Child Welfare: A State of Injury

Without the guidance of consistent adult role models, teenagers in the foster care system sometimes feel as though they lack opportunities to form their own positive identities. “You don’t really have an identity in foster care because you move around so much. And if you’re not sure of who you are, you don’t make good decisions,” former foster youth and teen mother Miranda Sheffield told TIME.  Defined by their interactions with the child welfare system, the teenagers in foster care are often reduced to numbers and statistics as they are managed by well-meaning but overworked social workers.  Even the small percentage of foster youths who go on to pursue higher education are likely to continue to define themselves by their interaction with the child welfare system.  Miranda, for example, now advocates for foster youth on Capitol Hill.  The article that quotes her ends cheerily, “it turns out that there is life after foster care,” which seems like an ill-fitting ending to a piece about a woman who continues to work for the system that she lived within for the majority of her life.  And Miranda’s success story is, unfortunately, a rarity.  Most youths in foster care want to get a four-year degree, but less than 10% ever attend university.  Of that 10%, most do not graduate.  Many that “age out” of the child welfare system on their eighteenth birthday continue to engage with the state for the rest of their lives.  Many former foster youths become homeless, unemployed, or incarcerated in the years after they turn 18, have children that will go on to be foster youth, or choose a career path based on their experiences in the child welfare system, perpetuating an identity that is based on a relationship to the state.

Foster youth are, of course, not a monolithic group that share universal experiences or behaviors.  However, there are some statistically significant ways in which their experiences and behaviors differ from those outside of the system.  Teenagers in the child welfare system tend to be more sexually active than their peers outside of foster care, and generally become sexually active at earlier ages.  According to Time, almost half of the roughly 500,000 youths in foster care had been sexually active before their sixteenth birthday, compared to only 30% of youths outside of foster care (Sullivan, 2009).  That, coupled with inadequate or nonexistent sexual education from foster parents and social workers, leaves teens in foster care more likely to have unprotected consensual sex than their peers.

Beyond the early consensual sexual encounters that females in the foster care system have, they are also more likely to be victims of sexual violence than females outside of the child welfare system or boys within the system.  In addition to the daily struggles of school and life as a teenager, “[…] these girls’ lives usually include histories of abuse or neglect; unstable, dangerous, or non-existent family environments; interpersonal violence; sexual victimization; frequent moves; inconsistent school attendance; lack of control over decisions affecting daily life; limited financial resources; and unmet physical, developmental, and mental health needs. These risk factors increase the probability that girls will suffer harm” (Baynes-Dunning, 2013). So much effort goes into placing children into adequate housing as quickly as possible that there is little time to engage with youths and address the various traumas they may have suffered, leaving them without strategies to cope effectively.  Furthermore, there is generally inadequate follow-up.  Females in foster care are often subject to revictimization at the hands of their foster families, and since there is rarely time to address their trauma, they may have trouble recognizing warning signs of abuse or mistaking abuse for normal attention and affection. As a result, they are significantly more likely to be victims of sexual violence as compared to their male peers.  For females in foster care, 72% of the violent crimes that they reported themselves as victims of to law enforcement were sexual in nature. For males, 24% of violent crimes that were reported to law enforcement were sexual assault (Bayes-Dunning, 2013).  These statistics, alongside the statistics demonstrating earlier engagement in consensual encounters, show why females in foster care are significantly more likely to become pregnant by the age of 19 and have higher reported instances of multiple pregnancies before the age of 20 (Sullivan, 2009).  Those children are five times as likely as their peers to become a part of the child welfare system at some point in their lives (Bayes-Dunning, 2017).

Effectively, by ignoring teenage sexuality, the state creates a situation in which women and their children become intergenerationally dependent on it.  This is because the state is inherently masculine.  This is not even necessarily intentional.  As Wendy Brown wrote in States of Injury, “the state can be masculinist without intentionally or overtly pursuing the interests of men precisely because the multiple dimensions of socially constructed masculinity have historically shaped the multiple modes of power circulating through the domain called the state” (Brown).  We see the effects of this in the foster care system.  Very little resources are allocated towards sexual education or contraception for foster youths.  One can imagine that this is because sex is not as high-risk a behavior for young men as it is for young women.  Both men and women risk sexually transmitted diseases from being sexually active without proper protection, but only women are at risk of becoming pregnant.  

