Addressing Health Injustice in the United States Through Accountability & Citizen Participation4/9/2020 PROLOGUE (COVID-19 update) I wrote this post before the coronavirus outbreak and I wanted to add some additional thoughts about this global pandemic as my words below are even more important and evident now. The novel coronavirus affects everyone, but some groups suffer more, such as marginalized populations who live in poverty and those who suffer due to health inequities. Coronavirus is exposing all of the weaknesses in the U.S. health system and has shown that the nation was less prepared for a pandemic than countries with universal health systems due to lack of universally accessible screening and the uninsured or underinsured still priced out of care. Those losing their jobs due to the economic shutdown will subsequently lose their health insurance coverage, showing us is just how unreliable the employer-based framework really is. In the interim, U.S. legislators have agreed to make American healthcare more like other nations by making COVID-19 treatment free or low-cost at the point of service, either by having the government cover the cost or by mandating private health insurers to cover services related to the pandemic. This helps bridge the insurance coverage gap for those who do not have private health insurance or qualify for Medicaid and was a pivotal and encouraging development. But this would have been far more impactful if it was already in place, removing any delay in care to anyone in an effort to control the spread. Amid this crisis, millions of Americans are now demanding that we have a government that works for all, making a stronger case for universal health coverage. As a result, it’s important that local and global public health leaders continue to pursue health equity during the outbreak response, aiming to protect vulnerable and marginalized communities from COVID-19. Even though Eleanor Roosevelt, human rights champion and First Lady of the United States, was Chair of the United Nations Commission that wrote the Universal Declaration of Human Rights in 1948, the U.S. still stands alone within the developed world in not making healthcare a basic human right to all of its citizens, without a mandate to provide universal health coverage (UHC) independent of income. This means that healthcare is, instead, treated as a commodity for most people, something that is bought, considered a privilege and a benefit. Recently, all United Nations member states adopted the Sustainable Development Goals of 2015, agreeing to try to achieve UHC by 2030, urging governments to move toward providing all people with access to affordable, quality healthcare services as a part of sustaining our human race and planet. Although these goals are a beautiful example of a universal call to action to protect the planet and ensure that all people enjoy peace and prosperity by 2030, unfortunately, accountability is lacking. The goals are all aspirational. There will be no sanctions or the like on the U.S. for not adhering to these goals. Americans have to take it up with their government if it does not do so. The United Nations will not.
While states are formally accountable to their populations, people often have limited meaningful opportunities to hold their governments accountable. However, I firmly believe in the power of the people and their voting rights to help provide pressure for domestic accountability towards UHC if they are supported by a treaty such as the Framework Convention on Global Health (FCGH). This treaty is aimed at addressing the shortcomings in implementing the right to health, including through binding standards requiring accountability and enforceability. The FCGH Alliance is in the process of articulating these standards. These binding remedies would hold states accountable for health justice violations and would advance health equity by better ensuring that those responsible for the abuses answer for their actions. One of the key principles that the FCGH Alliance proposes for the Framework Convention on Global Health centers around empowering people to claim and enforce their right to health. However, this all begins with education and being informed. Yet governments, especially in the U.S., often fail to adequately equip users with a good understanding of the health system. Information makes one liberated and is the foundation of progress. If Americans become knowledgeable, they have power, and that power can impact their healthcare system, enabling health to become a right embodied in U.S. law, and changing the status quo in which powerful interests, whether wealthy segments of the population who want to keep taxes low or corporations that prioritize their profits, keep the commodity-based system intact. The recent U.S. comprehensive health law, the Affordable Care Act (ACA) of 2010, helped to increase access, decrease costs, and raise quality standards. However, the Act lacks any provisions regarding the duty of the government to develop capacity in empowering people to claim and enforce their right to health. The ACA does include transparency of claim denials by insurers, costs of services and quality scores by providers, but is mute on principles that empower people to demand accountability from the government itself. The FCGH would seek to improve national accountability to health commitments, including by promoting the principle of people’s meaningful participation in developing, monitoring, and evaluating laws, policies, and programs that may impact their right to health. A genuine opportunity to influence decisions related to their health equity must be available locally, regionally, and nationally for everyday citizens, non-citizens, and civil society organizations. For example, a discussion draft of the FCGH includes a section on Participation that could contribute to accomplishing this. Other organizations, such as the National Issues Forum (NIF) can partner with and develop local town and district health committees and working groups that include members of the public. There are plenty of options available that elected U.S. public representatives can utilize to empower their constituents. However, provisions in federal health legislation must be developed to enforce this participation, such as requiring a certain number or percentage of people from various jurisdiction to participate before laws affecting the right to can become enacted or providing funding to enable these participation opportunities. An FCGH can assist and advise on the best way to bring about this accountability and participation for each country, in this case, the United States. But for a treaty like the FCGH to be successful in the United States, Americans must be informed enough to accept it and put pressure on their elected