03.14.18

The Mysterious “Disease X”

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Photo credit: Smithsonian Magazine

This week, the World Health Organization released a list of diseases that have the potential to cause public health emergencies, and that have no efficacious drugs or vaccines.  The list was meant to direct and prioritize research and development and included some familiar names: Crimean-Congo hemorrhagic fever, Ebola and Marburg virus diseases, and Lassa fever.  The most interesting disease among the list of eight was the last: “Disease X”.  What is Disease X?

Disease X is not so much a disease as it is a concept.  Disease X represents the unknown, and the likelihood that a new disease can emerge at any time and cause a serious international epidemic if the world does not prepare for such an event.  By creating this mysterious disease, WHO is implicitly encouraging the world to be prepared for the next unforeseen outbreak, something experts generally agree could happen any time, and is an event which has been long overdue.

Perhaps not coincidentally, this new deadly, mysterious pathogen was created this week on March 11, one hundred years to the day that the first cases of “Spanish flu” were reported at Fort Riley, Kansas.  The “Spanish flu”, or H1N1, would go on to cause a pandemic of influenza that would infect a third of the world’s population, and kill between 20-50 million.

A quick internet search of “next pandemic” should be enough to convince anyone that there is a great deal of concern for the health and safety of the world, in the context of disease outbreaks and global health security.  Although many in public health feel that they know what the next pandemic will be, and are working towards preparing us for such an event, the truth is no one really knows what will cause the next pandemic.  The WHO would like for you to consider the unknown, the disease you haven’t prepared for – the mysterious Disease X.

Posted in Global Health;

03.09.18

Death from a Toothache: The Story of Deamonte Driver and Where we Stand Today in Ensuring Access to Dental Health Care for Children in the District

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Oral health is an important part of overall health.  Unfortunately, many people forget this important aspect of wellbeing.  For children with special health care needs, dental hygiene is often low on the list of priorities for their parents and or caregivers.  In February 2007, twelve year old Deamonte Driver died of a toothache in Maryland.

Deamonte Driver is a name that may be familiar to people in the DC area.  Hopefully it is a name that will never be forgotten.  With his unfortunate loss of life, comes a reminder and a warning to ensure that something like this never happens again.

Deamonte was in need of a simple $80 tooth extraction.  Such a procedure would have saved his life.  However, due to a number of circumstances, Deamonte never received this common procedure.  His mother was not insured.   Medicaid dentists were difficult to find.  The family had lost their Medicaid coverage.  His mother was focused on finding a dentist for Deamonte’s brother, who had six rotting teeth.  Bacteria from the abscess in Deamonte’s tooth had spread to his brain by the time he received attention for his toothache.  Following six weeks in the hospital and two operations, Deamonte died.

Deamonte’s death sparked outrage and change in Maryland.  The system was disjointed.  Thousands of children weren’t connecting with Medicaid-sponsored dentists and little reimbursement was being paid for those dentists who were seeing Medicaid patients.   Only about one-third the state’s over 500,000 Medicaid-covered children were receiving dental treatment in the year before Deamonte’s death.  Five years later, Prince George’s County, the county that failed Deamonte Driver, was named one of the best places in the country for children’s dental care.

The sad reality is that all of this could have been prevented.  What is even more unnerving is that more than ten years later, the system in Washington, DC has seen little improvement in removing the barriers to accessing dental services for children with special health care needs.

Georgetown University’s Medical and Law centers have recently teamed up to form the Health Justice Alliance (HJA), a medical-legal partnership with a focus on “developing the next generation of leaders in medicine and law to work together to improve the health and well-being of people living in poverty.”   The HJA brings together students, clinicians, and other health care professionals as well as law center faculty, students, and policy experts “to engage in service, interprofessional education, advocacy, and research in pursuit of health, justice, and racial equity.”

