Understanding Black Women’s Heightened Risk of Maternal Mortality in the U.S.

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This post was written by Brenna Gautam and Rebecca Reingold. 

Image courtesy of Ms. Magazine

U.S. maternal mortality ratios are the highest in the developed world and are rising, in contrast to global trends. The national rate, however, hides an even more troubling fact: black women in the U.S. die at three to four times the rate of white women during pregnancy or within one year of pregnancy. Black expectant and new mothers in the U.S. now die at about the same rate as women in countries like Mexico and Uzbekistan. In Texas, while black women make up only 11% of live births in the state, they account for 29% of its maternal deaths.

So, why do black women in the U.S. face a significantly higher risk of maternal mortality?

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The Strange Case of Nodding Syndrome in East Africa

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Nodding Syndrome is described as a rare form of Epilepsy that disables children in Eastern Africa.  Chances are you have never heard of Nodding Syndrome before.  I hadn’t until recently.  This is likely because it is a rare disease that impacts children in East Africa, places the current President of the United States dismisses as “shithole countries.”

Nodding Syndrome was first documented in Tanzania in the 1960s.   Cases were later diagnosed in the Republic of South Sudan in the 1990s and in northern Uganda in 2007.   Nodding Syndrome affects children ages 5-15 years old and according to the World Health Organization is characterized as “causing progressive cognitive dysfunction, neurological deterioration, stunted growth and a characteristic nodding of the head.” The disease got its name from the epileptic seizures, which weaken muscles in the head and neck that cause head nodding.  The stunts in growth and the brain caused by Nodding Syndrome result in mental handicap among those affected.  The disease can even result in death, although a number of deaths cannot be directly attributed to the condition.

The Centers for Disease Control and Prevention (CDC) became involved in 2009 and in 2013 partnered with Uganda’s Ministry of Health to conduct a large survey to determine the burden as well as the geographic distribution of the disease.

Despite numerous and extensive investigations in all three countries, very little was known about the cause of the disease until recently.   There were a number of theories surrounding the cause of the mysterious illness such as toxins, chemicals in the environment, or nutritional deficiency.

In 2012, after mystifying doctors and researchers for decades, a possible cause of Nodding Syndrome was identified.  It is believed to be the body’s response to a parasitic worm known as Onchocerca volvulus.  The culprit worm that causes Nodding Syndrome is believed to be the same worm responsible for Onchocerciasis, more commonly known as river blindness, an eye infection that’s also found in East Africa.

The CDC and the Uganda Ministry of Health have continued investigations, including studying the brains of those affected, to better understand the pathophysiology of this mysterious illness.  There is currently no cure, but by studying those who have been infected, researchers hope to prevent this debilitating disease from affecting more children.

Posted in Global Health, WHO; Tagged: , , , , , .



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Hanhsi Indy Liu and Hisham Ali Alsabt are SJD candidates at Georgetown University Law Center. Any questions or comments on this post can be sent to: hl580@georgetown.edu or ha374@georgetown.edu.

Arabian Gulf countries, known for their high oil revenues and low tax rates for decades, have recently been suffering from declining oil revenues. To reduce their reliance on oil revenues, they have begun to follow global trends by implementing first-time excise taxes on tobacco (100%), energy drinks (100%), and carbonated drinks (50%) as well as a 5% value-added tax (VAT) for almost all products and services. In addition to compensating budget deficits, public health purposes have particularly been emphasized on implementing the new excise taxes

On June 10 and October 1, 2017, the Kingdom of Saudi Arabia (KSA) and the United Arab Emirates (UAE) became the first and second state members of the Gulf Cooperation Council (GCC), to impose the excise taxes on tobacco and soft drinks (including both energy drinks and carbonated drinks). The fiscal measures were implemented pursuant to the Common Excise Tax Agreement of the States of the GCC, an agreement adopted by the GCC in Riyadh, Saudi Arabia, on 9 -10 December, 2015. It requests the six GCC member states to adopt and impose excise taxes on goods that are deemed harmful to human health and to the environment (Article 3), while tobacco is the only health harmful product being explicitly singled out in the agreement (Article 6). The taxable product lists, as well as the tax rates, are determined by the Ministerial Committee of the GCC (Article 3).

The new high excise taxes, however, are not the only problems the Gulf nations have created for tobacco and soft drinks lovers. The GCC, in the same Riyadh meeting, also passed another agreement, the Common VAT Agreement of the States of the GCC, to create a new 5% VAT on most goods and services, including tobacco products and soft drinks. After the VAT implementation, there will be another 5% tax on top of the new excise taxes for tobacco and soft drinks products. The KSA and the UAE again become the first to implement the tax starting from January 1, 2018. All four other member states of the GCC, including Bahrain, Oman, Kuwait, and Qatar, expect to impose the VAT one year later in 2019.

