We 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:
¡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.
We have just published a new issue of Social Medicine/Medicina Social, our bilingual, online journal. It is available in both English and Spanish. Our 13th issue touches on several important issues in world health including the current economic crisis and the WHO Commission’s on the Social Determinants of Health. And, of course, the stories of activists like the young US students (shown below) studying medicine at the Latin American Medical School (ELAM) in Havana. They will be traveling in the Southwest US this summer to discuss their experiences with the American Indian community:
The Economic Crisis and Public Health
Barry S Levy, Victor Sidel
The current global economic crisis seriously threatens the health of the public. Challenges include increases in malnutrition; homelessness and inadequate housing; unemployment; substance abuse, depression, and other mental health problems; mortality; child health problems; violence; environmental and occupational health problems; and social injustice and violation of human rights; as well as decreased availability, accessibility, and affordability of quality medical and dental care. Health professionals can respond by promoting surveillance and documentation of human needs, reassessing public health priorities, educating the public and policymakers about health problems worsened by the economic crisis, advocating for sound policies and programs to address these problems, and directly providing necessary programs and services. Full Text: PDF
An Interview with Sir Michael Marmot
The Editors
In August of 2008 the WHO Commission on the Social Determinants of Health concluded its work with the publication of a report entitled: “Closing the gap in a generation: Health equity through action on the social determinants of health.” The Commission’s chair, Sir Michael Marmot, was kind enough to answer our questions about the Commission’s recommendations. This interview was conducted by email in May of this yea
Social Medicine: We congratulate the Com-mission on its excellent work in bringing attention to the social determinants of health and the Commission’s call for health equity. We appreciated the Commission’s recognition that: “Social Justice is a matter of life and death.” We were also happy that the Commission included representatives of civil society in their work. This was an important affirmation of democratic values.
When thinking about health inequalities people often use the analogue of the ladder to show how the gradient of worsening health outcomes affects all people in society except (presumably) those at the very top. Thinking about the ladder leads us to pose the following question: Is making the ladder shorter (i.e. reducing inequalities) the only approach to inequalities or is it possible to imagine making the ladder disappear entirely?
Sir Michael Marmot: All societies have hier-archies. It is not conceivable, therefore, to have a society with no ladder. The conceptual framework of the Commission on Social Determinants of Health leads us to think of at least two (linked) ways to address the relation between position on the ladder and health: act at the societal level to reduce social inequalities, and break the link between position in the social hierarchy and health.
The first argues for reducing the slope of the social gradient. To see this, suppose, just for a moment, that the ladder were defined on the basis of years of education. People who had three years or fewer had life expectancy of 50 years, those who had 13 years or more had life expectancy of 80 and the rest were ranged in between in a graded way: the social gradient in health. Now if we had a societal change so that everyone had at least 10 years of education, and better health followed as a result, the magnitude of health inequity would be reduced. We have reduced inequities by making the ladder shorter. [...]Full Text: PDF
Participation and empowerment in Primary Health Care: from Alma Ata to the era of globalization
Pol De Vos, Geraldine Malaise, Wim De Ceukelaire, Denis Perez, Pierre Lefèvre, Patrick Van der Stuyft
With the 1978 Alma Ata declaration, community participation was brought to the fore as a key component of primary health care. This paper describes how the concepts of people’s participation and empowerment evolved throughout the last three decades and how these evolutions are linked with the global changing socio-economic context.
On the basis of a literature review and building on empirical experience with grass roots health programs, three key issues are identified to revive these concepts: The recognition that power, power relations and conflicts are the cornerstone of the empowerment framework; the need to go beyond the community and factor in the broader context of the society including the role of the State; and, considering that communities and society are not homogeneous entities, the importance of class analysis in any empowerment framework. Full Text: PDF
Latin American Social Medicine and the Report of the WHO Commission on Social Determinants of Health
RAFAEL GONZALEZ GUZMAN
In October 2008 the Latin American Social Medicine Association (ALAMES) organized an international workshop entitled “The Social Determinants of Health.” Representatives of ALAMES’ seven regions participated in discussions of the various consultative papers prepared by the working groups of the WHO Commission on the Social Determinants of Health as well as the Commission’s final report. The workshop considered how ALAMES should respond to the work of the Commission. In this paper we summarize the main points outlined in the position paper prepared by the Organizing Committee1 as well as a synopsis of the main contributions made by each of the workshop’s study sections. Full Text: PDF
On April 28th, 2009 Social Medicine Rounds hosted four New York City food activists in a session entitled: “Feast or Famine: Building an Oasis in the Food Desert.” This rounds was arranged by Drs. Victoria Mayer and Vanessa Pratomo and is part of a larger series organized by the Public Health Association of New York City (PHANYC). [See our previous posting: Feast and Famine: Obesity, Diabetes and Hunger in New York City.]
