Carmen Ross – UAB Institute for Human Rights Blog

People of Color Live Disproportionately Close to Superfund Sites

As a Public Health major, I am often looking at disparities and inequities in the distribution of poor health. Environmental justice, which can be defined as “the fair treatment and meaningful involvement of all people with respect to the development, implementation, and enforcement of environmental laws, regulations, and policies” is one topic I’ve learned about in many classes because of the significant impact the environment has on health. Unfortunately, the color of one’s skin plays a large role in their likelihood to live and work in an area that has an unhealthy environment, and the history of people of color unknowingly living and working in areas that are hazardous is long.

The Memphis Sanitation Strike started the environmental justice movement in February of 1968 when sanitation workers in Memphis, TN organized a strike to protest unfair treatment and the effects on their health. The workers had been receiving less pay than their white coworkers, while also doing the more dangerous work. Before the beginning of the strike, two black men had been killed by the trash compactor during work. The movement eventually lead to a recognized union and higher pay. This was not the first instance of environmental racism. However, it was one of the first time that head way was made when it comes to equality and equity.

The most famous example of a fight for environmental justice, Love Canal, seems to have few people of color as part of the story as many of the vocal people involved were white women. After heavy rain fall in 1978, residents of Love Canal, NY, noticed that there was a bad smell in the air, children were returning home after playing outside with burns on their skin, and babies were being born with birth defects at a very high rate. They didn’t know that toxic chemicals had seeped from the chemical waste dump they had built their homes and school on.

However, there was a federal housing project in the area as well that housed mainly people of color, and their voices were overshadowed by people like Lois Gibbs. The movement to move people out of the hazardous area did not extend to moving the people living in the federally funded housing to a safer area even though they were affected by the hazardous waste just as significantly. Luckily, both groups were able to relocate and receive compensation for the health effects.

While the Memphis Sanitation Strike and Love Canal both happened over 40 years ago, the environmental injustice experienced during those times has not completely gone away. Today people of color and low-income individuals are still more likely to live and work in hazardous areas. Most Superfund sites, which are areas that have been deemed severely environmentally contaminated, are within one mile of federally funded housing. Even more disturbing, a disproportionate amount of these families are people of color.

The disproportionate placing of federally funded housing, and therefore low-income communities of color, into environmentally hazardous areas stems from systematic racism, or more specifically, a Not In My Backyard (NIMBY) mentality held by higher-income white communities. No one wants to live near a hazardous waste site, a factory that releases toxic fumes, or a stinky landfill. However, the people with the power to say no get their way while the people who are already more likely to have health risks are placed in dangerous situations.

A larger problem is that low-income communities and communities of color have been not listened to. In northern Birmingham, AL a recent study showed that a coke mill on a Superfund site has been releasing carcinogenic chemicals in the air for years. Many residents have severe respiratory problems, such as asthma, and now can’t survive without many medications. However, the EPA didn’t catch the extremely high levels of rarer toxins in the air because they don’t typically test for those. It took a study from a nongovernmental organization to expose the harm that the coke mill was doing to this community.

No one wants to live somewhere that is going to make themselves or their family sick, and they shouldn’t have to. While the United States has made progress towards environmental justice over the past 40 years, there is still a long way to go. Superfund sites were created in 1980, but most of the current public housing was created before then. New federally funded housing should not be put near hazardous areas like Superfund sites, and we should work on solutions to clean up Superfund sites near federally funded housing or moving that housing . By reducing the number of housing projects near hazardous waste and taking note when a whole community gets sick, we will begin to move towards racial and income equity when it comes to the environment we live and work in.

COVID-19’s Effect on Mental Health

Amidst the global pandemic, we have all had to make some changes to our daily lives. It used to be normal to go to restaurants, movie theaters, and concerts, but now, for the most part, we stay away from those activities and social distance instead. While social distancing has slowed the spread of COVID-19, most of us are aware of the toll it takes on our mental health. Humans are a very social species, and social isolation can have a severe impact on overall wellness. Financial hardships and anxiety over illness contribute to a decline in mental health as well.

Social isolation has many benefits when it comes to slowing the pandemic. However, it drastically impacted the lives of many people in an unintended way. Loneliness has skyrocketed due to people only having contact with the people they live with—or no one. The effects can be even more confusing because social isolation affects everyone differently. Some people have pre-existing mental health conditions, and when the pandemic forced them into isolation, they recognized their symptoms worsening. While their original symptoms worsen, they also are more likely to develop PTSD than their counterparts without pre-existing conditions.

Even those without pre-existing mental health conditions are vulnerable to worsened mental health when facing social isolation, especially children and adolescents. Many people in this age group get most of their social interaction through school, and with many schools closed or on limited schedules, they’re not receiving the social interaction they need to grow. Because of the loneliness these children and teens are feeling, there is the increased risk that some of them will develop depression at an early age, with even higher rates than normal among those that have a family history of depression.

College students are facing very similar challenges that adolescents in middle and high school experience, except many have the added pressure of being away from their families while also no longer having a strong social network on campus to rely on. Many students are experiencing increased fear and anxiety in addition to depression, which can lead to physical health issues; anxiety and depression can worsen sleep and eating habits, which can have profound effects on a student’s energy, and in turn their performance in school and overall health.

Financial struggles have been shown to have severe impacts on a person’s overall wellbeing outside of this pandemic. Over a third of the United States’ population experienced negative financial impacts due to the pandemic. Hourly workers, who typically already struggle financially, were hard hit, which creates a lot of stress for them and their families. People who are worried about their finances may also be unable to seek mental health help from professionals, which could potentially improve mental health.

