healthcare – UAB Institute for Human Rights Blog

How Covid-19 Exposes the American Healthcare System

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

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

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

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

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

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

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

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

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

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

Responding to COVID-19 in Developing Countries: An Appeal from Our Friends at Nashulai Maasai Conservancy in Kenya

Just a few short months ago, the IHR hosted Nelson and Maggie Reiyia from Kenya who spoke to us about Nashulai Maasai Conservancy, wildlife conservation, preservation of culture, and how to empower whole communities from the inside out, especially girls and women.

How long ago this seems now, in the midst of the COVID-19 crisis. The impetus of this blog post is Nelson and Maggie’s desperate appeal to help support their people who have been hit extremely hard by this crisis, and to show how COVID-19 affects people in the developing world.

COVID-19 in developing countries

While we have raised awareness of what this crisis means for some of the most vulnerable and marginalized in our own society, having to deal with a pandemic in developing countries is a whole different endeavor. The virus itself and the sickness it causes are only half of the danger. Major societal issues such as widespread poverty, economic deprivation, and lack of access to water, food, sanitation, and healthcare present huge challenges for people in the Global South. The COVID-19 crisis threatens already fragile economies and has the potential to negatively impact human rights, education, basic resource allocation, and food security. Under-resourced healthcare systems and hospitals are likely to be overwhelmed, creating a probability for higher death rates. A majority of people in developing countries also lack access to water and soap, increasing the likelihood of infections and facilitating the spread of the disease. In addition, there are no social safety nets or government bailouts for workers and businesses, exacerbating scarcity, political struggles, violence, and poverty.

Women and children talking in Maasai house. — Women and children in a Maasai house at Nashulai Conservancy. Source: Nora Nord, nashulai.com

In other words, it is not just the virus that threatens people’s lives in developing countries, but the whole context – poverty, underdevelopment, structural violence, lack of government resources to respond to the pandemic – that puts lives in peril and threatens the existence and survival of whole communities. People in developing countries are doubly at risk. This crisis will leave deep scars, not only with regards to lives lost, but also with regards to international development gains made in the last decades in development, human rights, and human dignity. These are the issues Nelson and Maggie are afraid of. They are not only worried about the immediate impact of this crisis on their people, but also about the setback this crisis will cause to the wildlife, economic, and cultural advances that have sustained and elevated their community for the last years and made Nashulai indispensable for their society. Their people, their project, and their way of life are in peril of survival.

What COVID-19 means for Nashulai Conservancy

Nashulai is a community-led conservancy in the Maasai Mara in the southwestern part of Kenya, close to the border to Tanzania. The Maasai are an indigenous community of strong and brave warriors, but poverty and lack of development have negatively affected their quality of life. Most Maasai exist on less than $1 a day, depending mostly on their livestock for food and income. More recently, due to Nashulai’s efforts, the community has been able to garner revenue through tourism by offering safaris and running guest houses and camps. About 2,000 people live on Nashulai’s 6,000 acre conservancy, and an additional 3,000 people live in the surrounding communities. Most of them reside in traditional Maasai villages, in which small dwellings arranged in a large circle for community living. Women, men, and children live together in small spaces and share food, resources, and chores with one another. Men mostly look after cows, sheep, and goats or work in local tourist camps and lodges, while women prepare food, raise children, and make jewelry and art work to sell to tourists. Livestock is sold on twice-weekly open markets in exchange for grains, oil, salt, and other basic necessities.

Picture showing a Maasai man with his cattle in a Maasai village. — The Maasai live in close-knit communities where women, men, and children of different families share all aspects of everyday life. Source: Marianne Nord, nashulai.com

COVID-19 has put all of this in danger. The markets are closed due to government safety measures, leaving people without food and without income. Tourist streams have run dry, which means no money and no jobs (90% of employed Maasai rely on the tourist industry). The communal way of Maasai life is in direct opposition to the guidelines of social distancing and self-isolation. There is no running water in Maasai homes, making constant handwashing not an option. Healthcare in the rural areas of Kenya is difficult access in the best case, and Sekenani health clinic in the conservancy is not equipped to deal with COVID-19 cases. It is unclear what should happen to people who become infected. There is a lack of information and education about the crisis, and an absence of guidance of what the WHO guidelines of handwashing, social distancing, and self-isolation and quarantine mean for people in places like Nashulai. There is no electricity beyond solar power, and while some people have phones or radios, spreading news and information is extremely difficult.

The situation is dire. People are starving.

Nelson and Maggie have developed an emergency plan to provide each household with basic food items, to repurpose part of Nashulai’s tourist camp to isolate sick people, and find ways to educate the community about safety measures and health. They have established a strategy on how they can become self-sustaining in terms of food production and continue their important conservancy work over the next months. However, because their stream of revenue has been cut, they rely on us, their friends, to support them, the Maasai people in their community, and the long-term survival of their project.

Please visit Nashulai Maasai Conservancy’s website if you would like to learn more and/or if you would like to donate to Nashulai Maasai Conservancy’s COVID-19 Emergency Fund.

