Category: Human Rights Issues

Human Rights in the Appalachian Region of the United States of America: an introduction

People living in the Appalachian region of the United States have been victims of a number of failures to protect their basic human rights since at least the nineteenth century. As a result, in nearly every measurable socioeconomic category, the Appalachian region lags behind the rest of the United States in development, or even shows signs of decline. This, in combination with their remoteness and social isolation, has led to a remarkably divided society evidenced over the last hundred or so years. Outdated and incorrect perceptions of the Appalachian people have led to antagonism and a struggle to implement democratic institutions that protect some of America’s most vulnerable populations.

The Appalachian mountains in the Eastern United States extend across thirteen states and are home to over twenty-five million people. Appalachia struggles with problems typical of rural poverty: social stratification, unemployment, lack of social services, poor education, and poorly developed infrastructure. The Appalachian region, and its perceived separateness from the rest of the Eastern and Southern United States, is especially relevant in contemporary times of remarkable social division. Healthcare disparities, income inequality, and extensive exploitation of Appalachian communities by outside corporations have all contributed to distrust and frustration among their inhabitants. In the late 19th and early 20th centuries, a large number of Appalachians sold their rights to land and minerals, leading to a massive disparity in ownership and control of the land. Ninety-nine percent of the residents of Appalachia control less than half of the land — despite the area’s vast natural resources, inhabitants remain poor (Hurst).

The Appalachian region has had a higher poverty rate and a higher percentage of working poor than the rest of the nation since at least the 1960s, in addition to low wages, low employment rates, and low-quality education. To address this, the Appalachian Regional Commission (ARC) was established in 1965, as a joint effort of ten governors of Appalachian states seeking federal government assistance. Still, by 1999, nearly twenty-five percent of the four-hundred twenty counties in the region qualified as “distressed”, the ARC’s lowest status ranking. Fifty-seven percent of adults in central Appalachia did not graduate high school, compared to less than twenty-percent for the rest of the United States. According to ARC, thirty-three percent of Appalachians suffer from poverty and their income was twenty-three percent lower on average than the level of American per capita income. There has been some improvement, however, with levels of economic distress reaching lows not seen since before the recession in 2007 (ARC.gov).

graph of distressed counties in appalachia
Number of distressed counties in Appalachia by year

In addition to economic inequalities, political inequalities are present in Appalachia. Racial divisions have often been stoked to divide workers and pit races against each other. During Reconstruction, the period after the American Civil War in which Southern states were radically reformed, coal corporations discouraged education and civic action, forcing workers to become indebted to company stores, live in company housing, and generally become vulnerable to their employers. Community members regularly experienced punishment as a reprisal for speaking out against their employers. In his study of culture and poverty in Appalachia, Dwight Billings suggests that this has resulted in a fatalistic attitude in the Appalachian people, based on a history of political corruption and disenfranchisement, leading to a sense of powerlessness.

The plight of the Appalachian people is deeply ingrained in me and will remain always of academic and personal interest. My own paternal kin originally settled in the Appalachian Mountains in North Carolina after arriving in America. As far as we can tell, my ancestors passed through the Cumberland Gap in the mid-eighteen-hundreds or earlier, finally homesteading in the foothills of the Appalachian Mountains on Sand Mountain, in northeast Alabama. On the other side of my family, my maternal ancestors shared many of the same challenges living as sharecroppers and later as miners in north-central Alabama. Eventually, both sides of my family came to work in blue-collar industrial jobs in mining and steel-work, industries that would become encumbered by the same failures, oppression, and corruption that were endemic in their Appalachian cousins.  My great-grandfathers and my paternal grandfather were heavily involved in the labor movement in the American South and leaders of rights-protecting unions, such as the United Mine Workers of America and United Steelworkers, even as those same unions fell into disorder and ineffectiveness.

My research has indicated that one of the best ways we could better protect workers and their human rights would be to focus on the renewal of unions in the Southern and Appalachian Regions of the United States. Unions have been shown to raise wages, reduce wage inequality, and protect rights for workers. Higher rates of unionization and collective action generally tends to be an indicator for greater respect of human rights in industry. After declining membership from its peak in 1954, a once-thriving union movement had shrunk to nearly a third of its size by the turn of the 21st century.

graph of union membership
Union membership in the US, 1930-2010.

Corresponding with this drop in membership, middle class incomes shrank accordingly. The Labor Department did report the first increase in union memberships in twenty-five years in 2007, which was also the largest increase since 1979, but it appears that this was a short-term gain in the larger scheme of things. Taking a broader look shows that from 1983, union membership has been on a steady decline.

chart of union membership
Union membership by category, 1983-2018

One silver lining is that there seems to be a slight turning of the tide among women and Black people, whose membership in unions is stabilizing at least, if not increasing slightly. If unions are meant to preserve and protect the rights of workers, it should inspire some optimism that some of the most vulnerable workers, BIPOC and women, are seemingly joining unions at higher rates than other demographics.

In a series of blog posts for the Institute for Human Rights, I will explore some of these challenges with which the Appalachian region are faced — workers’ rights challenges and the possibility of renewal for unions, socioeconomic disparity and the ensuing human rights failures in the region, and the political inequalities that are especially present in the region. In my next post, I will tell the story of the Battle of Blair Mountain, and describe the ways corporations have exploited workers and prevented unionization in the past. We will analyze how these barriers affect workers’ rights in some of the most vulnerable populations in America.

References:

  1. Hurst, Charles. (1992). Inequality in Appalachia. Social Inequality: Forms, Causes, and Consequences, 6th Edition. Pearson Education. pp 62-63.
  2. Speer, Jean Haskell (January 1, 2010). “Appalachian Regional Commission”. Tennessee Encyclopedia of History and Culture. Nashville: Tennessee Historical Society and University of Tennessee Press.
  3. Denham, Sharon. Mande, Man. Meyer, Michael. Toborg, Mary. (2004). Providing Health Education to Appalachia Populations. Holistic Nursing Practices 2{X)4:I8(6):293-3O1.
  4. “ARC History”. Arc.gov. Appalachian Regional Commission. Retrieved July 12, 2020.
  5. Duncan, Cynthia Mildred. (1999). Civic Life in Gray Mountain. Connection: New England’s Journal of Higher Education & Economic Development, Vol. 14, Issue 2, Retrieved July 12, 2020.
  6. Billings, Dwight. (1974). Culture and Poverty in Appalachia: a Theoretical Discussion and Empirical Analysis. Social Forces vol. 53:2. Retrieved July 12, 2020.
  7. Madland, Walter, and Bunker, “As Union Membership Rates Decrease, Middle Class Incomes Shrink.”, AFL-CIO, May 24, 2013.
  8. Freeman, Sholnn (January 26, 2008). “Union membership up slightly in 2007; Growth was biggest in Western states; Midwest rolls shrank with job losses”. The Washington Post. p. D2

Is Internet Access a Human Right?

Introduction

My sister is in middle school.

She is in VIRTUAL middle school, spending almost all her time in her room physically and mentally connected to her computer for more than five hours a day, Monday to Friday.

Two weeks ago, our family received a voucher in the mail giving us the chance to receive internet service for free until December 30th, 2020. The vouchers come from a program known as the Alabama Broadband Connectivity (ABC) for Students. The goal for this program is to provide “Broadband for Every K-12 Student.” ABC uses money from the Coronavirus Aid, Relief, and Economic Security (CARES) Act directed to Alabama ($100 million) in order to cover the costs of “installation, equipment, and monthly service” to all students “who receive free or reduced-price lunches at school.” Families who earn less than 185% of the federal poverty level ($48,470) are those considered eligible for the vouchers, including 450,000 children enrolled in the National School Lunch Program.

Which brings me to the topic of this blog post: Internet Access, and why it is so important given this day and age.

Now, I know what you might be thinking, “Yes, the coronavirus is still a major issue among governments today, and since people cannot really gather outside in large groups, the internet is the next best option. That’s why it is so important to have access to it.” Great, at least you understood that part, but what if I told you that there are governments around the world shutting down the internet, from India to Russia and even countries like Indonesia, in the attempt to resolve their problems?

Shocking right? I would personally think so.

But before we talk about Internet Access as a potential human right, let us talk about some of the things that we take for granted when we have internet access.

