You’ve got to admire the conservative echo chamber. In the shadow of a financial meltdown that McCain and Obama both (correctly) agree stemmed largely from a lack of governmental oversight of irresponsible corporate behavior, conservative spinmeisters are blaming the meltdown on too many loans to minorities, the Community Reinvestment Act, and the heavy hand of…wait for it…community organizers.
Read the entire post on BlogForOurFuture.
Taking another look at "New Progressive Voices," a collection of essays outlining a new long-term, progressive vision for America, today we turn to our Executive Director, Alan Jenkins', contribution.
The piece paints a bleak picture. Alan outlines many of the problems facing regular Americans today. Many people are having trouble getting a job that pays a living wage, paying for health care, and getting their children into quality schools. Tying this together with the present high rates of incarceration, all signs point to a general lack of opportunity in America.
In keeping with goals of this essay collection Alan's essay, "The Promise of Opportunity," strives to give concrete solutions to these communal ills. Alan's essay suggests making "opportunity" a metric by which to consider the viability of federal programs.
As with the environmental impact statements currently required under the National Environmental Policy Act, the relevant agency would require the submission of information and collect and analyze relevant data to determine the positive and negative impacts of the proposed federally funded project. Here, however, the inquiry would focus on the ways in which the project would expand or constrict opportunity in affected geographic areas and whether the project would promote equal opportunity or deepen patterns of inequality.
While the measures of opportunity would differ in different circumstances, the inquiry would typically include whether the project would create or eliminate jobs, expand or constrict access to health care services, schools, and nutritious food stores, foster or extinguish affordable housing and small business development. At the same time, [these Opportunity Impact Statements (OIS)] would assess the equity of the project's burdens and benefits, such as whether it would serve a diversity of underserved populations, create jobs accessible to the affected regions, serve diverse linguistic and cultural communities, balance necessary health and safety burdens fairly across neighborhoods, and foster integration over segregation.
To read the full article, click here.
The Opportunity Agenda is pleased to help announce, on behalf of the Progressive Ideas Network, the release of a new collection of essays outlining a new long-term vision for America.
"New Progressive Voices: Values and Policy for the 21st Century" brings together leaders from a wide array of organizations, of different backgrounds, to present a bold, progressive agenda for America's future. Integral to the project is a commitment, not to just presenting a new direction, but also realistic approaches to solving our collective problems.
From the collection's introduction:
In recent decades, progressivism has faltered. It was conservatives who developed and moved the big ideas, while progressives triangulated, tweaked, and tinkered. Since the 1960s, progressives have been running on the fumes of the New Deal and Great Society, confining themselves largely to narrow issue silos and poll-tested phrases and positions. Content to play defense in many of the major political battles of the day, they have all too often been cowed into submission by the vitality and confidence of the other side.
Now that is changing. Instead of obsessing about what we are against, progressives have begun to think about what we're for -- to prepare once again to play our role as agents of bold ideas and political and social transformation. Finding new confidence and imagination, we have begun to renew our intellectual capital. The essays in this volume draw on that new store of capital to sketch the outlines of a progressive agenda for 21st-century America.
Our own Executive Director, Alan Jenkins, contributed an essay to the collection. You can read "The Promise of Opportunity" here.
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.
• This past week there have been a number of news articles about the Black AIDS Institute study on the racial disparities among those living with HIV/AIDS in the United States. The New York Times pointed to the part of the study that said that if one only counted the African American population in the U.S., the country would have the 16th highest rate of people with AIDS:
Nearly 600,000 African-Americans are living with H.I.V., the virus that causes AIDS, and up to 30,000 are becoming infected each year. When adjusted for age, their death rate is two and a half times that of infected whites, the report said. Partly as a result, the hypothetical nation of black America would rank below 104 other countries in life expectancy.
The Washington Post's coverage of the study focused on the Institute’s criticism of the federal government’s approach to addressing the AIDS crisis in black communities:
African Americans with HIV -- at least 500,000 -- are more numerous than in seven of the 15 "target countries" in the Bush administration's global AIDS initiative, which has spent about $19 billion overseas in the past five years.
A DMI Blog posting last Thursday also discussed the study and questioned whether the next President would choose to focus on tackling racial disparities in the American HIV/AIDS population, or would continue to ignore the issue:
The bottom line is that the HIV epidemic in the US continues to spread, and at a rate greater than was previously thought. The real measure of political leaders and the American people is if this bad news spurs good action – the establishment of a comprehensive and accountable national AIDS strategy that will eliminate barriers to effective prevention, generate adequate resources, and hold the government accountable for ending this epidemic.
The Black AIDS Institute study can be accessed here. To learn more about the general prevalence of health disparities in the U.S., read The Opportunity Agenda fact sheet Healthcare and Opportunity.
