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

Karoshi: The Problems with Japan’s Work Culture

A colorful, busy street in Osaka, Japan. — Image 1: Dotonbori Street in Osaka, Japan, Source: Yahoo Images

Japan is famous for its blend of traditional and modern customs, rich culture, and revolutionized technologies. The country has drawn in millions of foreign nationals for its high quality of life, safety, and efficient public transport—but perhaps especially for its employment opportunities.

About 3% of Japan’s workforce consists of foreign workers, having quadrupled in the past 15 years to 2.05 million. On the other hand, Japan’s population has been shrinking, with a steadily declining birth rate and rapid aging. There are many proposed causes for this crisis, including dwindling marriage rates, but it is worth noting the socioeconomic pressures that stem from high living costs, unfavorable job prospects, and a rigid corporate environment.

The labor shortage that Japan faces poses a major threat to its economy—and its historically unforgiving work culture likely plays a big role.

Work Culture in Japan

Work is a highly valued aspect of life in Japan, and with it comes the concept of company loyalty. This can be demonstrated by working many hours overtime; these hours are expected and sometimes even contracted. According to data by Japan’s health ministry, 10.1% of men and 4.2% of women worked over sixty hours a week in 2022.

Tim Craig, a researcher of Japanese culture, said that there is a certain social pressure associated with working overtime hours: “If they go home early, then their colleagues will (a) look askance at them, and (b) have to work more to cover for them. Either way, it’s not a good feeling.”

While Japan’s 2018 Workstyle Reform Act outlawed working more than 45 hours of overtime in a single month, it’s not uncommon for companies to force their employees to hide their true working hours or for employees to even do so of their own accord.

Additionally, only 7% of companies give their employees the legally mandated one day off per week. Japan has been trying to push a four-day work week since 2021, but it will take much more to entirely dismantle the deep-rooted idea that employees must give all of themselves to their company in order to thrive—Panasonic, one of the country’s leading companies, offered the option to 63,000 employees, and only 150 opted in.

A man asleep in a chair in an empty subway stop. — Image 2: A man asleep in a subway station, Source: Yahoo Images

Some companies employ shady business practices, operating what lawyers and academics call a “bait-and-switch” policy: employers will advertise a seemingly normal full-time position with reasonable working hours. The prospective employee is then offered a non-regular contract with longer hours and no overtime pay. If the employee refuses the job, companies might tell them that they will be given regular contracts after around six months. Younger applicants and women are particularly vulnerable due to a lack of experience or settling while trying to re-enter the workforce.

Another common issue is power harassment, which a reported third of the workforce has experienced. This is a common form of workplace harassment that has garnered attention across the past several decades and specifically involves someone in a higher position of power bullying a lower-ranking employee.

In 2020, the Power Harassment Prevention Act took effect, which outlines six types of power harassment, requires companies to take proper action against allegations of harassment, and ensures that workers aren’t dismissed for submitting complaints. However, Nikkei Asia reported in 2021 that complaints about workplace abuse had climbed to 88,000 cases a year, more than tripling in the past 15 years.

While these circumstances are not specific to Japan, they have certainly contributed to a phenomenon that was first identified there: karoshi, or death by overworking.

The History of Karoshi

Karoshi was first recognized in the 1970s and is a sociomedical term used to refer to fatalities or disabilities caused by cardiovascular attacks that are ultimately work-related. This includes strokes, cardiac arrest, and myocardial infarctions. The International Labour Organization’s case study into the phenomenon outlines the following typical case of karoshi: “Mr. A worked at a major snack food processing company for as long as 110 hours a week (not a month) and died from a heart attack at the age of 34. His death was approved as work-related by the Labour Standards Office.”

Related to karoshi is karojisatsu, which is suicide from overwork and stressful working conditions. This issue became prominent in the late 1980s—an economic recession during that decade forced employees who had managed to keep their jobs to work harder for longer hours to compensate.

Factors like repetitive tasks, interpersonal conflicts, inadequate rewards, employment insecurity, inability to meet company goals, forced resignation, and bullying create a psychological burden that has led countless workers to take their own lives. Japan’s white paper report revealed that in 2022, 2,968 people died by suicide linked to karoshi, an increase from 1,935 in 2021.

Hiroshi Kawahito, a workplace accident lawyer, told the Pulitzer Center in 2023 that he has worked on around 1,000 cases of karoshi during a 45-year-period, and despite repeated efforts by the Japanese government to combat suicide rates, he has not identified a significant change in the number of cases.

A group of Japanese citizens protesting karoshi on a street in Tokyo. — Image 3: A “No More Karoshi” protest in Tokyo in 2018, Source: Yahoo Images

He did note two concerning shifts over the course of his career: that karoshi-related suicide has become more common than cardiovascular attack, and that about 20% of his cases are now women, as they have begun to enter the workforce and experience sexual harassment at an overwhelming rate compared to their male counterparts.

A recent case of Kawahito’s from September 2023 involves the suicide of a 25-year-old actress from the musical theater company Takarazuka Revue, who was overworked and bullied by senior members. She logged a total of 437 hours in the final month of her life, of which 277 were overtime.

According to Kawahito, the actress worked without any days off for a month and a half and barely slept more than a few hours a night. Two years earlier, she suffered burns when a senior member pressed a hair iron against her forehead and faced immense pressure from the company. Kawahito claimed that “excessive work and power harassment damaged her physical and mental health, leading to her suicide.”

Governmental Response

Suicide was considered a taboo topic in Japan for decades; families affected were left with no outlet to cope with their loss. However, in 2006, more than 100,000 signatures were collected to push for legislation on suicide prevention, which led to The Basic Act of Suicide Countermeasures that went into effect the same year.

This act takes a three-pronged approach: social systems, local cooperation, and personal support creating relevant laws like the Act on Mental Health and Welfare. It provides support via relevant agencies at local and community levels, including hotlines and consultation services.

In 2016, the Basic Act was amended to require all prefectures and municipalities to establish local suicide prevention plans based on regional data collected by the National Police Agency. The General Principles of the Basic Act are also updated every five years to reflect current trends in suicide data.

The Work Style Reform Act of 2018 aims to promote a healthier work environment, setting overtime limits and establishing paid annual leave, as well as offering free consulting services and subsidies from the labor ministry. This has motivated the push for the four-day workweek, part of the ministry’s “innovating how we work” campaign.

Change might happen slowly in a society where values surrounding dedication and sacrifice are so deeply ingrained in its working population, but it is happening; between 2006 and 2022, the suicide rate has fallen by more than 35%. Efforts by the government to deter karoshi and combat the falling birth rate are in full swing and hope for a better future in Japan is still on the horizon.

The Treatment of People with Disabilities in Institutional Care Settings in Brazil

A flag of Brazil flowing in the wind — Image 1: Flag of Brazil. Source: Yahoo! Images

Overview of the Issue

In Brazil, thousands of children and adults with disabilities are confined to institutions for people with disabilities, facing widespread neglect, abuse, and isolation. Designed ostensibly to provide care, many of these institutions have instead devolved into detention centers where individuals are deprived of their autonomy and dignity. Reports from Human Rights Watch reveal the harrowing conditions experienced by people with disabilities in these facilities, underscoring the urgent need for systemic reform to safeguard their basic rights. 

One relevant case is that of Leonardo, a 25-year-old man with muscular dystrophy who has lived in a residential institution since he was 15. His mother, unable to care for him due to a lack of adequate support, was left with little to no choice. Like many others, Leonardo shares cramped quarters with multiple residents, with minimal privacy or control over his daily life. There are very few meaningful activities available for him to partake in, and he has seemingly no apparent opportunity to participate in society as an autonomous individual, mirroring the experiences of countless other residents across Brazil’s institutions. 

