Tag Archives: Public Health

Family Caregiving—A Public Health Crisis

Caregiver in scrabble text.
Photo credit: Flickr, Michael Havens.

This last year was the hardest one of my life. And I’m writing a blog about it because my personal experience is a public health issue.

In the midst of taking vacation time off to help my 80-year old mom move into a retirement community, the St. Louis Dispatch released an article about the health impacts of caregiving for elderly parents. The article notes that adult children who are caring for elderly parents have a myriad of poor health outcomes themselves—stress, higher rates of chronic disease, social isolation, and economic harm.

I relate. My mom’s move came about 6 months after my father died after a lightning-quick struggle with stage 4 lung cancer. During the last year, I have experienced everything covered in the National Academies of Sciences, Engineering, and Medicine (NAS) report, Families Caring for an Aging America: lack of exercise, poor eating habits, lack of sleep, incredible stress, extreme difficulty navigating our insane medical care system, and lack of support in how to set up my mom’s new life. Tearfulness, depression. My brother, in commenting on the difficulty of the last year, said, “I see now why it is very common that people die within one year after their spouse dies.”

The NAS publication cautions that our society is dependent on family caregivers. Nearly 14% of the US adult population has been a caregiver for an aging adult in the last year, and that is a role that typically lasts 5 years or more.

So. My personal experience raises two public health issues. The first—as noted—how we need to get on it to deal with the dearth in support for family caregivers, or train and pay (and pay very well!) an army of caring people to help our aging population. Policies like the Domestic Workers Bill of Rights in New York and 5 other states newly support domestic workers’ rights to minimum wage, overtime pay, and other worker protections. The organizing efforts of the National Domestic Workers Alliance brought together family caregivers alongside the people they care for—people with disabilities, families with young children, and elderly people like my mom. Both domestic workers and the people who pay them understand that better working conditions will help ensure that our families are well cared for.

In addition to paid caregivers, sometimes we need to take time off to provide care directly. Only four states—California, Rhode Island, Washington, and New Jersey—and the District of Columbia have Paid Family Leave policies to help people take extended time off to care for their families. My own state of Massachusetts tried to pass a Paid Family Leave law earlier this year, which would have required employers to offer up to 16 weeks of leave for family care, with a portion of salary paid out of a state fund. Unfortunately it got blocked in the State House, so like the majority of the US, I still do not have access to these benefits.

So instead I took vacation time to take care of my mother. I can tell you, my time off was no vacation.

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.


Confessions of a Former Victim-Blamer

I admit it. I used to be a professional victim-blamer. I didn’t realize it at the time and I always meant well. But as a public health educator, I sometimes contributed to people blaming themselves for their own poor health – because I didn’t mention to them how hard it might be to do the things I was telling them to do, or that there might be other things that could be done to improve their chances. This probably left them thinking that if they didn’t succeed, it was their fault.

An overwhelming majority of Americans blame people, and people blame themselves, for being fat because they don’t eat right or get enough exercise. We in the public health community tell them about all the ways obesity will harm their health. Then our society, from the medical establishment to reality TV, perpetuates this message (even though the relationship between weight and health is more complicated than that). In my days as a public health educator, I toed the party line and supported efforts to encourage individuals to change their eating and exercise behaviors to maintain a healthy weight.

When people live in neighborhoods that lack safe sidewalks, bike paths, parks, or public transit they can walk or pedal to, they’re naturally less likely to be physically active. And when people don’t have easy access to affordable healthy food, but are surrounded by corner stores, gas stations, fast-food places, and food industries pushing cheap unhealthy food, guess what? They’re less likely to make healthy choices. While the public health community is now supporting some neighborhood and policy interventions, most of our messages about food and exercise still focus exclusively on the individual without information about the influence of the environment, which probably contributes to a lot of the blaming mentioned above.

Victim-blaming can also result from the way we talk about sexually transmitted diseases. I cringed when I heard an NPR story reporting that when people are told how bad STDs such as herpes are, they are less likely to want to get tested and find out if they’re infected. I used to be one of those people who did condom demonstrations on plastic bananas and then handed out brochures with scary pictures of what might happen if they didn’t use them.

These messages, like the ones about healthy eating and exercise, were focused exclusively on the actions individuals should take, without any context about how the environment might influence their choices. When we use messages that talk about the bad or scary things that can happen to people in an effort to motivate them to change, the underlying message can easily become if you don’t do these things to protect your health, you deserve it if you get fat or get an STD – leading people to blame themselves, and others to blame them as well.

But again, look at the neighborhood. If you live in a neighborhood where there’s nothing for teens to do after school, a neighborhood where there aren’t enough jobs so people resort to selling drugs, a neighborhood saturated with alcohol advertising, you have a higher chance of contracting an STD. Neighborhood factors can create a vicious cycle. In some urban neighborhoods more than half of the young men have been in prison, most often for selling drugs. Prison gives them a higher exposure to STDs. With so many of them locked away, people in the neighborhood have fewer partners to choose from, so those who have STDs are more likely to share them with others.

There was even some level of victim-blaming when I taught stress management, though perhaps this was more subtle. For nine years, I taught patients in an outpatient clinic of a hospital that primarily served a low-income African American population how to manage stress. I offered them guidance in different forms of meditation and ways to change their thoughts. It was deeply rewarding on one level – I loved hearing things like “My family says I smile more now!” – but I worried that people would not be able to sustain the benefits long-term, and eventually I came to see it as putting a Band-Aid over a bigger, deeper problem.

The fact is that poverty and racism are stressful. Learning how to manage your own stress does nothing to get rid of the root causes, and when you are surrounded by root causes that never go away, you must continually swim upstream to take care of yourself, and may blame yourself if you don’t succeed. Meanwhile, policies that work to reduce the impacts of poverty, such as minimum wage laws and wage theft ordinances, are a different way to tackle stress at the population level.

I’m not saying we should stop talking about the importance of physical activity, healthy food, safer sex, and ways to manage stress. And I’m not saying messages directed at individuals are inherently victim-blaming. But I am saying that when we know neighborhood and policy factors influence individual behaviors and we only tell people about the individual behaviors they should change, it can lead to moralizing about those behaviors and to victim-blaming.

In the systems thinking world, some might call victim-blaming an unintended consequence of individually-focused prevention messages. It’s time to recognize and address this unintended consequence by complementing those messages with information and advocacy for public policies that promote health and well-being. It’s time to stop fanning the flames to blame the victim and work together to change the conditions that lead to poor health.

A Powerful Prescription for Better Public Health: Raise the Minimum Wage

This week, we are reposting an article from “The Pump Handle.” The article is written by HIP co-founder, Rajiv Bhatia, M.D.

Over the past three decades, real wages for low-income workers in the United States have either stagnated or declined. The federal minimum wage is intended to maintain a decent standard of living, but has fallen woefully behind. The current federal minimum of $7.25 an hour is now worth less than it was in 1968.  Read more…