An image of a world map in blue showing lines representing connectivity across countries.
2015 Global Connectivity Index. Source: geobrava.wordpress.com. Creative Commons

How do we benefit from being online?

Instant Communication

    • We often tend to talk to others by text, rather than face-to-face. Texting allows people to communicate in speeds never thought possible in the past, which leads to an eventual disconnect in establishing a fully personal connection that people would have if they interacted in person.

Homework

    • Especially during these times, we need the internet in order to complete our homework, and not having that access most definitely leads to an inability to do work as efficiently as if we had access to the World Wide Web.

Yes, even the Weather

    • How many people check the weather before leaving their homes? Checking the weather resides among the most popular search terms, which makes sense, as people need it to avoid downpours and be prepared to any eventual changes in plans.

Opinions against Internet Access being a Human Rights

Reflecting on the above benefits really does help broaden one’s vision in understanding how connecting to google.com or other web sites is essential to the daily happenings of our lives. It makes sense to simply call access to the internet a human right because of the way most of us use the internet to live our lives more efficiently.

Well, before we explore the arguments why Internet Access should be a human right, let us look at two perspectives to the contrary, an NYT op-ed by Vinton Cerf, an “Internet pioneer and [who] is recognized as one of ‘the fathers of the Internet,'” and a statement by Commissioner Michael O’Rielly of the Federal Communications Commission.

According to Cerf, for something to be considered a human right, it “must be among the things we as humans need in order to lead healthy, meaningful lives,” In that end, he argues that access to the Internet should be an enabler of rights, but not a right itself.

“It is a mistake to place any particular technology in this exalted category (of human rights), since over time we will end up valuing the wrong things.” — Vinton Cerf

He then attempts to clarify the lines at which human rights and civil rights should be drawn, concluding his op-ed with an understanding that access is simply a means “to improve the human condition.” Granting and ensuring human rights should utilize the internet, not make access the human right itself.

While Cerf seems to believe that the internet is a necessity for people but not a human right, O’Rielly believes otherwise, making it neither a necessity nor a human right.

In a speech before the Internet Innovation Alliance in 2015, Michael O’Rielly introduces his guiding principles with a personal anecdote about his life, emphasizing the impact that technology has given him, even going so far as to claim it as “one of the greatest loves of [his] life, besides [his] wife.” Despite this personal love for technology, one of his governing principles is to clarify what he believes the term ‘necessity’ truly means. He claims that it is unreasonable to even consider access to the internet as a human right or a necessity, as people can live and function without the presence of technology.

“Instead, the term ‘necessity’ should be reserved to those items that humans cannot live without, such as food, shelter, and water.” — Michael O’Rielly

O’Rielly attempts to make the distinction between the true sense of the word ‘necessity’ and ‘human rights,’ trying to defend against “rhetorical traps” created by movements towards making Internet Access a human right. These definitions are the basis of his governing principles and how he attempts to create Internet policies with the government and ISPs (Internet Service Providers).

Opinions for Internet Access being a Human Right

One of the interesting things to note above is the distinction made between one’s need for Internet Access and its categorization into a human right. Today, many if not all businesses require the usage of the Internet, going so far as to purely rely on its presence for regular business transactions and practices to occur. This understanding of the importance of the internet is prevalent now more than ever. The onset of COVID-19 has forced businesses to shut their physical door, allowed for increased traffic of online e-commerce sites like Amazon, and pushed kids towards utilizing platforms like Zoom, Microsoft Teams, and Google Meet as substitutes for attending school. As such, these next few paragraphs will discuss why Internet Access is, in fact, a human right.

Violations to internet access are prevalent around the world, ranging from countries like India and Sri Lanka to others like Iran and Russia, aiming to either curb resistance or reduce potential sparks of violence. In India, for example, the government had shut down access to the Internet for Indian-administered Kashmir, an action that brought the condemnation of UN special rapporteurs, where the regions of Jammu and Kashmir experienced a “near total communications blackout, with internet access, mobile phone networks, and cable cut off.” In Sri Lanka, only specific applications are blocked by the authorities, while Iran works to slow “internet speeds to a crawl.” The internet system in Russia allows for it to seem like it functions while no data is sent to servers. These systems aim to restrict journalists from spreading news about violations of human rights while also limiting people’s ability to freely express themselves.

The Wi-Fi symbol, with a cross through it.
Offline Logo. Source: Wikmedia Commons. Creative Commons.

This attempt to curb the spread of information also violates Article 19 of the Universal Declaration of Human Rights, of which India and Iran voted in favor, the Soviet Union abstained, and Sri Lanka was nonexistent during its passage (accepted by the General Assembly in 1948).

“Everyone has the right to freedom of opinion and expression; this right includes freedom to hold opinions without interference and to seek, receive and impart information and ideas through any media regardless of frontiers.” — Article 19 of the Universal Declaration of Human Rights

Conclusion

There seems to be a fundamental agreement from many experts ranging from the United Nations to organizations like Internet.org that aim to connect people with others around the world, that Internet Access should become, or already is, a basic human right. Although arguments are made that the internet allows for freedom of speech and enable other rights to exist, accessibility to that medium of communication and connection should be guaranteed as food or water. Although the internet is not needed for physical survival, the internet is a requirement for advancement and productivity in life.

Which brings me back to the first point made. I am thankful to have a family and live in a home where I can access information and write blog posts about human rights all around the world. What about those living within my city, my state, the United States, or even Planet Earth who do not have that access to the Internet? What about people that cannot connect with people miles away from them, or people who cannot receive an education due to the environmental factors that affect us now.

Access to the internet is a critically important task that governments, local, state, and federal, all need to act upon in order for a successful and growing economy, not just for current businesses and enterprises, but for the future leaders of our country. It is during these trying times that disparities and inequities are revealed, and those in power must be held accountable for a connected and thriving population to exist.

An image of a man in a blue suit holding a tablet with a hologram of the world map shining above.
Source: PickPik. Creative Commons.

If you would like to learn more about Internet Equality and the case for Net Neutrality, I encourage you to read my previous blog post “Internet Equality: A Human Rights Issue?”

Beirut Port Explosion: How Government Neglect and Corruption Have Caused Human Rights Abuses in Lebanon

The recent explosion of the port in Beirut, Lebanon has garnered widespread international attention. While it is still unknown what caused this explosion, two things are known: explosive material had been stored there for years, and the Lebanese government was aware of this fact. For many years now, both government corruption and negligence have been causing human rights abuses felt across all Lebanon, so the explosion in Beirut, while one of the deadliest manifestations of this corruption and negligence, is no anomaly.

An image showing the aftermath of the explosion at the port in Beirut, Lebanon
The Aftermath of the Port Explosion in Beirut, Lebanon. Source: Yahoo Images, Creative Commons.

The Lebanese Government

To understand the culture and politics of Lebanon, it is important to understand the way the Lebanese government is set up. When Lebanon first gained independence, the government was divided up so that the several religions in the country would be represented in the government. To do this, it was decided that the President would be a Maronite Christian, the Speaker of the Parliament would be a Shia Muslim, and the Prime Minister would be a Sunni Muslim. In principle, this was a good way of ensuring political representation for each group. However, many problems have occurred because of this. Today, each religious group defends their own government representatives without holding them accountable for their corruption and negligence, and instead blame other groups’ politicians and representatives when problems arise in Lebanon. This has not only allowed for corruption to go unchecked, but it has also caused the divisiveness and sectarian conflict that has become characteristic of Lebanese society.

Government Corruption

While the extent of government corruption has been mostly speculative, an accusation leveled against one of the top politicians in Lebanon last fall seemed to confirm many Lebanese citizens’ suspicions about Lebanese politicians’ corruption. The politician in question is Najib Mikati, previous Prime Minister of Lebanon. Mikati is Lebanon’s richest man, with an estimated net worth of $2.5 billion. Many people have alleged that this accumulation of wealth could only have been the product of illegal activity, and this allegation seemed to be confirmed in October 2019, when a prosecutor pressed charges against Mikati, accusing him and his family of stealing millions of dollars that were meant to be used as housing loans for low and middle-income Lebanese citizens. Despite the fact that Mikati denied this accusation and it has yet to be shown to be true, the accusation was enough to gain traction among the citizens of Lebanon, who used this as conclusive proof of widespread government corruption. While this is only one instance, most of the politicians in Lebanon are millionaires, which leads many to believe that all are involved in some form of corruption.

