Is Inequality Making Us Sick?

A couple of months ago, I watched a video entitled "Place Matters".  I wanted to share some information from the video.  Here is just a collection of statements from researchers and policy analysts about how where one lives is the greatest predictor of their health.  This includes financial, emotional, and physical health. 

JAMES KRIEGER (Epidemiologist, Seattle Dept. of Public Health): Place matters. That’s where someone works, where they go to school, or where they live, because place determines what someone’s exposed to in terms of a whole host of factors that can affect their health. So place matters because it determines what kind of physical or chemical agents you might be exposed to. It matters what kind of social environment you are exposed to. It matters if there’s a lot of violence or crime in your neighborhood. It matters if it’s easy to go for a walk in your neighborhood or find healthy foods. Who your neighbors are and the way you interact with your neighbors can also affect your health. Place ultimately is a critical determinant of health.

DAVID WILLIAMS (Sociologist, Harvard School of Public Health): When we think about health, we usually think about health care and access to care and the quality of care. But what research clearly shows is that health is embedded in the larger conditions in which we live and work. So, the quality of housing and the quality of neighborhood have dramatic effects on health. Sometimes, we naively think of improving health by simply changing behaviors. But the choices of individuals are often limited by the environments in which they live.

ANA DIEZ-ROUX (Epidemiologist, University of Michigan): When most people think of the causes of chronic disease, for example cardiovascular disease, they think of individual level risk factors which we know about: diet, physical activity, smoking. However, it’s also true that they are socially patterned. And one of the dimensions across which it’s patterned is by neighborhoods.  If we look at a map of almost any geographic area and you map up rates of obesity, for example, or of hypertension, or of low-birth weight, we’ll see that these things overlap almost exactly. And if we overlay a map of environmental hazards, it fits in as well. And, it’s very common to see all these dimensions cluster.

DICK JACKSON (Professor of Environmental Health, UC Berkeley): A friend of mine said that she’d seen 10 or 12 teenage girls now who have had their gall bladders removed. If you eat a lot of fat in your diet, you can get gall bladder disease and it turned out that they’re eating breakfast, lunch and dinner in fast food outlets. And there were no farmers markets, there were no green grocers; there was no Safeway or supermarket that was reachable by these kids. And fast food is a bargain. You can get 1500 calories for a couple of bucks. It’s not a long-term bargain, but it’s a short-term bargain. And people make that trade.

ANGELA GLOVER BLACKWELL (CEO, PolicyLink): We had vast public investments in building the suburbs of America. Federally supported loans, FHA loans, went to people who were moving to the suburbs and for many years, up until the 1960s, those loans were available on a racially restricted basis. African-Americans and other people of color didn’t have access to them.

A concluding statement from David Williams of the Harvard School of Public Health:  What all of this means is that housing policy is health policy.  Educational policy is health policy.  Anti-violence policy is health policy.  Neighborhood improvement policies are health policies.  Everything that we can do to improve the quality of life of individuals in our society has an impact on their health and is a health policy.

Drug Testing Our Problems Away

Lawmakers in the State of Florida voted on a bill which would make drug testing mandatory for all that received benefits from Temporary Assistance to Needy Families (TANF).  This bill was signed into law by Florida Governor Rick Scott on last week.  This law, which will begin on July 1, makes Florida the only state that will make drug testing mandatory for its TANF recipients to obtain program benefits.  If a person tests positive for drug use, they will be denied benefits for a year. 

Beginning in July of 1997, TANF provides cash assistance to indigent American families with dependent children, for a maximum period of 60 months.  This program is administered through the United State Department of Health and Human Services.  TANF has its beginnings in the Aid to Families with Dependent Children (AFDC) program, which was created during the New Deal.  This program was reformed into TANF following the debates which stated that the issuing of welfare benefits, over a long period of time and without having to work, decreases any efforts to obtain full-time employment and self-sufficiency. 

TANF sets forward the following work requirements necessary for benefits: (1) Recipients (with few exceptions) must work as soon as they are job ready or no later than two years after coming on assistance; (2) Single parents are required to participate in work activities for at least 30 hours per week. Two-parent families must participate in work activities 35 or 55 hours a week, depending upon circumstances; (3) Failure to participate in work requirements can result in a reduction or termination of benefits to the family; and (4) States have to ensure that 50 percent of all families and 90 percent of two-parent families are participating in work activities.

For the sake of clarity, I want to make it known that I want to and I hope to live in a drug-free America.  Also, I hope that people can pull themselves out a poverty ridden circumstance, get trained or educated, get gainfully employed, and raise their families in healthy environments.  With that being said, I don’t exactly see what problems this law solves.

Proponents of this law argue that they don’t want public assistance money spent on extra-curricular drug use.  There is nothing wrong with addressing this, but I think the framers of this law failed to realize that public assistance money isn’t the only money that is used to purchase drugs.  Habitual drug users will find a way to purchase drugs.  Not to be outdone, drug dealers will find a way to sell drugs.  The point I’m making is that no one is addressing the drug problem.  Many of the drugs consumed in the United States come from outside of the United States.  It seems that cracking down on interstate and international drug cartels may be the best way to solve the drug problem.  Eventually no drugs will equate to no drug users.

Secondly, this law targets drug use among poor and low-income people.  I will admit that I am not an expert on equal opportunity, but this just might be discriminatory and insulting.  It insinuates that only poor people should be drug tested to receive benefits.  To make a law like this equal and fair, we would have to require drug testing for all that receive public assistance.  This would include: college students with federal financial aid, farmers that receive federal subsidies, AIG and other Wall Street executives, retirees that receive social security, homeowners that purchase homes through USDA or FHA programs, and elected officials and public employees that receive grant funds from other public entities.  Public funds are intertwined in more than we can imagine.  However, the abuse of public funds does not begin and end with low-income assistance programs.

In 2003, there was a ruling by a federal appeals court that covers Kentucky, Michigan, Ohio, and Tennessee which ruled that states cannot drug test public assistance recipients because it’s unconstitutional.  Ironically, in 2001, a pilot drug testing program in Florida was abandoned because it was not cost effective and it found that welfare recipients were not using drugs more than those who were not on welfare. 

The common issues that are present in this whole discussion are drug use and poverty.  By drafting reactive laws that stand to be overturned in a few years, we are only slowing down any real progress to address these issues.  The sizes of our solutions need to match or exceed the size of our problems.