representatives to support it. I see the FCGH Alliance as a partnership that can help Americans become more educated on health policy and their rights and cause this pressure to mount. In an effort to help move toward health equity in the U.S. through getting information to the American people, I have recently published a book to help close the gap of the health system illiteracy. This book aims to provide a snapshot of the core dialogue taking place in our healthcare system and provides a moral argument for health equity. I provide evidence showing how health inequity is the basis of the United States health system’s problems and the need for accountability and citizen participation as a requirement for any lasting change to happen. My book aims to provide a path for social empowerment for the often powerless American healthcare consumer. The balance of profit and social justice is a true dilemma in the U.S. healthcare system and leads to a level of inequality that is unconscionable. Its commodity-based system forces leaders of health organizations to be motivated by money, deterring them from the mission of caring for the sick and injured, promoting prevention, and keeping people healthy. For example, healthcare is unaffordable and inaccessible for many, yet executives of these companies take home salaries at the amount of millions of dollars. And many legislators make decisions that decrease coverage instead of increasing it, making healthcare more expensive for people, even while high compensation for executives continues. This commodity-based system has put incentives in the wrong places, compromising health justice. Implementing an FCGH in the U.S. would include catalyzing a domestic health financing and accountability framework that would protect limited resources for healthcare by demanding increased transparency and combating corruption through pathways such as improved resource allocation disclosure requirements and better enforcement of standards to ensure accountability for any misuse of public health resources. Moving to a system where the incentives change and the priorities shift to include everyone, will move us towards health justice. What a government prioritizes and spends its money on defines what is important to it, and extending access to quality healthcare to everyone has never been made a bi-partisan priority in the United States. One of the biggest issues in the U.S. healthcare system is not the lack of money for universal health coverage but how limited healthcare dollars are being spent. The U.S. is already paying what other countries pay for universal health coverage—except the U.S. doesn’t have it. Instead its current largely privatized and fragmented commodity-based healthcare system costs more than public healthcare for other countries around the world. It bears repeating: the U.S. is already paying for the cost of Universal Health Care and then some. An FCGH would provide legal backing in negotiating laws and policies that provide non-discriminatory healthcare to all, a long-standing global public health goal, and help elected public officials push back against policies that do the opposite through clear requirements for equitable distribution. Society suffers injustice when not everyone gets to share in the benefits and when distributions of resources are not equal. When health equity is compromised, health disparities shade society with injustice, which is the unfortunate reality in the United States. For example, 21% of non-elderly Hispanic people are uninsured, while only 8% of whites are. Additionally, babies born to black women with professional degrees are about three times more likely to die than babies born to white women with only a high school diploma or its equivalent. The FCGH shall be the foundation upon which marginalized communities in the U.S., such as people of color and low-income individuals, who have long been discriminated against and excluded from decision-making, will be ensured of avenues to demand their right to health and justice. No matter what our circumstance, environment, or influence, we are human, and basic rights for everyone in all positions of society must be observed to truly live in a moral, ethical, and just society. I am encouraged by the mission of the FCGH Alliance and its vision towards a more just society that ensures the right to health for all people by addressing health injustice through governmental accountability and citizen awareness and participation.
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After many years of working in various disciplines and industry sectors, none as a therapist, Kat is willing to tackle life's biggest (and smallest) personal questions. Email Kat your questions. _________________________ Kat, My little sister is 17 years old, a senior in high school, and dating a boy for about a year now who she has trust issues with. He seems to be a pretty good kid and really likes her, yet she always finds reasons to be upset with him, and in return, she is constantly unhappy. For example, she gets upset when she looks at his phone and finds him looking at Facebook pages of female friends they both go to school with, or when he talks with other girls in his classes. I love it that she comes to me for advice, but I am out of ideas of what to tell her as she seems to be going in the same circles, and changes nothing in her thinking, as the boy really hasn't given her any real good reason to worry. I hate seeing her unhappy her senior year, and would like for her to enjoy these times in her life as we both know it’s over quickly. -The Big Sister ************** Sis, Trust is not something that comes easily at a young age, it takes us into our adult years to really get an understanding of what trust is all about, and even for adults this can be hard. What makes it more complicated are the individual circumstances your sister has been in. Does she have trust issues with her parents? Was she abused as a child? Has she had prior boyfriends that she has caught cheating? Has she been abandoned by other authority figures in her life? What kind of baggage is she dealing with that’s making trust difficult for her? Some other questions to ask can be, is she overweight? Does she have bad acne, or an embarrassing scar? Self-conscious issues, especially in high school, can be very difficult for female teens especially. Your best bet is to be there for her to vent and not always try to fix. When you do try to fix, analyze what is the root cause, because usually it’s always some type of inner personal wound. Then work on that with her, by having her aware of it. She may or may not be able to do so quickly, so tell her to take it easy on herself. Trust will take time to learn. And without all doubt, remind her that if her man is cheating, she will eventually find out, and usually pretty quickly in high school. Lastly, she is a senior, which is a good distraction from everyday teen high school issues. Get her excited for prom, graduation, college, and the like. Good luck and trust that your sister is experiencing what she needs to in order to handle something properly in the future. -Kat Ask Kat Advice Column