Economic Decline and Revolution of 2019

While government corruption is in and of itself a problem, this corruption has also had negative ramifications on the economy; it has been argued that it is the primary cause of the steep decline in Lebanon’s economy. In 2018, economic growth for Lebanon was just 0.2 percent, with a 30 percent unemployment rate for youth, and due to these conditions, citizens of Lebanon were becoming increasingly critical of the quality of life in Lebanon, with many explicitly blaming politicians. In an attempt to improve the economy, Lebanese politicians began imposing taxes on many different commodities. While this angered many people, the revolution of 2019 did not begin until the government imposed a tax on WhatsApp, a free messaging service popular in the Middle East. It must be understood that the revolution was not just about the WhatsApp tax, as this was merely one of many contributing factors. In reality, much of the anger that spurred the revolution was due to both the dire conditions in Lebanon and the Lebanese government’s decision to place the burden of fixing the economy on the citizens, despite the fact that the politicians’ own corruption is what has led Lebanon to the brink of collapse.

An image showing protesters in Beirut, Lebanon
The 2019 Lebanese Revolution. Source: Yahoo Images, Creative Commons.

Coronavirus Impact

While government corruption is to blame for the bleak conditions in Lebanon, the coronavirus has only further exacerbated these issues. Since the first outbreak in Lebanon, there have been several lockdowns, all of which have negatively impacted the economy. The most damaging impact has been the devaluing of the Lebanese Pound, which was already losing much of its value before the pandemic, but has now lost over 75 percent of its value. The devaluing of the currency not only bears negative consequences on the health of the Lebanese economy as a whole, but it has also made it impossible for many in Lebanon to afford basic necessities. As a result of the devaluing of the currency, prices of medicine, food, and rent have all increased exponentially, nearly 40 percent of the population has been pushed below the poverty line, and almost one million people have insufficient access to food.

Explosion of the Port of Beirut

On August 4, 2,750 tonnes of explosive material improperly stored at the port of Beirut exploded, completely destroying the port and surrounding areas. Until today, it is unknown what caused the explosion, but it has since been revealed that the government was warned about this material almost six years ago and were even warned by security officials to remove the material a few weeks before the explosion. The fact that the government initially stored 2,750 tonnes of explosive material near a residential area and for years ignored warnings to confiscate this material attests to the level of negligence that the government has towards its citizens and its country. To say that the government’s negligence has devastated Beirut would be an understatement; at least 171 people have died, thousands are injured, and over 300,000 are now homeless. Since the explosion, the Prime Minster has resigned, protesters have returned to the streets, and Lebanese citizens are now determined to see the fall of the government. There are many uncertainties in the aftermath of this explosion, but one thing is certain for most, if not all, Lebanese people: the Lebanese government is solely to blame for this tragedy.

Due to government corruption and negligence, Lebanon has been slowly moving towards total collapse. As the country reels further into political, social, and economic unrest, the people of Lebanon have become more and more convinced that the government is not concerned with either their protection or livelihood. However, this is not the first time the Lebanese people have suffered at the hands of their government, and for this reason, voices of resilience and hope are ringing through the streets of Lebanon; just as the people of Lebanon have overcome other hardships before, they have a conviction that they too will overcome this. As a testament to this, many Lebanese people have been calling Beirut a phoenix, for despite the destruction caused by the explosion, the citizens of Lebanon believe that Beirut will rise from the ashes.

Mounting Peril: COVID-19 in Mexico

As the novel coronavirus (COVID-19) expands throughout the United States (U.S.), its impact has rapidly reached vulnerable communities south of the border. As the 10th most populous country in the world, Mexico is beginning to experience an influx in COVID-19 cases and, especially, deaths which has exacerbated many inequalities throughout the country. This blog addresses Mexico’s relevance in the COVID-19 pandemic and how it has influenced human rights issues concerning gender-based violence, indigenous peoples, organized crime, and immigration.

As of late-August, approximately 580,000 Mexicans have been diagnosed with COVID-19, while over 62,000 have died from the virus. Mexico’s capital of Mexico City is currently the country’s epicenter with over 95,000 confirmed cases of COVID-19. North of the capital, Guanajuato is nearing 30,000 confirmed cases as the second-largest hotspot, while the northern border state of Nuevo León has nearly 28,000 confirmed cases. Additionally, on the Gulf side, Tabasco and Veracruz are each nearing 28,000 cases of COVID-19. Interestingly, the southern border state of Chiapas, which has a large indigenous population, presumably has the lowest death rate (<1 death per 100,000 cases) which ignites concern about access to COVID-19 resources throughout this treacherous nation.

Gender-Based Violence

Mexico is on track to set an annual record for number of homicides since national statistics were first recorded in 1997. Femicide, which is the murder of women and girls due to their gender, has increased by over 30%. In the first half of 2020, there were 489 recorded femicides throughout Mexico. Much of this violence is attributed to the increased confinement of families since the arrival of COVID-19. For Mexican women, these atrocities are often the result of domestic abuse and drug gang activity which have both been on the rise. Regardless of how and why these acts are committed, it is plain to see that the vulnerability of women in Mexico has been exacerbated during the COVID-19 pandemic.

Mexico’s President, Andrés Manuel López Obrador (often referred to as AMLO), has been notorious for downplaying the country’s proliferation of gender-based violence. Despite an 80% increase in shelter calls and 50% increase in shelter admittance by women and children since the start of the pandemic, AMLO has insisted 90% of domestic violence calls have been “false”. As part of the COVID-19 austerity response, AMLO has slashed funds for women’s shelters and audaciously reduced the budget of the National Institute of Women by 75%. This all comes after the country’s largest ever women’s strike back in March, which AMLO suggested was a right-wing plot designed to compromise his presidency. AMLO has consistently scapegoated a loss in family “values” as the reason for the country’s endless failures while he promotes fiscal austerity during a global crisis.

Indigenous Peoples of Mexico

In Mexico’s poorest state, Chiapas, many indigenous peoples are skeptical about the COVID-19 pandemic. This is largely attributed to their constant mistrust of the Mexican government which views state power as an enemy of the people. As such, conspiracies have emerged such as medical personnel killing people at hospitals and anti-dengue spray spreading COVID-19, the latter inspiring some indigenous peoples to burn several vehicles and attack the home of local authorities. Nevertheless, Mexico has confirmed over 4,000 cases and 600 deaths of indigenous peoples throughout the country. The Pan American Health Organization (PAHO) suggests fostering better relationships with traditional practitioners can help limit the spread of COVID-19 in indigenous populations. Additionally, community surveillance efforts and communication through local language, symbols, and images will better protect Mexico’s indigenous populations.

Recently, 15 people at a COVID-19 checkpoint in the indigenous municipality of Huazantlán del Río, Oaxaca were ambushed and murdered. The victims were attacked after holding a protest over a local proposed wind farm, while the perpetrators are presumed to be members of the Gualterio Escandón crime organization, which aims to control the region to traffic undocumented immigrants and store stolen fuel. In 2012, members of the Ikoots indigenous group blocked construction of this area because they claimed it would undermine their rights to subsistence. This unprecedented event has garnered national attention from AMLO and the National Human Rights Commission (CNDH) as they seek to initiate a thorough investigation. As demonstrated, existing land disputes have been further complicated by the presence of COVID-19 and have thus drawn Mexico’s indigenous peoples into a corner of urgency.

Organized Crime

Over the past 50 years, more than 73,000 people have been reported missing throughout Mexico, although 71,000 of these cases have occurred since 2006. Frequently targeted groups are men ages 18-25 who likely have a connection with organized crime and women ages 12-18 who are likely forced in sex trafficking. This proliferation in missing persons is largely attributed to the uptick in organized crime and drug traffic-related violence that has plagued the country. Searches for missing persons have been stalled since the arrival of COVID-19 which counters the federal government’s accountability, namely AMLO’s campaign promise to find missing persons. AMLO insists that the government countering the drug cartels with violence, like Mexico’s past administrations, is not the answer. However, many analysts argue his intelligence-based approach has emboldened criminal groups, namely with homicides, during the COVID-19 pandemic.

