stigma – UAB Institute for Human Rights Blog

How Stigma Hurts: The Ethnicity in ‘Marijuana’

By Eva Pechtl

In my introductory blog on ‘How Stigma Hurts,’ I reviewed the opium crisis and the stigmatization of opium smoking by Chinese immigrants. I highly recommend reading this to better understand how addiction was viewed differently depending on the communities using drugs, and usually viewed negatively if that person is already seen as an ‘other.’ While anti-opium sentiment was centrally anti-Chinese, the anti-marijuana sentiment that developed in the 1900s was also, in ways, spurred by racist notions. It may be hard to hear, but the history of drugs has cultural complexities. In this blog, I will continue exploring the history of Marijuana stigmatization and how it intertwines with ethnic bias. I will review current information on the effects of marijuana, explain the shift from referring to weed as ‘marihuana’ to ‘marijuana,’ and display how the criminalization of marijuana has had a heavy toll relevant to Mexican and Black communities in the justice system.

Marijuana and its derivatives can be smoked, used for cooking, synthesized into vapes, boiled into edibles, and used for medical purposes. An image of a man breathing smoke out of his mouth. Image Source: Yahoo Images via Flickr Aldo Tapia Text Source: Healthline

History of Marijuana Propaganda

Marijuana, or cannabis, is a type of cannabinoid drug commonly known as weed, pot, or dope. The dried flowers from the cannabis plant contain compounds or cannabinoids, which can be impairing or mind-altering. Medical marijuana is prescribed for chronic pain relief, nausea relief, managing diseases, and stimulating the appetite. Marijuana is used to manage the side effects of cancer and cancer therapies, relieving nausea and vomiting from chemotherapy and severe nerve pain. Marijuana produces a euphoric, relaxing effect and affects the brain more rapidly if smoked, and the Center for Disease Control estimates that 10% of cannabis users become addicted. However, marijuana can cause disorientation and negative effects on mental health, especially when used frequently and in high doses. Smoking, in general, increases the risk of heart attack, stroke, and vascular diseases, and marijuana smoke carries many toxins similar to tobacco smoke. Today, marijuana legality is increasingly accepted but still controversial in the US, and is currently regulated by each state separately.

Before accurate information was provided about its effects, marijuana was highly questioned and feared in the US. In 1930, the Federal Bureau of Narcotics was created to address rising problems with many drugs, but with a particular focus on Marijuana. When alcohol prohibition was repealed, people in power and policymakers found marijuana as the next appropriate target to deem as detrimental to the country, as well as the communities using it. Weed was strongly stigmatized to be associated with Mexican immigrants since it was presumed to have been brought with those fleeing from the Mexican Revolution in the early 1900s. This is despite weed being farmed in North America since the 1600s and used generously in over-the-counter medicine since the 1840s.

This is a 'warning card' to be placed in public places like trains and buses made by the Inter-state Narcotic Association, displaying severe effects of marijuana use on the US population. — This is a ‘warning card’ to be placed in public places like trains and buses made by the Inter-state Narcotic Association, displaying severe effects of marijuana use on the US population.An image of an anti-marijuana propaganda poster that circulated in the US in the 1930s. Source: Yahoo Images via Wikipedia

Mass propaganda was produced by the federal government to induce fear about weed, linking marijuana with the devil, the degradation of women, and insanity. A notable example of this is the film Reefer Madness, an exploitation film showing high school students becoming addicted to marijuana and then committing various crimes such as manslaughter and attempted rape. The film misrepresents the realistic effects as the teens experience hallucinations, more relevantly representing the desire to demonize and, in that way, oppress drug users. When high, the teenagers in the film descend into unpredictable and insane behavior, perpetuating the notion that those who use marijuana, and interchangeably certain communities, were violent and criminal threats to the US.