Even when the potential of sexual violence is addressed, it is masculinist in nature; children are sometimes taken from their otherwise capable parents simply because the mother has been identified as a sex worker (Global Network of Sex Work Projects).  This is masculinist as it “protects” the child from sexuality that is disapproved of by society even if it is not inherently dangerous.  “Historically, the argument that women require protection by and from men has been critical in legitimizing women’s exclusion from some spheres of human endeavor and confinement within others” (Brown).  The masculinist state has created a world where mothers need to have money in order to take care of their children so that they are not taken away, but with the stipulation that there are many types of “wrong” work that will still result in having their children taken away.  In this way, mothers are punished simply for being certain types of mothers- poor, lower class, or women of color.  Does it not seem a little suspicious that, in protecting children from the strange men that their mothers are sexually engaging with, the children are often placed into homes with different strange men?  The difference, of course, is that these strange men are state-sanctioned and approved to “protect” the child.  The mother is not considered trustworthy enough by the state to make decisions about which men to potentially expose her child to because the state assumes that those men may be dangerous.  In turn, they punish the woman for having sexual behavior outside of the norm and exclude her from motherhood by separating her from her child.  While this is one extreme example, it is not as uncommon as one would like to think, and serves to prove that the state and the child welfare system seems to only engage with preventing risky sexual behaviors when it works towards punishing women, but not when it would prevent disease, trauma and pregnancy in teen girls.

This line of thought makes one wonder if the state even wants to prevent teen pregnancy for foster youths.  Is there any motivation to prevent foster youths from getting pregnant and remaining reliant on the system?  Wendy Brown would argue that there is not, since the woman’s relationship to the state has defined her and produced her into something familiar that the state is capable of maintaining.  Destitute, pregnant women and single mothers are reliant and easy to control.  The continued and growing relationship between women, especially poor women and women of color, serves to tie their identities to the state in a way that is tangible and comprehensible to the masculine powers-that-be.  “Do these expanding relationships produce only active political subjects, or do they also produce regulated, subordinated, and disciplined state subjects? (…) Are state programs eroding or intensifying the isolation of women in reproductive work and the ghettoization of women in service work?” (Brown).  As we saw with Miranda, the previously mentioned former foster youth and teen mother, even when these women go on to successfully exit the child welfare system, they do not necessarily disengage it.  In working with foster youths in the past, many of the girls that expressed interest in higher education specified that they intended to become social workers or advocates for foster care.  While there are no reliable statistics about the work that successful women who aged out of foster care do, it seems that many of them go on to work for the same system that produced them, perpetuating the cycle in a different but no less meaningful way than the girls that become pregnant while in foster care.

Luckily, there is potential for positive change in the California foster care system.  Jessica Chandler, a former foster youth pursuing her masters in social work penned an op-ed titled “Breaking the vicious cycle of foster care” for the LA Times, supporting the passage of California State Bill 528 in 2013.  The bill, which has since passed, requires increased pregnancy prevention education for young women in foster care.  Politically engaged women produced by the state actually managed to play a part in changing it in a way that may actually benefit future generations of girls in foster care.  Though Wendy Brown would argue that there is no sense in feminists attempting to better oppressive state programs, there is unfortunately no practical way to immediately disengage all of the nearly 500,000 children, 48% of them female, from the child welfare system.  While imagining a utopian future in which children never legitimately need to be removed from their parents, we must also continue to deal with the reality that some children need to be protected from abuse.  Until we create a society in which children are inherently safe from harm, we must continue to attempt to improve and demasculinize the systems in place that hundreds of thousands of children currently rely on.  As Audre Lorde famously wrote, “experience has taught us that action in the now is also necessary, always.  Our children cannot dream unless they live, they cannot live unless they are nourished, and who else will feed them the real food without which their dreams will be no different from ours?” (Lorde, 1982).  To begin to break the cycle of foster care, we must attend to the needs of the children, girls, and women reliant on it and ensure that they are nourished, inside and out, and able to create an identity outside of the foster care system.

 

Baynes-Dunning, Karen, and Karen Worthington. “Responding to the Needs of Adolescent Girls in Foster Care.” Georgetown Journal on Poverty Law & Policy XX.2 (2013): n. pag. Web.

Brown, Wendy. States of injury: power and freedom in late modernity. Princeton, NJ: Princeton U Press, 1995. Print.

Chandler, Jessica. “Breaking the vicious cycle of foster care.” Los Angeles Times. Los Angeles Times, 05 May 2013. Web. 24 Feb. 2017.

“Sex Work and Arbitrary Interference With Families.” The Real Impact of the Swedish Model on Sex Workers 7 (n.d.): n. pag. Global Network of Sex Work Projects. Web.

Sullivan, Amy. “Teen Pregnancy: An Epidemic in Foster Care.” Time. Time Inc., 22 July 2009. Web. 24 Feb. 2017.

Should we all be rushing to get copper IUDs?

You may have seen a meme floating around the internet after November 8th, urging women to get birth control that will “outlast a Trump presidency.” While it’s true that a copper IUD can be safely used for 10-12 years, is it really so urgent to get one right now? And are they right for everyone?