A team within the HJA has dedicated itself to oral health needs for children with special health care needs in the DC area.  At the end of March, with generous support from the George E. Richmond Foundation, the HJA, the O’Neill Institute, and the Harrison Institute for Public Law, will host a convening focusing on this important issue.  The convening will focus on finding to solutions to the barriers that prevent children with special health care needs from accessing oral health services in the District and beyond.  The event will begin with an introduction of the barriers with a panel featuring parents of children with special health care needs as well as a practicing pediatric dentist in the DC area.  Roundtable breakout sessions will allow the attendees to identify barriers and identify practical solutions.  The day will wrap up with a panel of policy leaders and health care professionals discussing solutions to ensure there will never be another Deamonte Driver again.

Posted in Human Rights, National Healthcare; Tagged: , , , , , .

03.05.18

Overcoming Barriers to Legal Abortion in Argentina

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This post was written by Camila Leone and Rebecca Reingold.

Image courtesy of Cienradios.

On February 22, the President of Argentina, Mauricio Macri, announced that the country’s legislature will debate a bill that would decriminalize abortion on broader grounds. Currently, abortion is only legal when the pregnancy poses a risk to women’s life or health and in case of rape, as established by Argentina’s Criminal Code and the 2012 case F., A.L. s/medida autosatisfactiva. Under all other circumstances, abortion is criminalized.

Further decriminalization of abortion by the legislature has enormous potential to advance the health and protect the rights of women and girls throughout the country, particularly given the many barriers they currently face when attempting to access legal abortions.

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Posted in Human Rights; Tagged: , , , , , , , .

03.02.18

Supporting College Students Living with HIV: A New Resource

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Young people heading off to college face a multitude of unknowns: Am I ready? Will I find friends? How will I handle the course load? Incoming college students living with HIV are faced with additional, complex questions that can make the transition even more difficult: How and where can I access medical care? Who do I have to notify/should I tell people about my HIV status? Will I be discriminated against?

Universities and organizations have begun realizing that resources are needed in order to help college students living with HIV. One such organization is Affordable Colleges Online (AC Online), which has created a resource entitled “Living with HIV in College: Student Support and Awareness” that provides information on HIV and support in areas such as disclosure, discrimination, and accessing treatment. In regard to information on HIV, this resource outlines how HIV can be transmitted through sexual intercourse and sharing needles and/or syringes. The resource also provides specific information that students living with HIV need to know. This includes the fact that a student’s HIV status is private medical information.

The AC Online resource also provides important information about HIV prevention and how to minimize risk for HIV. Effective prevention is critical to ensuring college students who are at a higher risk for contracting HIV do not become infected with HIV. Those who have an increased risk of contracting HIV include gay and bisexual men and transgender women, especially gay and bisexual men of color and transgender women of color, as well as Black women.

As the resource notes, colleges and universities will have their own approach to educating their students about HIV and sexual health. Some colleges and universities have been more proactive than others. Emory University, for example, has taken a step toward supporting effective HIV prevention by providing information about pre-exposure prophylaxis (PrEP) on their Student Health Services webpage. Emory has also created an in-house PrEP clinic so students can utilize PrEP without having to seek resources off-campus. Students at Emory interested in PrEP can follow steps outlined online which include: (1) talking to a provider about PrEP, (2) meeting with the PrEP team and obtaining a prescription, and (3) taking the medication, engaging in safer sex practices, and returning to the clinic every three months.

More resources are necessary to support people living with or affected by HIV so that they can live healthy lives. College students living with HIV need support in areas such as access to medical care and how to treat their HIV status information. With this support, these students can participate and function as any other college student would. College students who are at a higher risk of contracting HIV first need to be aware of their risk and get tested for HIV, but then need to be informed of what they can do to prevent HIV infection. While Emory University provides this information and has created an in-house PrEP clinic on its campus, there is an overall lack of access to this information and services at colleges and universities across the country. Colleges and universities should work to provide relevant HIV information and services to students living with or at risk of contracting HIV and may benefit from the AC Online resource.

This blog post was co-authored by Natalie Dobek, a second-year law student at Georgetown Law and a research assistant at the O’Neill Institute.

