they should.  I know 16 Black men, many of whom are family. Statistically, one of them could have HIV, but if they do, I wouldn’t know it. We don’t talk about it.

One innovative  strategy for addressing this issue developed by the NAACP in partnership with Gilead Sciences is to engage Black churches as partners in preventing the onslaught of this disease. They’ve  developed a training manual for pastors in Black churches, guiding them on how to address HIV/AIDS in their communities and emphasizing that it is a social justice issues.

Highlighting the interconnectedness of social inequality to health disparities is one of the most crucial ways to improve public health. The training manual encourages pastors to be inclusive to gay and lesbian congregants, and to exercise compassion as part of a mission to save lives.

It’s an unlikely partnership in some ways, but one that is meaningful and that will hopefully prove to be effective.

What do you think? Has HIV/AIDS affected you at all? Have you heard of other unlikely partnerships aimed at preventing other diseases?

 

 

 

 

Insourced

 

It’s been a rough year for workers in the US, with about 10 percent of the population unable to find a job, and many more not able to find enough consistent work. One sector that is consistently adding jobs is the healthcare industry. Since about 90 percent of healthcare support workers are women, and over half of new medical students are female, this should be great news for women, right?

Well…maybe. But maybe not.

In reality, the healthcare field is a complex and varied industry that often perpetuates inequality on a global scale. In her new book  — Insourced: How Importing Jobs Impacts the Healthcare Crisis Here and Abroad — Kate Tulenko exposes how global inequalities are reproduced by US immigration policy and lack of strong healthcare worker recruitment policy.

For example, almost 6,000 regions in the US don’t have enough healthcare workers, but recruitment of potential healthcare workers from these communities is rare. At the same time, a study in Malawi showed that there are more Malawian physicians in Manchester, England than in Malawi. Ironically, poor countries such as India and Malawi, invest a significant part of the income into training physicians and nurses who often go abroad because the pay and working conditions are better, meaning that the countries don’t even get a return on their investment.

 

The US facilitates this process by providing special healthcare worker visas to those seeking to immigrate.

Tulenko, the senior director of health system innovation at IntraHealth International, has worked both domestically and abroad and experienced many of these inequalities firsthand. She points out that when the US facilitates immigration of healthcare workers from these countries, it negatively affect health indices.

It is irrational and immoral to recruit health workers from countries where one in five children die before their fifth birthday when we could be recruiting and training workers domestically. Doing so would help our economy, global public health and the 314 million Americans who rely on our medical system to provide high-quality, affordable care.

This immorality crosses over into domestic policies as well, since many African American and Lation communities are served by transient physicians and nurses, who come to these communities to gan experience but rarely stay on longterm. Tulenko argues that recruiting healthcare workers (of all levels) from the communities that need them most could better serve disenfranchised neighborhoods in the US.

She  writes:

There are other casualties, closer to home. Every study that has examined how to incentivize health workers to move to underserved areas has shown that training people from these communities is the most cost-effective approach. But because we’ve essentially given up on recruiting from underserved places in the United States, we’ve made their chronic lack of health workers much worse. Some 54 million people live in the 5,700 parts of the country defined as “health professional shortage areas,” the communities with the worst health statistics and the worst unemployment.

Even with the high unemployment rate, there is often a healthcare worker shortage in this country. This shortage is attributable to a variety of factors: medical school (and post-secondary education in general) has become extremely expensive.

It’s similar to the so-called “skills gap” in manufacturing, described in this article. When manufacturing workers are paid only $10 an hour to do a complex job that requires they pay for training at a community college, they often find that financially they would be better off working at McDonalds.

At the same time that there is a growing demand for healthcare workers, the educational requirements have increased.  According to a report from Georgetown University:

The demand for postsecondary education and training in healthcare, already high, will continue to edge upward. In 2010, it was 81%; by 2020, it will rise slightly to 82%. For professional and technical occupations, however, that number rises to 94%. A bachelor’s degree will be required for 24% of all healthcare jobs, up from 21%  in 2010. This high demand for postsecondary talent in healthcare is second only to STEM and education occupations

Almost 90 percent of health support workers are women.

