COVID and Prisons

This piece was originally written in August 2020 by Jake Lindahl, 2020-21 Health Policy Ambassador

 

Schools across the country are struggling to reopen amid the COVID-19 pandemic. With small, poorly ventilated classrooms, high student/faculty ratios, and already overstretched budgets, the pressure is on localities to make these facilities safe. Many of the same problems have meanwhile been present in US prisons since the virus hit in March. “The number of US prison residents who tested positive for Covid-19 was 5.5 times higher than the general US population,” according to researchers at John Hopkins Bloomberg School of Public Health. After decades of overcrowding and underfunding, and without many advocates to pressure from the outside, US prisons are likely the worst place to be during a deadly pandemic like COVID-19.

The United States has the highest prison population in the world with 2.12 million people incarcerated. This is down from last year, mostly due to early release for immunocompromised prisoners in some states. Prisons remain overcrowded and violent with little to no resources for mental health and widespread inadequate health and dental care. With these conditions, it is clear why COVID-19 has hit prisons so hard. There is no way to social distance in a prison. Every meal is communal. Guards and staff interact with the outside world, sometimes reintroducing the virus many times over months. US prisons are a massive petri dish for COVID-19.

Conditions are especially harsh in Alabama, where the state correctional system was exposed for breaking federal law by not providing adequate healthcare back in 2014. USA Today reported on March 9, 2020 that, “chaos, confusion and corruption” plagued the prison system despite the ongoing federal investigation. The 17th Alabama prisoner died on August 11th, and six new inmates have tested positive. This puts the total cases at 296, but the Alabama DOC admitted in July that it neglected to adequately test the prison population.

Herd Immunity in Alabama

April 30, 2021 by Suzanne Judd, LHC Director

Herd immunity occurs when the level of immunity in a population is high enough to prevent the spread of an infectious disease. In other words, when the number of people who are immune to a disease reaches a certain level, the disease no longer has as many chances to spread. This is best achieved through vaccination. In the case of SARS-CoV2, most researchers still agree that at least 70% of the population needs some level of immunity to slow the spread of COVID. One researcher has even started to use “herd immunity” interchangeably with “normality”. On the other hand, several other scientist are questioning if herd immunity is even an achievable goal. Another way to think of herd immunity is to consider it to be the level of immunity others in the community around a person have that will provide a buffer to keep the virus from rapidly spreading.

Calculating Herd Immunity

Calculating the percentage that provides herd immunity is tricky and requires that researchers have first calculated R0, or the rate of the disease’s transmission in a population with no natural immunity to a particular virus. In order to calculate R0, we need data on the rate of case transmission before anyone in the population was infected or vaccinated. The estimates for R0 range from 0.8 – 10, which means herd immunity ranges from 50-90%. There are certain populations where diseases spread more rapidly, such as congregate living situations or those who spend long periods in places social settings where food is served.

[Table 1: Range of Possible Herd Immunity Levels for SARS-CoV2 Based on Observed R0]

Measuring Herd Immunity

Cases are decreasing in Alabama, which is certainly wonderful news! However, this does not mean that we have achieved herd immunity; we still need Alabamians to keep getting vaccinated. Research data suggests that the human body may not have lasting immunity from SARS-CoV2 infection. This means that some people who had immunity from a previous infection (symptomatic or asymptomatic) may not have the same level of immunity today. In order to maintain the level of immunity we currently have in Alabama – which is working to reduce the spread of SARS-CoV2 – we need to continue vaccinating about 100,000 people each week.

Estimating Current Level of Immunity in Alabama

Immunity to SARS-CoV2 could be achieved in three main ways:

  1. Immunity without infection – People have antibodies even without a positive test due to asymptomatic infection or lack of test availability early in the pandemic. These people may have had symptoms or may not have had any symptoms. We have no idea how long the immunity lasts in people who did not have symptoms. Early data suggests that immunity in this group may fade as soon as 90 days after antibodies were detected in their blood.
  2. Infection – People become sick, test positive, and then recover, having gained antibodies. This is the least desirable way to achieve immunity because some of the people who become sick will never recover. This approach leads to death, hospitalization and long term illness for some of the population.
  3. Vaccination – This is the most desirable approach. This leads to the greatest benefit in terms of keeping people from getting sick and potentially dying. The complication rate from the vaccine is not zero but it is extremely low.

[Figure 1: Model Estimating When Alabama Might Experience Herd Immunity]

Model Assumptions

  1. At least 70% of the people in the State of Alabama will receive a COVID vaccine in 2021 (number will be easier to achieve if FDA clears the vaccine for 12-15 year-olds)
  2. Vaccination is relatively similar across age, race, sex, and geographical location of residence
  3. For every 1 positive test, there are 4 individuals who were not tested but have immunity (from undiagnosed, likely asymptomatic, cases)
  4. Case rate will continue at current level
  5. Vaccine provides some level of protection against variants
  6. Immunity begins to fade after 6 months and by 12 months those with previous SARS-CoV2 infection are susceptible to reinfection
  7. 30% of those vaccinated already had some level of immunity (this is the primary reason the green curve decreases when vaccinations ramp up)

Which of these assumptions could cause the most problem if they are not met?