Causes of Institutionalization  of the Care for People with Disabilities

The institutionalization of the care for individuals with disabilities in Brazil is shown through several interrelated systemic issues. First, the lack of adequate support for families plays a significant role. The government offers limited resources, and financial assistance programs, such as the Benefício de Prestação Continuada (BPC), often fail to fully meet the comprehensive needs of individuals with disabilities, which include therapy, assistive devices, and accessible housing. Without meaningful support systems, families may feel they have no alternative but to rely on institutional care. 

Brazil’s legal and systemic framework also plays a crucial role. Guardianship laws that remove legal capacity from individuals with disabilities mean that many residents in institutions cannot consent to their placement. This lack of autonomy, combined with the stigma of ableism, creates an environment where people with disabilities are treated as passive recipients of care rather than individuals who should have rights and preferences. Public perception remains rooted in ableist attitudes, which continue to limit access to inclusive services and resources.  

The COVID-19 pandemic exacerbated these disparities, intensifying existing challenges for people with disabilities in Brazil’s institutional care settings. This revealed vulnerabilities in both healthcare access and living conditions. Individuals with disabilities were disproportionately affected by the virus due to several factors, including pre-existing health conditions, limited access to adequate healthcare, and cramped, unsanitary living environments within institutions. These conditions not only increased infection rates but also made it difficult to implement preventive measures, such as social distancing and proper sanitation.  

Image 2: Hospital Beds. Source: Yahoo! Images

Problems Within Institutions for People with Disabilities

The institutional care setting for People with Disabilities in Brazil fails to meet even the most basic standards of dignity and human rights. Living conditions in many of these institutions are deplorable. Reports from Human Rights Watch describe facilities that resemble prisons more than care centers. Physical restraints, such as tying residents to beds or sedating them, are surprisingly common. Such practices not only prevent individuals from engaging in any form of meaningful activity, but also contribute to a host of physical and psychological traumas. 

Isolation is another significant, impactful issue. Many residents are confined to their beds or rooms for extended periods, with little to no engagement in social interaction or personal development. Children, specifically, suffer due to the lack of educational and recreational activities, which then stunts their intellectual and emotional growth. This isolation leads to further stigmatization and marginalization, unfortunately reinforcing the perception that people with disabilities are separate from society and should be hidden from view, whether intentionally or not. 

The lack of oversight and enforcement of existing laws allows for egregious human rights abuses to go unchecked. In many cases, individuals are institutionalized unlawfully, deprived of family connections, and subjected to a lifetime of neglect. Children who enter these institutions often lose contact with their families permanently, which can lead to long-term emotional trauma and a deep sense of abandonment. 

Access to healthcare for people with disabilities in Brazil also remains alarmingly inadequate. Despite the legal frameworks designed to protect their rights, physical and financial barriers to healthcare still exist, compounded by a lack of training among healthcare providers to address the specific needs of people with disabilities. These gaps contribute to a high incidence of preventable health complications and reduced life expectancy.  

Efforts Toward Reform 

While Brazil has established a strong legal framework for the rights of people with disabilities, including the ratification of the Convention on the Rights of Persons with Disabilities (CRPD) and the enactment of the 2016 Law on Inclusion, the enforcement and practical implementation of these laws remain lacking in change. Legal rights exist on paper, but without mechanisms to enforce them, individuals with disabilities continue to suffer abuse, neglect, and loss of their freedoms. 

United Nations Committee on the Rights of Persons with Disabilities and many advocacy organizations have called on the Brazilian government to transition from institutional care to community-based services that prioritize individual autonomy and family support. These efforts encourage the development of small, inclusive residences and group homes to reduce the dependence on large-scale institutions. Although some of these programs have been started up, they fall short of ensuring true independence and often lack the necessary resources to fully support residents in their transition to independent living. 

Efforts to improve healthcare access are underway, focusing on providing disability-specific training to healthcare providers and addressing financial and physical accessibility challenges. These interventions are essential to improving the health outcomes of individuals with disabilities and to fostering an inclusive healthcare environment that treats people with disabilities as valued members of society. 

Looking Ahead 

The treatment of people with disabilities in institutional care settings in Brazil reveals a profound humanitarian crisis that requires focused attention. The combination of insufficient support systems, societal stigma, and legal challenges results in an environment where individuals with disabilities are denied their rights, autonomy, and dignity. While Brazil has made some strides toward recognizing and enshrining the rights of individuals with disabilities, significant gaps remain in the enforcement of these rights and in the availability of community-based alternatives to institutionalization. 

Addressing these issues calls for a multifaceted approach, including policy reform, enhanced support for families, and the development of inclusive, community-based care. By prioritizing the rights and voices of individuals with disabilities, Brazil can move toward a more just and humane society where all individuals are treated with respect, dignity, and equal opportunity. 

American Psychiatric Abuses: Residential Treatment Facilities

Content warning: this blog will include mentions of child abuse, child self-harm, child suicide, and child sexual abuse.

Psychiatric Residential Treatment Facilities (PRTFs) are in-patient institutions that provide inpatient psychiatric care to people under the age of 21. They are a common form of short-term psychiatric care for young people. Children do not choose to be committed to these facilities, and they do not want to be. Two children said they were being treated like animals. Many said, “I don’t feel safe.”

Physical Abuse

Children in PRTFs are extremely vulnerable due to both psychiatric issues and the nature of living in institutionalized care. Facilities are often understaffed, leading to minimal supervision and increased opportunities for abuse – by staff and other children.

Staff members at PRTFs have frequent opportunities to abuse their charges. A staff member at Cumberland Hospital in Virginia “poured scalding water on a non-verbal 16-year-old.” An 11-year-old boy from Arkansas was pushed down, had his hair pulled, and had a staff member place her foot in his back. A staff member at Devereaux Brandywine in Pennsylvania was found guilty of assault after she “punched and kicked a 14-year-old in the head, face, and body until the child was unconscious.” In December 2023, a staff member at a facility in Arkansas told a police officer, “I went in there, and I basically twisted his ear real hard in order to get him off the bed, which we’re not supposed to touch them.” A staffer at a facility in South Carolina “hit the child twice, including punching the child in the head.” At a Devereux facility in Viera, Florida, a staff member hit a boy on his neck, leaving marks. It is sad that state governments pay pay thousands of dollars daily for children to be abused by their caretakers.

Further, due to apathy and unawareness from staff, children are also able to abuse other children in PRTFs. At Riverside Hospital in Virginia, a child was “repeatedly stabbed by another child.” At North Star Behavioral Health in Alaska, after two children were accidentally placed in seclusion together, one child gave the other a bloody nose. At the same Alaska facility, a child was “punched, slapped in the eye, and kicked by other children.”

None of these instances of abuse were reported to the children’s guardians in a timely manner. Some parents were never notified.

Sexual Abuse

A caregiver at Lighthouse Care Center of Augusta, in Augusta, Georgia, was arrested and convicted of child molestation. An employee at a facility in Alabama was sentenced after sexually abusing a 13-year-old boy she should have been caring for. A man working at a facility in Chicago was charged with three counts after sexually assaulting minors in his care. A Utah man pled guilty to sexually abusing three male students at a residential school he worked at.

Staff members also allow sexual abuse to occur between children. At Devereux Brandywine in Pennsylvania, a 13-year-old boy asked not to be placed in a room with an older boy he was afraid of. They were placed as roommates, and “the older boy forced the younger child to perform oral sex on him on three successive nights in a walk-in closet.” This is one of many equally disturbing instances of staff enabling sexual abuse at facilities. One facility in New Mexico closed partially due to “the unchecked spread of HIV among patients” – something that brings to mind the hepatitis experiments of the 1950s, 1960s, and 1970s at Willowbrook State School, an infamous institution in New York.