On the other hand, with many Mexicans unable to work and put food on the table, drug cartels are stepping up to fill the void. The Sinaloa cartel, which is one of Mexico’s largest criminal groups and suppliers of Fentanyl and heroin, has been using their safe houses to assemble aid packages marked with the notorious Joaquín “El Chapo” Guzmán’s liking. Although this tactic has long been used by the drug cartels to grow local support, the COVID-19 pandemic has served as an opportunity to further use impoverished Mexicans as a social shield. These acts of ‘narco-philanthropy’, which is one of the many weapons employed by the drug cartels, has enraged AMLO who has relentlessly defended his administration’s response to COVID-19. This irony reveals how growing incompetence from Mexico’s government has left its people vulnerable to not only the pandemic of a generation but more drug cartel activity.

Immigration

With the U.S. government extending its border closures into late-August, tensions mount for the migrants who seek a better life in the U.S. In addition, with a growing number of COVID-19 cases in Arizona, California, and Texas, governors from Mexico’s northern border states have demonstrated reluctance to let Americans enter the country. These reciprocal efforts have made it exceedingly difficult for migrants, namely from Haiti, to seek asylum. As a result, the Mexico-U.S. border town of Tijuana has become a stalemate for 4,000 Haitian migrants in addition to another 4,000-5,000 in the Guatemala-Mexico border town of Tapachula. This has contributed to an economic crisis where there is no work available and people face the risk of being promptly deported, effectively nullifying their treacherous journey to Mexico.

Many undocumented migrants are afraid to visit Mexico’s hospitals due to fears of being detained which would introduce harsh living conditions that put them at greater risk of COVID-19. Across from Brownsville, Texas, in the Matamoros tent encampment, aggressive isolation efforts were enacted after it was discovered that a deported Mexican citizen had COVID-19. To curtail to risk of COVID-19, the mostly asylum seekers are now expected to sleep only three-feet apart, head-to-toe. On the other hand, some Mexican nationals are crossing the Mexico-U.S. border into El Paso, in addition to Southern California, under the travel restrictions loophole pertaining to medical needs. This influx is largely attributed to the lack of resources, such as oxygen and physical space, seen in many Mexican hospitals. As such, COVID-19 resource limitations are endured by both asylum seekers and medical migrants.

Woman sitting in front of a poster that includes pictures of femicide victims.
DRG Photo Contest Winner. Source: USAID U.S. Agency for International Development, Creative Commons.

Human Rights in Mexico

As shown, issues notoriously attached to Mexico, namely femicide, indigenous autonomy, organized crime, and immigration, have been further complicated by the COVID-19 pandemic. Femicide has grown due to a culture of misogyny that has proliferated during the lockdown. Indigenous communities have developed more distrust for the federal government, particularly as it relates to public health and land rights. Organized crime groups have extended their reign of terror on the Mexican people by weaponizing the effects of COVID-19. Immigrants, mainly from Central America and the Caribbean, are not only running from their dreadful past but also face the challenging prospects of a world with COVID-19.

As a global influence, Mexico fosters the responsibility to uphold international standards related to women’s rights, indigenous rights, and immigrant rights. Despite each of these issues having their own unique human rights prescription, they could all be improved by a more responsive government. This has rarely been the case for AMLO who has consistently minimized the urgency, and sometimes existence, of human rights issues in Mexico. Furthermore, austerity measures provoked by COVID-19 should not come at the expense of Mexico’s most vulnerable populations because they exacerbate existing inequalities and serve as a basis for future conflict, insecurity, and violence. One of the most important ways the Mexican government can limit these inequalities is by properly addressing the war on drugs which includes closing institutional grey areas that foster crime, strengthening law enforcement, and ensuring policies carry over into future administrations. All the while, the U.S. must address its role in Mexico’s drug and arms trade. Confronting these growing concerns from both sides of border is the only way Mexico while encounter a peaceful, prosperous future.

Republic At Risk: COVID-19 in India

While the novel coronavirus (COVID-19) has impacted almost every corner of the globe, parts of Asia are still just beginning to see the systemic effects of the pandemic. As the second most populous country in the world, India has experienced a rise in COVID-19 cases and deaths which magnify current injustices across the country. This blog addresses India’s importance within the COVID-19 pandemic and its relationship with human rights issues concerning feeble governance, police brutality, migrant displacement, and Islamophobia.

As of late-July, over 1.4 million Indians have been diagnosed with COVID-19, while over 32,000 have died from the virus. India’s western state of Maharashtra is currently the country’s epicenter with over 375,000 confirmed cases of COVID-19. On the southern coastline, the state of Tamil Nadu has the country’s second-largest number of confirmed cases (210,000+), while the capital territory of Delhi in the northwest has recently exceeded 130,000 confirmed cases. Additionally, the southeastern state of Andhra Pradesh has confirmed over 95,000 cases of COVID-19. Interestingly, India’s most populous state, Uttar Pradesh, has only confirmed just over 65,000 cases which triggers questions about access to COVID-19 testing and essential resources throughout the country.

A National Lockdown

In late-March, the Indian government issued a nationwide lockdown that lasted two months. Inconveniently, the country’s 1.3 billion inhabitants were given less than a 4-hour notice of this initial 3-week lockdown. The effects of this tall order were apparent on day one since so many people throughout the country live on a daily wage or in extreme poverty. As food supply chains became compromised and manufacturing facilities closed, the country’s unemployment rate reached a 30-year low. All the while, facilities such as schools and train coaches have been converted into quarantine centers. These attempts have seemingly delayed the inevitable spike of COVID-19 cases. However, it is speculated that the low number of confirmed cases is the result of low testing rates.

This outcome has been attributed to lax contact tracing, stringent bureaucracy, and inadequate health service coordination, namely in Delhi where cases have recently surged. However, as India reopens, the number of confirmed COVID-19 cases has increased. Additionally, the introduction of newly-approved antigen kits have allowed for rapid diagnostic testing, although testing is not to be distributed proportionately. More specifically, family members and neighbors of people who have tested positive for COVID-19 claim they are not being tested. Also, in several instances, the family members of people who have tested positive for COVID-19 were not being informed about their loved one’s diagnosis. After much scrutiny, however, local health authorities in Delhi have attempted to pick up the pieces by using surveillance measures such as door-to-door screenings, drones, and police enforcement.

Policing the Police

While the recent murder of George Floyd sent shockwaves across the world, India has been confronting its own relationship with police violence. In June, two Tamil Nadu shopkeepers, J Jayaraj and his son Bennicks Immanuel, were arrested for keeping their business open past permitted hours during the national lockdown. They were then tortured while in police custody and died days later in the hospital. Due to this event garnering considerable attention and protesting, six police officers have since been arrested for their deaths. Also, Tamil Nadu police officers with questionable track records will now undergo behavioral correction workshops. However, this incident is no anomaly. According to the National Human Rights Commission (NHRC), nine Indians die in judicial or police custody every day. In comparison, official government crime data claims 70 people were killed in Indian police custody in 2018. This striking differential in reported custodial deaths suggests India’s law enforcement entities lack accountability and are riddled with corruption.

Much like the United States, India has a history tainted with police violence that disproportionately affects minority groups, namely people from the lowest Dalit caste, indigenous groups, and Muslims. With no choice but to work during the national lockdown, many of India’s poorest citizens were beaten by police. Videos of these violent acts surfaced across social media. In opposition, there have been over 300 reported incidents of attacks on police officers alone in Maharashtra. These recent events highlight the need for the Indian government to pass anti-torture legislation that curbs police violence. By ratifying the United Nations Convention Against Torture, the Indian government can help remove the colonial vestiges of power and punishment that have plagued the country for generations.

Migrant Displacement

The sudden announcement of a national lockdown had tremendous repercussions for the tens of thousands of daily-wage migrants throughout India. Overnight, businesses closed and transportation systems suspended throughout the country, placing many migrant workers in precarious economic conditions. Men, women, and children hunkered down in urban centers across the country as they waited for their workplaces to reopen but to no avail. In response, India’s major cities experienced an exodus of migrant workers attempting to return to their home states on foot, many living hundreds, even thousands, of miles away. As thousands trekked home, many died due to dehydration, exhaustion, sunstroke, and traffic accidents. Reports of pregnant women delivering, and subsequently carrying, their children in these horrific conditions have also surfaced.

