The State of Opportunity

Refusal To Participate in Maternal Deaths Review Shows City Has Not Learned from Brooklyn Death

The public recently witnessed the lack of basic care that people are subjected to at Kings County Hospital Center in Brooklyn, New York.  A woman was left for dead in the middle of the hospital’s psychiatric ward waiting room as staff did nothing but walk away.  The evidence in the New York Civil Liberties Union's lawsuit against the city proved that this was not an isolated incident (it just happened to be one of the only ones caught on tape).  Unfortunately, New York City's government is not learning from this catastrophe and taking sufficient steps forward to examine their hospitals - Women's eNews is reporting that the city is refusing to participate in a state review of maternal deaths and racial disparities, despite the fact that New York City has the highest number of maternal deaths and one of the largest populations of African-American patients in the country.

The New York City Health and Hospitals Corporation (the same agency that is named in the NYCLU lawsuit as the agency that is responsible for the negligence at Kings County Hospital Center), has refused to participate in the review the Safe Motherhood Initiative is conducting.  Pamela McDonnell, a spokesperson for Health and Hospitals Corporation (HHC) said:

We chose not to participate in the Safe Motherhood Initiative simply because we already participate in a number of established monitoring and review processes, measures and collaboratives.

However, one of the main points in the NYCLU's complaint was that the city had insufficient monitoring and oversight measures at its hospitals - it was this lack of oversight that led to last month's death at Kings County, and it could be part of the cause of numerous maternal deaths at city hospitals.

Thursday Immigration Blog Roundup

•    On Tuesday, New York City Mayor Michael Bloomberg signed a ground breaking executive order requiring all city agencies to provide language assistance services for people who speak Spanish, Chinese, Russian, Korean, Italian or French Creole.  According to The New York Times, this is the first time that all New York City agencies will be forced to follow the same standard in providing translation and language interpretation services to people who do not speak English:

Immigrant advocates and city officials say it is the most comprehensive order of its kind in the country. The mayor refused to be specific about how much the services will cost, saying only that it was a “relatively small” amount given the size of the city’s budget. He added: “This executive order will make our city more accessible, while helping us become the most inclusive municipal government in the nation.”

The Opportunity Agenda fact sheet Immigration Reform: Promoting Opportunity for All details the need for immigrants to have access to language assistance services in order to achieve their full potential. In providing immigrant groups with this access, Mayor Bloomberg has taken the entire city forward and empowered communities throughout New York.

•     Politicians have also been busy down in Washington, D.C. working to provide language assistance for immigrant families across the United States.  At noon today, Senator Hillary Rodham Clinton and Congressman Mike Honda are introducing the “Strengthening Communities through Education and Integration Act of 2008.” In addition to providing English language literacy and civics education to immigrant families who are in the process of becoming citizens, the bill:

will help immigrant communities become a more integral part of the American fabric and maximize their social and economic contributions.

Legislation like this is crucial to aiding immigrants on their way to becoming U.S. citizens, and is a necessary part of treating immigrants like full and equal members of our community.

•    The aftermath of the ICE raids in Postville, Houston, and most recently Rhode Island, is still being felt in communities across America.  However, a Washington Post article describes how it is not only workers and their families feeling this strife – now, it is employers as well:

The crackdown's relatively high costs and limited results are also fueling criticism. In an economy with more than 6 million companies and 8 million unauthorized workers, the corporate enforcement effort is still dwarfed by the high-profile raids that have sentenced thousands of illegal immigrants to prison time and deportation.

•    A story in the MetroWest Daily News calls attention to a local organization in Massachusetts, the MetroWest Immigrant Worker Center, that is defending the rights of immigrant workers in the U.S.  Immigrant workers are routinely subject to labor law violations, including the denial of compensation and overtime, as well as unnecessary injuries on job sites.  In addition, the article points out that all immigrants, including undocumented ones, have worker rights:

Contrary to what many people think, illegal workers have rights. Although in the country illegally, those who work are entitled to be paid for their labor and overtime. If they are injured on the job, they are eligible for workers' compensation coverage, said [Diego] Low, [director of the MetroWest Immigrant Worker Center] who has been advocating for immigrant workers' rights for the last 25 years.

•    A DMI Blog posting points to an extremely upsetting Associated Press report of a beating in a Pennsylvania town that left a 25 year old Mexican immigrant named Luis Ramirez dead.   