Copper IUDs (intrauterine devices) are nearly 100% effective at preventing pregnancies, and I have written about them in the past as a good public health initiative to decrease abortion rates. They’re controversial amongst the religious right because some consider IUDs to be less contraception, more abortifacient. This is because of a debate about when conception truly begins- most doctors agree that conception begins when a fertilized egg attaches to the uterine wall, while members of some religious groups believe that conception begins when an egg is fertilized. (This belief was at the crux of the infamous Hobby Lobby case). In cases in which IUDs do not stop sperm from fertilizing an egg, they are still effective at making the uterus inhospitable to a fertilized egg.

Most of the time, however, copper IUDs are not at all abortifacient. Copper kills sperm, and so there is rarely an opportunity for an egg to become fertilized. Because of this, there is never an opportunity for one to know how, exactly, the IUD prevented pregnancy- just that it did prevent an unwanted pregnancy, and did so effectively.

Despite their impressive record, however, copper IUDs are not very widely used by young women. The median age of the copper IUD user is 30. Many of the women who use it get it implanted directly after having a child, because of the fear of insertion pain which can be extremely different in every case. Copper IUDs like Paraguard also have the potential for side effects like spotting, cramps, inflammation, or even expelling the IUD. Some of these symptoms are more likely to occur in young women, or women who have not yet had children. This may serve as a deterrent.

Delaware and Colorado currently offer programs discounting long acting contraception for young women. I’ve written about the success of Colorado’s program in the past. Despite this, there are certainly things to think about before embarking on a ten-year journey with an IUD. Make sure that your doctor knows all of your concerns before making a rash decision based on the results of the election.

http://www.theatlantic.com/health/archive/2014/03/heres-why-hobby-lobby-thinks-iuds-are-like-abortions/284382/

http://www.slate.com/blogs/xx_factor/2016/05/12/why_aren_t_more_young_women_choosing_iuds.html

http://www.mayoclinic.org/tests-procedures/paragard/basics/risks/prc-20013048

http://www.npr.org/sections/health-shots/2016/11/11/501611813/women-rush-to-get-long-acting-birth-control-after-trump-wins

Can my body really go out of style?

Last week, Vogue announced that cleavage is no longer in style. Apparently, much like Apple Bottom jeans or boots with fur, female body parts are capable of being in- or out- of style.

Vogue writers attempted to empower women by encouraging fashions that are not overtly sexual and centered on cleavage, but fell flat by focusing the article on anatomy instead of style. In doing so, the writers echoed the same oppressive message that many women are tired of hearing: female bodies are meant to be seen, shamed, and changed, rather than lived in and enjoyed by their occupants.

I am a woman who has grappled with an eating disorder since my teen years. I was once active on pro-anorexia websites. Rejecting breasts and cleavage is nothing new- it has been the mantra of people who hate their bodies for as long as I can remember.

As a budding teenager, I despised every ounce of fat on my body, and my breasts were not immune to my scrutiny. I saw my rejection of fat mirrored in every piece of fashion media I could get my hands on, with willow-thin, flat models flaunting clothes that my body would surely bulge out of. After years of unlearning the ideas I subscribed to on pro-anorexia websites, I now have maintained a healthy and consistent weight for over a year and no longer suffer from disordered eating.

But I can still taste the shame that pro-ana websites made me feel when I read Pro-anorexia websites tell young women that there are myriad ways in which their bodies should be changed. If a girl still has their period, it is because they have too much body fat to suffer from amenorrhea. If a girl has large breasts, it really just reflects how much fat they still have. Girls are works in progress. Their bodies always have room for improvement.

With what I have learned on my journey to mental and physical health, I propose that women reject the standards imposed by the fashion industry and pro-anorexia websites. We need to value physical and mental health over appearance.

Why it matters that men dropped out of the male birth control study

This week, the internet learned of a study that tested a male birth control shot for males that 96% effectively prevented pregnancy in female partners. While scientific discovery and contraceptive advancements are usually lauded, the results of this study were met with outrage and disdain from many women.

Why? Because the study was discontinued before it could be completed.

Men dropped out of the study citing side effects including depression, acne, libido change, and intense mood swings. Certainly, many women who have used hormonal birth control could understand this.

However, instead of meeting the news with empathy, women of the internet took the opportunity to mock the men of the study for not being willing to deal with adverse side effects that women who use hormonal birth control pills have faced since their inception.

These jokes do not further the real conversation that we need to have as a society. Hormonal birth control for women has a dirty past that many do not talk about. Drug trials were forced on Puerto Rican women who did not understand the possible risks of using it. Once enough women were resistant to taking the birth control, the drug trials moved into prisons, where women could not say no.

