ACEs: A Hidden Epidemic

Today’s blog post is written by Christine Cissy White and is a re-post of one originally titled “Boston’s architect of community well-being: Pediatrician Renée Boynton-Jarrett”. The post was first published on February 22, 2016 by ACES Too High News

The Aces movement is filled with pioneers. There are physicians, professors and researchers who treat, teach and study. There are leaders of non-profits who partner with individuals, neighborhoods and organizations. Volunteers who give time. Experts who draw on wisdom gained in academia, clinical practice, community work and personal experience. But rarely does one person do all of these things while parenting three children under the age of thirteen. Read more… 

Our Politics are Killing Us

Today’s blog post is written by Dr. Rajiv Bhatia, a physician, health scientist, Principal of The Civic Engine, and co-founder of HIP. The post was first published on December 18, 2015 by Medium

Doctors train to find the diseases behind the symptoms and signs. But, social diseases, like poverty, are usually hidden behind the ones that afflict our bodies. It’s something that medicine doesn’t often talk about it. And, our politics is what keeps these social diseases alive. Read more… 

Ensuring Development in South LA is Equitable, Sustainable, and Community-Led

Today’s blog post is written by Ramya Sivasubramanian, a Staff Attorney at Environmental Justice in Santa Monica, California. The post was first published on November 30, 2015 by Switchboard, the Natural Resources Defense Council Staff Blog. 

“Development is not for us, unless it is led by us.”

Dawn Phillips of Causa Justa delivered this powerful yet succinct statement at the recent PolicyLink Equity Summit that I attended along with a number of my colleagues and community partners. This statement captures what equitable development ought to be. Yet as simple as it is to articulate, it has proved more challenging to ensure developers and planners alike put it into practice. Read more… 

Development in South LA: A Threat or an Opportunity?

Today’s guest blog is by SAJE Executive Director, Cynthia Strathmann, PhD. In this blog, she writes about the ripple effects of development in South LA and opportunities for change.

It will come as a surprise to absolutely no one that Los Angeles is in the grip of a housing affordability crisis. Studies last year found Los Angeles to be the least affordable city in the country for renters. The average Los Angeles renter spends 47% of their paycheck on rent; to afford the average apartment a worker would have to make $33 an hour. Read more… 

Building Hope with Community: The Right to Affordable Housing in South Central Los Angeles

This week’s blog is a repost from Esperanza Community Housing. The post discusses the right to affordable housing in South Central Los Angeles and preliminary findings from HIP’s HIA on a development in the area

The narrative of South Los Angeles has been one of serial displacement. Community residents, primarily low-income people of color, have systematically been priced out of our homes and neighborhoods to make way for industry and for gentrifying trends. We’ve faced higher rents, skyrocketing property values, and a cost of living that has become unmanageable — even when working multiple jobs. This combination is a result of the city’s poor planning and spot-zoning policies, and the real estate development industry’s unchecked pursuit of profits without consideration of the human cost of housing, health, and security. This has put not only our homes at risk, but also our health, our identities, our livelihoods, and our environment. Read more…

‘New age trade’ could mean rollbacks on public health – what we found from doing an HIA on the proposed TPP in Australia

Today’s guest blog is by Katie Hirono from the Centre for Health Equity Training, Research and Evaluation at UNSW Australia. She is one of the co-authors of an HIA on the Trans Pacific Partnership Agreement (TPP).

Negotiators from the 12 TPP countries are convening this week in Atlanta for attempted last-stage negotiations, with ministers expected to meet from 30th September. Over the past five years, many public figures have commented on the TPP, including Senator Elizabeth Warren, Nobel Laureate economist Joseph Stiglitz, and reputable organisations like Doctors without Borders and the AFL-CIO. As we near the potential conclusion of negotiations, what can we say will be the impacts of this “21st century trade agreement?”

What is the TPP?

