public health – Page 4 – UAB Institute for Human Rights Blog

The Texas Social Worker’s Code

social work student listening to lecture — Social Work Students’ Accreditation Visit 3.26.13. Source: Southern Arkansas University, Creative Commons

Social work is a field in which professionals are intended to do their best to help connect members of vulnerable populations with the resources necessary to allow them to live with their rights and general well-being safe. However, on October 12 of this year, during a meeting between the Texas Behavioral Health Executive Council and the Texas Board of Social Work Examiners, a section of the social workers’ code of conduct was altered. A section which previously stated, “A social worker shall not refuse to perform any act or service for which the person is licensed solely on the basis of a client’s age; gender; race; color; religion; national origin; disability; sexual orientation; gender identity and expression; or political affiliation.” During the meeting, the words “disability; sexual orientation; gender identity and expression” were taken out. They instead replaced that phrase with the word sex, making the social workers’ code match the Texas Occupations Code.

This is concerning for a few reasons, the most glaring one being that it leaves members of the LGBTQ+ community and people with disabilities in Texas, two populations that are already seriously vulnerable, even more vulnerable than before, as social workers can now turn away potential clients from those communities.

This led to an uproar among advocates for the LGBTQ+ community and people with disabilities, as at puts their ability to access important resources that are related to their basic human rights directly at risk. There is an increasingly serious concern that members of these populations will face even more obstacles in accessing the things they need than they already do.

The Human Rights Connection

It’s important to recognize that is an issue of human rights, even outside of the clear issue of discrimination against these groups that is involved. Consider some of the jobs of social workers. They include therapists, case workers, workers for Child Protective Services, and much more. In addition to working with people with disabilities and members of the LGBTQ+ community in general, many social workers specialize in work with children and older adults, two groups which overlap with the former. Then these vulnerable populations are unable to get the support they need in order to access the tools, programs, and resources that exist specifically to help them live life and access their basic needs, they are by extension often kept from being able to access their basic human rights.

Sign that reads "Social Workers change the world" — Source: Yahoo Images

One clear example of this is when people with disabilities require financial aid to support themselves do to an inability to be a part of the general workforce. Social workers are an important part of the process of connect the people affected by this issue with the resources and government programs they need. Without the aid of social workers, they might have significant difficulty accessing their “right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control,” as recognized in Article 25 of the United Nations’ Universal Declaration of Human Rights.

The fact that this allows social workers to discriminate certain groups in accepting clients is human rights issue in itself, as according to Article 7 of the UDHR, all are entitled to equal protection under the law and, “All are entitled to equal protection against any discrimination in violation of this Declaration and against any incitement to such discrimination.”

The Purpose of Social Work: Helping Vulnerable Populations

Another reason this change in the Texas social workers’ code of conduct is problematic is that the field of social work is inherently meant to involve professionals helping vulnerable populations (such as the LGBTQ+ community and people with disabilities). According to the National Association of Social Workers’ (NASW) Code of Ethics, “The primary mission of the social work profession is to enhance human well–being and help meet the basic human needs of all people, with particular attention to the needs and empowerment of people who are vulnerable, oppressed, and living in poverty.” A vulnerable population is a group or community “at a higher risk for poor health as a result of the barriers they experience to social, economic, political and environmental resources, as well as limitations due to illness or disability.”

Social work is also built a set of core values: service, social justice, dignity and worth of the person, importance of human relationships, integrity, competence. It is the job of a social worker to do what they can to uphold those values by helping vulnerable populations access the resources they need. Therefore, social workers’ turning away members of the LGBTQ+ community and people with disabilities, particularly vulnerable groups, goes against the social work code of ethics.

The ethical principles of social work also bar social workers from participating in acts of discrimination on the “basis of race, ethnicity, national origin, color, sex, sexual orientation, gender identity or expression, age, marital status, political belief, religion, immigration status, or mental or physical ability.”

There is a meeting set for October 27, 2020 so that the Texas Behavioral Health Executive Council can discuss the issue of discrimination as it applies to the changes that were made to the Texas social workers’ code of conduct. It is vital that we do not underestimate the significance of this situation and the serious harm that it can cause.