  1. Vaccination rate: If at least 70% of Alabamans, do not receive the vaccine, community immunity levels will decline. By November of 2021, the total level of immunity in Alabama is estimated to be very similar to where it was in November of 2020 meaning the holiday season might look similar to last year.
  2. Vaccination is similar by group: In Alabama, the group that is least likely to pursue the vaccine currently are those aged 16-30. This is also the group with risk behaviors that make them most likely to be in situations where SARS-CoV2 could rapidly spread. SARS-CoV2 does has a lower rate of mortality for young people compared with older individuals but there is now way to know if future variants will behave in the same way. Previous coronavirus pandemics (SARS and MERS) demonstrated a higher mortality rate in young people (1 in 50 aged 25-34 died). Failing to vaccinate 70% of the population could place unvaccinated groups such as children in a very dangerous place if the virus mutates and becomes more lethal.
  3. Number of people with immunity but no positive test (asymptomatic individuals): Right now the bulk of the immunity in Alabama is from people who have immunity but have not had a positive COVID test and have not received a vaccine. If there are actually fewer of those individuals in the population, we are only at about 50% of the totally population with some level of immunity which is no where near high enough to stop the spread.

Conclusions and Next Steps

Overall we are in a good place in Alabama at the moment because:

However, if we do not continue to vaccinate at least 100,000 people per week through November 2021, we could be tossed right back into an outbreak. This would force us to make hard decisions about whether or not we can remain open, allow children to go to school in person, and hold major events, which is a place no one wants to return to.

Spring 2021 Events!

Happy New Year, Blazers! The past year has been quite eventful, to say the least. Last semester, we honed in on the manifestations of racism in America, ranging from mass incarceration in Alabama to the lives of the formerly incarcerated after prison. A key takeaway from our Fall 2020 events is that our policies are informed by a long, gruesome history of white supremacy and systemic racism. Additionally, our policies are often informed by several other prejudices, such as ableism, sexism, xenophobia, classism, and the like.

This semester, we will be exploring the manifestations of another pervasive prejudice which can be summarized as queerphobia. Individuals in the LGBTQ+ community face health disparities that often result in significantly poorer health outcomes relative to their straight and/or cisgendered counterparts. This is especially the case for transgender people, who are often denied medical treatment options and violently targeted by people both within and outside the LGBTQ+ community. Further, this experience is exacerbated for transgender people of color.

In light of this, with our Spring 2021 Semester Spotlight we will explore LGBTQ+ health issues through a policy lens while exploring ways to remedy institutional homophobia/queerphobia with policy change. We’re beginning the semester on January 25th with Dr. Vin Tangpricha, who will share his experiences in working with transgender medical care and shed light on the obstacles that he and his patients have faced. On February 17th, we will then shift our focus outside of the country to explore queerness in Palestine with Dr. Sa’ed Atshan, a distinguished professor of Peace and Conflict Studies who specializes in global LGBTQ social movements. Subsequently, we will shift the focus back to UAB on March 10th to highlight some of the ongoing LGBTQ+ research that UAB faculty are engaged with. To finish the semester, Dr. Billy Caceres of Columbia University will share information from his team’s project to map LGBTQ+ policy in The United States on April 7, providing an overview on the current state of LGBTQ+ policy across the country. All of these events are virtual and are open to the public.

For more information about these events and the other events we’re planning for the spring, make sure to follow us on social media or sign up for our newsletter.  We look forward to engaging with you all this semester!

Black & Blue: What’s Causing America’s Bruise?

June 19, 2020 by Stacy Moak, UAB Professor of Social Work

 

