Another Battle for Bodily Autonomy in Trans Youth

On February 10, 2021 the Alabama Senate Health Committee voted to criminalize transgender medicaltreatment for minors. With an 11-2 vote, the committee approved Senate Bill 10 (SB-10), a bill that will “outlaw puberty blocking medications and gender-affirming care for minors.” On March 3, the Alabama Senate passed this legislation, and it is currently awaiting Governor Kay Ivey’s approval. SB-10 empowers the legal system to prosecute clinicians and pharmacists with felony charges if they prescribe medication or provide treatment to aid in the transitional processes of minors. Bill sponsor Senator Shay Shellnutt (R-AL) claims that “minors are too young to be making this decision.” The Senator has also admitted that he’s never interacted with a trans teen before submitting the bill. Opponents of the SB-10 refute Shellnutt’s claim by acknowledging this decision is between the medical care provider, the patient, and the patient guardians. As such, SB-10 infringes on the private rights of parents to care for their children with necessary and proper interventions. Shellnut has mentioned that hormonal treatment and other transgender interventions cause long term issues and that a child is not mature enough to be making such a permanent decision. Shellnut’s claims are false; the effects of hormonal drugs that are puberty blockers are reversible. Also, when evaluating long term effects of gender reassignment surgeries, doctors prefer to wait until the patient is at least 18 years old before they perform the surgery.

A person holding a sign with a metaphor describing gender.
Source: www.mindfulword.org

Doctors must take the Hippocratic Oath which defines their ethical conduct and moral reasoning. There are two main tenets of the Oath: “benefitting the ill and protecting patients against personal and social harm and injustice.” Not only does SB-10 force doctors to dishonor the Hippocratic Oath, but it is also medically harmful to the patient pursuing care and prevents them from confiding in their medical care team. Dr. Marsha Raulerson says it will “take away child’s confidence in trusting doctors with their thoughts and to talk candidly.”

Healthcare providers are only one pillar of the support system for patients wishing to transition. So, when healthcare providers are unable to provide care to these young individuals, it can harm their mental and physical wellbeing and contribute to gender dysphoria. Adolescent and young adult years are incredibly formative. It’s in these years that young people thrive and when they are in need of a lot of support and care. When their support systems and adequate healthcare is taken away “adolescents can feel alone, stigmatized, and undervalued”. Rejection, discrimination, and stigma during these formative years can put young adults at a higher risk of mental health disorders such as depression and anxiety. The aforementioned mental health disorders can lead to the usage of addictive substances like drugs and/or alcohol, and suicidal ideation. These factors contribute to significant health disparities within the LBGTQ+ community. It’s vital the care they receive is given without stigma and affirms the patient’s sexuality and gender identity, but this care cannot be given with government intervention that holds traces of transphobia.

Protestors gathering against the transgender military ban legislation.
Source: www.britishherald.com

Gender is a very dynamic concept, and there is no binary. It is up to the individual to choose their identity. Gender reassignment treatments and procedures are one way to reaffirm and respect an individual’s choice. LGBTQ+ youth deserve to know that they are respected and that they deserve quality healthcare and treatment. Healthcare providers should not be prevented from fulfilling their responsibilities. They should be able to provide quality care and treatment for their patients. If they can’t, they should be able to refer the patient to a doctor who can provide adequate healthcare. This is not the first time SB-10 has been passed to the full Alabama Senate. It was passed all the way up to the Governor in 2020 to be signed into action and is only back on the table due to COVID-19 complications. Advocacy is an important aspect of healthcare, and providers should be willing to advocate the most for marginalized communities. It is important to lift barriers to care for these groups, instead of continuing to make healthcare inaccessible.

A separate companion bill (HB-391) is currently in the Alabama House. This bill would restrict transgender students from participating in school athletics with the gender they identify with. Lawmakers that support the bill claim that it protects fairness for female and “keeps them from having to compete against transgender athletes who were born male.” The biggest difference to make right now is to call Alabama Senate representatives and tell them the harms these bills will cause to LGBTQ+ youth and to the healthcare providers that try to help them.

COVID-19 vaccine disparity in Israel and Palestine

Since the middle of November, COVID-19 cases have hit record-highs for the pandemic across the world. Countries around the world are pushing to get healthcare workers and the general population vaccinated to ease the burden of increased cases on health systems, economies, and citizens. The logistics of obtaining and delivering the vaccine have proved a slow, arduous task in many countries across the world. 