Joel Berg, Triada Stampas, Debi Lomax, Zena Nelson, Drs. Mayer & Pratomo
As clinicians we daily see patients whose health is deeply affected by nutrition. Counseling patients on diet often seems a frustrating affair and there is scant evidence that it does much good. We were interested in a better understanding the politics of food and in learning about what local food activists were up to. Our invited panel included Joel Berg of the NYC Coalition Against Hunger, Debi Lomax of the Bronx District Public Health Office, Zena Nelson of the South Bronx Food Coop, and Triada Stampas from the Food Bank for New York City.
The paradoxical link between food insecurity and obesity
Joel Berg is the Executive Director of the New York City Coalition Against Hunger and author of the recently published All You Can Eat: How Hungry is America. He began by emphasizing the lack of nutrition education in medical schools, arguing that nutrition should be the centerpiece of public health. He saw hunger and obesity not as separate problems but rather as “flip sides of the malnutrition coin.” He pointed out that currently 25 million Americans (about 8% of the population) use food pantries and soup kitchens. Here in New York City an estimated 1.3 million people (about 16% of the 8.2 million New Yorkers) are living in food insecure homes. The poor are often accused of not knowing how to budget, shop and cook. But Mr. Berg pointed out that working class people often don’t have access to affordable, good food, a point reiterated by the other three speakers Faced with limited cash, people often choose unhealthier foods because their high fat content. Time constraints – due to work schedules – further limit the ability of working class families to shop and cook.
Mr. Berg argued that good nutrition is a three legged stool based on affordability, proximity and education. The way to make good food more affordable was the increase wages, expand access to WIC and encourage our kids to take advantage of food offered in the schools (breakfasts, lunch, afterschool meals and summer breakfasts). Making sure that school food is healthy is also an area of intense activism. While New York City has recently banned the sale of soda in the schools, highly sugared drinks like Snapple continue to be sold.
Farmers’ Markets in the Bronx
Debbie Lomax, a Program Officer for the South Bronx District Public Health Office of NYC Department of Health, then discussed the DOH Farmers’ Market Program. Quoting their program booklet: “The Farmers’ Market Program encourages fruit and vegetable consumption by promoting farmers’ markets in the South Bronx. There are currently 11 markets in the area. The DPHO publicizes these markets to community residents and health care providers, by giving out “Health Bucks” – $2.00 vouchers redeemable at farmers’ markets for the purchase of fruits and vegetables.”
A complete description of this program and a list of current Farmers’ Markets can be downloaded from this link. More information on Healthy Bucks can be found at this link.
A Food Coop grows in the Bronx
Zeena Nelson is one of the founders of the South Bronx Food Coop. Her interest in food was sparked by her personal difficulties finding good food in her South Bronx community. She had studied business at Fordham University but was unenthusiastic about working for corporate America. She was pushed into food activism when a friend died of complications of massive obesity. What, she wondered, were the economics behind the fact that certain neighborhoods don’t have good food available? She obtained a $20,000 starter grant from Merill-Lynch to set up a small food coop. The coop now has 155 members and operates a small store on Third Avenue Members of the cooperative are a diverse group about ½ of whom are from the South Bronx. The cooperative provides a variety of services including cooking and yoga classes. The Cooperative has plans to create a commercial hydroponic farm inside of a local building.
[For a fascinating look at the world of urban agriculture in New York City, visit Kerry Trueman's Retrovore.com.]
… as do the soup kitchens
Finally, Triada Stampas shared her work at the Food Bank for New York City. The Food Bank started 26 years ago in a big warehouse located in the Hunts Point food market in the South Bronx. The Bank initially supplied food to a handful of sites providing “emergency food.’ Sadly, it currently supplies some 1200 soup kitchens and pantries (yes, that’s 1200 sites) located throughout the City. . Ms. Stampas noted that such a network simply was not needed in the 1970′s.
