Archive for September, 2009

The dilemma in human rights work: when are service delivery, capacity building, advocacy and social mobilization really empowering?

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Disclaimer: i) The empowerment of some entails the dis-empowerment of others –usually the current holders of power. ii) Empowering people can well trigger repressive actions by these current holders of power.

Empowerment is a continuous process; it provides people with choices and the ability to choose; it expands the ‘political-manouvering-space’ in and of a community.
1. In the delivery of services, empowering means, or is, or are actions that tend towards:
  • Making sure the provision of services is gender-sensitive and culture-sensitive.
  • Using existing local human resources.
  • De-facto incorporating community representatives in the decision- making process about the services to be or already being delivered.
  • Basing the training of staff importantly on the Human Rights Framework; making training competence-based and in-service, and aiming it at behavioral change, as well as always following training up with regular support supervision.
  • Making sure beneficiaries cease to be passive recipients of services and demand responsibility for themselves; for this, they need to get trained in human rights (HR) and to take an active role in both the decision-making process and in the delivery mechanisms (including management issues).
2. In capacity building, empowering means, or is, or are actions that tend towards:
  • Through the use of the HR Framework, enabling individuals/communities to continuously upgrade their ability to analyze and understand their situation, i.e., people themselves collecting, interpreting and using information for action.
  • Also sharing with them the Conceptual Framework of the causes of their problems that categorizes these causes by level, i.e., immediate, underlying and basic/structural causes.
  • Exposing people to relevant information, especially about the UN HR covenants that guarantee their rights, about international HR law and about the real causes behind their problems.  (Includes warning people about the ‘misinformation’ they are exposed-to so as to replace it).
  • Raising people’s social and political consciousness so that their claims are legitimized.
  • Changing people’s perception of their potential to forge a new reality where HR become a way of life.
  • Increasing people’s awareness of what in the prevailing social system is ‘unfair’ to them.
  • Building growing networks and constituencies for the spread of people’s rights-based strategies.
  • Emphasizing the provision of practical skills that lead to community ownership of the interventions undertaken.
  • Giving high priority to overall literacy and to HR literacy, especially for women and girls.
  • Boosting women’s negotiation capabilities and thus their self-confidence.
  • Raising consciousness about the natural environment (i.e., “the rights of nature or Earth Rights”).
  • Emphasizing the training of local leaders; teaching  them to carry out HR impact assessments and social and political mappings that point to the current power structure in the control of resources; teaching them to carry out decision audits (about who currently makes what decisions). [For example, they need to find out who decides what training is given to community animators/’validators’ that are supposed to  act as our local strategic allies to introduce the HR Framework in the community].
  • Giving people a better income capacity by creating new  employment opportunities and democratizing access to credit, as well as setting up income generation activities for women.
  • Providing people with access to available support systems including the capacity to seek redress when denouncing HR violations to appropriate and relevant existing bodies.
  • Building the ‘mental preparedness’ for social mobilization, i.e., preparing people to press-on with needed claiming, needed advocacy and effective lobbying.
3. In advocacy, empowering means, or is, or are actions that tend towards:
  • Using the appropriate persuading methods when dealing with duty-bearers at different levels.
  • Increasing people’s de-facto claims to demand access to quality services.
  • Emphasizing work on measures to eradicate poverty. (what we are really talking about here is ‘disparity reduction measures’).
  • Going all-out to demand more economic justice and making every effort to decrease the skewedness in the distribution of income and wealth.
  • Advancing actions that decrease the workload of women and give them options for birth spacing.
  • Promoting the shifting of the explicit control of resources more to women.
  • Promoting a more local control of resources.
  • Addressing minority equity issues, including those of migrants.
  • Demanding active people’s participation in informed decision-making.
  • Raising people’s consciousness about what their HR are and translating them into specific claims.
4. In social mobilization, empowering means, or is, or are actions that tend towards:
  • Going from people’s felt needs to concrete demands and from these to making specific claims so they can actively struggle for their rights (i.e., mobilizing their social power).
  • Mobilizing people’s own resources as needed.
  • Organizing people to effectively use and progressively control external resources.
  • Networking with others to achieve a critical mass of concerned people (locally and externally) and, in the process, building coalitions.
  • Collectively identifying the problems at hand, placing them in the Conceptual Framework of Causality, and searching for the best solutions for implementation at the three (immediate, underlying and basic) levels. [Acting at one level or at one main cause only may be considered necessary, but is NOT sufficient].
  • Giving people power over decisions thus increasing their self-esteem and self-confidence.
  • Increasing local democracy, with people (especially women) participating more actively and vocally in local government.
  • Decentralizing decision-making, including shifting control of finances to the local sphere, i.e., a genuine devolution of power.
5. Here, then, you have a non-exhaustive list of the challenges you face when  you, sometimes lightly, speak about empowering the people and groups you work with. You can use it as a preliminary checklist…
Claudio Schuftan, Ho Chhi Minh City
cschuftan@phmovement.org
[The full set of Human Rights Readers can be found at www.humaninfo.org/aviva under No. 69]