          Discussions of police in everyday life have triggered strong reactions from citizens as long as we have had the concept of police. Arguments over whether they should wear uniforms, whether they should be paid, and whether they should carry weapons have all persisted throughout time and across multiple countries. The concept of the police in America was borrowed from the British system of having “beat cops” or officers who patrolled at the local level. In England, still today, these community officers do not carry weapons. The British police force was established in 1829 and employs the concept of police by consent, not by force. As a result, the general opinion is that arming the police sends the wrong message to citizens and creates more problems than it solves. Yet, in the US, officers cannot envision a police force that is not armed with firearms. Policing in America has evolved over time and developed into a punitive system of “enforcement” that has pushed the entire system away from community problem solvers and toward a militaristic mind set of reactions to certain situations, often without rational analysis of what is actually occurring. Thus, policing has evolved more toward fighting a war– the war on drugs, the war on poverty – in which police are the soldiers and citizens are the subjects. However, the evidence is clear that overuse of police as a form of social control has devastating consequences for the health of communities (Public Health Behind Bars, Robert Greifinger, 2007). Such over-policing leads directly and indirectly to destabilized communities and overall social injustice. Further, it creates a system in which activities of the poor and minorities are more highly policed and punished than activities of the wealthy or white majority. Communities that suffer the most from over-policing generally suffer from a host of other deprivations and become tangled in a web of instability. Once that occurs, perceptions of destabilized communities begin to shape the ways that people outside the community view persons who live in those communities. Persons from those communities are often portrayed as more violent, more aggressive, and less likely to respond to reason. These labels apply to everyone from that particular community, including children, and often follow those children as they enter school. Children from these communities are labeled trouble makers at very young ages (as young as 3 or 4) and are often pushed out of mainstream educational facilities. Because of interaction with the criminal justice systems, adults have trouble finding jobs and/or stable housing, and family dynamics are disrupted. A cycle of negative police/citizen interaction begins to occur because of overuse of punitive approaches to address social problems, and police officers are tasked with providing interventions across a wide array of social services more appropriate to social workers, school and marriage counselors, substance abuse counselors, soup kitchens and homeless shelters, and general mechanic and car maintenance.

          When police are the first responders to social problems, punishment is the response most often handed down. Punishment, enforcement, and restraint are the skills for which police receive most of their training. Examples of this problem can be noted across the life span, but are perhaps most easily demonstrated in adolescents. For example, white youth and minority youth participate in delinquency such as recreational drug use, underage drinking, skipping school, fighting, and other types of delinquency at similar rates. Self-report studies indicate that delinquency is almost universal as a part of adolescent development. However, black and brown youth are held in juvenile detention centers at 3 to 4 times the rate of their white counterparts. Their numbers continue to increase even when juvenile crime statistics drop. Part of the reason for the disproportionate numbers of youth in juvenile detention stems from the presence of police officers in schools. Because these youth are identified as more dangerous and less amenable to treatment, school-based police officers respond with punitive practices that work to remove them from school. Once removed from school, the only real intervention at the community level is the juvenile court. Most black and brown youth live in urban areas with larger public schools. More police officers are assigned to these schools; therefore, more poor children and children of color are victims of overusing police and courts for behaviors more appropriately handled by schools and parents. Overuse of punitive practices creates a school to prison pipeline that suspends and expels more minority youth from school than their white counterparts. Even when youth are “caught” for the same activity, the minority youth is more likely to be arrested, petitioned to juvenile court, and detained in a detention center which sets off an array of negative interactions and social stigma that is almost impossible to overcome. The school to prison pipeline creates generational disenfranchisement, poverty, and systematic oppression of entire communities.

rates drug use sale 1080 737 80 
 Source: The Hamilton Project

          But problems in school are not the only contributor to the overuse of police in society. Lack of adequate health care also works to ensure that poor people and people of color will go to prison instead of to mental health clinics or rehabilitation centers for substance abuse and mental health issues. Instead of having diagnoses that are recognized and treated, even at very young ages, people without adequate health insurance or preventative health care are labeled by the symptoms of their illnesses. As services shrink in the community, law enforcement is used as the social service delivery system for this group. Instead of citizens receiving counseling and accurate mental health diagnosis that could treat their health issues, they are arrested, incarcerated, and offered very few if any services. For a drug charge, a person with insurance will likely go to a rehab facility. A person without insurance will likely go to prison. Studies indicate that 20% of jail inmates and 15% of prison inmates suffer from major depression or psychosis and as many as 87% of those have comorbid substance abuse issues. Citizens without insurance in our society are more likely to have unresolved trauma, which is often exacerbated by interaction with poorly trained police officers. Those same individuals are more likely to be perceived as dangerous, more aggressive, and not amenable to treatment. As a result, they are more likely to be arrested, more likely to be detained prior to trial, and more likely to be incarcerated. When they are eventually released (95% will return to communities) they are sent back to communities with little to no continuity care plan which almost insures that they will encounter the criminal justice system again.