The food at the bank comes from various sources. The government – federal, state and city – provides some. Feeding America, a national umbrella for food banks, provides food largely donated by corporations. The bank itself raises funds to purchase food. The Bank also conducts research on who uses emergency food. By their estimates there are 4 million New Yorkers (nearly half the population) who have difficulty accessing affordable food. Ms. Stampas noted that the term “emergency food” was really a misnomer. For many people emergency food represented subsistence food. She pointed out, for example, that 80% of families receiving food stamps run out of food before the month is over. She spoke about understanding nutrition as a function of the “food environment.” Bronx residents, according to a recent study by the Marist Institute, have the greatest difficulty finding affordable food in the city.
Ms. Stampas had some specific suggestions for clinicians. She stressed that it was important to talk with patients about what they eat, where they shop for food, and how they afford the food they buy. She pointed us to a food bank locator on the web that could be used when our patients needed food. She signalled the importance of political advocacy to improve food stamp benefits and increase the Earned Income Tax Credit.
Clinicians as advocates
During the question and answer period a number of an additional areas for activism were suggested. Hospitals need to promote healthy eating for staff, patients and visitors. Political support is needed right now for the school meals program and WIC both of which are up for authorization in Congress. In New York State a Healthy Schools Law is being considered in Albany. The speakers highlighted the importance of physician voices in support of these programs.
The news clip below, from the Toronto Star website, is food for thought for social medicine practitioners. It shows very compellingly the damaging effects of lax and unjust labor policies and how these effects can spread to countries where labor policies are less lax. Clearly, viruses do not recognize political borders! For a very thorough and complete swine flu coverage click here.
by Linda Diebel, Staff Reporter at the Toronto Star
MEXICO CITY-Sewage-filled lagoons at a pig farm in eastern Mexico – a product of the North American free trade deal – are suspected of creating ground zero conditions for swine flu in this country.
Environmentalists argue lax regulations in the factory farming that boomed in Mexico right after the 1994 North American Free Trade Agreement with Canada and the U.S. are making people sick – and not just with swine flu.
“You might call this the ‘NAFTA flu,’” said Rick Arnold, co-ordinator of Common Frontiers, a Canadian coalition focusing on Latin America and issues of economic integration.
He argues multinationals are getting away with dire conditions not allowed north of the border.
Environmental groups three years ago began protesting against operations at the Carroll Farms in Veracruz, jointly operated by U.S. pork giant Smithfield Farms.
The first confirmed case of swine flu originated with a 5-year-old boy from the town of La Gloria, near the farm. He recovered.
Medical officials have not pinpointed where the outbreak began.
And from its Virginia headquarters, Smithfield officials insist there is no evidence linking their operations to the disease.
Smithfield Farms, the world’s largest pork producer with $12 billion in annual sales, opened Carroll Farms in 1994, calling it a “joint venture.
At home, the company was fined $12.6 million (U.S.) in 1997 after the U.S. Environmental Protection Agency disclosed it was dumping raw pig sewage into a river flowing into Chesapeake Bay.
The health ministry, which earlier said 168 people were believed killed by swine flu in Mexico, yesterday would confirm only 12 of those deaths as being from swine flu and would not say how many more cases were suspected.
The air in Mexico City, once called the “most polluted” by the World Health Organization, is loaded with human fecal matter, gases, dust and other toxic materials.
“The pollution affects our eyes, throats and lungs,” said Dr. Erendira Gallardo Lobera, a general practitioner. She said the Mexican government should take stronger measures to ensure residents of the capital aren’t breathing in rat and dog feces with their oxygen.
While Mexicans continue to wear masks and stay indoors in a country virtually shut down, people say the government should be more forthcoming with information.
“I think the government isn’t giving us the correct statistics about infected cases,” said restaurant employee Jose Gutierrez Hernandez. “I fear there’s not enough medicine to control this outbreak and there is no vaccine against swine flu.”
President Felipe Calderon promised his officials would provide timely information, adding as a “parent and as a person, there is nothing more important to me than the life and health of the Mexican people.”
