The Women of Can’t Catch a Break: Fall 2017

The summer can be a slow time for anyone looking for jobs, housing or just trying to get things done. That’s true for must of us, and doubly true for people who are dependent on multiple social service and governmental agencies with shifting personnel and rules. For many of the women, the dominant theme of the summer was waiting, waiting and waiting some more.


Ginger (see “The New Price of Freedomwas super excited last spring when her case manager at a housing agency told her she would get her into an apartment soon. In mid-summer the case-manager took Ginger she was taken to see an apartment in a community right outside Boston. She was thrilled – oohing and aahing as she described “my stove” and “my floors” in this recently renovated flat. She was waiting for it to be approved by the Housing Authority and she was sure there wouldn’t be any problems because the apartment seemed in great condition. We talked about where she would get a bed and what color sheets she wanted. She lined up my help to drive her possessions to the apartment (it turns out all that she owns — aside from a few outfits and toiletries — is a box of assorted glasses and cups she has received as Christmas presents or won at raffles at homeless programs over the years.)

And then she waited some more. Finally, the inspector came and found a leak in the basement of the building. The landlord was told he had to fix the problem before it could be approved. She waited for the repair and then she waited for the inspector to come back. Her housing advocate repeated to her that she just needs to be patient, that these things take a while.

They seem to have taken too long because in early October the landlord withdrew the offer of the apartment.

As of this writing, Ginger remains homeless, though her case-manager has promised to take her next week to see another apartment.


Isabella (see “Failure by Design: Isabella’s Experiences with Social Services“) is still in prison, waiting to find out when she will be let out. Her release date is up in the air while the system sorts out various old charges, warrants, and probation and parole violations.


Kahtia (See “Prostitution, Decriminalization and the Problem of Consent“) is still trying to regain custody of her children. It’s been two years at this point and she is beyond frustrated. In the middle of the summer I accompanied her to a long-awaited Court date.

We met in front of the Court House. Kahtia was sitting outside by herself, an hour before the scheduled Court time – she wanted to be sure not to be held up by public transportation or arrive looking disheveled. In fact, she looked lovely. She had a nice, modern haircut, was wearing beautiful make-up, had her new teeth (they look beautiful and natural), and was wearing a long flowing dress. She was very optimistic because the judge had told her that this would be it – that she would get the kids at this hearing. We joked around and made small talk and reminisced and talked about movies and news stories until it was time to go upstairs.

Outside the courtroom we sat down to wait and wait and wait. And as the hours went on Kahtia wilted.

Finally, a social worker from Kahtia’s lawyer’s office came out to show her the report DCF had filed. The report included descriptions of her visits with the children (all positive reports) and reports from her therapist and psychiatrist. And here is where it got weird. The therapist wrote that Kahtia has done well and learned to manage her emotions,  but then commented that she has failed to go for some of her urines (drug tests). The strange part is that Kahtia is not mandated to go for urines. It was her own idea and she goes voluntarily because she believes this will help her show that she should get her kids back. She missed one or two urines when she was sick. But DCF seized on that one comment from the therapist and gave it more weight than all of the positive feedback.  When Kahtia saw this document she became upset and interpreted it as further evidence that DCF has it in for her.

After another lengthy wait, the social worker returned to tell her that it’s time to go in to Court, but that she can’t bring anyone with her (she had hoped to bring me or sister with her for support) and that a new judge would be hearing the case. This was particularly devastating because Kahtia felt the judge who had been on the case since the beginning was fair and understood the issues. He was set to retire but told her he’d stay on her case until the end. At the last hearing he had berated DCF for dragging things out when Kahtia clearly was complying with all of their requests.

Kahtia was shocked by the news and furious to learn that her lawyer likely knew about the new judge a couple of hours ago but only told her as she was walking into the courtroom. We begged for a few minutes to help Kahtia calm down.

She went into the court room and came out a few minutes later. It turned out that one of the translators hadn’t arrived.

Another wait and she went in again, just for a few minutes. The case was continued for two months, at which time the lawyers will offer motions. Her lawyer will ask to increase her hours with the girls (for no known reason the hours had been cut from 2 per week to 1 per week). DCF will ask to see Kahtia’s mental health and other records for the two years preceding the opening of this case as well as a report from her domestic violence counselor. We asked why this necessitates a two month wait. We were told that all of the lawyers couldn’t find a date that worked for them any earlier.