How long are the waiting lines with U.S. health care?

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The answer of course is “we don’t have a clue”. Whose waiting lines? Those under which of the thousands of insurance plans and sub-plans? Or under which of the many taxpayer-funded plans that fill the gaps for the “bad customers” shunned by for profit insurers?

A recent study conducted by Harvard researchers offered a tentative answer: it showed that at least 45, 000 Americans each year (or 123 per day, or 5 per hour) do not even show up in the lines — they have no health insurance, and die for that reason. Of course now the “debate” has become how “accurate” these numbers are. But even a few hundred, or even a few thousand, less than that is still too many! And so are the 900,000 individuals per year (or 2,465 per day, 1,850 among whom had health insurance) who file for bankruptcy for medical reasons.

And yet, as I have argued elsewhere, the uninsured are not the “disease”, but the “symptom” of a truly, truly sick system built on the idea of a “competitive marketplace”  that offers “choice of plans” (which of course offers no true competition or meaningful choice to millions of Americans who are stuck with what they get through their jobs, if they get anything at all).

Europeans, Canadians and Taiwanese scratch their head in disbelief. But for some reasons our legislators do not (maybe they are ‘health care secure”, courtesy of taxpayer-subsidized policies? Maybe the answer lies in the very generous campaign contributions received from interested parties, particularly if they are sitting in the Senate Finance Committee).

 

To the point that the proposals coming out of Washington suggest that they will fix the mess with ‘more of the same’, that is, forcing us to buy a product (and making it illegal not to do so) that has repeatedly shown to be defective (for profit health insurance policies). And this product will be sold in a system built on the false assumption that health care behaves like a market commodity, no different from shoes or cell phone plans. (And, can you imagine a system of fire departments where “for profit fire-workers” competed for “clients” against “government-financed” fire-workers, or even “co-ops” of fire-workers…? The bad thinking knows no limit…).

But some legislative battles have been won (Kucinich and Weiner amendments). And we can still advocate for Medicare for All. The perfect public-private partnership, publicly-financed, privately delivered health care, built upon what works, here and elsewhere.

Honoring George Tiller by Improving Access to Reproductive Health Services

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Last Tuesday’s Social Medicine Rounds (9/8/2009) was prompted by the brutal murder of family physician George Tiller on Sunday May 31st 2009. While serving as an usher at the Reformation Lutheran Church in Wichita,  Dr. Tiller was shot in the head and killed.  We convened this Rounds to consider how we might respond to his death. Two issues dominated the discussion. The first was the failure of the American Academy of Family Physicians (AAFP) to condemn the murder.  The second was an examination of the ongoing barriers to abortion care that exist even in a relatively progressive state such as New York.  These problems were illustrated through 3 case vignettes.

The Death of Dr. Tiller

Dr. Tiller’s career as a family physician took a path he did not anticipate.  Like many conscientious physicians, his clinical practice responded to the needs of his patients.  Here is the story told in his own words (taken from the Physicians Voices section of the Physicians for Reproductive Choice and Health website):

In July of 1970, I planned to start a dermatology residency. On August 21, 1970, my father, mother, sister and brother-in-law were killed in an aircraft accident. My sister had a 12-month-old boy, Maurice. They had written out a will in longhand the evening before the airplane crash, that I was to raise Maurice. So we took charge of my sister’s boy and we moved back to Wichita. My game plan was to spend six months here, close out my father’s huge family medicine practice.