A recent Supreme Court order has urged the well-being of India’s 100 million internal migrant workers affected by the hardships of COVID-19 by requiring the government to register, feed, shelter, and transport them until they return home. However, these efforts are seemingly inadequate because most internal migrant workers have not qualified for these “relief packages”, while those who have qualified are experiencing limited coordination between state governments. All the while, India has ended its national lockdown and many migrant workers are trying to return to their places of employment. Some employers are sponsoring the return of their lost workers, while some must find their own means to return. As such, some states have sought local help to accommodate the loss of migrant workers which places many Indians in even greater economic uncertainty.

Migrant workers walking on the shoulder of a highway during the nighttime.
The Indian Lockdown Migration – IV (PB1_4728). Source: Paramvir Singh Bhogal, Creative Commons.

Pathologizing Islam

COVID-19 in India has contributed to a surge in anti-Muslim rhetoric that suggests this religious minority group is purposely spreading the virus.  The rumors began after Tablighi Jammat, a Muslim missionary group, held a congregation outside of India and, soon after, many members tested positive for COVID-19 in New Delhi. Videos on WhatsApp and various television channels have proliferated this misinformation to the Indian public alongside the usage of phrases such as “corona jihad” and “corona terrorism”. To make matters worse, the Bharatiya Janata Party (BJP)-led government, which is notorious for its Hindu nationalist sentiments, has begun incorporating Tablighi Jamaat-related statistics to its daily COVID-19 briefings. Such rhetoric has influenced a slew of Islamophobic acts such as prohibiting neighborhood entry, restricting sales by street vendors, and even violent attacks.

These recent events fuel an existing fire that posits Muslims as reproducing at a pace to outnumber Hindus and compromising “Mother India”. However, recent efforts between Muslim Indians and allies has been quick to respond to this COVID-19 misinformation because they have been protesting India’s new citizenship law that offers amnesty to various non-Muslim immigrants and a nationwide citizen count that necessitates proof of documentation dating several years back. The BJP has made it apparent that Muslims are not welcome in India and weaponized the COVID-19 pandemic as a part of its Islamophobic campaign. As such, these efforts corner Muslim Indians into political and economic insecurities that pressure apartheid at a time when unity is paramount.

Masked medical professionals walking with a crowd in the background.
coronavirus-india-rep-image-hyd. Source: Anant Singh, Creative Commons.

Human Rights in India

As displayed, India has an array of prevalent human rights issues that have compounded since the arrival of COVID-19. Among the efforts that could protect Indians from these concerns are labor protections, health care reform, civil rights for minority groups, food security, and income equality. However, Prime Minister Narendra Modi has propagated a narrative of self-reliance that undermines these systemic inequalities. Service provision has highlighted these discrepancies because resources are scarce, and those with power and privilege are placed to the front of the line. In addition, many Indians cannot abide to the recommended sanitation and social distancing measures due to living in poor, dense settlements in the heap summer when water sources are limited.

Although tearing through communities and disrupting daily life in India, the COVID-19 pandemic can be viewed as an opportunity for social change. More specifically, it is well within the power of Parliament, the media, civil society, and local governments to right these wrongs by ending communal bias and impartiality within state institutions. Addressing these corrupt and oppressive practices will not only remediate the effects of COVID-19 but help shape an equitable future for a country that is rapidly becoming a global super power and expected to be the most populous country in the world by 2027. Real change and equity in the world’s largest democracy could send a much-needed shockwave of justice across the globe.

The Right to Mental Health and the Importance of Self-Care

An image of a brain embroidered on a piece of fabric in an embroidery hoop.
Brain Anatomy Hoop Art. Hand Embroidered in Pink and Blue. Source: Hey Paul Studios, Creative Commons

While it seems that most people today would agree that taking care of one’s mental health is important, it may come as a surprise that mental health is actually a human right.  According to Article 25 of the Universal Declaration of Human Rights, all people have the right to “a standard of living adequate for the health and well-being of himself and his family…”  The Office of the United Nations High Commissioner for Human Rights has declared that “that the right to health is a fundamental part of our human rights and or our understanding of a life in dignity.”  

Mental Health as a Human Right 

The United Nations Human Rights Council recognizes three principles regarding the right to health: 

The first is that it is an inclusive right.  This means that it extends “not only to timely and appropriate health care, but also to the underlying determinants of health.”  This includes things like access to clean water, safe working conditions, and important information about health.  These factors, while clearly relevant to physical health, are also important in maintaining one’s mental health. 

The second principle is that the right to health includes both freedoms and entitlements.  Freedoms would include things like “the right to control one’s health,” while entitlements would include things like “the right to a system of health protection that provides equality of opportunity for people to enjoy the highest attainable standard of health.”  This is significant because one needs to be able to access important information and resources related to mental health in order to have meaningful support for their mental health.   

The third principle is that the right to health is a broad concept that can be divided up into more specific rights.  For example, there are some aspects of health that are specific to people who are assigned female at birth, and those aspects are associated with specific rights.  The right to mental health (and the rights associated with it) is one of the many rights that make of the right to health.   

Mental Health Impacts Your Overall Future Health 

According to the World Health Organization’s Constitution, health is “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.”  Based on this, taking care of your mental health is not simply making sure that you are not actively going through a crisis.  Being healthy is more than just surviving.  Taking care of your mental health involves taking daily steps to care for yourself that not only improve your health in the present, but also protect your health in the future. 

Having poor mental health puts you at a greater risk for physical health problems.  According to the American Psychological Association, having a mental health condition reduces men’s life expectancy by an estimated 20 years and reduces women’s life expectancy by about 15 years.  This is in part due to the fact that nearly two-thirds of people with mental health conditions do not seek any form of treatment. 

Mental Health is a Key Part of Accessing Many Other Rights 

In addition to being a right on its own, maintaining good mental health is also a key part of being able to meaningfully access many other human rights.  For example, even when given all the necessary tools that are directly related to education, struggling with mental health issues can impede a person’s ability to receive a truly meaningful education.  This is reflected by the long-term effects of depression.  In one study, scientists found that individuals who faced depression during mid-adolescence and continue to deal with it as young adults are at an increased risk of educational underachievement and unemployment.  One’s mental health can also impact their access to other rights such as the right to participate in the cultural life of their community, the right to rest and leisure, and the right to work. 

Scrabble pieces spell out the words "mental health."
Mental Health. Source: Kevin Simmons, Creative Commons

You Have to Help Yourself Before You Can Help Others  

You’re probably familiar with the concept of putting your oxygen mask on before assisting others on a plane.  If you are struggling to breathe yourself, not only is your ability to help others inhibited, but you’re putting your own health and well-being at risk of harm.  This can be applied to mental health as well.  If you are facing serious struggles with your own mental health, it is important to focus on helping and support yourself before taking on responsibilities related to other people’s mental health. 

For this reason, the maintenance of good mental health is especially important for people who work in fields such as human rights advocacy.  The world of human rights is full of issues and topics that can be emotionally draining, so one can easily become overwhelmed by it all.  It is vital that advocates make their mental (and physical) health a priority, even if their main concern is helping others.  Self-care needs to be a part of any human rights advocate’s tool kit. 

The Basics of Self-Care 

Self-care can be defined as “any activity that we do deliberately in order to take care of our mental, emotional, and physical health.”  

Raphailia Michael, a licensed counseling psychologist, suggests that there are three golden rules to starting self-care: 

  1. “Stick to the basics.”  This makes it easier to include self-care into your schedule, make it a part of your regular routine, and figure out what works best for you.
  2. “Self-care needs to be something you actively plan, rather than something that just happens.”
  3. “Keeping a conscious mind is what counts…if you don’t see something as self-care or don’t do something in order to take care of yourself, it won’t work as such.”  

Michael also gives a basic checklist of self-care tasks that can apply to pretty much anyone.  This list includes things such as eating a nutritious diet, getting enough sleep, following up with medical care, and looking for opportunities to laugh every day. 

It is so easy to get caught up in the hustle and bustle of everyday life and forget to take care of oneself.  We all do it sometimes.  It is important that we set aside time to properly take care of ourselves and pay attention to our own needs.  Mental health matters just as much as everything else that is going on, and that’s something we need to remember. 

 

Challenges with Undocumented Immigrants in the U.S.

