Right to Health and Public Health – Page 8 – UAB Institute for Human Rights Blog

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.

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

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. 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 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 20^th 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)

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

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

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

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

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

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

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

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

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

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

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

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

Coronavirus and Religion

As the Covid-19 pandemic is taking the whole world by a storm of chaos and confusion, it is directly affecting various aspects of people’s lives. People around the world are trying to get used to this new normal and cope up with the challenges and changes in daily life caused by this global crisis. Since we are facing an outbreak like none other, it has directly affected and changed how we live, work, communicate, and carry out our daily lives. Religion is a very important part of most people’s lives and affects their everyday routine as well as physical, psychological, emotional, and spiritual beings. The freedom to have, follow, and practice a religion is a fundamental human right, and I will explore how the novel coronavirus crisis is impacting and interfering with the religious rights of people.

Since the pandemic has affected most places in the world, religious institutions and houses of worship are no exception. Churches, mosques, synagogues, and temples have been closed for all kinds of gatherings due to the social distancing protocols set through by the CDC as a response to Covid-19. In these unprecedented times, billions of people are resorting to religion as a first resort for comfort and solace. When all else looks unsettling, people of faith are turning closer to religion and spiritual observance throughout the world. But the pandemic has also interfered with traditional ways of practicing religion through the closure of the places of worship and withdrawal of gatherings of this sort. As a Muslim myself, I would like to share my observation and experience of the influence of this pandemic on the religious experiences of Muslims around the world.

Islam is the second largest and fastest growing religion in the world with more than 1.9 billion followers, thus a significant population of the world is facing challenges in exercising their religious rights and rituals. During the initial phase of the outbreak, the first immediate effect on Muslims was the cancellation of the Friday communal prayer. People were ordered to pray in their homes in order to avoid close contact with each other. This congregational prayer is of great significance to Muslims as they come together in mosques to listen to the weekly sermon, pray together, and fulfill this obligatory ritual. Therefore, its dismissal was a big deal for the Muslim communities worldwide and also led to conflicts in some areas. For example, worshippers in Pakistan clashed with police personnel trying to enforce the lockdown at the time of the prayer. Similarly, some mosques in Bangladesh continued to operate despite government restrictions and a massive prayer gathering with tens of thousands of devotees was held without permission from the authorities. The pictures of the event were shared on social media, where it was greatly criticized and sparked an outcry from people in favor of the lockdown. People in Indonesia were divided over Friday prayers and coronavirus fears, resulting in some praying at home and others gathered in mosques. Religious leaders in the U.S. also faced a dilemma in making the best decision for their followers, facing disagreements on whether or not to cancel Friday prayers. In the second week of March, Muslim organizations including the Islamic Medical Association of North America and the Islamic Society of North America gave a joint statement suspending Friday prayers and recommending necessary precautions to the Muslim community.

Protecting human life is one of the fundamental objectives of Islamic Shari’ah. This concept takes precedence over all other objectives of Islamic faith as life represents the foundation of our existence. Therefore, at times, preservation of human life and human rights is far more significant than the continuity of even essential practices of devotion.

People are finding alternate ways to keep practicing religion while also practicing social distancing. Online platforms are being widely used to share information, resources, and ways to get closer to religion as well as interact with other people of faith for support. To lift up the spirits of the Muslim community amid this pandemic, the call to prayer, Adhan, was chanted from loudspeakers in the heart of Europe in early April. Nearly 100 mosques in Germany and the Netherlands rang out with the sound of Adhan as a gesture of support for Muslims. A lot of mosques in Muslims countries have added a line at the end of every call to prayer, asking people to pray at home.

