Category: Blog

Since the beginning of 2020, the Centers for Disease Control
Prevention (CDC)
has been mounting a response to a respiratory disease, that, at present, has
been declared a public health emergency in 80 countries, including the US. The
SAR-CoV-2 virus, also known as the Coronavirus (COVID-19), has elicited the
concern and attention of public health authorities, the healthcare community,
and the public-at-large. As the Coronavirus continues to grow globally and
begins to emerge through cases in parts of the US, the greatest dilemma is who
and what to believe. Social media has exploded over the recent conflicts in
reporting between leaders in government and public health officials.

Americans should be concerned about the credibility and
timeliness of reporting as this emergency continues to trend in the news. Here
are some tips for those of you want to know if Coronavirus is happening the way
it’s being reported.

• Consider the source. There are many internet and
  social media outlets reporting on every facet of news, so it is easy to be
  compelled by a flashy headline or a credible name reference. An agency like the
  CDC and organizations such as the World Health Organization (WHO) are tasked
  with protecting the health of the public nationally and globally, and in many ways
  are responsible for the preparedness of their respective officials and
  effectiveness of subsequent responses at every level. Specifically, the CDC, in
  collaboration with the WHO, confirmed COVID-19 emerged as a virus spread
  by person-to-person contact—and was first detected in travelers from the Wuhan
  Province of China.

• Remember news changes rapidly. Try not to get
  hung up on the evening news or trending social media updates about the virus,
  because these are likely to change within hours (sometimes minutes). Since
  January 21, the WHO released 42 “situation
  reports” on the Coronavirus, providing
  the most up-to-date and accurate developments concerning the virus. The purpose
  of these reports is to monitor the number of 
  confirmed cases and deaths globally, and to provide the public with
  routine updates on the WHO’s efforts to deliver supplies to support the global
  response to the Coronavirus. Similarly, the CDC continues to provide health
  notices to debunk the fear and stigma around the origin of the virus and the
  severity of the risk of its spread. Ultimately, you should expect to see
  changes in travel patterns, stories about the increased use of protective gear,
  and local and state officials making regular statements to the public.

• At a White House Press Conference last month,
  Vice President Mike Pence made a statement on the impact
  of Coronavirus in America. Pence reported the risk to Americans as “low” while
  the incidence of Coronavirus grows in different regions of the country. Pence
  also assured Americans that the administration rolled out a new Coronavirus
  Taskforce to streamline information to the public and coordinate efforts
  with partnering countries to track the progress of the global response. Nonetheless,
  CNN reports that the CDC urges Americans to prepare themselves for the worst. The
  report goes on to suggest how daily life will change in the face of a
  Coronavirus epidemic. CNN reports an uncertain future based on conflicting
  remarks during the White House Press Conference.

• Observe standard precautions. While the risk
  remains low, Americans are planning for the worst. California
  has declared a state of emergency after a recent Coronavirus-related death.
  Moreover, NBC
  News reports that President Trump signed an $8 billion spending package for
  CA to use in wake of the virus outbreak. To date, states affected by the virus
  have begun rolling out guidelines for treatment and possible quarantine of
  patients as new cases emerge. For instance, local health authorities in New
  York have implemented screening procedures for citizens returning to the US
  from countries affected by Coronavirus. Other states continue to publish
  statements of their efforts to prevent the transmission and spread of the
  Coronavirus through universities and schools in various communities.

What should be taken from the CDC and other state and local
health authorities is that you should observe standard precautions, which can
reduce the transmission of the virus. Health.gov
posted a simple statement about preventing human-to-human spread of the virus by
suggesting washing hands, covering mouths, and staying home if you’re sick. In
the wake of uncertainty of the trajectory of the virus, Americans can be
certain that our coverage of and reporting on the Coronavirus will be driven by
how the administration, health authorities, and media want to frame the
national and global response.

Since late December, the eighteenth inmate of Mississippi’s
prison system died
at Central Mississippi Correctional Facility in Rankin County, Mississippi. While
this inmate had no obvious signs of injury on his body, most of the other
deaths were the result of violence or suicide.

These deaths occur as the result of conditions that have
been in place for some time in the state’s prison
system. Reports of dehumanizing occurrences like murders, rapes, beatings,
and torture often targeting inmates of racial minorities are not uncommon. Many
prisons have open sewage, a polluted water supply, and kitchens with rodent and
insect infestations.

Such conditions are inherently damaging to all inmates’
mental health, and even more so for inmates with a history of mental illness. Interestingly,
in 2009, the ACLU
identified the mental health program at Parchman Prison in Mississippi as the
gold standard for prison-based mental health treatment. The program focused on
administrative segregation, or solitary confinement. Prison guards typically
use administrative
segregation to punish inmates for violent or disruptive behavior.Inmates
are isolated in their cells for twenty-three hours per day with only one hour
outside the cell for exercise and a shower.