Hate crime or not, the killing has exposed long-simmering tensions in Shenandoah, a blue-collar town of 5,000 about 80 miles northwest of Philadelphia that has a growing number of Hispanic residents drawn by jobs in factories and farm fields.

Lack of Basic Care Leads to Death at Brooklyn Hospital

On June 18, 49-year-old Esmin Green was admitted to the Kings County Hospital Center psychiatric ward.  After waiting to be seen for 24 hours, she fell to the floor, began to convulse and then passed out.  Two security guards and one doctor walked into the waiting room, looked at her and then walked away.  After one hour, a nurse finally came over, kicked Ms. Green, and then proceeded to get a stretcher.  Shortly afterwards, Ms. Green was pronounced dead.  The entire incident was documented on a security camera, and is now on YouTube, thanks to the Associated Press.

Hospital officials said they fired three of the workers and suspended another three, the New York Times reported on July 7.  However, it is clear that Ms. Greene’s death is far from an isolated incident at Kings County Hospital.  The New York Civil Liberties Union, in conjunction with Mental Hygiene Legal Service and the law firm of Kirkland & Ellis LLP, filed suit against the New York City Health and Hospitals Corporation (the agency that runs Kings County Hospital) in May 2007.  The plaintiffs claimed that patients at the hospital’s psychiatric facilities were subject to conditions of squalor and filth, as well as abuse by hospital employees.  A summary of the case can be found on the NYCLU website. 

Monday Health Blog Roundup

•    This past week there have been a number of news articles on HIV and the racial disparities among those who are infected.  The Washington Post reported that the number of young homosexual men diagnosed with HIV has risen 12%.  The largest increase of 15% was among young African American men (compared to a 9% increase among young white men):

Previous studies have found that gay black men on average have fewer sex partners, are less likely to use drugs and are no more likely to have unprotected intercourse than gay white men. Consequently, their higher rate of infection does not appear to arise from riskier behavior.

Instead, it reflects the higher prevalence of HIV -- as well as syphilis and gonorrhea, which increase a person's susceptibility to HIV -- in the black population.

Despite this negative news of increasing health disparities between whites and African Americans, there was also a positive step in the battle against HIV.  According to the New York Times, the New York City Health Department has announced a three year plan to give an HIV test to everyone living in the Bronx:

While Manhattan has long been the epicenter of the AIDS epidemic in New York, with the highest incidence of both AIDS and H.I.V., the virus that causes it, the Bronx, with its poorer population, has far more deaths from the disease. Public health officials attribute this to people not getting tested until it is too late to treat the virus effectively, thus turning a disease that can now be managed with medication into a death sentence.

Though the story does not mention the demographic population of the Bronx, 35.6% of Bronx residents are African American, a much larger percentage than the percentage of African American Manhattanites (who make up only 17.4% of the borough’s population).  Expanding HIV testing in the Bronx is an important part of combating the racial disparities among those with HIV and helping end the upward trend of HIV rates among young African Americans. 

•    The Kaiser Health Disparities Report has a story on a House bill to reduce allowable lead levels in paint.  The bill, which just unanimously passed the House Financial Services Committee, aims to lower the number of children exposed to lead-based paint (many of whom are poor, minority children who live in older homes):

According to bill sponsor Rep. Keith Ellison (D-Minn.) and other lawmakers, despite a 1992 law that restricted the use of lead-based paint in houses, hundreds of thousands of children are exposed to excessive levels of lead, which can cause brain damage and other serious health problems.

•    The HealthBeat blog has a posting on how progressives should incorporate cost control into their discussion of health care reform.  Without cost control on the agenda of health care reform, it will be difficult to bring Americans who are most concerned with rising costs of health care on board:

That is why I believe that progressives must begin talking about the high cost of care, and how we need to wring the waste out of the system to make truly effective, high quality care affordable for everyone. Don’t let the conservatives dominate the debate about spending. If they do, they’ll take the conversation in the wrong direction.

The Opportunity Agenda believes that addressing the issue of cost is crucial to a fruitful, productive discussion on health care reform. For example, 52% of American workers do not enroll in employer insurance plans because they are too costly.  Premiums for family coverage have increased by 59% since 2000.  Decreasing these costs, in addition to addressing the problems of unequal access and unequal quality, is absolutely necessary in order to reform the health care system in the U.S.  To learn more, take a look at The Opportunity Agenda fact sheet, Health Care and Opportunity.