Adhan recited from mosques to fight against COVID-19 in Germany. Source: Yeni Safak, Creative Commons

Islam’s holiest site in Mecca, known as the Kaaba, which is always packed with tens of thousands of pilgrims year-round, was emptied due to Covid-19 concerns earlier this March. Muslims around the world were shocked, shuddered, and deeply saddened to see the holy place deserted for the first time in millennia. The images of the empty Kaaba inside Mecca’s Grand Mosque were extensively spread over social media as Muslims showed their concern and disappointment on this unprecedented yet imperative move. Every year, nearly 2.5 million pilgrims visit the holy sites of Mecca and Medina for a week-long ritual known as Hajj; one of the five pillars of Islam and obligatory for every able-bodied Muslim once in their lifetime. The kingdom of Saudi Arabia stopped Umrah, a non-mandatory pilgrimage, in late February due to the pandemic. As the unfavorable situation still persists, the cancellation of Hajj, which starts in late July, is also being considered. This is one of the largest human gatherings in the world, and its potential cancellation will affect millions of people and businesses around the world.

The holy Kaaba in Mecca, Saudi Arabia. Before and after Covid-19. Source: Creative Commons

The Islamic month of Ramadan started a few days ago and it is one of the most important, sacred, and celebrated time of the year for Muslims. It is marked by fasting from sunrise to sunset, charitable giving to the less fortunate, spiritual renewal, praying and reading the Quran, abstaining from worldly pleasures to reconnect with the self and with God, and coming together as a community to celebrate. Muslims around the world are having a Ramadan like no other this year. The mosques are empty, the daily nightly prayer Tarawih is canceled, people are observing the holy month by praying in their homes and sharing meals with immediate families instead of large community feasts. People are trying to find alternate ways to have the Ramadan experience by holding virtual Iftar meetups, online sermons and halaqa sessions, and donating through online platforms amidst these social-distancing times. On one hand, lockdown in Ramadan has also allowed people to spiritually indulge themselves without worldly distractions like work and school and to modify their daily schedules accordingly. It has given some relief to those who are fasting to catch up on lost sleep from late night prayers and waking up in the middle of the night for the pre-fast meal suhoor. On the other hand, the cancellation of open Iftars organized by mosques and charitable organizations that allowed sharing a meal for everybody has taken a toll on the less fortunate who rely on these meals during Ramadan. Since the world is already facing an economic crisis and a lot of people are in an uncertain situation financially, this time of festive observance is becoming harder for those who are unable to provide for their families and take part in all the celebrations. Since the month of Ramadan teaches empathy and encourages acts of compassion and generosity, Muslims around the world are stepping up to help their brothers and sisters in this time of need. The act of fasting teaches patience, self-discipline, sacrifice, and empathy and these virtues are more important than ever for all of us to practice in these difficult times.

The end of Ramadan is commemorated with a celebration called Eid, which is also referred to as a gift for those who fasted the whole month. For us, the day of Eid is marked by wearing new clothes, going to the communal Eid prayer in the morning, celebrating with the community, and sharing meals and presents with family and friends afterwards. This year, it is expected to have a similar fate as Ramadan if the state of emergency continues, resulting in all the festivities being called off.

Muslims praying in a mosque. Source: Shaeekh Shuvro, Creative Commons

Coronavirus has also changed how funeral services and burials are carried out across the world. Islam has specific guidelines and rituals to perform for the deceased including washing/bathing the dead body, putting it into a coffin, and offering the collective prayer before a procession of friends and family takes the body for burial. According to the CDC guidelines, gatherings are not supposed to exceed 10 people and the body of the infected person should not be touched. Muslim scholars in the US have proposed alternative ways to carry out these procedures such as limiting the handling of the body to the specific staff of the graveyard or funeral home with the use of proper personal protective equipment (PPE). They have also suggested doing tayammum instead of bathing the dead body, which is characterized by wiping the face and hands of the deceased after touching a sandy surface. Additionally, family and friends are not allowed to be physically present during the burial or the prayer. Attendance at funerals is considered a collective obligation that must be carried out by a sufficient number of people, but changes are being made to ensure the safety of everyone. My mother’s uncle passed away from coronavirus last week in Boston, Massachusetts and his family was not allowed to see him at all. Instead, the funeral was live streamed and the prayer was held in the presence of only four people, one of them being the imam who led the prayer.