          So, what alternative police practices and systematic strategies could we envision that would work to dismantle this perpetual cycle of violence, trauma, and overall injustice that is levied disproportionately on poor and minority communities? First, I would propose that police agencies examine the role of police in everyday life and create policies that actually reflect those defined roles. The role of the police is “to protect and serve.” Let’s unpack that statement – to protect and serve – not to arrest, apprehend, serve as judge and juror, intimidate, harass, incarcerate, shoot, bully, or kill – protect and serve. Yet most of our emphasis in police departments across the US revolves around tactical weaponry, restraint techniques, defensive driving, and legal procedures of arrest that will lead to convictions. Perhaps refocusing training on de-escalation strategies, trauma informed care, and implicit bias could provide better understanding and more opportunities for officers to assist in resolving conflicts peacefully. Do police officers really need full armored SWAT gear? And military grade weaponry? When police posture defensively as if their role is to protect themselves against dangerous citizens (again as if they are soldiers and citizens are the subjects) the response from citizens is likely also to be defensive and reactionary. Beyond new recruits at the police academy, officers who have been on the force for long periods of time and serve as field training officers need the same training as new recruits on the above-mentioned issues. Many times, they work to undermine positive training received in police academies. If these more seasoned officers resist training, or refuse to comply with new protocols, they should be reassigned to departmental activities that do not require citizen interaction. We can no longer afford to have business as usual and rely on statements like, “that’s the way it has always been.” Agencies must be proactive in removing old ways of thinking and performing and replace them with more educated and better-informed practices that work to restore police-community relations. A merit system could be implemented that rewards positive behavior with pay incentives or merit toward promotions. Police should be treated as professionals, paid as professionals, and held accountable as professionals.

SRO
 Source: Justice Policy Institute

          Secondly, I would propose that we examine the services for which police are being used in place of other, more appropriate social service delivery specialists. For example, commissioned law enforcement officers are not the proper authority to handle adolescents in schools – especially when dollars spent to employ the police could be redirected to employ social workers and counselors to address the underlying causes of much adolescent behavior. The experiment with School Resource Officers (SROs) was intended to create trust among students and police where police would function in a counselor/educator role. However, the reality has been that schools have turned over general disciplinary actions as well as drug/alcohol enforcement provisions to SROs. They do not work as much in an education/counselor capacity as they do as the enforcer for a host of school-based rule infractions that lead to more kids being suspended, expelled, or processed in juvenile court. Instead of fostering healthy relationships with police and students, students do not trust them and try to avoid them. A better alternative seems to be to employ a school based social worker at each school instead of an SRO. One argument for SROs has been the prevalence of school shootings and the need for student safety. However, school shootings were not the original intent of SROs, and school shootings remain very rare occurrences. When these tragedies do occur, it is rarely an SRO who protects students or who intervenes during these instances, which makes school safety concerns an inadequate argument for placing police officers in schools. Their presence adds to the school to prison pipeline and works to create hostility between youth and police very early in life.  Zero tolerance policies should be replaced with restorative community policies within schools to teach negotiation strategies that students could actually use in future interactions. Dialogue about complex issues should be encouraged among students and opportunities should be seized to provide education around community health, community harm, and community restoration.  

          This conversation would not be complete without recognizing that the work of policing a community is stressful. Rarely do police officers receive adequate training for the job. Even more rarely do they receive counseling and support for their own trauma that they experience on the job. For example, one of the most stressful parts of law enforcement jobs is not the hostage negotiation that ends in a shoot-out; instead, it is responding to traffic accidents. Officers might retire from the police force without ever using their firearm, but the chances of them viewing a dead child in an overturned car after a crash are high. When officers’ trauma is not addressed, that trauma becomes the lens through which everything else is viewed. A normal response is to have a heightened sense of self-preservation – and every possible encounter with a citizen presents the possibility of a negative outcome. Some of the resources within police departments should be reinvested in the officers to provide training, support, and counseling that they need to be healthy community members both on and off the job. To complement these resources, the culture within the department must also change to promote positive mental health among officers. Currently the stigma of mental health issues as signs of weakness permeate police culture. Changing those views will take time, but the culture of health that is discussed in commu
nities must also apply to police agencies throughout the US.

85 percent

Source: University of Phoenix

Police Mental Health

          Finally, and probably the most inflammatory part of this post, we must have honest conversations about the systematic racial oppression in the US and the role that all systems of government have played in developing and keeping it in place. Minority groups are presented as more dangerous, more violent, more in need of police, and only responsive to force. Such portrayals are not accidental, but work specifically to detract from empathy that might otherwise be shown to them as fellow human beings. The scourge of racism is so deeply engrained in our justice systems in the US that even minority officers do not know how to discuss it, react to it, or work to dismantle it. The militarized hierarchy within police agencies causes a veil of silence among officers who fear reprimand if they are perceived as trouble makers, liberals, or sympathizers. Citizens have so little trust in the police, or the system of justice, that they are often victims without a voice. These are not characteristics of a free society, and they must be replaced with conversation, understanding, and a shared vision for what citizens want the police to do in their communities and how that will be accomplished. In the end, police officers are public servants, and their role is to protect and serve the community and every member of the community. For anyone who reads this and has an interest in taking a deeper dive into racism in the US, I would recommend three books to readThe Color of Law: A Forgotten History of How Our Government Segregated America by Richard Rothstein; Why are all the black kids sitting together in the cafeteria by Beverly Daniel Tatum; and So you want to talk about race by Ijeoma Oluo.