The TPP, or Trans Pacific Partnership Agreement, would be the largest free trade agreement (FTA) in the world. It will include 12 Pacific rim nations – Australia, Brunei, Canada, Chile, Japan, Malaysia, Mexico, New Zealand, Peru, Singapore, United States, Vietnam – and will potentially encompass 36% of world gross domestic product. Unlike most ‘old school’ FTAs that set rules related to the import and export of goods between countries, the TPP seeks to standardize domestic rules related to everything from copyright infringement to pharmaceutical patents. It has been argued that the TPP is a mechanism for the U.S. to impose domestic standards and agendas onto other countries. Note the exclusion of China from the current agreement. Once the TPP is finalized, any additional countries that want to join will have to agree to the rules already set in place.

Why should we be concerned?

Despite the broad and far-reaching implications of these trade provisions, the TPP is negotiated without public involvement and draft texts are confidential. Even members of Congress have restricted access to reading the text. Witnessing the effects of other trade agreements, many organisations are concerned with the TPP’s potential effects on health and human rights.

To understand the potential impacts, a team of researchers in Australia conducted a health impact assessment (HIA) on the proposed TPP. Using leaked draft texts, we determined what the potential provisions could be, and then mapped them out onto public health policy scenarios that could be implemented in the future. Keep in mind the TPP will only affect future policies, not ones that already exist. We then looked at how changes to those policies could affect health in Australia, particularly looking at who would be affected most.

Working with a technical and advocacy advisory committee, and knowing that there are no formal channels for the HIA to be supplied to decision makers, we decided to disseminate our findings to advocates who could then use them to inform their efforts.

What did we find?

In a nutshell, we found that the TPP has the potential to harm the health of people in Australia in four areas we looked at: access to medicines, changes to tobacco control policies, changes to alcohol control policies, and the regulation of food labelling.

In the area of medicines, we found that the extensions to monopoly periods which the U.S. is pushing for, would be likely to lead to increased out-of-pocket costs for consumers. This often leads to people taking less of their medication (or not at all) and is associated with higher hospitalizations and declining health, particularly for low income people or people with chronic conditions who are less able to accommodate rising costs.

Although tobacco control is far more advanced in Australia than the U.S., we found that additional policies, such as restrictions to tobacco marketing and regulation of e-cigarettes could be hindered by the TPP. This could happen through TPP provisions that protect intellectual property or protect against barriers to trade. Most concerning is the TPP’s investor state dispute settlement (ISDS) mechanism, which allows foreign companies to sue governments when they feel that their investments have been infringed upon by domestic policy. ISDS has been used to attack public health policy in the past. For example, Philip Morris used the ISDS provision of an investment treaty between Hong Kong and Australia to sue the Australian government over its implementation of tobacco plain packaging. While plain packaging is considered a best practice in tobacco control, Philip Morris’ use of the ISDS clause has cost Australia millions in defending the policy. Although it is extremely unlikely that Philip Morris will win, public health regulations can be put at risk through ISDS. In countries that can’t afford high litigation expenses, even the threat of using ISDS can have a chilling effect in which countries choose not to pursue innovative policies for fear of retribution. This is particularly troubling for populations that have high smoking rates, and that are in need of new and innovative anti-smoking policies.

We also considered how the TPP could impact future alcohol control measures, particularly restrictions on alcohol availability, bans on alcohol advertising, and pregnancy warning labels. We found similarly that TPP provisions may restrict the ability of the Australian Government to implement new alcohol control policies. Rules in the cross-border services chapter may prohibit governments from limiting the number of licensed alcohol outlets per geographic area. The public health evidence clearly shows that when alcohol is more available, people are more likely to drink, and to have higher rates of violent assault, drunk driving, and pedestrian injury. These impacts are particularly relevant to adolescents who have higher rates of risky drinking.

Lastly, front-of-pack nutrition labelling is not mandatory at this stage in Australia. Rather, it relies on industry compliance with a voluntary scheme. TPP provisions could require greater involvement of the processed food industry in policy decision making, which could influence the effectiveness of food labelling systems. Without adherence to best practices in food labelling, it is likely that there will be no change to the current high rates of overweight and obesity in Australia and their associated health effects, which is particularly relevant to low socioeconomic populations who often have high rates of obesity but lower health literacy rates.

While we focused on the particular impacts that could occur in Australia, it is likely that similar impacts, including those we did not assess, could take place in many of the 11 other countries involved, including the U.S.