It is important to note that not only is this Covid-19 situation affecting religious experiences, but some of these rituals have also contributed to the spread of the virus. For example, a gathering of 16,000 worshippers at a Malaysian mosque became the largest known viral vector of the pandemic in Southeast Asia, spreading the coronavirus to half a dozen countries. Similarly, the pilgrimage of Shia sect Muslims to the holy cities of Iran led to the spread of the virus through Central and South Asia. The pilgrims reportedly caught the virus in the holy city of Qom, which was the epicenter of covid-19 in Iran and caused it to spread in their home countries upon return. Even though Pakistan shares its border with China, the novel coronavirus was introduced into the country through pilgrims returning from Iran. Similar cases have been seen around the world where coronavirus infections have been linked to religious gatherings, such as church services in South Korea and North Carolina, Jewish Purim celebrations, and Muslim prayer gatherings.

To conclude, religion is both a source of solace as well as a possibility of risk during a pandemic. People of faith around the world are struggling to keep a balance between religious practices and safety precautions. It is in the best interest of everyone to follow the social distancing guidelines whenever possible and find peace in their own beliefs, whatever they may be.

COVID-19: A Glimpse to the East

An image of a crowd of people in Wuhan, China. They are all wearing masks as a response to the COVID-19 pandemic. — 2019-20 Wuhan coronavirus outbreak. Source: Wikipedia. Creative Commons.

COVID-19, otherwise known as the 2019 novel coronavirus, has spread to many countries around the world, affecting many immunocompromised populations and impacting millions of people worldwide. My colleagues have referenced hotspots where the response has impacted the most, from the Middle East to migrants right outside U.S. borders. They have illustrated how discrimination, isolationism, and plain ignorance have shattered families and populations, destroyed economies, and brought fear and terror into the hearts and minds of Earth’s people. It is in that essence that this article will continue to explain the impact of COVID-19 in another hotspot of the world, Asia.

The Asian continent, comprising 48 countries, according to the United Nations, encompasses immense diversity and roughly 60 percent of the global population within its boundaries. This diversity includes, but is not limited to, having the highest and lowest points on Earth, “the world’s wildest climatic extremes,” and “the birthplace of all the world’s major religions.” For the sake of this article, I will be focusing on three countries that are handling the virus very differently, India, China, and South Korea.

Food Insecurity

Having one of the highest populations in the world, India is often referenced as a case study when examining the impact of overpopulation, economics, and food security. In 2012, Uttar Pradesh, India’s most populous state, 60 million out of 200 million people were considered living below the poverty line. Economic inequality has further negatively impacted India’s poorest communities with “57 billionaires controlling 70 percent of India’s wealth” as of 2017. Such inequality has led to the increase in poverty, a lack of medical equipment and access, poor living conditions, and a lack of food.

An image of Indian Census data from 2011. The country is seen with an immense population density per square kilometer. Uttar Pradesh and the city of Kolkata are most dense. — Demographics of India. Source: Wikipedia. Creative Commons.

However, this pandemic has exacerbated the lack of access to food by Indian residents that comes on the heels of Prime Minister Nahendra Modi’s announcement to begin a “21-day nationwide lockdown.” With such an announcement also came with rising panic from Indians, crowding grocery stores and shops with people panic buying everything in sight. Under Modi’s plan, the “Prime Minister’s Poor Welfare Scheme”, individuals will be able to receive five additional kilograms of rice or wheat for the next three months. Although proposed to benefit 800 million people, many are wary of its success due to the closure of interstate travel, trains, and flights. It is under this lockdown that residents could face two years in jail and a financial penalty if they leave their home for non-essential reasons. In an interview with Time, an autorickshaw driver expressed concern over Modi’s decree to lockdown the entire country. Before the decree, his main concern was to save enough money to help get his son through college. However, “as he stays home with no daily income, his main concern is putting food on the table. He’s not sure what he will do” once those savings run out. When examining a singular issue impacted by COVID-19, the situation in India highlights the issues that countries with an enormous informal sector may face due to economic hardship and lack of infrastructure. For example, India can grow enough food for its growing population, although millions are left underfed due to “bottlenecked supply chain[s], inadequate logistics, food wastage and sharp societal inequalities.” The virus has further called to attention the lack of food security that many around the world face on a daily basis which infringes upon their basic human rights and a Sustainable Development Goal that must be achieved by 2030, Zero Hunger.

