Every year, 11% of Baltimore’s population goes through central booking. One in four African American children have a father in prison at some point during their youth compared with one in thirty Caucasian kids. The yearly drug consumption costs in Baltimore total approximately $16 billion, making our city a hotbed for drug raids and high rates of incarceration.
These are all facts that I learned during the Social Determinants of Health Symposium on Squandered Resources: Incarceration – Its Consequences, Costs and Alternatives, which was convened by the Johns Hopkins Urban Health Institute on April 28th. Speakers examined the reality of incarceration in America and provided promising solutions for prevention, community re-entry and lessening recidivism.
(Photo credit: Wikipedia)
Throughout the symposium, speakers framed the prison industrial complex as a big business that has expanded in the past forty years to house a multitude of individuals – many of whom have not committed serious offenses and/or have mental health issues. The prison population in America is disproportionately poor and African American, perpetuating the shameful history of racial discrimination and disenfranchisement in the U.S.
Experts explained that as more jails are built, more people are isolated behind their walls, waiting only for a day when they are sent back to their neighborhoods with the expectation to obtain gainful employment (which is difficult – if not impossible – due to job application forms that require applicants to disclose whether they have committed a felony). Oftentimes, these individuals end up back in jail due to lack of opportunity and support services.
Clearly, the social and economic factors that lead individuals on a path toward prison must be addressed in order to build individual and community wellness.
One of the solutions outlined during the symposium is preventing incarceration in the first place. This can be done through (1) interventions with community members and (2) altering correctional practices.
It was suggested that nonprofits and service providers follow the police and identify the same neighborhoods and people that are being targeted for arrests … then, work within those systems to build stronger safety nets, effectively tailor strategies, and set up alternative programs for income generation that may include education and job training.
At the same time, police can alter their practices by interacting with community members and seeking to divert criminal behaviors rather than laying wait to throw people in jail. Although the “stop and frisk” policy in New York City is invasive and creates barriers between the police and community members, the other diversionary practices that police have adopted in New York are promising and have led to only 400 arrests within a city of 8 million over the past year. South Africa’s Truth and Reconciliation Commissions are another promising strategy to address criminal offenses without throwing every offender in jail. Speakers defined this reversal of incarceration as “decarceration.”
Another tactic that was addressed during the symposium was easing community re-entry and ensuring that formerly incarcerated individuals don’t re-offend. A main point of discussion here is the need for job training and placement to ensure that these transitioning community members are able to effectively contribute to society, while providing them with mental health and addiction treatment services as necessary.
“Ban the box” bills, such as the one that Baltimore City Council passed on April 28th, are a step in the right direction – ensuring that employers are not allowed to ask applicants about their criminal past until they have made them a conditional offer. This ensures that formerly incarcerated citizens are given a fighting chance to succeed in the job market.
By applying these promising practices, we may be able to reserve prison for the small percentage of people who really do need to be behind bars, and help formerly incarcerated individuals transition back into their communities as productive and successful members of society.
Los Angeles Clippers logo (1984–2010) (Photo credit: Wikipedia)
By now, unless you have been living under a rock, you are aware that the NBA Commissioner announced that in addition to a lifetime ban from any business with the Los Angeles Clippers and $2.5 million fine, he is pushing to force current owner, Donald Sterling, to sell the team over his racist remarks.
When the news broke a few weeks ago, besides thinking that it was incredulous that Donald Sterling actually believes that his comments were not racist, the other immediate thought that crossed my mind was:
I feel sorry for the L.A. Clippers team who have to feign business as usual and go to work knowing that the world now knows how their employer regards them.
I am sure that when the Clippers played the next game, the stress of having the spotlight on them for such a negative reason was not only disheartening but also affected how they were able to perform. To me, it is no coincidence that they lost the game that they played just a day after the Sterling recording surfaced and won the game that they played just hours after the NBA Commissioner ousted Donald Sterling – the source of their stress.
Why am I mentioning Donald Sterling’s racism in the context of a blog dedicated to promoting health equity?
Because, racism is a public health issue.