Posted in Resources; Tagged: , .

02.27.18

Several modest proposals to improve safety, reduce gun violence, and make Americans happy

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Marjory Stoneman Douglas High School students and supporters rally for gun control in Tallahassee, Florida, on February 21, 2018. Image courtesy of the Denver Post. Photo by Don Juan Moore/Getty Images.

Over the past month or two, we’ve heard some proposals, both innovative and long-standing, to address violence and joblessness.

Let’s start with the President’s suggestion that immigrants who enter our country – whether through several legal immigration routes or as unaccompanied minors – are a great threat to our safety. The proposed solutions are to keep would-be immigrants out of the United States and to do more to remove immigrants from this country who have not entered legally.

Surely the President is right. The fewer immigrants in this country, the less crime there will be here. I admit to not having checked the statistics, but I would venture that countries like Tuvalu (you know, one of those small Pacific islands) and Lichtenstein have both fewer immigrants than the United States and less crime too, proof if you ever needed that keeping your immigrant totals low is good for public safety.

Now, one might be tempted to look to some statistics for here in the United States. I was. Turns out that native-born Americans are nearly twice as likely to be incarcerated as undocumented immigrants, and more than three times as likely to be incarcerated as legally-present foreign-born immigrants.

I can only conclude, then, that if keeping out (and kicking out) immigrants is a good solution to crime and violence in the United States, then a truly great solution would be to expel native-born Americans. Perhaps we might begin with a one-to-one match – for every immigrant deported, or estimated to be stopped by a big beautiful wall at our southern border, one randomly chosen non-immigrant American is stripped of their citizenship (clearly undeserving of being a citizen of the United States given their criminal propensity) and expelled. If the policy proves successful, we could increase the number of expulsions. And given the statistical evidence, if we really, truly want to make America safe, we would best redirect funds from that wall along our border to be used instead to pay countries to accept all those former American citizens whom we expel.

Moving now to another crime-related issues, gun violence. The latest scene of that American tragedy called “School Mass Murders” unfolded in Florida a few weeks ago. As the debate of what to do to prevent future such incidents picked up, I was reminded of that favorite line of the National Rifle Association: “The only way to stop a bad guy with a gun is with a good guy with a gun.” That always seems to be the answer, doesn’t it? More guns will make us safer, just as long as the guns are in the right hands. Makes perfect sense, of course. We need lots of good guys to have guns. Then the forces of good can win all these wars playing out in our schools and our places of public gathering.

This raises the question: Who are the “good guys”? How can you tell the good guys from the bad guys? There is much talk these days about arming teachers. Let me propose another possibility: look to our children. After all, who could be more “good guys” than our innocent children? The younger the better, before society’s ills can influence them. If enough young children have guns, then we could have an all-children, national police force that can keep us safe.

Some good news on this front – we’re on our way there. Take the recent Wisconsin law that removed the minimum age at which children could hunt. In fact, Wisconsin is the 35th state to extend the right to bear arms to our youngest children when it comes to hunting. Our political leaders are seeing the light. They know who will comprise the well-regulated militia to protect us.

Enough talk of violence and tragedies. Let us look to a progressive attempt to enable people to work, surely a fine goal. I am referring to the waivers that the current administration will, and has begun to, issue to states to condition Medicaid on requiring recipients to work or undertake other “community engagement activities,” like volunteering and job training. The administration’s and states’ rationale is infused with benevolence – they want to help move people out of poverty and into jobs. Work will provide dignity and better health.

Now, this seems to presuppose that people on Medicaid who are jobless are not working because they don’t want to work. If they are poor and don’t want to work — that is, if they are apparently quite content to live in poverty — then I must conclude that there is something very satisfying about a life of poverty. (Is it the thrill of not knowing whether your food budget will last you and your family until the end of the month? Or the adrenaline rush of finding yourself unable to pay your phone bill and needing to figure out how you will cope without phone service?) Indeed, they must enjoy being out of the workforce quite a bit to need the threat of ending their health coverage – which their very lives may depend upon – to encourage them to work.