Holes in the safety net of healthcare

June 8, 2020, by Katherine Hymel Downs, RN, MPH

 

Many of us were forced to delay routine healthcare in one way or another due to COVID-19, whether a dental cleaning or counseling session. In fact, according to researchers at Harvard University, visits at ambulatory health clinics dropped by 60% by late April and were finally seeing a rebound as of mid-May. Now, we are left to investigate the continuing impact. Tangible metrics include the effects of economic loss incurred by the facilities themselves, including staffing furloughs and office closures. But how do we quantify losses in health of patients—losses from delay of care? What about those patients that now find themselves on the outskirts of our healthcare system due to unemployment and loss of benefits? For patients who rely on safety net clinics (rural health clinics, federally qualified health centers, free and charitable clinics), where can they turn when those already strained facilities are forced to close?

In early April, the Health Management Association predicted that Medicaid enrollment could increase from 71 million to the upwards of 94 million due to COVID-19 and related legislation. The process of Medicaid enrollment can be done by phone, without need of internet access. However, patients often require assistance selecting a plan accepted by their healthcare provider or gathering the necessary documentation. In the wake of social distancing measures where many public libraries and even social services buildings are closed to the public, where are people to turn? How many patients even realize they are now eligible to enroll, unless they were advised by a care coordination team at the end of a hospital stay? States are no longer held to the same timeliness standards amidst the pandemic, with limited staff and modified workflows.

Part of the Families First Coronavirus Response Act (FFCRA) did address this prediction of increased enrollment from a financial standpoint. States could benefit from a 6.2% increase in federal match rate (FMAP) (an estimated $36 billion) if they met certain criteria, including the assumption of cost for testing and treatment of the virus. But how exactly does this money reach an individual clinic that serves Medicaid patients—many of whom may not be coming in the door due to COVID-19? Clinics were forced to quickly adopt telehealth services, defined by Medicaid as including both a video and audio component for reimbursement. This presents the following barriers to patients: adequate technology, internet service, and digital literacy. Hybrid clinics that serve a variety of patients—Medicare, Medicaid and uninsured—rely on reimbursements to reserve other funding sources for uninsured patients and general overhead (payroll and benefits, PPE for staff, translation services). Now they are dependent on other relief measures such as the Paycheck Protection Program and outside grants to keep doors open and meet a growing need for care.

As a healthcare provider at a rural health clinic, I admit I do not have all the answers to policy changes. However, the following action items are worth investigating:

  • Medicaid expansion for states who have not already done so
  • Modify regulations to remove barriers from the Medicaid application process
  • Consistent and clear guidelines on reimbursement for telemedicine
  • Provision of cell phones with video technology by managed care organizations (MCOs) to ensure patients have access to telemedicine

The State of Menstruation

May 20, 2020, by Sara Harper, LHC Student Assistant

 

Humor me, if you will, and think back to the first time you learned about periods. As I was entering the dreaded “tween” years, my mother pulled me aside for yet another “big girl talk,” conversations about impending physical and social changes in my life. I didn’t learn much about my period that day. However, I did gain a sense that it was not something I should openly talk about. I learned I should hide my period because even the idea of menstruation could make others uncomfortable. Queue many years of figuring out the best way to grab a tampon or pad and get to the bathroom without suspicion…

Even as an adult, this needless taboo is still deeply ingrained in me. In honor of the upcoming Menstrual Hygiene Day, I have decided to write this blog to coax myself and readers out of our comfort zone and examine how shame, culture, and money can influence menstrual hygiene around the world.

Barriers in the US Education System

Beyond parent-child conversations, learning about menstruation can happen in biology or sex-ed courses taught in some schools. However, only 29 states in the US require sex education in public schools. Each school decides the degree to which they choose to teach sex-ed and only 13 states mandate the information to be medically accurate. Therefore, if an institution believes menstrual education is unnecessary, entire cohorts of students graduate without comprehensive knowledge on an essential part of sex education. Without proper education, some youth may only be able to refer to their peer’s anecdotes about their menstrual experiences. Others refer to the internet for answers or even struggle in silence for months before asking for help managing their menstrual hygiene.

sex ed policies legislationImage credit: University of Southern California Department of Nursing

Economic Barriers

Mandatory sex education remains a challenge to achieve in every country, but inequities in education and hygiene access can lead to higher rates of “period poverty” in some populations. Period poverty is a concept that includes lack of access to both menstrual hygiene products and educational support for those who menstruate, which can lead to social and economic consequences. Even in countries that have adequate menstrual hygiene supplies, cost can be a barrier to proper menstrual hygiene. In the US, 35 states place a tax on period products because they are not considered to be a necessary expense. Additionally, neither SNAP nor WIC cover these products, leaving some to resort to using absorbent materials like toilet paper or even clothing.