In the article “Why Racism is a Public Health Issue,” author Tara Culp-Ressler refers to research data and studies that show that African-American teens who experience racial discrimination in adolescence were more likely to have higher levels of blood pressure, a higher body mass index, and higher levels of stress-related hormones once they turned twenty.
Stress alone is harmful because it breaks down the body, but stress caused by discrimination disproportionately affects minorities and often pushes individuals to respond in unhealthy ways. The psychological toll that racism takes on adults has also been well-documented.
Nancy Krieger, a social epidemiologist, is among a growing number of public health scholars that are adding to the literature on how racial discrimination raises the risk of many emotional, physical, and mental problems. She coined the term embodied inequality to explain this reality.
Racial bias exacerbates disparities in access to health care.
Two years ago, a study found that about two-thirds of primary care doctors harbor biases toward their African-American patients, leading those doctors to spend less time with their African-American patients and involve them less in medical decisions. This creates a situation in which African-Americans will shy away from seeking treatment that they need. Coupled with the fact that disparities in access to preventive health care continues to be a major problem in communities of color, racial bias towards minorities will further create this divide.
I hope that it is now clear that racism has plenty to do with health and wellness. It increases health disparities and decreases the well-being of those who are discriminated against due to the biases of others.
What can we do individually and as a society to address racism and discrimination and ensure that neither are negatively correlated with health and wellness?
Summer is coming, and the WellPower Blog Team would like to suggest some free or low-cost ways to get involved in the community and stay healthy!
English: The Baltimore Rock Opera Society’s “Brothership”, a converted 1988 Saab 900, which first premiered at Artscape in Baltimore, Maryland, July 2010. (Photo credit: Wikipedia)
Go to Artscape
From July 18-20 go to “America’s Largest Free Arts Festival.” Here you will find magnificent exhibits, designers, artists, film, and a packed tight schedule of live concerts, dance, theatre and so on. You don’t want to miss it!
Volunteer at Velocipede Bike Project
Volunteer on Sundays at Velocipede, a non-profit focused on helping people to “acquire bicycles to benefit their lives.” Meet new friends and learn all about bikes as you polish up your new skills. Then, on your own time you can use Velocipede’s extra bike parts to make a bike of your own!
Go to Single Carrot Theatre
Expand your mind at Single Carrot Theatre. See a show, or sign up to volunteer and have a chance to interact with some of these talented and interesting people. Information on when different volunteer opportunities arise can be found here.
Have a picnic
Pick up some healthy organic snacks-Ok Natural Food Store is a great option (and it’s not just because of their Polydactyl cat). The charming store is packed with a great variety of natural foods, vitamins, and supplements that keep you healthy and happy. Then grab a blanket and head to Patterson Park…the “Best Back Yard of Baltimore,” for a relaxing, outdoor afternoon.
Go to Crystals, Candles & Cauldrons
Visit this eclectic, New Age store filled with essential oils, crystals, candles, and stones. Have your fortune read for fun! I’ll be aiming for health and longevity.
Volunteer at the Whitelock Community Farm
Volunteer at the Whitelock Community Farm. You can volunteer on Mondays, Wednesdays and Fridays from 9am-1pm. After your hard work you are rewarded with fresh produce. Don’t forget to say hello to a fellow volunteer Michelle Geiss, our friend from the socent hustle event. (She’s the one who told us about this hidden gem)
Sign up for the Baltimore Running Festival
Consider running for a cause when you sign up. All causes can be found here. Race day is October 18th, so take advantage of training in the nice weather!
Visit Fort McHenry
Be sure to check the Schedule of Events before you arrive. If you’re a nature lover, you can jump on the Saturday Monitoring Bird walk.
More ideas can be found here.
We would love to know what you enjoy doing during the summer time in Baltimore. Please comment below!
(Photo credit: Malingering)
In honor of National Minority Health Month, the WellPower Blog team continues to raise awareness on health disparities affecting racial and ethnic minority groups in the U.S., including the ways social determinants affect health, specifically obesity.