Image 2: A postcard from Willowbrook State School. Source: Yahoo Images

Neglect and Unsafe Environments

Staff at PRTFs are often unable or unwilling to prevent children from harming themselves. Disability Rights Arkansas, the Protection & Advocacy Agency for Arkansas, reported that one girl “still had access to items to cut her arms. There were numerous new scars over her old scars.” The staff did not care. Another child at the same facility said that she had “used the second stall [with cracked and sharp shower tiles] to self-harm.” The staff did not care. If they had, the children in their care would be safe. A child at Palmetto Pines Behavioral Health in South Carolina “barricaded themselves inside of his suicide watch room…[and] used the plastics piece to cut his neck in an attempt to kill himself, but it was not sharp enough.” The staff did not care. A child at Provo Canyon School in Utah “caused personal injury during self-harm, with wounds that were one and two inches in length… through the fatty tissue.” At Oak Plains Academy in Tennessee, two 15-year-olds overdosed on Benadryl. The mother of one of them said, “I’ll never see her again; I just want justice for her; I just want her story told. And I want – I never want this to happen again to anyone.”

Image 3: A box of Benadryl. Source: Yahoo Images

Minority Children

Children who are also members of minoritized groups, especially children of color and LGBTQIA+ children, have even greater difficulties in PRTFs.

According to a Senate report, “[T]he longer an RTF stay, the longer a child is at risk of exposure to harms, including the use of restraints and seclusion, physical and sexual abuse, insufficient education, and substandard living conditions. This risk is heightened for children of color, LGBTQIA+ youth, and children with I/DD (intellectual/developmental disabilities) who are most likely to live in these settings.” Black children are 35% more likely than white children to be placed in institutionalized care facilities.

Cornelius Frederick, a 16-year-old Black boy from Michigan, was killed at a facility in Kalamazoo, Michigan, in April 2020. Seven male staff members restrained Frederick for 12 minutes. The medical examiner ruled his death a homicide – asphyxiation.

In 2018, a gay 16-year-old was attacked while residing at St. John’s Academy, a Sequel facility in Florida. His attacker told him that he “didn’t want a fa***t in the pod.” Disability Rights Washington reported that two “crisis plans” for children residing at PRTFs used incorrect gendered pronouns when referring to the child. In 2020, two transgender girls resided at Sequel Courtland in Courtland, Alabama – a boys’ facility. One girl was being stalked by other residents. She did not feel safe.

Further Information

For further reading about the kinds of abuses that go on in these facilities, consider reading a blog I wrote in April about group homes. You can also reach out to local representatives about ending or reducing out-of-state institutionalizations, which are harder to investigate than in-state institutions.

The Eradication of Malaria in Egypt: A Triumph for Public Health and Human Rights

When thinking about malaria, we tend to forget its impact across the world. Especially living in the global north, my experience with malaria has been restricted to my coursework; however, the reality of the disease is that it exists and poses a prominent issue in many countries across the world. The illness, spread by a mosquito vector, had over 247 million cases in 2021; this spanned across many regions worldwide, primarily impacting Africa.

In recent years, the WHO (World Health Organization) has worked in many different countries to eradicate malaria and has successfully done so with their WHO Guidelines for Malaria. An example of these guidelines being successful is Algeria, which reported its last case in 2013. However, a recent accomplishment in the world of malaria has been noted, which is the eradication of the disease in Egypt. For decades, Egypt had struggled with the disease and the associated outcomes.

Image 1: Receipt of malaria-free certification in WHO Eastern Mediterranean Region.Source: WHO — Image 1: Receipt of malaria-free certification in WHO Eastern Mediterranean Region. Source: WHO

Malaria’s History in Egypt

The nature of Egypt had made it susceptible to the fruition of the illness. Historically, the disease was tested around the Nile Delta and Upper Egypt, tracing back to 4000 B.C.E. As most of the population was concentrated in these areas, it led to the development of disease impacting millions of individuals. In recent history, the illness has contributed to the fragility of the country, ranging from increased economic losses, inflated healthcare costs, and decreased labor productivity.

The first ever effort to control malaria can be dated to 1950, with the introduction of dichloro-diphenyl-trichloroethane (DDT). This initial intervention was an insecticide that was used to help not only reduce the mosquito population but also address the development of typhus and other insect-borne diseases. However, this intervention resulted in some resistance amongst the community and additional environmental concerns; as of 2001, the intervention was observed as a possible human carcinogen and has since been banned in Egyptian agriculture.

In 1969, the creation of the Aswan Dam posed a new risk for the development of disease, all of which resulted in the need for new interventions. With additional adjustments to the approach against malaria, in the 1980s, the WHO helped push towards the eradication of malaria in Egypt with their eradication program. This program included regions like Africa, the Americas, Asia-Pacific, and the Middle East and Eurasia. This resulted in outcomes such as reducing the number of cases by 300,000 between 1980 and 2010. Though these outcomes are significant, those with limited access to healthcare were still disadvantaged in the global conversation.

Image 2: Doctors in Egypt are conducting malaria tests on elderly patients in rural Egypt.Source: WHO — Image 2: Doctors in Egypt are conducting malaria tests on elderly patients in rural Egypt. Source: WHO

The New Approach to Malaria

Building upon previous interventions, additional interventions have been explored in the past few decades; these have contributed meaningfully to the eradication of malaria in the country. Before mobilizing interventions, it is important to educate communities about what malaria is and develop trust in proposed interventions. The Egyptian government, in collaboration with different NGOs (Non-Governmental Organizations), launched different campaigns that reached communities all across the country; these talked about prevention, symptoms, and where people can find diagnostic centers. These were taught in schools, local community centers, and other locations to ensure that populations were able to access the information needed to become a part of the solution. This resulted in an 80% increase in malaria case reporting in disproportionately impacted areas by 2020.

These education opportunities are coupled with healthcare access and monitoring. By improving the healthcare infrastructure, treatment facilities were able to strengthen their interventions for those impacted by malaria. However, with recent inflation and economic instability in the country, with the support of international supporters, these interventions became even more accessible by being low-cost or even free. With the additional investment into data collection and monitoring systems, the Egyptian Ministry of Health was able to monitor trends in malaria incidence and collaborate with healthcare providers to mobilize and target interventions for those who need them most. With the compounded efforts of treating and monitoring malaria, strides were made to help understand the spread of malaria in the country.

Beyond education and monitoring, it is valuable to identify interventions that would be accessible to the population. These interventions must be easily understood to ensure they are efficacious. Vector control is noted to be central to Egypt’s strategy. Leveraging the use of insecticide-treated bed nets was the most prominent intervention; by 2019, 3 million of these nets had been distributed to reduce the incidence of malaria, especially in high-risk areas. This, coupled with indoor spraying, helped reduce malaria cases by 90% in over 2 decades.

Malaria Eradication is a Victory for Human Rights

As outlined in the International Covenant on Economic, Social, and Cultural Rights, the right to health is fundamental to human existence. By working to eradicate malaria in the country, Egypt has made strides to fulfill this right for its citizens of all socioeconomic classes.

Egypt’s victory brings hope to the fight against malaria; not only can public health interventions align with human rights, but they can create a sustainable model for health equity. Many countries in the global south are in a place that Egypt was in not too long ago; as global communities begin to face the amplification of health issues, Egypt’s framework and history of eradication can be seen as a success and applied to other countries.

Now that malaria is off the docket of issues Egypt faces, it is not time to focus on addressing other inequities the country is facing. As health equity is improved in the country, issues such as mental health, maternal and child health, and non-communicable diseases can be addressed with the utmost efficiency, helping improve outcomes in the country.

The Death Penalty in the US: Legalized Murder?

On September 24, 2024, the state of Missouri executed an innocent Black man. Why did they kill him?