Many people with stable work before the pandemic hit, lost their jobs. They experience an added stress of worrying about evictions and foreclosures and where their next meal is going to come from. This can lead to higher levels of anxiety and depression, and in the past, economic downturn, which we have experience during the pandemic, is associated with an increased rate of suicide.

This pandemic has been a new experience for all of us. The COVID-19 pandemic wasn’t the first pandemic, and many are realizing it won’t be the last. This realization is increasing anxiety in many people, along with worrying about the health of immunocompromised loved ones or personal health. Additionally, many are worried about dying alone. This increase in stress can lead to an increase in anxiety and depression, along with other mental health issues, and worsen existing mental health conditions.

Being home all day has kept people in front of the TV, watching the news. It’s beneficial to be informed, but studies have shown that too much COVID-19 news can worsen mental health issues. This can exacerbate issues that already existed. One way to reduce being overwhelmed with the news, but to stay informed is to limit the time watching the news and instead get reliable information from the CDC, which updates information regularly.

Mental health is a human right, and should be a priority, especially during times or social isolation, financial hardship, and illness. An emphasis should be put on practicing self-care, but it’s also important that people who need help from a psychologist or psychiatrist get the chance to see them. During this pandemic, mental health has been put on the back burner. While many of the steps taken have saved countless lives, their impact on mental health should not be overlooked. In the future, when we take drastic measures, such as social isolation, we need to make sure the mental health aspects will be given the attention they need to be able to keep our population healthy in every way possible.

World Diabetes Day

World Diabetes Day is recognized globally on November 14^th. It’s important to recognize the progress we’ve made in managing diabetes. In the past, a diagnosis of diabetes was devastating in many ways: type I and insulin-dependent type II diabetes were often fatal until the discovery of insulin in 1921; gestational diabetes drastically worsened pregnancy outcomes for women and their babies; and other types of type II diabetes resulted in severe complications. Diabetes now has become known as a serious, but treatable, disease. While medically we’ve come a long way with the treatment of diabetes, there are still improvements that need to be made in relation to the social treatment.

Despite the great strides made in the medical community in regard to diabetes, people with diabetes still face hardships and discrimination in the workplace, the classroom, and in the health sector. Many people with diabetes need accommodations in the workplace that are protected by the Americans with Disabilities Act (ADA). For example, many people with diabetes have rapid drops or spikes in blood sugar—hypoglycemia and hyperglycemia, respectively—and they need to take time to remedy it. If an employer does not accommodate these needs, they are in direct violation of the ADA. There are exceptions, such as when hyperglycemia, hypoglycemia, or the breaks make the employee unable to do the essential function of the job. However, in many workplaces, these breaks are possible.

Kristine Rednour was hired as a reserve paramedic for the Wayne Township Fire Department (WTFD). When she was hired, she let the WTFD know that she had type I diabetes. She was promoted to full time, and during work had two hypoglycemic episodes within the same year, which affected her ability to respond as a paramedic. She was put on paid leave, during which she was required to have the medical director clear her. He cleared her for restricted duties and with workplace accommodations, which the WTFD refused to put in place and instead fired her. She sued the WTFD for violating the ADA and won. This is just one of many examples of workplace discrimination that people with diabetes face.

The ADA also protects children at school that have disabilities, including diabetes. However, like with employment discrimination, discrimination at school still occurs. Schools that receive federal funding are required to be able to make accommodations for students with diabetes, such as allowing them to have snacks and having staff that is qualified to administer care.

Some schools don’t offer these accommodations, especially the latter, which can put children at risk for life-threatening medical complications. Some schools even tell parents that their children will not receive medical assistance from staff even if the complications have become so severe that they are unconscious. Often, parents have to put their jobs on hold to be able to make trips to school to check on their children, potentially placing them under increased financial strain.

Blood Glucose Monitors can send blood sugar levels to an app that the child can download and have more immediate updates on their blood sugar. For some children with severe type I diabetes, they can find out life-saving information about what would otherwise be a severe drop in blood sugar. However, many schools are unwilling to accommodate students by letting those with diabetes access their phones or the Wi-Fi, which puts them at risk for missing a life-threatening drop in blood sugar.

Some children have been denied entrance into schools because they have diabetes, which violates the ADA if the school receives federal funding. Many students are sent to schools that they are not zoned for because the schools closest to where they live do not have staff trained to take care of them, despite the requirement of this accommodation. This means that parents have to drive their students to a school farther away, potentially disrupting their ability to get to work. Some schools participate in this type of discrimination knowingly, while others do not understand enough about diabetes or the ADA. Regardless, denying entry into a school because of a disability is a direct violation of the ADA.

Due not only to the discrimination those with diabetes face, but also the stress and anxiety of not knowing when they’ll have a drop or spike in blood pressure, people with diabetes often suffer from worsened mental health, which according to many sources, including the UN, is a human right. This lessened mental health takes many forms: people with diabetes are two to three times more likely to suffer from depression; diabetes distress can occur when a person with diabetes feels controlled by their illness instead of the other way around; and when physical health gets worse, mental health often follows. It is important for people with diabetes to know they can seek medical attention for their mental health as well as their physical health.

The final place people with diabetes face a violation of their human rights is in the healthcare setting. Healthcare is expensive even without taking into account chronic diseases, especially medication. Insulin is a relatively cheap and easy medication to make. In the 1990s, a one month supply was less than $50, whereas now it’s upwards of $200, which is not accounted for by inflation. For people without insurance, or those that are underinsured, this can put a huge financial burden. This has led to people with insulin-dependent diabetes to ration their insulin, which can lead to death. For example, a nurse, who knew how to manage her diabetes, was found dead due to not using enough insulin. For people with insulin-dependent diabetes, insulin is a human right, which is being denied to many by the sharp increase in prices.