• The Kaiser Health Disparities Report has pointed out that new data from the Centers for Disease Control and Prevention shows the presence of racial disparities in the current U.S. infant mortality rates. According to the new data, black infants are 2.4 times more likely to die before they turn one year old than white infants are:
CDC officials say the higher rates in large part can be attributed to low birthweights, shorter gestation periods and premature births. Experts say that it is difficult to identify a link between race and higher infant mortality but noted that higher rates of poverty, limited access to health care and dietary differences are possible contributors.
• An editorial in last week’s Los Angeles Times discusses how rising food prices are actually likely to increase obesity rates in the U.S., not decrease them. In many other parts of the world, an increase in food prices leads to an increase in rates of hunger (not obesity). However, the article points out that obesity has a lot to do with the type of food people consume, not just the amount:
Obesity isn't simply about too much food. It's about the type of food, how it's prepared and the balance of calorie intake with physical activity. Stress and social conditions can also play a role.
Obesity rates have long been more prevalent in poor communities in the U.S. - the article also points out that the states that have the highest rates of obesity also have the highest proportion of families living in poverty. People living in poor communities, particularly poor communities of color, must have access to healthy food in order to prevent these health disparities from becoming more extreme. To learn more about inadequate health care access in communities of color, read the CERD report to the UN, Unequal Health Outcomes in the United States.
• An essay in The New York Times discusses how the American Medical Association’s apology for its past racism towards black physicians and patients brought to light the historical split between the AMA and the National Medical Association, a group that represents black physicians. The essay pointed out that while last month’s apology was an important step in bridging the gap between the two organizations, more needs to be done to overcome the inadequate representation of black physicians in the medical profession:
Yet reminders of this rancorous history persist, and the A.M.A.’s apology remains pertinent, if long overdue. Consider this statistic: In 1910, when Abraham Flexner published his report on medical education, African-Americans made up 2.5 percent of the number of physicians in the United States. Today, they make up 2.2 percent.
• In the past week, there have been numerous reports that call attention to the disparities among those living with HIV/AIDS in the U.S. The Kaiser Health Disparities Report has linked to a CBS Evening News story on the disproportionate number of African Americans that have HIV or AIDS. According to the story, blacks account for 49% of new HIV diagnoses, 69% of AIDS cases among ages 13 to 19 and 56% of AIDS cases among ages 20-24. Despite these high percentages, blacks only make up 13% of the population:
"No matter how you look at it through the lens of gender or sexual orientation or age or socioeconomic class or level of education or region of the country where you live, black folks bear the brunt of the AIDS epidemic in this country," Phill Wilson, founder of the Black AIDS Institute, said. Wilson added that early HIV/AIDS advocates did not send the right HIV prevention and education messages to the black community. "The mischaracterization of the epidemic in the early days ... made black folks think we didn't have to pay attention to the disease," Wilson said.
• Rates of HIV/AIDS are not only disproportionate in African American communities – The Washington Post is reporting that Hispanics represent 22% of new HIV/AIDS diagnoses, despite only making up 14% of the population. While the Post notes that HIV rates are highest among blacks, it also claims it is harder to target enough resources towards Latinos, particularly those who are immigrants, who have been diagnosed with HIV:
Blacks still have the highest HIV rates in the country, but language difficulties, cultural barriers and, in many cases, issues of legal status make the threat in the Hispanic community unique. For those who arrived illegally, in particular, fear of arrest and deportation presents a daunting obstacle to seeking diagnosis and treatment.
• On a more positive note, the Senate passed a bill that calls for a reauthorization of federal funding for a program that supports community health centers, the Deseret News reported last Tuesday. The bill, sponsored by Senator Ted Kennedy (D-Mass.) and Senator Orrin Hatch (R-Utah), allows for continued support for health centers that provide affordable and quality care for many Americans, particularly those with low income:
Hatch said that since 2001, increased funding has enabled community health centers to treat 4 million new patients in more than 750 communities across the nation. His bill reauthorizes funding for the program for five more years.
• State governments were also discussing implementing health care measures this past week – in Massachusetts, the Council on Racial and Ethnic Health Disparities, chaired by State Senator Dianne Wilkerson and State Representative Byron Rushing, met on July 21 to discuss the recommendations of the Special Legislative Commission on Health Disparities. According to A Healthy Blog, the Council discussed various successes and failures in the state's health care reform:
The presenters all pointed to the success of health care access expansion in Massachusetts as an important step in disparities elimination efforts, but also noted the need to continue working to address quality, cultural competence, and social context problems.