Marcellus Williams was convicted and sentenced to death for murdering Felicia Gayle. There was no physical evidence linking Williams to her murder: fingerprints, footprints, hair, and DNA found at the crime scene did not match Williams. The only evidence against Williams was testimony from two witnesses whose accounts were inconsistent and unverifiable. Gayle’s family favored life imprisonment. The county prosecutor favored life imprisonment. Only Missouri’s Attorney General wanted Williams executed – and he got his wish.

Williams was innocent of the crime for which he was executed. He never had a fair trial. The prosecution struck 6 of 7 Black jurors, one of whom was rejected “because he looked too much like Williams.” Missouri knew they were executing an innocent man – and they did it anyway.

History of the Death Penalty in America

Capital punishment has been a part of the American legal system since before the United States was a country. The first person executed in the British colonies was George Kendall, who was executed by firing squad for mutiny in 1608. By the early 1900s, public support for the death penalty was beginning to wane, and some states abolished the practice.

Utilizing capital punishment was briefly illegal nationwide. The 1972 Supreme Court Decision Furman v. Georgia ruled that existing death penalty statutes were discriminatory and therefore unconstitutional. That lasted until 1976, when the Court ruled in Gregg v. Georgia that Georgia’s updated death penalty statute was constitutional, and executions resumed. Since 1976, 1,601 people have been executed. Today, only 21 states still have the death penalty, and only ten have executed people in the last decade.

Methods for capital punishment have varied greatly over the last two centuries. Early in American history, the most common were firing squad and hanging. Over time, hangings have become associated with lynchings. Despite that history, in 2023, a Tennessee lawmaker proposed that “hanging by a tree” be used as an alternative method of execution in the state. In 1890, the first person was executed with the electric chair, which was the most common method for several decades until lethal injection became more popular after its first use in 1982.

A white room with a gurney with several thick straps used for restraining prisoners. — Image 1: A white room with a gurney and several thick straps was used to restrain prisoners. Source: Yahoo Images.

Lethal injection has faced challenges in recent years for a few reasons. Drug manufacturers do not want to be associated with homicide – and thus refuse to sell the required drugs to state governments – and medical professionals refuse to administer the medicines. Instead of medical professionals, correctional workers struggle to find veins and sometimes fail entirely, causing delayed executions. Roughly 3% of executions are botched, and people subjected to botched executions are disproportionately Black – 1/3 of executions nationwide are of Black prisoners, while 1/2 of botched executions are of Black prisoners. Even when not botched, lethal injections have been shown to be less humane than originally believed. The drugs used are painful and cause the lungs to fill with fluid – typically without proper anesthesia.

Black prisoners are also treated differently immediately before they are executed. Jeff Hood, who has witnessed six executions – three of Black prisoners, three of white – told NPR, “I can definitely tell you that the restraints that I have seen on Black folk have been unquestionably tighter than the restraints that I have seen on white folk.”

More recently, there has been controversy over a new execution method: nitrogen hypoxia. The state of Alabama has executed two people – Kenneth Smith and Alan Eugene Miller – by nitrogen hypoxia in the last year. The state had previously attempted to execute both Smith and Miller by lethal injection, but correctional workers were unable to place IV lines in either man over the course of several hours. There is another Institute of Human Rights blog post, published in the fall of 2023, that extensively details execution methods.

Problems of the Death Penalty

Two of the most common reasons given for keeping the death penalty are deterrence and justice. Justice argues an eye for an eye – that, for some crimes, the only possible form of justice is death. That is a philosophical debate, and one I will not discuss today. Instead, I will focus on the effect of the death penalty on homicide rates – deterrence. Deterrence is the idea that the existence of the death penalty deters crime – it reasons that prospective murderers are logical people who will be less likely to kill others if it will result in their death.

In 2012, the National Research Council conducted a literature review on studies examining any deterring effects executions – and the general presence of the death penalty – have on homicide rates. They concluded that studies had not yet demonstrated any effect capital punishment has on homicide rates and recommended that the “research… should not influence policy judgments about capital punishment.”

One of the most powerful arguments used by death penalty abolitionists is about wrongful convictions. Someone who is sentenced to life in prison can be released if they are found innocent; that is not so with someone who is dead, such as Marcellus Williams. Wrongful convictions are common; for every eight executions in the United States since 1977, one person sentenced to death was exonerated. 82% of death penalty exonerations are due to official misconduct and 36% of death penalty sentences are overturned.

Glynn Simmons was exonerated in December 2023 for a crime he did not commit. He spent 48 years in prison. The state knew when he was convicted in 1975 that Simmons was innocent; he was in Louisiana when the crime was committed in Oklahoma. Despite that, it took almost 50 years – 2/3 of Simmons’ life – for him to finally be exonerated. Imprisonment is reversible. Death is not.

A broken chain. — Image 2: A large broken chain. Source: Yahoo Images

What Can Be Changed?

Activists have worked for decades to reform or eliminate the death penalty. Two organizations that have been involved in numerous exonerations are the Innocence Project and the Equal Justice Initiative. Both organizations provide legal aid to innocent prisoners. Other ways to support change include petitioning state and federal legislators to end or reform the death penalty.

Understanding Vaccine Diplomacy in the Case of COVID-19: A Global Approach to Health EquityUnderstanding Vaccine Diplomacy: A Global Approach to Health Equity

In the landscape of global health, vaccine diplomacy has emerged as a compelling strategy, melding healthcare initiatives with international relations. This approach is pivotal in the ongoing battle against infectious diseases, most recently the COVID-19 pandemic. Vaccine diplomacy involves countries utilizing their surplus vaccine supplies to forge diplomatic ties, enhance global influence, and foster goodwill. This is often done in partnership with private pharmaceutical entities and public health organizations. However, while aiming to address the urgent need for equitable vaccine access worldwide, vaccine diplomacy raises critical questions concerning human rights and health equity on a global scale.

Evolution of Vaccine Diplomacy

The vaccine diplomacy has existed long before the COVID-19 pandemic, but we noted its increased influence during this unique time. Nations like the United States, Canada, and the United Kingdom, possessing robust vaccine manufacturing capabilities, sought to leverage their surplus doses as a means of geopolitical influence. For example, the United States promised to donate over 1.1 billion vaccines by 2023. This approach gained momentum as vaccine shortages persisted across continents, exacerbating health inequities, especially among women and children, and prompting a response beyond national borders.

Photo of vaccine vile.Source: Flickr — Photo of vaccine vile. Source: Flickr

Examples of Vaccine Diplomacy

Vaccine diplomacy has manifested in diverse forms. China and Russia have actively supplied their respective COVID-19 vaccines, including Sinovac, Sinopharm, and Sputnik V, to various nations as part of aid packages or through bilateral agreements. India, known for its significant vaccine production capacity, contributed doses through the COVAX initiative and direct donations to neighboring countries and beyond. These mobilization efforts are valuable to the development and growth of vaccine diplomacy through the lens of aid. This improves the well-being of marginalized groups and pushes national interests abroad.

Photo of kids lining up to get vaccinated.Source: Flickr — Photo of kids lining up to get vaccinated. Source: Flickr

Human Rights and Vaccine Diplomacy

At its core, vaccine diplomacy intersects with human rights, particularly the right to health. Access to vaccines is considered a fundamental human right, and ensuring equitable distribution is paramount to providing equal protection against COVID-19. Yet, the disparities in vaccine access have sparked concerns about the violation of this right for marginalized and vulnerable populations globally. Several countries have taken commendable steps to uplift vaccine diplomacy and do their part to make interventions more accessible. The United States pledged substantial donations of vaccine doses through COVAX and direct allocations to nations facing acute shortages, aiming to bolster global vaccine access. Countries like Sweden and Norway have also committed funds to support COVAX’s efforts in distributing vaccines to low-income nations.