This is not the first time that the Gulf countries have levied taxes to raise the price of the products for the sake of both revenue generation and public health promotion. On March 11, 2016, Saudi Arabia has already imposed a 40 % import duty on tobacco products; As a result, the price for a pack of imported Marlboro cigarettes (with 20 cigarettes) increased to 14 Saudi Arabian Riyals (SAR) (approximately equals to USD $3.73) from 10 riyals ($2.67), while the new 100% excise tax plus 5% VAT then almost double the price to approximately 26 riyals ($ 6.93) per pack, according to a local cigarette user in Riyadh.

Tobacco and soft drinks are both popular products in the Arabian Peninsula. In Saudi Arabia, for example, the prevalence of current smoking among persons aged 15 and above is 27.9 (2015: Male. WHO Data); and the county has been listed as the fifth in the world for sugary drinks consumption per capita (behind only Chile, Mexico, the US and Argentina). These consumption patterns, as well as sedentary lifestyle, certainly lead to higher levels of chronic diseases in the country and the region. For example, the high consumption of sugary drinks in Saudi Arabia is likely one of the reasons that a survey conducted jointly by the KSA and the Institute for Health Metrics and Evaluation at the University of Washington found that the country’s prevalence of obesity is around 30% and among the countries with the largest increase in obesity.

The World Health Organization (WHO) has constantly advised that increasing taxes is an effective strategy for increasing prices and reducing the demand for tobacco products and sugary drinks. Article 6 of the Framework Convention on Tobacco Control, an international treaty that all GCC states have signed and ratified, emphasizes that “price and tax measures are an effective and important means of reducing tobacco consumption by various segments of the population, in particular young persons”. However, an abrupt price increase of about 150% within two years in the KSA, especially for an additive product like cigarettes, might not only increase revenues and reduce usage of the product, but also produce negative effects such as smuggling, illicit transactions, and black markets. Regional and international cooperation on striking all forms of illicit trade, manufacturing and counterfeiting will then be necessary to avoid the adverse byproducts.

While further observation and research will be needed to evaluate the public health impact of the new taxes in the Gulf States, price and tax measures have been proved as an effective tool to reduce the demand for tobacco and soft drinks in other jurisdictions. Let us wish Gulf people can reduce consumption of harmful products and move steps forward to “the highest attainable standard of health”!

Posted in Non-communicable diseases, Tobacco, Trade; Tagged: , , , , .


Zombie Deer Disease: Is Your Venison Safe?

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Photo credit: outdoor channel.com


If you were around in the 1990s-2000s, you might remember Mad Cow Disease – a disease in cows that can spread to humans via consumption of infected meat, and that leads to a degeneration of the brain and spinal tissue (known as Creutzfeldt-Jakob disease in humans).  Despite having a more scientific name—bovine spongiform encephalopathy (BSE)—and a low incidence of human disease, “Mad Cow” latched onto the collective conscious twenty years ago, leading people to think twice about where they got their meat, and causing panic in some when they found out that the disease could lay dormant in human brain tissue for decades. If you’ve been feeling nostalgic for “Mad Cow”, I’ve got some great news. Get ready for the next big thing in degenerative brain diseases spread by meat consumption – Zombie Deer Disease!

Zombie Deer Disease, otherwise known as Chronic Wasting Disease (CWD), has been observed among mule deer in the United States since 1967. Currently, the disease can be found in wild herds in 24 states and in Canada. Similar to BSE, CWD is spread by prions, a type of distorted protein that binds to other similar proteins, causing them to change as well, creating a chain reaction that leads to the propagation of disease and creation of new infectious prions.  Also like BSE, an animal infected with CWD may not show symptoms for up to two years: vacant stares or exposed ribs are clear indicators of disease.

Don’t get too excited, Zombie Deer Disease has not been proven to infect humans… yet.  A recent Canadian study showed that macaques could be infected with CWD by consuming infected deer meat.  Scientists believe that a “zoonotic jump” is inevitable, meaning that with the right mutation, humans could soon be susceptible to infection.  This new research is spurring warnings to avoid consuming deer meat, and to take precautions when handling deer carcasses.

Most people will have no problem adhering to these warnings, as deer meat (venison) is nowhere near as popular as other protein sources, such as beef, poultry, or pork. However, those that do consume wild deer meat—game hunters and indigenous peoples—are the most at risk due to the lack of safety barriers involved with consumption of wild deer meat.  Meat that is hunted is not subject to the rigorous safety measures as meat purchased from the grocery store, and because CWD can lie dormant in infected deer for so long without showing symptoms, hunters cannot visually distinguish between sick and healthy deer. State wildlife agencies may have the capabilities available for hunters to test their kills, and would be able to recommend that kills testing positive be destroyed.

Hunters should be aware of CWD—a state or national campaign highlighting the reality of Zombie Deer Disease is practically begging for production, and would certainly get the attention of both hunters and lay persons, as Mad Cow Disease did nearly two decades ago.  Encouraging hunters to test their kills and making test kits available for testing would also improve surveillance and reduce the chance that CWD will cross over to humans.  However, until CWD prions can successfully infect humans, all talk of a Zombie Deer Apocalypse is pure fiction.