• According to The Health Care Blog, The Century Foundation has announced that it is creating a working group to establish a blueprint for Medicare reform. Maggie Mehar, author of HealthBeat Blog, will direct the group and plans to review issues such as:
Revising Medicare’s physician fee schedule to pay more for primary care, palliative care, and co-ordination and management of chronic diseases.
Rethinking Medicare’s fee-for-service system to reward doctors for quality, not volume.
Creating an independent Comparative Effectiveness Institute that reviews head-to-head testing of drugs, devices, and procedures to ensure that they are effective.
Identifying and rewarding hospitals that provide better outcomes and higher patient satisfaction at a lower cost while helping other hospitals meet benchmarks.
• The New York Times is reporting that a recent study of the American health care system, conducted by the Commonwealth Fund, has found that while the U.S. has the most expensive health system in the world, the quality it delivers is grossly inferior to other industrialized nations’ health care. The report highlighted the fact that many of the improvements made in the U.S. health care system over the years, such as decreasing the number of preventable deaths, dwarfed in comparison to the greater achievements other countries made:
Other countries worked hard to improve, according to the Commonwealth Fund researchers. Britain, for example, focused on steps like improving the performance of individual hospitals that had been the least successful in treating heart disease. The success is related to “really making a government priority to get top-quality care,” [Karen] Davis, [president of the Commonwealth Fund] said.
The report also emphasized the inefficiencies in the U.S. health care system and the role they play in diminishing quality:
The administrative costs of the medical insurance system consume much more of the current health care dollar, about 7.5 percent, than in other countries…
Bringing those administrative costs down to the level of 5 percent or so as in Germany and Switzerland, where private insurers play a significant role, would save an estimated $50 billion a year in the United States, Ms. Davis said.
• An article in Friday’s Washington Post discusses the potential that community health providers have to save states millions of dollars in health care costs by shifting some of their health programs’ emphasis to preventing illness. A recent Trust for America’s Health report found that nonprofit community programs could have an enormous role in developing health initiatives such as anti-smoking laws, healthy eating and physical activity programs. However, despite the fact that many of these programs target at risk groups in impoverished areas, they face a serious lack of funding:
The researchers found that many such programs lack funding, a chronic problem for many preventive health initiatives.
"People think preventive health care pays off 20 or 30 years from now, but this shows you get the money back almost immediately, and then the savings grow bigger and bigger," [Senator Tom] Harkin [D-Iowa] said.
To learn more about the importance of community health programs, please see the previous posting on The State of Opportunity titled Local Progress in Tackling Health Disparities.
• An opinion piece in yesterday’s Chicago Tribune calls attention to the health disparities among women with HIV. Black women have higher rates of HIV, despite the fact that studies have shown that they do not engage in “risky sex” any more than white women do:
A black woman in a poor neighborhood, for example, who engages in the lowest levels of risky behavior is dramatically more likely to acquire a sexually transmitted disease than higher-risk women in communities with low rates of infection, according to public health experts…
In short, who you are, and where you live and, consequently, the sexual partners you choose, matters when it comes to HIV prevention.
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.
Continue reading "Lack of Basic Care Leads to Death at Brooklyn Hospital" »
Last Thursday, the American Medical Association issued an official apology for its past racism toward African American patients and physicians. Along with the apology were the findings of a study conducted by the Commission to End Health Care Disparities, a group that the AMA and the National Medical Association (an organization representing black physicians) co-chair. The study has found that between 1846 and the 1960s, the AMA's past transgressions included:
substandard care for black patients or segregated them to black hospitals; a lack of support for black physicians and for the Civil Rights Act; and exclusion of blacks from medical schools, hospital staffs and residency programs.
The apology can be found here, and the study is available in the online version of the Journal of the American Medical Association. To learn more about the work of the Commission to End Health Care Disparities, go to the AMA website.
It is also worth noting that a number of doctors were opposed to the AMA's discriminatory policies in the 1960s. A group of physicians picketed the AMA convention in Atlantic City in 1963 in order to call attention to the AMA's racist acts. Among these physicians was Dr. Robert Smith, a leader of the Medical Committee for Human Rights in Mississippi (MCHR). The MCHR grew out of the Medical Committee for Civil Rights, and organized a number of volunteers to come down to Mississippi to provide care to black patients who were not being treated in their communities:
Though MCHR volunteers were not licensed to practice professionally in Mississippi, they could offer emergency first-aid anywhere and anytime to civil rights workers, community activists, and summer volunteers. Working without pay, they cared for wounded protesters and victims of police and Klan violence, assisted the ill, visited jailed demonstrators, and provided a medical presence in Black communities, some of which had never seen a doctor. They established and staffed health information and pre-natal programs in many Black communities. Appalled at the separate and unequal care provided to Blacks by Mississippi's segregated system, they soon involved themselves in political struggles to open up and improve Mississippi's health care system for all.