Obesity is defined as a person weighing at least 20% more than they should for their height – and it disproportionately affects minority populations, according to the U.S. Department of Health and Human Services Office of Minority Health:
- African American women are 80% more likely to be obese than Non-Hispanic White women
- Native Hawaiian/Pacific Islanders are 30% times more likely to be obese than the overall Asian American population
- American Indian/Alaskan Natives are 60% more likely to be obese than Non-Hispanic Whites
Obesity causes serious health conditions, including:
- Heart Disease and Stroke
- High Blood Pressure
- Gallbladder Disease and Gallstones
- Breathing problems, such as sleep apnea and asthma
- Some cancers
Alarming research shows that:
- 49% of African American women (ages 20 and older) have heart disease
- 54 – the average age of Native Hawaiian/Pacific Islanders when they had a stroke, compared to 68 years for non-Hispanic Whites
- 16.1% – American Indians and Alaska Natives have the highest age-adjusted prevalence of diabetes among all U.S. racial and ethnic groups
So why are minority populations at a greater risk for obesity and related health issues? In many cases, they are part of low-income populations, with limited access to:
- Health education and services
- Safe recreational activities
- Nutritious foods including fresh produce
Also, it’s worth noting that some cultures have different attitudes and beliefs about being overweight and obese.
Recognizing that these socio-economic factors contribute to individuals’ risk for obesity and serious health conditions, it’s important that our policies and programs continue to increase access to health care services and healthy food options, while individuals educate themselves on getting – and staying! – healthy.
In 2012, the U.S. Census Bureau reported that the average life expectancy for black males is approximately 64 years old, compared with 73 years for white males. Racial and ethnic minority groups are less likely to have access to the preventive care they need to stay and are more likely than white Americans to suffer from chronic conditions, prompting the theme for this year’s Minority Health Month; “Prevention is Power: Taking Action for Health Equity.”
Luckily, 10.2 million Latinos, 6.8 million African Americans, nearly 2 million Asian and Pacific Islanders, and over a half million American Indians and Alaska natives will have the opportunity to receive health coverage thanks to the Affordable Care Act.
But – does acquiring health insurance mean that minorities will be more likely to access much-needed preventive care?
A recent study in the journal Science compared thousands of Portland citizens who recently obtained health coverage through Medicaid versus those who remained uninsured, and found that people with health insurance made 40% more trips to the emergency room during the first 18 months that they were covered. Emergency room visits are precisely the trend that we want to reverse by increasing access to preventive care.
This study made me ponder the reasons why recently insured people may go directly to the emergency room:
- Perhaps they were already suffering from chronic/untreated conditions and rushed to the emergency room as soon as they received coverage?
- Maybe, after years of ER visits, people who used to be uninsured don’t automatically think to visit primary care doctors, but rather turn to the medical care option that they are familiar with?
- Could it be difficult for this population to schedule preventive visits with primary care physicians?
This last question stuck with me. We know that due to the thinning out of primary care physicians and skyrocketing numbers of specialists, the U.S. is currently short 16,000 primary care doctors. This is understandable from the perspective of medical students – why be a general practitioner when you can make so much more money as a specialist and pay off those hefty student loans faster? However, it is discouraging to realize that 1 in 5 Americans live in Health Professional Shortage Areas throughout the country.
In order to prevent these doctors from turning too many new patients away, the Affordable Care Act has authorized a 10 percent bonus to primary care physicians who offer services to Medicare patients through 2015. This is a great incentive, but the question remains of whether these doctors will have the capacity to meet an increased demand for preventive visits.
Consider the lack of doctors, and factor in the likelihood that many of the existing primary care physicians still need training in culturally and linguistically appropriate services as pointed out in last week’s WellPower blog post, and it would be easy to understand why minority groups aren’t accessing preventive care.
One thing is for certain – we need to continue working with recently insured populations to ensure that they know that they are eligible for low-cost or no-cost annual check-ups through the Affordable Care Act, and help connect them with existing primary care doctors.
Why do you think recently insured people are going directly to the ER, and how can we refocus efforts on preventive care? Please comment below and let us know.
Emergency Room (Photo credit: Mark Coggins)
I recently read an article about Deisy Garcia, a woman who filed a police report saying her husband had assaulted her and that she feared for her life. That report, filled out in Spanish, sat untranslated — and without follow up – for months until she and her two children were murdered.