From ‘Marihuana’ to ‘Marijuana’

The ‘Mexican Hypothesis’ of drug prohibition demonstrates how the extreme prejudice already well-developed against Mexicans was then attached to their drug of choice. In Mexico, in the 1900s, the common notion of marijuana users was dangerous and unpredictable behavior concentrated among prisoners or soldiers. However, a sort of “Mexican marihuana folklore” was instilled in Americans, and this racist sentiment only grew when immigrants’ effects on the economy made them more threatening. In the context of unemployment increasing public fear of immigrants, many acknowledge that the fear of marijuana was tied to intentional racist undertones, specifically associating Mexican communities with violence and crime. The change in spelling from marihuana to marijuana in legislation, plus references to Mexican ‘locoweed’ or ‘crazy weed’ from Spanish to English, reflects the deliberately xenophobic choice to associate the drug with Mexican immigrants and, frankly, any Mexican communities. Referring to weed or hemp as a foreign, unrecognizable word caused actual confusion, and some Americans did not realize the “new Mexican drug” was the same plant that had already been farmed and used in the US for many years.

Harry Anslinger was a leader in the Bureau of Narcotics and, unfortunately, a notable proponent of repressive anti-drug measures. Some sources reflect that before Anslinger took office, he expressed that claims of marijuana inciting violence or insanity were absurd. His immediate change in opinion when he began his leadership seems to reflect a political power’s interest in finding something and someone to strictly prohibit rather than using his own opinion to advance regulation purposes. Anslinger used his position to defund, discredit, and prevent the publication of research that contradicted his reasoning for marijuana penalties, claiming the drug was something to fear to an extreme. This is an early example of actions by the government raising assumptions that the drug wars weren’t really meant to increase public safety. Anslinger expressed throughout his campaign that marijuana users were infectious and even that they caused white women to be sexually promiscuous with men of color. Overall, Anslinger and related anti-drug propaganda associated drugs with people of color and induced panic and fear about both.

Marijuana was seen by jazz musicians as a way to stimulate creativity, and this is reflected negatively in this image. An image of an advertisement associating marihuana with Black swing musicians and denoting it as dangerous. Source: Yahoo Images via the Strategic Business Institute

From another perspective, marijuana was specially connected to jazz music and the Harlem Renaissance, a creative movement in Black culture in the 1920s. This period embraced the reconceptualization of Black identity apart from the negative stereotypes that had impacted their relationship to their heritage and communities. Harry Anslinger also publicly complained about Black people, claiming the music of the cultural revolution was satanic and that “jazz and swing results from marijuana use.”

Understanding Criminalization

In 1937, the Marijuana Tax Act criminalized and regulated marijuana use, including an expensive stamp requirement, which made legal compliance nearly impossible for people living in poverty. Income inequality disproportionately affected communities of color due to the racial wealth gap, which was about 10 to 1 for White to Black in 1920, with Latinos unrecognized. No longer being able to afford this drug led to the emergence of illegal markets among communities of color. In the meantime, wealthier White communities could still purchase and use marijuana without violating the law. One’s race and class contribute to their risk of criminalization, and the overrepresentation of certain groups easily invites stigmatization. White communities were not subject to the bias or policy that racial and ethnic minorities faced, and still, in this century, people of color are overrepresented in marijuana arrests. Institutional factors like financial means, neighborhood of residence, and unconscious bias in policing practices are said to contribute to continued discrimination.

The paper shows four of twelve youth arrested for gang-related criminal activity amonst the outrage of the Zoot Suit Riots. An image of a newspaper article labeling four Mexican men as ‘pachucos,’ signifying them as delinquent or involved in gang membership. Racial outrage against those wearing ‘Zoot Suits’ popular among minority communities, culminated in the ‘Zoot Suit Riots.’ This was a week of racially oriented beatings framed in the newspapers as a vigilante response to crime waves by immigrants, and police mainly arrested Latinos who fought back from the unwarranted beatings. Image Source: Local Wiki Text Source: History.com

The government continued to strengthen cannabis regulation, with the Boggs Act in 1951 establishing 2-5 year minimum sentences for first-time drug offenses. This essentially treated weed as harshly as heroin, and representatives clarified that repressive legislation on marijuana belonged in the Narcotics Control Act of 1956, later classified as a Schedule 1 dangerous drug by the Controlled Substances Act in 1971. Prejudice against Mexican immigrants played a fundamental role in federal prohibition, as some employers and stakeholders feared Mexican people as a source of crime and drugs. Legal scholars Bonnie and Whitebread acknowledge past federal law, noting that as immigrants supposedly introduced marijuana smoking to the US, anti-marijuana statutes followed in the states along with Mexican migration patterns. Around the 1960s, marijuana became popular among the middle class and mostly white college students, a movement that I will explore in my coming blog about the counterculture movement and Peyote in Indigenous culture. Similarly to that topic, existing punishments for marijuana appeared inappropriate once people of different classes and communities advocated for its free use. What is highlighted in Isaac Campos’ reassessment of prohibition is how extremely stigmatized a drug was that was so historically used and relatively mild in effects. Discrimination was even clearer cut in news sources, with claims that Mexican peddlers would distribute marijuana samples to children and the idea that marijuana was a direct product of unrestricted immigration.