After I had been there for a little while, patients in the practice began to ask me if I was going to do abortions like my father did. I was outraged. Why would these nice people say that he was a scumbag kind of a physician?

I began to ask some of these women. And I found out that in 1945, ’46, or ’47, a young woman for whom Dad had already delivered two babies came to him pregnant again right away, and she said something to the effect that, “I can’t take it, can you help me?” That is apparently the way you asked for an abortion from your regular doctor before abortion was legal. Dad said, “No. Big families are in vogue, by the time the baby gets here, everything will be all right.” She had a non-healthcare provider abortion and came back and died.

I can understand how upset my father was. I do not know whether he did 100 abortions or 200 abortions or 300 abortions. I think it may have been something like 200 over a period of about 20 years, but I don’t know for sure. The women in my father’s practice for whom he did abortions educated me and taught me that abortion is about women’s hopes, dreams, potential, the rest of their lives. Abortion is a matter of survival for women.

When it became legal and my patients began to ask for it, I’d say, “Sure. It’s a legal process.” I was a service provider. I was a physician. The patients needed abortions, and I did them. It is my fundamental philosophy that patients are emotionally, mentally, morally, spiritually and physically competent to struggle with complex health issues and come to decisions that are appropriate for them.

We’ve been picketed since 1975. My office has been blown up. In 1993, I survived an assassination attempt. My kids were harassed in high school. I had to write letters of complaint to the City Council and the Board of Education. We had people who actually camped across the street from our house. I restrict where I go to eat, where I travel. You see a car following you, you think, “Ah-ha, let’s watch that.” You’re always on alert. You’re always looking around.

I was leaving the office. It was 7:00 in the evening. As I’m driving out, I have to slow down and I have to stop. Bang, bang, bang, bang, bang, bang, and I thought to myself, “That lady is shooting me with rubber bullets. I’m not afraid of rubber bullets.” Then I looked down and all this blood is all over the place. I thought, “She shot me. She can’t do that! I’ll get her.” I saw her running through some front yards. So I zipped down the street, turned in front of her to block her escape. She stops and reaches into this little fanny pack that she’s wearing in the front, and I thought, “She’s going for her gun again. She shot you once, George. She’ll shoot you again. You are in the wrong place at the wrong time.”

So then I drove off. Ended up back at the office, and I don’t remember anything for about 20 minutes. I remember trying to get into my car and drive myself to the hospital. I said, “Let’s not make this a big media event.” Well, I had lost 20 minutes and the TV trucks were there. I thought, “How’d they’d get here so soon?”

There was never any question in my mind that I was going back to work the next day. I belonged there and they were not going to separate me from my job and they were not going to separate me from my community. So I did go to work the next day, and we got everything done. People got taken care of, it took a long time. Arms hurt, bled a little bit, but so what? I am not going to be run over and I’m not going to run out. It’s just that simple.

I am a member of this community. Our DNA has been here since 1880. I belong here. The folks that come in from out of town, they are the intruders. Forty percent of all the people who were arrested here during the Operation Rescue in 1991 came from out of state. I intend to stay here. I am part of the fabric of Kansas and Kansas is part of the fabric of me.

I have more to be grateful for than I have to be resentful about. We have much more support in Wichita than we have rejection and castigation. If Wichita and our community did not want us to be here, I wouldn’t be here. But the vast majority of people in Wichita support, on a quiet level, what we do, which is help women and families.

Extensive coverage of the murder can be seen in this June 1, 2009 broadcast of Democracy Now.  This program includes an excerpt from a 2008 speech Dr. Tiller gave to the Feminist Majority Foundation in which he explained his social vision: “We’ve given war, pestilence, hate, greed, judgment, ego, self-sufficiency a good try, and it failed. We need a new paradigm that consists of kindness, courtesy, justice, love and respect in all our relationships.”

Non-Response of the American Academy of Family Physicians

Tiller’s death was clearly not a random act of violence.  As noted by Colorado physician Dr. Warren Hern:

I think it’s the inevitable consequence of more than 35 years of constant anti-abortion terrorism, harassment and violence. George is the fifth American doctor to be assassinated. I get messages from these people saying, ‘Don’t bother wearing a bulletproof vest, we’re going for a head shot.’

