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. 

 

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.

Oil: The World’s Black Gold?

Known as black gold, petroleum has long been, a valuable resource that many of us benefit from during our daily lives. The petroleum industry’s products range from transportation to even the feedstocks that make the “plastics and synthetic materials that are in nearly everything we use.” Shockingly, the United States has consumed almost 7.5 billion barrels of oil per year, with about 46% of it used as motor gasoline. However, “there is an alarming record of human rights abuses by governments and corporations associated with fossil fuel operations,” ranging from relocation to even suppression of critics.

What is Petroleum?

An image of a pipe pouring some type of green substance, oil in particular, into a barrel.
Recirculated petroleum is pumped from the well by a replica steam engine. Source: Wikipedia, Creative Commons.

Known officially as crude oil, petroleum is a fossil fuel that can be found underneath the Earth’s surface in areas known as reservoirs. Petroleum is mainly used for gasoline that fuels most cars in the world. Petroleum is also used as diesel, jet fuel, heating oil, propane, and others.

However, petroleum is not just a fuel source. Many factories and production sites use petroleum in order to make “crayons, dishwashing liquids, deodorant, eyeglasses, tires, and ammonia.”

Beginnings of the Petroleum Industry

An image of an oil well, colored black, in the process of digging for oil. Located in Lufkin, Texas.
Pumpjack, Spindletop oil field. Source: Flickr, Creative Commons

Through the growing and prosperous iron and steel industry, the 20th century became a period of “great change and rapid industrialization.” However, the birth of the railroad and new construction materials gave way to the petroleum industry offering an alternative source of fuel needed in everyday life.

In Texas, the discovery of the Spindletop oil reserve allowed for the creation of hundreds of oil companies, especially Texaco and Golf, and for the massive decrease in oil prices, from “$2 a barrel to 3 cents.” In 1901, the Hamill brothers, contracted to drill into the ground using a steam engine, came into contact with 160-million-year-old crude oil, shooting up in a geyser meters high. They had anticipated 50 barrels of oil being produced in a day, but more than 80,000 barrels were being produced each day, enriching the backers of the oil rig exponentially.

When talking about the history of oil, one must never forget one of the key figures in the industry, John D. Rockefeller. Through his experience in entrepreneurship and organization, he became a leading figure in the oil industry by creating the Standard Oil company, one of the “world’s greatest corporations.” Through a monopoly, his company integrated itself both horizontally and vertically by eliminating competition and making products cheaper and production more efficient.

The discovery of the Spindletop oil reserve allowed for competition against Standard Oil, through the rise of the Texas Company and the American Gasoline Company (Shell Company of California during the mid-1910s). However, because of Standard Oil’s attempts to “monopolize and restrain trade,” the Supreme Court decided to split up the company into 34 smaller companies.

Oil in the World

Reserves can be found all over the world, but there are countries that produce more oil simply due to the vast reserves found underneath the Earth’s surface. In the United States, the five largest oil producing states are Texas, Alaska, California, Louisiana, and Oklahoma. In the world, the top oil producing countries are Saudi Arabia, Russia, the United States, Iran, and China. The need for oil in the United States surpasses the amount it can produce, generating the need to import oil from Canada, Saudi Arabia, Mexico, Venezuela, and Nigeria.

Looking closely at the top producers of oil in the world, you may notice that two countries in the top five are countries in the Middle East, each with their own host of problems regarding human rights. They range from Saudi Arabia’s supposed killing of journalist Jamal Khashoggi in 2018 and the killing of more than 6,500 Yemeni civilians as a result of numerous airstrikes against the Houthi rebels to Iran’s crackdown on peaceful protestors and the presence of Iran’s death penalty for most extreme offenses. Allegations of human rights abuses also extend to China as well, where Xi Jingping has removed term limits for the president and enabled the mistreatment of Muslims living in northwestern China. Many consider these human rights issues are due to something called the “Resource Curse,” where the abundance of natural resources in developing countries, like oil, usually lead to “economic instability, social conflict, and lasting environmental damage.”

Oil and Human Rights in the United States

If you read the news as much as I had a couple of years back, then you might recall a certain conflict occurring in North Dakota regarding the Dakota Access Pipeline. The Dakota Access Pipeline, built by Texas-based Energy Transfer Partners, is designed to transport more than 500,000 barrels of crude oil everyday from North Dakota to Illinois. Proposed by Energy Transfer Partners in 2014 and completed in 2017, many interest groups protested the pipeline, ranging from environmental activists to the Standing Rock Sioux tribe.

An image of protesters holding up a banner with the words "STOP DAKOTA ACCESS PIPELINE" across it.
Dakota Access Pipeline protesters against Donald Trump

The pipeline currently travels under the Missouri River, a source of drinking water for the Standing Rock Sioux tribe as well as a source of biodiversity in the environment. Part of the reason for the protests include the damage to the water supply that said pipeline could inflict if leaking occurs which is justifiable due to the more than 3,300 occurrences of leaks since 2010 at many pipelines in the United States.