So far, in the ‘How Stigma Hurts’ series, exploring bias in responses to early drug crises has revealed similarities across the criminalization of Chinese people and opium smoking and the scare about Mexican and Black people over marijuana. Especially strong was the idea that immigrants and these drugs would harm the purity of white women. Since bias was so ingrained in society, it was simple for people to follow along with repressive legislation because it made sense to them to criminalize these minorities. Importantly, government responses to these issues demonstrate the dangerous effects of a lack of knowledge, especially the tendency to falsely attribute national issues to international people. In times when information about novel drugs was scarce, the same drugs were viewed and criminalized differently because of the groups using them.

How Stigma Hurts Series: Opium and Chinese Repression

By Eva Pechtl

Samuel Walker proposes that America has two crime problems, one affecting most white, middle-class Americans and another affecting mostly people of color in poverty. Racial bias has been expressed in drug policy for centuries and has not ceased to marginalize certain racial and ethnic minorities. Chinese immigrants have been historically discriminated against in the United States and have not ceased to face racism in everyday life, especially after being associated with the COVID-19 pandemic. Bias has not only affected drug policy over time, but drug policy has reiterated this bias.

Stigma refers to a negative attitude toward a particular group of people, which is usually unfair and leads to discrimination. Stigma can be both explicitly expressed, like thinking people with mental health conditions are dangerous, and subtly embedded in societal norms, like repeatedly showing people of certain groups in the media in negative situations. Labeling someone in a positive or negative way is an easy solution to avoid the toll of understanding the challenges they are experiencing. Stigma is hugely based on social identity and perception of other groups, in that negatively stigmatizing other groups can be a way to justify inequalities in one’s own privilege compared to others.

Understanding stigma toward other social identities is especially important in the context of historical and present drug policy. In this series of blogs, I will explore some important historical examples of how stigma against minority groups has been embedded in American drug sentiment. Throughout this series, I will review the opium trade and Chinese repression, the criminalization of marijuana and Mexican immigrants, the unequal playing field of the hippie counterculture movement and the Indigenous Peyote movement, and the controversy over racial disparities in crack and cocaine sentencing. I hope to offer new perspectives on how targeting and incarcerating drug users has resulted in challenges specifically for minority groups, and how stigma hurts in the criminal justice system.

Outlining the Opium Wars in China

An early point to recognize in the development of drug prohibition was the Opium Wars in China and their effects on the criminalization of Chinese immigrants, especially in the US. This example importantly impacted policies on opiates, the term for the chemicals found naturally and refined into heroin, morphine, and codeine. These variations are derived and created from opium, a depressant drug from the sap of the opium poppy plant. Opioids can refer to both naturally derived opium and its variations synthetically made in the laboratory, like oxycodone and hydrocodone (partly synthetic) or tramadol and fentanyl (fully synthetic). As a medication, opium is meant to be used for pain control, but smoking opium causes euphoric effects almost immediately since the chemicals are instantly absorbed through the lungs and to the brain. The coming of opium smoking to the US created very toxic discrimination by those in privilege against Chinese immigrants, leading to blatant policies against Chinese people in poverty, even when the opium frenzy that followed was far from their goal.

The cultivation of opium increased substantially after the Opium Wars strongly shifted China's economy. — An image of a woman and two children picking the opium poppy fields grown in Old China around 1900. Source: Yahoo Images via Flickr. The cultivation of opium increased substantially after the Opium Wars strongly shifted China’s economy.

In the 1700s, opium poppy fields in India were conquered by the British Empire and smuggled into China for profit. Even though China banned the opium trade in 1729, the illegal sale of the drug by outside nations caused an addiction epidemic and devastating economic consequences. In the Opium Wars, the Qing Dynasty attempted to fight against opium importation, but the British consistently gained more power over trafficking and forced China to make the opium trade legal by 1860. China had imported tea through the East India Company to Britain for many years, but it no longer appealed to Britain’s trade options, and this was detrimental to trade. As Britain ran out of silver to maintain the tea trade, the East India Company found that opium could be sourced in bulk from China, which led to a growing and promising market. The East India Company did not initially create the demand for opium but found a way to maximize the economic disruption and addiction in China for the benefit of trade.