People with diabetes now are able to live happy and healthy lives, especially compared to a hundred years ago. However, they are still set back due to discrimination and human rights violations. It is important as a society to work towards removing the barriers that people with diabetes, among other disabilities, face so that they have access to health, both mental and physical.

COVID-19’s Impact on Gender Equality

COVID-19 has had a significant impact on the health and social structure of the world. Over one million lives have been lost, and over 35 million people have been infected with the virus. While infectious diseases don’t discriminate by age, race, social class, or gender, these factors do influence how COVID-19 and the related social ramifications will affect the illness experience for different people. For instance, when looking at gender, women have been more severely impacted than men. Men are more likely to die as a result of contracting COVID-19, but women experience the brunt of the long-term social effects, partially due to preexisting gender inequalities.

Looking at the healthcare sector alone, women were affected tremendously for many reasons. First of all, about 70% of healthcare workers are female. This means that a disproportionate number of females are putting their health and lives at risk to improve the lives of others. They were more heavily affected by PPE shortages at the beginning of the pandemic, and when PPE did become available, the “one-size fits all” design, which defaulted to the typical cisgender male body, was often ill-fitting and not conducive to managing menstrual cycles. Additionally, women who work in healthcare delivery have been historically overworked and underpaid. In normal circumstances, many healthcare professions, like nursing, have high burnout rates. However, studies have shown that the pandemic has increased the negative mental health effects of the job, primarily in females and in nurses.

Additionally, women live longer than men, and women are the vast majority of the population in nursing homes. During the pandemic, nursing homes have had to take drastic action to ensure the safety of their residents through restricting visitation and group events. This has led to significant social isolation in nursing homes, and loneliness follows closely behind. Further, many elderly people that live alone are women who rely on the care from their family. With the social distancing and their increased risk for severe disease, this has left many women almost entirely isolated—with the exception of family and friends dropping off groceries. This has led many women over 65 to meet up with friends. This makes them more likely to contract COVID-19, but for many, the increased risk is worth it to not be lonely.

Another health effect of the pandemic for women has been reduced access to healthcare, especially sexual and reproductive health. Across the globe, procedures considered elective were postponed due to concerns of restricting nonessential personnel from being in hospitals. However, many elective procedures can play an important role in a woman’s health. For example, endometriosis is a disease in which the uterine lining grows in areas where it shouldn’t, such as in the fallopian tubes and on the bladder, and it can cause immense pain in women who have it. One of the treatments is surgery to remove the excess growth. This not only may relieve pain but also increase fertility, so women who want to have children are more likely to be able to do so. While this surgery undoubtably improves the lives of women with endometriosis, it is considered an elective surgery, and in many places, women had their surgeries postponed. For women with immense pain, finally seeing the light at the end of the tunnel, this was devastating.

This is one of many experiences that women have faced. Many treatments and prevention methods for women’s sexual and reproductive health are considered nonessential, so many women have had to postpone their HPV vaccines, and STI and cervical cancer screenings. Additionally, some states have tried to roll back abortion services. India had a very strict lockdown, which prevented many women from access to contraceptives. This led to “over 800,000 unsafe abortions,” which is the third most common cause of death among pregnant women in India.

Outside of the healthcare sector, women have experienced many social repercussions due to the pandemic. Even before the pandemic, women were largely responsible for the unpaid care work, such as taking care of children or older family members. Now, with children home from school, and older people less able to do their own errands because of the risk of contracting COVID-19, the burden is falling on women and girls. Because of this, many women have to give up their job, or at least cut back hours, and many girls have to put their education on pause.

mom reading a book and son holding a baby while doing homework — Homeschooling. Source: Iowapolitics.com, Creative Commons

Before the pandemic, there were indications that great strides were being made towards gender equality in society and in work. However, a lot of the progress was lost with the onset of the pandemic and with lockdowns. While female-dominated jobs are typically the most protected during economic downturns, lockdowns affected female-dominated jobs at a higher rate than male-dominated jobs: it is estimated that female job loss was 1.8 times higher than male job loss. This is mainly because women are more likely to work jobs that are part-time or temporary, which makes their job security decrease significantly. As mentioned before, women are more likely to take care of family due to closures in school and older family needing assistance, making them less able to work, even from home. All of these factors mean women will be making less money because of the pandemic.

Finally, because of lockdowns, women are staying home more. While this is frustrating for many people, it can be dangerous for women in abusive relationships. Abusive relationships are dangerous to begin with, but with the added stress of the pandemic and being stuck in the same house for days, weeks, or even months, the severity rises. Additionally, a lockdown places women experiencing domestic abuse in a dangerous situation because it’s harder for them to escape the abuse through women’s shelters. Another way some women would typically be able to escape a domestic violence situation would be through a community, but even in normal circumstances those can be hard to come by as it’s typical for abusers to isolate their victims, and with the added isolation of the pandemic, it’s even harder.

Everyone has been significantly impacted by the pandemic. However, some people have been affected more than others, especially when indirect health effects and social effects are taken into account. Because of the disparity between the effects on men and women, we must aim interventions at women and girls. Not doing so could negatively affect years of progress made toward gender equality, and negatively impact the mental and physical health of women in the future.

Diversity in COVID-19 Trials

Man using micropipette to perform COVID-19 test — State Public Health Laboratory in Exton Tests for COVID-19. Source: Governor Tom Wolf, Creative Commons.

Since COVID-19 became a pandemic, researchers have been rushing to develop an effective vaccine. There has been a lot of progress made in a short amount of time, but one barrier that every trial in the United States is facing is a lack of diversity within the trials. This is not uncommon for modern research trials, as the majority of participants are typically white and males. However, for a trial to demonstrate effectiveness and appropriate dose for the population, the study population needs to be representative of the whole population at risk.

