Tag Archives: Government

Gratitude for Being Invited into a New Community


Photo from LA convening of incarcerated women and women working in public health.
Charlene Sinclair, Center for Community Change, speaking at A Women’s Gathering on Criminalization and Community Health Inequities.

In mid-September, I attended A Women’s Gathering on Criminalization and Community Health Inequities. The gathering was different in many ways, but one aspect of it really stood out: We were being invited into a community that most of us knew very little about, a community of women who had been incarcerated at some time in their lives.

As Andrea James, founder of Families for Justice as Healing and The National Council of Incarcerated and Formerly Incarcerated Women and Girls (The Council) said, “I am a former lawyer, a community activist, the wife of a man who was incarcerated, an active resident of Roxbury, MA, and a mother. I have a lot of professional and personal experience. But I didn’t become a expert until I was incarcerated.”

Only now am I beginning to understand this reality. For the past two years, I’ve been researching the health and equity impacts of the criminal justice system and working with advocates to create a new system, one that puts health and wellbeing, instead of punishment, at the forefront. Some of the people I collaborated with had been incarcerated, and I felt as if I had some understanding of how the criminal justice system destroys people and families.

But, really, it wasn’t until September 15, 2016—when 30-plus women who had been incarcerated met with about 15 women who worked in the field of public health—that I became more profoundly and intimately connected to those experiences and impacts. The women I met drove home the urgency of needing to work together to create a system of justice that values every life, treats people with dignity, demonstrates compassion, promotes a restorative and rehabilitative approach, creates space for accountability, and improves both health and safety.

And particularly for women and girls.

The reality hit me that, as women, we all have some degree of familiarity with the conditions that led to the women being incarcerated. While I had not had the experience of being incarcerated, I had experience with many of the pre-cursors—and that was a connection I had not made until hearing their stories.

Consider this: No woman is immune to the threat of community violence, oppression, being judged by her looks, being harassed on the street. And so many of us women (1 out of every 3) have been physically, psychologically, or sexually abused. And out of women who become incarcerated, that number is even higher—a recent Vera Institute report showed that 85% of women in jail have been physically or sexually abused.

What I heard from the women who shared their experiences is that these exposures (as we say in public health) —combined with acute and ongoing bias, mistrust, and maltreatment among many government agencies and institutions—led to them making choices that were ultimately criminalized. Behaviors that a more humane society would respond to with an offer of support, healing, and recovery—were instead met with surveillance, arrest, and incarceration in the United States.

But while I felt a connection to those exposures, it became deeply clear that we experienced a different, and unequal, set of outcomes based on things like racism and where you live. My childhood and home life weren’t perfect and I had some of the same teenage behaviors that I heard about in the room. But growing up white, in a suburb, middle class—these worked in my favor. People—rooted in institutions and systems—gave me leeway to make mistakes and gave me second chances. That is what privilege looks like, and that is where much of my experience diverged from the women in the room. Being confronted with that in an honest and face-to-face dialogue was so important to our ability to establish trust and try and build an authentic partnership.

Another thing happened that also stretched my understanding of what it takes to build trust with communities who have experienced significant trauma. The public health women in the room, many of whom work in government, were held responsible and asked to own the fact that we worked in and with institutions that repeatedly harmed, alienated, and failed the formerly incarcerated women throughout their lives. The level of distrust that existed in the room—understandably—was, well, rough. But my level of respect and admiration for every single woman in that room went through the roof after hearing their honesty and their doubts. I had such respect for women who are formerly incarcerated for getting themselves to that room, sharing their stories, calling out institutions for failing them, but also having hope that we can work together. And I had such respect for women in public health who listened with compassion and anger at the stories of women, who were not offended by the call to be accountable for the sins of government, and who eagerly asked “What can we do? To help repair the harm.”

It was a full day. It was a day like no other I have ever had in my 20+ years of public health work. The Women’s Gathering on Criminalization and Community Health Inequities was a beginning and we are now figuring out what we can do together. Lots of ideas emerged: new research and advocacy campaigns, new collaborations and capacity-building efforts, invitations into our institutions to humanize each other. It is on all of us now to continue to build this fledgling trust.

To be explicit about my gratitude: thank you to all the women who attended from The Council, women who are formerly incarcerated but may not be part of The Council, and all the women from the public health institutions. Your open hearts and minds is what made the day such a meaningful experience.