Impact of Covid-19 in Conflict Zones

“Wash your hands.” “Avoid close contact with others.” “Stay home.” These are the CDC’s recommendations for protecting yourself against the coronavirus and the disease that it causes, COVID-19. For those of us fortunate enough to have clean water and soap and space and a home, that is helpful advice and easy enough to follow, even if it is somewhat of a disruption to our normal lives. Unfortunately, these recommendations are completely irrelevant to the millions of people across the globe who live in conflict zones and refugee camps where fresh water is scarce, sanitary facilities are lacking, and the healthcare infrastructure has been decimated by war and continuous violence. In places where day to day survival is already a key concern, the novel coronavirus poses a new kind of threat, one that the struggling healthcare systems in these countries is not prepared to take on.

While the U.S. government and media have focused on individual vulnerabilities, such as age and underlying respiratory conditions, very little has been done to address social and structural vulnerabilities, including limited access to basic services, health care, safe water, sanitation, and hygiene, in some of the most dangerous places in the world. Overcrowded refugee camps are a virus’ dream – they provide conditions in which the virus can spread rapidly and easily. Individuals living in these places are already prone to respiratory problems due to air pollution and living in close quarters. Unsanitary conditions and lack of housing, food, and clean water exacerbate the risk of contracting an infectious disease, and the lack of access to basic health care makes fighting any kind of infection difficult. The coronavirus is highly contagious and has a very high global mortality rate, even in places where social distancing and healthcare are accessible, and this rate will likely be significantly higher in conflict zones where large numbers of displaced people live. Preventing the virus from entering these spaces is the only hope, but as Dr. Esperanza Martinez, head of health for the International Committee of the Red Cross, has said, “this is uncharted territory,” and it is unclear how effective containment strategies will be in reality (or if they are even possible in certain places).

According to the Center for Strategic and International Studies, 126 million people around the world are in need of humanitarian assistance, including 70 million who have been forcibly displaced from their homes, mostly due to violence. COVID-19 is adding a new layer of uncertainty and fear to the already precarious and vulnerable status of these individuals and families. The UN High Commissioner for Refugees (UNHCR) and the International Organization for Migration have suspended refugee resettlement programs, and many governments worldwide have stopped the intake of refugees who are fleeing violence and food insecurity. Cases of COVID-19 have been confirmed in war-torn areas in the Middle East, including Afghanistan, the Gaza Strip, and Ninevah, a displaced persons camp in Iraq, as well as in several African countries, including war-torn Libya, Cameroon, and the Congo. This post considers how this global pandemic will likely impact people living in three particularly dangerous and vulnerable countries in the Middle East and West Africa: Syria, Yemen, and Burkina Faso.

Syria

Nine years into the seemingly endless civil war in Syria, more than 380,000 people have died, dozens of towns and cities razed to the ground and half of the country’s entire population displaced. Targeted attacks have left Syria’s once thriving public health care system in shambles. Hospitals and clinics have been destroyed or damaged to the point of not functioning. Medicine and medical supplies are limited, healthcare workers are few, and travel to the still-operational clinics and hospitals is out of the question for many of the sick and suffering. Of particular concern is the refugee camp in Idlib, a town in the northwestern province near Turkey, where many displaced individuals now live. The conditions of the camp are dire – there is limited access to soap and water and overcrowding makes social distancing impossible – so self-protecting is a major challenge.

Syria reported its first case of coronavirus a few days ago, from a woman who had recently traveled to Iran, a country that is backing the Syrian government in the civil war and where Shia pilgrims frequently travel. There are now five confirmed cases (the actual number is suspected to be much higher), and there is growing fear that the virus is spreading unimpeded throughout the northwest, where there is limited capacity to test and monitor the situation, but experts have warned that “if the disease starts, it will spread massively.” Jan Egeland, director general of the Norwegian Refugee Council, has warned that COVID-19 could “decimate refugee communities.” Containment is the only hope, but the shortage of supplies, including test kits, makes this unlikely.

Yemen

The United Nations has labeled the situation in Yemen the world’s worst humanitarian crisis. No cases of COVID-19 have been confirmed yet in Yemen, but the country is bracing for a devastating catastrophe if and when the virus arrives. Since the U.S.-backed war in Yemen began five years ago, Saudi and Emirati coalitions have leveled 120 attacks on medical facilities throughout the country. These attacks, including airstrikes, ground-launched mortar and rockets, and attempts to occupy hospitals and clinics, have led to widespread disruptions in access and service to some of the world’s most vulnerable people, including displaced women, children, and persons with disability. With a mere 51% of the country’s health centers operational, there is a severe shortage of medicine and medical equipment. Even if people in this area can get to a hospital, many hospitals don’t have electricity, rendering a ventilator — a potentially life-saving device for people suffering the most severe symptoms of COVID-19 — out of the question. The decimated healthcare infrastructure is unable to control preventable disease (there was a cholera outbreak a few years ago) and is completely ill-equipped to handle a pandemic. Both the Houthi rebel group (aligned with Iran) and the government recognize the threat the virus poses and are implementing precautionary measures, such as closing schools and halting flights into the area. However, both sides are amping up their rhetoric and are posed to blame the other if and when cases of COVID-19 are confirmed. The United States, for its part, has cut off emergency aid to Yemen, citing the Houthi’s interference in the distribution of supplies and services to starving Yemenis (likely a Saudi-directed approach), but humanitarian officials have warned that this decision will create major funding gaps in efforts to provide hand soap and medicine to clinics and to staff health centers with trained healthcare workers. Yemen’s basic healthcare programs are heavily reliant on foreign aid – about 8 out of 10 Yeminis rely on some form of aid. Eliminating this source of funding could mean suffering and death for millions of displaced persons in Yemen.