What can we do about it?

We developed recommendations that could be applied to the current negotiations to avoid the potential harms we identified. For example:

  • The TPP could include strong and clear public health exceptions which would prevent public health policy from being affected by trade concerns. They could also completely exclude harmful and unnecessary provisions like ISDS.
  • HIA should be conducted after the final text is available to fully understand the potential impacts from the trade provisions.
  • To improve the trade negotiating process in general, there should be greater transparency and public involvement, and formal channels for involvement of public health experts. This could include the release of draft texts and publication of the government’s negotiating position on issues of public interest.

Our advocacy partners used the findings and recommendations to put pressure on the political bodies involved in the negotiations. In some ways, we have seen great success from this – with Minister of Trade Andrew Robb refusing to agree to any monopoly extensions for some medications. Yet he still hasn’t ruled out having the ISDS clause apply to Australia.

Although negotiations have gone through 20 rounds, with many claiming to be “the final round,” it behoves us to consider the Atlanta negotiations as a key opportunity to inform the discussion. The U.S. Congress will need to approve the trade agreement once negotiations are final – so make sure you let your congress person know how you feel about the TPP! You can also throw your support towards many of the existing advocacy campaigns that are taking place in the U.S. Or simply read the findings from the full HIA report to keep yourself informed.

The Health Impact Assessment of the TPP was conducted by:

Katie Hirono and Fiona Haigh, Centre for Health Equity Training, Research and Evaluation, UNSW Australia

Deborah Gleeson, School of Psychology and Public Health, La Trobe University

Patrick Harris and Anne Marie Thow, Menzies Centre for Health Policy, University of Sydney

For more information about the TPP HIA in Australia, contact: Katie Hirono (

Climate Action is Health Action: Why Support for California Climate Legislation is Good for Our Health

This week’s blog was originally published by the Public Health Institute (PHI) on August 25, 2015. 

“Amid a historic drought that has been linked to climate change, California’s state legislature is currently considering bills that aim to significantly reduce greenhouse gas emissions in the coming decades. Often considered a bellwether in American politics and a global leader in combating climate change, California’s proposed bills could provide a model for other governing bodies to set similar goals at local, state and international levels. This year, the state’s governor, Jerry Brown, assembled state-level governments from around the world to sign a commitment to match California’s proposed target for reducing emissions. The U.S. government also recently announced a Clean Power Plan that echoes California’s groundbreaking 2006 climate change legislation.” Read more… 

Lead Poisoning and Crime: Why the Pipeline to Prison is Running Dry

In my previous post (Does less lead mean less crime?), I wrote about research showing how the rise and decline in environmental lead levels could account for the bulk of crime trends in the US since the 1940s. (In fact, lead exposure is correlated to crime as far back as the 1870s.)

At the end of my post, I asked about the seemingly growing gap between lead exposure levels and crime rates since the early 2000s. Rick Nevin, a Senior Economist with ICF International and one of the researchers at the forefront of investigating the lead/crime connection, reached out to HIP to address that question and write a guest blog providing more information about his research, how lead exposure is driving the aging of the U.S. prison population, and the implications that may have for the criminal justice system.

At HIP, we are passionate about understanding the complex ways that social, political and economic factors interact with the environment to impact health outcomes, and the relationship between lead exposure and crime is a perfect example of this dynamic. We thank Rick for contributing his time to help us learn more about this phenomenon and sharing his professional and personal perspective on the topic.

Darío Maciel

Rick Nevin is a Senior Economist with ICF International. More information about his research can be found at

I want to thank HIP for this opportunity to present more evidence linking lead exposure and crime trends. The ongoing strength of this relationship has important implications for debates over the death penalty, criminal justice racial disparities, and mass incarceration.

I knew very little about the effects of lead poisoning, or crime data, when I began work in 1994 on an Economic Analysis of lead paint hazard regulations. My initial bias was to doubt that the costs of that regulation were justified by benefits. I was mistaken: costs were far lower than benefits associated with how lead exposure affects IQ, education, and lifetime earnings. My client also mentioned that we didn’t even count crime prevention benefits, suggested by recent research. I was aware of studies showing a strong relationship between lead exposure and leaded gasoline use in the past, and I wondered if there might be a relationship between crime trends and earlier gas lead trends. What I found was a stunning visual fit with a 23-year lag, consistent with early childhood lead exposure affecting the peak age of violent offending.