Tiller’s death was condemned in the strongest terms by American College of Obstetricians and Gynecologists:

The American College of Obstetricians and Gynecologists (ACOG) finds the murder of George Tiller, MD, deplorable and tragic. There is no excuse, no explanation, and no justification for this brutal slaying of a courageous and honorable physician who provided safe and legal reproductive health care to women who otherwise might not have received it. It is especially chilling and deeply disturbing that this violence has occurred at a time when the leaders of this country are committed to finding a common ground in the abortion debate.

ACOG extends its sympathy to the family of this dedicated physician who treated his patients with dignity and compassion.

As ACOG expressed in response to the 1998 murder of Dr. Barnett A. Slepian, “With each new incident of anti-abortion violence, the previously unthinkable becomes commonplace—that vandalism could turn to murder, that slayings could move from the clinic to inside the home.” The murder of Dr. George Tiller is even more horrific in that he was killed in a house of worship as he and his family attended church services.

There is no common ground when it comes to violence of this nature. All groups in the abortion debate, whatever their personal opinion on abortion, must condemn such brutality in the strongest possible terms. Failure to make such condemnation is acquiescence to violence and intimidation. Only by standing together can we ensure that acts of brutality end.

In fact, even some anti-abortion groups condemned the killing. Here are the words of Troy Newman of Operation Rescue from a June 3, 2009 editorial in USA Today:

The fundamental tenet of the pro-life movement is that human life has intrinsic value and is deserving of protection from the moment the seed and egg unite, until natural death. To take a life without due process devalues all life.

We at Operation Rescue were shocked to hear of the killing of late-term abortionist George Tiller and were among the first groups to denounce the cowardly act that took Tiller’s life. It was not justice, but vigilantism, which must be abhorred by a society that embraces the rule of law over anarchy.

With even the anti-abortion movement condemning the murder, how odd it seems that the American Academy of Family Physicians (Working for Family Medicine,  Working for You), of which Tiller was a member, refused to issue a statement.  A strongly critical commentary by Dr. Joshua Freeman (The Murder of George Tiller – Where is Family Medicine’s Response) in this month’s Family Medicine explored the reasons cited by the Academy for this refusal.  The AAFP pointed to a policy that it “does not comment publicly on a member’s death (regardless of how it occurred) but expresses condolences privately to the family.”  Of course George Tiller did not merely die.  He was murdered.  He was not simply murdered.  He was assassinated for carrying out his duties as a physician.  One cannot help but remember the comments of ACOG:

All groups in the abortion debate, whatever their personal opinion on abortion, must condemn such brutality in the strongest possible terms. Failure to make such condemnation is acquiescence to violence and intimidation.

Several State Chapters of the AAFP have introduced Resolutions condemning the murder to be considered at the next Congress of Delegates.  Truly, AAFP’s silence on this issue shames family medicine.

Barriers to Abortion Access in New York: 3 case studies

We then considered three case scenarios illustrating the barriers to abortion access in New York  State.  Each case came with a series of discussion points.  One point, considered in each of the cases, was the role of abortion in current health care reform proposals.  (All identifying information has been removed or altered in these cases).

Case 1: Teresa is a 22 year old woman, G1P1, who comes to your office for a refill of her Nuva-Ring. She reports that she had actually run out 4 weeks ago, but couldn’t afford the time off from work at the Post Office to get in any sooner.  She had unprotected sex 2 weeks ago.  Her pregnancy test is now positive. Teresa is sure she cannot afford to have another baby right now. She decides with you to have an abortion.  You give her the number to call Planned Parenthood to schedule it, and she calls you back later to tell you her insurance does not cover the procedure because she is a federal employee.

Discussion Points:

  • The Hyde Amendment bans the use of federal funds for abortions except in cases of life endangerment, rape or incest.
  • In addition, 32 states and the District of Columbia have prohibited the use of their state Medicaid funds for abortions except in limited cases allowed under the Amendment.
  • What is your role as her primary care doctor in facilitating her timely access to abortion care?
  • What are the implications for a universal federal health plan?

Case 2: Angela is a 31 year old woman G6P4, who works as a babysitter “off the books,” and comes to your office because she is pregnant and wants an abortion.  You know that she has Medicaid so you refer her to the local abortion clinic for care.  She calls you the next day to tell you she was denied care because her insurance does not cover abortion. You are confused because in New York Medicaid does cover abortion, so you call the clinic. They tell you that your patient has Fidelis (a Catholic HMO) and Fidelis does not cover abortion care.

