Tag Archives: Health

The Greater Health Impacts of the Affordable Care Act

My son had an accident and broke his leg and I found a lump for which a routine biopsy was needed.

When these things happened to my family, I was relieved I had health insurance to help meet our medical needs. But it’s been an expensive and confusing experience – even quality health insurance coverage (procured through my partner’s employer) is proving inadequate at sparing my family the negative health effects of high medical bills. It made me wonder – how has the expansion of health insurance through the Affordable Care Act impacted peoples’ economic security? How much farther do we have to go to ensure that people can access health care without significant financial stress?

While our health issues were serious enough to require treatment, they were not unusual. I had to spend $1,500 (after insurance paid what they would) to discover my lump was, thank goodness, totally fine from a cancer perspective. Not so, from a financial perspective. Then recently, my son was playing with his cousins, fell, and broke his leg. Not sure what the total bill for this is going to be yet, but I’m guessing it also will be around $1,000 after insurance. In the health insurance world, these are probably considered moderate costs for a “consumer” who also pays health insurance premiums every month. But for a household with a tight and perpetually stretched budget like ours, this extra expense causes a great deal of stress.

This financial stress has a number of additional impacts to our family’s health and well-being. My partner and I have to make decisions about the things we will forgo in order to pay these bills. These are not fun conversations and I could see how over time they might end up putting too much stress on a relationship. For couples that separate, there is a cascade of health effects that happen: isolation, depression, anxiety, and negative impacts on children are well documented in the research.

There’s also research that looks at the long-term “economic scarring” that happens (such as during a recession) when families have to make tough choices about spending money on basic needs and medical bills, rather than on things like educational achievement, investments, or starting a small business. When scores of families are forced to make these trade offs (such as during a recession) our whole economy suffers. Our current system of health insurance not only does not protect people’s right to be healthy and productive, but when one of us gets sick or injured in the current system, we all pay.

In HIA, we seldom look at the health impacts of health care policy. We usually focus our policy efforts more upstream, and think of health care as a safety net after upstream efforts have failed. Health care becomes relevant when we aren’t able to change the unhealthy places where we live, work, go to school, and play. Yet through my personal experiences with the financial burdens of health care, I am gaining a different perspective on the greater health impacts of inadequate health insurance. It’s informing my research on the health impacts of financial stress through a new HIA project in our Economic Security Program that I’m leading with our partners, ISAIAH, in Minnesota.

Although the ACA represents a leap forward, we still have a long way to go towards ensuring everyone has health care that doesn’t come with a heavy dose of financial stress. I believe that health care could and should be considered a human right rather than a commodity, as it is now. We should all have the ability to be healthy and lead productive lives, without living in fear of having an accident, or being stricken with an unwanted illness and not being able to afford diagnosis and treatment. We are still far from this ideal.

Do Corporations Have a Right to Profit From Endangering Our Health?

We are re-posting a March 4, 2014 Scienceblogs.com blog by Jonathan Heller.

In his farewell address, President Dwight D. Eisenhower famously warned Americans about the growing power of the military-industrial complex. More than 50 years later, Nicholas Freudenberg, Distinguished Professor of Public Health at City University of New York, has issued a warning no less grave about “the corporate consumption complex” – the interconnected web of corporations, financial institutions and marketers that, in the name of individual rights, promote and profit from our unhealthy habits.

In Lethal but Legal: Corporations, Consumption, and Protecting Public Health, Freudenberg argues that “In a global economy that focuses relentlessly on profit, enhancing the bottom line of a few hundred corporations . . . has become more important than realizing the potential for good health.” According to Mark Bittman of The New York Times, “Freudenberg details how six industries — food and beverage, tobacco, alcohol, firearms, pharmaceutical and automotive — use pretty much the same playbook to defend the sales of health-threatening products. This playbook, largely developed by the tobacco industry, disregards human health and poses greater threats to our existence than any communicable disease you can name.”

To turn this destructive calculus around, Freudenberg told Bittman, “What we need is to return to the public sector the right to set health policy and to limit corporations’ freedom to profit at the expense of public health.”