The Illicit Pharmaceutical Industry and its Impact on Public Health

by Sadie-Anne Jones, guest blogger

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

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

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

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

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

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

People of Color Live Disproportionately Close to Superfund Sites

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

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

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

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

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

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

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

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

Human Rights in Appalachia: Socioeconomic and health disparities in Appalachia

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

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

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

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

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

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

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

These issues are exacerbated by the fact that there is a much lower supply of health care professionals per capita, including primary care physicians, mental health providers, specialists, and dentists in Appalachia. The supply of speciality physicians is sixty-five percent lower in the central sub-region of Appalachia than the rest of the nation as a whole. Other factors negatively impact health in Appalachia, as well. Nearly twenty-five percent of adults in Appalachia are smokers, compared to just over sixteen percent of all American adults, and obesity and physical inactivity are extremely prevalent. However, it is worth noting that in some areas of public health interest, such as the occurrence of STIs/STDs and HIV, Appalachia does better than the rest of the country.   Healthcare disparities are an increasingly dramatic phenomenon. From 1989-1995, the cancer mortality rate in Appalachia was only 1% higher than the rest of the US, but by 2008-2014, it had risen to be 10% higher. In the same time frames, the infant mortality rate was 4% higher versus 16% higher, respectively. And, in 1995, the household poverty rate in Appalachia was 0.6% higher than the national average, but by 2014 was 1.6% higher. We like to think of these problems as things of the past, but the gaps are still very much relevant. Fortunately, people living in Appalachian communities are more likely to have health insurance coverage than other Americans. 8.8% of the population in Appalachia do not have health insurance versus the national average of 9.4%.

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

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

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

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

Cataclysm: COVID-19 in Brazil

As the number of novel coronavirus (COVID-19) cases continue to grow in the United States (U.S.), another epicenter has been growing in South America. As the sixth most populous country in the world, Brazil has experienced an uptick in COVID-19 cases and deaths alongside an array of national controversies that make the response efforts considerably more difficult. This blog addresses Brazil’s growing importance in the COVID-19 discussion and how it impacts human rights issues concerning indigenous peoples, environmental degradation, favela communities, and good governance.

As of late-June, more than 1.3 million Brazilians have been diagnosed with COVID-19, while over 55,000 have died from the virus. Brazil’s most populated state, São Paulo, is currently the country’s epicenter with nearly 250,000 confirmed cases of COVID-19. The northeastern state of Ceará has the country’s second-largest number of confirmed cases (100,000+), while Pará in the northwest is nearing 100,000 confirmed cases. Additionally, the iconic city of Rio de Janeiro has over 105,000 confirmed cases of COVID-19. Unfortunately, Amazonas has to the highest COVID-19 death rate of any state with 67 deaths per 100,000 cases, compared to Bahia’s 11 deaths per 100,000 cases, which highlights the disproportionate impact of COVID-19 on indigenous communities that have been systematically killed, displaced, and denied access to health care and other preventative services that could help fight the spread of the virus.

Indigenous Peoples of Brazil

As the largest Brazilian state in the Amazon region, Amazonas is known for its indigenous communities who often live in isolated villages and have poor access to health care. In the city of Manaus, which has a population of 2 million+ and is only accessible by aircraft or boat, many recent respiratory-related deaths have resulted in quick burial in mass graves, which has likely led to a severe underestimate the pandemic’s toll on the local population. In the remote community of Betania, the Tikuna tribe has five government medical workers that accommodate an approximate 4,000 inhabitants, but they are not treating the sick due to lack of protective equipment and COVID-19 testing supplies. One considerable threat are the indigenous community members who are not quarantining and are, instead, traveling in and out of town for work.

These unprecedented events compound the colonial legacy that has threatened Brazil’s indigenous peoples for centuries. Centuries ago, indigenous tribes throughout the Amazon were decimated by diseases brought by Europeans. In a way, history is repeating itself because the Brazilian government’s ineffectual response to the crisis have allowed COVID-19 to ravage the surviving indigenous communities and put them on the brink of genocide. Aside from the tribes who have contact with the modern world, the Brazilian Amazon inhabits 103 uncontacted tribes who have virtually no knowledge or resources to protect them from the threat of COVID-19. Signing this petition will help urge Brazilian officials to protect the surviving indigenous communities throughout the Amazon.