However, Israel has reported success in rapidly vaccinating health care workers and the general population. At the end of December and early January, Israel reported that it had administered vaccines to around 17% of the population. According to the Jerusalem Post, Israel has secured enough vaccines to have all Israeli citizens vaccinated by March 16th of this year. Israeli Prime Minister Netanyahu has declared, “We will be the first country to emerge from the coronavirus. We will vaccinate all relevant populations and anyone who wants to can be vaccinated.” He went on to say that Israel will be a “model-nation” for how to exit the coronavirus.

A man walks down the street during the Bnei-Brak Coronavirus shutdown in Israel
Source: Amir Appel, Flickr

A significant portion of Israel’s borders is made up of 5 million Palestinians who live in the West Bank, Gaza Strip, and East Jerusalem. Israelis within the defined borders of the state number at 8 million, making Palestineans comprise 39% of the population. Israel occupies the West Bank, meaning most of the territory is under the control of the Israeli government. Gaza Strip has been blockaded, and the Israeli government controls all resources entering and exiting the area. However, Israel has no plans to vaccinate any Palestinians even though they are inoculating residents living in Jewish settlements in occupied territory. They sight the Oslo Peace Accords from the 1990s, saying that Palestine is responsible for their own healthcare. So far, the only Palestinians that have received any vaccines are those living in East Jerusalem, since they have Israeli residency and access to Israeli healthcare. 

A view of the West Bank, Palestine
Source: archer10 (Dennis), Creative Commons

Within Israeli territory, Palestinians have carried the higher burden of COVID-19 cases and deaths per capita. Of the people who get COVID-19 in Palestine, 1.1% will die from the disease. In Israel, this number is 0.7% due to better access to higher quality healthcare. Israel has begun to give vaccines to medics, nurses, and doctors working in the 6 Palestinian hospitals, but they were not available until the past few weeks. Vaccines are still unavailable to Palestinians with high-risk health conditions and those over 65, even though all Israelis over 40 are now eligible. 

A woman gets her first COVID-19 vaccine
Source: Joint Base San Antonio Public Affairs, Flickr

The human rights body of the United Nations has released a statement saying that it is Israel’s responsibility as an occupying power to provide equitable access to Covid-19 vaccines for Palestinians in Gaza and the West Bank. There has been a huge inequality in vaccine distribution between Israel and Palestine, and the people of Palestine need vaccinations like those in the occupying power of Palestine. 

UPDATE (March 29, 2021):  According to BBC News, in early March, Israel decided to start offering the vaccine to the some 130,000 Palestinians living in occupied East Jerusalem or coming to work in Israel or in Israeli settlements in the West Bank. In other parts of the West Bank and in Gaza, the situation continues to be very bleak – infections are rising, new restrictions are being imposed, and vaccination efforts have been much slower to start. The Palestinian authorities have begun administering vaccines supplied under the international Covax vaccine-sharing scheme, which is intended to help poorer countries access supplies, and the UAE has donated 20,000 doses of the Russian-made vaccine to residents of Gaza. There is some argument over who is responsible for vaccinating Palestinians, with Israel pointing to the specification in the Oslo Accords stating that “Powers and responsibilities in the sphere of Health in the West bank and Gaza Strip will be transferred to the Palestinian side, including the health insurance system.” On the other hand, the United Nations issued a statement saying that according to the Fourth Geneva Convention, Israel (the occupying power) is “responsible for providing equitable access to Covid-19 vaccines for Palestinians in Gaza and the West Bank.” In any case, now that the vaccine is in greater supply, Israel has begun including Palestinians with work permits in the vaccine rollout.

The Keystone XL Pipeline and America’s History of Indigenous Suppression

A fake pipeline with the words "stop the xl pipeline" protesting the pipeline
Stop the XL Pipeline. Source: tarsandaction, Creative Commons.

On his first day in office, President Joe Biden signed an executive order canceling the Keystone XL Pipeline Project. The pipeline, which had severe environmental and human rights implications, has been on a long road towards failure. This pipeline was proposed in 2008 and has been referred to as either the Keystone XL pipeline or KXL. In 2015, the Obama administration vetoed the pipeline due to its potential threats to the climate, drinking water, public health, and ecosystems of the local communities. In 2017, the Trump administration reversed Obama’s veto, signing an executive order to advance the Keystone pipeline as well as a similar crude oil project, the Dakota Access Pipeline despite the many valid arguments made against the two pipelines. President Trump also issued a cross-border permit to the pipeline developer, a permit that had been long sought after for the developers. Since the approval, the Trump administration has been sued twice by environmental organizations and lost each time.