From the Mexican embassy in Ottawa, spokesperson Alberto Lozano Merino said Mexican authorities are not concerned with pig farm operations near the suspected epicentre of the swine flu outbreak. Authorities acted quickly to send Veracruz samples to the Centers for Disease Control and Prevention in Atlanta, Ga., and have “followed every regulation and protocol.”
However, the Veracruz newspaper La Marcha, as well as the Mexico City daily, La Jornada, reported widespread cases of people falling ill near the pig farm in March.
Several local groups argue the farms should be closed pending extensive environmental and health reviews of an operation that raises 950,000 pigs a year and doesn’t have a sewage treatment plant.
In a 2006 article on Smithfield’s Virginia operations, Rolling Stone reported: “(The) pigs live by the hundreds or thousands in warehouse-like barns, in rows of wall-to-wall pens (and) trample each other to death.
“The floors are slatted to allow excrement to fall into a catchment pit under the pens, but many things besides excrement can wind up in the pits: afterbirths, piglets accidentally crushed by their mothers, old batteries, broken bottles of insecticide, antibiotic syringes, stillborn pigs …”
The article said the “pipes remain closed until enough sewage accumulates in the pits to create good expulsion pressure; then the pipes are opened and everything bursts out into a large holding pond.”
Yesterday, La Jornada ran a photo of a large waste-filled lagoon at Carroll Farms in Veracruz. A caption under the photo says farm officials stress the pork waste flowing into the lagoon generates “absolutely no type of contamination.”
C. Larry Pope, president and CEO of Smithfield Farms, sent a letter yesterday assuring all employees the company is doing everything possible “and will continue to do so (to keep) our workers and pigs healthy.”
In January of this year the Lancet published an article entitled Mass privatisation and the post-communist mortality crisis: a cross-national analysis written by David Stuckler and Lawrence King of Oxford University’s Department of Sociology and Martin McKee of the London School of Hygiene and Tropical Health. The article concluded that the adoption of mass privatization (a component of “shock therapy”) during the transition from Soviet-style communism was associated with increased mortality among working age men. This finding adds to the ongoing discussion on the health impacts of privatization and more generally to the study of the health effects of economic policy. [A prior posting on the portal discussed Oxfam's recent report, Blind Optimism which examined privatization in health care.]
The Context
The transition from Soviet communism to capitalism after the fall of the Berlin Wall in 1989 was associated with increases in mortality in certain countries, particularly those of the former Soviet Union. In a 2004 British Medical Journal editorial Dr. McKee and Kristina Fischer summarized the situation:
Life expectancy at birth is now lower in the transition countries than that in western Europe. Although in the 1960s it was slightly higher in former East Germany than in former West Germany, by the 1970s the numbers reversed and the gap has been widening ever since. In 2000, life expectancy at birth was almost 12 years less in the countries of the former Soviet Union than in western Europe, and it is continuing to decline, making the former Soviet Union one of only two regions in the world where life expectancy is declining, the other being sub-Saharan Africa. But in other post-communist countries life expectancy is generally improving.
The health consequences of the transition were, thus, different in different countries. Life expectancy decreases were particularly marked in Russia while in Croatia and Poland life expectancy increased. What accounted for these differences between countries?
What the authors did
Stuckler and his colleagues set out to understand whether economic policies could explain the differing health experiences of the transition countries. They distinguished between countries who adopted “shock therapy” (“liberalisation of prices and trade to allow markets to re-allocate resources, stabilisation programmes to suppress inflation, and mass privatisation of state-owned enterprises to create appropriate incentives”) and those that adopted more gradualist approaches. Russia, for example, instituted shock therapy in the early 1990′s at the urgings of Harvard economist Jeffrey Sachs.
The authors suspected mass privatization would increase unemployment; unemployment has a variety of negative health effects. If unemployment increased mortality, the effect might be seen in working age men. The authors created a statistical model to explain the intra-national differences in mortality rates for men aged 15 to 59. In their statistical model they controled for a variety of variables (such as whether a country was at war or changes in trade in policies). To examine the effect of privatization they used two different mesasures; one was a measure that they developed on their own and the other was a ranking system from the European Bank for Reconstruction and Development (EBRD). Using a technique called logistic regression, they concluded that “Mass privatisation programmes were associated with an increase in short-term adult male mortality rates of 12·8%.” They found some evidence that unemployment mediated this increase and that participation in civic organizations decreased it.