To enhance the accessibility and efficacy of vaccine diplomacy, countries must prioritize transparent vaccine-sharing mechanisms, equitable distribution plans, and fair allocation strategies. Greater collaboration among nations, regulatory transparency, and a resolute commitment to multilateralism are essential elements for ensuring broader vaccine access. This can be done through working alongside pharmaceutical companies, local organizations, and many other avenues.

How to Get Involved

Individual engagement plays a pivotal role in advancing the cause of equitable vaccine distribution. Advocating for fair vaccine distribution, supporting initiatives that promote vaccine access in underserved communities, and raising awareness about the critical importance of global health equity are impactful ways for individuals to contribute. Engaging with policymakers, supporting organizations dedicated to vaccine distribution, and staying informed about global health issues are pivotal steps toward effecting change.

Vaccine diplomacy stands at the nexus of opportunity and challenge in addressing the global vaccine disparity. While it serves as a conduit for international cooperation, its success hinges upon ensuring vaccines reach those most in need, aligning with the fundamental principles of human rights and health equity.

Yemen in the News? Let’s Recap.

In the past couple of months, Yemen has been mentioned a lot. More specifically, the Houthis or, as some have called them, Ansarallah. You might be wondering first, “What is Yemen?” Why are they being talked about? Who are the Houthis/Ansarallah? How is Saudi Arabia involved? And where is the government? These are all questions that I heard many people around me ask. So, in this article, we will answer all these questions as well as explain Yemen’s situation and wars coming from a Yemeni American.

HISTORY

Before diving into the issues concerning Yemen, we have to cover some important history of Yemen to have a full understanding. Yemen’s history can stretch back 3000 years and the biggest evidence of that is the architecture of the villages and towns in it. Yemen had three successive civilizations: Minean, Sabaean, and Himyarite.

Ancient Yemen played a crucial role in overland trade between Egypt, Mesopotamia, and the Mediterranean civilizations due to its strategic location. Pre-Islamic trading kingdoms, such as Minaean and Saba’, thrived on incense trade. The decline began with the Romans favoring the Red Sea, leading to the loss of wealth for southern Arabian kingdoms.

The rise of Islam in the 7th century saw Yemen’s rapid conversion. Muslim caliphs ruled, followed by local dynasties like Zaydi imamate and Rasulids. The Ottoman Empire took control in the 16th century, bringing Yemen under their rule. Despite a flourishing coffee trade, Yemen remained culturally isolated.

The 19th century marked the division of Yemen into North and South, controlled by the Ottomans and British, respectively. North Yemen faced opposition, leading to the Ottoman evacuation in 1918. Two powerful imams ruled North Yemen until the 1962 revolution, resulting in the establishment of the Yemen Arab Republic (YAR).

The YAR faced internal conflicts and external interventions, including support from Egypt and Saudi Arabia. A coup in 1974 led to military rule under Colonel Ibrahim al-Hamdi. His assassination in 1977 and subsequent leaders set the stage for the lengthy presidency of Ali Abdullah Saleh, who ruled North Yemen until its unification with South Yemen in 1990.

TIMELINE OF YEMEN’S CONFLICT

Yemen’s modern history is a tumultuous journey marked by political transitions, civil wars, and external interventions. Understanding the dynamics of this complex narrative is crucial, especially for students seeking clarity amid the intricate details. Let’s embark on a journey through the early years of Yemen, focusing on key events involving President Ali Abdullah Saleh and the Houthi rebels.

In the 1990s, Yemen underwent a significant transformation with the reunification of North and South Yemen. Ali Abdullah Saleh, the president of North Yemen since 1978, transitioned to become the president of the Republic of Yemen. Concurrently, the Zaidi-Shia group Ansar Allah, commonly known as the Houthis, gradually gained power, with President Saleh’s tacit support. A brief civil war erupted in 1994 between the unintegrated armies of the north and south, resulting in the defeat of the southern army and solidifying Yemen’s reunification.

In 2000, President Saleh reached a border demarcation agreement with Saudi Arabia, seeking to disarm the Houthis, whom he had previously considered a valuable tool against Saudi interference. Tensions escalated between Saleh’s government and the Houthis, leading to a rebellion in 2004 initiated by Hussein Badreddin al-Houthi.

The conflict unfolded in several phases, with government crackdowns, rebellions, ceasefires, and amnesty grants. Saleh’s government faced sporadic clashes with the Houthis, and in 2010, Operation Scorched Earth aimed to crush the rebellion. The Houthis, however, persisted, engaging in cross-border clashes with Saudi forces.

Inspired by the Arab Spring, Yemen experienced widespread demonstrations in 2011, calling for an end to Saleh’s 33-year rule. Despite initial concessions, the protests intensified, leading Saleh to agree to a Gulf Cooperation Council (GCC)-brokered deal. However, clashes persisted until November 2011, when Saleh’s deputy, Abdrabbuh Mansour Hadi, assumed power.

The National Dialogue Conference in 2014 laid the groundwork for a new constitution, and a political transition plan was approved. However, anti-government protests erupted, leading to the dissolution of President Hadi’s cabinet. In 2014, the Houthis seized control of Sanaa, and by early 2015, they took over the Yemeni government, prompting President Hadi to flee.

In response to Houthi advances, a Saudi-led coalition initiated Operation Decisive Storm in 2015, launching indiscriminate airstrikes and imposing a naval blockade. Despite subsequent efforts like Operation Restoring Hope, the conflict escalated, leading to a dire humanitarian crisis. Yemen became a battleground, but not for what is being told. One of those example is Al-Mahra.

In the shadows of Yemen’s well-documented conflicts lies a lesser-known struggle for control in the easternmost governorate of Al-Mahra. While the global narrative often focuses on the Houthi rebellion and the Saudi-led coalition’s efforts, the intricate dynamics at play in Al-Mahra offer a unique perspective on regional power shifts and economic interests.

Since 2017, Al-Mahra residents have witnessed a gradual influx of Saudi troops, raising concerns and sparking anxiety among the local population. What initially seemed like a limited military presence evolved into a comprehensive campaign by Saudi Arabia to establish control over the governorate, extending its influence to the Omani border in the east.

The intensified Saudi presence in Al-Mahra, marked by establishing over 20 military bases and outposts, fueled speculations regarding the kingdom’s interest in constructing an oil pipeline. With a population of no more than 300,000, Al-Mahra became a battleground for what some believed was a strategic move to secure a pipeline route for Saudi crude oil to the Arabian Sea.

Leaked diplomatic cables from 2008 revealed Saudi Arabia’s longstanding interest in building a pipeline by securing territories and gaining the loyalty of local leaders. The Saudis went beyond military installations, recruiting Mahri locals and attempting to create their irregular military force. The transfer of Mahri tribes from Saudi Arabia to Al-Mahra further deepened suspicions, leading to clashes between Mahri tribes and Saudi engineering crews.

Saudi forces secured Nishtun port, raising suspicions that it could serve as the intended site for an oil export terminal. A leaked memo from 2018, thanking the Saudi ambassador for a feasibility study on an oil port, added fuel to the speculation. While not explicitly mentioning Al-Mahra, the memo heightened concerns and contributed to the belief that Saudi Arabia was preparing to extend an oil pipeline through Yemen.

Governaorates in Yemen — Governorates in Yemen.

Amidst these developments, skepticism arose, suggesting that Saudi deployments and tactics aimed to counter Oman’s influence in Al-Mahra. Tensions between Saudi Arabia and Oman, exacerbated by the Yemen war, saw Oman leveraging various factors, including granting citizenship and maintaining ties with Mahri political leaders, to resist Saudi influence. Publicly, Saudi Arabia claimed its troop deployments focused on combating Houthi arms smuggling.