And a special thanks to our Women’s Advisory Team who helped plan the gathering: Jeanne Ayers (Minnesota Department of Health), Solange Gould (California Department of Public Health), Donna Hylton (The Council), Paula Tran Inzeo (University of Wisconsin Extension and THRIVE Wisconsin), Andrea James (Families for Justice as Healing & The Council), Marilyn and Pamela Winn (Women on the Rise & Georgia Racial Justice Action Center)—and especially to Charlene Sinclair, Caitlin Dunklee, and Cindy Eigler from the Center for Community Change for organizing the gathering and including HIP as co-conveners. Thank you all!


Group photo
Group photo at A Women’s Gathering on Criminalization and Community Health Inequities

The Long Road Home: Decreasing Barriers to Public Housing for People with Criminal Records

For individuals with a criminal history, finding affordable and stable housing becomes extremely difficult in a place like the Bay Area, with high cost and limited supply. People with a criminal history can legally be excluded from housing. In a survey from the 2015 Ella Baker Center for Human Rights and Forward Together report, “Who Pays? The True Cost of Incarceration on Families,” 79% of people who had been incarcerated were either ineligible or denied public housing as a result of criminal history. More than half of those released from jail or prison have unstable or nonexistent housing.

Safe and affordable housing is a fundamental basis for success in all areas of life, and without stable housing, an individual’s health, employment and education opportunities, family reunification and social networks are compromised. In Alameda County, California, nearly 20,000 people are at risk of residential instability because of having a recent criminal history.

Having housing improves health directly and indirectly, decreases recidivism, improves the chance of becoming employed and having more income, and helps with family reunification. These factors, known in public health as the social determinants of health, create opportunities to succeed and are known to be important for health and wellbeing. For example:

  • Moving often affects recidivism. The odds of recidivism increase by at least 70% for every time someone who is formerly incarcerated changes their residence.
  • Six randomized control trials analyzed supported employment in public housing against other approaches to help residents find jobs, and found 58% of public housing program participants obtained employment compared to 21% in the control group.
  • More than 70% of those leaving prison indicated that family is an important factor in keeping them out of prison, and up to 82% of people leaving prison or jail expect to live with or get help from their families.
  • Having stable housing upon leaving jail or prison decreases a person’s chance of having their probation revoked.

It’s clear from the research; the lack of stable and affordable housing forces families to frequently move and live in unhealthy and crowded environments, increases stress and depression, and can lead to homelessness. Homelessness brings higher rates of infectious diseases; substance use and mental health disorders; exposure to violence; overexposure to cold and rain; and suicide. Studies show that 25% to 50% of people who are homeless have histories of involvement with the criminal justice system.

Public housing admissions screening policies play an important role in creating the conditions for successful reentry of people who were incarcerated. HIP recently released a report called, “The Long Road Home: Decreasing Barriers to Public Housing for People with Criminal Records” done in partnership with Ella Baker Center for Human Rights (EBC). I worked closely with EBC staff starting in September 2015 to complete this Health Impact Assessment (HIA), as part of my Health & Equity Fellowship with HIP. We studied the Oakland Housing Authority (OHA) as a case study to understand the impacts of screening policies on health.

To fully understand OHA’s admission and screening policies, HIP met with two staff from their office. We learned that OHA denials due to a criminal history in the first round of screening have decreased significantly from 12% to 0.8% between 2010 and 2012. Of those who were screened out by OHA due to a criminal history, 75% request an informal hearing, and 64% of those have the decision reversed, allowing them to continue on in the application process. This is a powerful statement for the presentation of mitigating circumstances; at OHA, when people are allowed to tell their story and present supporting documentation, it often results in a reversal. We know that historical policies have created racial inequities in housing and health outcomes. However, data on race and ethnicity is not being recorded or reported, making it impossible in OHA’s case to analyze inequities in screening practices.

While more people with criminal histories are able to move forward in the screening process when OHA allows them to present mitigating evidence, there are additional changes OHA and other public housing authorities can make to improve housing stability for individuals with criminal history:

  • Allow mitigating circumstances to be presented in the initial application for public housing
  • Ensure proper implementation of policies that allow individuals with criminal history to join their family in public housing, and eliminate any practices of evicting existing residents from public housing for allowing a family member returning from prison or jail or denying admission if there is no valid reason for doing so
  • Collect, track, and publicly report the race and ethnicity of applicants and those screened out due to their criminal history to examine the potential impact of screening policies on people of color with a criminal history

Read more of the findings & recommendations in the full report.