The authors drew the following policy implications from their conclusions:
“Great caution should be taken when macroeconomic policies seek radically to overhaul the economy without considering potential effects on the population’s health. As variants of rapid reform policies are being debated in China, India, Egypt, and several other developing and middle-income countries—including Iraq—which are just beginning to privatise their large state-owned sectors, the lessons from the transitions from communism should be kept in mind.”
The Response
Within days of the Lancet report, Dr. Jeffrey Sachs published an angry response (“‘Shock therapy’ had no adverse effect on life expectancy in eastern Europe”) in the Financial Times. He cited the increased in life expectancy in Poland as evidence that shock therapy did not increase mortality and went on to implicate non-economic factors (such as corruption and the poor Soviet diet) for what happened in Russia. (Stucker et. al’s response to Sachs was published by the Financial Times on January 22nd.)
The Lancet itself published two letters to the editor (and a response) on April 11.
One letter by Italian researchers Giorgio Tamburlini and Adriano Cattaneo looked at different rates of infant mortality decrease (from 1990-2005) in Moldova and Georgia, countries with differing degrees of health care privatization. In Moldova, which was transiting to a national health insurance system, infant mortality rates dropped by 54%, while in Georgia, where the health care system was increasingly privatized, infant mortality rates decreased by only 4%.
The other letter by John S. Earle, of theUpjohn Institute for Employment Research, used data from individual firms in four post-communist countries to argue that privatization did not result in job cuts, a finding that contradicted that of the Lancet authors and which they described in their response as “counter-intuitive.” Earle’s argument is presented in fuller form in this link.
Commentary
Stuckler’s paper was accompanied by a Lancet editorial (Societal Transition and Health) written by Martin Bobak and Michael Marmot of University College London. While supporting the authors conclusions, they note:
“Even with the use of an ingenious design, such as that adopted by Stuckler and colleagues, pre-existing societal characteristics cannot be taken into account. This flaw is not a criticism, but rather an illustration of the difficulties faced by investigators who wish to disentangle the effects of different factors that act at the societal level.”
There are inherent limitations in the study of historical events which are by their nature unique and unreproducible. These difficulties are compounded when one studies different countries; statistical models really cannot control for all differences. The fact that Poland adopted a gradualist approach to privatization makes Poland intrinsically different from Russia where the political class adopted a more radical approach.
Nonetheless, it would be hard to argue that shock therapy did not have negative health effects. It is unfortunate that the Dr. Sachs is so closely associated with this policy that the debate has a personal tone. Clearly, privatization (often forced) of social institutions is a policy that has had broad support amongst those who dictate global economic policy.
The conclusion of the Lancet authors – that radical macroeconomic policies need to be considered in light of their health consequences – should be pretty uncontroversial. If it is controversial we should wonder why.
The documentary “Capitalism hits the fan” (click here for a preview) offers a good analysis of the global financial crisis and argues that the stimulus package, bailouts, and calls for regulation will not work unless more fundamental changes, including, yet not limited to, reversing the downward trends in wages over the last three decades, are made.
If, as social medicine practitioners, we believe that living conditions are extremely relevant to health, and in turn depend on social, economic, public health and political policies, the documentary gives us a way to understand, and as the preveiw points out, “react to the unraveling economic crisis”.
The latest economic downturn and the collapse of global finance are eroding the very foundations of human health: millions are losing their homes, their means of livelihood, their health care and their dream of an education. And while most analysts agree that, collectively, the productivity of American workers has grown dramatically over the last thirty years, wages have remained stubbornly stagnant, at the same time as wealth is increasingly concentrated in fewer hands (which, as Professor William Domhoff points out, indicates increasing concentration of power). Clearly, the huge wealth created by the world’s most powerful “capitalist democracy” has not been equitably distributed.
So it comes to no surprise that many are questioning the “benefits” of global capitalist practices (whose shortcomings are masterfully described in this old but remarkably current article by Mark Weisbrot from the Center for Economic and Policy Research), and indeed, the very notion that, as we are often told, “capitalism is good for democracy”, assuming of course, democracy as a form of political organization concerned with, and able to, improve the wellbeing of the ordinary people who give it its legitimacy.
