Being poor and sick in America

This apocryphal story about a cancer patient was written prior to Obamacare (appeared in the Norwalk Patch).

I will never forget the first time I heard her voice in the university hallways. “Are you from Cape Town?,” she asked. I stopped momentarily, because that familiar-sounding accent brought back a flood of memories about South Africa. When I turned around, I saw a tall, middle-aged lady with a smile, reminiscent of the African sunshine in my former homeland, beaming at me. This was the beginning of a decade-long friendship between two lost souls in the heart of Manhattan. I quickly learned that Lady M., as I will call her, had been through a lot of ups and downs in her life. She had been diagnosed with an insidious oral cancer that eventually required surgical removal of part of her tongue, rendering her sounding like a female version of Scrooge McDuck. Lady M. did not let her condition get the better of her. She became a mother figure, who dispensed advice along with recipes for how to make tarts and stews based on the produce on offer at Jack’s World and other cheap emporiums in Manhattan. Visits at Lady M’s place were filled with laughter, stories and trips to the local bodegas to search for the Hispanic equivalent of South African staples such as Marie biscuits (a cookie with a hint of vanilla, best consumed with tea) and Milo (a Nestlé chocolate and malt powder product that we liked). She showed me tokens of her youth as a South African lass born to Scottish parents. I learned about the influence of friends on her formative years and about how she had cared for her aging parents before emigrating here.

While her cancer was in remission, we could both ignore the elephant in the room. In many respects, Lady M’s story was similar to those of others in households all over New York; however, she faced the added burden of being poor and without health insurance in a country that regards this item as a benefit and not a necessity. The first sign that her cancer had returned was marked by slurred speech and pain in her jaw. After finally securing insurance and consolidating her medical records from various institutions, experts confirmed her worst fears. The cancer had spread and this time it would be fatal. It was ironic that she was the one that ended up comforting the few people that knew her. Lady M quietly started preparing for her own death. She withdrew from the few friends that still kept in contact with her. Gradually her speech became incomprehensible. People would automatically assume that she had a mental disability when she spoke to them. So she learned to get by with a pen and paper.

And then she died, not registering a blip on the radar of thousands of passers-by in the busy city. In reality, dying of cancer is not as sanguine as euphemistically portrayed on television. People are not always fortunate to be surrounded by loving families or live in fancy houses. Sometimes people fight, because they want to live or they have someone waiting for them. Sometimes people are poor, they have no one and in the end the fight against bureaucracy and to improve the quality of their lives prove be overwhelming. I salute those people. May their struggles remind us of the human component of the financial equation in the search for effective, affordable healthcare for all citizens.

The great jobless economic recovery

In May 2016 the American unemployment rate was 4.7% and the consumer price index rose by 0.2%, building on an increase noted in April. This would be cause for celebration if one overlooks another number, the proportion of Americans participating in the labor force, which stands at 62.6%. According to The Economic Policy Institute’s flagship publication, “The State of Working America,” this country’s low- and middle-income families have suffered a lost decade, in which the median family income was 6% lower in 2010 compared with 2000. Despite a 22% increase in productivity, typical wage-earners made about the same amount per hour as in 2000. While the bottom 60% suffered a decline in wealth, almost three-quarters of the wealth went to the top 5% between 1983–2010. In fact, if one looks back over a span of more than a decade, productivity grew 69% and wages grew just 7%.
Once upon a time, if you went to college, worked hard and paid your dues you were virtually guaranteed the American Dream. There was an inextricable link between hard work, economic growth and falling poverty. Today that is no longer true. Over 46 million Americans live in poverty, according to 2010 statistics. More than half of them were African-American or Hispanic. Nearly half of black children under the age of 6 years old lived in poverty compared to 14.5% of white children. Digging deeper into the numbers, 44.3% of poor people are in deep poverty (living on half or less of the official poverty line; this deep-poverty threshold stood at $11,057 in 2010 for a family of four). This number could in fact be higher, since experts think that the official estimates understate the number of actual people living in poverty. In their book, “$2.00 a Day: Living on Almost Nothing in America,” Kathryn Edin and Luke Shaefer, noted that nearly 1.5 million Americans lived on $2 a day, including about 3 million children.
Changing racial compositions, code words for immigration or instability in some political quarters, account for only a 0.9 percentage-point increase in poverty rates, according to the Economic Policy Institute study spanning the 1979–2007 period. The most significant contributor, income inequality, contributed 5.5 percentage points to increased poverty rates. The Pew Research Center’s recent analysis on the shrinking middle class builds on this theme, while a brief from the UC Berkeley Labor Center fills in the details on declining manufacturing wages and the proliferation of temporary staffing agencies in this document: Producing Poverty: The Public Cost of Low-Wage Production Jobs in Manufacturing. When a day’s wages can no longer feed your family, the default action is to rely on government programs such as Medicaid and food stamps, to survive.