•    For a touch of humor, check out a recent posting on Disease Management Care Blog.  Along with a YouTube video of Canned Heat’s “Let’s Work Together” there are new lyrics encouraging all to work together to reform health care in the U.S.:

Together we'll stand
Divided we'll fall
we need more data
the… cash flows will stall
let’s work together
Come on, come on
let’s work together
Now now people….
Because together we will stand
Every doc, all the vendors and Plans!...

Six Years Later, Health Disparities by Race and Ethnicity Persist

Amidst the energy and momentum for health care reform in the United States, it is important to remember that getting an insurance card into everyone's wallet is not the same as guaranteeing equal access to quality health care.  Recent studies have shown that, in America, health is not just about having insurance or paying bills: it's also, unfortunately, about the color of your skin.

The Lancet, a journal of global medicine, published an article this last Saturday (free registration required) on persisting racial and ethnic disparities in health, six years following the groundbreaking Institute of Medicine study, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care.  The Opportunity Agenda Research Director and primary editor of the 2002 IOM study, Brian Smedley, is quoted in the Lancet article:

“As the report's study director, I was pleased to see that Unequal Treatment prompted a sober discussion in health policy, academic, and political circles”, Brian Smedley, former senior programme officer at the US Institute of Medicine, wrote in a blog to mark the latest issue of the journal Health Affairs, which includes research on health disparities. “But ultimately the report failed to prompt passage of significant new federal legislation or spur the Department of Health and Human Services to adopt its core recommendations. As a result, little has been done, in my view, to systematically address the problem.”

Citing some of the papers in the latest issue of Health Affairs, called Disparities: Expanding the Focus [paid subscription required], he said that some of the most shocking health care gaps that were not documented when Unequal Treatment was published, were found in mental and oral health care. Meanwhile, the biggest gains in life expectancy occurred among the best-educated Americans.

Because of the failure of HHS to adopt recommendations to reduce disparities, and the stalling of major legislation in Congress to address disparities, many of the inequities identified half a dozen years ago are still prevalent.  In very real terms, this means that communities that often have the most need for quality health care are the ones that receive the least of such care. 

"Brave New Laws" by Alan Jenkins at OurFuture.org

Check out The Opportunity Agenda Executive Director Alan Jenkins' new column, "Brave New Laws," at the Campaign for America's Future blog, Blog for Our Future.  Jenkins discusses the need for new, proactive laws that recognize what technological advances and scientific research have clearly demonstrated--that many Americans are still at risk of discrimination:

A growing body of research shows that, while old fashioned bigotry has declined, subconscious stereotypes and implicit biases continue to pose daunting barriers to equal treatment in health care, education, and the criminal justice system, among other sectors. Particularly compelling is the work of Harvard’s Project Implicit (https://implicit.harvard.edu/implicit/), which shows that we all carry around subconscious biases based on race, gender, religion, and other human characteristics that often influence our decisionmaking. The Institute of Medicine at the National Academies, among others, has found that such biases can influence health care and other decisions, including by professionals who have no conscious intention to discriminate.

Despite this established research, the courts have interpreted the Constitution’s Equal Protection Clause, as well as Title VI of the Civil Rights Act of 1964 (which bars racial discrimination in federally funded programs), to address only intentional efforts to harm people of a particular group. Because that reading fails to respond to the realities of modern exclusion, Congress should amend Title VI, and the next Administration should advocate a reading of the Constitution that embodies the Framers’ intention to eradicate discrimination, in its evolving forms, from our nation’s institutions.

Read the full column here.

Disappearing Food

Rising rents are not only displacing New York residents but their food as well.  As the New York Times reports, the city of eight million now has just over 550 moderately sized supermarkets, defined as at least 10,000 square feet.

The dearth of easily available fresh food isn't confined to poor communities but these areas are disproportionately affected.  A Health Department study from last year specifically compared the Upper East Side with Harlem finding a vast disparity in access to healthy foods.  Harlem has twice as many bodegas, or corner stores, than the Upper East Side but these stores typically offer less healthy food.  Only three percent of Harlem bodegas even sell leafy green vegetables.  Expanding to other food options, 16 percent of Harlem restaurants serve fast food compared to only four percent on the Upper East Side.

Predictably, the result is Harlem residents are three to four times as likely to be obese or have diabetes.  Yesterday's NYT article features an excellent citywide map (see below) showing the correlation of low supermarket density and incidences of diabetes.  Pay particular attention to the Bronx and the intersection of Queens and Brooklyn.