I am appreciative that we now live in an era where people can report horrible side effects of a drug and have the trial cut short. Drug trials should absolutely not be forced upon communities who don’t understand the repercussions, or on prisoners who cannot say no. No one deserves to face depression, mood disorders, blood clots, or drastic weight gain simply because they do not want to have a child.

We can advocate that we need to have better options for women without demanding that people complete a medical trial that does not work for them. In the past, they forced Puerto Rican women and prisoners to complete the trials for female birth control, and look where that got us- a product that many women are dissatisfied with, because respondents’ needs were not taken into account.

Science will progress. We have seen now that male birth control is possible. We have seen now that the side effects of hormonal birth control are considered unacceptable by the medical community. I am excited to be alive in a time when contraception is becoming so accessible and potentially even user-friendly for people who want to use it- women and men.

Sex Work, Sexual Assault, and the Election

Today, another woman has come forward to accuse Republican nominee Donald Trump of sexual assault. Her name is Jessica Drake, and she is one of eleven women to officially speak about her experiences with Mr. Trump.

Jessica Drake offers photographic evidence of her and Trump together at the event where the sexual misconduct took place, while some of the other accusers have failed to prove that there was an interaction. Her story- that Donald Trump offered her money and the use of his private jet in exchange for sleeping with him- sounds entirely plausible, given Trump’s own admission on the 2005 Access Hollywood tapes that he once took a woman furniture shopping as an attempt to advance on her. Given that Jessica Drake has made it clear that she is not seeking money or retribution, there seems to be no reason to doubt her claims.

Yet, unfortunately, I assume most people will do so regardless, based on one trivial fact. Ms. Drake happens to be an adult film actress. And for whatever reason, people have trouble respecting the sexual autonomy of women who have sex for money.

In recent years, we’ve seen popular porn actor James Deen’s adult film career thrive despite rape allegations against him by Stoya, an adult film actress. When Stoya spoke out about the abuse she faced from him, she was quoted as saying that she had called a friend asking to be talked out of coming forward, saying

“I was calling to say, ‘Kayden, remind me of the slut-shaming, remind me how I will ruin our business, remind me how I will be told that porn stars can’t be raped, remind me of how I will be called a liar, remind me that it will quite likely undo and undermine a decade of work in the porn industry.’”

Sure enough, Stoya was victimized on social media by fans of Deen’s claiming that she was lying for attention. After the allegations, Deen’s career has continued to thrive, while Stoya has largely stayed away from adult film work besides contractual obligations. Deen was accused of sexual misconduct by at least ten women, and his career has hardly taken a hit. The women who were bold enough to speak out have not experienced the same success.  

Now, outside of the microcosm of the porn industry, we are experiencing something similar. A well-known man has been accused of sexual misconduct by eleven women and counting, and these women are widely being accused of being money-seeking, slanderous liars. On social media sites, people are asking why the women had never filed police reports or sued previously, implying that they must be motivated by fame or money. According to the New York Times, 

The pressure not to name names can be strong whenever the perpetrator is someone the woman knows. An accusation forces everyone who knows the two people to choose a side: accuser or accused? Choosing the accuser often means going against the broader group or community.

In her work on college campuses around the country, Ms. Brodsky said, she has observed that “peers and friends are much more inclined to be sympathetic to victims if they don’t make anyone’s life more complicated.”

It’s easy to support a victim if we don’t know who victimized them. It is easy to support a victim if we don’t like the person who hurt them. It was easy, last week, for Donald Trump to support the women who have made allegations against Bill Clinton. This week, he threatens to sue anyone who comes forward with allegations of sexual misconduct against himself.

Donald Trump has already made it clear that he disrespects women who work in adult films, as he tried to discredit Alicia Machado’s claims that he bullied her by tweeting that she was “no angel” and had been in a “sex tape.” While that turned out to not even be true, it makes me cringe to imagine what will be said before the end of the day to discredit Jessica Drake. I have already read tweets accusing her of seeking fame- but if what Stoya experienced in the adult film industry is any predictor, any publicity that comes from coming forward with sexual assault allegations is not worth the trouble.

A public health initiative for pro-life Mike Pence to consider

 

In Tuesday’s vice presidential debate between Tim Kaine and Mike Pence, both discussed how their Catholic faith influenced their personal opinion on abortion. During the debate, Democratic candidate Kaine asked Pence,

Why don’t you trust women to make this choice for themselves? We can encourage people to support life. Of course we can. But why don’t you trust women? Why doesn’t Donald Trump trust women to make this choice for themselves?

In the wake of these comments, some accused Kaine of “trying to have it both ways”- playing to a demographic of people who personally oppose abortion, while also attempting to garner votes from the pro-choice electorate.

However, we really can have it both ways by taking public health initiatives that simultaneously improve women’s reproductive health care while lowering the rates of teen pregnancy and abortion. It’s being proven in Colorado, as well as in the Carolinas.