Public Health Advocates – Stop Waiting for Evidence about Gun Control!

In public health, especially government-run public health departments, we often debate whether there is “enough” evidence, or whether the evidence is “robust” enough, to justify speaking out and becoming an advocate on a particular issue. A bill in the California legislature right now would fund a Gun Violence Research Center at University of California at Davis if passed – a welcome addition. However, pioneering researchers have already provided scientific evidence that indicate there is no reason for public health practitioners to tiptoe around this issue.

Guns lead to death and injury. You don’t need a study to know this. There is a mantra that the National Rifle Association perpetuates, that even Michelle Obama has echoed, that there are instances in which it is justified for someone to own a gun to make the gun owner safer.

Well, owning a gun is dangerous and does not make you safer. It actually increases the chance that the gun owner or a family member will die or be injured (see links to that evidence below), and the number of guns per capita in a country is a predictor for the number of firearm-related deaths. And despite a ban that muzzled the Centers for Disease Control and Prevention (CDC) from doing research on guns (which was lifted in 2013 but not funded), academics have been doing the very difficult work of studying the impact of owning guns and policies and practices that limit or ease gun ownership.

The increase in risk of gun owners being injured or killed – compared to people who do not own guns – has been proven in several epidemiological studies that control for factors that might make gun owners at higher risk, such as area levels of violence, unemployment, urbanization and other factors. Some studies looked at keeping guns in the home, and found the same results: a higher risk of being harmed by guns among those who own guns. Yet the NRA’s claim is that any law to make restrict gun access will hamper the ability of law-abiding citizens from owning a gun. And Americans, despite the evidence, believe it.

I’m just going to say it again, though: By owning a gun, you are 4.5 more likely to be shot by a gun. And every single case-control study conducted has found that gun ownership is a strong risk factor for suicide. In fact, more than 60% of the firearm-related deaths are suicides.

A recent HIP study considered the health impacts of police purchasing “smart guns”, which only operate when activated by a biomarker (such as a fingerprint) of the owner. The study showed that between one-third to over one-half of the deaths by firearm could be prevented – this is homicides and suicides, and includes deaths from guns shot by children, by those who steal legally purchased guns, and guns taken from police. Based on 2013 deaths by firearm, this means between 9,400 to 17,200 deaths could be averted.

The data and evidence are out there. Webster, Vernick and Wintemute have studied the impact of policies to keep firearms away from high-risk individuals; Wintemute has shown that it is possible to take guns away from those who have been arrested and convicted of domestic violence or have a restraining order; Anestis and Anestis have found that laws that limit access to guns decrease suicide deaths. Irvin, et al studied the impact of regulating firearm dealers, finding that states requiring licensing and inspection have lower homicide rates. These brave researchers have bucked significant pressure to look away from these life and death questions.

In some cases the data can be flawed. For example the Department of Justice’s reporting of civilians killed by law enforcement was viewed as so unreliable that news source’s such as the Guardian and The Washington Post started collecting and analyzing their own data on police killings.

If public health practitioners consider themselves advocates for health – and consider themselves opposed to death and injury – there is truly plenty of excellent evidence that makes it imperative for us to stand up, call ourselves advocates for reducing gun ownership, and speak out.

‘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 (k.hirono@unsw.edu.au).

Dignified & Just Policing: Gang Injunctions and Other Policing Practices Have Uncertain Impacts on Community Safety and Health

Today, HIP and Santa Ana Building Healthy Communities (SABHC) released a report on the health and equity impacts of a gang injunction in the Townsend-Raitt neighborhood of Santa Ana, California.

A gang injunction is a controversial policing practice that essentially acts as a group restraining order against alleged gang members within a safety zone, a specific geographic area thought to be “controlled” by a gang. Since the 1980’s, over 60 gang injunctions have been imposed in California in an attempt to curtail a historic spike in violent crime in the state (and in the nation) during the late 1980’s and early 1990’s, a topic we tackled in a previous blog post.

