overview of economic, health, and human rights issues of racial and ethnic minorities martin donohoe

Overview of Economic, Health, and Human Rights Issues of Racial and Ethnic

Minorities

Martin Donohoe

Outline

• Exploitation

• Economics, Education, Environment, Health Care, Criminal Justice System

• International Perspective

• Solutions

Colonial Exploitation• Christopher Columbus’ log entry upon

meeting the Arawaks of the Bahamas:

“They…brought us…many…things…They willingly traded everything they owned…They do not bear arms…They would make fine servants…With fifty men we could subjugate them all and make them do whatever we want.”

Colonial Exploitation

• Sir Jeffrey Amherst (French and Indian Wars - smallpox):

–“You would do well to try to inoculate the Indians, by means of blankets, … to extirpate this execrable race”

Colonial Exploitation

• Winston Churchill (speaking in favor of RAF’s “experimental” bombing of Iraqis in 1920s, which killed 9,000 people with 97 tons of bombs):“I am strongly in favor of using poisoned gas against uncivilized tribes to spread a lively terror…against recalcitrant Arabs as an experiment”

Colonial Exploitation• Cecil Rhodes (Rhodesia, Rhodes

Scholarship, DeBeers Mining Company):

“We must find new lands from which we can easily obtain raw materials and at the same time exploit the cheap slave labour that is available from the natives of the colonies. The colonies would also provide a dumping ground for the surplus goods produced in our factories.”

Historical and Contemporary Exploitation

• Slavery

• Built U.S. infrastructure

• Apartheid

• Civil Rights Movements (U.S. and international)

• Native American and immigration policies

Exploitation leads to:

• Maldistribution of wealth and resources

• Environmental degradation

• Wars

Racial Disparities: Economic

• Median income of black U.S. families as a percent of white U.S. families:

–60% in in 1968

–62% in 2002

–62% in 2011 (69% for Hispanic families)

Racial Disparities: Economic

• Recession, housing crisis has hit black and Latino families harder than white families– Home ownerships rates: whites (73%),

Latinos (48%), African-Americans (43%)– 7.5% on Blacks live in substandard housing

(vs. 2.8 % of Whites)

• Minorities face higher levels of unemployment

Poverty and Hunger

• U.S.: 14.3% of residents and 20% of children live in poverty– Rates of poverty in Blacks and Hispanics =

almost 3X Whites

• Poverty associated with worse physical and mental health

Income Inequality• Lower life expectancy

• Higher rates of infant and child mortality

• Short height

• Poor self-reported health

• AIDS

• Depression

• Mental Illness

• Obesity

Voltaire

“The comfort of the rich rests upon an abundance of the poor”

Hudson River, 2009

Functional Apartheid

• Segregated communities

• Stress consequent to ongoing racism and poverty

• Undocumented immigrants face constant threat of deportation, disruption of family and social relationships

Functional Apartheid:Voter Restriction Measures

• Photo ID requirements

• Limits on number of polling sites and poll hours

• Elimination of Sunday voting

• Long waits

• Limits on early voting

• Gerrymandering districts

• Intimidation

Functional Apartheid:Voter Restriction Measures

• Stated aim: eliminate voter fraud– 2000-2010: 643 million ballots cast in general

elections, 441 killed by lightning, 13 credible cases of in-person voter impersonation

– Recent study of 146 million registered voters found 10 cases of voter impersonation

• Result: potential disenfranchisement of tens of millions of voters, mostly poor, elderly, and racial minorities

Undocumented Immigrants

• 25 million non-citizens in U.S.– 11-12 million undocumented

• 80% of these in labor force

– 2/3 lack insurance, source of non-emergency care (and many afraid to visit emergency rooms)

– Children particularly affected

Functional Apartheid

• Undocumented immigrants pay taxes:

– State and local income

– Property

– Excise taxes

– Employer’s share of Social Security

– Medicare

– Unemployment taxes

Functional Apartheid

• BUT, they are not eligible for many public services:– Medicaid– Supplemental Nutritional Assistance Program– Social Security– Medicare