No human being should be denied protection from bodily harm due to language barriers and cultural incompetence. Deisy Garcia’s death could have been prevented had she been given the protection she sought. Her health, well-being, and ultimately her life was taken from her, and this could have been prevented. Prevention is power.
Deisy’s situation reminds me of how many non-English-speaking people who seek emergency treatment at hospitals are often left in precarious, harmful, or life-threatening situations. Consider the following cases:
- A 7-year-old girl with an ear infection whose mother was told by a poorly trained interpreter to put the oral antibiotic in her daughter’s ears.
- A 2-year-old who fell off her tricycle was taken from her mother by social workers because a doctor misinterpreted the Spanish words “Se pego” to mean “I hit her” rather than “She hit herself.”
- An 18-year-old who said he was “intoxicate”, which can mean nauseated, spent 36 hours being treated for a drug overdose before doctors realized he had a brain aneurysm.
As I reflect on the events that led to the death of Deisy and the cases mentioned above, I am reminded that language barriers can be deadly and life-changing. Ensuring that language barriers do not exist between a police officer and a domestic violence survivor is equally as important as ensuring that these barriers do not exist between a patient and a provider.
There is a need for more culturally competent practices on the part of police departments, medical facilities, and other facilities that serve the public. Minorities are entitled to the same protections as the majority population, including access to preventive measures attributed to health and wellness.
Under Title VI of the Civil Rights Act of 1964, the denial or delay of medical care because of language barriers is discrimination. Any medical facility that receives Medicaid or Medicare must provide language assistance to patients with limited English proficiency.
This past year, the federal government released an enhanced version of the National Standards for Culturally and Linguistically Competent Services (CLAS Standards). This blueprint for cultural/linguistic competence has been expanded beyond traditional hospitals and health care centers to include human service providers. This is a great start; however, more work remains to be done.
How can we as a society work together to ensure that patients with limited English proficiency are not discriminated against when seeking medical care?
Please comment below.
Pharmacy Rx symbol (Photo credit: Wikipedia)
“I’m sorry,” is all the doctor could say at that point. The patient would have to have surgery–an amputation…all because he didn’t have access to medical care before diabetes took over.
According to the Center for Disease Control, African Americans, Hispanic/Latino Americans, American Indians, Asian Americans, and Pacific Islander Americans are at higher risk for type 2 diabetes than the rest of U.S. population. These racial and ethnic minority groups are more likely to develop type 2 diabetes due to poverty, lack of access to health care, and cultural factors that result in barriers to preventive and diabetes management care.
Hundreds of thousands of minorities are stricken not only with diabetes, but with asthma, chronic fatigue syndrome, fibromyalgia –ailments that could at times have been easily prevented with access to something as simple as a healthy living environment or access to more nutritious food.
Rebecca Onie speaks about these health care gaps in her TedTalk, titled ‘What if our healthcare system kept us healthy?’ She proposes altering health care’s focus from searching for “cures,” to advancing preventive solutions-solutions that could save lives of people in need.
Rebecca’s story starts when she becomes an Intern at the housing unit of Greater Boston Housing Hospital. After working here for many months, she realized that by the time many minority families in Boston made it to the hospital, four bus rides later, “they were already in crisis.”
Rebecca began asking doctors in Boston Medical Center this simple question: “If you had unlimited resources what’s the one thing you would give your patients?” The answers, she said, were always similar. Doctors explained that every day they were prescribing medications, antibiotics for ear infections, but the real problem was that the patient was living with 12 others in a small apartment at home…with no food. The doctor didn’t have any help or “even know where the nearest food clinic is.”
As a sophomore at Harvard College, Rebecca used this information to start a system of her own called Health Leads. In the clinics where Health Leads operates, “instead of asking patients what they need to get healthy, they ask the patient what was needed to be healthy.” For instance, the patient with asthma might be given an inhaler script, as well as a “script” for a volunteer to give the patient’s utility provider a call. The volunteer can then work with the utilities company to formulate a payment plan for the patient. Fewer inhalers are needed in the future, leading to a true path to health.