The injunction in Santa Ana, the city’s second, would prevent alleged gang members from associating with each other or carrying out certain illegal and legal activities within the safety zone. The injunction has stirred up heated debate in Santa Ana since June 2014, when it was first implemented, and has been a flashpoint for controversy more recently amidst allegations of police brutality. Supporters of the injunction say it will lead to decreased crime and violence for all residents, while opponents say the injunction fails to address the root causes of crime and may lead to increased police mistreatment of local youth.

The HIA, which worked locally with SABHC, Chican@s Unidos de Orange County, KidWorks, Santa Ana Boys & Men of Color, Latino Health Access, UC Irvine’s Community Knowledge and Community & Labor projects, and the Urban Peace Institute, examined the impact the gang injunction would have on crime, safety, community-police relationships, education and employment, and collected data on community safety through surveys, interviews and focus groups. The HIA focused on populations that may be disproportionately affected by the gang injunction, including youth, undocumented immigrants, transgender or queer-identified people, the homeless, and those with physical and mental disabilities. Members of these groups fear that increased police presence in the neighborhood will exacerbate the potential for profiling and discrimination.

The HIA concluded that the injunction is unlikely to bring about significant and lasting reduction of serious crime, based on the outcomes of other gang injunctions and input gathered from residents, city officials, community organizations and police. On the contrary, the injunction could have negative effects on public safety, public health and public trust.

The HIA found that:

  • The evidence is insufficient that a gang injunction will reduce violent crime, gang activity or gang membership, or that it will improve community-police relationships.
  • An injunction could make some in the community, particularly parents, feel more safe, but members of marginalized groups may, in contrast, feel more threatened by increased police presence.
  • An injunction could lead to significant disruptions to education and employment opportunities for those named in the gang injunction, with immediate harm to their health and well-being and long-term harm to their chances in life.
  • Young black and Latino men who experience repeated, unsubstantiated searches and other forms of suppression-based policing may experience higher levels of anxiety and depression than their peers.
  • An injunction could divert funding from community programs that address the economic and social problems that are the root causes of much crime and a detriment to public health and well-being. In contrast to the mixed evidence on the effects of policing strategies on crime, there is solid evidence that correlates reductions in crime with environmental, educational and economic factors.

Our findings led us to make specific recommendations for the police and other law enforcement and criminal justice agencies, city officials and community organizations. Our partners plan to use the data from the HIA in their campaigns on healthy policing practices and in upcoming court proceedings to determine whether the gang injunction will be upheld or reversed.

This report marks HIP’s third HIA on criminal justice policies, with a fourth HIA on policing in Ohio in the works (stay tuned!).

The efforts of groups such as those in Santa Ana to evaluate the public health impacts of policing practices, especially on communities of color, help to move us forward into rethinking how to best promote community safety for all.

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… 

How Ferguson Became Ferguson: The Legacy of Racist Public Policy

In the aftermath of the fatal shooting of Michael Brown, much anger and blame has been directed at racism within the Ferguson, Missouri police department and the militarization of local law enforcement agencies across the nation. But in a compelling new report from the Economic Policy Institute, legal scholar Richard Rothstein says those are not the root causes of the tragedy, or of other similar killings of unarmed African American men and boys. He argues that decades of explicitly racist policies at all levels of government created the conditions that turned a small St. Louis suburb into a racial powder keg:

We flatter ourselves that the responsibility is only borne by rogue police officers, white flight, and suburbanites’ desire for economic homogeneity. Prosecuting the officer who shot Michael Brown, or investigating and integrating Ferguson’s police department, can’t address the deeper obstacles to racial progress.

Rothstein is a senior fellow of the Chief Justice Earl Warren Institute on Law and Social Policy at the UC Berkeley law school. In The Making of Ferguson, he lays out in damning, impeccably documented detail how “deliberate racial discrimination in the housing market by the real estate industry and agencies of the federal, state and local governments” have worked together to isolate African Americans in communities with few jobs, inadequately funded schools and substandard services. In St. Louis and elsewhere, he writes, those governmental policies included:

  • Zoning rules that classified white neighborhoods as residential and black neighborhoods as commercial or industrial;
  • Segregated public housing projects that replaced integrated low-income areas;
  • Federal subsidies for suburban development conditioned on African American exclusion;
  • Federal and local requirements for . . . property deeds that prohibited resale of white-owned property to African Americans;
  • Tax favoritism for private institutions that practiced segregation;
  • Municipal boundary lines designed to separate black neighborhoods from white ones and to deny necessary services to the former;
  • Real estate, insurance and banking regulators who tolerated and sometimes required racial segregation;
  • Urban renewal plans whose purpose was to shift black populations from central cities . . . to inner-ring suburbs like Ferguson.