When studies don’t have a diverse study population, there are adverse outcomes and side effects that are not accounted for. For example, about one in five medications has a different recommended dose across different racial and ethnic populations. This means that without diverse trials, doctors won’t know how safe the medicines that they prescribe their patients actually are.

For the COVID-19 vaccine trials, the issue of diversity is particularly important because people of color, specifically the Latinx and Black communities, are not only three times more likely to contract COVID-19 than white Americans, but they’re also twice as likely to die. Despite this health inequity, people of color only make up 29% of participants in the vaccine trial with the most diversity. This is an improvement from most studies, but still not representative of the affected population: 49.9% of the United States population is not white, and people of color experience severe cases of COVID-19 at a higher rate.

But why is it so hard to achieve representative diversity in trials? The main reason is that the United States has a history of taking advantage of people of color when performing medical studies. One of the most glaring examples of this is the “Tuskegee Study of Untreated Syphilis in the Negro Male” in which almost 400 Black men were diagnosed with syphilis and left untreated. They were promised free food and physicals but were never informed of their diagnosis. Despite the discovery of penicillin, which is an effective treatment for syphilis, while the trial was still ongoing, none of the men involved in the study were ever treated. Because of this, many of them died, and many of their wives and children also contracted syphilis. The study ended after 40 years when a public health service investigator informed the press of what was going on.

The Tuskegee Study was devastating for the men who unknowingly participated and their families, but the effects did not stop with them. Because of the dishonesty within this study, Black American patients are less likely to trust their doctors and the medical system as a whole. A study done by Marcella Alsan and Marianne Wanamaker showed that immediately following the news of the Tuskegee Study, health outcomes, trust of medical professionals, and life expectancy all decreased, which shows not only a social effect but a physical one.

Mural of Henrietta Lacks with description "Henrietta Lacks, a poor black farmer, died in 1951 of cervical cancer. Her tumor cells were taken without her knowledge, and became the first human culture cells because they were found to divide indefinitely. Her cells have saved countless lives. Jannai B" — Henrietta Lacks. Source: yooperann, Creative Commons.

Another case that plants seeds of distrust towards the medical community is the case of Henrietta Lacks. Lacks was an Black American woman being treated for cervical cancer at Johns Hopkins in the early 1950s. During treatment, and without her knowledge, doctors took samples of her cervical cells to see if they would replicate in culture, which they did. HeLa cells, as they are now called, were a huge breakthrough for medical research, but it was done without Lacks’ knowledge and consent. Additionally, her family received no compensation and has only recently gotten a say and acknowledgement in research that uses HeLa cells. Because of these two injustices, many Black Americans have little trust in the medical systems.

Black Americans are less likely to seek medical treatment and participate in trials, which leads to worse health outcomes immediately and for future generations. Because they are less likely to seek medical treatment, conditions will worsen before seeing a doctor, and treatment in later stages is more costly—financially and personally. Additionally, because of the lack of participation in trials, as discussed earlier, we don’t know about the presentation of diseases and the side effects that people of color experience. The small percentage of Black Americans that do participate in trials are often reminded by their friends and family of the injustices of the past, urging them not to participate.

How do we fix this problem? This issue is deeper than implementing policies to require more diversity, protect research participants, and ensure they have the full knowledge of the trial before going into it; all of that has already been done, and these policies have done little to increase diversity in trials. What is really needed now is to build back trust. To do this completely will take decades, but for now there are some short term plans.

To increase diversity in COVID-19 vaccine trials, pharmaceutical companies are enlisting historically Black medical schools, such as Meharry Medical College and Morehouse School of Medicine, to carry out trials. Studies have found that patients that have similar racial and ethnic backgrounds to their physicians trust their doctors more. By using this information, these predominantly black medical schools, which predominantly serve Black patients, are able to reassure their patients that the study that they are enrolling in will not repeat history.

While the effort of diversifying trials is important for COVID-19 trials, it must not end there. Many people are trying to publicize the safeguards that all studies have today, which prevent any injustices like what happened in the Tuskegee Study and in the collection of cells from Henrietta Lacks. However, this information must come from people that the patients trust. The medical community must work to rebuild trust in communities of color so that we can decrease the health inequities experienced and understand the safety of medications and vaccines for the whole population instead of just for white males.

Eugenics in Peru

Many people don’t know what the eugenics movement is. Others know what it was, but think it was restricted to Germany’s sterilization—or making people unable to reproduce—of millions of people they saw as unfit: Jews, people with mental and physical disabilities, and the LGBTQ community, among others. However, Germany was not the first or the last to sterilize certain citizens in an attempt to “better the gene pool”; the United States’ policies actually inspired Hitler’s eugenic goals. After WWII, the United States publicly condemned sterilization and eugenics, but the last forced legal sterilization in the country wasn’t until 1981.

Eugenics has operated as a science of improving humans, whereby the procreation of the people deemed fit is promoted and procreation of those deemed unfit is limited. Proponents of eugenics believe nature wins in the nature vs nurture fight; if you’re born into poverty, it’s because you have a gene that’s keeping you there. Throughout history, the groups of people that were deemed unfit were those in low socioeconomic groups, minorities, and epileptics, most of which were women—basically, the people that didn’t fit the mold. They did this under the broad and vague diagnosis of “feebleminded”.

While the sterilization of poor and minority women in the United States is over, eugenics still goes on today. There are groups of people targeted by the modern eugenics movement—one of which is indigenous people. In Peru, almost 300,000 people—mostly poor, indigenous women living in rural areas—were sterilized between 1996 and 2000. Most of these sterilizations were forced or coerced, and some even led to death.