Parchman Prison’s program involved three
parts: (1) identify inmates in administrative segregation who needed mental
health treatment, (2) reward inmates in administrative segregation for good
behavior by allowing them to return to the general population, and (3) create
humane conditions in the general population to prevent the need for
administrative segregation. The
response to this program showed a decrease in violence and gang activity
throughout the prison. The number of inmates in administrative segregation
decreased by eighty percent.

This program is no longer in place in Parchman or any prison
in Mississippi. One reason for the falling conditions may be due to a loss of funding.
With inadequate funding, staffing and the maintenance of facilities becomes difficult.

Parchman Prison’s program was the result of heavy litigation
by prisoners who challenged the administrative segregation classification and
the lack of mental health services. Following various court orders, the
population in administrative segregation was reduced and violence decreased. Mental
health staff worked closely with custody staff to ensure that inmates with
severe mental health issues were receiving appropriate treatment and an avenue
to return to the general population. These programs were monitored
by the federal courts until 2011.

In addition to violence within prisons, failing to provide
adequate mental health treatment for inmates who need it will cost states more after
releasing inmates, through recidivism and health care costs.

Overcrowding
is another cause of violence in prisons. A Mississippi health inspector
recently visited a Parchman Prison housing unit and declared it unsafe
for habitation due to crumbling infrastructure and unsanitary conditions,
meaning that 1,500 inmates needed to be moved to adequate cells. Currently, 625
inmates still need cells.

If Mississippi wants to prevent more deaths, then it must
increase funding to provide sanitary and humane conditions and adequate mental
health treatment for its inmates. Failing to do so will likely cause more
housing unit condemnations, overcrowding, and violence.

American Indians and Alaskan
Natives continue to have worse health outcomes and a wide mortality disparity
compared to the rest of the United States’ population. This includes higher rates of heart disease, cancer, diabetes,
alcohol addiction, suicide, sexual assault and a life expectancy of five and a half years lower than all other
racial and ethnic groups in the United States. Why is this, and what are the
possible solutions policymakers are proposing to address these disparities?

Historical trauma through colonization and
federal laws such as the Indian Removal Act led to generational trauma and
contribute to present-day health disparities. The United States Commission on Civil Rights has
attributed “the failure of the federal government to adequately address the
wellbeing of Native Americans over the last two centuries” to these health
disparities. These generational traumas are developed through continued
suppression of indigenous cultures and a long-term lack of resources dedicated
to addressing these disparities. The Indian Health Service, which is supposed
to fulfill the United States’ treaty obligations to provide
healthcare for American Indians and Alaskan Natives, is consistently underfunded. In 2013, only fifty-nine percent of the projected need for
the Indian Health Service was funded, demonstrating a severe lack of priority
for addressing Native American health disparities. The National Congress of American Indians has called
on Congress to commit an additional $2 billion per year to address this funding
gap.

The IHS needs to receive more
funding, but also needs to diversify where services are provided. The majority of Native Americans live in urban areas
because of federal government relocation policies following a history of
colonialism. Native Americans in both urban and rural areas need access to IHS
services, and the increase in funding can go to addressing the needs of these
geographically separate populations. Increased funding is only one part of the
solution—addressing mental health outcomes continues to be one of the most
persistent problems among Native Americans and Alaskan Natives.

Solving this problem not only
includes advocating for more mental health providers in traditionally underserved areas but also, as one study found, that “participation in traditional
cultural activities” is associated with positive mental health outcomes. The
United States can encourage positive mental health outcomes by respecting
tribal sovereignty and recognizing traditional cultural practices. Tribal
governments should be partners in addressing these disparities and respecting
traditional cultural activities and sovereignty must be part of the solution.
Tribal governments are leading the way with innovative solutions to
bring low-cost and high-quality healthcare to their members. Partnering with
state governments to create new and collaborative programs often combine the
expertise of tribal governments with funding from programs like Medicaid and
have the potential to lead the way in addressing these disparities.

Addressing these health disparities
also calls for addressing the persistent issue of sexual violence and missing
and murdered indigenous women. Even the IHS is facing allegations of sexual
abuse that resulted in a civil suit. The first steps to address this issue
include a presidential task force dedicated to studying and
producing a report as the full-sight of the problem has yet to be understood.
Additionally, Congresswoman Deb Haaland—one of the first Native American women
elected to Congress—has introduced multiple bills to address this issue. These bills
include the Not Invisible Act of 2019, the SURVIVE Act, the Justice for Native
Survivors of Sexual Violence Act, and provisions to address sexual violence
against Native women in the Violence Against Women Act reauthorization.