In remarkable detail, Rothstein traces the history of Ferguson, from “a sundown town from which African Americans were banned after dark” to the first black families to move in during the late 1960s, to the “blockbusting” tactics real estate agents used to scare white families into selling en masse when any African Americans moved in, and how government agencies not only tolerated but encouraged white flight. He shows convincingly how decades of government-sanctioned housing segregation are in large part responsible for the economic inequality that divides white and black America today: After World War II, federal policies helped millions of white families acquire property, which has appreciated in value, creating wealth that is passed down to succeeding generations. Denying or impeding African Americans the opportunity to buy property and accumulate wealth has left them much poorer than whites.

And make no mistake, this is a public health issue. Income and education are perhaps the most important, and most definitively established, social determinants of health. The poorer you are and the less education you have, the more likely you are to suffer from chronic disease such as asthma or heart problems, to smoke, to become obese, to suffer from stress or depression, to go to jail or prison. Lower income means decreased access to health care. Poor people are more likely to live in substandard housing. People of color are far more likely to go to jail or prison.

We must realize that what happened in Ferguson, and what continues to happen every day across the country, cannot be fixed by integrating police departments and providing officers with better training in community relations. The changes needed are fundamental and won’t happen overnight, but Rothstein offers some immediate steps:

  • Prohibit landlords from refusing to accept tenants whose rent is subsidized under the Section 8 housing assistance program;
  • Require suburbs to repeal zoning ordinances that prohibit construction of housing that lower-income residents can afford;
  • Require all communities to permit development of housing to accommodate a fair share of its region’s low-income and minority populations.

Every American who wants to understand how and why Ferguson happened should read this report.

Giving Thanks for Obama’s Bid to Bring Millions of Immigrants Out of the Shadows

This Thanksgiving, I have a lot to be thankful for: a healthy family, a roof over my head, a well-paying and secure job and a community I feel safe in. Most of all, I am thankful for the peace of mind of knowing my family will be here for me, day in and day out.

As I write this morning, up to 5 million more people who live, work, and love in this country also have the promise of knowing they will not be torn apart from their families and communities. Last night President Obama announced that he will grant deportation reprieves to many undocumented parents whose children are American citizens and legal permanent residents. Migration Policy Institute data shows who will be affected.

The president is exercising his executive powers to end the cruel breakup of families of children entitled to be here, and allowing them to remain and work here legally. Although it offers no path to citizenship, the order effectively ends the Secure Communities program that has resulted in the deportation of hundreds of thousands of immigrants, and local police can no longer routinely detain immigrants without papers.

What the executive order does, first and foremost, is create a reprieve for many mixed-status families who have been suffering from anxiety, stress and other ill health effects from the lack of legal status. In 2013, HIP released Family Unity, Family Health, an HIA to understand how immigration policy – specifically the ongoing threat of detention and deportation – influenced the health and well-being of children and families. Our evidence overwhelmingly showed that harsh and inflexible immigration policies were harming hundreds of thousands of children, and that their health suffered needlessly as a result of laws that threatened to tear their families apart.

We learned that nationwide, an estimated 4.5 million children who are U.S. citizens lived in families where one or more of their parents was undocumented. Between 1998 and 2012, at least 600,000 children who were citizens had a parent or guardian deported. If deportations were to continue at 2012 rates, in 2014 alone, more than 152,000 children who were citizens would have a parent taken away from them.

I earlier wrote in detail about findings from our report. To summarize, these children and their families live with anxiety about the future – fearful that arrest, detention or deportation will tear their families apart. And anxiety and fear are only part of the damaging impacts of their families’ precarious legal status: Children of the undocumented may also suffer from poverty, diminished access to food and health care, mental health and behavioral problems and limited educational opportunities—particularly when a parent is arrested and detained or deported.