Then President Alberto Fujimori ran on a campaign of expanding health care and lowering poverty rates. However, instead of providing contraceptives to indigenous women, doctors forced sterilizations on them. Fujimori claims that doctors that forcibly sterilized women were not following the strict regulations that were put in place to prevent these occurrences. However, many of the doctors who performed these sterilizations have revealed they were given quotas to fulfill: “Dr. Hernando Cevallos… received an order to sterilize 250 women in 4 days in 1997.”

There were many ways doctors reached their quotas. Some sent public health officials to the homes of women with large families and pressured them to be sterilized even if they wanted more kids. For example, officials visited Gloria Basilio multiple times until she finally agreed. When she changed her mind in the operating room, they restrained and blindfolded her so they could continue with the surgery. Some of these women are illiterate or don’t speak Spanish at all, so the officials took advantage of that and got them to sign the consent forms without them understanding the procedure. Other officials never tried to get informed consent. Women have been pressured to be sterilized moments after giving birth.

These women have been affected in a far greater way than just being unable to have children. One woman had serious medical complications, which were written off by the doctors. She died less than two weeks later at home. She is not the only woman to have sterilization disable or kill her.

Aside from medical complications, they also experience social and mental complications as a result. In the indigenous culture, women are expected to have many children, and women who have been sterilized can no longer serve that purpose. These women can lose a sense of purpose in themselves and also lose the people close to them who were counting on them to have children. Maria Elena Carbajal, a woman who was pressured into a sterilization after giving birth at the hospital, lost her husband because he thought she had willingly been sterilized so that she could be unfaithful without consequences. She found another partner, but he also left her because she could not provide kids. Additionally, these women have to face the fact that they will never have more children—while some will have none at all. Florentina Loayza was only 19 years old when she was forcibly sterilized. She hadn’t had kids, but she wanted some, and she often felt “a deep sadness” whenever she saw a baby.

Another profound impact this has on many women is their connection with religion. Some religions, Catholicism included, believe that sterilization is a sin and that those who have been sterilized, voluntarily or not, have sinned. Justina Rimachi was told by nuns that she could no longer come to church because she had been sterilized. The stigma felt within the walls of a place that felt like home were only relieved by the forgiveness from the priest. He did not tell her it was not her fault, but he did not tell her to leave, so she was grateful.

The crimes against these women were atrocious, and luckily, they are starting to receive attention. In November of 2000, Fujimori stepped down after ten years of presidency. It wasn’t until 2009 that he was arrested and sentenced for some of his crimes, but none of them were for the sterilizations that occurred under his regime.

Some women and their families have received settlements and the Peruvian state promised in 2003 to conduct investigations. However, the Peruvian state continues to deny that the government had a part in the forced sterilizations. They blame instead the public health officials and medical practitioners. To this day, the Peruvian government, which is no longer under the control of the Fujimori regime, has not issued apologies or reparations to the survivors and their families.

While the government continues to deny its role in the sterilization of indigenous people, activists and human rights organizations are trying to call global attention to these injustices. One group, The Quipu Project, has used a free telephone service to collect the stories of over 150 people who have been sterilized, and the number continues to grow. You can hear these stories on their website in Spanish and in English. Not only is this campaign used to bring international awareness to this issue, but these stories are also being used by people fighting for justice within Peru.

COVID-19 and Healthcare

COVID-19 has had a significant impact on the lives of billions across the globe from a disruption of our daily lives to the loss of loved ones to the severe financial burden that has been placed on the world economy. One aspect of society that has been disproportionately affected is the healthcare system. Aside from the financial impact on healthcare systems the way we receive our general healthcare is changing rapidly with this new pandemic. While our primary concern internationally is getting control of this pandemic, non-infectious and chronic conditions are still prevalent and at an increased risk of being neglected.

With the increase in COVID-19 cases in every part of the country, people are being discouraged from coming to hospitals and doctors for non-emergent care. This means that primary healthcare visits either have to be postponed or done through telehealth, which is a remote visit. While telehealth is a great way to have normal checkups without having to go to a doctor’s office, many insurance plans don’t cover telehealth, which makes it harder to afford necessary visits safely.

Additionally, many people no longer have the financial stability they used to. With the downturn in the economy, not only are people who are working making less, but there are also some that have been laid off or furloughed and no longer have access to insurance through their employer. A quarter of those that remain insured have deductibles that are $2000 or higher, which they can no longer afford. This means that in addition to postponing primary care visits, more emergent and necessary visits are being put off.

Those with chronic conditions face more barriers than before to receiving health care. Those with underlying conditions are more likely to have a severe case if they contract COVID-19. However, they need continual care that must be done at least occasionally face-to-face. For example, people with cancer must continue to receive treatment, but many times that treatment makes them immunocompromised. Because of the increased risk, many hospitals no longer allow visitors in, which can decrease patient morale. Many patients also run the risk of having their treatment delayed due to coming in contact with someone that has tested positive for Covid-19. Many chronic conditions, like cancer, are time sensitive, so delays in treatment can be devastating.

Another group of people that have had their healthcare greatly impacted by COVID-19 is pregnant women. There are many check-ups that women are recommended to attend when expecting a baby to ensure the best health possible. However, with the pandemic, that has become harder. There is no evidence that pregnancy makes it more likely to have a severe case of COVID-19. Additionally, there is no evidence that it can be transmitted to a fetus. It’s still important that pregnant women do everything they can to prevent coming in contact with COVID-19. To help in that effort, many OB/GYNs have reduced the number of visits pregnant women should attend in person, switching these visits to telehealth visits.