The delay means the girls won’t start the school year in their mother’s neighborhood and likely will have to transfer schools mid-year, again.

The day that started so hopefully ended with crushing pain, again.


Melanie, one of the few women who has been employed for most of the past ten years, was let go from her job last spring because of health problems.  Earlier in the summer her mother — a woman who had held her family together even when she herself was extremely ill — passed away. “I feel the hits just keep coming, with losing my job and then my mother,” Melanie told me.


Francesca (see “The Bitch at the Welfare Office“) has been busy. During the summer and into September her time and efforts revolved around caring for her granddaughter. She and her son mostly got along well and were doing a good job of raising the child (whose mother died about a year ago.) Francesca organized pool parties, took her granddaughter shopping for school clothes, and more or less lived her long-time dream of having a house with her kids and being a Mom and homemaker.

Unfortunately, about a month ago she and her son had an argument during which “he disrespected me. He said I’m dead to him he doesn’t want me in his or [his daughter’s] life; that I’m a loser and never will get anywhere in life. That’s something his [abusive] dad would say to me when we were married.” He kicked her out of their house and threatened to throw her possessions onto the street.

Francesca handled the situation with a great deal of grace and a maturity that, she told me, she knew she didn’t have even a few years ago. She moved in with her boyfriend, continues to spend time with her granddaughter, and has started an on-line business that she conducts from her phone. The downside, and this is not new for her, is that her boyfriend lives in a fairly remote community and Francesca does not have a car. He has a car and a steady job so she is dependent on him for transportation and for financial support. In the past, this sort of power imbalance has not ended well for her.


Tonya continues to amaze me with her resilience and resourcefulness. In July everything seemed to be going wrong. “The blows are coming left and right. They cut my income. I go into panic mode at  the threat of being homeless. My mother is 70 years old and out on the street [due to a fire in her apartment].”

Tonya’s check was cut because she did not consistently make it to her required community service (required in order to get cash benefits – transitional assistance). She was supposed to go to a certain office in downtown Boston everyday, but often did not have money for transportation to get there. “It costs almost $100 a month and the trip takes an hour and a half. They cut me from $490 to $478.” I asked how she’d been able to stay on transitional assistance for so long – the usual cut-off is two years. “Because I’ve been applying and reapplying for Disability. I have pain in my body. So many forms to fill out. Susan, I don’t want to do it anymore. I’m 42 and I’m exhausted. I gained 65, 70 pounds.” She described pain in her knees, back and hands.

“The one good thing is that “my record cleared through Annie Dookhan [the state employee who tainted evidence in the state’s drug labs] but ten years of my life were ruined [because of her record]. I feel I won’t last a lot longer. My father died at 52. I’m going down the same path. Drinking, stressed, tired. I just keeping do more programs and more job training.” One recent program “told me I need to wear business clothes, but I can’t afford to even do my hair, I wear a scarf all the time. Susan, nothing has progressed since you met me. I just want to be a normal person but you can’t on welfare. They want you to be then they make it impossible. … It’s an ongoing battle. Non-stop.”

A month or so later I ran into her as she was walking her son home from day camp. (Full disclosure: I’ve known her son since the day he was born and I can say — with full scientific integrity — that he is the cutest child in the world!) She had signed up for another job skills program but missed the first day of the  because she did not have money for transportation. So she enrolled in another program that teaches people how to be an employee (how to look for a job, how to set an alarm clock, how to talk to your boss). The program is far too basic for her; in fact, she could teach it she has taken it so many times. “But I have to be in a program in order to get help for sending my son to camp. He is at the [] Camp and loves it!”

Tonya always manages to surprise me. Yesterday she sent me a photo of the broccoli she managed to grow in the little patch of dust outside her apartment. I told her that I believe the success of her broccoli plant is an omen of good things to come.

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For those of you who have come to know the women — and for those of you meeting them here for the first time — please feel free to ask questions. You can post your questions in the Comments or email them directly to me at ssered@suffolk.edu. I’ll pass along your questions to the women as best I can. They know that I write about their lives and are eager to share their thoughts and opinions with more people.