Critics argue that the theory of a Saudi pipeline in Al-Mahra is implausible given Yemen’s entrenched political instability. Protecting a multi-billion dollar pipeline would pose significant challenges with ongoing conflicts, external pressures, and internal threats. Even before the 2011 uprising, reports suggested Yemen’s volatility made it unsuitable for such projects. Adding another layer to the complexity of this conflict.

International outrage grew over the humanitarian crisis, and in 2018, the US Senate invoked the War Powers Resolution to end its support for the Saudi-led coalition. The Stockholm Agreement in December 2018 aimed for a ceasefire, but peace remained elusive.

In February 2021, President Biden announced a shift in the US approach, revoking the Houthi FTO designation and ending support for the Saudi-led coalition’s offensive operations. Efforts toward peace continued, with UN-mediated talks and a two-month truce declared in April 2022.

NOW

Despite the recent peace agreement between the Houthi rebel group and the Saudi-led coalition, Yemen continues to make headlines due to the dire humanitarian situation and escalating conflicts. The so-called “peace” only involved the Houthi rebels and the coalition, leaving the rebel group in power and the Yemeni people still suffering. Let’s examines the recent events that have unfolded in Yemen, shedding light on the complexities of the situation.

By mid-2023, dissatisfaction with the Houthi rebels’ control began to rise among the Yemeni population. The rebels’ oppressive regime, characterized by restrictions on rights, exorbitant “protection” fees, and crippling economic conditions, fueled public discontent. However, the rebels cleverly diverted attention by exploiting the longstanding Yemeni support for Palestine. On December 9, the rebels announced their blockade of Israeli ships in the Red Sea, citing the ongoing situation in Gaza as the reason. This move united Yemenis, temporarily halting internal uprisings and garnering increased support for the rebel group.

In response to the rebel blockade, the US and UK coalitions initiated airstrikes on multiple Yemeni cities on January 11. The airstrikes were portrayed as retaliation for the rebels’ interference with ships due to the Gaza conflict. This military response effectively quashed any attempts at democracy, sparking anger and resentment among Yemenis who felt victimized by the international intervention.

The US-led coalition’s bombing campaign intensified, with the worst attack occurring on February 3. Many described it as more severe than previous assaults, even during the Saudi-led coalition’s offensive. The bombings targeted vital infrastructure, including one of Yemen’s international airports, resulting in halted flights, disrupted electricity, and widespread fear among the population.

Yemen, already grappling with eight years of conflict, faced an alarming humanitarian crisis. The World Food Programme (WFP) highlighted the unprecedented level of hunger, with 17 million Yemenis experiencing food insecurity. Child malnutrition rates were among the highest globally, and a significant portion of families lacked essential dietary elements. The WFP’s December 5 announcement of a pause in food distribution in the North due to funding shortages further worsened the situation.

UN Secretary-General António Guterres pleaded for de-escalation, urging all sides to avoid worsening the situation. Despite initial warnings and concerns expressed by global leaders, including President Joe Biden, the airstrikes persist, deepening the crisis in Yemen.

As Yemen grapples with the aftermath of international airstrikes, the fragile peace has shattered, leaving millions of Yemenis in an increasingly dire situation. The humanitarian crisis, exacerbated by disrupted food distribution and ongoing military actions, demands urgent attention and international cooperation to alleviate the suffering of the Yemeni people.

Group Homes for People with Disabilities are Harbors for Abuse

By James DeLano

“I don’t feel safe here.”

That statement was uttered repeatedly in interviews performed by the Alabama Disabilities Advocacy Program (ADAP) with residents of Sequel Courtland, a psychiatric group home for boys in Courtland, AL. The residents of the home reported consistent patterns of abuse. One boy “reported witnessing a staff member lifting another resident up by the throat and slamming him to the floor.” Multiple boys reported being slammed into the ground and not being allowed to receive medical attention.

Sequel Courtland is a facility for boys. At the time the letter was sent in July 2020, there were “at least two transgender girls inappropriately placed at Courtland,” one of whom reported that she “is constantly touched, smacked on the butt” and that “they [other residents] try to watch me dress.”

At a Sequel facility in Owens Cross Roads that was part of the same investigation, “male staff repeatedly enter girls’ bedrooms and put them in violent containments.” At the same facility, residents were frequently ordered to sleep in common areas rather than in their bedrooms as a punishment. Staff also failed to report or make any attempt to prevent suicide attempts.

Sequel Montgomery practiced “Group Ignorance” as a punishment. Group Ignorance, or GI, involved staff and other residents completely ignoring the person being punished. The isolated person was unable to interact with peers in any way; just being within ten feet of another resident would be considered a violation. The facility’s then-current guidelines read that “They can participate with peers only during direct billable services—BLS and therapist-led group therapy.” One resident reported attempting suicide specifically because of the stress of being isolated under GI.

Sequel Tuskegee utilized a “time-out room” for up to days at a time as a means of controlling residents. There was no mattress present in the room; boys were required to move the mat from their bedroom into the confinement area. It also lacked a toilet or sink. Because of that, residents were forced to either try – and often fail – to gain staff’s attention to use the restroom or, failing that, “urinate in the corner of the room and clean it up later.”

A Sequel group home in Ohio was also investigated by that state’s protection & advocacy (P&A) agency, Disability Rights Ohio. They reported that one of the children living at that home told them he was “Put in a hold so strong that it almost broke my arm; they kept holding me tighter and tighter; my hands and arms were tingling and going numb.” Another said, “I don’t feel safe.”

Abusive group homes are not exclusive to Sequel. Group homes are often abusive, no matter what company owns them.

At a residential facility called Canyon Hills Treatment Facility in North Carolina, “at least one-third of residents lost weight after they were admitted for treatment.” Canyon Hills’ residents were children who should still have been growing. When residents asked for more food, their portions were cut even further. At another facility in North Carolina called Anderson Health Services, “Ten staffers at this facility have been charged with child abuse since 2017.”

At a group home in California, a woman with severe autism often went out on rides in the home’s van. She occasionally tried to stand up, after which “the staff member driving would slam on the brakes and, like, brake check her.” That practice caused bruises. The same woman, who had harmed herself in the past, was frequently left alone and unsupervised, during which time she banged her head into the wall, leaving large holes in the process.

Neglect in Group Homes

Many group homes are chronically understaffed. That, along with low pay and a lack of care from and proper training for staff, collectively leads to preventable injuries and death.

A woman choked to death at a New Jersey group home in 2017. She was unable to swallow large pieces of food; everything needed to be in small pieces, and she required supervision while eating. Two years prior, she had been taken to the hospital after choking on a bagel – an incident her family was never told about.

As a result of poor staffing, a resident of an Oklahoma group home named Terry Brown was strangled by his roommate. There was only one staff member on duty; when she intervened, she was attacked as well and “watched Terry’s body turn purple, go limp and fall lifeless.” At a group home owned by the same company, a resident drowned in 2011 on an outing. He was supposed to be wearing a life jacket. When he died, there was no life jacket for him to wear.

One Texas caregiver worked for almost 70 hours straight while caring for two disabled women; her only breaks were a short nap and a trip to run errands. She is the only caregiver for two women who require constant care and supervision. She was clocked in from 8:16 Tuesday morning to 10:08 Friday morning, and only four hours after clocking out she returned for another 19-hour shift. She said that, “I’m always here. The only thing I do for fun — besides sleep — is go to church, read my Bible, hang out with my family.” The only occasional help she has comes from equally understaffed and exhausted workers at other group homes. For her work – providing constant, necessary care to two people – she makes $9 per hour, which is a wage that is not uncommonly low and serves as one of many reasons group homes are so often neglectful.

At the previously mentioned Sequel group home in Courtland, Alabama, ADAP investigators found blood and feces on windows and floors. The same investigation had residents report insufficient and inadequate food and water, nonexistent education and medical treatment, and that “there’s mold in the showers, and rats and roaches in our bedrooms and the hallway.”