Culture of Shame

Starting the conversation about menstrual hygiene has become a public health initiative around the world, most notably in low- and middle-income countries where there is the greatest opportunity for positive growth. Researchers note a “culture of silence” in Uganda around the idea of discussing menstruation and an overall lack of support services in schools and families in Kenya. East and Southern African taboos restrict girls from touching water, cooking, attending religious ceremonies, or participating in community-wide events while they are menstruating. Some Nepali communities still practice the custom of sending girls to live alone in unheated, unprotected Chhaupadi huts, far away from the rest of society. This custom is by far the most isolated and dangerous measure I have come across while researching, sometimes even leading to the death of the menstruating woman. These taboos perpetuate a culture of shame and misinformation that negatively impact the health of those who menstruate as well as the children who rely on them. Maintaining an open and bilateral conversation about menstruation can diminish the mysticism and shame that clouds the opportunity for necessary education.

Girls ClubGirls’ club members discuss menstrual hygiene at school in Sheno, Ethiopia. Several schools in the region launched clubs like this one as a way to tackle the problem of girls dropping out because of shame and discomfort around the topic of menstruation. The goal is to replace silence and misconceptions with open discussion and information. © UNICEF/UN064418/Tadesse

Gender Achievement

Keeping girls in school is one of the most effective ways to promote positive growth within a country. Educated women have the ability to find jobs and create their own stream of income, making them less dependent on male counterparts. Women with primary education typically have fewer children and are able to increase their family’s quality of life. However, many pubescent girls in Sub-Saharan Africa find themselves missing school due to their lack of menstrual hygiene education and resources, further widening the gender achievement gap. In extreme cases, some girls will participate in transactional sex to obtain money to buy sanitary towels so that they can continue to attend school. Schools that provide adequate menstrual support are giving their students the dignity and autonomy to manage their own menstrual hygiene and avoid unnecessary absenteeism.

Positive Steps

Non-governmental organizations around the world are working to make inequities due to menstrual hygiene a thing of the past. The organization behind Menstrual Health Day (May 28) raises awareness through sale and donation of menstruation bracelets. These bracelets can be used as period trackers to help young people stay aware of where they are in their cycle in the absence of other tracking resources. Wearing the bracelet signifies that you are refusing the stigma around periods and standing in support of improving menstrual health across the globe. Grassroots groups have seen improvements just by creating girl’s clubs that provide a safe space for youth to voice their questions and concerns without fear of being shamed. Some schools have found success in simply switching girls’ uniforms to darker colors in order to prevent possible staining. Improving menstrual hygiene can help achieve up to six of the Sustainable Development Goals and increase the overall quality of life for those of us who menstruate. These successes prove that menstrual health equity is possible with the correct supportive measures in place.

bracelet alexandra klobouk facebook

Unintended Consequences: COVID-19 Policy

May 8, 2020 | Sean McMahon and Sara Harper, LHC Staff

 

The COVID-19 pandemic seems to have launched us into the great unknown. It’s hard to predict what will change in the world outside the safety of our homes. While news outlets are operating a constant stream of pandemic-related updates, there are other changes going on that don’t make as many headlines. Even in normal times, every policy change leads to unintended consequences, side-effects of the change that are not in line with the goal of the policy. Stay-home orders have certainly slowed the spread of SARS-CoV-2 (the novel coronavirus which causes COVID-19), but what else have those orders done? We’ve rounded up some of the news of the last two months that may be side-effects of staying at home.

Excess Deaths

WeeklyExcessDeaths condensedExcess death data from the CDCUsing data from previous years, the CDC uses statistical modeling to calculate “expected deaths” across the country on a weekly basis. “Excess deaths” is the difference between observed deaths and the expected number. Of course, with over 75,000 COVID-19 deaths in the United States, we would expect roughly that same number in excess deaths. However, in several cities and states the number of excess deaths is larger than their COVID-19 deaths. Death certificates are often submitted without a cause of death with the intention of later completion, so the particular causes can’t be teased out just yet. These deaths stem from a number of possible factors: people may be avoiding healthcare facilities, foregoing medical treatment; people are struggling financially, possibly unable to afford necessities; food insecurity is on the rise. We won’t know exactly what is causing the excess deaths until we have more complete data from death certificates.

 

Primary Health

On the other end of the healthcare spectrum, a survey of 2,000 primary care physicians reported that approximately 20% predict they will be forced to close within the coming weeks. Privately owned primary care clinics typically operate as small businesses, which have taken a massive blow during the COVID-19 pandemic. Patients aren’t engaging with primary care as we quarantine within our homes, and in consequence, we may see a surge in preventable illnesses in the coming months. Of course, with fewer patients, fewer primary care offices have the resources to remain open. When we emerge from this crisis some families will be left without a primary care physician. Primary care losses can impact treatment access for other deadly diseases like routinely screened cancers, as most treatment referrals come through primary care physicians. Already, lockdowns have resulted in an 86-94% drop in routine cancer screenings and a 60% decrease in chemotherapy attendance.