Deforestation in the Amazon

Since COVID-19 has reached these Amazonian communities, deforestation in the region has also proliferated. The Amazon is the largest rainforest in the world and is important to the global ecosystem because it absorbs approximately 5% of the world’s carbon dioxide (CO2) emissions. Thus, protecting the Amazon is pivotal for stalling the effects of climate change. However, for years, the Amazon has been ravaged to accommodate the agricultural industry as well as illegal loggers and drug traffickers. As a result, indigenous leaders fear that the COVID-19 pandemic will be used to exacerbate the destruction these industries have already caused.

During the month of April, deforestation in Brazil increased by nearly 64% which resulted in more than 150 square miles of rainforest destruction. In response, 3,000+ Brazilian soldiers were deployed to the region to prevent illegal logging and other criminal activities that contribute to deforestation. Some worry that such activity in the rainforest will lead to outsiders giving indigenous communities infectious diseases, namely COVID-19. Brazil’s Secretariat of Indigenous Health (SESAI) has made efforts to distribute N95 masks, gloves, and goggles to the region, but activists warn that the only way to protect uncontacted tribes is by keeping illegal loggers and miners out of these areas. Despite the Brazilian government establishing three military bases to prevent illegal actors from permeating the region, they are only expected to be present for 30 days. This is because Brazil’s main environmental enforcement agency, Ibama, is expected to take over these efforts but are currently understaffed and underbudgeted.

Favelas in the Age of Social Distancing

More than 11 million Brazilians live in favelas which are shantytowns outside of urban centers. Already hit hard by gun violence, unsanitary conditions, and militaristic police presence, people living in Brazil’s favelas struggle to adhere to social distancing measures. Research has found that people living favela-like conditions spend roughly 50% more time per day with others than people in less-impoverished areas. Often, favelas are composed of two or three rooms with five or six people sharing these spaces. As such, favela conditions enable the spread of COVID-19, and with precious little assistance from the government, Brazil’s most impoverished communities are left to fend for themselves.

With little government help, residents of Paraisopolis in Sao Paulo (population: 100,000) have offered a community-based solution. Due to donations and volunteer work, residents have responded to COVID-19 by organizing distribution of free meals, ambulatory services, and neighborhood watch persons. They even designated one building the quarantine house and repurposed closed schools in self-isolation centers. In Rio, members of the gang City of God drive through the local favelas, blaring a recorded message ordering people to stay home. Other gangs have become knowledgeable about COVID-19 in order to deliver essential goods to favela residents and have even gone as far to enforce social distancing measures by preventing restaurants from putting tables out. These forms of gang vigilantism in Brazil’s favelas demonstrate the lack of government support and tension with local police.

Small grave onlooking a favela. — At the bottom of this block destined to the burials of COVID-19, is the favela of the Vila Nova Cachoeirinha housing complex. Source: Léu Britto, Creative Commons.

Trump of the Tropics

These criticisms are largely attributed to the leadership of Brazilian President Jair Bolsonaro who notoriously dismissed COVID-19 as a “little flu”. Aside from personally ignoring social distancing measures, Bolsonaro has organized large rallies in an effort to confront local governors who have locked down their regions. Recently, after ignoring federal regulation that require wearing a face mask in all public places, a judge ruled that Bolsonaro (and any public official) is not exempt from this policy and should expect a 2,000-reais ($387) fine like anyone else. Bolsonaro even fired his Health Minister, Luiz Mandetta, in April after he supported social distancing measures. His successor has since promoted a reopening of the economy and unproven medical treatments for COVID-19.

Known by many as the “Trump of the Tropics,” Bolsonaro has successfully maintained a strong coalition of supporters such as the agriculture community, evangelical Christians, and the military. Unlike the U.S., Brazil is an emerging economy with a weak social safety net that makes it difficult for government officials to convince people to stay at home. Health care access and the conditions to work from home are also quite limited. Recent cell phone tracking data has revealed that 45-60% of Brazilians are not complying with social distancing measures, likely due to the fact that they have to choose between feeding their families and being exposed to the virus. As such, it is assumed Bolsonaro’s defiance of a public health approach to COVID-19 is an effort to appeal to his core supporters. Bolsonaro has also slashed regulations and enforcement of land grabbing, which exacerbates the deforestation crisis currently impacting the Amazon.