Picture Message
Source: Yahoo Image

Humans have always been regarded as higher animals due to several similarities we share, including instinct, cognition, problem solving skills, introspection, creativity, emotional intelligence and planning skills. Just as planning is an ability of both humans and animals, it involves adequate effort and encompasses a wide range of ideas and research put in place to actualize our desired objective. One of the most fascinating parts of planning to me includes identifying the best place or location we can truly reach our goals, achieve our objectives and fulfil our purpose, which all basically centers around migration. Migration remains a constant and unending phenomenon for both humans and animals, and various motives can be attributed to this endeavor, such as the search for food and water, seasonal weather change, mating reasons, employment opportunities, health and education reasons, adventures and thrills, insecurity, and many others. More still, we can basically summarize migration purposes as a search for a better life, which is a basic instinct all living things possess.

In the last ten years, migration within the international context has risen to a significant level despite continuous efforts many countries have dedicated in ensuring their borders are adequately tightened with hope of discouraging immigrants from illegally entering their borders. According to Ross, Cunningham, & Hanna, an estimation of 244 million migrants are presently living temporarily or permanently outside their country of birth.  Violent conflict, discrimination and lack of employment opportunities are major reasons for the increasing number of immigrants in several developed countries, and has forced many countries into adopting drastic measures such as rigorous identity checks, detention camps and deportation, to reduce their entry. Another means of curbing the increasing number of immigrants includes formulating and enforcing policies that limits them access to affordable healthcare services. For instance, the United States Affordable Care Act excludes undocumented immigrants from accessing health insurance, while the immigrant provisions of the 1996 Welfare Reform Act, the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) excludes undocumented immigrants from publicly funded services.

Several immigration laws and policies within the United States continuously hinder undocumented immigrants’ access to adequate healthcare services, which constitutes a major challenge to all who fall under this category despite evidence proving they contribute more money in taxes to the U.S. economy than they consume in services.  What I believe the U.S. government has failed to understand is the fact that these laws and policies not only put the health of these undocumented immigrants at a high risk, but also the health of the general public and socioeconomic development of the country. One of the most detrimental ways these laws and policies have greatly affected this vulnerable population is in the fight against the HIV epidemic. According to Ross et al., migrants who reside in developed countries are disproportionately affected by HIV as the proportion of new HIV diagnosis amongst migrants exceeds the percentage of the general population. HIV, as we all know, is a global epidemic that demands the best care and treatment which was the reason that spurred world leaders in 2015 to restate their commitment to the right to health by enacting the universal health coverage in the sustainable development goals that guarantees all people and communities access to high quality health services.

HIV +-
Source: Yahoo Image

It is clear the United States government clearly disregards this universal policy that aims at ensuring everyone receives the best healthcare services irrespective of their personality or condition. I guess the U.S. government by their own understanding believes migrants do not fall under the universal coverage as it is evident through their discouraging treatment of undocumented immigrants, more so, those living with HIV. Ross et al. believes migrants persons living with HIV have more characteristics that are associated with poor HIV clinical outcome, and are more likely to die from HIV compared to non-immigrants. For undocumented people living with HIV, there are more factors that exacerbate their condition such as discriminatory laws and policies, lack of follow-up care, ignorance, stigmatization and discrimination. I do believe these discriminating laws and policies serves as the major factor affecting undocumented people living with HIV. One area that typifies this can be seen during the documentation process of a patient health record, which compulsorily demands the immigration status information of individuals. This got me wondering if a client’s immigration status information is actually needed in their health record.

Kim, Molina & Saadi believes documenting immigration status in patient records not only possess a challenge to the clients but also to clinicians. Although by recording this, the information would most likely improve the communication process between the client and the clinician, and also facilitate continuity of care, on the other hand, recording the same information could expose the client alongside their family to risks of being stigmatized or discriminated by non-immigrant friendly clinicians who may expose them to immigration enforcement officers even though it violates patient confidentiality. They believe explicit documentation of immigration status of patients alongside their families in a health record be avoided as evidence suggest risks outweigh benefits in this regard. Conversation about immigration status using indirect language in describing social context should rather be prioritized over written documentation to ensure patients have their healthcare needs met without fear. They concluded by advising clinicians and the general healthcare system to ensure policies and guidelines reduce the high level of stigma and discrimination for all rather than the present opposite.

Families fighting against forced separation
Madison, WI, USA- February 18, 2016 – group of people protesting new Wisconsin immigration laws. Source: Yahoo Image.

Another area that strikes me hard for undocumented immigrants living with HIV are those who are currently in detention camps across various states in the U.S., a revelation which came to me through one of my on-campus events with the representative of the Alabama Latino Aids Coalition. The speaker spoke about the inhumane treatment undocumented immigrants go through while in detention, more so, people living with HIV. This made me do some research and I found several evidences that confirmed undocumented immigrants living with HIV can actually maintain continuous access to care and treatment while being detained in correctional facilities to ensure they sustain or achieve good virologic outcomes and well-tolerated regimens if structured protocols are implemented and enforced. It should be noted that the detention process for migrants during their deportation proceedings is complex and rigid which has led to several lapses due to poor access to proper medical care. Even though there are 21 Federal Detention Centers across the U.S., which are operated by the Bureau of Prisons, and all provide Antiretroviral treatment and medication to detainees who disclose their HIV status, there exists fear of stigmatization or discrimination amongst detainees living with HIV as they believe their disclosure may negatively impact their immigration trial, especially if they also fall under any gender or sexual minority groups. Also, the poor living condition and environment of this population while in detention forces some to relapse into substance use, engage in risky sexual behaviors, and disregard their treatment plan.

Based on this understanding, it is hard to imagine the inhumane condition undocumented immigrants are forced to live through while being detained. There is need for the U.S. government to understand that even though several undocumented immigrants after their trial, are usually deported or released at the nearest borders or territories close to their home countries, several others return into the society without receiving adequate rehabilitation or reintegrative education which possess a challenge to the society at large. Human and material resources that could have been used to resolve other pressing needs will then be used to serve their avoidable demands. To resolve this challenge, there is the need to abolish any form of discrimination against detainees living with HIV and ensure it does not affect their deportation trial. Also, clinicians and correctional officers need to be more sensitive to the needs of the detainees having been separated from their families and may never see them again, which is a situation that can easily exacerbate their condition in such a hostile detention environment. Human rights institutions, immigration right advocates, academicians, alongside health authorities, media and the general public should also advocate and help raise awareness about the poor condition of these detention facilities. For deported detainees living with HIV, the U.S. government alongside non-governmental institutions should provide adequate health education using evidence-based treatment medications and materials that meets the specification of their home country to ensure transnational HIV continuity of care.

Picture of Undocumented Immigrants
Undocumented Immigrants in dire need of help. Source: Yahoo Image

In all, we all should understand that undocumented immigrants are also humans and should be treated with utmost respect irrespective of their situation. There is need to ensure their health and wellbeing are adequately met and well taken care of. As humans, we should not only sympathize with them, but also support them by raising awareness and advocating for better laws and policies that can assist them during their ordeal. We should always aim for a multi-sectoral approach that addresses the structural challenges for undocumented immigrants living with HIV such as housing, food security, mental health, and access to employment because there is a continuous effort by the U.S. government to dehumanize undocumented immigrants as community members and remove vital resources that is available to them. As we all know the U.S. government remains extremely resolute in enforcing the 2015 immigration laws that places all undocumented immigrants at risk of being deported, they can also ensure the universal law on respect to all life is adequately respected by enforcing laws, guidelines and policies that protects the lives and wellbeing of undocumented immigrants.

A Human Rights Perspective on Solutions to the Opioid Crisis in America

My most recent article described an overview of the opioid addiction crisis from a human rights perspective. You can view it here. In this article, I attempt to explain the different solutions from medical professionals regarding opioid addiction and the racial and economic disparities that have arisen amongst the most successful solution.

There are two forms of treatment that most clinics can decide between: traditional counseling therapy with a focus on mental strength or using medication, such as buprenorphine and methadone, to combat addiction. Research has proven that without medication, people are twice as likely to die from an overdose. However, the traditional counseling methods have persisted across treatment centers. The Journal of Substance Abuse conducted a study that showed that between 2003 and 2010, of 50,000 opioid addiction patients on Medicaid, patients who had received counseling therapies were six times more likely to relapse than those who received methadone as treatment and four times more likely than those who received buprenorphine. The risk of overdoses is increased during the period of detoxification utilized by abstinence based programs because of a lack of tolerance.

A counseling session
Counseling. Source: Alan Cleaver. Creative Commons.