Once we start concentrating on preventive health, we will not have to worry as much about problems like antibiotic resistance, medications like insulin for diabetics, or spend so much of our money on disability funds or Band-Aid solutions for those with chronic illness.
Rebecca ends her talk stating, “I believe that at the end of the day when we measure our health care it will not be by the diseases cured, but by the diseases prevented, it will not be by the excellence of our technologies or the sophistication of our specialists, but by how rarely we needed them, and most of all I believe that when we measure our health care it will not by what the system was, but by what chose it to be.”
As we consider the theme for Minority Health Month, “Prevention is Power: Taking Action for Health Equity,” it makes sense to consider innovative new approaches for preventive care. What do you think about Rebecca’s approach with Health Leads? Could a system like this be more widely used? What other ideas do you have that might help to bridge the gap of “cures” to preventive care?
April is National Minority Health Month, an opportunity to raise awareness about health disparities affecting racial and ethnic minority groups in the U.S. The WellPower blog team is committed to raising these issues to public consciousness, and writing about the ways that social determinants like education, housing, and jobs affect health.
Throughout April, we will be blogging about issues that are aligned with this year’s Minority Health Month theme; Prevention is Power: Taking Action for Health Equity. This brings to mind the old saying that ‘an ounce of prevention is worth a pound of cure.’ Although there are many benefits to preventing negative health outcomes, preventive care is vastly underutilized in the U.S. – particularly among racial and ethnic minorities.
Some of the reasons why population groups are not receiving preventive care:
- Lack of access to health care services due to transportation issues, the inability to take time off of work, or the money to pay for non-essential visits.
- Language barriers between the patient and the provider and/or the need for more culturally competent practices on the part of the medical facility.
- Lack of health insurance. Although the Affordable Care Act has expanded health insurance to millions of Americans, many states have not expanded Medicaid, making it impossible for low-income individuals and families to purchase insurance.
Stay tuned to WellPower throughout the month of April to learn more about this issue. Additional resources can be found on the Office of Minority Health website at: http://minorityhealth.hhs.gov/nmhm14/.
We’d love to hear from you! You are invited to comment on our posts on the WellPower website and via Twitter at @WellPowerBlog #NMHM14.
This piece by Stephanie Moore is re-posted from the Eyes Wide Open Blog: http://eyeswideopen.org/soldiers-protect-us-protects/
I recently read a disturbing article in the Baltimore Sun that quoted a Veterans Administration report that there is an average of 22 suicides a day by veterans. 22 a day. Where are we as a nation if we cannot help and support those who risk their lives to protect us?
The website, Veterans and PTSD shares these statistics from a major study done by the RAND Corporation (full pdf of study), the Congressional Research Service, the Veterans Administration, and the US Surgeon General.[i]
- at least 20% of the over 2.3 million American veterans of Iraq and Afghanistan have PTSD (Post Traumatic Stress Disorder) and/or Depression.
- 50% of those with PTSD do not seek treatment
- out of the half that seek treatment, only half of them get “minimally adequate” treatment (RAND study)
- 19% of veterans may have traumatic brain injury (TBI)
- 7% of veterans have both post-traumatic stress disorder and traumatic brain injury
- rates of post-traumatic stress are greater for these wars than prior conflicts
- more active duty personnel die by their own hand than combat in 2012 (New York Times)
Where suicide is often seen as a sensitive and private family matter, it can come to the forefront like in yesterday’s shooting in Fort Hood. As the nation turned on the news, it felt like déjà vu. As we learn more of the attack, I expect we will be learning of many distinctions that separate it from its earlier horrific assault. Where the first attack was claimed as an act of terrorism, this incident will be raising the issue of Post Traumatic Stress Disorder (PTSD) and traumatic brain injuries (TBI). The shooter served 4 months in Iraq (non-combat) in 2011 and was undergoing diagnostic procedures for post-traumatic stress disorder, suffered from depression and had self reported a traumatic brain injury. He killed 3 people and wounded 16 before taking his own life. Perhaps we won’t ever know if his military service impacted his decision to harm others and eventually himself, but it should at least ask the question, if it did, how can we help the next veteran?