To read previous updates click on:  Early Summer 2017  January 2017   Summer 2016   New Years 2016   Summer 2015   Christmas 2014 / 2015    Fall 2014 

Check back often for more updates on the women of Can’t Catch a Break!

 

Pinktober 2017

I’ve written about the commodification and cute-ification of pinkwashing in earlier posts, as well as issues around the cultic glorification of “survivors,” the profits to be made in pinkwashing, and perhaps most troubling — increasing inclinations to present breast cancer as if it is a normal life stage for women. Here are the links to those articles:  Pinktober: A Consumer Dystopia and Pink Ribbon Extravaganza and Pinkwashing: It Really Can Get Worse

This year I’m just going to share a round-up of the latest images that have crossed my screen.

The Sexification of Breast Cancer

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The Commodification of Breast Cancer

These seem to be advertising make-up and nail polish, much of which, according to the most rigorous research, actually is carcinogenic. Particularly important to point out the serious health risks endured by women working in nail salons.

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Lethal Breasts: A theme I haven’t seen much in the past – the idea that women’s breasts are lethal – to women!Image result for breast skeleton pink ribbon

 

Save the tata's!!!

 

If breast cancer doesn’t kill you, walking around in these might:

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This year you can join the “Vape for Breast Cancer” movement

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Or just go about killing yourself the quick way

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The guys want to get in on the pink weapon action too! 

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I definitely feel safer knowing that “Lumberton Police Chief Danny Sullins and his officers, including (from left) Sgt. Chad Wilson, Off. Dale Tinsley, Lt. Joey Breaux, and Sgt. Kenneth Powell, have taken the “pink challenge” made to Hardin County.”  In case you’re wondering, that’s the same Lumberton that made national headlines for a particularly gruesome case of beating a man to death.

Medicalizing Healthy Breasts, or Just Plain Weird?

I’m not sure how to categorize this one but it does give me a weird feeling in the pit of my stomach.

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Substance Abuse and Social Capital

While the Donald Trump / Jeff Sessions administration is working to re-invigorate the war on drug users, a number of new studies look at relationships between social / cultural / economic capital on the one hand, and drug use, on the other. In my own research with criminalized women in the Boston area I witness the drug-encouraging perfect storm of poverty, marginalization, and the absence of meaningful opportunities for understanding how social inequalities cause suffering.

Despite popular articles (including this one in the New York Times) extolling drug treatment in prisons, newly emerging research suggests that locking up drug users is just about the worst thing we can do if we want to reduce drug-related deaths. By removing people from sources of social and cultural capital, we are exacerbating the very conditions that lead far too many Americans to abuse substances to begin with.

Opiate deaths in a former manufacturing community

A recently published qualitative study looks at factors contributing to drug overdose in the Monongahela Valley of Pennsylvania. This is a region that used to be a center of steel production but is now economically very depressed as manufacturing has shifted out of the area. The author interviewed people at a drug treatment program and found that they mostly spoke about lack of jobs and overall hopelessness in the local communities. The author concludes, “While state and county efforts to ameliorate overdose mortality have focused upon creating an open market in naloxone, this study suggests the need for interventions that address the poverty and social isolation of opiate users in the post-industrial periphery.”

To me, it’s interesting that the author makes the connection between poverty and social isolation for the “post-industrial periphery” but I think the same argument can be made for urban and suburban areas.  When people feel isolated and hopeless — and, of course, when mood altering substances are easily available — drug use can be quite attractive.

I suppose that the appeal of 12 step groups such as Alcoholics Anonymous and Narcotics Anonymous lies both in the sense of community (though, of course, it’s a constructed community that one loses as soon as one “relapses”) and the hope relayed by the success stories recited at meetings. Unfortunately, however, the hope and success (which is not as common as 12 step proponents like to claim) are limited to the specific context of the meetings. Commitment to sobriety does not change the economic reality of dead-end jobs, companies that do not have loyalty to employees, wages that don’t allow people to save money towards things like home ownership that truly bring hope, and so on.