Opioid substitution has proven to reduce mortality. To avoid a misuse of buprenorphine and methadone, the two medications are tightly controlled by doctors. Buprenorphine is a drug that reduces the craving for opioids and reduces the chances of a fatal overdose overall. Suboxone, a compound of buprenorphine, is engineered to reduce the possibility of an overdose. However, using medication as treatment for addiction has only truly been utilized at a small number of walk-in clinics and has not been fully incorporated into the nation-wide health care system. In 2015, in the United States, 8-10% of treatment programs offered buprenorphine and methadone as substitution therapy. Even in this small number of programs, the method was often unsuccessful as the medicine was offered for too short of a period to be effective. The treatment is only provided in very regulated clinics and prescribers are limited to a maximum of 275 patients.

Between 2012 and 2015, the number of doctor visits where the health professional prescribed buprenorphine greatly rose. Despite this, a research report found that of 13.4 million medical cases involving buprenorphine, there was no increase in prescriptions written for minority groups. Dr. Pooja Lagisetty, one of the authors of the study, reported that white populations are nearly 35 times more likely to have buprenorphine discussed in their visit than black populations. Accessibility and insurance ability are commonly cited as reasons why this disparity has occurred, especially as the majority of white patients paid for their treatment using cash or insurance whereas only 25% of visits were covered by Medicare or Medicaid. This is especially concerning when it is taken into consideration that the rise in the use of buprenorphine occurred at the same time that opioid overdose related deaths were rising significantly faster for black populations than for whites.

Representation of the cost of healthcare.
The cost of healthcare. Source: ImagesMoney. Creative Commons.

In many cities, opioid addiction treatment is segregated by income. Lower income patients find themselves needing to attend a clinic in order to receive treatment while more affluent patients are able to avoid the clinic and instead receive treatment from a doctor’s office where medicines can be prescribed. These clinic programs are federally funded and often covered by Medicaid. However, in order to receive treatment from the highly regulated clinics, patients must visit daily. Many patients commute for hours every day before waiting within the clinic to receive their life-saving medication. These patients, who are already part of a lower income bracket, are losing precious hours where they could be working or with their families. Work, childcare, families, and other related life events must revolve around the daily trip to the clinic. Some patients have described needing to turn down job offers. Because of this, methadone has earned the nickname, “liquid handcuffs.”

In order to prescribe buprenorphine, physicians are required to undergo a special form of training. Only 5% of physicians have participated in this training. The shortage of clinicians has resulted in the ability of physicians to demand cash payments in return for a prescription of buprenorphine. 40% of white patients paid cash while 35% relied on private insurance. Just 25% of these visits were covered and paid for by Medicaid and Medicare. These percentages highlight just how costly a lifesaving prescription can be for people of low income. Because of the racial disparities within the United States economy, the people who fall into this category tend to be of a minority group. Gentrification has also caused a problem within the clinic community as their buildings get bought out in favor of other businesses. In 2016 in New York City, 53% of participants in methadone programs were Latino and 23% were black, while 21% were white. Also, in 2016 more than 13,600 people in New York filled at least one prescription for Suboxone with nearly 80% of these 13,600 paid for the medication using private insurance.

2011 Protest against the War on Drugs
No More Drug War. Source: Neon Tommy. Creative Commons.

Buprenorphine was purposely introduced into a private market, intended only for those who could pay a high price. Therefore, the unequal distribution of the drug can be determined to be not accidental. Due to the government regulations surrounding the prescription of the drug and the training required for doctors, there are too few doctors actually allowed to prescribe the medication. Those who can often do not accept insurance for their services as demand is so high and they can make more of a profit. Insurance will pay for the actual drug, but patients must pay for the doctor out of pocket.

A permanent stigma surrounding methadone has developed, hailing from the War on Drugs days in the 1960s. Racially charged stereotypes regarding addiction have fueled this stigma which has in turn caused lawmakers to be reluctant in passing legislation that would make the drug more accessible to underprivileged populations. However, this would be the push the community desperately needs. Medicines like buprenorphine and methadone need to be significantly more accessible, both for patients and doctors alike. They need to be included in more clinics while therapy based solely on mental counseling should be phased out from the common addiction treatment centers. In order to close the racial and economic disparities within this crisis, it is important to first recognize them. Once that has been done, our communities need to take direct action that will result in a positive change.

Cataclysm: COVID-19 in Brazil

As the number of novel coronavirus (COVID-19) cases continue to grow in the United States (U.S.), another epicenter has been growing in South America. As the sixth most populous country in the world, Brazil has experienced an uptick in COVID-19 cases and deaths alongside an array of national controversies that make the response efforts considerably more difficult. This blog addresses Brazil’s growing importance in the COVID-19 discussion and how it impacts human rights issues concerning indigenous peoples, environmental degradation, favela communities, and good governance.

As of late-June, more than 1.3 million Brazilians have been diagnosed with COVID-19, while over 55,000 have died from the virus. Brazil’s most populated state, São Paulo, is currently the country’s epicenter with nearly 250,000 confirmed cases of COVID-19. The northeastern state of Ceará has the country’s second-largest number of confirmed cases (100,000+), while Pará in the northwest is nearing 100,000 confirmed cases. Additionally, the iconic city of Rio de Janeiro has over 105,000 confirmed cases of COVID-19. Unfortunately, Amazonas has to the highest COVID-19 death rate of any state with 67 deaths per 100,000 cases, compared to Bahia’s 11 deaths per 100,000 cases, which highlights the disproportionate impact of COVID-19 on indigenous communities that have been systematically killed, displaced, and denied access to health care and other preventative services that could help fight the spread of the virus.

Indigenous Peoples of Brazil

As the largest Brazilian state in the Amazon region, Amazonas is known for its indigenous communities who often live in isolated villages and have poor access to health care. In the city of Manaus, which has a population of 2 million+ and is only accessible by aircraft or boat, many recent respiratory-related deaths have resulted in quick burial in mass graves, which has likely led to a severe underestimate the pandemic’s toll on the local population. In the remote community of Betania, the Tikuna tribe has five government medical workers that accommodate an approximate 4,000 inhabitants, but they are not treating the sick due to lack of protective equipment and COVID-19 testing supplies. One considerable threat are the indigenous community members who are not quarantining and are, instead, traveling in and out of town for work.

These unprecedented events compound the colonial legacy that has threatened Brazil’s indigenous peoples for centuries. Centuries ago, indigenous tribes throughout the Amazon were decimated by diseases brought by Europeans. In a way, history is repeating itself because the Brazilian government’s ineffectual response to the crisis have allowed COVID-19 to ravage the surviving indigenous communities and put them on the brink of genocide. Aside from the tribes who have contact with the modern world, the Brazilian Amazon inhabits 103 uncontacted tribes who have virtually no knowledge or resources to protect them from the threat of COVID-19. Signing this petition will help urge Brazilian officials to protect the surviving indigenous communities throughout the Amazon.

Deforestation in the Amazon

Since COVID-19 has reached these Amazonian communities, deforestation in the region has also proliferated. The Amazon is the largest rainforest in the world and is important to the global ecosystem because it absorbs approximately 5% of the world’s carbon dioxide (CO2) emissions. Thus, protecting the Amazon is pivotal for stalling the effects of climate change. However, for years, the Amazon has been ravaged to accommodate the agricultural industry as well as illegal loggers and drug traffickers. As a result, indigenous leaders fear that the COVID-19 pandemic will be used to exacerbate the destruction these industries have already caused.

During the month of April, deforestation in Brazil increased by nearly 64% which resulted in more than 150 square miles of rainforest destruction. In response, 3,000+ Brazilian soldiers were deployed to the region to prevent illegal logging and other criminal activities that contribute to deforestation. Some worry that such activity in the rainforest will lead to outsiders giving indigenous communities infectious diseases, namely COVID-19. Brazil’s Secretariat of Indigenous Health (SESAI) has made efforts to distribute N95 masks, gloves, and goggles to the region, but activists warn that the only way to protect uncontacted tribes is by keeping illegal loggers and miners out of these areas. Despite the Brazilian government establishing three military bases to prevent illegal actors from permeating the region, they are only expected to be present for 30 days. This is because Brazil’s main environmental enforcement agency, Ibama, is expected to take over these efforts but are currently understaffed and underbudgeted.