Opium was then trafficked increasingly and was effectively destructive to the Chinese. For example, for the British to get their fix of caffeine, the Chinese got their fix of opium. The drug was sold and medicalized to merchants around the world, notably America, which played a significant role in finding new sources of supply from China and expanding the opium market until 1840. In Chinese culture, smoking opium was initially a ritual luxury that was used to display privilege, but as it became more accessible, the government was less concerned with controlling its pharmacological effects and more with controlling the social deviance associated with it. The Opium Wars ended in an unequal trading arrangement in Europe’s favor, continuing importation and causing the market to become socially segmented. Depending on their wealth, people bought different varieties of opium. However, addiction did not discriminate by wealth.

Judging Drugs by Culture

When many Chinese immigrants came to the US in the mid-1800s, primarily to escape the social and economic devastation brought upon them by the Opium Wars, they were an easy scapegoat for US politicians to blame for the internationally emerging opium crisis. Opium smoking, as well as poverty, was popular among them, so many started businesses of their own, including Opium Dens. These were hidden places to smoke without social consequences, popular in San Francisco, and were typically run by Chinese immigrants, though people of all backgrounds could be found there. These dens were compared to sin and hell, which only increased the already pervasive anti-Chinese sentiment. There was popularity in claims that vulnerable white women who entered the dens were manipulated and their honor surrendered by Chinese men. Males made up 95% of Chinese immigrants in the late 19th century, working for the few available jobs amid the great depression, leading to strong discriminatory sentiment among Americans affected by unemployment, such as referring to cheap laborers as ‘opium fiends.’

An image of two men inside an opium den run by Chinese immigrants in San Francisco in 1898. Source: Yahoo Images via Flickr. Opium users sit and lay relaxing on the floor of a small and organized Opium Den, wearing traditional Chinese clothing and smoking the drug through a pipe next to a tray of materials.

A drawing of an opium den with several Chinese men appearing delirious and their surroundings unclean. Opium Dens were commonly perceived as disgusting places when many were well-kept and included people of different backgrounds. Source: Yahoo Images via Uncyclopedia. Several Chinese immigrants sit beside each other inside a dark and smoky Opium Den, some of them passed out or laid back.

Chinese people were at first welcomed by some Americans as “the most industrious, quiet, patient people among us,” by a California newspaper in 1852. Still, tensions rose at the same time that immigrants started impacting opium use and the workforce. Policies on opium reflect xenophobia and racism, perpetuating fear of the ‘yellow peril,’ a racist color metaphor in American campaigns disguised as ‘anti-drug.’ To further conceptualize racism in politics during this time, the California Supreme Court case People v. Hall in 1854 categorized several racial and ethnic minorities as lacking the progress or development to testify against White people. Even if states did not blatantly pass these laws, Chinese people would be dismissed as liars before even speaking for themselves. This pervasiveness made it impossible for Chinese immigrants to seek justice against the severe discrimination and bias of the drug wars or practically any repressive measures they were subjected to. With the completion of the railroad in 1869, thousands of Chinese people were out of work, denied access to jobs, and targeted as competition as soon as they began to succeed.

With the quote "the Chinese must go," an American figure with long legs labeled 'the Missouri Steam Washer' chases away a Chinese man representing the competition of immigrant businesses. The fleeing man clutches a stool and a container of opium. — An image of a political cartoon describing the exclusion of Chinese immigrants, pushing them away from San Francisco back to China. A Chinese man flees from the American market competition while clutching a stepping stool and a container of opium. Source: Yahoo Images via History1700s. With the quote “the Chinese must go,” an American figure with long legs labeled ‘the Missouri Steam Washer’ chases away a Chinese man representing the competition of immigrant businesses. The fleeing man clutches a stool and a container of opium.