Providing access to safe, long-term, reversible contraception has helped Colorado lower their teen birth and abortion rate faster than the lowering national average. The state has provided IUDs and implants to low-income women and teenage girls for free since 2007. About 1 in 15 of low-income women in Colorado use one of these forms of contraception because of the availability of the program. Both the IUD and the implant can be taken out if a woman decides that she is ready to have children, but are more than 99% effective at preventing unwanted pregnancies.

Using Colorado’s lowered rate of abortion and lowered rate of unplanned pregnancies, it stands to reason that a good way to prevent ‘unnecessary’ abortion is to aid women in gaining access to contraception. A private grant was needed to provide the types of contraception used in Colorado. Currently, Medicaid is encouraging providers to educate young women about the possibility of long-term, reversible contraception.

Unfortunately, Pence has proven himself as being against contraception in several forms. As a congressman in 2002, Pence gave an interview with Wolf Blitzer that indicated he was against condom usage because he believed they are not effective enough to prevent sexually transmitted diseases (a stance that fellow Congressman Schakowsky compared to disavowing flu shots because they are not always effective). As a congressman and as governor of Indiana, Pence made it his mission to end funding to Planned Parenthood (the clinic where many low-income women go for access to contraception) through Title IX. With Pence as our vice president, could we really see the public health and contraception initiatives enacted that would truly prevent abortion?

As Tim Kaine asked, do Mike Pence and Donald Trump trust women to make this choice for themselves?

We need to pay attention to foster youth

Foster care in the United States does not have a positive reputation, to say the least. Many immediately conflate foster children with a high rate of unpredictable behavior, and feel pity for adoptive parents who take “troubled children” into their homes. Their concerns are confirmed by anecdotal evidence, as well as by the low rates of success experienced by former foster youths. Kids in foster care tend to behave differently than other children, because they are largely treated differently than other children when it comes to mental health care. While it is true that foster youths tend to have higher rates of mental health problems than most other children, they do not necessarily have adequate resources to cope with their issues.
These youths are oftentimes separated from their entire lives- siblings, schools, friends, and extended families as well as their parents, which leaves caseworkers as their only advocates in the world of mental health care. And with growing evidence that caseworkers are spread far too thin, it should come as no surprise that the state of mental health care for foster youths is horrifyingly substandard. To create a healthier world for our nation’s vulnerable children, we must immediate work towards dismantling our current system of neglect, and create a standardized national health care system for foster youths that follows procedural guidelines, is subject to scrutinized oversight, and provides structured continuity of care.
The current state of foster care is well-known to be problematic- costly, ineffective, and desperately in need of change. The system seeks to support youths who do not have the support of the biological parents, but often fails to provide the consistency that children yearn for. Almost half of the estimated 500,000 children in the system live with strangers that they are not related to. These children, on average, are placed in different homes about three times. According to ABC News, there are documented cases of a youth moving up to thirty times during their stay in foster care. A large portion (approximately 24%, according to ABC) of foster youths leave their biological parents to live in kinship care, a form of foster care in which relatives care for the children. Even these children can suffer from lack of continuity in their health care, because crossing state lines to live with a different family member often requires finding new mental health care providers who are able to work with the child. When a suitable provider is found, they may not have access to the full breadth of a child’s health care history, as it may have been lost or previously poorly documented.
I recommend creating a standardized system that provides continuity of care for foster youths by securely storing and sharing detailed records of their care with each new case worker, foster parent, and health care provider that the youth depends on. Some states, like Texas, have already implemented useful strategies that make it easier for youths to verify their health records. For example, foster youths in Texas have a state issued “health passport” that provides a summary of their health history and needs. However, even the health passport is not a full medical record, and isn’t used in all fifty states. For the health passport to be truly effective, it would need to be relevant across state lines, in case a foster youth moved to a relative’s home in a different state. And, currently, only Texas and a handful of other states have begun to standardize their health care information. Until such a system becomes standard in each state, a foster youth who moves from another state to kinship care in Texas with a relative will still not have the detailed health passport that they need to receive appropriate and adequate care.
With a nationalized “health passport” style system that accurately depicts their medical needs, foster youths could enjoy more medical oversight from the court system, as judges would be able to accurately determine whether the use of psychotropic medication was adequately supervised by the doctors prescribing it. For a variety of reasons, the current system has lent itself to foster children being prescribed psychotropic drugs at a much higher rate than other children their age. Furthermore, doctors prescribe these drugs to foster youths without guarantee that the combination of the psychotropic drugs with their other medications is appropriate, or that the youth will have reasonable oversight from a psychiatrist while taking the medication . Caseworkers and doctors are clearly actively engaged in providing mental health care for foster youths, as is evidenced by a 2004 article published by Psychiatry Online that shows 94% of foster youths receiving mental health services in their lifetimes. However, the same report shows us that the mental health care that foster youths have access to are often extreme. Rather than utilizing community-based services, like outpatient therapy, 77% of foster youths in the study to residential or inpatient based services. Of those, about half of youths had never received community services before entering residential care for their mental health or behavioral issues. This is not an appropriate way to moderate the psychiatric and behavioral abnormalities of children, but the lack of organization of the health care records of foster youths makes it more difficult for courts to provide oversight of the quality of care. With proper organization, a social worker may have the time to read through a foster youth’s medication list and notice that there is no record of community-based treatment to support it. That gives the social worker the opportunity to recommend services to complement the use of psychotropic medication so that issues are managed at their root, and not simply masked by medication.
Creating a system in which a child’s health care is maintained carefully and valued can make the child feel safe and comfortable during a stressful and inconsistent time. When children in foster care feel as though their mental health is important to the adults in their lives, they are able to make observable changes to their behavior- as significant as breaking drug or self-harm habits. Furthermore, foster youths in a study funded by the National Institute of Mental Health indicated that their dissatisfaction with their medications often went unheard. A highly organized health passport system could help children in foster care push their medication concerns to the forefront, as their prescription list would need to be revisited frequently. This would allow the children many opportunities to discuss their displeasure with their medications- each time their doctor or caseworker checks in with them to monitor their mental health progress.
Taking these measures to protect foster youths from irresponsibly administered health care can improve our society by contributing to a decline in homelessness and incarceration. A national system that uses health passports would be conducive to judges and caseworkers becoming better advocates for foster youths. Judges play a valuable role in deciding the outcome of behavioral problems that manifest themselves as disruptions in school or criminal behavior in foster youths. Seeing medical history that reflects a child’s mental health care history and medications could make a difference in whether the child receives help or punishment for their behavior. Once a foster youth is involved in the criminal justice system, they can find themselves in juvie repeatedly for minor delinquencies and violations of arbitrary rules of probation. Youths that have been incarcerated tend to be involved with more serious crimes as they age. If we are serious about making sure that foster children have healthy and successful futures, it is crucial that their behavioral issues are treated with the expectation of improvement and rehabilitation, like children who have the support of their biological parents. Rather than punishing and jailing these children, judges with the information provided by a comprehensive mental health passport could recommend community-based therapy that would give foster youths adults to look up to and emulate.
Foster care does not need to be the predicator for homelessness and incarceration that it is now. As a society, we could focus on the roots of these problems- one being the mismanagement of mental health- and help change the outcome of these children’s lives. Organization and oversight can go a long way to make these children feel as though their needs are important to the adults that manage their well-being. Providing a system that is organized with the intention of providing consistency for foster youths will ideally help foster children with mental health or behavioral problems continue their mental health care after aging out of the system as an adult. This new culture of valuing health care in foster care will hopefully inspire former foster youths to maintain the habits and mindsets that will help them find employment, housing, and educational opportunities, in turn lowering their incarceration and homelessness rates.