After many years of working in various disciplines and industry sectors, none as a therapist, Kat is willing to tackle life's biggest (and smallest) personal questions. Email Kat your questions. _________________________ Hi Kat, When is it "TOO LONG" to wait on a relationship with someone you know and see all the time to actually begin? -Layden ************** Hey Layden, Relationships do not begin until there is awareness and acknowledgement from both sides. Unless there is an understanding between you both that a relationship should begin, then it will never happen. I am wondering if the question here is regarding a friendly relationship, or an intimate one. It is a different story to some degree depending on which one that is, but for the most part, a few things come to mind that can support both. A few questions however… Are you already friends? If so then this makes it easier to know if a mutual understanding exists. Have you not talked with this person yet? If so, then you must initiate conversation. Depending on how that goes, you can deduce if a relationship should begin. Talking with someone, either the first time or not, is a very special bond between two people. Cultures establish speech and language as a way to communicate and create that special connection. With that, you should be able to pick up body language, or tone, to know if someone wants to welcome you as a friend, or as intimate. Typically, relationships that begin as friends are better in the long term because you know each other on a different level before getting intimate, allowing you to determine better if intimacy should occur. If it never does, no need to worry, it’s either not time yet or never will be. So don’t wait around on someone and keep from experiencing life because of it. Instead trust it will happen if was meant to be. In the meantime, start a conversation if you haven’t already and spend some time with the other person with no expectations. -Kat Ask Kat Advice ColumnAfter many years of working in various disciplines and industry sectors, none as a therapist, Kat is willing to tackle life's biggest (and smallest) personal questions. Email Kat your questions. ______________________________
Dear Kat, My daughter’s doctor suggests birth control pills to assist with her acne and heavy periods. She is 16 years old and I am afraid that putting her on the pill will give her the “go ahead” to have sex. Although I want to help her with her medical issues, I am being a paranoid parent. What are your thoughts? -Traci ************* Hi Traci! It seems to be very common for doctors to prescribe birth control to teens for these medical issues. I suggest calling the birth control pills by its medical name, Estrogen or Mestranol for example, instead of referring to them as “birth control pills.” Then when she is taking them daily, have conversations with her about the purpose of its treatment, asking her how she is feeling with her periods, comment on her acne clearing up, etc. Perhaps staying away from the contraception aspect of the drug and focusing on the medical necessity of it may help get her mind in the right place about its purpose for her at that moment. However, having the “sex” conversation with your daughter regularly is extremely important to do when they become teens, and hopefully you have already opened that door. If you haven’t, do so as soon as possible and emphasize condoms, not birth control pills, as the most important aspect of a safe sexual relationship. I am personally not a fan of abstinence due to the fact that having sexual attraction to another human being is natural to our physiology, but if that is a big part of your culture, faith, and spirituality, by all means make that the most important part of the “sex” conversation. Hope she feels better soon! -Kat Ask Kat Advice Column
After many years of working in various disciplines and industry sectors, none as a therapist, Kat is willing to tackle life's biggest (and smallest) personal questions. Email Kat your questions. _________________________ Kat, I keep going in circles with paying off my debt and it is keeping me from being able to save. What’s the best approach to take so that I can finally save and be able to invest in a house? -Tinley ************** Hey Tinley, A college I went to allowed tables all over campus that enticed students to sign up for credit cards. I fell for the free swag and racked up debt that messed up my credit. It took me many years to get my number out of the hole. It was hard to pay off credit card debt when trying to save, but it was the best action to take in the long run. Get rid of credit card debt as fast as you can. It is the fastest way to save money, as you no longer are paying interest, and most likely pretty high interest rates at that. After credit card debt is paid, try your best to keep balances off of them and if you do add a balance, pay if off in full before the next payment is due. Yes, that means living within your means. This is only temporary, once they are paid off you more disposable income. By the way, if you do payoff a credit card and plan not to use it except in emergencies, contact the company and tell them. They will stop any fees, such as annual fees, until you use the card. Otherwise you may be in for a surprise three months down the road when you get a statement with a balance for a card you haven’t used in months. For loans, I find paying a little bit more on every payment can help reduce the principle, thereby reducing the overall amount of interest paid. This would pertain to most, but not all, car loans, mortgages, student loans, etc. The debt has to be paid eventually, and the sooner it can be gone, the better. The easiest way to put money back in your pocket is to eliminate or reduce interest payments overall. Paying interest is wasted money. Sometimes we have to pay interest and that’s ok, but the amount that’s paid is the kicker. The less interest to pay, the less you’re wasting. Reducing the amount of interest, you pay monthly is a long-term investment to your financial well-being because it heals our credit scores, which lower interest rates with future loans, when needed. Thereby saving money in future too. Eventually we will wean ourselves into living within our means and not needing credit (emergencies do not count). The next goal then is to save three months of expenses… that’s a whole other beast! Good luck! -Kat |
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