An image of the route of the Dakota Access Pipeline, with the Standing Rock Sioux tribe tribal location highlighted as well, showing where the pipeline would threaten those tribal areas.
Le Dakota Access Pipeline avec la réserve indienne de Standing Rock en orange. Source: Wikipedia, Creative Commons.

Reactions towards the protestors have also been extreme, as Maina Kiai, UN Special Rapporteur, has reported. The North Dakota National Guard, law enforcement officials, and private security organizations have used extreme force, shown through the use of “rubber bullets, tear gas, mace, compression grenades, and bean-bag rounds.” These reactions have been in violation of the U.S. Constitution, specifically the First Amendment. Although some protests have become violent, Kiai suggests that “the response should remain strictly proportionate and should not impact those who protest peacefully.”

“The right to freedom of peaceful assembly is an individual right and it cannot be taken away indiscriminately or en masse due to the violent actions of a few.” — Maina Kiai

By also having part of their cultural homeland destroyed during the construction process, the company contracted for this project is violating the United Nations Declaration on the Rights of Indigenous Peoples, where Article 8 of the Declaration clearly states that “Indigenous peoples and individuals have the right not to be subjected to forced assimilation or destruction of their culture.” However, it is clear to note that U.S. support does not consider the Declaration as a “legally binding or a statement of current international law,” but instead a political or moral force.

Economic trends and forces have commanded the way in which our country has treated those who have been disenfranchised and harmed culturally. The creation of the Dakota Access Pipeline is merely an example of the effect that these economic interests can have on native populations, the environment, and the treatment of those peacefully protesting. Although the pipeline’s main intent is to provide a source of energy for the United States, the threat to harm a cultural tribal site can lead to the destruction of homes for many residents.

STD Rates Among the Poor and Homeless in Alabama

by Kelsey Johnson (guest blogger)

Picture of a homeless shelter with people standing around and lying down, waiting for a meal and a bed
Source: Yahoo Images

As of 2018, approximately 38.1 million people in the U.S. live below the poverty line. Furthermore, on a given night, over 550,000 people experienced homelessness. 

Of those numbers, more than 800,000 Alabama residents live in poverty, making it the sixth poorest state in the U.S. Approximately 3,434 people experience homelessness in Alabama on a given night. 

Poverty and a lack of adequate housing are considered human rights violations, as they interfere significantly with an individual’s ability to live safely and with dignity. For people experiencing poverty and/or homelessness, these situations impact all aspects of their lives, especially their physical health.

One way that these health issues manifest is in the prevalence of sexually transmitted diseases (STDs) and HIV/AIDS among these populations. Overall, rates of STDs, particularly chlamydia, gonorrhea, and syphilis, are at an all-time high in the U.S., according to a 2019 report from the Center for Disease Control and Prevention (CDC). In 2017-18, there were nearly 2.5 million total reported cases of the three STDs, including over 1.7 million cases of chlamydia, 583,405 cases of gonorrhea, and 115,045 cases of syphilis. 

Two urban areas in Alabama, Montgomery and Birmingham, are among the top 20 U.S. cities reporting the highest rates of STDs, including HIV, syphilis, gonorrhea, and chlamydia. Mobile and Huntsville also ranked in the top 100. Alabama has the fourth highest rate of gonorrhea infections in the country. Additionally, as of 2016, there were 12,643 people in Alabama living with HIV. 

While the CDC report examined STD prevalence among various demographics, it did not focus on STD rates among low-income or homeless populations. However, a literature review published in 2018 in the journal Sexually Transmitted Diseases found that STD prevalence ranged from 2.1% to 52.5% among the homeless adult population. 

This study also identified many of the factors that increase the risks of contracting an STD among homeless individuals. A number of these risk factors also apply to individuals living in poverty, even if they have stable housing. Additional studies offer more insight into the recent rise in STD cases, as well as recommendations for how to decrease their spread among all populations.

Factors contributing to STD prevalence among low-income and homeless populations 

There are several factors that contribute to the prevalence of STDs in low-incomes and homeless communities, including lack of access to affordable prevention and treatment options; lack of comprehensive sex education; the comorbidity of issues like mental illness or substance abuse, and the stigma surrounding STDs. 

According to a 2019 report by the National Coalition of STD Directors, “…poverty is both a cause of infection, and a barrier to the ability to seek care. Poorer populations are less likely to receive appropriate sexual health education, suffer higher rates of substance abuse, and may have more trouble accessing sexual health services.”

Poor or homeless individuals are less likely to have health insurance, or resources to pay for out-of-pocket healthcare costs. Many individuals living in southern states, including Alabama, fall into what is known as the coverage gap, meaning they make too much money to qualify for Medicaid, but not enough to pay for health insurance.