In 2000, Environmental Research published my first peer-reviewed study on lead exposure and USA violent crime trends. The same journal published my 2007 study on lead exposure and international crime trends, and my 2009 study on lead exposure and education trends. My 2009 study reported related shifts in incarceration rates by age and race, and showed that the lead research literature demonstrates all of the accepted indicators of causation: lead exposure is not just correlated with subsequent trends in intellectual disability, education achievement, and crime rates – lead poisoning caused those societal trends.

I have acknowledged that the strength and consistency of societal impacts from preschool lead exposure sounds like a bad science fiction plot. As an economist, starting out with a healthy skepticism about the costs of lead poisoning prevention, I am also an unlikely advocate for this improbable plotline, but the evidence is overwhelming.

Historic Trends: Dangerous Dust, Delinquency, and Crime
The most pervasive cause of lead poisoning is lead in dust, contaminated by lead in paint and air lead fallout. Lead in dust is ingested via normal hand-to-mouth activity as children learn to crawl. The bloodstream carries lead to the brain where it causes neurodevelopmental damage. Behavioral impacts are most evident after affected children reach adolescence, during another period of rapid brain growth.

Variations in biological vulnerability and lead exposure severity result in different outcomes for individual children, but higher risks of delinquent behavior among youths with preschool lead exposure have been documented by Denno, Needleman, Dietrich, and Wright. My study in 2000 found that homicide rates from 1900-1998 were also largely explained by the use of lead in paint and gasoline from 1879-1977.

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The use of lead paint fell over the 1920s and 1930s but we didn’t ban lead paint until 1978. From the 1940s through the 1980s, average blood lead tracked trends in air lead fallout from leaded gasoline, as lead paint exposure changed slowly with changes in the housing stock. Many children in the 1960s had additive exposure to city air lead and lead paint in old homes, sending “large numbers of comatose and convulsing children” to inner city hospitals. Lead in dust from lead paint in older homes is the main cause of USA preschool lead exposure today.

My 2000 study also found that 90% of violent crime rate variation from the early-1960s to 1998 was explained by earlier lead exposure trends. The time-lag relationship between lead exposure and violent crime has now been confirmed in state and city crime studies. My 2007 study found that lead exposure also explained most of the violent and property crime rate variation across decades in the USA, Britain, Canada, France, Australia, Finland, Italy, West Germany, and New Zealand. The best-fit lag was 18 years for property crime and 23 years for violent crime, consistent with peak ages of offending. In seminal reporting on this issue, Kevin Drum calls this “an astonishing body of evidence. We now have studies at the international level, the national level, the state level, the city level, and even the individual level.”

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Ongoing Trends: Shifts in Arrests and Incarceration by Age

The crime decline in recent years has been slower than the earlier decline in blood lead because steep arrest rate declines for youths have been partially offset by rising arrest rates for older adults. From 1991-2013, arrest rates for children under 10 fell by 83% for violent crime and 94% for property crime, and juvenile (under 18) arrest rates fell by 63% for violent crime and 71% for property crime, as arrest rates for adults ages 50 and older increased. In absolute terms, the violent crime arrest rate for juveniles was twice the rate for ages 35-49 in 1991, but the juvenile rate was lower in 2013. The property crime arrest rate for children under 10 was about the same as the rate for ages 35-49 in 1991, but the 2013 rate for children under 10 was just 7% of the 2013 rate for ages 35-49. This shift in arrest rates shows ongoing massive declines for youths born across decades of declining lead exposure, smaller arrest rate declines for adults born in the early years of the lead exposure decline, and increasing arrest rates for older adults born when lead exposure was increasing.