By the 1870s, it became apparent that many individuals, including white people, were picking up on opiate addiction. Opium use had increased alarmingly by the 1880s across the American medical field as well, and this led to criticism of Chinese immigrants by people who saw their fellow Americans as plagued by a disgusting habit. When more others were associated with Chinese people in this way, the criminalization of Chinese people represented a shift in focus toward protecting the perceived integrity of white people. For example, the San Francisco Opium Den Ordinance in 1875 made it illegal to maintain or visit places where opium was smoked, so many Chinese people and their neighborhoods were criminalized. Essentially, the US passed the Chinese Exclusion Act in 1882, which was the first major federal legislation to explicitly restrict immigration for a specific nationality. This meant pushing Chinese people away from the US even when they were producing the backbone of American railroad labor and only making up 0.002% of the population at that time.

A group of US Marshals stand close by a pile of opium and smoking materials to be burned on a busy Chinatown street while hundreds of people surround and watch. — An image of US Marshals burning opium and opium pipes resulting from an Opium Den raid in the middle of a crowded Chinatown street. Source: Yahoo Images via FoundSF. A group of US Marshals stands close by a pile of opium and smoking materials to be burned on a busy Chinatown street while hundreds of people surround and watch.

Parallels of Criminalization and Overprescription

The Smoking Opium Exclusion Act in 1909 continued to ban the possession, use, and importation of opium for smoking, being the first federal law to ban the non-medical use of a substance. Even though opioids were rampantly prescribed and available in America by this time, the criminalization only applied to smoking opium, primarily done by Chinese immigrants in Chinatowns. Contrary to assumptions, it is not illegal drug cartels but pharmaceutical companies that fueled the opioid epidemic. For example, many Union soldiers in the Civil War returned home addicted to opium pills or needing treatment only possible by hypodermic syringes, which had become widely overused by both doctors and addicts due to their powerful relieving abilities. Male doctors prescribed morphine for women’s menstrual cramps, and it was even infused into syrup to soothe teething babies who became addicted. This was known as the ‘Poor Child’s Nurse,’ since the drug often led to infant death by starvation when sold as a medicine to calm hungry babies. In a broad sense, depending on or relating to one’s racial or ethnic community, opioids were regulated differently.

When narcotic sales were banned in 1923, this forced many addicts subjected to this overprescription to buy illegally from the thriving black markets, especially in Chinatowns, again criminalizing Chinese people. Countless doctors warned and panicked over the rising commonality of addictiveness in opiates as early as 1833, and opium was rapidly synthesized by scientists all over the world into more dangerous variations. When problems with addiction to medicalized opioid variations spun out of control, the US blamed Chinese immigrants rather than consulting with the professional field to avoid harm in the irresponsible dispersion of highly addictive drugs. Instead of dispersing research on the new and dangerous variations, opium smoking was specifically centralized, with opium being generalized into street names like ‘Chinese molasses’ or ‘Chinese tobacco.’

The narrative of opioid addicts was changed when opioid abuse rose among white people, and by this, I mean both the attitudes toward addiction and the actions taken to solve it. Framing addiction as a disease rather than a disgusting crime came when it was no longer just people of color getting in trouble. The idea of pharmaceutical treatments for drug abuse came when it was white people suffering and dying from the opioid epidemic. Meanwhile, opium ordinances had a heavy burden on the incarceration and continued detainment and deportation of Chinese people in the United States especially before accurate research was done. Repression was tied to opium but also purposely deprived Chinese immigrants of opportunities to succeed and created criminalized reputations among their communities. Despite its age, the history of the Opium Wars and its impact on societal discrimination in America is not a point to be missed when considering drug stigmatization.

The Increase of Hate Crimes in the United States

It is undeniable that hate crimes directed towards Asian Americans have been increasing throughout the COVID-19 pandemic. An organization created to respond to racism against Asians, Stop Asian American Pacific Islander Hate, has received thousands of reports of hate crimes across the United States just throughout the duration of the pandemic in 2020. This is a very large increase from previous years. Racist rhetoric surrounding the pandemic including terms like “China virus” and “kung flu” is a significant reason why these forms of hate crimes are increasing at such a rate in the United States. Many of the attacks are targeting elderly Asian Americans. In San Francisco, an elderly Thai man was attacked and later died from the injuries he sustained. In New York, one man had his faced slashed with a box cutter, a woman was assaulted in the subway, and another woman also experienced assault on the subway. Hate crimes towards many groups have been increasing in the United States for the past few years, with COVID-19 and the Trump administration providing a lenient space for hate crimes and speech.

new york — New York during COVID-19. Source: Metropolitan Transportation Authority of New York. Creative Commons.