Instead of asking “Do people have the right to smoke?,” Freudenberg and Bittman agree, we should ask: “Do people have the right to breathe clean air?” Instead of “Do junk food companies have the right to market to children?” we should ask: “Do children have the right to a healthy diet?” Instead of “Do we have a right to bear arms?” we should ask: “Do we have the right to be safe in our streets and schools?”

Reframing the debate with these questions, Freudenberg says, has led to changes in the food and beverage, tobacco, alcohol, firearms, pharmaceutical and automotive industries.

But we must go further. The labor practices of many industries also have huge impacts on health. The unspoken assumption today is business owners have the right to run their businesses as they see fit. Neoliberalism proclaims that reducing government regulation is essential for a healthy economy. But don’t workers have the right to live healthy lives?

In the past, the answer has only sometimes been yes. The once-powerful alliance of labor and workplace safety advocates won a series of rights for workers, including the 40-hour week and weekends off, a minimum wage, and occupational health and safety standards. But the political pendulum has swung back in the direction of corporate power, and dangerously too far.

  • Minimum wage hasn’t kept up with inflation, so many people are working but not earning enough to escape poverty. Living in poverty has a huge impact on health and well being. Efforts to raise the minimum wage are in progress across the nation, and public health professionals should be supporting these efforts.
  • About 40% of U.S. workers – and 70% of restaurant workers – are not given paid time off for illness. Health Impact Assessments conducted by Human Impact Partners (HIP) on paid sick days legislation show clearly that workers and society as a whole benefit when workers take time off and avoid spreading infectious disease. Visits to emergency rooms also drop.
  • Wage theft – the illegal withholding of wages or the denial of benefits rightfully owed to an employee  – is a common occurrence among low-income workers. HIP has begun a Health Impact Assessment of wage theft in Los Angeles and are finding that employers stealing their workers’ income has significant negative affects on physical and mental health and well-being for families and children.
  • Both in the U.S. and abroad, too many business owners cut corners on worker safety to increase profit. The recent garment factory fires in Bangladesh and Pakistan that killed and injured hundreds of workers are a clear example.

What obligations do corporations have back to society and their workers? Should profits for owners be valued over everything else, including health?  The public health community should lend its support to campaigns that seek to ensure that corporations are not allowed to profit at the expense of workers. Asking those questions, and others, is a good start.

Overcrowded Prisons, Immigration Reform and the Power of the Presidency

In his fifth State of the Union Address, President Obama declared that he would defy a do-nothing, obstructionist Congress and use his executive authority to address the ever-growing gap between the richest Americans and the rest of us. “America does not stand still,” the president said, “and neither will I. So wherever and whenever I can take steps without legislation to expand opportunity for more American families, that’s what I’m going to do.”

Raising the minimum wage for federal contract workers and other executive actions to fight inequality are important steps, and they are directly connected to improving public health. But there are other crises the president can tackle with the power of his office. Two of the most serious are, like inequality, strong determinants of public health.

In an op-ed in The New York Times, Bill Keller points to “the famously shocking numbers of Americans behind bars.” With 2.3 million prisoners, the incarceration rate in the United States is by far the highest in the world – with only 5 percent of the world’s population, we have locked up nearly one-fourth of the prisoners on earth.

Much of the increase in incarceration has come from harsh mandatory sentences for non-violent drug offenders and people with mental health issues – people who need treatment, not punishment. HIP’s Health Impact Assessment on reducing the prison population in Wisconsin found that sending non-violent offenders to treatment rather than prison would mean healthier lives, stronger families and safer communities. Treatment is much more likely to help people recover from substance abuse, reduce the need for future psychiatric care, and improve the health of children by keeping their parents at home, not behind bars.

And yet, writes Keller, Obama – a former community organizer in inner-city Chicago – “has had surprisingly little to say about the shadow cast by prisons on the families left behind, about the way incarceration became the default therapy for drug addicts and the mentally ill, about the abject failure of rehabilitation.” Although Attorney General Eric Holder has recently been more bold about urging states to rethink the cruel consequences of incarceration, the Administration has done little to reduce drug prosecutions or provide more money for treatment programs. Of the 8,000 people in federal prison because of outdated crack cocaine laws, which affect young black men disproportionately, last year Obama pardoned only three.