Burkina Faso

On March 18, Burkina Faso, the impoverished West African country of 20 million people, registered its first confirmed case of COVID-19. A week and a half later, that number leapt to146 cases, with hundreds more suspected, making it the hardest hit West African country so far. This tiny, conflict-scarred country is no stranger to hardships, including poverty, drought, rampant hunger, and militia-led coups. In 2019, clashes between government forces and militia groups linked to ISIL and al-Qaeda led to more than 2,000 deaths in Burkina Faso and forced more than 700,000 people to flee their homes. This escalation of violence has led to the closure of 135 health centers in the country, and an additional 140 have reduced their services, leaving 1.5 million Burkinabe in dire need of humanitarian health assistance. With a healthcare system that has been ravaged by war, a mere three facilities in the country are able to carry out the tests, and only a few hundred test kits have been provided. As part of the government’s response, Malian refugees once displaced into Burkina Faso are being forced back into Mali, where ongoing violence inhibits humanitarian and medical access to affected populations. COVID-19 will exacerbate an already dire situation — it is feared that an outbreak would see fatality rates of ten times higher than the global average. “These populations are already very vulnerable to diseases that are otherwise easy to treat,” says Alexandra Lamarche, senior advocate for West and Central Africa at Refugees International, “but that’s not the case when they have no access to water or proper sanitation or health care.” She adds, “We could watch entire populations vanish.”

Bumper sticker that says "All people are created equal members of One Human Family" — Source: Yahoo Images

Against a common enemy?

Rarely does a disaster – natural or otherwise – affect the entire world. The coronavirus is a different story, unlike anything we have witnessed in the modern age. It is exposing the fragility of even the most advanced economic, technological, social and medical systems, and it poses a grave threat to humans the world over. The virus doesn’t discriminate on the basis of status or religion or skin color or any of the other things that divide us or give us cause to fight each other. It travels across borders and between enemies, and the more people it infects, the greater the risk for everyone. Just like the virus, the distribution of basic human rights must not be qualified on the basis of anything other than humanity. Turning a blind eye to the suffering and inadequate conditions of the world’s most vulnerable populations only facilitates the spread of the virus. In a practical sense, limiting the spread of the virus in refugee camps and conflict zones in Yemen and Syria and West Africa is just as important as it is in wealthy countries if the goal is to eliminate the virus and end this global pandemic. That requires distributing resources and investing in large-scale infrastructure improvements in places where people are not able to follow the protocols for containment under the current conditions. As we scramble to make enough surgical-grade masks for healthcare workers in the United States to wear, we need to be concerned with sending as many as possible to medical facilities in places around the world that are under-served and over-taxed, including displaced persons camps. We cannot hope to protect ourselves if we refuse to protect our fellow humans, no matter the distance or cultural difference between us. U.N. Secretary-General Antonio Guterres has called this “the true fight of our lives,” insisting that we put aside our differences, which now seem small and inconsequential, and turn our aggression toward a common enemy. “That is what our human family needs, now more than ever.”

A Time to Recognize and Safeguard The Rights That Connect Us

by Peter Verbeek, Ph.D. (Associate Professor, Program Director MA Anthropology of Peace and Human Rights)

A picture of a girl with a surgical mask covering her mouth and nose — Source: Yahoo Images

On March 6, 2020, the UN High Commissioner for Human Rights, Michelle Bachelet, issued a statement calling for an holistic human rights based approach to combat COVID-19. She wrote, “As a medical doctor, I understand the need for a range of steps to combat COVID-19, and as a former head of government, I understand the often difficult balancing act when hard decisions need to be taken.” However our efforts to combat this virus won’t work unless we approach it holistically, which means taking great care to protect the most vulnerable and neglected people in society, both medically and economically.” She added, “COVID-19 is a test for our societies, and we are all learning and adapting as we respond to the virus. Human dignity and rights need to be front and centre in that effort, not an afterthought.”

To heed Dr. Bachelet’s call we must remind ourselves of the fact that human rights are universal and inalienable, indivisible, interdependent and interrelated. We also must recognize that the essence of human rights is human dignity. All human rights arise from it and all human beings are born with it and posses it throughout their life span. Human dignity is not measured on a sliding scale. To illustrate, there is no difference in human dignity between that of the office holder of the Presidency of the United States and the migrant at the US Southern border. The accused in the court proceeding has the same human dignity as the judge presiding over her case. The convict and the prison guard do not differ in their human dignity. The human dignity of the disabled veteran is the same as that of the person pushing her wheelchair. And the human dignity of the COVID-19 patient in the isolation ward is the same as that of the health-care worker taking care of him.