The real cost of malnutrition

After a discussion during the week regarding food deserts in Los Angeles, I decided that it was time for me to learn more about the health problems that people who live in these areas face.

For those who might not know, a food desert is defined by the USDA as “part of the country vapid of fresh fruit, vegetables, and other healthful whole foods, usually found in impoverished areas.” People who live in these areas have access to overpriced, unhealthy foods from liquor stores and corner markets, and end up suffering from malnutrition because of it.

Though malnutrition may seem like only an individual health problem, it becomes a statewide economic problem as well. According to Modern Healthcare, individual states can spend between $25 million and $1.7 billion annually on diseases linked to poor nutrition. That’s because more than ⅓ of patients admitted to hospitals are already malnourished, or become malnourished during their treatment. And though only 14% of patients use Medicare, they account for 28% of spending due to poor nutrition.

The majority of malnourished people appear to be the elderly- and the elderly are more likely to be living on fixed incomes and needing government assistance, like SNAP (Supplemental Nutrition Assistance Program) benefits. In fact, in California, every dollar that is spent on SNAP saves between $3.67 and $8.34 in health care costs associated with malnutrition. Now imagine if there were actually grocery stores stocked with healthy foods in every impoverished neighborhood- perhaps we would make government spending even more productive.

There are valid reasons why a grocery store would be wary of opening in an impoverished neighborhood. It is more profitable to open in neighborhoods where wealthy people are guaranteed to spend money without tight budgets. However, with evidence pointing towards balanced nutrition saving government spending on healthcare, perhaps it makes sense to subsidize grocery stores in neighborhoods where extensive profits are not guaranteed.