While a mother cannot pass COVID-19 to her unborn baby, the baby can contract it after birth from her or any other caregivers. To prevent spread to new babies, nurses, and doctors, many mothers are tested when they arrive at the hospital to give birth. Additionally, those that have scheduled C-sections are sometimes tested at home.

doctor performing a checkup on an infant — Dusti Tellez, a registered nurse at Naval Hospital (NH) Jacksonville’s maternal infant unit, holds a newborn baby for a checkup. Source: U.S. Navy, Creative Commons

According to UNICEF, around 116 million babies will be born during the COVID-19 pandemic. These babies along with the babies born shortly before the pandemic will be missing important doctor’s appointments. The appointments in the first two years of a child’s life play a large role in the child’s overall health for two reasons. First, children will typically receive vaccinations at these appointments, which will keep them from contracting deadly, but preventable diseases. The growing number of children who will not be receiving their vaccinations on time raises concerns about outbreaks of diseases that we’ve kept at bay while also still in the midst of the COVID-19 pandemic. Second, these visits are a good way to track the health of children early as screening for conditions, such as developmental delays, are frequent, and catching them early can give kids with these conditions a helpful jumpstart. Because of these two reasons, many experts advise parents to keep children’s visits up to date, but parents are still hesitant.

In addition to regular checkup visits, people are hesitant to go to the emergency room when they need to for non-COVID-19 related illnesses and emergencies. Hospital visits in the Baptist Hospital system in Memphis, TN were down 27 percent between March 15 and April 15 compared to the month before. Additionally, they noticed that the people that were coming in were more likely to have to be admitted instead of treated and sent home. This means sick people are staying at home longer for fear of COVID-19, and some are dying at home from treatable conditions.

Finally, there are areas of healthcare that are overlooked when we mention essential healthcare workers. My mother is a home health physical therapist, which means she goes to people’s homes to work with them. She mainly works with elderly people, and often visits nursing homes and assisted living facilities. According to her, these places have stricter requirements than before when it comes to letting people in: visitors have to have their temperature checked and have a symptom screening. Some facilities don’t even allow visitors anymore, even for wound care or physical therapy. While therapy might not seem essential, it is often used in this population to prevent accidents, like falls, that would send them to a hospital, where they would be even more at risk of contracting COVID-19.

While many of the changes to the healthcare system are temporary, like the decrease in general healthcare visits, some may become permanent. Telehealth has been shown to be beneficial for healthcare visits that don’t require tests and scans. In fact, many shy children have felt more comfortable with these visits. Additionally, the precautions taken by nursing homes and assisted living facilities when it comes to screening visitors make sense during flu season as the flu kills the over 65 population at a disproportionate rate. While the pandemic has changed some things for the worst, it has also helped us find where some changes need to be made to increase our safety in the future.

Coronavirus and Racism

At this point, I’m sure almost everyone knows about COVID-19. With schools shutting down, conferences being cancelled, and travel being restricted, even those in uninfected areas are affected. However, while some of us are most worried about washing our hands and not touching our faces, some people have to worry about discrimination. Those of East Asian descent are being discriminated against all over the world, whether they’re from China or not, whether they’ve been in infected areas or not, whether they’re sick or not. COVID-19 is bringing out racism that has laid dormant, and, unfortunately, this isn’t the first time it has happened.

Historically speaking—especially before the scientific knowledge we have now—large outbreaks were blamed on minority groups. In 14^th century Europe when the Black Death occurred, many looked for an answer, and when they couldn’t find an answer, they found a scapegoat: the Jews. They were seen as nonconformists by the Christian majority and were subsequently blamed for the outbreak that would be known as the Black Death. Many were tortured until they made false confessions and killed, and their persecution continued centuries later.

Since then, almost every major outbreak has illuminated underlying racism within the global community: when syphilis appeared in Renaissance Europe every country blamed another; Irish immigrants were blamed for the 1830 cholera outbreak; and Mexicans and others from Latin American countries were discriminated against during the Swine Flu epidemic in 2009.

Most recently, the Ebola outbreak of 2014 brought out racism towards those of African descent. College admission was denied to two Nigerian students to Navarro College, and a Guinean high school soccer player attending school in Nazareth, Pennsylvania was heckled by the opponent’s fans, who chanted “Ebola” at him. Americans hesitated to shake hands with people of African descent, whether they were American or not, and the US imposed a travel ban to and from West Africa.

What we are seeing now with COVID-19, is similar to what we saw during the 2003 SARS outbreak. While the Ebola outbreak illuminated prejudices towards African Americans, in 2003, those of East Asian descent, regardless of their nationality were discriminated against in certain areas. The three Chinatowns in Toronto, Canada were empty for weeks, East Asians were constantly asked if they were sick when no one else was, and they were avoided when they went out in public. In Canada, there is the stereotype of yellow peril that labels Asians as “unsanitary, lower-class, and alien.” This stereotype obviously found root in SARS and only exacerbated these prejudices.

picture of xenophobia in the dictionary — Spiritual Xenophobia. Source: George Ian Bowles, Creative Commons

Unfortunately, it seems like we haven’t learned from these numerous outbreaks, and the racism and xenophobia along with COVID-19 is way more widespread and way more violent. A man attacked an unidentified woman was attacked on the subway in New York, and reports say that the confrontation was a result of the Asian woman wearing a mask. Like in 2003, the discrimination is not restricted to people of Chinese descent: a man singled out a Thai American lady on a bus in LA. He gestured at her while saying that “every disease ever came from China.” Finally, in Indiana, two men of Asian descent were denied a room at a hotel and told that if they were Chinese, they’d be “picked up and quarantined for two weeks.” All of these attacks were before any deaths occurred in the US.