The Keystone XL pipeline was proposed by the energy infrastructure company TC Energy. It was proposed to be an extension of the existing Keystone Pipeline System, which has been in operation since 2010. The goal was to transport 830,000 barrels of crude, tar sand oil to refineries on the American Gulf Coast each day. Tar sands lie beneath the northern Alberta boreal forest. They contain a form of petroleum called bitumen, a relatively sludgy substance that can be turned into fuel. Because of the highly corrosive and acidic nature of the tar sands oil, there contains a higher likelihood that the pipeline will leak. A study set between the years 2007 and 2010 found that pipelines carrying tar sands oil spilled three times more per mile than pipelines carrying conventional crude oil. The southern portion of the pipeline, from Oklahoma to Texas, has already been completed. This portion of the pipeline is called the Gulf Coast Pipeline. The climate impact of a complete and fully operational Keystone XL would be drastic. It would increase mining by accelerating the production and transportation of crude oil. It has also been determined that tar sands oil emits 17 percent more carbon than other forms of crude oil. In 2017, the US State Department released a study which proved that carbon emissions could be between 5 and 20 percent higher than the original 17 percent estimation. This means an extra 178.3 million metric tons of greenhouse gas would be emitted annually, a similar impact to 38.5 million cars.

A few protestors with flags in front of the Washington Monument
Keystone XL protestors. Source: Victoria Pickering, Creative Commons.

President Biden’s executive order was a landmark achievement and a sigh of relief for indigenous and environmental activists alike. Indigenous leaders are encouraging him to go even further and cancel more controversial fossil fuel projects, such as the Dakota Access pipeline. Several indigenous leaders, including Dallas Goldtooth of the Mdewakanton Dakota and Dine nations and Faith Spotted Eagle of the Ihanktonwan Dakota nation, have seen Biden’s executive order as a sign of the administration keeping its campaign promise to work against climate change and work with indigenous communities. Many indigenous populations have fought for over a decade to defend their water and land rights against fossil fuel companies. Goldtooth called Biden’s decision a “vindication” of the hard work and struggle many indigenous communities have put forth in protest of the pipeline. Pipelines like the Keystone XL and Dakota pipelines as well as other fossil fuel projects actively pollute native land and water resources as well as consistently contribute to global warming due to their high greenhouse gas emissions.

A similar crude oil project, the Dakota Access Pipeline has received media attention in previous years due to the police and state reactions to the protests over its creation. This pipeline transports 470,000 barrels of crude oil from North Dakota to Illinois, over 1,172 miles. The pipeline continually threatens the sanctity of indigenous sacred lands and the purity and safety of the local water supply. The Standing Rock Sioux tribe has been one of the most vocal groups in working to oppose the creation of the Dakota Access Pipeline. There did occur a series of protests for many months, in opposition of the creation of the pipeline. The protests were primarily peaceful, with camps and prayer circles set up on the land where construction was to take place. However, despite youth and elderly leaders being in the front during the inevitable standoffs with police, Mace, tasers, and rubber bullets were used against the protestors.

A group of young protestors holding a red banner reading "indigenous justice is climate justice."
Indigenous Justice. Source: John Englart, Creative Commons.

The briefest look at American and Canadian history clearly shows that the pipeline situations are most certainly not the first instance of the government refusing to respect the lands, waters, and even peoples of indigenous groups. Until 2016, Canada officially objected to the United Nations Declaration on the Rights of Indigenous Peoples. Canada is considered one of the most water-rich countries in the world and yet many indigenous communities continue to be provided with inadequate access to safe drinking water which provides a large public health concern for these communities. The Canadian federal government refused to provide child and family services funding for indigenous children living on reserves, a purposeful discrimination tactic against indigenous communities. It has been determined that the pervasive violence against indigenous women amounts to genocide.

In the United States, there live over 5.2 million indigenous peoples and among them, 573 federally recognized tribes, numerous unrecognized nations, and many communities scattered across the North American continent, displaced by a long history of western oppression and forced assimilation. Between the years of 1778 and 1871 alone, the United States government has signed over 370 treaties with different indigenous nations, nearly all of which promised peace, defined land boundaries, and protection of land, water, and hunting rights. Based on the current status of indigenous peoples within the United States, it is evident that these treaties and those that followed were either never fulfilled or were manipulated to provide leverage for the United States government. President Biden’s executive order ending the construction of the Keystone XL is a very hopeful step forward, however it needs to serve as a pushing off point for the administration to continue furthering both environmental and indigenous rights.