Michael Perenti, a long-time political analyst, argues that unless the state saves capitalism from itself, for instance, through equitable economic and social policies, as seen in European social democracies, free-market capitalism is doomed to collapse under the “seeds of its own destruction”, much like Karl Marx argued close to one hundred and fifty years ago, and Friedrich Engels, Marx’s intellectual partner, so very well described in his masterpiece “The conditions of the working class in England” (click here for an excerpt), arguably among the classics of public health..
Below go fragments of Perenti’s recently published article (click here for the full article), where he lays out his thesis, and an interview with Amy Goodman, where he discusses the bailout of major financial institutions (essentially, how the money is being used), and what this implies for what the health professions know as the social determinants of health.
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“Let us consider democracy first. In the United States we hear that capitalism is wedded to democracy, hence the phrase, “capitalist democracies.” In fact, throughout our history there has been a largely antagonistic relationship between democracy and capital concentration. Some eighty years ago Supreme Court Justice Louis Brandeis commented, “We can have democracy in this country, or we can have great wealth concentrated in the hands of a few, but we can’t have both.” Moneyed interests have been opponents not proponents of democracy.
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The conservative plutocracy also seeks to rollback democracy’s social gains, such as public education, affordable housing, health care, collective bargaining, a living wage, safe work conditions, a non-toxic sustainable environment; the right to privacy, the separation of church and state, freedom from compulsory pregnancy, and the right to marry any consenting adult of one’s own choosing.
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Consider the United States. In the last eight years alone, while vast fortunes accrued at record rates, an additional six million Americans sank below the poverty level; median family income declined by over $2,000; consumer debt more than doubled; over seven million Americans lost their health insurance, and more than four million lost their pensions; meanwhile homelessness increased and housing foreclosures reached pandemic levels.
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About a century ago, US labor leader Eugene Victor Debs was thrown into jail during a strike. Sitting in his cell he could not escape the conclusion that in disputes between two private interests, capital and labor, the state was not a neutral arbiter. The force of the state–with its police, militia, courts, and laws-was unequivocally on the side of the company bosses. From this, Debs concluded that capitalism was not just an economic system but an entire social order, one that rigged the rules of democracy to favor the moneybags.
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The immense inequality in economic power that exists in our capitalist society translates into a formidable inequality of political power, which makes it all the more difficult to impose democratic regulations.
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If the paladins of Corporate America want to know what really threatens “our way of life,” it is their way of life, their boundless way of pilfering their own system, destroying the very foundation on which they stand, the very community on which they so lavishly feed.
Because shelter is a basic human need, and housing a critical social determinant of health, policy makers need to take bankrupcty reform seriously, to prevent millions of Americans from losing their homes to foreclosure.
As CREDO, a virtual grassroots movement has put it, “billions upon billions of dollars have been given to the banking industry” yet judges are yet to be given the power to restructure mortgage loans. CREDO also warns that “the banking industry has spent an exorbitant amount of money lobbying Congress to keep judges from getting that power”. To sign their petition click here.
For those interested in a deeper understanding of these issues, in “Matters of Principal”, op-ed contributors John D. Geanakoplos and Susan P. Koniak explain (in terms that a non-economist like me can understand) why the staggering amount of 275 billion dollars that President Obama’s stimulus plan set aside presumably to address the housing crisis is unlikely to work – that is, for homeowners. Because if you are a lender the story is different, and not a bad one at all — yet another instance of “tails I win, heads you lose”.
The long version is really worth reading, but the short version is that while with the president’s plan homeowners may see the interest rates on their mortgages, hence their monthly payments, decrease, too many among them will still be “under the water”, i.e., owing more than what their house is worth at current market values.
Which in turn means that they will have very little equity (the writers offer an example with very simple numbers), if at all. Which means that after a few years, while the lenders, courtesy of taxpayers, will have recovered at least partly what they otherwise would have lost for engaging in reckless lending, many homeowners are still likely to default, and face homelessness.
Geanakoplos and Koniak argue that only bankruptcy reform can work, hence the timeliness of CREDO’s action alert. Bankrupcy reform allows for a reduction of the principal, and gives homeowners equity – and a real stake at keeping their homes – while costing taxpayers very little. Of course in this alternative plan lenders have to live with losing some money. But hey, was this plan not about homeowners, not lenders?
We wanted to alert our readers about an upcoming conference entitled Housing, Health and Serial Displacement which will be held at the New York Academy of Medicine on April 8, 2009, 8:30 AM to 5 PM. The following text and photographs are from the flyer for this event.