These incidents aren’t unique to the Untied States either. In London, a student from Singapore was attacked in a busy shopping area. While he was being attacked his assailants told him, “I don’t want your coronavirus in my country.” He was left with fractures on his face, and he might need reconstructive surgery.

The racism that is emerging is not new, it has just been hidden. The fear that everyone is feeling is being redirected towards previous biases. The student from Singapore reported that he had been experiencing racist comments for the entire two years he had been studying in London. Because COVID-19 originated in China, the racism already present towards those of Asian descent has been exposed, and thanks to misinformation, it continues to grow. Fear has been shown to bring out the racism that already exists within people, not cause it.

In times like these it’s important to know the facts because that’s how we fight this discriminatory fear culture: Asians are no more likely to have COVID-19 than the rest of us. No one is any more likely to get COVID-19 because of their race or ethnicity. Despite the virus originating in China, there is no evidence Chinese people or Asians are predisposed to infection. Secondly, just because someone of Asian descent is wearing a mask, it does not mean they’re sick. In many East Asian cultures, it is normal to wear a mask year-round, not just when you’re sick.

It’s important to spread the facts. One of the biggest factors in discrimination is ignorance, so education is the best way to fight it. People are scared, and that is bringing out the prejudices they’ve kept hidden and might not even know they had. Additionally, catch and correct yourself when you think or do something with prejudice. Start improving our global community by improving your own thoughts.

COVID-19 is a pandemic, and it’s a serious infection, especially for the elderly and those with preexisting health conditions. However, the racism and xenophobia are spreading just as fast. As a global community, we shouldn’t add to the burden of this disease by using it as an excuse to be discriminatory.

Water Insecurity in the United States

Access to clean water and sanitation is rarely something we have to worry about here in the United States; it comes out of faucets and water fountains at a seemingly endless supply. However, in many parts of the world—including some areas of the United States—access to clean water and sanitation is a major issue and can affect more than just people’s physical health.

In 2010, the UN recognized access to safe water and sanitation as a human right, and the issue was included among the UN’s sustainable development goals in 2015. With the UN’s focus on clean water access, many developing countries have started making efforts to increase access. However, many developed countries, like the United States, have neglected to develop their rural areas, which leaves a significant portion of their population without clean water for drinking and sanitation purposes. In fact, their situations can be similar to situations in developing countries.

Many Americans would be surprised to know that in more rural areas, it’s often not uncommon for people to go without a sophisticated sewer and water system because the infrastructure has not yet been built. In Lowndes county in Alabama, a largely rural and agricultural area, less than one fifth of the population has a safe way to dispose of their sewage waste. This issue can cause the sewage to back up into their systems or to overflow to their backyards. Neither of these outcomes are ideal for promoting health.

The people that are mainly affected by water insecurity and a lack of clean water in the United States are those that are already disadvantaged; the higher your income, the more likely it is you will have complete and adequate plumbing. This leaves those that live in lower socioeconomic areas with lower performing schools and fewer resources more likely to experience issues like inadequate plumbing and lead-contaminated water.

The systems that have the most problems are the ones that serve rural communities. When a city has a sewer issue, more people are paying for the water, so the extra cost is distributed more widely. In a rural community, there are less people to distribute the cost across, so it’s harder to come by the money to update the sewer systems. Because smaller communities have a harder time paying for necessary repairs and upgrades, the residents in these areas have to choose between drinking contaminated water or paying for bottled water.

Another issue that arises is when communities have a city water system but lack the appropriate people to run it. Some areas have no one to run their systems, while other rural sewer systems are operated by volunteers. In Kanawha Falls, West Virginia, a resident was elected to clean the water, but failed to test and report the water, and the state threatened to arrest him. Scotts Mills, Oregon cannot afford to hire workers for the water system, so they rely on volunteers and community reports of smells to know when work needs to be done.

Because some systems don’t have the staff and infrastructure to test regularly, many don’t realize their water is contaminated until they experience an adverse health outcome. For example, in Kanawha Falls, cited 2 thousand times over ten years for not testing and reporting water quality, a man who had skull surgery got two infections from the contaminated water. He now has to keep his head covered when he showers.

These problems aren’t exclusively in rural areas; lower-income areas—typically those in minority communities—also experience these problems. The most famous example is the lead poisoning in Flint, Michigan, where 62.6% of the population is a racial or ethnic minority. At one point, the lead levels—caused by improperly treated water corroding pipes—were almost three times past being considered hazardous waste. While the lead contamination was discovered in 2015, Flint is still dealing with these issues today. The lead’s effect on the community of Flint was enormous: children came down with a rash and mysterious illness; experts believe that lead was responsible for 198 to 276 fetal deaths; and twice as many children were diagnosed with lead-poisoned blood than before.

Flint is not the only area that has experienced issues like this, and Flint is not the only community at risk. Using income information and housing age, Vox and the Washington State Department of Health created a map to show what areas are more susceptible to lead poisoning. They also take the potential of lead paint into account, but the map shows that the at-risk areas are mainly cities, especially those that used to be industrial areas. Looking at the cities I know—Birmingham and Chattanooga—I can tell the areas at the highest risk are those that have a large minority population.

Water insecurity affects people’s mental health as well. Those that have less access to clean water experience more emotional distress. One thing many people, especially in urban areas, count on is easy access to water from their taps. However, when that easy access turns out to be harmful, like it is in Flint, anxiety and worry can rise. Parents that unknowingly gave their children contaminated water may feel guilt even though they didn’t intentionally give their children toxic water. In Flint specifically, levels of fear and anxiety were at an all-time high following the news of the contamination. In 2016, there were reports of parents coming to the ER with water-related breakdowns; many were distressed over the health of their children.