The Illicit Pharmaceutical Industry and its Impact on Public Health

by Sadie-Anne Jones, guest blogger

Image of a packet of pills
Source: Creative Commons

The illicit pharmaceutical industry is bigger than one might think. In an age where coverage for prescription drugs may be limited and an opioid crisis is rampant, more and more people are turning to this illicit market. Because not everyone that purchases pharmaceutical drugs is aware they are doing so, this industry has been difficult for law enforcement to track. Thus, it has grown internationally and there are few places that are not affected by it.

The illicit pharmaceutical drug industry is a far reaching one. One reason for this is because counterfeit drugs can be made relatively cheap. A recent 60 Minutes segment illustrates how easy it is for companies to produce counterfeit pharmaceutical drugs; small rooms with relatively primitive equipment are used to make multiple drugs including blood pressure medicine, Viagra, painkillers, and seizure medication. One-way people are able to get these drugs is through illicit dealers posing as legitimate online pharmacies. So, even if an individual is not intentionally seeking out alternatives to legally prescribed medication, they may be tricked into it none the less. Other dealers have been much less reserved in how they market their products. As with the “Silk Road” site that operated on the dark web from 2011 to 2013, which included 4,000 dealers and around 100,000 buyers, it made no attempt to hide their illegality. This site acted as a huge distributor of numerous illicit substances including prescription drugs. While the “Silk Road” has been shut down for years, there are still many other sites on the dark web facilitating illicit pharmaceuticals. Additionally, when costumers buy illicit drugs online from sites posing as legal businesses, or even from sites like the “Silk Road,” they are often shipped to buyers through the postal service. This makes drugs difficult to stop, especially when they are shipped in small amounts. All in all, this makes it easy to deal in counterfeit drugs and allows the industry to spread across the globe.

But what are the negative implications? Is it only the pharmaceutical industry’s profit margins that suffer from this illicit industry? The answer is, sadly, no. There have been numerous negative consequences for public health that have resulted from it. Especially in the wake of the opioid pandemic–which hit the country largely due to doctors over prescribing highly addictive opioid painkillers–this industry has caused a large amount of irrevocable damage. As one source states, it is hard to know for sure how much the illicit drug industry has impacted people’s health. That said, it is predicted to have contributed significantly to the 42,249 deaths that resulted from opioid related causes in 2016 alone. Additionally, counterfeit pharmaceuticals are entering hospitals and pharmacies around the country. Even if the drug itself was manufactured licitly, counterfeit materials can make their way into the ingredients, or the ingredients may be safe but the wrong dose is recommended, thus making it counterfeit. These counterfeit ingredients can be anything from chalk to flour. While chalk and flour are fairly harmless, when those ingredients are used in life-saving medications, the results can be catastrophic. In one instance, counterfeit materials found their way into the blood thinner, Heparin, which resulted in the deaths of 80 people. While most pharmaceutical drugs that people receive are not counterfeit, the illicit pharmaceutical industry is continuing to grow and deceive people.

Image of a medicine bottle with a caution label encouraging users to ensure what they are taking is correct
Source: Creative Commons

So, what can be done? As previously stated, most of these illicit pharmaceutical drugs are shipped through the mail and they have proven difficult to stop. Even so, there is still hope. There are new procedures being put in place including implementing new technology in international mail carrier facilities that allows those working there to scan packages and detect even minuscule amounts of opioids, and dark web sites are increasingly being monitored by government analysts. As of now, counterfeit drugs account for less than 1% of all pharmaceutical drugs sold in the United States. While counterfeit drugs are still a major problem in developing countries, it seems like likely that countries across the globe will eventually pick up similar measures to the U.S. and other countries that have reduced the problem significantly, so that this trade can be further snuffed out.

In essence, there are many outlets to the illicit pharmaceutical industry. These range from seemingly legal sites on the internet, the dark web, and even pharmacies and hospitals. These outlets have knowingly, and sometimes unknowingly, helped distribute sometimes dangerous counterfeit drugs to citizens across the globe. This has resulted in the deaths of many people and also helped perpetuate the opioid epidemic. Thankfully, the U.S. has amped up regulation in recent years leading to very little illicit pharmaceuticals ending up in the homes of people across the nation. In the future, it seems hopeful that the regulations that have been implemented in countries like the U.S. will soon be commonly used in other countries as well in order to stop this industry for good.