 

WHO Mental HealthWHO mental health materialsMental Health

“Are we required to wear masks or not? Are we still seeing 3,000+ deaths a day? All my hometown Facebook friends are posting conspiracy theories. Working from home is not as great as I thought it would be.”

Uncertainty can be hard to deal with. Things are changing so quickly that it’s difficult to keep track of what’s going on. Overall, it seems that mental health and our support systems are taking a hit around the world. Isolation can be a trigger for suicidal ideation, panic attacks, depression, and several other concerns. US alcohol sales spiked at the beginning of the crisis, and “problem drinking” is on the rise in the United Kingdom. Our support systems are also on the rocks. Drug users across Europe cannot access their opioid substitutes and other treatment services. With support groups held online with virtual platforms, participation and accountability may be lower as well. A lack of readily available support services coupled with an economic downturn has led to an increase in deaths from drugs, alcohol and suicide; or what researchers call “deaths of despair”.

 

Economics

LucysImage of Lucy’s Coffee & Tea. Image from the shop’s Facebook pageOf course, ordering businesses to close has dealt a major blow to the economy. To mitigate this, Congress passed the CARES Act in late March. This $2 trillion stimulus has proven too little, too late in some cases. As of the writing of this blog post, 33.5 million people have filed for unemployment as a result of the pandemic. Over 7 million small businesses are at risk of permanently closing their doors. Several small businesses across the country have already been forced into this. Much to our dismay, Lucy’s Coffee & Tea has shut its doors for good. While some community favorites are forced out of business, other companies find themselves in a position to turn a profit by raising prices on everyday items. Texas Attorney General Ken Paxton, along with a group of individuals in California, has filed a lawsuit against the country’s largest egg producer for price gouging in the midst of a pandemic.

 

Environment

Not every unintended consequence of stay-home orders has been detrimental. Air quality in the world’s major cities has improved since the lockdowns started. Some cities have seen particulate matter 2.5 (PM 2.5) levels decrease by 60%. This drastic change has increased breathability and visibility in normally crowded cities; quite noticeably in New Delhi. These PM 2.5 declines are beneficial to the environment and human health in general. Lower levels of air pollution also could help fight the novel coronavirus, according to a study from Harvard that found increased susceptibility to COVID-19 in those who have been chronically exposed to high levels of PM 2.5. Air quality will continue to change as countries reopen their economies, hopefully with an increased awareness of sustainability. The National Oceanic and Atmospheric Administration is set to conduct its own studies on the environmental effects of stay-home orders. Delhi ComparisonNew Delihi’s India Gate war memorial on 17 October 2019 and on 8 April 2020. Photograph: Anushree Fadnavis/Adnan Abidi/Reuters

More Speculations:

Re-opening strategies put communities of color at greater risk

Some domestic violence aid organizations are worried about a drop in reports, a sentiment echoed by the UN Secretary-General.

Some people may be grappling with a “Quarantine 15,” as physical activity decreases and calorie intake increases.

Experts predict a rise in tuberculosis cases as a result of lockdowns’ impact on treatment and mitigation efforts.

The role of private sector in public health

April 23, 2020, by Aarin Palomares, Deputy Director, Global Handwashing Partnership (FHI 360)

 

There is often a misconception that the private sector has no role in public health. However, the private sector can be a valuable partner in addressing poverty, injustice, and inequality around the world. Especially in times of crisis, companies work in tandem with governments, public authorities, and other stakeholders to address public health issues and support sustainable systems.

The novel coronavirus (COVID-19) pandemic has created a humanitarian and economic crisis and provides a call to action for stronger and more resilient public health systems. Government leadership is crucial – that we know. However, companies and civil society organizations also play a vital role in working together to respond to this immediate crisis. For two years, I have worked for a public-private partnership housed at FHI 360. Private sector engagement, especially through public-private partnerships like the Global Handwashing Partnership, can play a significant role in developing both immediate and long-term solutions.

The business case for public health

faucet soap hand washing fountain previewThere is a clear link between tackling public health issues and business motivations. Despite global progress, 5.3 million children died before the age of 5 in 2018. Diarrheal disease and pneumonia remain two of the biggest causes of child mortality, yet research suggests the simple act of handwashing can reduce mortality by up to 50%. The social issue is clear: too many children die before their fifth birthday. The business opportunity is equally clear for businesses like P&G and Unilever; both soap manufacturers are partners of the Global Handwashing Partnership.

Companies are often quite transparent about their commercial interest in tackling a social issue. The reality is that they need to be. As you can imagine, it can be difficult to portray these two objectives – saving children and increasing profits – without some resistance from those with a strong social public sector background. However, this transparency builds external credibility and the reassurance that these companies are invested in this issue beyond publicity. Because hand hygiene is inherently engrained in their business ambitions, it naturally aligns with their social goals.