In addition, the 2009 median age of an American was 36.8 years old, with researchers agreeing that the country is becoming a nation of older people. In an evolving job market, where sought-after skills in green energy and engineering may be the prerogative of a select group of highly-educated younger people and, yes, immigrants, room will have to be found at the table for these older Americans. This means foregoing the piece-meal block grant approach, dreaming of transforming everyone into entrepeneurs and facilitating a long overdue inter-generational conversation on what it would take to match existing skills to available/new jobs and ultimately steer the economic ship back into clear waters of progress.

So the systemic economic issues plus or minus security/nationalism/radicalism/jihadism/-fill in any other -ism are here to stay and will not disappear through rhetoric alone. Is anyone listening?

Poverty in the United States

Happy Mandela Day to all the readers. In keeping with the spirit of Madiba, today is meant to be a time to share your expertise or volunteer to improve the lives of others. This is especially the case for the 45.3 million people (many of them are children) currently living in poverty in the United States. Poverty can be described in absolute terms by citing federal poverty level guidelines for 2015 ($15,930 for a family of two; try living on that amount of money as a single person in New York City) or by comparing income between different groups. In the case of women, a recent Huffington Post article cited a report that retired women are twice as poor as retired men for a litany of familiar reasons. Together with a 2012 Infographic about Poverty by the Numbers in the USA, an image crystallizes of a country where we have much to be thankful for, but where much remains to be done.

Being poor and sick in America

This post, which first appeared in the pre-Obamacare days in the Norwalk Patch, still resonates with me today. I miss my friend and dedicate this post to her.

I will never forget the first time I heard her voice in the university hallways. “Are you from Cape Town?,” she asked. I stopped momentarily, because that familiar-sounding accent brought back a flood of memories about South Africa. When I turned around, I saw a tall, middle-aged lady with a smile, reminiscent of the African sunshine in my former homeland, beaming at me. This was the beginning of a decade-long friendship between two lost souls in the heart of Manhattan. I quickly learned that Lady M., as I will call her, had been through a lot of ups and downs in her life. She had been diagnosed with an insidious oral cancer that eventually required surgical removal of part of her tongue, rendering her sounding like a female version of Scrooge McDuck. Lady M. did not let her condition get the better of her. She became a mother figure, who dispensed advice along with recipes for how to make tarts and stews based on the produce on offer at Jack’s World and other cheap emporiums in Manhattan. Visits at Lady M’s place were filled with laughter, stories and trips to the local bodegas to search for the Hispanic equivalent of South African staples such as Marie biscuits (a cookie with a hint of vanilla, best consumed with tea) and Milo (a Nestlé chocolate and malt powder product that we liked). She showed me tokens of her youth as a South African lass born to Scottish parents. I learned about the influence of friends on her formative years and about how she had cared for her aging parents before emigrating here.

While her cancer was in remission, we could both ignore the elephant in the room. In many respects, Lady M’s story was similar to those of others in households all over New York; however, she faced the added burden of being poor and without health insurance in a country that regards this item as a benefit and not a necessity. The first sign that her cancer had returned was marked by slurred speech and pain in her jaw. After finally securing insurance and consolidating her medical records from various institutions, experts confirmed her worst fears. The cancer had spread and this time it would be fatal. It was ironic that she was the one that ended up comforting the few people that knew her. Lady M quietly started preparing for her own death. She withdrew from the few friends that still kept in contact with her. Gradually her speech became incomprehensible. People would automatically assume that she had a mental disability when she spoke to them. So she learned to get by with a pen and paper.