The recognition of our shared human dignity and the safeguarding of the rights that arise from it is a powerful unifier in troubled times. Now that we are faced with a near global outbreak of an until recently unidentified corona virus we can stand united in the recognition that every person on this Earth has an irrevocable right to health care and security in the case of illness (UDHR, Article 25). With rights come responsibilities, and the unifying power of universal human rights is the way that each of us in accordance with our specific context and abilities has a role to play in safeguarding access to appropriate preventive and interventional health care and personal security regarding COVID-19. Our individual roles are necessarily varied, from driving a neighbor without proper means of transportation to a health care facility, to following “doctor’s orders” concerning personal hygiene or social distancing. If infected or taken ill we have a right to receive the best available care and the responsibility to follow the guidelines in place so as to minimize the risk of infecting others. Each of us has a responsibility to listen to the relevant and evolving science as communicated by medical experts, and each of us has the responsibility to comply with the local and national guidelines that are based on this science.

Some of those taken ill with COVID-19 will die in spite of our best efforts to care for them and protect them. If the fight to save their life is at the cusp of being lost we have the responsibility to see to it that their death reflects the human dignity that they possess. Medical science does not yet have the answer to the question of how to protect oneself conclusively against viral infections such as the current corona virus. That realization, while sobering, should not keep us from doing all we can in terms of what we do know about prevention. There is much that we can do to limit the risk of infection, provided we follow the relevant science. The human rights motto is that any infection, or worse, any death, linked to insufficient preventive measures is one too many, and we all stand united in this through the human dignity that each of us possesses.

The Nutrition and Health Crisis in Venezuela

Child wears hat that says Venezuela on it and stares off into the distance. — ELEICOES 2013 NA VENEZUELA. Source: Joka Madruga, Creative Commons

The current president of Venezuela, Nicolás Maduro, was elected in 2013 by a very small margin. During his first term, the Venezuelan economy took a turn for the worst. He was reelected for a second term in 2018, but his opponents feel that the election wasn’t valid because many of the other candidates were made ineligible to run or even jailed, so the National Assembly does not recognize his presidency and considers the presidency vacant. According to the Venezuelan Constitution, in cases of a vacant presidency, the leader of the National Assembly (currently Juan Guaidó) takes over as president. Guaidó has very little political power because the military still supports Maduro.

I first heard about the political and economic unrest in Venezuela when I went on an exchange trip to Spain in May of 2016. My host family had moved to Spain eight months earlier because their jobs had been the first affected by the economic downturn. They were lucky that the dad was a Spanish citizen—it was much easier for them to move to Spain than if none of them had been citizens—but many Venezuelans have not been so lucky.

Protests in Venezuela — Venezuelan Protests. Source: Trong Khiem Nguyen, Creative Commons

Since 2015, health statistics have been underreported—if they’ve been reported at all. December of 2016 marked the last report from the Venezuelan Ministry of Health. This report describes an alarming increase in previously eliminated and controlled infectious diseases, such as malaria and diphtheria, and in maternal and infant mortality rates. The report has many alarming statistics, but aside from that, it is the last one to have been published. Additionally, the Health Minister who published the report was fired immediately afterward.

With no one within the country reporting on the health needs and statistics of the people, it is nearly impossible for other countries to give external aid. Additionally, even when aid sent, the Venezuelan government refuses help. Even nongovernmental organizations (NGOs) are forced by law to refuse help: the Supreme Court ruled in 2010 that any NGOs receiving financial assistance from other countries would be committing treason. This has a devastating impact on the citizens as they are not receiving the help that they need.

The situations in the hospitals are dismal. According to a survey conducted by the political opposition, many services in hospitals are not consistently available, if at all, due to lack of supplies. Many supplies have gone missing from public hospitals and clinics, and those being shipped in often are embargoed and never make it past the ports. The reason is unknown, but many suspect it has to do with the corruption of the government. This has forced patients to bring their own medical equipment—which can include anything from medicine to surgical equipment—when going to the hospital, so they know they’ll have what they need. Private clinics, which have most of the supplies they need, ask for payment in US dollars, which means only the wealthiest can get that level of care. This leaves the average citizen without proper medical care in a country where the government is actively keeping lifesaving materials out of the hands of doctors.

Because of the low levels of health care, many diseases are reemerging and worsening. Between 2008 and 2015, there were no cases of diphtheria reported and one case of measles reported. However, in the past three years, over one thousand cases of diphtheria and over six thousand cases of measles have been confirmed. These statistics show a lack of vaccinations in children, which is potentially due to limited vaccines available. Malaria rates, which were once controlled through pesticides, medication, and reduction of mosquito breeding areas, have increased by over ten times from 2009 to 2017. Tuberculosis cases more than doubled from 2014 to 2017, which is even more concerning with the cases of untreated HIV on the rise as well. According to the Human Rights Watch, “Venezuela is the only country in the world where large numbers of individuals living with HIV have been forced to discontinue their treatment as a result of the lack of availability of antiretroviral (ARV) medicines.” 90 percent of HIV positive Venezuelans have to live without ARV medicines, and these people are majorly susceptible to and will be severely affected by the many diseases that are on the rise. Because all of these diseases are on the rise and the limitations of hospitals, maternal and infant mortality rates in Venezuela have risen back to their levels from the 1990s. Venezuela is the only Latin American country where this has occurred.