The Health Care Blog has a posting that discusses My Health Direct, the web-based solution to overcrowding in emergency departments. The idea of My Health Direct is for hospitals to use an online appointment system to re-route their Medicaid and uninsured patients to community and safety-net clinics. According to the blog posting, the program has been successful in increasing patients' access to primary care and improving the quality of care and treatment outcomes for those patients:
More than 12,000 health appointments have been made with the vast majority of these appointments for patients who are uninsured or enrolled in a Medicaid managed care plan. These appointments were made for patients who either presented for care with a non-emergent condition, or needed follow-up care in a primary care setting.
A utilization review of My Health Directs impact demonstrated that more than 92% of patients who received an appointment did not present to the ED again. Patients who obtained appointments were more than 4 times more likely to actually attend their appointment compared to previous referral efforts from the ED. Lastly, there was a 25% reduction in repeat non-emergent visits of those patients assisted by My Health Direct.
A recent Health Beat blog posting titled "The Realities of Rural Medicine" discusses the unequal access to health care for people who live in rural areas. The study on rural health care, conducted by the Center for Studying Health System Change, found that both patients and doctors feel significant strain in living in communities that do not have enough primary care options.
The Washington Post is reporting that Los Angeles City Councilwoman Jan Perry is trying to limit the prevalence of fast food restaurants in South Central Los Angeles by placing a moratorium on new fast food locations in the area. Perry is a representative for District 9, an overwhelmingly African American and Latino constituency that has significant health disparities in comparison to the wealthier West L.A. area:
Perry quoted research showing that although 16 percent of restaurants in prosperous West L.A. serve fast food, they account for 45 percent in South L.A. Experts see an obvious link to a health department study that found that 29 percent of South-Central children are obese, compared with 23 percent county-wide.
• A recent study has found that black men are more likely than white men and women to be unaware that they are suffering from high blood pressure, according to an article in Wednesday’s Reuters Health. The researchers claim that this disparity stems from the fact that men are less likely than women to believe that they need to see a doctor. Moreover, men, particularly African American men, are less likely to have access to a primary care physician:
What is not good, the researchers say, is that men were less likely than women to have a regular doctor, and they were four to five times more likely to say they had no doctor because they did not need one.
Study participants who did have a regular doctor were nearly four times more likely to know they had high blood pressure, and more than eight times more likely to be taking medication for it.
• The Kaiser Health Disparities Report has linked to a study on the prevalence of asthma that appeared in the Journal of Health and Social Behavior. By looking at 10 different racial and ethnic groups in New York City, researchers examined how housing and neighborhood conditions might contribute to disparities among asthma patients:
Researchers found that Puerto Rican-Americans, other Hispanics and blacks had the highest levels of asthma, while Mexican-Americans, Chinese-Americans and Asian/Indians had the lowest levels. They also found that reducing minorities' exposure to deteriorated housing conditions and increasing levels of community unity, as well making improvements in other household factors, reduce asthma rates among blacks and Puerto Rican-Americans.
• An article in Saturday's New York Times discusses how rising gas prices have led to cuts in various services for the elderly. Agencies have been forced to cut back on many programs, such as Meals on Wheels, because of the rising costs of transportation. Elderly people, particularly those who are homebound, are among those most affected by these cuts, since they rely not only on the programs but on at-home volunteers as well:
Val J. Halamandaris, president of the National Association for Home Care and Hospice, said that rising fuel prices had become a significant burden for the 7,000 agencies represented by his group, with some forced to close and others compelled to shrink their service areas or reduce face-to-face visits with patients. A recent survey by the group concluded that home health and hospice workers drove 4.8 billion miles in 2006 to serve 12 million clients. “If we lose these agencies in rural areas, we’ll never get them back,” Mr. Halamandaris said.
• The Washington Post is reporting that New Jersey is one of the states facing the harshest effects of the health care crisis - hospital closures. New Jersey's state hospitals are required to treat any person that walks through their doors, and in turn the state is supposed to reimburse the hospitals. However, the state’s budget crisis has led to cuts in reimbursements, and ultimately to hospital closures:
Six [hospitals] have closed in the past 18 months, and half of those remaining are operating in the red…
The situation has come to a head in this city [Plainfield, NJ] of 48,000 people -- majority black, largely poor and with many new immigrants moving in. The city's hospital of 130 years, Muhlenberg Regional Medical Center, is slated to become the latest casualty of this faltering system, closing its acute-care facility later this year. The obstetrics and pediatrics wards have already shut, and equipment is being packed up and wheeled out.
New Jersey is not the only state that has a problem of hospital closures. To learn about the extent of the problem of hospital closures in New York, visit The Opportunity Agenda's GoogleMaps mashup site, Health Care That Works.
Recent Comments