Government Control

An image of the spread of the coronavirus in January. The Wuhan province is shown to be the most effective, colored in black. — Timeline of the 2019-20 coronavirus pandemic from November 2019 to January 2020. Source: Wikipedia. Creative Commons.

Being the most populated country in the world, China is often criticized for its drastic measures and horrifying treatment of Muslim minorities. When examining the pandemic, COVID-19 is known to have originated in the Wuhan province in China and was noticed by Chinese ophthalmologist Li Wenliang. Dr. Wenliang had used a private online chat to explain his worry for the novel virus, which quickly went viral, resulting in him being reprimanded by Chinese police. Following this observation, the province had shut down, cutting off transportation and sealing residents off from the outside world. In an interview with Dr. Bruce Aylward, “the leader of the World Health Organization team that visited China,” had praised the Chinese government’s decisive actions towards preventing the spread of the virus:

“I think the key learning from China is speed — it’s all about the speed.” — Dr. Bruce Aylward

Although the Chinese government has sought to demonstrate its prowess and handling of the virus, through building hospitals in 10-days and publishing photos of patients who have been cured of the disease, many human rights groups have expressed concern and worry over the treatment of those who have been critical of the government. For instance, Chen Qiushi, a Chinese human rights lawyer, was “put under quarantine”, Fang Bin, a citizen journalist, disappeared in February, and Li Zihua, another journalist, was taken away by a group of men. Dr. Wenliang had died due to the virus early February of 2020. With the news of his death, thousands of comments flooded Chinese social media site Weibo criticizing the Chinese government and censorship in the country with top hashtags such as “Wuhan government owes Dr Li Wenliang an apology” and “We want freedom of speech.” According to the British Broadcasting Corporation (BBC), when they searched for the hashtags a day after Wenliang’s death, they disappeared having been censored alongside many comments aimed at the Chinese government.

From Wuhan province, we now turn to the Xinjiang province in Western China, where the imprisonment of millions of Uyghur Muslims could prove to be a breeding ground for the virus as it spreads throughout the world. You can read more IHR blogs about The Uyghur Muslims in the context of Crimes Against Humanity here and how this crisis is affecting refugees on the US-Mexico border here. In Xinjiang, there are an estimated three million people detained in re-education camps in Western China, mostly of Uyghur Muslims who have been suppressed by the Communist Party. As alleged by Jewher Ilham, the daughter of a jailed Uyghur academic, some of the “conditions at the detention centers offered the perfect chance for coronavirus to spread” citing “systematic abuse, serious overcrowding and poor sanitary conditions inside the camps.” Given allegations of China’s unwillingness to publish the truth about these conditions combined with the alleged suppression of critics and ethnic minorities, it is deeply concerning to gauge the risks of infection amongst those who have been cited as not having enough to eat or doctors on staff to treat those infected. This is also a signal to international groups and organizations to ensure that all people have the chance to be cured and not suffer as a result of the virus or violating the human rights to freedom of speech.

An image of China divided into province. The Xinjiang province is highlighted with the highest concentration of Muslims — Xinjiang Region, China. Source: Flickr, futureatlas.com. Creative Commons.

Some Potential Success?