While nurses and other healthcare professionals are paid well, according to the report, 70 % of healthcare support workers earn less than $30 000. Soon, most of these jobs will require at least some post-secondary education, but there’s no guarantee that wages will go up.

Healthcare systems – like the economic system – are intertwined, we don’t live in a vacuum. This is an interesting example of the ways that the broken US healthcare system has spread its tentacles all over the world.

Friday News Roundup

Yep, it’s inevitable. Another week has come to an end. In health news this week:

  • Saturday is World Prematurity Day, which is very close to my heart since my son was born 12 weeks too soon. The US isn’t doing a great job in preventing prematurity, we’re currently 113th in the world in numbers of preterm births (?!). According to the World Health Organization, 15 million babies are born too soon every year. That’s more than one in 10 births — and more than one million of these babies die shortly after they are born. The WHO and the March of Dimes estimate that three-quarters of preterm babies who die could survive without expensive care if a few proven and inexpensive treatments and preventions were available worldwide.
  • Turns out that doctors with less than ten years experience spent an average of 13% more than more experienced physicians.  I like this study because it looks at how physicians — instead of patients — are responsible for escalating healthcare costs. This isn’t something that you hear very often.  =
  • Drug makers called “compounders” are to blame for the recent meningitis outbreak caused by fungal contamination in a steroid prescribed to people with back pain. These companies (like Ameridose, the company responsible for the tainted steroid in question) are essentially unregulated by the FDA. They have been supported by many in congress because their products are often an affordable alternative to huge drug manufacturers. One argument about regulation was that states should be left to do it themselves. This confirms my theory that whenever a government official makes a states’ rights argument, it is cause for concern.
  • A study of pregnant Medicaid recipients in 14 southern states found that African-American women were more likely than to have longer hospital stays and pregnancy complications. The study estimated that eliminating disparities in adverse pregnancy events could save between $114 and $214 million annually in Medicaid costs in the 14 states studied.
  • Access to contraception is a human right. Even the United Nations says so.

Have a great weekend! Meet you back here next week, when I’ll be posting about healthcare in-sourcing, premature birth, and sharing an interview with a wonderful doula and author!

 

 

 

You are not a loan

As Obama eases into office for his second term, and the economy seems to take a turn for the better, there’s still one thing that’s hanging over our heads.

Debt, debt, debt.

I’ve lived my life pretty simply. I have no desire to be rich, just happy. I don’t pine after a bigger house or nicer clothes, I don’t want a new car or a new iPhone.  I just want a stellar life. I want experiences, travel, and time with friends, family. I want time to think and read and putter around. I want to write and bake cakes and watch weird movies, and lie on the beach and take road trips.

And mostly, I’ve been able to do this. I drive an old car. I buy my clothes at thrift shops. I cook dinner from scratch every night, and we eat a lot lentils and sweet potatoes. We don’t have cable or smartphones or new computers. Our television is ten years old, I have a prepaid Tracfone, and I can’t remember the last time I saw a movie in the theater.  I get my CDs, DVDs and reading material from the library, and buy my son’s toys at garage sales.  It’s a simple life, but it’s a very good one.

But there’s always this nasty thing hanging over my head. Debt, debt, debt.

I have $40,000 in student loans, racked up when I was a graduate student. And if I do say so myself, I was a great student. I got excellent grades, I won three awards and I finished two graduate degrees in five years. I taught ten undergraduate classes, was busy every minute of the day. But somehow, I still came out drowning in debt.It just doesn’t seem right that I have these loans hanging over my head for my education. It’s not like I went out and bought thousands of dollars of shoes, or a car I couldn’t afford, or went out to fancy restaurants every night.