While
the federal government takes these important first steps, and leaders like
Congresswoman Haaland introduce bills aimed at ending sexual violence against
Native Americans, ending health disparities will take a coordinated and
deliberate effort. Tribal, federal, and state governments must work as partners
to draw down health disparities and coordinate their efforts to make sure
long-term gains are addressed. It will take acknowledgment of historical
trauma, new funding and innovation to ensure that Native Americans and Alaskan
Natives receive the high-quality care that they are owed through historic

            Last month, the
Trump Administration unveiled a new demonstration program that has the
potential to dramatically overhaul the way Medicaid operates.  Currently, Medicaid is designed as a federal-state partnership in which the federal government matches the
money a state spends to cover its Medicaid population. The new program, Healthy
Adult Opportunity (HAO), would provide a route for states to receive a capped
amount of federal dollars (i.e., a block grant) in exchange for fewer
restrictions on determining who qualifies and what services are available to
them. Seema Verma, the Administrator of the Centers for Medicare and Medicaid
Services (CMS), celebrated this plan as an innovative approach to ensure the
long-term financial sustainability of Medicaid. While Medicaid’s financial
maintenance is an ever-present concern, HAO may reduce access to important healthcare
services, create greater financial risk for states, and present significant
legal barriers.

            Changing Medicaid’s financing scheme
creates greater financial risks for states that pursue HAO. Medicaid’s current
open-ended financing structure was designed
to broaden states’ ability to provide healthcare coverage to their low-income
residents by adjusting
federal funding depending on the state’s level of need. For example, if a
recession hits and Medicaid enrollment grows, federal funding would increase to
cover most of the additional costs. However, states adopting the new approach
must accept responsibility for costs higher than the caps. This change would shift financial risk to states, with federal funding cuts likely to occur
when states have the least ability to accommodate them— such as during
recessions, public health emergencies, and other instances when states must
balance high demand for coverage and budgetary strain. The risk of hitting the
funding caps would put pressure
on states to control spending by cutting coverage.

            States that adopt HAO will likely
face litigation. By offering funding through a capped fund scheme, the Trump
Administration claims expansive authority to overturn explicit statutory
requirements for Medicaid eligibility, cost sharing, and financing. The legal basis of HAO lies in the “expenditure authority” outlined
in section 1115 of the Social Security Act. This section authorizes federal
matching funds for expenditures not typically allowed under Medicaid, if these
expenditures are needed to implement an experimental project likely to assist
in promoting Medicaid’s objectives. However, two legal problems exist for this framework. First, the ability
of block grants to promote the objectives of Medicaid, the legal standard for the authorization of
these waivers, is unclear. The U.S. Court of Appeals for the D.C. Circuit recently affirmed that Medicaid’s main objective is to provide
health coverage to low-income people, but block grants would incentivize
coverage of fewer people. Second, the part of the Medicaid statute that governs
its open-ended financing structure is not listed
as a provision that is alterable through waiver.

            The heightened discretion offered by
the demonstration program may reduce access to services and impact millions of
people. To receive federal matching funds, states must provide core benefits (e.g.
hospital services) to mandatory populations (e.g. low-income pregnant women)
without imposing waitlists or enrollment caps. States may also receive matching
funds to cover “optional” benefits, such as prescription drugs. Conversely,
states that adopt HAO would receive broad, and in some instances unprecedented,
authority
to change benefits. The demonstration project encourages states to include the
millions of low-income adults without children who obtained coverage through
the Affordable Care Act’s Medicaid expansion under capped funds, which would
likely negatively impact their ability to access health care. Moreover, states
would also gain the ability to deny coverage
for costly but necessary prescription drugs, including those for diabetes and
cardiovascular conditions. Finally, states may impose new out-of-pocket costs for physician visits and prescription drugs on
low-income enrollees. Cost sharing in Medicaid, even in the amount of a $1
copay, has been shown to deter people from accessing care.   

            The idea of capped funds to meet
Medicaid’s financing challenges is far from new. Policymakers have discussed
block grants for Medicaid since the Nixon Administration and as recently as the 2017
repeal-and-replace. In light of this history, the Trump Administration should
consider why prior administrations and congresses have chosen not to take up
this policy, as well as its potential to create financial risks, lead to
litigation, and reduce access to healthcare for millions
of low-income people.

A severe mental illness can be a death
sentence, but not for the reasons you might think. Individuals living in the
United States with untreated mental illness are 16 times more likely to be
killed during a police encounter than any other civilian approached or stopped
by law enforcement. The reality is,
police officers are often the “first responders” to individuals with severe
mental illness–answering calls about “disturbances”, suicidal ideation, or
crimes committed– but are ill-prepared for dealing with these complex psychiatric cases.