In addition to the health crisis, there is also a nutrition crisis. The last nutrition data published was in 2007, but many Venezuelans report only eating yuca or a tin of sardines for their one meal of the day. According to the UN’s Food and Agriculture Organization (FAO), 11.7 percent of the population is undernourished, meaning they are not getting enough nutrients. This is severely affecting Venezuelan children; as of March 2018, 17 percent of children under 5 in lower income areas of Venezuela have moderate acute malnutrition (MAM) or severe acute malnutrition (SAM)—a 7 percent increase from February 2017 and a level of crisis. According to WHO, the fatality rates for children under the age of five who have SAM and MAM are between 30-50 percent, so it is important that children not only have access to healthy food, but that hospitals also have access to the necessary treatments, and at this time that is not generally the case in Venezuela. Pregnant women are also affected by MAM and SAM, which can lead to adverse outcomes during pregnancy, childbirth, and the child’s infancy.

Venezuela is not the only country that is experiencing a health and food crisis. However, many countries have these issues due to lack of resources, funding, or aid. While Venezuela is experiencing an economic downturn, they have been offered plenty of aid, which they have repeatedly refused. Additionally, the lack of reporting health and nutrition statistics is concerning for many reasons. First, this most likely means that no one, including the Venezuelan government, knows the extent to which the Venezuelan citizens are suffering. Second, it shows that the Venezuelan government is willing to conceal the level of suffering experienced by its citizens in order to protect their image, instead of asking for assistance; it sends a message that they do not care about the wellbeing of the citizens they are supposed to serve and protect. The UN continues to urge the Venezuelan government to let them send assistance, warning that their situation can become much worse than it already is, but they continue to refuse and push back on any assistance offered and put the lives of their citizens on the line.

Health Care Is a Human Right

by Pam Zuber

a photo that reads "Save the ACA." — “Save the ACA”. Source: Creative Commons.

Being sick or struggling with a chronic medical condition can harm health, emotions, and finances. Sickness can hurt various aspects of a person’s life and impact society as well. It causes people to miss days of work. It creates financial costs if people have to cover medical expenses for uninsured people. Isn’t it better to help treat and prevent illness in the first place? One would think so, although some people don’t believe that health care is a fundamental right. But, restoring and maintaining health improves the quality of life and so much more. Ensuring proper health care can produce a healthier, happier, and more productive society.

What are some federal government attitudes about health care?

Attitudes about health care are different in different areas. There are many diverse opinions and proposed solutions regarding health care in just the United States alone. The Patient Protection and Affordable Care Act (also known as the Affordable Care Act, the ACA, and Obamacare) represents a microcosm of this diversity. Although it became law in 2010, the Affordable Care Act has garnered considerable controversy before its creation and continues to generate controversy after its passage. Much of this controversy has coalesced around party affiliations. Some members of the Republican Party have decried the ACA a form of socialism because it’s a federal government program that works with state government programs. In this view, the ACA is un-American because other countries sponsor their own state-funded health care programs.

While not a socialist state, Canada is one such country. According to a Canadian federal government website, “Canada’s publicly funded health care system is best described as an interlocking set of ten provincial and three territorial health systems. Known to Canadians as ‘medicare,’ the system provides access to a broad range of health services.” Canada’s federal government funds, administers and sets policies for this system under legislation known as the Canada Health Act (CHA). The goal of the CHA is “to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers,” according to the Government of Canada. The CHA thus features complex interactions between federal and provincial governments and the Canadian health care system. This is reminiscent of how the U.S. federal government administers and funds government programs in U.S. states as part of the Affordable Care Act.

How is New York approaching health care?

Federal governments aren’t the only government bodies that feel strongly about health care. In January 2019, the administration of New York, New York mayor Bill de Blasio announced that the city would offer health care for uninsured residents. City residents would pay for health services on a sliding scale. Known as NYC Care, the initiative would provide mental health care and substance abuse care. “We recognized that obviously health care is not just in theory a right,” de Blasio said. “We have to make it in practice a right.” “Health care is a right, not a privilege reserved for those who can afford it,” stated the mayor. “While the federal government works to gut health care for millions of Americans, New York City is leading the way by guaranteeing that every New Yorker has access to quality, comprehensive access to care, regardless of immigration status or their ability to pay.”