 

The social case for private sector

Public-private partnerships provide an effective model for handwashing programs because they combine the health objectives of the public sector with the marketing and supply chain expertise of the private sector. While the private sector stands to gain market expansion, the public sector gains from resources of the industry. In the current context, for example, companies are leveraging their current supply chains to provide access to water, sanitation, and hygiene (WASH) through their products, laboratories, expert advisors, and key workers who are providing essential public utility services.

Moreover, through their social impact missions, companies can play a major role in developing and sharing rapid solutions with households, frontline health workers, and policy makers. Most recently, Colgate-Palmolive, Essity, P&G, and Unilever worked with public sector partners to develop communications materials in response to the growing need for WASH-specific guidance around COVID-19. This idea that a large company helping marginalized and vulnerable communities may seem foreign, but using local brands that communities know and trust can be an accepted approach to educate them about a topic like hygiene.
Girls washing hands as part of global handwashing day.

Reflections from a public health perspective

Over the past two years, I’ve grown to appreciate the value that private sector partners have to offer. Based on my experience, here are some of my thoughts on the role of the private sector in public health:

  • Broad coalitions are necessary to provide coordinated and unified programming. Coalitions that connect community networks, such as schools and community organizations, provide a mechanism to amplify messages and strategies to reach all individuals, even the most vulnerable. The Kenyan National Business Compact on Coronavirus is a good example of how these coalitions can support and amplify the work being done by the Ministries.
  • The private sector has a voice. Harnessing the power of private sector brands can achieve immediate impact. Most recently, the private sector constituency of Sanitation and Water for All called on all governments to take the lead and prioritize WASH during and beyond the COVID-19 pandemic.
  • The role of the private sector is crucial, now more than ever. To help countries solve their own development challenges, USAID developed a policy framework called the Journey to Self-Reliance. This calls for innovative financing beyond the more traditional aid mechanisms. Private sector engagement is essential to this framework.

Engaging with the private sector may be key to the innovative and sustainable solutions we often seek. Whether we like it or not, the private sector has a growing role in public health and human development, and perhaps they are doing more good than we give them credit for.

Checking the Facts (or Fiction)

April 9, 2020, by Sean McMahon, LHC Program Manager

 

We’ve all had our experiences with fake news. I mean real, legitimately fake news. The catchy headlines that beg you to click them because they’re so outrageous and you’re already biased towards believing anything so infuriating about the people who disagree with your interpretation of reality.

Wait a minute. I don’t want to get ahead of myself here. It’s hard to remain unbiased, especially when we’re surrounded by news outlets propelled by a 24-hour news cycle and the expectation of high viewership. It’s hard to remain unbiased when we typically surround ourselves with people who agree with us. It’s hard to remain unbiased when we’re human.

Maybe we shouldn’t be trying to beat fake news at its own game – inciting anger, promoting tribalism, and engaging in all sorts of fallacies. Instead of diving into some of my more recent experiences with crazy, incendiary headlines in the past few months (off-the-wall commentaries on presidential candidates, the president himself, the current pandemic, and a host of other things), let’s look into why the click-bait works so well, and how these sorts of things spread.

When I started writing this, I remembered a couple of YouTube videos that I saw a few years ago on this very topic. The first is from the channel Smarter Every Day, in which the host of the show reflects on his interview with President Obama.

The second video, “This Video Will Make You Angry,” come from CGP Grey. This video goes further in explaining the “echo-chambers” brought up in the Smarter Every Day video.

In the midst of the current crisis, it may be bad taste to liken fake news and memes to a pathogen. But then again, perhaps that is the perfect metaphor. After all, it’s called “going viral” for a reason.

While we all have the right to view the world however our beliefs and values guide us, we also have a responsibility to protect the truth. My rule of thumb: If it sounds outlandish, it probably is. Look into it before you believe it and dig deeper before you share it. Just like how you’d wash your hands before eating, and how you’d cough into your elbow instead of directly onto other people.

Census 2020: How and Why

March 26, 2020, by Ariann Nassel, LHC Director of Geospatial Data Visualization

 

census graphicThe first wave of letters containing Census forms were mailed out to approximately 140 million households two weeks ago and last week those letters were followed up with reminder letters for households that had not already responded. If you’ve been busy and haven’t gone through the pile of mail on your kitchen counter, stop everything, find the letter, and fill out the form either online (https://my2020census.gov/) or over the phone (https://2020census.gov/en/ways-to-respond/responding-by-phone.html). If neither of those options works for you, a form will be mailed to you later in the month.

I received my letter on March 12th at 5:52 pm. Including the time it took to open the letter, sit down on the sofa, and log on to the internet, I had completed it by 6pm. That’s, right it only took me 8 minutes.

But, there might be a few other things going on right now that have your attention. You might be wondering, “Why bother with the Census?”