Social capital and drug overdoses: a quantitative analysis

Another new study makes a similar point. In “Bowling alone, dying together: The role of social capital in mitigating the drug overdose epidemic in the United States” the authors used large-scale county-level data. The data show a pretty clear correlation between low social capital and high overdose death rates. The authors measured social capital in terms of the density of civic organizations, the percentage of adults who voted in elections, response rate to the census, and the number of non-profit organizations in the county.

While these measures are not perfect (in my opinion) they are suggestive. I’m particularly interested in the correlation between voting and drug overdose rates. In my own work I see a connection between substance abuse and the sense that one is stuck in world over which one has no power to make things better. Not just hopelessness but also powerlessness seem to drive at least some of the excessive drug use that we are witnessing around the country. In fact, according to the Sentencing Project, “one of every thirteen African Americans has lost their voting rights due to felony disenfranchisement.” Moreover, “A record 6.1 million Americans are forbidden to vote because of … laws restricting voting rights for those convicted of felony-level crimes. The number of disenfranchised individuals has increased dramatically along with the rise in criminal justice populations in recent decades, rising from an estimated 1.17 million in 1976 to 6.1 million today.”

What this study cannot get at is the variability of access to social capital within particular counties. I sometimes hear the women I have come to know speak with deep sadness about how other people seem to get the breaks while they just can’t catch a break. These women are likely to see their misfortunes as an individual failure or bad karma, but when I look at their life experiences I often see how identifiable policies forced them to be cut off from sources of social capital. Locked into jails, homeless shelters, rehab programs, low income housing and temporary jobs (at best), they are systematically excluded from the primary sources of social capital in our communities.

The women I know tell me that they want to help others, but even volunteer positions require criminal background checks. Many want to be part of church communities, but they find that churches drop them like hot potatoes when it becomes clear that they need more help than the congregations want to provide to any one individual.

Creating social and cultural capital: A revolutionary program in San Francisco

I’ll close here with a third article I read this week. This one highlights a program that addresses social and cultural capital in a very profound way. “Making the case for innovative reentry employment programs: previously incarcerated women as birth doulas – a case study,” documents a San Francisco program in which formerly incarcerated and low-income women were trained as birth doulas. 

According to the authors, “Realigning women within communities via birth support to other women also provides culturally relevant and appropriate members of the healthcare team for traditionally vulnerable populations. Doulas are important members of the healthcare workforce and can improve birth outcomes. Our work testing doula training, as a reentry vocational program has been successful in producing 16 culturally relevant and appropriate doulas of color that experienced no re-arrests and to date no program participant has experienced recidivism.”

Of course, not everyone is suited to be a doula! But the lesson from this project is far broader. Through participation in the program the women joined an on-going community, learned that they can be powerful agents in helping other women take control of their own births, and they not only acquire but also create meaningful social and cultural capital.

 

On-going Zika Crisis in Brazil: Lessons for the U.S.

A report released this week by the Human Rights Watch documents the ongoing tragedy of Zika in Brazil. The Brazilian government has declared an end to the national public health emergency. Yet pregnant women are still becoming infected with the Zika virus, babies are coming into the world carrying the effects of Zika, and families will continue to care for their Zika-affected children for years to come. More broadly, the social, economic and environmental conditions that gave rise to and then exacerbated the Zika outbreak in Brazil have not changed. Sadly, many of these conditions are present in the United States as well. And while Zika has not wrecked havoc in the continental US (Puerto Rico has experienced significant Zika outbreaks), these same conditions are fertile ground for a multitude of public health disasters.

Environment and Infrastructure

I spoke with Margaret Wurth, a children’s rights researcher who spent a year interviewing nearly fifty women and girls who were pregnant or gave birth in two of the states most affected by Zika. She learned that Brazilian authorities warned women to spray their homes with insect repellant and to cover open water jars, “but there is only so much as individual can do.” In communities with erratic water supplies, people have no choice other than to fill tanks with drinking water. But these same tanks can quickly become breeding grounds for mosquitoes. The Human Rights Watch report also describes, “Untreated sewage flowing into open, uncovered channels, storm drains, roads, or waterways.”

Wurth recalls meeting a pregnant sixteen year old who did everything she could to protect herself and her fetus. She wore long sleeves, doused herself and her home with insect repellent and covered water jars in and near her house. She did not know, however, that Zika can be transmitted sexually. And she could not, of course, single-handedly clean up the standing water and sewage in her favela.