People of Color Live Disproportionately Close to Superfund Sites

dirt field with a dumpster and a sign that reads "EPA Quanta Resources Superfund Site. Warning: Hazardous substances present in the soil. No trespassing.
Quanta Resources Superfund Site. Source: Anthony Albright, Creative Commons.

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

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

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

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

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

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

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

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

Human Rights in Appalachia: Socioeconomic and health disparities in Appalachia

The previous blog posts in this series are located here:
Human Rights in the Appalachian Region of the United States of America: an introduction
Human Rights in Appalachia: The Battle of Blair Mountain and Workers’ Rights as Human Rights

In the Appalachian region of the United States, there have long been overarching socioeconomic problems that have prevented the region from seeing the same levels of growth as other parts of the country, and even been part of its decline in other domains. Much of Appalachia’s population of twenty-five million people remains remote, isolated from urban growth centers and beneficial resources that exist in cities. The rural towns and counties in which many Appalachian people live have not had the ability to maintain the public infrastructure, furnish the business opportunities, or provide the medical services that are necessary to sustain populations.

There are three regions of Appalachia: the southern region, which covers parts of Georgia, Alabama, Mississippi, the Carolinas, and Tennessee; the central region, which covers parts of Kentucky, southern West Virginia, southern and southeastern Ohio, Virginia, and Tennessee; and the northern region, which includes parts of New York, Pennsylvania, northern West Virginia, Maryland, and northern and northeastern Ohio. While the entire Appalachian region struggles with higher levels of poverty, unemployment, and lack of services and infrastructure, some sub-regions suffer worse than others, and in different ways (Tickamyer & Duncan).

graph of people in poverty by age group
Percent of persons in poverty in rural Appalachia by age group: 2014-2018

Even when compared to other rural areas, Appalachia struggles on measures of educational attainment, household income, population growth, and labor force participation. Rates of disability and poverty are significantly higher in rural Appalachia than they are in other rural areas of America. In 2018, the number of Appalachian residents living below the poverty line was higher than the national average in every age group except those 65 and older. The largest disparity was among young adults (18-24), where the Appalachian population was more than 3% higher than elsewhere. From 2009 to 2018, median household income in Appalachia went up by 5%, not far behind the national average of 5.3%. However, the median household income in Appalachia remains more than $10,000 lower than the national median.

 

map of population age in appalachia
Map of population age in Appalachia

One area where disparities between Appalachia and elsewhere in the country are particularly noticeable is in healthcare. The Appalachian Regional Commission released in 2017 “Health Disparities in Appalachia”, which reviews forty-one population and public health indicators in a comprehensive overview of the health of the twenty-five million people living in Appalachia. The study found that Appalachia has higher mortality rates than the rest of the nation in seven of the nation’s leading causes of death: heart disease, cancer, COPD, injury, stroke, diabetes, and suicide. In addition, diseases of despair are much more prevalent in Appalachia than the rest of the country. Rates of drug overdose deaths are dramatically higher in the Appalachian region than the rest of the country, especially in the region’s more rural and economically distressed areas. Research indicates that diseases of despair will increase under COVID-19, as well. This will be especially true for women, who experience death from diseases of despair at a rate 45% higher than the national average in Appalachia. The ARC found that, while deaths as a result of diseases of despair were more numerous in metropolitan counties of Appalachia, rates of suicide and liver disease were higher in rural counties.

These issues are exacerbated by the fact that there is a much lower supply of health care professionals per capita, including primary care physicians, mental health providers, specialists, and dentists in Appalachia. The supply of speciality physicians is sixty-five percent lower in the central sub-region of Appalachia than the rest of the nation as a whole. Other factors negatively impact health in Appalachia, as well. Nearly twenty-five percent of adults in Appalachia are smokers, compared to just over sixteen percent of all American adults, and obesity and physical inactivity are extremely prevalent. However, it is worth noting that in some areas of public health interest, such as the occurrence of STIs/STDs and HIV, Appalachia does better than the rest of the country. 

Healthcare disparities are an increasingly dramatic phenomenon. From 1989-1995, the cancer mortality rate in Appalachia was only 1% higher than the rest of the US, but by 2008-2014, it had risen to be 10% higher. In the same time frames, the infant mortality rate was 4% higher versus 16% higher, respectively. And, in 1995, the household poverty rate in Appalachia was 0.6% higher than the national average, but by 2014 was 1.6% higher. We like to think of these problems as things of the past, but the gaps are still very much relevant. Fortunately, people living in Appalachian communities are more likely to have health insurance coverage than other Americans. 8.8% of the population in Appalachia do not have health insurance versus the national average of 9.4%.