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The shift in arrest rates has caused a corresponding shift in prison incarceration. From 2001 to 2013, incarceration rates fell by 59% for males ages 18-19 and 30% for males in their 20s, but increased 33% for men ages 40-44 and surged 86% for men ages 45-54. Proponents of “tough-on-crime” sentencing credit prison incapacitation for much of the USA crime decline – “when a criminal is locked up, he’s not ransacking your house” – but the largest arrest rate declines have occurred among younger age groups with large contemporaneous incarceration rate declines.

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From 2000 to 2013, there was also a 69% decline in the number of juveniles in adult prisons, and a 46% decline in juveniles placed on probation. Juveniles in local jails also fell 40% from 2000-2014, and the number of youths in residential placement fell 50% from 1999-2013 (juvenile offenders account for 90% of youths in residential placement). The largest percentage declines were recorded by the youngest juveniles, including an 82% decline in the number of children under age 13 in residential placement. Mendel reports that lead exposure can explain juvenile justice trends that cannot be explained by reform efforts or other crime theories.

Ongoing declines in juvenile arrests reflect blood lead declines over the 1990s (the birth years of juveniles in 2007-2013). The percent of children ages 1-5 with blood lead above 5 mcg/dl fell from 31.4% in 1988-1991 to 2.6% in 2007-2010, due to new homes without lead paint, demolition and renovation of old housing, and implementation of the Residential Lead Hazard Reduction Act of 1992 (including regulations that were the subject of my 1990s analysis).

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Future Trends: A Road Less Traveled
Two decades after I first saw the correlation between gasoline lead and crime, the research on this issue is still ignored in many news stories related to lead poisoning. Jim Haner, who wrote extensively about lead poisoning for the Baltimore Sun, was the only reporter who wrote about my study in 2000, just a few years after Freddie Gray was poisoned by lead paint in Baltimore, steering his life toward academic and crime problems shared by many lead poisoning victims. In 2006, John Pekkanen wrote a brilliant story about this issue for Washingtonian magazine, but we are still waiting for an answer to the question posed by his story title: “Why Is Lead Still Poisoning Our Children?”

The “pipeline” to prison has alliterative appeal, but it is a misnomer. There is a road to prison, with signs that some offenders fail to heed. A 1991 prisoner survey found that 80% of inmates had served prior sentences to probation or incarceration, including 40% with prior sentences as juveniles. Another analysis found that prisoners released in 1994 after serving sentences for nonviolent offenses had criminal records that included, on average, 9.3 prior arrests and 4.1 prior convictions. We can disagree about many criminal justice issues, but one thing we know for certain is that very few prisoners made it to age 20 before their first felony arrest. The steep declines in juvenile arrest rates and the age 18-19 incarceration rate ensure that the road to prison will be a road less traveled for many years to come.

The Supreme Court has ruled that the death penalty and life without parole are excessive sanctions for crimes committed by juveniles, citing evidence that “adolescent brains are not yet fully mature in regions and systems related to higher-order executive functions such as impulse control, planning ahead, and risk avoidance”. We now know that preschool lead exposure impairs those specific types of brain development linked to impulse control, planning, and risk avoidance; other research links those specific types of brain impairment to homicide offending; murder trends by city size have tracked lead exposure trends from 1900-2013; and murder arrest rates by race and racial disparities in death penalty sentences have tracked racial disparities in lead poisoning.

From the 1950s through the 1970s, African-Americans were disproportionately exposed to city air lead and lead paint hazards in substandard urban housing. The percent of black preschool children with blood lead over 30 mcg/dl fell from 12% in the late-1970s to less than 1% in the late-1980s, and the black juvenile murder arrest rate then fell by 83% from 1993 to 2003. Black children are still disproportionately exposed to lead contaminated dust in older homes, but the racial disparity in elevated blood lead has narrowed from the late-1980s through 2010.

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There is a stale statistic that one in three black boys will end up in prison at some time in their life, based on an old analysis that assumed arrest and incarceration rates by age and race would remain unchanged at 1991 levels. Criminologists in the early-1990s used that same assumption to forecast a rising violent crime rate, largely based on projected demographic growth in the black juvenile population. Those forecasts were wildly wrong because the assumption about stable black juvenile offending was wrong. From 1991 to 2012, black juvenile arrest rates fell by 59% for violent crimes, 55% for property crimes, and 61% for weapons offenses. From 2001 to 2013, the incarceration rate for black males fell by 43% for ages 25-29, 50% for ages 20-24, and 62% for ages 18-19.