In 2020, the FBI released their annual hate crimes report for the previous year, 2019. This report showed that hate crimes rose by 3%, a number that may not seem that significant at first glance but breaks a record with the highest number of hate crimes in a year. Of the more than 7000 hate crimes reported, 51 were fatal, another record breaking number. 22 of the 51 killings motivated by hate towards another group came from a domestic terrorist attack in El Paso, Texas, a mass shooting in a local Walmart targeting shoppers of Mexican descent.

The FBI defines hate crimes as “motivated in whole or in part by an offender’s bias against a race, religion, disability, sexual orientation, ethnicity, gender, or gender identity.” It is important to realize that while the FBI’s report is key for understanding the hate dynamics in our country, it is ultimately an undercount. Many hate crimes go undocumented and even more are not categorized as hate crimes. Over 15,000 law enforcement agencies participate in reporting hate crimes. In 2019, over 86% of these agencies did not report any hate crime. The FBI report clearly shows that deadly hate crimes are increasing, however less and less agencies are reporting their data.

The categorization of hate crimes is also a major issue. For example, for the 2019 report the FBI recorded only one attack against those of Hispanic origin despite the El Paso, Texas shooting being largely recognized as an extremely deadly attack against El Paso’s Hispanic population. The deaths that resulted from the shooting were listed as “anti-other race/ethnicity/ancestry.”

El Paso Texas post card — Greetings from El Paso, Texas. Source: Boston Public Library. Creative Commons.

The breakdown for hate crimes in 2018 is as follows:

Anti-Black: 2,426
Sexual orientation or gender identity: 1,445
Anti-white: 1,038
Anti-Jewish: 920
Anti-Hispanic: 671
Anti-Muslim: 236
Anti-Indigenous Peoples: 209

According to the National Institute of Justice, 60% of most hate crimes are motivated by racial bias. Hate speech is protected by the First Amendment, freedom of speech. Therefore, speech intended to hurt, degrade, disrespect, and discriminate against a group of people can not be punished by law. However, the language used can be used in court as evidence of a hate crime.

The Department of Homeland Security revealed in their Homeland Threat Assessment that the growing upward trend of hate crimes represent a larger threat from extremist right wing groups. The DHS report also acknowledged that the largest domestic terror threat in the United States is the threat posed by white supremacist groups. The record-breaking white supremacist attacks in 2019 created the most deadly year of domestic terrorism since 1995. In 1995 Timothy McVeigh committed a bombing in Oklahoma City, a person and act that many white supremacist leaders look up to. Violent attacks like the one in Oklahoma City and the more recent one in El Paso work to encourage more violence, causing harm to specific groups and bringing more white attention to the cause.

Conspiracy theories are a large part of white supremacy. One conspiracy theory, “The Great Replacement” claims that white people are being replaced and erased from Western countries in a plot created by Jews. This conspiracy theory was alluded to by the El Paso shooter who described a “Hispanic invasion of Texas” and by the person who attacked a synagogue in California in 2019, leaving one person dead and three others injured. The rise in hate crimes coupled with the growing presence of hate groups is not a coincidence. Between 2017 and 2019 white supremacist groups grew in numbers by 55%.

white supremacy flag — White supremacy. Source: Robert Thivierge. Creative Commons.

The recent increase in hate crimes also coincides with rhetoric perpetuated by former President Trump and his supporters. The words, opinions, and discriminatory speech used by the former president has been clearly identified as motivating many hate oriented attacks. An analysis of the FBI report shows that loaded remarks made by Trump are followed by increases in hate crimes and increases in hate speech on online platforms, especially directed towards Hispanic and Jewish peoples. The rhetoric used by former President Trump regarding groups of people and the COVID-19 pandemic has created a lenient space that does not punish hate speech or hate crimes. Hate crimes have been increasing, showing how harmful stereotypes and racism can truly be. It is important to recognize how and why hate crimes have been increasing in order to better address them and keep communities safe.

Let’s #BreakTheChains

“I used to be chained around the waist and one ankle. My waist used to hurt because the chain was so heavy. My leg used to hurt, I would scratch it and cry. I felt relieved when the chain was removed.”