 

http://americannutritionassociation.org/newsletter/usda-defines-food-deserts

http://www.justharvest.org/advocacy/the-truth-about-snapfood-stamps/

http://www.modernhealthcare.com/article/20160923/NEWS/160929940

 

Zika and Planned Parenthood

 

This week, a Republican-driven bill regarding Zika funding was blocked by Democrats in the Senate. Though Democrats have been publicly pushing for emergency funding to fight the disease, this is the second time they have blocked such a bill. Why?

It boils down to the actual content of the bill. Though Zika emergency funds would be bolstered, Planned Parenthood would be completely blocked from receiving funds to provide contraception to women in affected areas. Blocking funds to Planned Parenthood in this capacity sets a precedent that Democrats in the Senate are unwilling to set.

To many, this may seem unreasonable in one way or another. Why are Democrats so unwavering in their support of Planned Parenthood? Why don’t Republicans think that providing contraception to women who may contract Zika, which seems to cause microcephaly in children, is unreasonable?

At risk of coming across as too partisan, I will confess that I am an ardent Planned Parenthood supporter. I’ve canvassed on their behalf, approaching strangers while wearing a bright pink tee shirt and saying “Care to stand up for women’s healthcare with me?”. I’ve heard the majority of arguments for and against Planned Parenthood (occasionally accompanied by some kind of picket sign). And I know that people’s stance on Planned Parenthood essentially hinges on their stance on abortion. If a person is pro-choice, they will generally support government funding of Planned Parenthood. If they’re pro-life, they’re generally against government funding of Planned Parenthood.

I also know that, thanks to the Hyde Amendment, federal funds can not be used to pay for abortions (unless the mother’s life is in danger, or if the pregnancy was caused by rape or incest). These federally allocated funds will not be going towards abortions. They will be used to provide contraception to people who, without contraception, would potentially have a child with health defects. Contraception is also a controversial issue at times, but even the Pope suggested that using contraception during this uncertain time would be acceptable. Catholics are usually morally opposed to using artificial birth control.

It’s time to pass effective funding to control Zika. A debate on the legality of federally funding for abortion and contraception can wait. If the leader of the Catholic church is willing to adjust his stance on birth control in a time of crisis, our elected officials should be able to pass bipartisan legislation to avoid calamity.  

 

A profile of the public health intellectual

It seems as though everyone has an opinion about the current state of American healthcare policy. Conservatives rail against the insurance mandate of the Affordable Care Act, preferring an entirely private system. Ultra-liberals push for a single-payer national healthcare system in which insurance, public or private, would be deemed unnecessary. A few years before the Affordable Care Act was implemented, Jacob Hacker wrote a healthcare reform scheme that scathingly referred to the American medical complex as “enormously wasteful, ill-targeted, inefficient, and unfair.” In his reform, Hacker suggested  expanding Medicare while allowing private and employer-based insurance companies to compete for clients with the public option. If that sounds familiar, it is because Hacker had laid the foundation for the Affordable Care Act. Commonly known as Obamacare, the ACA is a health care policy that remains extremely controversial to this day amongst liberals and conservatives alike.

According to Jean Bethke Elshtain, it is the role of a public intellectual to “puncture the myth-makers of any era, including his own” (Mack, 2016). I believe that Hacker punctures both liberal and conservative myths indiscriminately, though he clearly leans left in his personal politics. Hacker focuses on economic viability when challenging partisan myths on both sides of the aisle, from anti-government economic policies to socialized medicine.

Despite the controversy of the policy that was built based on his ideas, the Affordable Care Act, Hacker writes in a way that is clear and accessible to people. He is Harvard educated and a professor at Yale, but has an unpretentious, matter-of-fact writing style that rationally explains the thought process behind his policy suggestions without using terms that are unfamiliar to the casual reader. He also habitually publishes in widely accessible places, like the Los Angeles Times, the Washington Post, and the Boston Globe, allowing a large scope of people free access to summaries of his ideas. Through reading his body of work, you will find that Hacker is undeniably what Elshtain would describe as a public intellectual who is a “party pooper,” because his practicality and incrementalism prevent him from promising an American health care utopia any time in the immediate future. He has no flowery words, nor grandiose and unachievable plans- just easily read, moderate policy goals.

American Amnesia, Hacker’s most recent book that is co-authored by Paul Pierson, argues that the idea that government inhibits economic growth is actually a myth, evidenced by the effectiveness of “mixed economies,” especially in earlier eras of American history.  American Amnesia argues that government was well-regarded as recently as the 1950s, a time in American history that some are looking back to with nostalgia. Most notably, president-elect Donald Trump won both the Republican primary and the presidential election with his infamous campaign slogan “Make America Great Again,” which harkened back to the prosperous economy of the 1950s. Hacker argues that the economic prosperity of the time was the result of a mixed economy- one in which the public and private sectors worked congruently to create an effective economy.