I’ve decided to not let it stop me from living the life I want, but it’s still there, this nagging feeling in the back of my mind. Debt, debt, debt.

So when I read that about the Strike Debt movement, I was intrigued. The movement attempts to organize people as debtors.  According to Jodi Dean, a professor of political science at Hobart and William Smith Colleges:

“Debilitating medical and student debt are the result of a market approach to medicine and education. So if Strike Debt grows, we could see demands for free healthcare and free universities. Once people stop thinking of banks as entitled to interest and fees, then we may also decide as a society that public sector workers, pensions and basic infrastructures are more important than playing the bankers’ game.”

What does this have to do with health? Everything.

I don’t have any medical debt, but my student debt obligations gobble up a distressingly large portion of  my fairly measly income, making it financially impossible for me to purchase my own health insurance. I’m self-employed, so no one is going to provide it for me. I’ve been lucky so far, no major medical catastrophes since I’ve been uninsured, but really I’m just one bad pap test or car accident away from medical bills that could push me into financial ruin.

What about you? Do you have medical or student debt? Is it affecting your health? Have you heard about the Strike Debt movement? Let me know!

Women and War

Yesterday was Veterans Day, and President Obama marked the event by laying a wreath at Arlington Cemetery.

The rituals of Veterans Day are all very scripted, solemn and patriotic.  There are always serious faces, the requisite honoring of old men, the sporting of uniforms, remarks about freedom and sacrifice and America being great.

All in all, it’s a very male event.

But the military is changing.  Since 9/11,over  200,000 women have served in Iraq and Afghanistan.

This means that there are a whole host of health issues that are now part of the military that weren’t before, and the VA medical system is struggling to keep up. According to the Service Women’s Action Network (SWAN):

Only 15% of women veterans use VA facilities. VA culture is still rife with male-bias, leading many women veterans to feel that the VA cannot properly attend to their gender-specific health needs […] Furthermore, VA healthcare is characterized by its “fragmentation,” meaning that women are not able to access comprehensive health services from their primary providers but rather must be referred elsewhere or travel enormous distances for routine services such as gynecological exams. Additionally, VA hospitals often foster uncomfortable, unwelcoming or hostile environments for women.

The VA is doing some work to address this, and for that they should be commended. The VA has initiated  “Culture Change Campaign” complete with PSAs:

 

Still, the biggest health challenge faced by female veterans, however, is not figuring out where to get a Pap test, it’s dealing with the aftermath of sexual assault, often perpetrated by their own colleagues. As many as one out of three  (!!) women leaving military service have reported being the victim of some kind of sexual assault. Rape and sexual assault continues to be a huge problem for women in all branches of the US military.

Part of this is because of the nature of military culture. To a significant extent, constructs of masculinity, of what it means to be a man, are built on domination of women. And the military is nothing if not a masculine institution.  In her book Earth Follies,  Joni Seager points out the “surprisingly transparent phallic imagery” that pervades military language: “soft laydowns, deep penetration, hard missiles.”

I mean, what does this look like to you?

Is an army without rape even possible?

Even more disturbing is the fact that this epidemic of sexual assault is unequally distributed across the population, given that the US Army consists of an all-volunteer force. According to the Population Reference Bureau,  while the most powerful predictors of who will serve in the military are survey responses indicating that people want to serve, or expect to serve, in the military, enlistment is also highly contingent on social class.

Children of college educated parents are less likely to serve. Those with higher  high school grades are less likely to serve. African Americans and Hispanics are more likely to serve than whites. That means that an African American woman whose parents do not have a college education is more likely to enlist and be at risk for sexual assault than a white woman from an affluent family whose parents have a college education. Once again, health disparities are contingent on income and social class.

It’ssomething to think about amidst all the parades and noble speeches about the greatest generation.

What are your thoughts? Have you been in the military? Known someone who is? What do you think are the most pervasive issues female soldiers and veterans face?