In the same issue, the Times reported on the annual congress of United We Dream, a national network of immigrant youth, many of whom were once undocumented themselves and whose parents are undocumented. Many Dreamers live in daily fear that their families will be torn apart by the arrest and deportation of their parents.

During his presidency, Obama has deported almost 2 million undocumented immigrants, more than any other president. HIP’s recent HIA on immigration reform found that if deportations continue at the present rate, each year more than 150,000 children will have a parent taken away, pushing more than 80,000 households into poverty and triggering poorer health or behavioral problems for approximately 100,000 children.

The Dreamers called on the president “to cut back programs that have greatly expanded the reach of federal immigration authorities” and grant deportation deferrals to parents of the more than 520,000 youth who have also received deferrals. In words that echo our HIA, United We Dream’s Cristina Jimeniz said: “These deportations are ripping our families apart; this has to stop. And we know the president has the power to do it.”

How San Francisco Restaurant Inspectors Help Assure Workers Get Paid

We are re-posting a December 6, 2013 Scienceblogs.com blog by Kim Krisberg.

There are few factors that shape a person’s health as strongly and predictably as income. And while enforcing wage and labor laws may at first seem outside the purview of public health agencies, Rajiv Bhatia adamantly disagrees. In fact, he says that public health may wield the most persuasive stick in town…Read More

Reflections on the National HIA Meeting

Two weeks ago I took a trip to a fun city, reconnected with old friends and made some new ones, and came back rejuvenated, inspired, and ready to get back to work. But I wasn’t on vacation. I was at a conference, and definitely not the boring, stuffy event you might think of. This year’s National HIA Meeting, Sept. 26-28 in Washington, D.C., was the second time practitioners from all over the country have gathered to discuss our work. It was my first, and to me it felt like a lovefest. Here are three reasons why:

Keynote Address by Councilman Joe Cimperman of Cleveland. Cimperman’s moving and inspiring address made me want to jump out of my seat and move to Cleveland right then and there. He discussed the importance of health and equity in his city, and the success of HIA in bringing health into decision-making and generating recommendations for improving health. He also talked about HIA as a tool for creating grassroots support and building relationships. Here is a great interview with Cimperman.

As a participant, my favorite breakout session was “Achieving Health and Equity in Education HIAs.” To my knowledge, the HIAs discussed in this panel are the only education HIAs ever completed in the US. Panelists included Phyllis Hill from ISAIAH in Minnesota, Susana Morales-Konishi and youth researcher Asha Simpson from Youth UpRising in Oakland, and Maisie Chin from CADRE in Los Angeles. These inspiring women represent community-based organizations that prioritize health and equity in their work. Community organizations are a growing group of HIA practitioners, but were under-represented at the conference, so these women brought fresh voices. Asha Simpson and her young colleagues, who were also in the room during the session, are the first youth team to conduct an HIA.

In the final minute of this session, an audience member asked a provocative question: “What about the fact that qualitative, community-generated data is not legitimate?” We didn’t have time to tackle it from the podium, but later talked privately and decided the real question should be: “Has the community legitimized your data?” Many HIAs are conducted without taking into account community knowledge and lived experience, and panelists agreed that practicing HIAs like this raises the red flag of illegitimacy more than the opposite approach. This episode and subsequent discussion really illuminated for me the value that community organizations bring, not just to an HIA but also to conferences like this one. This conversation should definitely be continued at the next national meeting.

My very favorite highlight was the people who came together from around the country and the world to make the conference happen. I never stopped running into old friends I’ve gotten to know over the last five years of doing HIAs. Just as often, I met new people and heard new stories about fascinating HIA projects and other health and equity work. (I guess you call this networking, but that word is too boring for describing the passion people brought to these conversations.)

Now I’m back home and ready to apply my renewed enthusiasm to a couple of new projects. But also excited for the next opportunity to meet with the 450-strong (and counting) national HIA community. The 3rd National HIA meeting is tentatively scheduled for Spring 2015 in Washington, DC.