Public influence and regulations, ideally, protect the interest of both consumers and corporations, creating economic growth. In Making America Great Again, Hacker argues that an economy with only private actors would be like a hand with only fingers, and an economy with only public influence would be all thumbs. This criticizes the current insistence by politicians on the right, like Texas senator Ted Cruz, who insist that closing myriad government agencies will give the economy a boost by allowing the private sector more free range. Instead, he demonstrates that mixed economies, in which government agencies and regulations support consumer and private interests, are the healthiest economies. After all, on the other side of a healthy taxation rate is the ability of a government to subsidize industries that would otherwise become extremely expensive, like oil and energy. Those industries are subsidized federally, and prominent in the few consistently red states that have quickly growing economies, like North Dakota. This is an example of how mixed economies can be successful and beneficial, even in traditionally conservative areas.

In the same vein, Hacker shows that it is unrealistic in the current political climate to rely on either a strictly privatized or a public nationalized health insurance system. Rather, he proposed that private options, like the ones provided by employers, remain, and that a Medicare-like public option be provided for people who do not have workplace insurance or qualify for Medicaid. This proposal, which the Affordable Care Act borrowed heavily from, is incrementalist rather than idealistic and provides a mix between consumer and corporate protections. Traditional workplace insurance remains, while coverage is extended to more people through a decent public competitor.  

The public intellectual’s role as a critic, however, also exposes them to criticism.  Hacker wrote about the criticisms he received after writing a proposal for standardizing health insurance. Most are familiar with the conservative disdain for the Affordable Care Act and public healthcare- after all, no Republicans in the House or Senate voted for the bill in 2009. Hacker was attacked by the right for proposing that there should be a public option for health insurance, but his plan has also been criticized by the left for ‘appeasing’ conservatives by allowing the public option to compete with private plans. Bernie Sanders, for example, deemed the Affordable Care Act a “good Republican program” in 2013 (Hacker, 2016), despite it being a Democratic president’s signature piece of legislation. And, to be fair, Obamacare has its kinks that need to be worked out; Hacker himself describes the public option as being “Medicaid for all” when it was intended to be “Medicare for all.” The public option is not as robust or dependable as many progressives would hope. The difference is, however, that more progressive plans are less likely to pass through both the House and Senate.

Even in countries that have successfully adopted large national healthcare systems, incrementalism has created monumental results. Regarding socialized medicine in other countries, Hacker argues

“(…) it’s attractive to think the only way to get to “real” reform is to bury the [initial] law and create something else. But the history of health reform in rich democracies suggests otherwise. (…) Most European systems moved from programs focused on wage earners to universal or near-universal programs that turned once-private sickness funds into quasi-public institutions. In Canada, provincial programs (initially just for hospital care) were stepping stones to today’s comprehensive (though still provincially based) system” (Hacker, 2016).

A mixed public health care economy, in Hacker’s view, sets a foundation for more progressive legislation to eventually pass. Single-payer universal health care in America was, until recently, a somewhat lofty and overly ambitious goal. Though President Truman was advocating for single-payer health care as early as 1948, it was painted by groups like the American Medical Association as “socialist” and Leninistic. At the time, Republican Senator Taft “(…) suggested that compulsory health insurance, like the Full Unemployment Act, came right out of the Soviet constitution and walked out of the hearings” (Palmer, 1999). Lingering fears of socialism and communism remained for years after the Cold War. The Clintons’ 1993 attempt at expanding health care was largely rejected by both Republicans and Democrats for similar reasons. In 1993, it became a Republican catchphrase to claim that “there is no health care crisis” (Time, 2007). Now, with the establishment of an insurance mandate and public option with Obamacare, incremental progress of taking public health care a step further is more possible. Only a few short years after the insurance mandate of the Affordable Care Act and the implementation of the public insurance option, a serious contender for the Democratic presidential nomination ran with a campaign promise of creating single-payer health care. People are now having serious discussions and debates in this country about whether or not health care is a right.

In this way, Hacker’s writings have inspired a cultural shift of people’s perceptions of health care. Many of the criticisms of Obamacare capture the feeling that Americans, in some way or another, “deserve better.” Some believe that “better” is single-payer healthcare, and others believe that “better” is the freedom to pay for their own private insurance, while not being taxed to support the health of others. In any case, however, Hacker’s ideas and the policy inspired by them have caused enough controversy to inspire a desire for progress and policy change from people of all political backgrounds. And despite the criticisms that his policies have attracted, Hacker encourages other political scientists to get involved in public intellectual work- especially inviting those with specific public policy initiatives to share their ideas in an attempt to better society (Hacker, 2010). Controversy drives policy incrementally towards progress, and nothing will change without specific policy goals.