With this insight in hand – that living in or near poverty is a highly desirable lifestyle – then perhaps the work requirements are the wrong way to go. Perhaps it would be better to enable more people to enjoy the life of poverty. Let’s replace the minimum wage with a maximum wage. Good-bye Earned Income Tax Credit. Congress could demonstrate real leadership here, axing their own salaries so congresspeople, too, can experience the joys of poverty.

Okay. Back to reality. Of course expelling Americans is not the answer to crime in the United States – just as limiting legal migration or speeding up deportations of undocumented immigrants is not the answer. If we are really concerned about crime among undocumented immigrants, we should ensure them a pathway to citizenship – I noted above that while undocumented immigrants commit less crime than native born Americans, legally present foreign-born Americans commit less crime still – and facilitate their ability to earn a good living.

And as for crime, while that is also a far larger topic than I can address in this short piece, suffice to say that addressing conditions that drive crime, and more targeted approaches like the Portuguese model of decriminalizing drug use, investing in education in prison, and helping people who have been imprisoned re-enter the community, would help a great deal. So would deconstructing the innumerable legal barriers that keep people who have been imprisoned from integrating into society, including restrictions on voting, public benefit programs, and employment.

Moving on, arming children is of course a scary, dystopian idea. What we could do, though, is to follow the lead of other wealthy countries (and efforts of some U.S. states) to enact and enforce meaningful gun control measures – measures that would protect our children and all of us not only against the headline-making mass murder of a school shooting, but also against the far more common reality of gun death in America, suicides and the daily shootings that don’t make national headlines. Singer-songwriter Tom Paxton puts it so well, so simply, referring to instances of mass shootings, but applying as well to the other 30,000-plus gun deaths in the United States each year: “What if he couldn’t lay hands on a gun?” (Listen.)

I know that the political dynamics have long worked against gun control, with occasional glimmers of hope only for the narrowest of (though still valuable) measures at the national level. But political dynamics are not immutable; ours would be a far different country if they were. Rep. Gabby Giffords, shot in January 2011 in a mass shooting that left 6 dead, Michael Bloomberg, and others have started political organizations against gun violence. John Lewis led a remarkable House sit-in in 2016. Survivors of the Florida school shooting earlier this month are demanding change. Change will come when enough people demand it.

And lastly, the Medicaid work requirements. Facilitating people’s path to employment can indeed help them out of poverty, and to a greater sense of personal dignity and to better health. But conditioning people’s human right to health on working? This is an approach that not only violates people’s rights, but is illogical. Losing health insurance will lead to worse health, impeding people’s ability to work.

Most people on Medicaid do work, 60% of nonelderly adult recipients, while 79% live in a household with at least one working adult. And when people who have Medicaid are not working, it is typically for a very sound reason – they are ill or disabled themselves, taking care of their home or caring for a family member, or going to school, to name the top three reasons in a 2016 review. A small minority, 6%, were not working because they could not find a job. If any were not working simply because they choose not to, their numbers were too few to register.

So if the aim is to help Medicaid recipients work, more and better health care, not less, may help some (those presently ill and disabled). So might expanding Medicaid support for home care for the elderly, or other programs to help with caregiving, such as affordable child care. Threatening an end to their Medicaid will not help people who haven’t been able to find a job to find one. Expanded job training and helping connect people to jobs for which they are qualified (parts of the Indiana Medicaid work requirement program), a serious infrastructure plan to create new jobs – these are among the approaches that could help.

It is easy to scapegoat, whether immigrants or low-income Americans. It is easy to leave things as they are, as we have with national gun laws. We could travel down paths to further darkness, and create a more violent, angry, divided, fearful country, replete with walls that block people, that block understanding (such as resorting to stereotypes as to why people are not working), and that block basic human decency and compassion. Or, as so many millions of Americans are doing, we could know that there can be a very different America…and persist, persist, persist.

Posted in Human Rights, National Healthcare; Tagged: , , , , , , , , .

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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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