Even if individuals have health insurance, their coverage may be limited to certain providers or services, and may exclude STD testing or treatment. The time and money it takes to travel to healthcare facilities, especially in predominantly rural states like Alabama, also present a barrier to care, even for insured individuals. 

Additionally, budget cuts have forced many STD clinics to close or reduce their services. The loss of these clinics is harmful because not only do they often provide STD testing and treatment on a sliding fee scale, they are staffed by individuals with specialized knowledge in diagnosing and treating STDs.  

The other primary factor in higher STD rates is a lack of comprehensive sex education. As the NCSD report states, “States typically define the broad parameters of sexual health education in public schools. Not surprisingly, these parameters vary widely among states.” Studies show a correalation between insufficient sex education and higher STD rates. Kathie Hiers, the CEO of AIDS Alabama, says the state represents a “perfect storm” for the spread of AIDS and other STDs, in part because of its “poor educational systems that often ignore sexual health.”

This lack of education about STDs also perpetuates the stigma surrounding them, which prevents people from seeking treatment, according to Hiers. Other conditions that are prevalent among poor and homeless populations, including mental illness, incarceration history, and intravenous drug use, also make individuals more susceptible to STDs, and present barriers to seeking treatment.

How to prevent the spread of STDs among low-income and homeless populations

The studies and experts cited in this post offer several recommendations for steps that can be taken, nationwide and in individual states, to decrease the spread of STDs among low-income and homeless populations, including: 

  • Removing financial barriers to healthcare, including adopting Medicaid expansion. The Alabama Hospital Association estimates that by adopting Medicaid expansion, an additional 300,000 residents would be eligible for health insurance.
  • Increasing or restoring funding to public health agencies and STD clinics that provide free or low-cost testing and treatment.
  • Improving access to healthcare facilities through transportation and operating on evenings and weekends.
  • Providing comprehensive sex education in schools. In 2019, the Alabama House of Representatives failed to address a bill that would have made the state’s sex education curriculum more scientifically and medically accurate. The bill would have updated the curriculum’s language to address “sexually transmitted diseases” as “sexually transmitted infections,” which is considered less stigmatizing.
  • Expanding resources to support homeless individuals, and increasing their access to stable housing. A 2016 report by the Homelessness in Alabama Project offered several specific recommendations for addressing homelessness in Alabama.

Additional Resources

Pigmented Pandemic: Racial and Ethnic Disparities in COVID-19

Ubiquity of the novel coronavirus (COVID-19) has drastically changed the way we behave in almost every corner of life. One silver lining drawn into these unprecedented times is that many people are more appreciative of their families, friends, and communities. However, the odds of being in a social network that knows someone who has been diagnosed or died from COVID-19 are greater if you are a racial/ethnic minority living in the U.S. As such, this blog focuses on COVID-19’s disproportionate effect on communities of color and how a human rights approach can help address racial/ethnic health disparities.

Racial/ethnic minorities are particularly vulnerable to reduced access of health services and the psychosocial stressors of discrimination which is why some argue that racism is a fundamental cause of health inequalities. These disparities are largely due to the disadvantaged economic and social conditions commonly experienced by many racial/ethnic minorities. Compared to Whites, racial/ethnic minorities are more likely reside in densely populated areas, live further from grocery stores and medical facilities, represent multi-generational homes, and be incarcerated. Additionally, racial/ethnic minorities disproportionately represent essential worker industries and have limited paid sick live. As a result, the living and working conditions for many racial/ethnic minorities put them at odds with threat of COVID-19.

Vestiges: Black American Health Disparities

Black Americans have disproportionate rates of COVID-19-related risk factors such as diabetes, hypertension, and obesity. As such, they are disproportionately dying of COVID-19 in many counties across the U.S. These disparities are even more alarming at the state-level. For example, in Georgia, 83% of all COVID-19 cases linked to a hospitalization were Black patients despite the community only representing a third of the state’s population. Also, in Michigan, Blacks represent 14% of the state’s population but 41% of the COVID-19 deaths. On a national level, Blacks (13% of the total population) represent 33% of all COVID-19 hospitalizations, while Whites (60% of the total population) represent 45% of all COVID-19 hospitalizations.

Not only do Black Americans disproportionately live in many of the U.S.’s early COVID-19 hotspots (e.g., Detroit, New Orleans, and New York), they are also more likely than their White counterparts to experience poverty and have no health insurance. For centuries, the labor of Black Americans has been deemed “essential”, while the COVID-19 pandemic adds insult to injury. In the medical field, Blacks are less likely to be health professionals and more likely to represent personnel that cleans, provides food, or work in inventory. As such, Black essential workers who are not on the frontlines are more likely to acquire COVID-19 in the pernicious form of regularly contacting cardboard, clothing, or stainless steel. Thus, health disparities in the Black community demonstrate how the legacy of slavery and segregation thrive in the social and economic conditions of COVID-19.