Amongst all the panic buying and the loss of toilet paper throughout the country, there seems to be some light at the end of the tunnel manifesting itself through ‘flattening the curve’. This method has seemed to be close to perfected by South Korea whose growth in COVID-19 cases has significantly slowed compared to the United States. When examining South Korea, many writers have explained the situation by comparing it to religion and culture, chalking it up to higher levels of social trust and the lingering aspect of Confucianism. However, that does not seem to be the case. By flattening the curve, South Korea has demonstrated that it is due to “competent leadership that inspired public trust.” Having tested more than 5000 people per million inhabitants than the United States, it is no wonder that taking early action and mobilizing health officials could lead to a successful response.

“No sacred Confucian text advised Korean health officials to summon medical companies and told them to ramp up testing capacity when Korea had only four known cases of COVID-19.” — S. Nathan Park

Compared to China, India, and even the United States, South Korea did not have to “lockdown entire cities or take some authoritarian measures,” rather, they learned from their past experience with MERS (Middle East Respiratory Syndrome). Such preparation allowed the South Korean government to be proactive and “improve hospital infection prevention and control.” Combined with South Korea’s industrial and developmental advantages over both China and India, the government was able to take a proactive approach and deter the worst effects of the virus. Once South Koreans started getting sick in early February, the government immediately began “testing aggressively to identify cases — not only testing people who are so sick that they’re hospitalized but also mild cases and even suspected cases.” This initiative has allowed South Korea to quarantine those at a high risk while also managing to keep their factories, schools, hospitals, and entire cities open while other countries around the world are having to shut down everything to contain the spread.

An image of the cumulative and new cases of coronavirus in South Korea. The graph is showing a flattening of the curve. — 2020 coronavirus cases in South Korea. Source: Wikipedia, KCDC. Creative Commons.

Conclusion

Looking back at India, China, and South Korea, it becomes apparent that a swift and proactive response is necessary in order to not allow for the lockdown of entire cities and countries. However, that proactivity must balance itself between being lax and aggressive. For example, China’s efforts to curb the spread of the news rather than the virus has made human rights concerns more apparent to the world, especially since the freedom of speech for civilians is being curbed to protect China’s global reputation. In India’s case, the pandemic has shown many human rights groups and countries the issues that a country with a massive impoverished population faces during difficult times. By being able to demonstrate good leadership and mobilizing experts, South Korea has ultimately done what many other countries would only hope to accomplish. Such success has already inspired other Asian countries to follow suit, especially Singapore, Japan, and others. And although South Korea’s population is significantly small compared to that of India and China, their success is one that can be successfully implemented worldwide. Instead of casting these successes aside as an element of Confucianism or culture, it is necessary for us to be able to model our response like South Korea’s so that were such an event to occur again, we will be able to swiftly contain the spread rather than suffer through weeks and months at home without physical human interaction.

How Covid-19 Exposes the American Healthcare System

When I studied abroad in Spain, I had many discussions with my host family comparing the United States and Spain. These conversation topics ranged from politics, social expectations, and the weather. One topic that my host mother was especially interested in is the American health care system in comparison to the Spanish health care system. Spain has a universal health care system while still allowing private insurance whereas the United States has purely private insurance. Neither system is perfect. However, as the Covid-19 crisis continues to progress it is important to understand how the crisis brings to light the many issues with the American health care system.

A woman in a mask. — Woman in Mask. Source: Patrice CALATAYU. Creative Commons.

It is a well-accepted fact that the United States was significantly less prepared for the impact of Covid-19 than most other developed countries. By any metric of pandemic preparedness, America is significantly behind the rest of the developed world in regard to medical supplies. The country has a severe lack of health care infrastructure within the system; even before the international pandemic, the United States had fewer doctors and hospital beds than the majority of other developed countries. The United States lacks in the number of doctors per capita with 2.6 doctors per 1,000 people. The comparable country average is 3.5 per 1,000 people, which shows just how behind America is. The United States also has fewer hospital beds per capita than the majority of other developed countries. To make matters worse, America has some of the highest rates of unnecessary hospitalizations. These are hospitalizations of patients with chronic conditions that have preventable treatment, making it unnecessary for the patient to be hospitalized. With a pandemic such as Covid-19, these unnecessary hospitalizations are diminishing. However, in the beginning of the crisis within the United States, unnecessary hospitalization significantly slowed down the efficiency of the health care system in caring for Covid-19 patients.