Human Rights in Brazil

As demonstrated, Brazil has an array of chronic human rights problems that have been compounded by the arrival of COVID-19. In 2016, a constitutional amendment was passed that limited public expenditures in Brazil for the next 20 years. As a result, we are now witnessing how these austerity measures have affected access to housing, food, water, and sanitation when Brazilians need it the most, particularly within the most vulnerable groups – women, children, Afro-Brazilians, indigenous peoples, rural communities, and informally-settled persons.

Much like the U.S., Brazil’s COVID-19 response has mostly been subnational social distancing measures and an emergency basic income to placate the masses. However, these efforts are clearly inadequate considering Brazil’s COVID-19 cases are surging alongside another potential Zika outbreak. As a result, Brazil has effectively become the most prominent COVID-19 case study in the Global South, a nation plagued by a deadly virus and an array of human rights issues. Human rights experts suggest fiscal stimulus and social protection packages would only be the beginning of a COVID-19 response because many of these concerns are the consequence of marketization and privatization of public goods and services. As such, the COVID-19 pandemic serves as an opportunity to reverse the market-based ideology that has failed so many countries, especially the Land of the Palms.

Please sign the petition to help urge Brazilian officials to protect the surviving indigenous communities throughout the Amazon.

Pigmented Pandemic: Racial and Ethnic Disparities in COVID-19

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

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

Vestiges: Black American Health Disparities

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

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

Segmented: Latino American Health Disparities

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

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

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

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

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

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

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

Health and Human Rights

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

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

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

COVID-19 and Healthcare

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

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

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

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

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

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

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

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

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

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

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

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.

Breathing Lessons: Disability Rights in the Wake of COVID-19

The novel coronavirus (COVID-19) has provoked an unprecedented reality for much of the global population by streamlining widespread bureaucratic frustration, health anxiety, and social distancing. Most people know that older adults and people with underlying health conditions are disproportionately affected by COVID-19, although many people fall under both these categories and identify with a disability. Also, due to the limited resources available to treat people with COVID-19, concerns have emerged about who receives what type of care. This would force health providers with the grim task of dictating whose lives are worth saving. This blog addresses concerns about rationing care amid the influx of COVID-19 patients and how this might affect the largest minority group in the United States (26%) and world (15%), people with disabilities.

Word Health Organization suggests COVID-19 is particularly threatening to people with disabilities for a list of reasons: (1) barriers to implementing proper hygienic measures, (2) difficulty in social distancing, (3) the need to touch things for physical support (e.g. assistance devices; railings), (4) barriers to accessing public health information, and (5) the potential exacerbation of existing health issues. These issues add insult to injury because, even without COVID-19, people with disabilities by-and-large receive inadequate access to health care services. This is largely due to the competitive nature of health systems which value profit maximization and, thus, disadvantage people with disabilities as consumers in the health care market.

Recently, select states and hospitals have issued guidelines for health providers that would potentially deny people with disabilities treatment for COVID-19. Two entities, Alabama Department of Public Health (ADPH) and Washington State Department of Public Health (WSDPH), have recently come under scrutiny because of their efforts to fulfill such guidelines.

ADPH’s Emergency Operations Plan suggests that ventilator support would be denied to patients with “severe of profound mental retardation”, “moderate to severe dementia”, and “severe traumatic brain injury”. This controversial protocol has recently grabbed the attention of Alabama Disability Advocacy Program and The Arc thus leading to a complaint with U.S. Department of Health and Human Services Office for Civil Rights (OCR) regarding discrimination toward people with intellectual and cognitive disabilities.

With Washington notoriously being one of the first COVID-19 hotspots, WSDPH and the University of Washington Medical Center have come under fire for their plans to develop a protocol that would allow health providers to access a patient’s age, health status, and chances of survival to determine treatment and comfort care. These efforts have been confronted by Disabilities Rights Washington with their own complaint to OCR that declares any medical plan that discriminates against people with disabilities effectively violates the their rights and is, therefore, unlawful.

OCR swiftly responded to these concerns, as well as those from Kansas and Tennessee, by stating that, even in the case of pandemics, hospitals and doctors cannot undermine the care of people with disabilities and older adults. OCR Director Roger Severino exclaimed, “We’re concerned that crisis standards of care may start relying on value judgments as to the relative worth of one human being versus another, based on the presence or absence of disability,” and “…that stereotypes about what life is like living with a disability can be improperly used to exclude people from needed care.”