• All immigrants heavily subsidize Medicare’s Trust Fund (reducing immigration could seriously undermine Medicare)

– Unemployment benefits– Temporary cash assistance

Educational Apartheid

• High levels of de facto school segregation by race and SES

• Gross discrepancies in per-pupil spending and teacher salaries

• Achievement and graduation gaps growing

Benefits of Education

• For every $1 spent on early childhood education, up to $17 are saved from increased school achievement, improved health, reduced crime, and reduced reliance on public assistance

• Income increases 11% for every year of education

Benefits of Education

• College graduates live 5 years longer than high school dropouts

• Eliminating educational inequities would have saved 8X as many lives as medical advances from 1996-2002

Environmental Racism

• Polluting factories/waste dumps/incinerators more common in lower SES neighborhoods

• “Cancer Belt” (Baton Rouge to New Orleans)

• Poor, African-Americans, and Hispanics more commonly exposed to lead, other toxins

Pesticides

• EPA: U.S. farm workers suffer up to 300,000 pesticide-related acute illnesses and injuries per year– 25 million cases/yr worldwide

• NAS: Pesticides in food could cause up to 1 million cancers in the current generation of Americans

• WHO: 1,000,000 people killed by pesticides over the last 6 years

Racial Disparities in Health Care Coverage

• Percent uninsured:– Hispanics = 24%– African-Americans = 16%– Asians = 15%– Whites = 10%

– Undocumented immigrants = 100% (emergency care exception)• CA Proposition 189

Racial Disparities: Health Care

• Higher maternal and infant mortality• Higher death rates for most diseases• Shorter life expectancies for African-Americans

– Not for Hispanic Americans (healthy immigrant effect and Hispanic paradox may be relevant, but largely due to decreased tobacco use)

• Fewer diagnostic tests / therapeutic procedures / pain medications

Health Disparities Among Latinos

• Higher rates of:– Overweight and obesity– Certain cancers– Stroke– Diabetes– Asthma/COPD– Chronic liver disease/cirrhosis– HIV/AIDS– Homicide

Racial Disparities in Health Care:African-Americans

• Equalizing the mortality rates of whites and African-Americans would have averted 686,202 deaths between 1991 and 2000–Whereas medical advances averted 176,633 deaths• AJPH 2004;94:2078-2081

Diseases Responsible for Illness and Death

• Deaths in 2000 attributable to:

–AMI – 193,000

–CVD – 168,000

–Lung CA – 156,000

– AJPH 2011;101:1456-1465

Social Factors Responsible for Illness and Death

• Deaths in 2000 attributable to:– Low education: 245,000– Racial segregation: 176,000– Low social support: 162,000– Individual-level poverty: 133,000– Income inequality: 119,000 (population-attributable

mortality – 5.1%)– Area-level poverty: 39,000 (population-attributable

mortality – 1.7%)– AJPH 2011;101:1456-1465

Deaths per year

• Tobacco = 400,000 (+ 50,000 ETS)• Obesity = 300,000• Alcohol = 100,000• Microbial agents = 90,000• Toxic agents = 60,000 (likely higher)• Firearms = 35,000• Sexual behaviors = 30,000• Motor vehicles = 25,000• Illicit drug use = 20,000

Exploitation: Post-WW II Human Subject Experimentation

• Tuskegee Syphilis Study

• Guatemalan Syphilis Experiment

Exploitation: Contemporary Research Imbalances

• Unethical research on special populations (cultural minorities, prisoners, developing world, etc.)

• 90% of research dollars spent on diseases affecting 10% of the world’s population

• Limited access of developing world to results due to scarcity of open-access publications

Medical Care

• 50% of global health care budget spent in the U.S.