Segregation in Pittsburgh, 1930 Map: Joe Darden
Urban renewal, highway construction, gentrification, HOPE VI, foreclosure crisis: a long list of policies and programs have led to the displacement of communities. What is little understood is that these policies have led to repeatedly upheaval in American cities, destroying housing and undermining health. This conference will explore the history, tactics and consequences of serial displacement.
Program: (Speaker biographies are available here).
Keynote: Thomas Hanchett, Author of Sorting Out the New South City
Morning Panel: Serial displacement and health
• Mindy Thompson Fullilove, NYS Psychiatric Institute
• Rodrick Wallace, NYS Psychiatric Institute
• Pat Sharkey, Columbia University
Working Groups: Linking Serial Displacement to Our Work
LUNCH
Afternoon Panel:
• Mehret Mandefro, TruthAIDS
• Patrick Morrissy, HANDS, Inc., Orange NJ
• Terri Baltimore, Hill House, Pittsburgh
Working Groups: Identifying New Perspectives
Afternoon Keynote: Displacement as a violation of human rights
Summary and Closing Remarks: David Vlahov, NY Academy of Medicine
Planned shrinkage in Harlem, 1995
New York Academy of Medicine is located at: 1216 5th Ave, New York, NY 10029
Sponsors (list in formation):
NYAM Working Group on Serial Displacement
Community Research Group, NYSPI & Columbia University
Columbia Center for Youth Violence Prevention
Columbia Center on Homelessness Prevention
Registration free and a box lunch is available for $10
Well, a lot, even if the New York Times doesn’t seem to find my case compelling when I developed it in a letter to the editor, so I never heard back from them (yes, it was under 150 words!). Interestingly, the Times really gets it when it comes to education, as indicated by its excellent editorial (“Helping Students, Not Lenders“) calling for substituting a “wasteful” and “corrupt” student loans system that has turned out to be a windfall to private lenders, yet of little help to students. And yet, the editors just cannot bring themselves to see the parallel between education and health care, both of them arguably social 0r public goods (even if they do not exactly fit the technical definition, whereby consumption of the good by one individual does not reduce availability of the good for consumption by others).
So when it comes to a publicly financed, privately delivered health care system – single payer – they consistently dismiss it as “politically unfeasible”, when not ignore it altogether. Indeed, in a recent detailed account of Hillary Clinton’s past experiences with health care reform (“Obama Taps Clinton Ideas But Not Clinton Herself“) , New York Times reporters quote former health secretary Donna Shalala as saying that “we’ve learned…that people don’t want to lose the health insurance they currently have”. Which leaves a reader who reads no other sources thinking that Clinton’s views on health care have matured, and have a shot, because, as she asserted during the elections, “under my plan those who like their health insurance can keep it”. No matter that under systems favored by Clinton (or by President Obama), where the private insurance sector plays a key role, the likelihood that the insurance plan you have today, and presumably like, will still be there — or assuming it is, that you’ll be able to afford it — is rather slim.
New York Times‘ reporters also praised President Obama’s performance during a major health care forum held this past Thursday (“Obama Says He Is Open To Altering Health Plans“) for having “bluntly warned lobbyists and special interests” that nobody would stand in the way of major reform, while forgetting to mention that the White House initially refused to invite any single payer advocate to the forum, only relenting by including two guests (out of a list of 120) after huge public pressure.
In the spirit of filling the void left by the New York Times in its failure to notice the implications of its views on education for health care, here goes my letter, which I hope readers of the Social Medicine Portal will find more persuasive that the Times‘ editors have.
So the Times’ editors get it: the point of a college lending system is to help students, not lenders. Thus eliminating the middle-men who reap enormous profits on students’ and taxpayers’ backs is the wise and right thing to do. Let government do the lending directly and let students freely choose whatever college they please.
As in education, so in health care: the point of a health care system is…you guessed it! To provide health care! Let us then eliminate the waste and corruption of a private insurance sector that has failed to deliver the goods for decades. Let us all contribute a predictable proportion of our income into a single risk pool, and let us have our government use the pool’s huge purchasing power to buy health care for all. And let patients freely choose the doctors or hospitals they like. Let us have single payer. It is about time.
We 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.
In January of this year the Lancet published an article entitled 