In the United States most communities have covered sewage disposal systems and household running water. Yet the American Society of Civil Engineers graded the country with a D+ in wastewater management in 2017. Their assessment is that more than $105 billion is needed for wastewater funding. With Congress stalled and no real plan for investing in infrastructure, this kind of funding seems unlikely. And while some states have reasonably good water and sewage systems, in other states – most notably Alaska and Mississippi – significant numbers of households lack both.

Reproductive Health and Rights

One in five of Brazilian mothers raising children with Zika syndrome are under the age of twenty. These young women were unlikely to have access to birth control. Given Brazil’s prohibition on abortion, women may turn to dangerous “backstreet” abortions. A young woman who especially touched Wurth’s heart underwent a clandestine abortion at the age of thirteen; she had become pregnant as a consequence of rape. Wurth met women who had used caustic acid to induce abortion. Facing the terror and the stigma of bearing a child with Zika-syndrome, these women risked their lives. Not all survived.

In the United States access to contraception and abortion are increasingly under attack. The Republican health care bills would further reduce access to reproductive health care through defunding Planned Parenthood and removing birth control from the list of basic services insurance must cover.

In Brazil, government efforts to educate about Zika are disproportionately aimed at women, implicitly absolving men of the responsibility to prevent transmission or to help raise children living with Zika-syndrome. “Mothers are overwhelmingly the primary carers for kids with Zika syndrome. It’s very challenging. They can’t continue working or going to school. They often need to travel long distances and fight with agencies and officials to get the services they are entitled to,” according to Wurth.

In the United States family planning is similarly delegated to women, especially in communities that do not allow comprehensive sex education in schools. An abstinence-only curriculum does not prepare young men to be responsible sexual partners. And, like in Brazil, American mothers – especially low income mothers – face suspicion when they request government services. Republican demands that food stamp and Medicaid recipients work at paying jobs will hit hard at mothers of disabled children.

The Way Forward

There are measures that should be taken in the short and long terms to prevent future outbreaks of diseases like Zika, and to support those who are most affected. Developing and maintaining safe water distribution and sewage systems in all communities is crucial. Women and girls need access to the full range of medical services, including contraception and abortion. Men must be educated to shoulder their share of the responsibility for sexual safety, family planning and child rearing. And families and communities must be able to rely on ongoing support to care for ill and disabled individuals.

It’s unclear if the Brazilian government’s declaring the Zika crisis over was naively optimistic or blatantly political. In any case, it is eerily reminiscent of the declaration that “America has the best health care system in the world” when all data show health care in the US ranking last among developed nations. There are important lessons for the US both in the underlying causes of the Zika disaster in Brazil and in the Brazilian government’s response. We ignore them at our own peril.

The Women of Can’t Catch a Break: Early Summer 2017 Update

I’ve finally had time this summer to try to touch bases with all of the forty-eight women who started in this project eight years ago.

Seven women have disappeared from (my) sight. None of their old addresses or phone numbers are still good. None of the people we knew in common have heard from them. I couldn’t reach any of their family members. And I couldn’t find any trace using Google searches (I tried various nicknames and known aliases).

Five women are dead.

Only three women are currently housed, sober and employed (or stay-at-home moms whose husbands are employed), and have been so throughout most of the eight year period. 

The rest of the women continue to cycle in and out of housing, jobs, detox and rehab, hospitals, and jail. Some of these women have stable housing but are on Disability. In some cases, they are unable to do any kind of work. More commonly, they cannot find a job that for which they are qualified and that allows them sufficient flexibility to take care of children, health problems or mental health crises.

I’ve been reminded again and again that I cannot predict how any particular woman will be faring at any given time. Just this week I went to jail to visit a woman whom I never dreamed would end up incarcerated again. At just about the same time, I learned that a woman whom I assumed would continue to bounce between prison and the streets is now stably housed and raising her children. 