What was new about HIP’s research was that we shined a light on health consequences that are rarely discussed in the immigration policy debate. Our findings were highlighted extensively in national and international news coverage.

When the children of undocumented immigrants live daily with the effects of losing a parent, or anxiety about losing a parent, they are fearful that their families will be torn apart. The trauma of actual separation – or simply just the fear of it – can imprint on a young child’s brain, and result in what researchers call toxic stress response. The effects of immigration policy matter not just to children’s health today, but pose risks to health as these kids grow into adolescents and adults.

The new executive order goes a long way towards alleviating these risks. Tens of thousands of fewer children will experience poorer physical health outcomes. Over 100,000 fewer children will show signs of withdrawal. Over 125,000 fewer children will live in a food insufficient household. As Paul Krugman put it in today’s New York Times:

Today’s immigrant children are tomorrow’s workers, taxpayers and neighbors. Condemning them to life in the shadows means that they will have less stable home lives than they should, be denied the opportunity to acquire skills and education, contribute less to the economy, and play a less positive role in society.

There is still much more to do. It is unknown whether the order will be maintained under future administrations, and the order excludes access to food stamps, health care subsidies, and other public benefits – the very supports that create optimal health for children and families. And another 5 million people – including the parents of DREAMers and farm workers – who are not covered under the order will be forced to remain in the shadows.

But let us be thankful for progress – even as we vow to continue to work for just and humane immigration policies that place family unity and children’s health before fear, exclusion and punishment.

Transit Policy Gets Moving in Columbia, Missouri with Help from HIA

By Jason Wilcox

“Believe it or not, when I started working on transit, I had hair.”

Mayor Bob McDavid of Columbia, Missouri, joked about the stressful discussions surrounding the city’s public transit system. The conversations kept circling back to whether the financial impact of public transit was positive or negative. City representatives and pro-public transit groups searched for ways to keep the transit system economically feasible, while many opponents wondered why the city continued to subsidize what they saw as a non-essential service.

To take a new approach, in 2013 a Health Impact Assessment was conducted, providing an opportunity to present information through a health lens – not the usual frame for discussing public transit. The Columbia/Boone County Department of Public Health and Human Services focused the HIA on the potential impacts of expanding the public transit system on physical activity, mobility and access to jobs, health care, employment, and social capital.

With the release of the HIA, transit policy started moving. Within three months, Columbia Transit presented a draft of a new, budget-neutral public transit system, COMO Connect. The new system would feature neighborhood routes, as recommended by the HIA, ensuring access to essential services. New routes would run near large employers, health care facilities, and stores that offered healthy food options. After a year of public input, COMO Connect began running the new routes on August 4, 2014.

After completion of the initial HIA, a subsequent assessment was performed to focus on the potential health impacts of a transportation utility fee to help fund COMO Connect. The fee would be tacked on to residents’ utility bills, allowing them to ride the bus without paying a fare. The assessment found that the additional fee could hurt low-income households. Interviews with local residents discovered that many in the community already go without food or medical care due to high utility bills. This potential funding source is still being considered by the City, with a likely vote in 2016.

The completed HIAs have not only strengthened existing partnerships between the health department and community organizations, but have also allowed for the creation of new relationships. The interest in HIAs continues to grow in the community, with various City departments choosing to approach issues from a health perspective. The value of seeking out changes that impact the City’s overall landscape and infrastructure, as well as changes that positively impact citizen health, is becoming clearer.

Jason Wilcox is a Senior Planner with the Columbia/Boone County Dept. of Public Health & Human Services in Columbia, Missouri.


Treatment, Not Prison: Reforming Sentences for Low-Level Crimes Will Boost Health and Safety for All Californians

[Originally posted at The Pump Handle]

Reforming California’s sentences for low-level crimes would alleviate prison and jail overcrowding, make communities safer, strengthen families, and shift resources from imprisoning people to treating them for the addictions and mental health problems at the root of many crimes, according to a study by Human Impact Partners.

Rehabilitating Corrections in California, a Health Impact Assessment of reforms proposed by a state ballot initiative, predicts the changes would reduce crime, recidivism, and racial inequities in sentencing, while saving the state and its counties $600 million to $900 million a year – but only if treatment and rehabilitation programs are fully funded and implemented properly.

Read the full article at The Pump Handle.