Speaking English: A Benefit, Not a Mandate

• Immigration News Daily has posted a couple articles related to the US as an English-speaking country. In Philadelphia, a well-known cheese steak restaurant is under review by the city's human rights commission for a sign that says "This is America - when ordering, please speak English." City officials are alleging that the sign violates the ban on national origin discrimination. On the other end, the blog has reported on an opinion in Newsday which argues that Immigrants would thrive with more English classes. The piece talks about the shortage of English classes on Long Island while also explaining how poor language skills have prevented immigrants from continuing to work in their previous professional careers:

Plenty of anecdotal evidence shows that these programs work. Two years ago, for example, a Peruvian-born former computer programmer was stuck on the assembly line at Love and Quiches Desserts, a Freeport-based manufacturer. After he completed Freeport Adult Education's ESOL program, he was promoted to supervisor.

In the Long Beach school district, several women from Central America who were dentists in their home countries but worked in dead-end jobs here boosted their English and found jobs as dental hygienists.

Author Tara Colton makes a case for government investment in the productivity of immigrants via language classes, noting that this strategy enjoys bipartisan support:  

This is a crucial problem, because the more fluent immigrants are in English, the more they can contribute positively to society. This is a point that all sides of the immigration debate agree on. Making this improvement in the lives of millions of people living and working here has got to be as vital as deciding whether to punish them for how they arrived.    

For business and government, it's also a matter of economic development. Boosting workers' English skills improves productivity, reduces turnover and helps growth.

• Immigration Orange posted about the 'widow penalty' which ends the permanent residency process for immigrants whose citizen spouse dies within two years of marriage. The blog recommends contacting your public officials in order to end this "obscure interpretation of the Immigration and Nationality Act (INA)," examples of which are quoted in the post:

Marlin Coats didn't hesitate to jump in the water to try to save two drowning teens caught in a riptide at San Francisco Beach Park. He lost his life that Mother's Day in 2006, but because of his heroism those two teenagers survived.  So why is the U.S. now responding to Coats' ultimate sacrifice by deporting his wife Jacqueline Coats?

U.S. Army contractor Todd Engstrom of Illinois gave his life for his country when he was killed in Iraq, and now the federal government is telling his wife Diana she too must go. And so must Dahianna Heard of Florida, whose husband Jeffrey Heard was shot in the head by insurgents in Iraq. What will happen to their children?

• The 'Just News' blog reposted an article from the Omaha World-Herald about a family divided by US immigration policy. Joe Wood of Nebraska had decided it was time to 'do the right thing' and legalize his wife Laura Roldan's immigration status, so he, Roldan and their two daughters traveled to a US Consulate in Mexico to begin the process.  However, Roldan has been accused of fraud for giving a false name upon her entry in 2001, and barred from ever returning to the US.

• Last up, it has recently come to the ImmigrationProf blog's attention that all four grandparents of Republican Presidential Candidate Tom Tancredo were immigrants from Italy. Author KJ links to a great article in Reason Magazine about the discrimination faced by Italian immigrants in the early 20th Century, along with how, in two generations, the American Dream has brought Tancredo to a place where he has internalized the same distaste for foreigners.

President Bush Vetoes SCHIP, Again

• The Huffington Post has linked to an article noting that President Bush has used the seventh veto of his administration in order to reject the revised version of a bill seeking to expand health insurance coverage for children.

• Meanwhile, the New York state assembly is considering a plan to extend health care to all New Yorkers. The DMI Blog summarizes the proposed legislation:

In New York State, Child Health Plus and Family Health Plus are pretty good programs. They allow participants to choose from a variety of managed care plans that contract with the state to provide coverage. Families making up to 150 percent of the poverty line pay no premiums and there are no deductibles and few co-payments. Despite the fact that people enrolled in these programs tend to be less healthy than those enrolled in commercial plans, the premiums the state pays are much lower and have remained virtually flat even as the cost of private insurance has skyrocketed.

So why don’t we open these successful state program to every New Yorker, regardless of income?

That simple idea is the basis of New York Health Plus, a new universal health care proposal from Dick Gottfried, Chair of the NYS Assembly Health Committee.

Under Gottfried’s plan, any New Yorker could get free health coverage from the state, and have their pick of the plans contracting with the state. Everyone would also be free to opt out and keep paying for their own private health care coverage. Businesses would no longer have the burden of employee health care costs. The more than 2 million uninsured New Yorkers would face no barriers to coverage. Gottfried also argues that plans under New York Health Plus would have incentives to offer higher quality care more preventive services, providing a better choice for New Yorkers who already have insurance too.