Discussion Points:

  • What is your role as her primary care doctor in facilitating her timely access to abortion care?
  • What happens with Medicaid HMO’s that are “owned” by the Catholic Church?
  • What does this mean about how our tax dollars are being spent?
  • Can Angela use her Medicaid to pay for her abortion?
  • Would she be covered by a federal health plan?

Case 3: Monica is a 16 year old woman, G0P0, currently attending Roosevelt High School. She was sent to you by her school-based health center because she had a positive pregnancy test.  Monica’s parents have insurance, but she does not want them to know that she is pregnant.  After talking to you, she decides she would like an abortion.  But she stresses the importance of not letting her parents find out.  She tells you that last year her 18 year old sister got pregnant and they kicked her out of the house.

Discussion points:

  • What are the rules in New York State regarding confidentiality for teens around pregnancy care?
  • Can she get other insurance to pay for her abortion?
  • What are the systems issues around eligibility for Medicaid?
  • What is your role as her primary care doctor in facilitating her access to abortion care?
  • Would she be covered by a federal health plan?

Resources for Women needing Reproductive Services

The Portal has reported extensively on free and low-cost health care as well as free clinics in New York.   The New York City Free Clinic, located on 16th Street in Manhattan, includes a Women’s Health Free Clinic in operation since February of this year.  The list of services provided at the Women’s Health Free Clinic includes Medication Abortion (up to 9 weeks).  It is a project of the Reproductive Health Access Project (RHAP) which offers detailed instructions on setting up free women’s health clinics.

Posted by Matt Anderson, MD

If you want to know what doctors think, don't ask the AMA

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According to a study published on Monday in the New England Journal of Medicine, 63% of doctors support expanding health insurance coverage through both private and public options. NPR reported on this survey with the headline, “poll finds most doctors support public option,” and immediately elicited comment from the American Medical Association, since the organization has equivocated on support of the public option in its public statements, while the study explicitly demonstrated support for the public option among AMA members (62%).

Dr Fox’s diary

Not surprisingly Dr. James Rohack, the president of the AMA (who has previously made confusing comments about his support for the public health insurance option implying that subsidized private plans could be considered a public option), challenged the meaning of the findings, “[the public option] means different things to different people, kind of like the Rorschach ink blot test.” However, his attempts to obfuscate only further emphasize that the official positions of the American Medical Association do not represent the viewpoint of most American doctors (or apparently in some cases even AMA members).

While it is true that there are different versions of the public health insurance option described in the bills coming out of the House, the Senate HELP committee, and the framework envisioned by Jacob Hacker, the findings of this study are not up for interpretation. A Rorschach test is purposefully vague so a clinician can interpret a patients’ psychological state. Conversely, good researchers ask precise questions and describe their methods in detail so that their findings can be reproduced. The reputation and influence of peer reviewed journals, like the New England Journal of Medicine, is dependent on publishing quality research.

In 2003, Ronald Ackerman and Aaron Carroll asked 3188 randomly sampled physicians, “In principle, do you support or oppose government legislation to establish national health insurance?” At that time 49% supported this type of legislation and 40 % opposed.

In 2008, the authors repeated the study, this time with 59% agreeing and only 32% opposing national health insurance. They also asked, “do you support achieving universal coverage through more incremental reform?” 55% supported and 25% opposed this type of proposal.

And now, with the study by Keyhani and Federman we have another question directly relevant to the current health care debate:

Respondents were asked to indicate which of three options they would most strongly support:

  1. Public and Private Options: Provide people under age 65 the choice of enrolling in a new public health insurance plan (like Medicare) or in private plans.
  1. Private Options Only: Provide people with tax credits or low-income subsidies to buy private insurance coverage (without creating a public plan option).
  1. Public Option Only: Eliminate private insurance and cover everyone in a single public plan like Medicare.

63% of doctors chose option #1 – the public and private options. It is not clear to me how Dr. Rohack could be unsure what the public option means in this context. It’s right there in the study’s methods.

These research findings are robust and consistent: doctors support national health insurance (i.e. Single Payer); but when asked specifically about a public health insurance option similar to Medicare and available to everyone below 65, they overwhelmingly support it. There even seems to be a trend developing where a greater percentage of doctors support public health insurance.