• Per capita expenditure on health care:

–U.S. = $8,160

–Typical poor African/Asian country = $5-10

Exploitation: The Medical Brain Drain

• Five times as many migrating doctors flow from developing to developed nations than in the opposite direction

• “Inverse care law”:

–Those countries that need the most health care resources are getting the least

Racism in the Criminal Justice System

• Violent crime associated with poverty, not race• Persons of color are more likely than whites to be:

– Stopped by the police (e.g., “Driving while black”, “Stop and frisk”)

– Abused by the police– Arrested– Denied bail– Charged with a serious crime– Convicted– Receive a harsher sentence

Race and Detention Rates

• African-Americans: 1,815/100,000

– More black men behind bars than in college

– 13% of black men currently have no voting privileges

• Latino-Americans: 609/100,000

• Caucasian-Americans: 235/100,000

• Asian-Americans: 99/100,000

Outside the U.S.

• Racial and cultural inequalities

• Poverty, famine, war

• Governments/corporations promoting poverty and worsening maldistribution of wealth and resources through trade agreements, internalization of profits and externalization of costs

The Third World Debt Crisis

• Each African child inherits approximately $379 in debt at birth

• Countries spend more each year repaying debt than on education and healthcare

Consequences of Debt Repayment Agreements

• Government spending on food, fuel and farming subsidies reduced

• Social service (healthcare/education) program spending cut

• Countries strip and sell their natural resources

Foreign Aid

• In total dollars: U.S. #1

• As a % of GDP, U.S. #21

• U.S. Aid: Over 1/3 military, 1/4 economic, 1/3 for food and development

Foreign Aid

• Americans think that 24% of the federal budget goes toward foreign aid

• 0.19% of the total federal budget, vs. UN target of 0.7%

U.S. Charitable Giving

• Approximately $250 billion/year– 2.5% of income

–2.9% at height of Great Depression

U.S. International Non-Cooperation/Isolationism

• Failure to sign or approve:–Kyoto Protocol on Climate Change

–International Covenant on Economic, Social, and Cultural Rights

U.S. International Non-Cooperation/Isolationism

• Failure to sign or approve:–Convention on the Rights of the Child

–Convention on the Elimination of Discrimination Against Women

–UN Convention on the Rights of Disabled Persons

U.S. International Non-Cooperation/Isolationism

• Failure to sign or approve–UN Declaration of the Rights of Indigenous Peoples

–The Stockholm Convention on Persistent Organic Pollutants

–WHO International Code of Marketing of Breast Milk Substitutes

U.S. International Non-Cooperation/Isolationism

• Failure to follow World Court Decisions

• Failure to recognize International Criminal Court

Primo Levi

“A country is considered the more civilized the more the wisdom and efficiency of its laws hinder a weak man from becoming too weak or a powerful one too powerful.”

Solutions

• More equitable distribution of medical research funds and health care dollars

• Living wage laws– E.g., NY, LA, Chicago, and

Philadelphia

• Education reforms

Solutions

• Creation of healthier communities

• Stronger environmental and occupational and safety laws / enhanced enforcement

• Single payer health care– Canadian blacks are as healthy as Canadian

whites

Solutions

• Improve status of women / access to reproductive health care

• Increase racial and ethnic diversity of physician workforce

• Overhaul immigration policy– Pass Dream Act

• Reparations• Changes in law enforcement and sentencing

Fyodor Dostoyevsky

“A society should be judged not by how it treats its outstanding citizens but by how it treats its criminals”

Solutions

• Publicly financed campaigns and campaign finance reform

• Proportional representation

• Instant runoff voting/cumulative voting/range (rating) voting

Solutions

• Increase U.S. voter turnout– U.S. 139/172 worldwide– Wealthy vote at almost twice rate of poor– Whites > Blacks > Hispanics– Old > Young– Property owners > Renters

• Activism / Protesting / Whistleblowing• Halt disenfranchisement, overturn voter restriction

laws• Work in Groups

Günter Grass

“The first job of a citizen is to keep your mouth open.”

Anita Roddick

"If you think you are too small to have an impact, try going to bed with a mosquito in your tent"

Public Health and Social Justice Website

http://www.publichealthandsocialjustice.org

http://www.phsj.org

martindonohoe@phsj.org