If you are a veteran or know of a veteran who needs help, please contact the Veteran Crisis Line at 1-800-273-8255
“Peace Corps Volunteers, stay as you are—be servants of peace; work at home as you have worked abroad—humbly, persistently, intelligently. Serve your neighborhoods. Serve your cities. Serve the poor. Join others who serve. Serve…Serve…Serve…that’s the end. That is the challenge. For in the end it will be the servants who save us all.”
– Sargent Shriver, Peace Corps First Director
Kennedy and Johnson greeting Peace Corps volunteers, 1962 (Photo credit: Wikipedia)
The WellPower Blog is committed to creating a healthier nation by lifting up community involvement, including drawing attention to local organizations striving to end health disparities in Baltimore. As such, we are highlighting the Shriver Peaceworker Fellows Program as described by Assistant Director, Meghann Shutt:
Serving in the Peace Corps is a life changing experience for most people. Returned Peace Corps Volunteers (RPCVs) often speak of a life-long orientation to service as a result of that experience. In fact, when the Peace Corps was originally introduced by John F. Kennedy and Sargent Shriver (the agency’s first director and for whom our program is named), they spoke widely of the need for a critical mass of internationally trained men and women who would return from the Peace Corps to build a better America.
Personally speaking, as a Peace Corps volunteer, I found myself very engaged in my work in a rural village in Southern Kyrgyzstan, but I was often thinking about changes needed in Baltimore City, my own hometown. I initially went abroad thinking I wanted to do international development work for a career and discovered that the politics of working internationally changed my mind.
If I was going to work that hard at community development, I wanted the fruits of those efforts to go to Baltimore. This city reminds me of a developing country in so many ways, and the skills I built as a Peace Corps volunteer have been unbelievably helpful working on various community efforts here in Baltimore City. For some of our Peaceworker Fellows, they had similar experiences. Others came to the realization that in order to be more effective agents of change, they needed specialized graduate degrees. Still others came back looking for opportunities to work and serve at the same time. All of these things bring applicants to the Shriver Peaceworker program, and most fellows are not native to Baltimore.
The Shriver Peaceworker Fellows Program is a graduate level service-learning program housed at UMBC for returned Peace Corps volunteers (RPCVs). The program is highly competitive and seeks to recruit dynamic change leaders to work, study and live in Baltimore. The fellowship combines:
What are current fellows doing now?
Now more than ever, we see the need for professionals who understand the rich and nuanced world of local international and immigrant communities, cultural differences and how to build on that diversity rather than see it as a threat. The Peaceworker Program builds a community of returned Peace Corps volunteers who are interested in transforming this Peace Corps experience into social change leaderships either here or abroad.
Whatever their reasons for coming, one of the secondary aims of the Shriver Peaceworker Fellow’s Program is to attract these leaders to Baltimore and keep them here. And it’s working! Some Peaceworker alumni continue their commitment to international development in agencies and organizations like USAID, Peace Corps and Catholic Relief Services.
Still, many more Peaceworker alumni are currently serving and leading in local government agencies like the Maryland Department of Natural Resources, Baltimore City Council President’s Office, Mayor’s Office of Economic Development and Baltimore City Public Schools, as well as nonprofits, philanthropic organizations and companies focused on social change including the Annie E. Casey Foundation, Friends of Patterson Park and Campaign Consultation.
RPCVs, including Campaign Consultation’s own Michelle Bond, Julia Krieger and Megan Wall, are continuing to make changes in Baltimore long after their Peace Corps experiences ended. This is a sign that our approach of investing in people and creating meaningful community around social change is working.
WellPower Blog is pleased to showcase the Shriver Peaceworker Fellows Program, which exemplifies lifting up community involvement and collective action to create a healthier city – and nation.
Click here to find out more.
“The benefits of the Peace Corps will not be limited to the countries in which it serves. Our own young men and women will be enriched by the experience of living and working in foreign lands. They will have acquired new skills and experience which will aid them in their future careers and add to our own country’s supply of trained personnel and teachers. They will return better able to assume the responsibilities of American citizenship and with greater understanding of our global responsibilities.”
– John F. Kennedy, Message to Congress March 1, 1961
logo (Photo credit: Wikipedia)