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“Anchor Babies”, “Birth Tourism”, and Most Americans’ COMPLETE Ignorance of Immigration Law

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Photo Credit: East LA Gazette

The 14th Amendment of the U.S. Constitution states that: All persons born or naturalized in the United States and subject to the jurisdiction thereof, are citizens of the United States and of the State wherein they reside. This means that if a mother is present in the U.S. when a child is born, then the child… THE. CHILD… is a U.S. citizen. Put a pin in this point.

Few would argue the point that an infant child is wholly dependent on its caregivers, usually its parents, to maintain its well-being, so remaining with the parents seems most logical to secure the child’s welfare. However, there is no legal provision that links the citizenship status of non-U.S. citizen parents to that of their newborn American child. This becomes an issue when the child is born to illegal immigrants in the U.S., and it is also the source of misconceptions about immigration status in this country that often have subtle… and overt… racial and political undertones.

The “Anchor Baby” Myth

There are many Americans who believe that illegal immigrants deliberately plan to have children on U.S. soil in order to circumvent the immigration system and secure legal status. I will also admit that there are a number of immigrants who believe this to be an effective pathway to U.S. citizenship. These children have been given the moniker “anchor babies”, because they supposedly stall deportation action against their immediate family members, who now fall under the protective force field of the baby’s legal citizenship status.

However, the truth is that a child’s citizenship status does nothing to improve her parents’ immigration status in the U.S. The parents remain subject to deportation and any other legal consequences of their illegal status despite having a citizen child. In fact, a 2013 report noted that each year 153,000 citizen children could have one or more parent deported if the current detain-and deport policies remain in place. 

The result is these children are either left in this country with family members, put into the foster care system, or they return to the home country with their family. These children often have negative mental health consequences from the stress of losing one or both parents, a sharp decline in the family’s income, housing and food security, or facing the unknown, harsh, and oftentimes dangerous environment in the home countries their families fled due to fear or abject poverty in the first place.

So, am I telling you that having a citizen child cannot garner parents U.S. citizenship? No. A citizen child is able to sponsor her parents to get green cards… once she turns 21 years old. Even at that time, the parents need to meet very specific character criteria in order to qualify for lawful permanent resident status. This is hardly the speedy, jump-to-the-head-of-the-line strategy described in the rhetoric of those who want to limit or revoke birthright status of the children of illegal immigrants. In fact, those in law and politics know that birthright citizenship serves no immediate benefit to illegal immigrant parents, but those kind of pesky facts do not support their objective of limiting the growing presence of immigrants in the U.S., particularly from poor countries, nor does it incite the level of rage and fervor in the supporters they seek in order to further promote an anti-immigration message. Facts are always getting in the way of personal opinion!!

Birth Tourism

In tangentially-related other news, there is a growing practice taking place in the U.S., called “birth tourism.” Women from foreign countries, mainly China and Russia, are paying tens of thousands of dollars to temporarily relocate to the U.S. during their pregnancy in order to give birth in the U.S. and thereby guarantee U.S. citizenship for their child. Needless to say, these are almost always women of means who can afford this practice, and dual U.S. citizenship and passports are seen as status symbols in their home countries.

The federal government and immigration authorities are trying to crack down on this practice. As previously mentioned, it is not illegal, per se, to travel to the U.S. and have a baby while you are here. However, the popularization of this trend has spurred an industry that assists pregnant women to gain visas, lodging, and medical care in the U.S. These visas are often applied for using false statements as to why the women are traveling to the U.S., and that is where the Department of Homeland Security and Immigration and Customs Enforcement get involved. Federal authorities couch their concern about birth tourism in the usurping of American laws by foreigners to gain the prized benefit of U.S. citizenship. It is a valid concern, but I must note that the primary objective of these “tourist” is to gain entry to this country through subterfuge in order to acquire citizenship for their children the way they would walk into Tiffany’s and buy the child a jewel-encrusted rattle. It is sought as an accessory, not a life-altering or even life-saving opportunity for betterment. I would also be remiss if I did not mention that this frivolous poaching of the most coveted of America’s assets – the ability to be a U.S. citizen – is not drawing the same level of ire from the anti-immigration faction.

If all our immigrants came from Norway, we would have no problems!

President Trump’s recent inflammatory statements about immigrants from countries that he, shall we say, finds less than desirable, evinces the not-so-subtle racial and cultural subtext of this country’s immigration debate. It is irresponsible and disingenuous for anyone to form an opinion about immigration policy in this country without acknowledging that much of the negative rhetoric about immigration references people from poor countries, most of which have brown-skinned people. That is simply a fact, but again, we have noted how annoying facts can be when they try to compel someone to see that their opinion JUST MIGHT be misinformed or even *GASP* dead wrong.

By the way, Norway has a $1 trillion national pension fund for its entire citizenry, and universal health care. They will not be clamoring to come to the U.S. anytime soon.

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The views reflected in this blog are those of the individual authors and do not necessarily represent those of the O’Neill Institute for National and Global Health Law or Georgetown University. This blog is solely informational in nature, and not intended as a substitute for competent legal advice from a licensed and retained attorney in your state or country.

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