According to the Treatment Advocacy
Reports, 1 in 5 inmates in America have a serious mental illness; even more
have diagnosable mental illness. First
responders (including police) are reluctantly taking over the role many believe
that should involve psychiatrists or other mental health professionals. The
justice system in turn is tasked with solving the social problems that occur as
a consequence of a severe mental illness. It is abundantly clear that prison is
not the answer for solving serious
mental health issues. Rather, reports compiled by organizations such as the WHO show that incarceration will only
exacerbate these problems. Still, law enforcement see few options apart from
arrest and/or incarceration when dealing with mentally ill individuals; when
they are tasked with balancing individual well-being against public safety.

The alternative to incarceration is
involuntary hospitalization. The misconception held by some mental health and
legal professionals is that involuntary hospitalization can be the best thing
for people with severe mental illness; and protects those with severe mental
illnesses from ending up in the justice system. However, there is
inconclusive evidence of the effectiveness of involuntary hospitalization.
Ironically, one of the reasons why there is an overrepresentation of persons
with serious mental illness in the justice system is because of deinstitutionalization. Following the arrival
of antipsychotics in the 1950s, the public view became that it was not
necessary to detain individuals with mental illness since treatment of psychiatric
symptoms was available. By the 1990s the number of psychiatric inpatients had
been reduced from 550,000 in 1950
to 30,000. Nonetheless, the issue became that individuals with serious mental
illness, who were disproportionately homeless or extremely low-income, could
not afford access to these new treatments. As a result, the number of
individuals with untreated serious mental illness within the prison population increased.

At the end of what seems to be a very
complex issue is a very simple solution. The medical profession has reached a
point where effective treatments are available for
individuals with mental illness. Medical facilities provide access to mental
health professionals beyond psychiatrists; facilities have social workers,
counsellors, psychologists, occupational therapists, even specialists with specific training to treat addiction.
The only remaining issue is funding. How can those who need access to mental
health services get that access when the cost is so high? Well, recent research
has shown that publicly funding psychiatric medication may save taxpayers money. A Desmarais study
recently found that people who receive less mental health services
unsurprisingly incurred higher criminal justice costs, which averaged $95,000 per person. In
comparison, the study showed that people who received more mental health
services had lower arrest rates bringing the criminal justice costs down to
$68,000 per person

The answer is to
provide better access to mental health services for people who need it the
most. Simply pushing mental health issues away has caused these issues to be
dealt with in inappropriate, and often detrimental, ways that are not only
unhelpful but economically burdensome to society. Our choice
does not need to be between involuntary and incarceration as the means to
combating serious mental illness.

There’s an
app for just about everything. There’s an app for pretending to
shave your beard. There’s an app for helping bread become toast. There’s even
an app for timing your pee breaks at the movie theater. However pointless these
apps might be, one of their functions is much more sinister…. they collect and sell your data. You might think, “Why
does it matter if someone knows when I take my pee break during a movie?” Well.
It probably doesn’t. But the practice of selling your data isn’t isolated to
silly apps like these— apps may actually sell data about your  health and personal habits.

Let’s take
an ovulation tracker, for example. Young women across the country willingly
download apps to manually submit information about the schedule of their
monthly period for a variety of reasons. They may be trying to get pregnant.
They may be trying to avoid getting pregnant. They may just want to be as informed
about their body as possible. But what they likely don’t know is the privacy
policy of that app… or lack thereof.

According
to a study by the British Medical Journal, 19
out of the 24 health monitoring apps they tested shared health related data
with companies like Google or Amazon. Furthermore, one third of the apps that sold this personal data to
companies did not even disclose the practice in any privacy policy.

In many cases, this data will be used in
marketing and advertising campaigns. While targeted ads are annoying, they
aren’t the real threat here. If health insurance
companies gain access to your medications or medical history, it could affect
insurance rates or employment benefits. The healthcare privacy rules that
typically protect people simply don’t apply to information voluntarily
submitted to mobile apps. The majority of health apps aren’t subject to
national regulations, which can be detrimental to the financial well-being and
privacy of people utilizing apps to help them with weight loss, addiction, and
mental illnesses. This is even more worrisome as companies, such as Amazon, Apple, and Google, attempt to move into the
healthcare market.

Thankfully,
this issue has not been completely ignored. Vermont recently passed privacy laws to
force companies to be transparent about the collection of health-related data.
Last November, legislation was proposed in the Senate to
prevent companies from mining personal health data from patients. In the meantime,
if you are worried about how companies may use the information from your apps, the best advice is to read an app’s privacy
policy, know your own privacy settings, and be wary of free apps.