Also, with New York currently having most of the U.S.’s confirmed COVID-19 cases, they may very well be the first state to face the imbalance of available ventilators and patient demand. Disability advocates have recently decried verbiage in New York’s Public Readiness and Emergency Preparedness (PREP) Act that could provide immunity from civil rights for some patients. Thus, U.S. state and federal powers are playing tug-of-war with the status of disability rights during the COVID-19 crisis.

Not Today #COVID19 Sign Resting on a Wooden Stool. — Not Today COVID-19 Sign on Wooden Stool. Source: Pexels, Creative Commons.

However, these concerns are not limited to the U.S. In the developing world, many people with disabilities are segregated from their communities in overcrowded facilities, while thousands of others are shackled and incarcerated. This weak enforcement of disability rights positions people with disabilities, in countries such as Brazil, Croatia, Ghana, India, Indonesia, and Russia, at-risk of further inhumane treatment by receiving limited or no appropriate care related to COVID-19. As a result, Human Rights Watch urges state and local authorities to return these populations to their families and demand they provide needed support and services within their communities.

Nearly every country in the world has ratified the United Nations’ Convention on Rights of Persons with Disabilities (CRPD) which aims to fulfill the human rights and fundamental freedoms of people with disabilities. More specifically, Article 25 of CRPD suggests people with disabilities have the right to non-discriminatory health care and population-based public health programs. Thus, nearly every person with a disability around the globe is associated with a governmental power that claims to be dedicated to fulfilling the promise of CRPD. However, in the wake of COVID-19, will these words be put into action?

These unprecedented events are a turning point for how we view our bodies, health, and communities. This is also an opportunity to view the world through the perspective of those in your community such as people with disabilities who represent an array of impairments, challenges, and experiences. Despite boredom and apathy being at the forefront of many people’s isolation, images of life versus death surround others, and for a good reason. In these decisive weeks, and likely months, there has never been a greater time for people in the U.S. and abroad to acknowledge that disability rights are human rights.

Healthcare Disparities for Rural Communities

Hospital closed sign directing patients to the next nearest hospital — Hospital Closed. Source: Nigel Goodman, Creative Commons

Access to healthcare is one of the biggest predictors of health. When someone has access to healthcare, they are more likely to seek treatment for and catch chronic diseases in early stages. This can greatly improve health outcomes and quality of life. However, when access to healthcare is restricted in any way, health outcomes and quality of life decrease, those who need consistent treatment may go without, and preventable deaths increase. Rural areas disproportionately face decreased access to healthcare, which greatly affects the health and productivity of these already disadvantaged areas.

Lack of Insurance

There are many barriers to healthcare that rural Americans face. First of all, there is a lack of insurance. This is mainly because insurance premiums are more expensive in rural areas than they are in urban areas. Urban areas have larger populations, which encourages more insurance companies to compete with each other, driving the costs of premiums down. Additionally, their larger population means the cost of medical expenses can be spread among more people. This also lowers premium prices. Because these two factors are not present in rural areas, they are left without affordable healthcare.

Additionally, many people in rural areas have incomes that fall in th e gap between qualifying for Medicare and being able to afford private insurance. Medicare is available to specific low-income groups. In states that haven’t expanded Medicaid, the most common income limit for Medicaid eligibility is 43 percent of the Federal Poverty Line and childless adults are excluded regardless of income. These qualifications leave over 2 million adults in the United States uninsured. Insurance is important because it can help cover costs of healthcare which can otherwise become insurmountable. Those without insurance are less likely to seek healthcare, and when they do, it is typically worse quality than those with insurance receive. Additionally, when an uninsured individual does seek healthcare, the costs are sometimes too high and turn into medical debt. Since much of the rural population is uninsured, these problems plague many of them.