Stories about the de Blasio proposal highlighted that this health care would be available to all New Yorkers, even undocumented immigrants. This proposal occurred at a time when immigration was a hotly contested topic. In fact, immigration was so contested that the topic helped spark a partial shutdown of the U.S. federal government in December 2018 and January 2019 because of debate over funding for a wall between the United States and Mexico to prevent illegal immigration. The de Blasio administration’s decision to fund health care for undocumented immigrants reflected the view that health care should be universally accessible to all, regardless of financial cost or political repercussions. In this view, health care is a human right and the right thing to do.

Why is healthcare a right?

Health care is a human right in part because health – or more accurately, bad health – can permeate every area of a person’s life. It can even have repercussions far beyond a single individual. Say a person is struggling with depression. Depression is a mental illness. It’s also physical one since depression can cause pain, other physical symptoms, or conditions such as substance abuse. (Pain and other conditions can cause depression as well, which underscores the importance of treating mental and physical illnesses so they don’t influence each other.) Depression is more than mental and physical pain. It can wreak havoc on other areas of people’s lives. For example, conditions such as depression may prevent people from going to work. If people take frequent absences, their coworkers may have to perform work extra work to compensate for their absent coworkers. Or, taking frequent absences could lead depressed people to lose their jobs. Losing their livelihoods means people may have trouble paying for food and shelter. People without jobs may not be able to support their families. People who are depressed may lack the physical and mental energy to attend parent-teacher organization meetings, to vote, to run for office, to manage their lives, or to contribute to the lives of others. They can’t fully exercise their human rights because they’re struggling to meet their basic needs. Basic access to mental health care could prevent these struggles and ensure basic rights.

What is the status of current health care initiatives?

It’s clear that spending a little money early may prevent future health problems (and possibly save money) in the long run. But, it appears that some entities don’t want to spend money on such purposes. Others have reluctantly, grudgingly accepted health care initiatives. In 2017, the U.S. Congress passed the American Health Care Act (AHCA). This legislation would have prevented Medicare expansion and other aspects of Medicare funding and would have reduced taxes for some insurers and higher income people. The legislation never took effect, so the ACA remained intact. Commentators have noted that despite efforts to reverse the Affordable Care Act, the ACA is “gaining in popularity – despite the repeal-and-replace rhetoric Trump and fellow Republicans have voiced for years.” The commentators note that politicians realize this and are using the increasing acceptance of the program to bolster their own political fortunes. They recognize that gutting a popular program could hurt their own popularity. The administration of U.S. president Donald Trump issued rules regarding the implementation of health care programs in U.S. states in 2018, for example. This acknowledged that the programs exist, serve many people, and are well-liked and well-used by voters who could determine the political future of the administration and its members. The administration’s rules vividly illustrated the old adage, “If you can’t beat ‘em, join ‘em.”

What is the future of health care?

The future of universal health care is uncertain. On one hand, the Affordable Care Act continues. Conservative administrations and everyday voters have acknowledged the ACA and support it to various degrees. There is still considerable pushback to the ACA and similar initiatives, however. Not surprisingly, some of this pushback is from entities that could be affected by universal health care plans or other health care reforms. Private insurance companies often oppose universal health care reforms because they could affect their profits. The companies and other free-market supporters say that universal health care and other reforms are a direct rebuke to capitalism and the practice of small government. The Partnership for America’s Health Care Future is one such opponent. This organization includes a number of private insurance companies and health-related entities. Interestingly, though, it also includes a number of politicians from the Democratic Party and people affiliated with the party, such as workers from the presidential administrations of Bill Clinton and Barack Obama.

On the other hand, this organization is operating at a time when other Democrats are criticizing their fellow party members for not being progressive enough. A number of Democratic candidates running for the U.S. Congress in 2018 supported a single-payer health care system known popularly as Medicare for All to replace private health insurance. A Reuters poll in that same year reported that growing numbers of voters affiliated with both the Democratic and Republican parties also favored Medicare for All-type policies. A growing number of people and some politicians support universal health care. Other politicians and private corporations don’t. Given the increasingly divided political climate, it’s uncertain whether we’ll reach workable decisions about health care any time soon. But, given the far-reaching impact that good health can provide, aren’t they worth a try?

Pamela Zuber is a writer and an editor who has written about human rights, health and wellness, business, and gender.

We, too, are America

a picture of a microscope — microscope. Source: milosz1, Creative Commons.

We see you. More specifically, I see you. I see you and I understand your fear. Your fear, though, is not of our ascent and overthrow of your supremacy. Your fear is that we–those for whom you believe yourself superior in gender, race, ability, intelligence and religion, but equal to under the law—will treat you as you have treated us. This is your actual fear.

For so long, you have hidden behind your power to give and take at will and random, without accountability. You believed might and standing would continually protect you as you abused, assaulted, and harassed us behind closed doors, in elevators, at parties, or in cars. You assumed your strength would guard against numbers because silence remained your closest companion until it revealed you. Now, silence is your betrayer and light is shining into the darkness. With light comes freedom.

However, not for you.

Finally, thanks to the unfaithfulness of silence, the light that comes with freedom will change you, as the nullifications of uneasy interactions, creepy glances, and videotaped confessions that “boys being boys” and “locker room talk” conclude what we have known all along: you are an insecure predator.