Physical and Chemical Restraint

Mental healthcare professionals generally agree that restraining someone who is in crisis only makes things worse. Many group homes do it anyway.

As part of the previously mentioned investigation into Sequel facilities in Alabama, numerous instances of inappropriate restraint were reported. A report compiling the results of several investigations by various state Protection & Advocacy Agencies (P&As) reads about an Alabama group home, “One boy described his head being caught on a nail in the wall during a restraint; another said he was picked up and slammed on his stomach onto the concrete. A boy who had visible gashes to his head said that facility staff had slammed him against a wall the previous night.”

In 2020, a 16-year-old boy was physically restrained by several staff members at a Sequel facility in Kalamazoo, Michigan, for twelve minutes. They used their body weight to restrain his torso and legs. He died two days later due to being asphyxiated while he was restrained. His name was Cornelius Frederick. In the 18 months preceding his death, emergency services visited the facility 237 times.

A group home in Carlton Palms, Florida has yet another pattern of restraints being used. Those restraints include cuffs, residents being strapped to chairs or being tied down, and straitjackets. These restraints directly cause physical harm – broken bones, bruises, and broken teeth, to name a few.

A box of Seroquel in front of a laptop. Source: Wikimedia Commons

Seroquel is an antipsychotic drug that is approved by the FDA to treat some severe mental illnesses. Seroquel does not have an immediate effect. It is not approved as a form of chemical restraint or as a treatment for insomnia or anger management, among other off-label uses, but that is what it has been marketed and used for. Disability Rights Tennessee, the P&A agency in Tennessee, reported that “In one facility, staff increased a child’s Seroquel dosage from 50 mg to 300 mg as an emergency intervention.” The same problems occurred in North Carolina; “staff had administered Seroquel numerous times to a child who did not have any diagnoses that would indicate use of antipsychotics.”

What Is Being Done?

Several of the group homes mentioned above have shut down since investigations into them concluded, including some Sequel group homes. Sequel changed its homes’ names to Brighter Path due to the negative press. In other cases, states have stopped sending children to abusive group homes or, rarely, revoked their licenses. Other group homes, while not yet shut down, are no longer receiving new residents or are being downsized.

The Unrecognized Effects of the Opioid Crisis on Native Americans

by Abigail Shumate

A Brief History of the Opioid Crisis

Beginning in the late 20^th century, opioid prescription rates skyrocketed in shocking numbers, and in just over ten years, opioid sales quadrupled. With the introduction of OxyContin into everyday life and medication sales, an opioid that was falsely advertised as non-addictive, as well as pill mills across the United States, millions of people fell into a deadly addiction. As people lost access to prescription opioids, they often turned to more illicit drugs, such as heroin. This was worsened by the prices of heroin going down, making it much easier for people to afford large quantities of the drug. The use of heroin is often looked at as the second wave of the drug crisis, and heroin deaths surpassed prescription drug deaths in 2015. The third wave of the opioid crisis is where we currently reside, and it is characterized by overdose deaths related to synthetic opioids, such as fentanyl.

Connection to Native Americans and Alaskan Natives

The opioid epidemic has been heavily discussed in the past few years; however, it has been occurring for even longer. Opioid usage affects most groups; however, its large-scale detriment to minority race and ethnicity groups is frequently ignored. Native Americans and Alaskan Natives (here referred to as NA/AN) are disproportionately affected by the opioid crisis, and this discrepancy is ignored by many critical groups.

American Indians have the highest drug overdose death rates, and these rates are not stagnant. The CDC reports that overdose deaths have increased by 33% within the last several years. This pattern of drug abuse and overdose is not isolated to adults, as NA/AN youth also struggle with the use of unauthorized prescription painkillers, with some reports showing as many as 11% of high school students using painkillers without explicit orders from their doctors.

There are many factors that cause NA/AN groups to be affected more heavily than other groups, and these include historical trauma, lower educational attainment, lack of easy access to healthcare, housing problems, poverty, unemployment, violence, and mental health issues. In this post, I will choose to focus on two main reasons: lack of easy access to healthcare and mental health issues caused by lost connection to culture.

Health Disparities in NA/AN Communities

NA/AN groups have serious healthcare inconsistencies that must be addressed for these communities to gain adequate support during the opioid crisis. The Indian Health Service (IHS) is a group that provides care to over 2.2 million people, but it is severely underfunded by Congress. As this is one of the main organizations providing healthcare access to NA/AN groups, this underfunding affects millions of lives. To put these funding issues in perspective, funding would have to almost double to match the degree of care provided to federal prisoners, and it would have to increase by even more to equate to Medicaid benefits.

Alternate Text: Image of white OxyContin bottle with white pills laid out in front. Source: Flickr — Image of white OxyContin bottle with white pills laid out in front. Source: Flickr

Poor healthcare consistently results in the treatment of symptoms instead of causes, and, unfortunately, this means the prescription of opioids. Whether injuries occur from manual labor, physical activity, or driving accidents, NA/AN individuals are more likely to be treated with opioids as opposed to more effective means of treatment, such as physical therapy. Poor healthcare aligns directly with low-quality insurance or no insurance at all, and opioids are more likely to be prescribed in areas with uninsured people.

Mental Health and Cultural Disconnect

The traumatic history of Native American groups has a massive impact on these overdose rates, as forceful deprivation from culture leads not only to issues such as inadequate healthcare and poverty, but also mental health issues, one cause of opioid treatment, these being direct pathways to opioid addictions.

Mental health issues are incredibly prevalent within NA/AN communities, with suicide rates for them being more than double those for the entire U.S. population. NA/AN individuals are also more likely to be diagnosed with anxiety disorders and PTSD. These mental health conditions, when left untreated or inadequately treated, can often lead to drug abuse. The IHS does provide care for mental health and substance abuse issues; however, the already underfunded organization only uses about 10% of these funds to support substance abuse treatment

These mental health issues can be attributed to many things; however, a major force playing into this is the history of trauma amongst Native Americans. This topic could be one if not several, entire blog posts, but here I will attempt to briefly sum it up. It is important to note that there are around 600 federally recognized tribes, so the experiences of NA/AN individuals can vary greatly. One thing most groups share is a prevalent history of displacement and loss of culture. In the late 19^th century, the majority of Native American individuals were forced to relocate to reservations or into urban areas. This resulted in a decline in socioeconomic status, which resulted in poor living and working conditions, as well as heightened health issues, both mental and physical.

It is vital to remember that NA/AN groups are underrepresented in major clinical research studies. This results in the general public being unaware of the true extent of issues within these communities. This underrepresentation in research exacerbates the disparities and can easily result in the continuance of the opioid crisis for Native Americans with little to no acknowledgement from major government parties. Another impact of inadequate research is misconstrued statistics, and it is likely that the opioid crisis is worse for NA/AN groups than scholars anticipate, as overdose cases may be underestimated by as much as 35% due to race miscalculations.

Alternate Text: Image of a white hospital room with two bed placed in the center. Source: Flickr. — Image of a white hospital room with two bed placed in the center. Source: Flickr.

Creating Change

The first thing that needs to be done in order to improve the worsening opioid crisis in NA/AN areas is to improve funding for the Indian Health Service. The United States Congress must take action and increase funding—the funding in 2022 is less than half of what patients need. With adequate health care, individuals with mental health and substance abuse issues will be able to get the help that they need, and, on the more preventative side, with better care, individuals will be less likely to be prescribed opioids as a substitute for proper treatment.

The second action that needs to be taken is better awareness. There needs to be more research devoted to NA/AN groups, so that we are able to pin down what leads to these heightened addiction statistics. Overall, it is vital for individuals to take personal responsibility and increase their own awareness of the issues. Native Americans have been ignored and mistreated for decades, and this must be remedied in the present.