Closing Hospitals and Pharmacies

Those that do have insurance still face a bigger problem: many rural areas don’t have hospitals within a twenty-minute drive. 25 percent of those living in rural areas report that they have to drive at least 30 minutes to get to the nearest hospital. In fact, almost one in four rural Americans say access to adequate healthcare is a major issue for them. Additionally, many hospitals in rural areas are shutting down, leaving communities without the healthcare they are used to. Since 2010, there have been over eighty rural hospital closures, mainly in the southeast. These hospital closings have a devastating effect on the communities they were a part of. Mortality rates for accidents, heart attacks, strokes, and anaphylactic shock risedue to longer ambulance rides. Additionally, residents may be unable to attend routine appointments because of transportation limitations; much of the rural population is elderly, which restricts their ability to drive, and public transportation is less common in rural areas than urban areas. This also means that with the onset of troubling symptoms, residents of rural areas may wait longer to see a doctor because of the inconvenience.

Many rural areas also lack pharmacies, which can hurt those who rely on prescription drugs for good health. Even the rural communities that have hospitals may lack a pharmacist, and many of the pharmacies in rural areas are in danger of closing; many have already. This is due to higher costs of medications at rural pharmacies and lack of pharmacists in rural areas. This can have a devastating effect on residents, as many go periods of time without their prescriptions—like Insulin or medication for depression— until they can get to the nearest pharmacy. Additionally, pharmacists in rural areas are helpful in educating the community on when they can use over-the-counter meds and when patients should see a doctor.

But why are hospitals and pharmacies closing? They have few patients, many uninsured, and they are greatly affected by states’ refusal to expand Medicaid. Medicaid expansion, which 14 states have not ratified, would close the gap between those that qualify for Medicaid and those that can pay for private insurance. As discussed previously, those with insurance are more likely to seek medical care, which would bring more business—and therefore, funding—to hospitals and pharmacies, making them less likely to close. Additionally, they lack the staff required to stay open. 99 percent of students in their last year of medical school report they plan to live in communities with over 10,000 residents. Without a staff, a hospital cannot stay open.

Lack of Specialists

In many rural areas, including those with hospitals, there’s a lack of specialists, like oncologists and OB/GYNs among others. Specialists typically work in large hospitals that have adequate resources, so they tend to reside in cities. This means that those with specialized needs often have to drive to the nearest city to receive care. Traveling can pose a problem to many rural Americans as many of them are older, but this also affects many younger rural inhabitants as they may not have the time off from their jobs to drive hours to receive specialized care. This leaves many without treatment that they need and worsens health outcomes. This is especially concerning considering many rural communities have higher rates of diseases than urban communities do. Specifically, “rural African Americans have higher rates of cancer morbidity and mortality than other rural residents and have higher rates of comorbid conditions” according to Robin Warshaw from the Association of American Medical Colleges. Rural African Americans also have higher rates of disease than urban African Americans. This makes the fact that specialists are not easy to access even more concerning, especially considering they are the largest rural minority. Minorities in general have less access to healthcare, and living in an area that doesn’t have easy access to healthcare in general can exacerbate this issue.

Low Health Literacy

The healthcare system is complex, which means that patients have to work to understand what care they need and when they need it. The ability to do so is called health literacy. Studies have shown that health literacy is important to health outcomes. The higher level of health literacy a person has, the more likely they are to seek out preventative care, such as screening tests and immunizations, that can catch diseases in early stages or prevent them altogether. If a patient doesn’t understand what the doctor tells them, they are less likely to be comfortable enough to seek care. Additionally, higher health literacy rates make it easier to understand how to manage existing conditions. In addition to less access to healthcare, rural Americans have lower health literacy, which compounds their health problems. However, because rural citizens are less likely to have access to health care, it is especially important for them to have high health literacy, which can be attained by using programs that work to educate patients and clinicians on the importance of patients having an active role in their healthcare.

Solutions

Rural healthcare in America is a big problem, but it can improve. In addition to the health literacy programs, there are many solutions to close the gap in healthcare between rural and urban areas. While the common medical school experience trains students for work in populated areas, a consortium of 32 medical schools has created a rural healthcare track with their medical schools. This not only puts more doctors in rural areas, but also trains them for rural areas’ specific health needs. While the program is too new to see a significant increase in rural healthcare professionals, the majority of students who have gone to residency have stayed in rural areas and are studying specialties that are in much needed in rural areas. Additionally, there are many scholarships for those planning on practicing medicine in rural areas, further encouraging medical students to practice in areas in need of doctors.