In areas where there’s a lack of water altogether, people can face similar issues. A lack of access to water—whether it be a loss of water through drought or a lack of water to begin with—has been connected to decreased mental health. Those in areas that are water insecure may experience anxiety, water-related emotional distress, and insomnia, among other symptoms. Additionally, the effects of dehydration play a role in mental health. Dehydration has been linked to increased stress, anxiety, depression, and panic attacks. Those facing water insecurity are more likely to become dehydrated, so these symptoms should not be taken likely.

Water insecurity and lack of clean water access disproportionately affect minorities and rural populations. This means these already disadvantaged groups are more likely to experience the adverse effects. Clean water access is considered a human right, but even here in the United States there are people suffering from a lack of clean water.

The Global Waste Trade

While the United States’ recycling numbers are nowhere near the highest, as a country, we continue to recycle more and more each year. Many people are able to send items for recycling from their home, which has made it easier for the average person to recycle. However, most people don’t know where their recycling is going after it leaves their house. Ideally, it goes to be sorted and then is sent to be recycled, but that is not always the case.

Before China’s foreign waste ban began in 2018, the United States sent over 70 percent of its plastic waste to China to be recycled, which China used to fuel its manufacturing sector. Because of the profit they made and their environmental regulations, they were able to cheaply take contaminated plastic and sort it. However, as China has moved away from manufacturing and sorting through contaminated plastic has become less profitable, they have less of a need for the recycling. Since they have stopped accepting foreign recyclables, recycling has become immensely harder for the countries who relied on China for a consistent way to affordably recycle plastic waste.

China bought so much of the United States’ recyclable waste that we never created the infrastructure to recycle all of the waste we create, so when China stopped accepting our recyclables, those in charge of recycling had to figure out where to send it. Much of this waste ends up in a landfill instead of going to a recycling plant.

Additionally, the Chinese recyclers needed to figure out what they were going to do after they would lose the majority of their business as well. Some liquidated their assets, hoping to make a final profit on decades of hard work, while others decided to take their services to other areas, often illegally. These illegal recyclers set up in countries where they are able to hire workers cheaply and can take contaminated shipments because the government can’t track their work like it can a recycling plant that is set up legally. This means they are able to pay more and still make a profit, which attracts countries like the United States and the UK.

Many countries in southeast Asia, like Malaysia, have been affected by schemes like this. When the US could no longer send their waste to China, we almost tripled our exports to Malaysia. With the growing market, many illegal recyclers have been able to fly under the radar. They edge out legal recycling plants by paying more for the recycling and taking highly contaminated plastics, about 70 percent of the which is unable to be recycled, is burned or discarded to pollute the nearby areas.

The increasing number of illegal recyclers is taking a toll on the environment and the people living near illegal recycling plants. Illegal recyclers don’t have to properly clean contaminated water sources, which can affect nearby villages water sources. While legal recyclers have to pay to properly dispose of unrecyclable plastic, illegal recyclers can dispose of the unrecyclable waste easily and cheaply by burning it. This releases toxic chemicals into the air, which can make people in nearby villages sick. In Jenjarom, Malaysia, residents “began suffering en masse from headaches, respiratory problems, skin allergies and other ailments.” Additionally, the fires that are meant to burn the plastic often are not monitored and can become uncontrollable very quickly. They are extremely difficult to extinguish and can be dangerous to firefighting crews as many don’t wear masks.

Even those that are set up legally have been found to not follow regulations. Within the first year of the Chinese plastic ban and Malaysia’s new government, over 100 recycling companies lost their permits to import plastic waste because they didn’t follow regulations. They were able to reapply for permits after three months.

Because of these issues, the top three importers of plastic waste—Malaysia, Thailand, and Vietnam—have temporarily banned plastic waste imports, and all three are also working towards a permanent plastic ban. Developed countries, such as the United States and the UK, will have to figure out how to properly dispose of their plastic waste in an environmentally friendly way.

The blame is not all on illegal recyclers; companies from developed countries, in an effort to save money, send contaminated plastics to illegal recyclers without vetting them. These exporters have an “out of sight, out of mind” mentality that is damaging our global ecosystem. The American citizens—along with citizens of other developed countries—believe their recyclables are being recycled, while instead they are being sent to illegal recyclers that are further damaging the environment.

The international waste trade cannot feasibly continue like this. Norway’s proposed solution was to add plastic waste to the Basel Convention, which would impose more regulations on its trade. Since being added to the Basel Convention in May of 2019, plastic waste could not be sent to countries that aren’t a part of the convention. This ensures that plastic is not being sent to countries that do not have the infrastructure to properly recycle or dispose of it. Additionally, it would add more transparency to the trade deals; citizens of the exporting countries would know where their recycling is going. One downside to adding plastic waste to the Basel Convention is that not every developed country that exports plastic waste is a part of it: most notably the United States.

Another solution proposed has been to transition from a linear economy to a circular economy. In a linear economy, which is what most countries are a part of, a material is made, used, and the disposed of. In a circular economy, materials go through a cycle, and as little as possible is disposed of. A transition such as this one would not be easy, but it might be necessary to maintain our level of consumption.

China’s plastic ban brought to light just how much plastic we use and discard—not only for the importing countries like Malaysia, but also for the exporting countries. Part of the problem is our level of consumption, but another huge issue is the lack of transparency surrounding how our plastic is recycled. It is not enough to place our plastic waste in a recycling bin and expect it to be recycled; as consumers of plastic waste, we must demand that those exporting our recyclables are being honest about where it’s going.