An important trend in the preparedness of the United States for Covid-19 is that the United States, with a private health care system, was noticeably less prepared than countries with universal health care systems. It is true that universal health care is not the perfect response to pandemic emergencies like Covid-19. This is shown by Italy, a country who has a federalized national health insurance program. Italy still needed to lock down and for a while had the highest case and death rate than any other country. However, countries like Italy with universal health care were able to begin recovery and slow the spread of the virus much quicker than those without.

a hospital — Hospital Beds. Source: Presidencia de la Republica Mexicana. Creative Commons.

As health providers have been working tirelessly to make the necessary changes to care for Covid-19 patients, private health insurance companies have been making very few changes to their processes. One system health care providers have been implementing is telemedicine, a program that allows patients to securely consult with their health care providers virtually therefore easing the burden on the infrastructure of the hospitals. Despite President Trump expanding provisions on telemedicine, private health companies are not required to pay health systems for telemedicine. At the same time, while some insurance companies have waived some Covid-19 related costs, out-of-pocket expenses are not waived resulting in patients needing to pay thousands of dollars. To put these costs in perspective, in 2018 the average amount for a patient covered by private insurance admitted to the hospital for a respiratory condition similar to coronavirus was $20,000. Additionally, as hospitals across the country prepared for an influx of Covid-19 patients, stable patients without the virus were forced to stay in the hospital beds. These patients, who should have been moved to a rehab facility or released, were taking up unnecessary space due to private insurance companies taking multiple days to authorize the next steps for each patient. This has been a known delay in hospitals before the pandemic but now it is a delay that has dire consequences.

Quite possibly the biggest problem in the American health care system is cost. This problem is unique to the United States. Citizens are required to pay higher out-of-pocket costs than those in most other countries, leading Americans to forgo their health care in order to save money. Reports have shown that 33 percent of Americans reported a cost-related barrier to receiving care. This is in comparison to the 7 percent who reported the same in Germany. In 2019, a study showed that 33 percent of Americans also reported postponing medical care due to the cost of that care. It is only in the United States that citizens are risking thousands of dollars in order to seek help in a medical crisis like the one posed by Covid-19. A major concern across the world is that Americans will not seek care for corona symptoms due to the high costs of healthcare in the United States and the high amount of people without insurance in the country. This will spread the disease significantly faster than officials within the country would like to believe.

man with supplies — Medical Supplies. Source: Navy Medicine. Creative Commons.

As the Covid-19 cases rise in number across the country, an unusually high number of African Americans in the United States have been infected with Covid-19. This news, while terrible, is unfortunately not shocking and highlights the many racial inequalities in the health care systems. Coronavirus does not have a racial factor but the structural racism within the American health care system is evident. African Americans are over-represented in many essential workplaces making the population more at-risk than other populations. At the same time, African American populations are less likely to have health insurance coverage leading to a disproportionate number to not receive the necessary help from the health care system. There also exists a racial empathy gap that disproportionately affects African Americans and Hispanics within the United States. A racial empathy gap is when medical professionals show less empathy and sympathy to African American patients who are experiencing pain. Human rights workers have been working on mandatory reviews to ensure that health workers are providing an equitable form of treatment for minority patients. However, due to a bias developed and enforced by societal constructs of different races, there exists a higher risk for minority populations within the American health care system.

A few examples of problems within the American health care system that have been exacerbated by Covid-19 are highlighted above. While officials within this system and within the government must work to make necessary changes, it is also important to recognize the lifesaving and tireless health care workers who work within the imperfect system. Covid-19 has shown the country how necessary health care workers are. Nurses, doctors, surgeons, and so many other health care providers have dedicated an immense number of hours to fighting Covid-19. These individuals who are working to save lives within the corrupt health care system are extremely important and we must recognize their hard work while we work to make the system fairer and more equitable.