This year, in the midst of the coronavirus pandemic, some factors of the Appalachian population have put people living there at greater risk of COVID-19. 18.4% of people living in Appalachia are over age sixty-five, which is more than two percent higher than the national average. In more than half of Appalachian counties, over 20% of people are older than 65. This, combined with high rates of obesity and smoking, put many people in the “high-risk” category. COVID-19 has affected Appalachian communities in ways that don’t result in death but make surviving even more difficult. Food insecurity, for instance, is an increasingly severe problem. At one soup kitchen, “…we were serving about 200 people a day, and our numbers have nearly tripled since COVID started,” social worker Brooke Parker, from Charleston, West Virginia, said.
However, perhaps due to the isolated nature of many Appalachian communities, mortality rates from COVID-19 have not been markedly higher than the national averages.

With schools moving to online learning, problems with access to internet in Appalachia become more relevant and pressing. Around 84% of Appalachian households have a computer, which is five percentage points below the national average. 75% have access to reliable internet, which is also five percent lower than average. There is no easy solution to this lack of access to education. Even in non-Appalachian counties, students are being severely impacted by the disruption to their normal education activities.

Human rights organizations ought to keep a close eye on Appalachia as we see the results of COVID-19 on an already vulnerable and at-risk population. The ultimate consequences of the pandemic will likely be more severe here than elsewhere in the country. People living in Appalachia deserve the same assistance being offered to and resources being put towards urban centers in other parts of America. Too often have they seemingly been forgotten.

Additional References:
1. “Health Disparities in Appalachia”. Marshall, J.,Thomas, L., Lane, N., Holmes, G., Arcury, T., Randolph, R., Silberman, P., Holding, W., Villamil, L., Thomas, S., Lane, M., Latus, J., Rodgers, J., and Ivey, K. August 23, 2017. https://www.arc.gov/wp-content/uploads/2020/06/Health_Disparities_in_Appalachia_August_2017.pdf. Retrieved December 3, 2020.
2. Population Reference Bureau. https://www.prb.org/appalachias-current-strengths-and-vulnerabilities/. Retrieved December 9, 2020.
3. Tickamyer, A., Duncan, C. (1990). Poverty and Opportunity Structure in Rural America. Annual Review of Sociology. 16:67-86.

Reproductive Justice: Voices Not Just Choices

What Is Reproductive Justice?

Indigenous women, women of color, and trans people have long fought for the right to make decisions about their bodies. Coined in 1994, the term reproductive justice is defined as the “human right to maintain personal bodily autonomy, have children, not have children, and parent the children we have in safe and sustainable communities.”

One way to differentiate reproductive justice from reproductive rights is that the latter is the “legal right to access health care services such as abortion and birth control”. Initially, spokespeople of this women’s rights movement often included educated wealthy, middle class White women. This left marginalized communities and minority women who did not have easy access to their rights with minimized opportunities to voice their problems and experiences. This begs the question of what good are these rights, if they aren’t accessible. Built upon the United Nations human rights framework, reproductive justice is an intersectionality issue where reproductive rights and social justice are combined so the voices of LGBTQ+ people, marginalized women, and minority communities are uplifted.

Abortion as a Voice, Not a Choice

Choice comes from a place of privilege. The chance of deciding reproductive options is more easily accessible to middle class White women, while these same options are typically unavailable or restricted for poor, low-income women of color. These are the same marginalized women who historically bore the burden of unethical research in reproductive medicine from issues regarding the study of gynecology, to sterilization, and everything in between. For example, James Marion Sims, the father of modern gynecology, conducted medical procedures on enslaved Black women, which is unethical in more ways than one. No consent was given. A patient that has no knowledge of what is going on or what is being done to them cannot give consent. As an enslaved person, the patient was not seen as a human being, but rather as property, and therefore no consent was necessary. The medical procedure was purely experimental, and Sims’ likely had poor knowledge of what he was doing which made his actions torturous. Women like the patients Sims practiced on, women of color, women who were and are oppressed and marginalized, women with disabilities, and people of the LGBTQ+ community continue to be exploited, and it is important that their voices are heard now more than ever.

Source: Robert Thom, circa 1952. From the collection of Michigan Medicine, University of Michigan. Sims’ not only purchased Black women to conduct his inhumane experiments on, but he did so on the belief that Black women could not feel pain.