You always have been.

For centuries, you employed power to mask your insecurity while building empires and corporations upon the backs of those “under your feet and purview”. You made rules and assured yourself they did not apply to you. The rules are changing, and you are afraid. You shudder at the possibility of the enforcement of an unjust law you created, applying to you. You are fearful that you will rot in jail for a crime you may or may not have committed, based upon the verdict of 12 who are not truly your peers because they do not look like, live like, or know what it like to be someone like you. You will know what it is like to tell your side of the story and find yourself defending your participation in and motives about the situation that caused you to end up here. Identified as you truly as a perpetuator of trepidation .

You always have been.

Your taxonomy and modus operandi, whether on the forced labor field of terror, in a Las Vegas hotel room or Charleston church, or behind a “news” desk or podium, remains hiding in plain sight because the condition of many is blind submission. The conditioning served us well too, for a while. However, now we are woke. Eyes wide open and aware of the insidiousness of your nature. This scares you, so you label us a threat because we discarded the previously employed labels you doled out. Threat, in your mind, encompasses all manner of challenges you have not experienced during your time in authority. We are a threat to your domination, to your supremacy and privilege. This is what frightens you. The poisonous fruit you provided opened our eyes to the facts about who you are and what we have known all along: you are an idol worshipper.

You have believed the lies told to you and by you for so long, that in many ways, the facts cannot penetrate the walls around your heart and mind. You contrive revisionist history as a method to mask the brutal reality of your ancestors, unwilling to yield to handwritten letters, photographic and videotaped evidence that counter your claims, and absurdly ask us to disbelieve what we see what our eyes, hear with our ears, and experience over time. The words you employ are not for freedom of expression but an expression of your hate, leaving us to wonder if you know how to express yourself in a manner to prove your point without resorting to vileness. You are not out to institute unification, rather everything about you proceeds from an inner core of division. You are in an identity crisis.

You always have been.

Conflicted on one hand about the creation of humanity as made in the image of an unseen God, while on the other, using some as cattle and unpaid laborers, burdened by cherry-picked scriptures applied to build a theology of exclusion. You claim to seek the facts through the reading of words written in years past but systematically avoid anything that may shatter the illusion of grandeur created in the ivory towers which redlining amassed. You proclaim belief in gender equality, except when it comes to leadership, reproduction, sexual experience, and wages. You defend colonization and imperialism due to a misapplied belief that those demonized and dehumanized are ignorant and incapable of civilization; however, pyramids, irrigation systems, and social order existed before the feet of your ancestors stepped on this, and that land. You balk at peaceful solutions and challenges to your authority by responding with insults and name-calling as though life and death are games played in a schoolyard. Even when you are wrong, you are uncompromised in your steadfastness to show your superiority, while marketing yourself as a humble follower of God. You want to be a mirror without looking in one.

I see you.

We see you.

We know the facts.

The fact is, change has arrived. For we, too, are America.

Additional readings:

Langston Hughes

The Color of Law

America’s Original Sin

Nations and Nationalism

Jessica Valenti

HIV and Human Rights

People and Places. Source: Ted Eytan, Creative Commons

The history of the HIV and AIDS epidemic started in illness, anxiety and mortality as the world encountered and handled a new and unidentified virus. It is commonly believed that HIV begun in Kinshasa, in the Democratic Republic of Congo around 1920 transmitted from chimpanzees to humans. The original earliest case where a blood sample could confirm the infection of HIV was from a blood sample taken in 1959 from a man living in the Kinshasa region. Available records suggests that the rampant spread of HIV and contemporary epidemic started in the mid- to late 1970s. During the 1980s, the HIV pandemic spread across South America, North America, Australia, Africa and Europe. The progress and efforts made in the last 30 years to prevent the disability and mortality due to HIV have been enormous. Despite the tremendous improvements regarding HIV research and support, progress remains hindered by numerous challenges. Originally, HIV was identified and diagnosed in men who have sex with men, people who inject drugs, and sexually active people such as sex workers. HIV was perceived and declared a disease only deviant people get because they engage in inappropriate behavior; therefore, HIV and people infected with HIV have been subjected to a corresponding negative social image. Research and education has aided in countering the negative association of HIV transmittance. The CDC explains HIV transmittance takes place via “only certain body fluids—blood, semen (cum), pre-seminal fluid (pre-cum), rectal fluids, vaginal fluids, and breast milk—from a person who has HIV can transmit HIV.” People impacted by HIV, regardless of how it was transmitted, withstand constant stigmatization, discrimination and violations of their basic human rights. There is an inseparable link between human rights and HIV is now extensively acknowledged and accepted.

“Protecting, promoting, respecting and fulfilling people’s human rights is essential to ensure that they are able to access these services and enable an effective response to HIV and AIDS.”