The consistency and reliability of the research demonstrating doctors’ support for public health insurance similar to Medicare should relieve us all of the fear mongering around “socialized medicine.” Ironically, conservative politicians fear “government bureaucrats standing in between them and their doctors,” while their doctors do not. The evidence is crystal clear.

Doctors are not afraid of government health insurance bureaucrats, because we already have private insurance companies’ utilization reviewers to contend with. The study’s findings may be a surprise to some, since doctors tend to be conservative as a whole, but the truth is that most doctors are sick of fighting with insurance companies. The average physician spends 43 minutes per day and $65,000 per year on interactions with health plans; there have already been multimillion dollar class action lawsuits against Aetna, Cigna, Humana, Blue Cross Blue Shield, and others for underpaying doctors (among other charges), and ultimately we have yielded too much decision making capacity to managed care companies.

So when we talk about a public health insurance option, we mean a plan modeled on Medicare. We do not mean a co-op; we do not include a trigger option; and we don’t want expansion in coverage limited to public subsidies for private plans. The data is there in black and white – in the shape of a bar graph, not an ink blot.

Aaron Fox, MD

The Last Straw! A Board Game on the Social Determinants of Health

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imagesWe have just learned that The Last Straw! A Board Game on the Social Determinants of Health has been released in an  English/Spanish version [para información en español, veáse abajo].  For readers of the Portal who are not familiar with it, “The Last Straw” is a board game designed to teach about the Social Determinants of Health.

The game was developed in 2004 by Kate Rossiter and Kate Reeve during a health promotion class at the University of Toronto and has won numerous awards.  They designed the game to promote discussion about the social determinants of health, to  help players build empathy with marginalized people and gain awareness of their own social location; and to encourage learning in a fun and supportive environment.

To get a sense of the game, you can watch the training video:

Drs. Rossiter and Reeve have also published two papers about the game:

Rossiter, K., Reeve, K.  “The Last Straw! A Participatory Education Tool About the Social Determinants of Health.” Progress in Community Health Partnerships: Research, Education, and Action. 2(2): 137-144. 2008.

Reeve, K. Rossiter, K., Risdon, C. “Board Game on the Social Determinants of Health.” Medical Education. 42(11): 1125-6. 2008.

The Last Straw website also contains a list of resources for teaching about the social determinants of health.

posted by Matt Anderson, MD

___________________

¡La gota que colmó el vaso! es una herramienta pedagógica divertida y apasionante sobre los determinantes sociales de la salud.

*Para adquirir ¡La gota que colmó el vaso! puede contactar en inglés solamente a **sales@thelaststraw.ca* <sales@thelaststraw.ca>* o llamar en
inglés a Michael Jackel en Fernwood Books al 416-703-3598.*

El juego tiene tres objetivos: • promover la discusión sobre los determinantes sociales de la salud; • ayudar a los jugadores a desarrollar empatía con las personas marginadas y a tomar conciencia de su propia posición social; • estimular el aprendizaje en un entorno divertido y de apoyo.

De acuerdo con las investigaciones actuales sobre los determinantes sociales de la salud, la situación socioeconómica es uno de los principales
determinantes de la salud en este juego, tanto como la raza, el género, la orientación sexual y otros factores.

La retroalimentación demuestra constantemente que los jugadores adquieren una mejor comprensión de los determinantes sociales de la salud y de las
interacciones entre diversas fuerzas a nivel comunitario e individual. Tanto los jugadores como los facilitadores (“Maestros de Juego”) afirman que con
este juego se divierten mucho.

También hemos desarrollado un manual de capacitación y un vídeo en inglés para ayudar a los Maestros de Juego a aprovechar el juego al máximo.

Academic & Health Policy Conference on Correctional Health (December 3-4, 2009)

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The  University of Massachusetts’ Commonwealth Medicine division and Nova Southeastern University’s College of Osteopathic Medicine will be sponsoring their 3rd Annual Academic and Health Policy Conference on Correctional Health from December 3rd and 4th, 2009 in Fort Lauderdale, Florida. This conference focuses on collaborations between academic medical centers and correctional institutions.  This link will take you to a listing of the presentations at last conference.