Often there are misguided notions that reproductive justice is just about abortion, and while access to abortions is a major component of the movement, the movement does not end there. Reproductive justice also goes on to include access to proper sex education, inclusive to all genders and sexualities, affordable contraception, and access to safe and healthy abortions. It’s not enough for abortion to be legalized. “Access is key,” meaning that the cost of the medical procedure is bearable. Medical expenses include travel to a medical provider, paid time off from work, prescription costs, dietary expenses, relocation, etc. all of which can cause difficulty in accessing care. As something that women of color, women with low incomes, and the LGBTQ+ community have brought to attention, reproductive justice is an umbrella that goes beyond the pro-choice versus pro-life debates. It calls into light that factors such as race and class in society affect each woman and LGBTQ+ persons differently. This means not every person has the choice to choose or not choose a pregnancy due to lack of access to services, stigma, or historic oppression, which is where the pro-voice movement intercedes.

The pro-voice movement is meant to “replace judgement with conversation” from both pro-choice and pro-life advocates. Abortion is an incredible emotionally and morally draining topic to converse on, and it’s a decision that should be void of politics and instead filled with empathy and compassion so an individual can make the healthiest choice and live their healthiest life. It is important to validate a person’s lived experiences and to acknowledge that they made the best decision they felt like they could with the resources available to them at the time.

Stigma Around Reproductive Health

There is lack of access to the topic of reproductive health due to incomprehensive sexual education in school systems. Access to this information, access to proper medical care, access to contraception and abortion “is a political, human rights and reproductive justice issue.” Some educational systems fail to mention how to obtain contraceptive methods, how to use them, and which methods are more suited for an individual. This lack of information and stigma around sexual education does not reduce the incidence of unsafe and “unprotected sex or rates of abortion.” In fact, lack of education around contraception and restrictive abortion practices leads to more unsafe abortions globally due to financial burdens as well as social and cultural stigma.

Source: Maria Nunes. An LGBTQ+ Pride event takes place in the Caribbean.

Another issue is heteronormativity which is the trend in sex education focusing “on straight, cisgender young people, but ignores LGBTQ+ youth.” These conservative views that do not cater to a whole population of young adults exacerbates this stigma around sexual and reproductive health. This leads to people feeling like they cannot ask questions due to fear of social repercussions or that their sexuality is abnormal. Not being provided with “information to address their health needs, leaves the LGBTQ+ youth at risk for sexual violence and unprotected sex,” making them more vulnerable to various sexually transmitted diseases, teen pregnancy, and mental health disorders. As important as it is it to address reproductive justice and reproductive health as a women’s issue, it’s even more important to know that LGBTQ+ people “can get pregnant, use birth control, have abortions, carry pregnancies, and become parents.” Part of fighting for and providing reproductive justice involves activism against controlling reproductive voices, and often controlling sexualities and gender expressions are synonymous with gatekeeping those voices.

Providing access to sexual and reproductive healthcare to LGBTQ+ people is one way to ensure that all communities are able to have information, resources, and the power to make their own decisions about their bodies, genders, sexualities, families, and lives. Access to reproductive healthcare can come in the form of gender affirming care and treatment for transgender, nonbinary, and gender nonconforming individuals. Having free access to reproductive education is a foundational piece within the reproductive justice movement. Talking about the framework around sex and reproductive justice is so much more than sex. It involves intersectionality and considerations of reproductive health regarding pregnancy, abortions, racial and class division and discriminations, maternal mortality rates, and environmental conditions. It’s about the dichotomies between oppression and liberation, individuality and collectivity, and most importantly choices and voices.

Source: Terry Moon for News and Letters. An individual in Chicago attends a protest in support for Planned Parenthood.

What Are Three Things I Can Do?

  1. Understand that it’s not about being pro-choice or pro-life. Understanding abortion is about validating people’s stories and experiences. If you haven’t experienced abortion or don’t know of someone who has, the first step is to come from a place of compassion and empathy.
  2. Know that reproductive justice goes beyond being a women’s issue. The same resources and information given to women need to be disseminated throughout the LGBTQ+ community.
  3. Research organizations such as SisterSong, Planned Parenthood, and URGE to start your activism and make your impact.

Poland’s Rise in Populism

In 2015, the Law and Justice Party (PiS) became the majority in the Polish Parliament alongside the presidency for the first time since 2007. The Law and Justice Party is a right-winged populist party that has faced ongoing controversy and scandals since its formation in 2001. The Law and Justice Party began as a center-right party with an emphasis on Christianity.  The party began forming coalitions with far-right parties in 2007, which positioned its ideology closer towards nationalism and populism. During the last few years support dwindled for the PiS; however, their messages calling for family unity and Christian values have appealed to deeply religious sectors of the country. A country that is trending towards nationalism and populism risks violating the rights of those that the nation deems as “other”. By establishing a national identity, particularly around religion, they are also establishing those that do not belong to the national identity. This carries the risk of isolating and ostracizing individuals.