To read previous updates click on:  January 2017   Summer 2016   New Years 2016   Summer 2015   Christmas 2014 / 2015    Fall 2014 


Andrea passed away.  The fifth woman for whom we’ve written a Eulogy, Andrea was the only one whose death was described as “natural.” Two others were murdered (see Eulogy for Elizabeth and Orange-Frosted Hostess Cupcakes), one died with a needle in her arm (see Eulogy for Nicole), and one died of complications of HIV/AIDS (see Eulogy for Junie). Andrea had a congenital heart defect, but I can’t help but wonder whether the decade she lived in homeless shelters contributed to her death.

Andrea loved working out while watching exercise shows on television. For years, she urged me to do the same. I would smile and nod my head, and tell her that I’d try. Finally, this spring, not long after she died, I started going to a zumba class. I wish I could tell Andrea about it.


Carly (see “A New Home for Carly“) is still homeless. Though she has a voucher for Section VIII (subsidized housing), she cannot find an apartment in the permitted price range. DCF (child welfare department) has not returned her baby to her custody. She’s been told she needs to see a therapist (she is) and attend a parenting class (she is waiting for DCF to run one), but the reality is that without an apartment she is unlikely to get her child back. She has been focusing a great deal of her attention on reaching out to the baby’s father. He is incarcerated, so it’s not clear to me how she expects him to become involved with the child.


As of this writing, Erin is no longer using drugs and seems to have settled down. “One day I just decided to stop. I can’t live like this again. I knew if I kept using I’d die.” She continues, however, to experience memory lapses, “probably [caused by] the drugs. I used to be on anti-psychotics, mood stabilizers. I was diagnosed bi-polar but I think they freely throw that [diagnosis] around. My problems are more because of how I lived.”

Erin’s husband died last year. She now is living with a man whom she has known for many years. He is employed, and she makes a bit of money selling cosmetics. Her main concern at this time is her back. She suffers from degenerative disk disease that interferes with her sleep and with her ability to stand up straight.


Two months ago Francesca (see “The Bitch at the Welfare Office“) had major surgery on her neck. Both before and after the surgery her doctors prescribed large amounts of Percocet, an opioid that has always been her drug of choice. There were a few weeks during which I was worried that she was going to slide right off the slippery slope of monitored pain medication use back into drug abuse, but she seems to have weathered the worst of the post-surgical pain and is doing a good job of going about her life. She still lives with her son and granddaughter, works part-time, and is involved with a man who does not seem (to me) to be abusive.


Ginger (seeThe New Price of Freedom) called me every single day when my father was in the hospital back in January. She never intruded – she’d just call to say that she is thinking of me and is available if I need to talk. It amazes me that she has this much compassion — and consistency in showing compassion — when she herself is homeless.

The last time we spoke she was optimistic about getting housing. She’s been working with a case manager at a housing agency and had been told that she is high on the housing list. But as of this writing I haven’t heard from her for a month. Her phone number is no longer working and I don’t know where she is.


Isabella (see “Failure by Design: Isabella’s Experiences with Social Services“) is back in jail. Though still unemployed and grieving for her late husband, she seemed to be managing her life. She had a reasonable place to live, was consistent about going to the methadone clinic for her daily dose, and had re-established good relationships with her family.

Then, a few months ago she was in a car accident (it was not her fault). She was knocked unconscious at the time of the accident. She woke up in the hospital — handcuffed to the side of the bed.

It turns out that when the police checked her identification on their computer system they found that she had outstanding warrants on a number of old drug charges. Because she had moved frequently, she had not received the summonses to appear in court.

After a week in the hospital, she was transferred to jail, where she detoxed from methadone. The detox process led to major weight loss and seizures. She now is feeling better and is happy to be off the methadone. She would like to enter a drug treatment program to get support in staying clean.

In the meantime, she has lost her apartment as well as all of her belongings (from jail she couldn’t arrange to transfer her clothes and furniture to a storage locker.) No one in her family has written or come to see her.


Kahtia (See “Prostitution, Decriminalization and the Problem of Consent“) continues to work with DCF to regain custody of her children. Each time it seems that the matter is resolved, something else comes up.

She is still going to all of the required appointments and programs, still volunteering at  soup kitchen, and still seeing her children once each week.

Unfortunately, her health has deteriorated. She has trouble breathing, carries oxygen with her, and struggles to go up the four flights of stairs to her apartment. Most days she only goes out one time so that she won’t have to navigate the stairs more than once. It’s unclear to me how she’ll manage when her children come back home.