Correctional health is an area of increasing concern to clinicians as more an more Americans find themselves arrested and behind bars.  In fact, so many Americans are arrested that some have spoken of a “plague of prisons.”  This impacts not only on the people who are incarcerated but also on their families and communities.  Interested readers should consult our prior posting on marijuana arrests in the US (Record Marijuana Arrests Feed the Prison Industrial Complex ) and the Pew Charitable Trusts report: One in 100: Behind Bars in America 2008.

The conference will take place at the Hilton Fort Lauderdale Airport Hotel.  A special conference rate of $109/night will be available to conference participants; mention the 3rd Annual Academic and Health Policy Conference on Correctional Health to secure this rate.

The conference website is located at: http://www.umassmed.edu/commed/ch_conference09/index.aspx

Posted by Matt Anderson, MD

Amnesty International Calls for an End to US Embargo on Cuba

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We wanted to share this press release from MEDICC:

embargo cartoon Neubecker_CubaSeptember 2, 2009:  An Amnesty International report released today recommends an end to the US embargo on Cuba, which it says has imposed severe social and economic hardship on ordinary people on the island. The report (The US Embargo against Cuba: Its Impact on Economic and Social Rights) concludes that the sanctions have endangered the health of millions and denied them access to important medicines and medical technologies.

Amnesty’s 28-page findings cite supporting evidence from UN agencies, as well as MEDICC and earlier research carried out by the American Association for World Health, which Amnesty called “still the most comprehensive study on the issue” (Denial of Food and Medicine: The Impact of the U.S. Embargo on Health & Nutrition in Cuba).

“The US embargo against Cuba is immoral and should be lifted,” said Irene Khan, Amnesty International’s Secretary General, calling on US President Barack Obama to “distance himself from the failed policies of the past” by taking immediate steps to begin dismantling its restrictions.

In a CNN interview about the report, MEDICC International Director Gail Reed commented: “…the embargo has a sweeping effect on Cuban healthcare. Over the past decades, I would say the people most affected have been cancer and HIV-AIDS patients.” She also said the embargo affects the way Cuban physicians think about the future: “Doctors in Cuba always worry that an international supplier will be bought out by a U.S. company, leaving medical equipment without replacement parts and patients without continuity of medications.”

Amnesty found that the embargo also threatens children’s health by restricting Cuba’s ability to import nutritional products for schools, hospitals and child care centers, contributing to a high prevalence of iron-deficiency anemia. And it notes that children’s health was also put at risk by a decision from US suppliers to cancel an order for three million disposable syringes made in 2007 by UNICEF’s Global Alliance for Vaccines and Immunization upon learning the units were destined for Cuba. Similar situations have affected implementation of UN programs to prevent and manage HIV/AIDS on the island.

Finally, the Amnesty report called on the US Congress to repeal US embargo legislation, a necessary step since under current law, the President’s powers to ease restrictions are limited.

RPSM @ the Unity Walk for Health Care Reform in Times Square

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hcrally01

Credit: Casperr of the Daily Kos

spaceballLast Saturday (8/29/2009) at least 3000 people (according to police estimates) gathered in Times Square for the Unity Walk in support of health care reform.   Montefiore Residency Program in Social Medicine resident, Cameron Page, and graduates Oni Blackstock, Karen Wang, Manel Silva, Bill Jordan, David Herszenson, Giliane Joseph, and Jonathan Arend all played a large role in organizing the event.  There were dozens of students from Einstein, Mt. Sinai, and other NY medical schools.

Here is a list of some of the news coverage of the event:

Dr. Herzenson wrote to us that: “This is a cause that is close to my heart, and unfortunately, there has been a lot of misinformation out there about the current proposals.  This site offers an insightful article on what reform means for those who already have insurance: (click here).   This site debunks a lot of the myths that have been spread: (click here).  Finally, if you want to get more involved, even just by writing an e-mail to your legislator or putting a sign in your window, go to http://www.healthcareforamericanow.org/ This is an umbrella organization that is out there fighting the fight.”

The RPSM participants are all involved with the National Physicians Alliance.  The webpage for their local (New York City) NPA group is http://npany.blogspot.com/ Their next meeting will be on Wed, Sept 9th at 7:30 pm, location: TBD

posted by Matt Anderson, MD




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