Protestors march for LGBTQ rights in Warsaw (Source: Creative Commons)

The Close Relationship Between Religion and Government

The Polish identity is tied very closely to Catholic beliefs and practices. Around 87% of Polish people  identify as Roman Catholic. In Poland Catholic values are taught in public schools, over ⅓ of Polish citizens attend church regularly, and the Polish government has an intense working relationship with the Catholic Church. Public ceremonies are often held with the blessings of priests, and church officials often act as a lobby group having access to large amounts of public funding. Priests in the countryside of Poland often campaign for members of the more conservative party who support legislation that aligns with the ideals of the Catholic Church. This close relationship is criticized because of the archaic and often divisive legislation that the Church tends to support. The Catholic Church’s alignment with the government will inevitably ostracize those who are not Catholic as well as those who live their life in a way that the Catholic Church condemns. The issue is at a governmental level, this allows for discriminatory policy to be passed.

 President Duda and the 2020 Elections

The support of the Catholic Church was paramount in the Law and Justice Party candidate winning the 2020 Presidential election. President Duda, the PiS candidate, narrowly won re-election after a very divisive campaign against the progressive Mayor of Warsaw.  President Duda exploited negative rhetoric citing LGBT ideology as being more destructive than Communism. Poland’s history of Union of Soviet Socialist Republics (USSR) occupation accompanied with this rhetoric led to the success of President Duda in the 2020 Presidential election. PiS members and Catholic Clergymen asserted LGBT values as being in opposition to family values and sought to associate the LGBT community with pedophilia. President Duda’s narrow win ignited mass unrest spreading throughout Polish cities as progressives viewed his win as a step back for LGBT rights in Eastern Europe.

President Duda of Poland meets with President Trump of the United States (Source: Creative Commons)

LGBTQ Free Zones

Anti-LGBTQ rhetoric did not begin in the 2020 Polish elections. Over 100 towns and regions around Poland have declared themselves LGBTQ Free Zones since 2018. These declarations are largely symbolic; however, they have further divided the country and suppressed the LGBT community. LGBTQ free resolutions have been pushed by the Catholic Church and politicians across Poland. Protests against these zones have resulted in mass countermarches of right-wing Poles that have ended in violence. The LGBTQ community has continued to face oppression from their government and these zones just serve as a way to further disenfranchise them.

“Stop Financing LGBT+” Sign hanging outside a building in Warsaw (Source: Creative Commons)

Access to Abortion

Along with the anti-LGBT legislation, Poland’s Supreme Court recently ruled in favor of strict regulation of abortion. Poland previously had regulations only allowing abortion access to victims of rape, incest, preservation of the mother’s life, and if the baby has fetal defects. Legal battles erupted in 2019 by the Law and Justice Party to ban abortions in the event of fetal defect. Judges nominated by PiS members ruled in favor of a ban of all abortions due to fetal defects, which account for approximately 98% of all Polish abortions. The decision led to outcry across Poland inspiring protests in almost every major city.

 What is the future of Poland?

The future of Poland is unknown, and it is clear the Polish government has become increasingly populist and nationalistic. Public figures are using rhetoric that divides the general population from “western elites” and activists within their country that seek to strive towards more encompassing human rights. Polish activists are fearful of future legislation that will further violate human rights. International human rights activists, the United Nations (UN) and European Union (EU) have all attempted to pressure Parliament to pass legislation showing outward support of the LGBTQ community. Polish officials responded claiming LGBTQ people have equal rights in the country and organizations should instead focus energy on Christian discrimination taking place internationally. As part of the international community, we can demonstrate our support for the people of Poland by staying up to date on what is happening there. It is also important to create dialogue around the issues in Poland which can include everything from social media posts to organizing events that bring awareness to the situation.

 

 

 

 

 

 

 

 

COVID-19’s Effect on Mental Health

woman sitting alone on a bench next to a backpack
Self Isolation. Source: Bicanski, Creative Commons.

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

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

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

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

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

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

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

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

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

World Diabetes Day

A hand pointing to text underneath it which reads "World Diabetes Day"
World Diabetes Day. Source: Ashley Huslov, Creative Commons

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

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

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

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

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

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

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

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

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

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