-Avert Society

Human rights treaties and laws play an essential role in protecting the rights of HIV positive populations. The Universal Declaration of Human Rights (UDHR), Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW), and the International Covenant on Economic, Social and Cultural Rights (ICESCR) are all important documents that thoroughly elaborate the rights of all people, which include HIV positive individuals. Article 25 of the UDHR, Articles 10 – 12, and 14 of the CEDAW, and lastly Article 12 of the ICESCR all secure the human right of healthcare and the prevention, treatment and control of diseases. Finally, the ICESCR and the UDHR secures employment, cultural and community participation rights for individuals regardless of age, disabilities, illness, or any form of discrimination.

Human rights violations in the context of HIV

Access to health care services

In 2015, 36.7 million people are currently living with HIV/AIDS, with the majority of HIV/AIDS positive individuals– 25.5 million – living in sub-Saharan Africa. Today, in 2017, only 46% of HIV positive adults and 49% of HIV positive children worldwide are receiving treatment, with large gaps in access to HIV testing and treatment in Africa and the Middle East. Individuals living in low-middle income locations face constant financial, social and logistical barriers to accessing diagnostic services and treatment. Some of the main obstacles individuals of lower income families’ face include the high costs of medical services, the lack of local and nearby health care facilities, and the inability to leave work to visit the doctor. vert Society asserts that stigma and discrimination from community and family influences the utilization of HIV healthcare services by HIV positive individuals. Additionally, the criminalization of HIV is also significantly affecting the access to HIV health care services. In 2014, 72 countries have implemented laws that allow HIV criminalization. Criminalization laws are usually either HIV specific, or either HIV is just one of the diseases covered by the law. HIV criminalization laws normalize, instigate and allow discrimination and stigma towards HIV positive individuals. HIV criminalization laws and socio-ecological barriers undermine HIV prevention efforts and do not decrease the rates of HIV.

Our Lives Matter !! Anti-LGBTI Laws Stall HIV Prevention. Source: Alsidare Hickson, Creative Commons

Criminalization of men who have sex with men (MSM)

Currently, 76 countries around the world continue to criminalize same-sex conduct. Having these laws set up really discourages MSM and the public to get tested for HIV, transition into treatment, and disclose their information due to possible discrimination and arrest. A comparison between nations with anti-homosexuality laws and nations without such law shows considerably higher HIV prevalence rates among MSM in countries with anti-homosexuality laws compared to nations without such legislation. For example, Jamaica has strict anti-buggery laws but has a prevalence of HIV in over 30% of MSM, compared to Cuba that lacks anti-buggery and has a prevalence of HIV in less than 5% of MSM. These laws also make it particularly problematic for organizations providing sexual health and HIV services to reach men who have sex with men. Further research is needed to clarify the correlation between the criminalization of same-sex conduct and rates of HIV. The criminalization of MSM ultimately ignores the fact that HIV can be transmitted through various ways such as unintentional exposure, mother-to-child, and non-disclosure of HIV status which results in individuals not seeking health care services due to the fear of people assuming HIV was transmitted through a different route than how it was actually transmitted.

Gender Inequality

HIV disproportionately affects women and young girls because of unequal cultural, social, and economic standing in society. Gender based violence (GBV) is normalized in many societies. GBV such as rape, trafficking and early marriage makes it more difficult for women and adolescent girls to protect themselves against HIV. Women do not have power over sexual intercourse encounters. Women, in many cultures, are economically dependent on their male counterparts, making it increasingly difficult to choose their lifestyle choices. Additionally, due to the imbalanced gender power dynamic, women do not have control over family planning services, sex-based community rituals, or the choice to participate in safe sex. Studies reveal the impact of gender-based discrimination and HIV. According to one study, women living in Sub-Saharan Africa, on average have a 60% higher risk of HIV infection than their male counterparts. Another study analyzed the role of gender power imbalance on women’s ability to discuss self-protection against HIV/AIDS in Botswana and South Africa. Results concluded that “women with partners 10 or more years older than them, abused women, and those economically dependent on their partners who are less likely to suggest condom use to their partners. Gender power imbalance also influences men’s inclination towards refusing to use the suggested condom.” There is a great need to focus on women education, empowerment and self-confidence to suggest condoms, and lastly to educate and encourage men about safe sex. Gender inequalities towards women are addressed in the CEDAW; therefore, publicly and legislatively addressing the issues could significantly reduce HIV.

Millions of people have lost their lives fighting to make sure HIV positive people are able to live a long, healthy and quality filled lives. Even though we live in a country that does provide HIV healthcare services, the prevalence of HIV in the USA is still relatively high. The Human Rights Campaign reported in 2014 that Birmingham, Alabama had one of the highest rate of infection in the nation; however, the latest CDC report Birmingham is presently 12th, citing a myriad of reasons including a lack of sex education. We have and opportunity and need to stand up for each other, advocating for education and equality. There are various ways to get involved in advocating for human rights and HIV in our Birmingham community, including volunteering at local clinics: 1917 Clinic or Birmingham Aids Outreach. If you’re sexually active, you can help prevent the spread of HIV by knowing your status, getting tested, and talking openly about HIV. Constructive conversations aid in removing the stigma and fear attached to HIV because it becomes a part of the social discourse. An HIV/AIDS prognosis is a life changing event, not a life ending moment.