Mental Illness in U.S. Prisons and Jails

by James DeLano

“I run the biggest mental hospital in the country.”

That was Los Angeles County Sheriff Lee Baca in 2005. He was referring to the fact that, in 2005, over 2,000 people in the county jail had been diagnosed with a mental illness. That has not changed. Nationwide, between 16% and 24% of incarcerated people have a severe mental illness. In the general population, 4% of people have these illnesses. Prisons are serving as replacements for psychiatric hospitals, but they are not changing to accommodate that.

In the 1840s, people with mental illnesses were generally imprisoned. That was due to the criminalization of many symptoms and a lack of societal acceptance. Although mental disability has not been a legitimate excuse for imprisonment, mental health problems are still significant in today’s prisons.

National Problems

Nationally, estimates for the percentage of inmates with a severe mental illness range from 15% to 20%. As previously mentioned, the Los Angeles County Jail was described by its sheriff in 2005 as the largest mental hospital in the country. At the Cook County Jail in Illinois, about 1/3 of the incarcerated population has a mental illness. According to the mental healthcare supervisor at the Gwinett County Detention Center in Georgia, the closure of a nearby psychiatric hospital caused the number of mentally ill inmates to skyrocket. In Polk County, Florida, the jail has a mental health unit based on psychiatric hospitals and “immediately put[s] them back on medication because the vast majority of them – the overwhelming majority of them — have decompensated.” In the U.S. Virgin Islands, individuals who were found not guilty of a crime by reason of insanity – that is, who committed a crime but were determined not to be culpable due to a mental illness – are kept in the general prison population rather than being hospitalized. For that reason, the U.S. Virgin Islands has been involved in a class-action lawsuit, Carty v. Mapp, since 1994, one which shows no signs of being resolved.

These situations are exacerbated by the criminalization of symptoms and coping mechanisms of people with mental illnesses. Some people use illegal substances as a means of self-medication. Others steal food or break into buildings to find a place to sleep. Rather than investigating the reasons behind these crimes, people are incarcerated, sometimes medicated, and only occasionally given true mental health treatment. They are then released with no outside support or ways to continue accessing medications.

That is still entirely ignoring that prisons can cause mental health issues on their own. Solitary confinement, something that is widely used in American prisons, can cause or worsen symptoms of mental illness. Incarcerated people kept in solitary confinement are almost seven times as likely to harm themselves and more than six times as likely to “commit acts of potentially fatal self-harm” when compared to the general prison population.

Failures in the South

In 2017, a federal district court found that the Alabama Department of Corrections (ADOC) was providing “significantly inadequate care.” This decision came after years of litigation. The case, Braggs v. Dunn, is still ongoing almost ten years after it was first filed in 2014. Since then, little has changed in ADOC’s prisons.

An opinion given in the case mentioned Jamie Wallace and his testimony 36 times over 300 pages. Wallace was incarcerated in 2014 for the murder of his mother. He had been diagnosed with bipolar disorder and schizophrenia. He testified in December of 2016. He died of suicide ten days later while in a unit dedicated to severely mentally ill inmates. Five days prior to his suicide, a healthcare worker at the prison wrote that he was “using crisis cell/threats to get what he wants.”

Wallace was mentally ill. For that, he was punished by prison guards. He was disciplined twelve times for harming himself, six of which involved being subjected to solitary confinement. Solitary confinement is regularly criticized for being inhumane, and it is especially so for those with preexisting mental health issues. According to Solitary Watch, a non-profit dedicated to ending the overuse of solitary confinement, citing a 2014 study on the topic, “individuals placed in solitary confinement were 6.9 times more likely to commit acts of self-harm and 6.3 times more likely to commit acts of potentially fatal self-harm than people in the general population.” Adding that people with mental illnesses are more likely to harm themselves than people without paints a grim picture of what happens inside these walls.

After Wallace’s suicide, the court ordered an emergency plan to be made to prevent future suicides. That plan was too late for James David Johnson, who hung himself only a few days after Wallace.

The court also accused correctional workers of being ambivalent or actively encouraging suicide. “ADOC officers essentially called a prisoner’s bluff, and then that person attempted suicide.” During his testimony, Wallace said that a correctional officer handed him a razor blade and told him, “You want to kill yourself? Here you go. Use this.” The two parties in the case had previously settled over the issue of razor blades’ presence in crisis cells – the same kind of cell Wallace was able to hang himself in. This lack of awareness on the part of ADOC was only exacerbated by the chronic understaffing of mental health workers. In January of 2023, ADOC stopped reporting the number of deaths – both homicides and suicides – that occurred in its prisons.

In 2021, Disability Rights Mississippi, Mississippi’s federally mandated watchdog agency (protection & advocacy agency), filed suit against the Mississippi Department of Corrections due to severe mistreatment of numerous disabled inmates. One individual, who was described as having ADHD, OCD, and bipolar disorder, was refused access to his medications and, according to DRMS’s investigative report, “during suicide watch, recalls being told by a passing officer to go ahead and kill himself.” Another person with PTSD and bipolar disorder “needs… mood stabilizers. MDOC has yet to treat this offender.” The lawsuit itself, Wallace v. Mississippi Department of Corrections, reads, “DRMS has encountered many offenders who have attempted self-harm, which was ignored by MDOC staff. In some cases, the self-harm was encouraged by MDOC staff.”

Florence Supermax

A short time after Braggs v. Dunn, another lawsuit was filed for similar reasons – this time against the supermax prison in Florence, Colorado, also called the ADX. Rodney Jones, who assisted in the early stages of the lawsuit and who was previously held in the ADX, told the New York Times in 2015 that a staff psychiatrist stopped the medication he took for his bipolar disorder because “We don’t give out feel-good drugs here.”

One of the plaintiffs in that lawsuit is Jack Powers. Powers was sent to the ADX after an escape attempt preempted by threats from members of the Aryan Brotherhood, some of whom he had testified against after witnessing the murder of a friend. All three men he testified against were being held at ADX Florence when Powers was transferred there. While incarcerated there, Powers “lost his mind.” He mutilated himself numerous times, including by removing his earlobes, chewing off one of his fingers, removing one of his testicles, and tattooing himself with a razor and black carbon paper dust.

David Shelby was incarcerated for threatening President Bill Clinton after he “became convinced that God wanted him to free Charles Manson from prison.” While incarcerated, Shelby sliced off part of his finger and ate it. Herbert Perkins, another prisoner, attempted to cut his throat with a razor. After being treated, he was ordered to mop up the blood left in his cell – it had not been cleaned since he was taken to the hospital.

Conclusions

American prisons often have inhumane conditions. Those issues are compounded even further when the inmates in question have a mental illness. Prisons are unprepared to serve as psychiatric institutions, nor have they, overall, attempted to change to do so. Even so, that is what they are doing. Between the lack of adequate treatment, the negative psychological effects being incarcerated can cause, and the lack of assistance from correctional workers, it should be no surprise that rates of self-harm, suicide, and mental illness in prisons are so high.

Courts take time to process cases. This is demonstrated by many of the cases mentioned; Carty v. Mapp has been ongoing for 30 years, Wyatt v. Stickney ended in 2003, 33 years after it was first filed, and Braggs v. Dunn, one of the more recent lawsuits mentioned, is over a decade old. This is by design. A longer trial gives more opportunity for both parties to adequately present cases and, in the cases of these lawsuits, make changes. Despite that necessity, something needs to change. Mentally ill people are suffering and dying in jails and in prisons. The correctional system will not change on its own; it takes outside pressure to change things, and lawsuits, the most effective means of creating this change, take decades to be resolved. Systemic changes need to be made to how these prisons function and the societal role they play.