And then she died, not registering a blip on the radar of thousands of passers-by in the busy city. In reality, dying of cancer is not as sanguine as euphemistically portrayed on television. People are not always fortunate to be surrounded by loving families or live in fancy houses. Sometimes people fight, because they want to live or they have someone waiting for them. Sometimes people are poor, they have no one and in the end the fight against bureaucracy and to improve the quality of their lives prove be overwhelming. I salute those people. May their struggles remind us of the human component of the financial equation in the search for effective, affordable healthcare for all citizens.

Children are our future (first appeared in The Norwalk Patch)

Children are the poorest age group in the country, according to the Children’s Defense Fund. Nearly 22% of all US children live in families with incomes below the federal poverty level– $23,550 a year for a family of four. Current and future health risks are greatest for children who experience poverty when they are young and/or when they experience persistent poverty, according to several reports. Where do these dismal trends fit into the national dialogue about building a healthier America?

According to the Robert Wood Johnson Foundation’s (RWJF) 2014 report, improving the health of all Americans should start with an investment “in the foundations of lifelong physical and mental well-being in our youngest children.” Investing in the very young fosters success in later life and may reverse the negative health consequences of prolonged exposure to adversity (e.g. the Adverse Childhood Experiencesstudy was among the first investigations to report a strong link between adverse early childhood experiences and conditions such as depression, addiction, diabetes, and heart disease). Support for vulnerable young children should therefore be a national health priority. The building blocks for a lifetime of good health should include education and “direct interventions designed to improve health and protect the developing brain from significant adversity that can lead to illness.” Health initiatives may include strategies to decrease widespread childhood obesity– a key risk factor for numerous chronic conditions. The New England Journal of Medicine reported that” incident obesity between the ages of 5 and 14 years was more likely to have occurred at younger ages, primarily among children who had entered kindergarten overweight [1].”

The RWJF report focused on factors that must be addressed in order to prevent the United States from slipping even lower than its 2009 ranking of 27th place in terms of life expectancy at birth (out of 34 of the world’s affluent countries). The recommendations are:

1.       Make investing in America’s youngest children a high priority

2.       Fundamentally change how we revitalize neighborhoods, fully integrating health into community development

3.       The nation must take a much more health-focused approach to health care financing and delivery. Broaden the mindset, mission, and incentives for health professionals and health care institutions beyond treating illness to helping people lead healthy lives

The health and educational rewards of meeting the first objective are currently being measured in different states. For instance, a longitudinal study (2006-7) of the outcomes associated with 3 cohorts of 4-year olds in 11 Utah schools most impacted by poverty, showed that at-risk children (who attended high quality preschool programs) used special education services at significantly reduced rates compared with those who did not receive high-quality early tuition (cost savings of about $1 million). Moreover, the SY06-07 Preschool Cohort had closed the achievement gap by the 3rd grade. Social impact investments, along the lines of the Early Childhood Innovation Accelerator, could increase the access, availability, and quality of early childhood programs for disadvantaged children. The aim of the Accelerator is to “rapidly increase the availability of high-quality early childhood learning opportunities, while building measurable successes backed by evidence, accountability and results.”

The priorities for meeting all the health objectives were summarized in a recent Google hangout and the full report of the RWJF commission can be viewed here.

Reference

1.    Cunningham, S.A., M.R. Kramer, and K.M.V. Narayan, Incidence of Childhood Obesity in the United States. New England Journal of Medicine, 2014. 370(5): p. 403-411.

The importance of literacy for peace and empowerment (and the impact of women)

An infographic from UNESCO (Institute for Statistics) spells out the importance of literacy for peace, development, poverty eradication, empowerment, health, and gender equality.  Approximately 776 million people in the world are still nor able to read or write. The situation is especially dire in the Muslim world, according to one report: 40% of Muslim world’s population unable to read or write: Study Thirty countries participating in the study reported that gender parity for adult literacy is estimated to be achieved in 2015. However, much more remains to be done. Dr. Bruce Wydick’s (University of San Francisco) infographic shows the ripple effect of educating girls in poverty.

female-literacy-infographic-large