–Rose, Kenya

An estimated 792 million people globally – that is 1 in 10 people, including 1 in 5 children – have a mental health condition. Despite this irrefutable fact, governments spend less than two percent of their health budgets on mental health. The absence of proper mental health support and knowledge of how to cope with a mental health condition has lead to thousands of people being shackled in inhumane conditions.

“People in the neighborhood say that I’m mad [maluca or n’lhanyi]. I was taken to a traditional healing center where they cut my wrists to introduce medicine and another one where a witch doctor made me take baths with chicken blood.”
—Fiera, 42, woman with a psychosocial disability, Maputo, Mozambique, November 2019

This brutal practice is an open secret in many communities, according to Kriti Sharma, the senior disability rights researcher at the Human Rights Watch. Sharma and her team compiled a 56-page report titled “Living in Chains: Shackling People with Psychological Disabilities Worldwide,” shedding light on the conditions in which people with mental disabilities are bound by families in their own homes or in overcrowded and unsanitary institutions against their will. This is due to the widespread stigma and taboo of mental health issues within governments and health institutions in several countries. In state-run, private, traditional, and religious institutional “healing centers,” people with mental health conditions are often forced to fast, take medications or herbal concoctions, and face physical and sexual violence.

“A mentally ill patient is chained in a cell at Mia Ali Saeb Shrine in Samar Khel, Afghanistan on Nov 12, 2008. Patients, usually brought here by family members, are only given daily rations of bread, black pepper and water, and are kept in their cells for 40 days. With mental illness widely misunderstood, many Afghans believe God will cure the patients with such treatment.” Source: Yahoo Images.

The Human Rights Watch’s study of 110 countries unveiled evidence of shackling people with mental health conditions across age groups, ethnicities, religions, socioeconomic levels, and urban and rural areas in about 60 countries. Countries that indulge in these types of practices include Afghanistan, Burkina Faso, Cambodia, China, Ghana, Indonesia, Kenya, Liberia, Mexico, Mozambique, Nigeria, Palestine, Yemen, and several more.

Though a number of countries have started to acknowledge mental health as a real problem, the inhumane act of shackling remains largely out of sight. There is no data or coordinated effort at either international or regional level to eradicate the binding of people who are mentally ill. The act of shackling impacts both the mental and physical health of someone who is already ill. Some effects include post-traumatic stress, malnutrition, infections, nerve damage, and cardiovascular problems, not to mention the loss of dignity. The #BreakTheChains Movement is an organization devoted to bringing awareness of shackling to nations and increasing access and awareness of mental health services in countries where shackling is a common problem. The movement has been successful in Indonesia where its country-wide interviews and advocacy led the government of Indonesia to deepen its commitment to #BreakTheChains. Over 48 million households in Indonesia now have access to community-based mental health services.

Laymen can also assist the movement by following two easy steps: sign the pledge, and share the movement on social media to promote awareness. It is time to acknowledge that mental health is a real issue that affects millions of people, and shackling and ignoring the issue will not resolve any issues, nor will it reduce the stigma associated with mental health. If we, as global citizens, have learned anything from this pandemic, it is how deathly and dangerous the invisibility of a disease is. Mental health is invisible like COVID-19, but there are always symptoms. Make an effort to educate yourself, and take the opportunity to check in on people by simply asking how someone has been. It really is that simple.

Brief Video about the Chained

World Diabetes Day

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

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

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

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

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

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

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

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

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

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

STD Rates Among the Poor and Homeless in Alabama

by Kelsey Johnson (guest blogger)

As of 2018, approximately 38.1 million people in the U.S. live below the poverty line. Furthermore, on a given night, over 550,000 people experienced homelessness.

Of those numbers, more than 800,000 Alabama residents live in poverty, making it the sixth poorest state in the U.S. Approximately 3,434 people experience homelessness in Alabama on a given night.

Poverty and a lack of adequate housing are considered human rights violations, as they interfere significantly with an individual’s ability to live safely and with dignity. For people experiencing poverty and/or homelessness, these situations impact all aspects of their lives, especially their physical health.