Lead exposure impacts on crime are as global as the rise and fall of leaded gasoline use. My 2007 study found that 80% to 90% of burglary rate variations in Britain, Canada, and Australia through 2002 were explained by earlier trends in lead exposure. The burglary rates in all three nations fell by more than 50% from 2002-2014, tracking earlier lead exposure trends. The title of a 2013 story in The Economist asked: “Where have all the burglars gone?” Now you know. In the future, the road to prison will be less traveled all over the world.

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Education: the Key to Health and Success for Foster Youth

carleneThis week’s post is written by HIP’s Social Media, Research, and Data Collection Summer Intern, Carlene Ervin. She is a sophomore at Yale University and a resident of Oakland, CA. 

Since I was five, my foster mom told me I would go to college. She never went to college herself but she wholeheartedly believed it was the only way to break the cycle of poverty, substance abuse, and violence. She did everything she could to get me there, including enrolling me in a college prep charter school. After a while, I had no doubt I was going to college and no one could stop me. It wasn’t until I was older that I realized my expectations were not common for most foster youth in California.

As an intern at Human Impact Partners, I was excited to see HIP has researched the educational experiences of foster youth. Last year, HIP completed a research project to inform California’s Local Control Funding Formula (LCFF), a 2013 bill that completely overhauled K-12 school funding. LCFF increases funding for all schools, but reserves the biggest funding increases for low-income children, English language learners, and foster youth. According to HIP’s analysis, one in 150 school-aged children in California are currently in foster care. Sixty-seven percent of foster youth are removed from their homes because of neglect, and another 18 percent because of abuse.

Both of my parents struggled with substance abuse and had disabilities that limited job opportunities. When I was placed in foster care at age five, I was old enough to know something was wrong but too young to understand what exactly happened. First, I was placed in two different foster homes within three months. My third foster home became my forever home, the place I still come back to for school breaks.

Once I was finally settled, I learned that I loved learning. School soon became a refuge because I could escape in the process of learning new things. While in school, I had some behavioral issues. And I wasn’t alone: according to HIP’s report, compared to the general population, foster children have more behavior problems, more anxiety/depression disorders, attention problems, and aggressive behaviors.

Foster youth also have higher levels of mental health problems. Early life and chronic stress can lead to mental health disorders and substance abuse. These issues make it harder for many foster youth to thrive in school. One study found that only about a third of teens in foster care graduate from public school, compared to almost 60 percent of their peers.

When I got accepted to Yale University, I couldn’t believe it. I didn’t know many people who attended an Ivy League school. Most foster youth don’t even make it to a four-year university. In general, only 1 in 10 of foster youth attend college and of those, fewer than a third graduate in 4 to 6 years. These statistics are especially troubling because of education’s long-term impacts. People with more education are likely to live longer, have healthier babies and children, have better social networks of support, and earn more money.

Now I see that given my history, I am lucky to value education, and how that benefits my health. Growing up, I always heard stories of former foster youth who ended up in jail or living on the street. Now I see the links between education, health, and quality of life.

Happily, the State of California seems to get this. In recent years California has taken steps to address the education deficits for some of the most vulnerable youth. In addition to the local control funding law, in 2012 California extended foster care to age 21.

Although the LCFF program has had a rocky start, I think it has great potential to help foster youth succeed in school if it provides services such as mentorship and/or counseling. Although these policies are still fairly new, with greater accountability on the state’s part, they can help foster youth have a chance to improve their education and ultimately their health.

What Happens to a Dream Deferred?

This week’s blog is a repost by Rachel Davis of Prevention Institute. She links efforts to prevent injury and death due to violence to many of the policy issues that we research at HIP, including incarceration, economic security, education, and housing policy. The article was originally published by “Nation of Change” on May 27, 2015.  

Earlier this month at the National Forum for Youth Violence Prevention’s fourth summit on preventing violence, Baltimore presented its city-wide blueprint, “B’More for Youth! Building Baltimore’s Cradle to Career Pipeline”. Read more …