Favelas in the Age of Social Distancing

More than 11 million Brazilians live in favelas which are shantytowns outside of urban centers. Already hit hard by gun violence, unsanitary conditions, and militaristic police presence, people living in Brazil’s favelas struggle to adhere to social distancing measures. Research has found that people living favela-like conditions spend roughly 50% more time per day with others than people in less-impoverished areas. Often, favelas are composed of two or three rooms with five or six people sharing these spaces. As such, favela conditions enable the spread of COVID-19, and with precious little assistance from the government, Brazil’s most impoverished communities are left to fend for themselves.

With little government help, residents of Paraisopolis in Sao Paulo (population: 100,000) have offered a community-based solution. Due to donations and volunteer work, residents have responded to COVID-19 by organizing distribution of free meals, ambulatory services, and neighborhood watch persons. They even designated one building the quarantine house and repurposed closed schools in self-isolation centers. In Rio, members of the gang City of God drive through the local favelas, blaring a recorded message ordering people to stay home. Other gangs have become knowledgeable about COVID-19 in order to deliver essential goods to favela residents and have even gone as far to enforce social distancing measures by preventing restaurants from putting tables out. These forms of gang vigilantism in Brazil’s favelas demonstrate the lack of government support and tension with local police.

Small grave onlooking a favela.
At the bottom of this block destined to the burials of COVID-19, is the favela of the Vila Nova Cachoeirinha housing complex. Source: Léu Britto, Creative Commons.

Trump of the Tropics

These criticisms are largely attributed to the leadership of Brazilian President Jair Bolsonaro who notoriously dismissed COVID-19 as a “little flu”. Aside from personally ignoring social distancing measures, Bolsonaro has organized large rallies in an effort to confront local governors who have locked down their regions. Recently, after ignoring federal regulation that require wearing a face mask in all public places, a judge ruled that Bolsonaro (and any public official) is not exempt from this policy and should expect a 2,000-reais ($387) fine like anyone else. Bolsonaro even fired his Health Minister, Luiz Mandetta, in April after he supported social distancing measures. His successor has since promoted a reopening of the economy and unproven medical treatments for COVID-19.

Known by many as the “Trump of the Tropics,” Bolsonaro has successfully maintained a strong coalition of supporters such as the agriculture community, evangelical Christians, and the military. Unlike the U.S., Brazil is an emerging economy with a weak social safety net that makes it difficult for government officials to convince people to stay at home. Health care access and the conditions to work from home are also quite limited. Recent cell phone tracking data has revealed that 45-60% of Brazilians are not complying with social distancing measures, likely due to the fact that they have to choose between feeding their families and being exposed to the virus. As such, it is assumed Bolsonaro’s defiance of a public health approach to COVID-19 is an effort to appeal to his core supporters. Bolsonaro has also slashed regulations and enforcement of land grabbing, which exacerbates the deforestation crisis currently impacting the Amazon.

Human Rights in Brazil

As demonstrated, Brazil has an array of chronic human rights problems that have been compounded by the arrival of COVID-19. In 2016, a constitutional amendment was passed that limited public expenditures in Brazil for the next 20 years. As a result, we are now witnessing how these austerity measures have affected access to housing, food, water, and sanitation when Brazilians need it the most, particularly within the most vulnerable groups – women, children, Afro-Brazilians, indigenous peoples, rural communities, and informally-settled persons.

Much like the U.S., Brazil’s COVID-19 response has mostly been subnational social distancing measures and an emergency basic income to placate the masses. However, these efforts are clearly inadequate considering Brazil’s COVID-19 cases are surging alongside another potential Zika outbreak. As a result, Brazil has effectively become the most prominent COVID-19 case study in the Global South, a nation plagued by a deadly virus and an array of human rights issues. Human rights experts suggest fiscal stimulus and social protection packages would only be the beginning of a COVID-19 response because many of these concerns are the consequence of marketization and privatization of public goods and services. As such, the COVID-19 pandemic serves as an opportunity to reverse the market-based ideology that has failed so many countries, especially the Land of the Palms.

Please sign the petition to help urge Brazilian officials to protect the surviving indigenous communities throughout the Amazon.

A Human Rights Perspective on the Opioid Crisis in America

Pills
Pills. Source: Jamie. Creative Commons.

The opioid crisis in the United States is not something I often hear about in the news nowadays. Or maybe it is so often in the news that the title fades into the background amongst the news about politics. However, the opioid epidemic affects millions of people across the United States, and it has affected them for years. Human rights concerns connected to the epidemic have begun to grow in recent years as controversies regarding the United States health care system and law enforcement systems have come to light.

The crisis began with the expansion of opioids for medical purposes in the 1990s. The initial goal with opioids was to treat pain but the drugs soon became exploited by pharmaceutical companies eager to increase their profit revenue [1]. Before the addictive and harmful properties of opioids became known both to the public and to healthcare professionals, prescriptions for opioid medications increased rapidly across the country.

The introduction of extended-release oxycodone in 1996 along with claims by the manufacturers that it was less addictive and effective for up to 12 hours was a major catalyst for the epidemic. There are three described waves of opioid overdose deaths in the United States. The first wave began with an increase in the prescription of opioids, increasing since at least 1999. The second wave included overdose deaths involving heroin, the increase beginning in 2010. The third wave included an increase in overdose deaths involving synthetic opioids such as illicitly manufactured fentanyl (IMF) in 2013.

Hospital
Hospital. Source: Marissa Anderson. Creative Commons.

The first reaction to the opioid crisis was to limit the number of prescriptions in the market. However, this drove many to use the less expensive and more accessible street heroin. Cheaper and stronger opioids kept reappearing on the market, leading to an accelerated rate of fatal overdoses. Most addictions start with diverted supplies instead of among doctors’ patients. This was the case with heroin, which causes 4% of those who were using prescription opioids to switch to heroin. While 4% seems like a small percentage, 4% of the large number of people taking opioid pills is actually very large and enough to exacerbate the crisis [2]. In 2017, the United States Department of Health and Human Services declared a public health emergency. Over 130 people die every day from opioid-related overdoses and 10.3 million people in the United States misused prescription opioids in 2018. In 2017, more than 70,200 people died from drug overdoses. Of those 70,200, around 68% involved opioids.

White Americans make up roughly 80 percent of opioid overdose victims. The attention of the coverage of the opioid crisis has primarily centered on white Americans, pushing aside the attention on minorities affected by the crisis. Minorities made up 20 percent of opioid related deaths in July of 2019, but that number is growing. The crisis has highlighted the racial disparities in the US healthcare system as many experts believe that the number of opioid related deaths in minority populations would be greater if minorities had access to the same level of health care as white Americans. It is known that people of color have had a significant lack of access to the American healthcare system throughout history and throughout the recent years. This disparity lowers the probability that non-whites in American would be prescribed opioids and thus lowers the chance that the population would suffer fatal overdoses. Despite the low death rates due to the exclusions within the health care system, the abuse of opioids is still abundant in communities of color. Scientists have witnessed a doubling of overdose death rates among African Americans, a factor that is being overshadowed by the media and societal focus on the death rates of whites.

Police
Police Officer. Source: G20 Voice. Creative Commons.

The law enforcement system has failed minorities in the opioid crisis as well. The War on Drugs, an attempt at cracking down on the opioid epidemic, has disproportionately affected African American communities across the United States. Studies have shown that law enforcement officials target black communities for drug violations significantly more than they target white communities. While drug use is similar between white communities and black communities, members of the black community are 13 times more likely to be arrested for buying and using drugs. In 2013, black and Hispanic populations represented 29 percent of the entire United States population. Despite this, the number of black and Hispanic prisoners arrested for drug related charges dominated that of whites. Not only is this true, but the United States Sentencing Commission also released a report stating that black prisoners receive longer sentences than white prisoners, despite both groups being convicted of similar weighted crimes.

The opioid crisis has hurt millions of people and families across the United States, one of the most diverse countries in the world. Despite this, the national attention has primarily focused on how the crisis has affected the white population. It is important to focus not only on how the opioid crisis has affected minorities, but also how the health care and law enforcement systems have responded to the opioid crisis in minority groups. The disparities within these systems must be fixed in order to provide an equal treatment of all groups.

[1] The Global Commission on Drug Policy. The Opioid Crisis in America. 2017.

[2] The Global Commission on Drug Policy. The Opioid Crisis in America. 2017.