One way that these health issues manifest is in the prevalence of sexually transmitted diseases (STDs) and HIV/AIDS among these populations. Overall, rates of STDs, particularly chlamydia, gonorrhea, and syphilis, are at an all-time high in the U.S., according to a 2019 report from the Center for Disease Control and Prevention (CDC). In 2017-18, there were nearly 2.5 million total reported cases of the three STDs, including over 1.7 million cases of chlamydia, 583,405 cases of gonorrhea, and 115,045 cases of syphilis.

Two urban areas in Alabama, Montgomery and Birmingham, are among the top 20 U.S. cities reporting the highest rates of STDs, including HIV, syphilis, gonorrhea, and chlamydia. Mobile and Huntsville also ranked in the top 100. Alabama has the fourth highest rate of gonorrhea infections in the country. Additionally, as of 2016, there were 12,643 people in Alabama living with HIV.

While the CDC report examined STD prevalence among various demographics, it did not focus on STD rates among low-income or homeless populations. However, a literature review published in 2018 in the journal Sexually Transmitted Diseases found that STD prevalence ranged from 2.1% to 52.5% among the homeless adult population.

This study also identified many of the factors that increase the risks of contracting an STD among homeless individuals. A number of these risk factors also apply to individuals living in poverty, even if they have stable housing. Additional studies offer more insight into the recent rise in STD cases, as well as recommendations for how to decrease their spread among all populations.

Factors contributing to STD prevalence among low-income and homeless populations

There are several factors that contribute to the prevalence of STDs in low-incomes and homeless communities, including lack of access to affordable prevention and treatment options; lack of comprehensive sex education; the comorbidity of issues like mental illness or substance abuse, and the stigma surrounding STDs.

According to a 2019 report by the National Coalition of STD Directors, “…poverty is both a cause of infection, and a barrier to the ability to seek care. Poorer populations are less likely to receive appropriate sexual health education, suffer higher rates of substance abuse, and may have more trouble accessing sexual health services.”

Poor or homeless individuals are less likely to have health insurance, or resources to pay for out-of-pocket healthcare costs. Many individuals living in southern states, including Alabama, fall into what is known as the coverage gap, meaning they make too much money to qualify for Medicaid, but not enough to pay for health insurance.

Even if individuals have health insurance, their coverage may be limited to certain providers or services, and may exclude STD testing or treatment. The time and money it takes to travel to healthcare facilities, especially in predominantly rural states like Alabama, also present a barrier to care, even for insured individuals.

Additionally, budget cuts have forced many STD clinics to close or reduce their services. The loss of these clinics is harmful because not only do they often provide STD testing and treatment on a sliding fee scale, they are staffed by individuals with specialized knowledge in diagnosing and treating STDs.

The other primary factor in higher STD rates is a lack of comprehensive sex education. As the NCSD report states, “States typically define the broad parameters of sexual health education in public schools. Not surprisingly, these parameters vary widely among states.” Studies show a correalation between insufficient sex education and higher STD rates. Kathie Hiers, the CEO of AIDS Alabama, says the state represents a “perfect storm” for the spread of AIDS and other STDs, in part because of its “poor educational systems that often ignore sexual health.”

This lack of education about STDs also perpetuates the stigma surrounding them, which prevents people from seeking treatment, according to Hiers. Other conditions that are prevalent among poor and homeless populations, including mental illness, incarceration history, and intravenous drug use, also make individuals more susceptible to STDs, and present barriers to seeking treatment.

How to prevent the spread of STDs among low-income and homeless populations

The studies and experts cited in this post offer several recommendations for steps that can be taken, nationwide and in individual states, to decrease the spread of STDs among low-income and homeless populations, including:

Removing financial barriers to healthcare, including adopting Medicaid expansion. The Alabama Hospital Association estimates that by adopting Medicaid expansion, an additional 300,000 residents would be eligible for health insurance.
Increasing or restoring funding to public health agencies and STD clinics that provide free or low-cost testing and treatment.
Improving access to healthcare facilities through transportation and operating on evenings and weekends.
Providing comprehensive sex education in schools. In 2019, the Alabama House of Representatives failed to address a bill that would have made the state’s sex education curriculum more scientifically and medically accurate. The bill would have updated the curriculum’s language to address “sexually transmitted diseases” as “sexually transmitted infections,” which is considered less stigmatizing.
Expanding resources to support homeless individuals, and increasing their access to stable housing. A 2016 report by the Homelessness in Alabama Project offered several specific recommendations for addressing homelessness in Alabama.

Additional Resources