Segmented: Latino American Health Disparities

Many Latinos in the U.S. have immigrant status and work in high-risk essential industries such as agriculture, food service, and health care. This largely explains why Latinos are up to three times more likely than Whites to be infected and hospitalized by COVID-19. These striking outcomes are compounded when considering that Latinos face other disproportionate hurdles such as inadequate communication resources and language barriers. Also, Latinos often socialize in “mixed status” immigrant networks which means those who are undocumented are not eligible for COVID-19 stimulus funding.

A recent Pew poll found that Latinos are almost 50% more likely than the average American to have been laid off or lost a job due to the pandemic. This is particularly salient to Latinos with a high school education or less and those ages 18-29. However, immigrant Latinos were less likely to lose their jobs but more likely to take a pay cut. As a result, the Latino experience during the COVID-19 pandemic is not only fraught with social and economic drawbacks, much like other communities of color, but complicated by the fact that their large immigrant population is ineligible for needed resources and often relied on in the essential workforce. These outcomes suggest the social and economic consequences of COVID-19 are uniquely challenging to Latinos, namely immigrants with limited access to resources that are often afforded to citizens.

Overlooked: Native American, Native Hawaiian, and Pacific Islander Health Disparities

Often overlooked in the racial health disparities conversation are outcomes for Native Americans. Some state health departments (e.g., Texas) classify Native American COVID-19 statistics as “other” which ultimately dismisses the unique health profile of this underserved population. However, early statistics from Arizona and New Mexico suggest Native Americans represent a disproportionate number of COVID-19-related deaths and cases, respectively. Reports from health authorities in Navajo Nation, which is comprised of areas in Arizona, Utah, and New Mexico, indicate this community’s confirmed COVID-19 prevalence rate is the highest in the country, although they have a test rate higher than most U.S. states.

In March, the Seattle Indian Health Board requested medical supplies from local health authorities but instead received body bags and toe tags. This callous response demonstrates that local authorities in Washington state have actively devalued the lives of Native Americans during these trying times. The Cheyenne River Sioux Tribe in South Dakota have responded to their state’s negligence by refusing to end COVID-19 highways checkpoints across tribal land. Cheyenne River Sioux Tribe Chairman Harold Frazier argues that the checkpoints are the best thing the tribe has to prevent the spread of COVID-19 because they are only equipped with an eight-bed facility for its 12,000 inhabitants. The nearest critical care facility is three hours away.

Also overlooked are COVID-19 outcomes among Native Hawaiians and Pacific Islanders (NHPI). Early reports from California, Hawaii, Oregon, Utah, and Washington indicate that NHPI have higher rates of COVID-19 when compared to other ethnic groups. A precursor to these outcomes is that NHPI have some of the highest rates of chronic disease which puts this demographic at higher risk of COVID-19. Much like other racial/ethnic minority groups, NHPI are more likely to work in the essential workforce and live in multi-generational households. Thus, these conditions allow COVID-19 to proliferate among NHPI enclaves.

Person with a protective mask preparing food with a front door sign that reads "No Mask, No Entry".
Thank you essential workers! Source: spurekar, Creative Commons

Health and Human Rights

Health is argued to be a fundamental human right. Ways this can be achieved is through creating greater access to safe drinking water, functioning sanitation, nutritious foods, adequate housing, and safe conditions in the workplace and schools. As such, health exists well outside the confines of the typical health care setting. However, the U.S. has yet to officially ratify the Universal Declaration of Human Rights which ultimately prevents the government from being held accountable for the socioecological influences that generate health disparities across racial/ethnic minority groups.

These health disparities are not debatable and even acknowledged by the U.S. Commission on Civil Rights. In response, national efforts, state-level policies, and public health programs have successfully reduced these disparities but have only made modest progress. Thus, comprehensive, systemic, and coordinated strategies must be implemented to achieve health equity. Although solving this daunting task cannot achieved by the U.S. government alone. It must also incorporate non-profit and philanthropic on-the-ground efforts already seeking this goal as well as greater public awareness about the impact social and economic policies have on racial/ethnic health disparities.

Despite these discrepancies, the COVID-19 pandemic serves as an opportunity for social change. More specifically, these unprecedented events bring greater light to issues such as poverty, homelessness, unemployment, and migration, all of which disproportionately affect communities of color. As a result, the ubiquity of COVID-19 has gathered people from every corner of the justice community to declare that health is a human right, thus bringing us one step closer to true equity and inclusion.

COVID-19 and Healthcare

two doctors demonstrate glucometer to patient.
How to make most of doctor’s appointment. Source: Army Medicine, Creative Commons.

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.