• The ImmigrationProf Blog has posted a piece entitled 'Another Slavery Report: Yawn?' which begins: "We have reported so much on slavery lately (here and here) that  we may have to give up on such reports as newsworthy." However, the Naples Daily News has just reported that a Florida family has been charged with forcibly holding 15 undocumented workers on their property and charging them for basic needs such as food and showers.  That these cases are increasingly reported on is further indication of the need for comprehensive immigration reform. Our broken immigration system is fostering abusive work situations that contradict the values of mobility, equality and security for which our nation stands.

• The 'Just News' blog has posted another article on the University of Texas Law School Immigration Clinic. Advocates from the clinic have just filed complaints with the Office of Civil Rights and Civil Liberties at the Department of Homeland Security as well as the Texas Department of Protective Services in the case of an eight-year-old girl held at nearby Hutto detention center who was separated from her pregnant mother for four days. While keeping immigrant children in detention centers is a human rights violation in and of itself, removing the child from her mother went against ICE guildelines, according to the Houston Chronicle:

"ICE officials have previously said detaining families at the facility is meant to help "children remain with parents, their best caregivers" while they are processed for deportation. They also told the Texas Department of Family and Protective Services that parents would be at the facility with their children and would be responsible for their care, so state regulation wasn't needed."

 

Defending the Human Rights of Immigrants

• As the Immigration and Customs Enforcement (ICE) is boasting more than 30,000 immigrant arrests this fiscal year, double that of last year, many Americans are coming to the aid of their undocumented neighbors.

• The ImmigrationProf Blog has written about a new coalition of lawyers from big firms who will work to defend the constitutional rights -- or human rights -- of all people:

According to NBC11.com, dozens of attorneys from powerful law firms have united to create a task force that will come to the aid of undocumented immigrants. 60 attorneys from 14 law firms have said they will face the government head-on -- challenging the legality of Immigration and Customs Enforcement (ICE) raids. The list of law firms includes Dechert LLP, Wilson Sonsini, Skadden-Arps and Orrick, Herrington & Suttcliffe. The legal plan called for the lawyers to vigorously defend the constitutional rights of all people, including undocumented immigrants. Andrew Thomases said Dechert LLP, which represents Yahoo, and the other law firms would represent undocumented immigrants for free.

Mark Silverman is with the Immigrant Legal Resource Center in San Francisco, which is working with the attorneys involved in the task force. "We are not trying to make ICE's job difficult," Silverman said. "We just want ICE to do their job by conforming to the U.S. Constitution."

• Similarly, the 'Just News' blog has shared a New York Times article about a new plan by the Manhattan District Attorney's office to create an 'Immigrant Affairs' program to "encourage immigrants who are crime victims or are aware of illegal activity to come forward without fear of arrest and deportation."

• Latina Lista has blogged about a toy drive underway to provide some holiday cheer for the children living in the ICE detention center in Hutto, Texas. Students from the University of Texas Immigration Law clinic have organized the drive and will be delivering the toys this coming Saturday.

• Last but not least, the Immigration Equality blog has been talking about the impact of the Department of Homeland Security's new travel restrictions on people who are HIV-positive. At a press conference held two days ago, Immigration Equality discussed tangible ways in which these government policies will work to needlessly discriminate against people with HIV:

"We are hearing from three people affected by the ban:

• Augustin Dussault, a Canadian barred from entering the country even to visit his husband in the hospital;
• Lillian Mworeko, a Ugandan AIDS professional who cannot visit the US for training or conferences; and
• Bernard Cazaban, a Frenchman who was kicked out of the US 15 years ago on the eve of getting his green card.

We will also be joined by Susannah Sirkin from Physicians for Human Rights, as well as our own Victoria Neilson.

• The first thing that strikes you about the press conference is that we had to hold it by telephone, since the people most affected by the ban can’t be here, by definition.
  Susannah points out what a waste it is for the US to lead in global AIDS funding while continuing to perpetuate AIDS stigma. 'There is absolutely no public health interest served by imposing travel restrictions on people with HIV/AIDS . . . It cannot be transmitted by casual contact.' What year is it that we have to continue to point that out? These policies fuel the stigma that discourages people from seeking treatment . . .'
• David and Augustin, the American/Canadian couple who now live in Canada because they cannot live together in the U.S., make the point that people from countries with national health insurance cannot by definition prove they have 'private health insurance,' which the new regs require."