This week she was too sick to go to her volunteer job. At this writing, she is sitting in the emergency room waiting to see a doctor.


Melanie – a woman who had worked steadily for the first seven years I knew her, is now on Disability because of mental health challenges. She desperately wants to go back to work.


Patricia has overcome a great deal in her life. Her mother died of an overdose and her father is serving time in a European prison for drug trafficking. She began drinking in her early teens, and ended up in prison because of a string of DUIs.

After her stint in prison she trained as a medical assistant and worked fairly consistently for the past six years. At this point she feels that she is a functioning alcoholic, though there are times she drinks too much and has to phone in to miss work. Unfortunately, she recently lost her job at a clinic.  “A doctor behaved inappropriately to me. The clinic fired me, not him, because he brings in the clients and the money.”  As of this writing, she has been collecting unemployment for several months.

Even with all of that history, Patricia looks and sounds like a soccer mom! She relishes hosting pajama parties and going to her kids’ school events. Patricia is one of the few women who has never been homeless. An attractive woman with a friendly and pleasing manner, she has always had a boyfriend, a “sugar daddy” (her words) or extended family to stay with. She and I agree that the fact that she has never been forced onto the streets or into the shelters is a function of how she looks and sounds (middle-class) as well as the reason that she continues to look and sound so very well.


Paula, a white woman in her early fifties, had fallen off our radar for a number of years. A few years ago she was arrested on a drug charge. Last year we heard through the grapevine that she died of an overdose. It turns out that she, in her words, “almost died”.  Paula explains, “I caught pneumonia and I was using hard, so I got septic and my lungs acquired ARDS – a fatal lung disease. I was on life support for 6 weeks.”

Just last week she told me, “I’m OK, I guess. I’m clean but lost both parents and am dealing with an alcoholic husband. We’re living in a low rent room in [central Massachusetts]. I have been out of prison now for two years and have lived in five different spots. It sucks.”

On the positive side, “I passed my driving test and bought my first car. I never thought I’d actually have a car!”


Life is unpredictable for all of us – the reality of impermanence is one of the four noble truths of Buddhism. But the women of Can’t Catch a Break seem especially vulnerable to shifts in public policies and in social service programming as well as to the vicissitudes of luck and fate, and the challenges of their own mortal bodies.

 

Will Massachusetts Pass Meaningful Criminal Justice Reform Legislation?

I wish to thank Jean Trounstine for contribution to this post.

On June 19, 2017, I spent the afternoon and early evening at the Massachusetts State House listening to testimony regarding several bills aimed at reforming incarceration policies. The large Gardner Auditorium was packed with people wearing T shirts calling for the end to mass incarceration, solitary confinement, mandatory minimum sentencing, and parole reform, and for “jobs not jails.” The members of the Joint Committee on the Judiciary listened intently to testimony from criminal justice experts, legislators, sheriffs, attorneys, physicians, and people personally impacted by criminal justice policies. With the exception of a representative of the association of Massachusetts District Attorneys, speakers from all over the Commonwealth spoke to failures of current policies to keep people safe, to safeguard human rights of prisoners, and to provide appropriate health care services to justice-involved individuals.

It all seemed so promising. If only this whole crew hadn’t been there before.

Nearly all of the bills have been proposed in the past (albeit sometimes in slightly different forms). None of the bills seemed terribly controversial, at least to me. None proposed a complete overhaul of the criminal justice system. Rather, the bills, cumulatively, addressed several of the most obviously ineffective or inequitable current practices.

House Bill 74 – implementing programs to reduce recidivism

The first bill introduced, House Bill 74, calls for implementing the recommendations made as part of an extensive review conducted by the Council of State Governments Justice Center and chaired jointly by Governor Baker, the Lieutenant Governor, Senate President, Speaker of the House of Representatives, and Chief Justice of the Supreme Judicial Court.

As a sociologist, I often find political discourse and machinations to be a bit confusing. In this case, it was hard to get my head around reiterations that “all the players” were involved in crafting this legislation.  Other proponents expressed pride that “all justice partners”; that is, representatives from all three branches of state government, worked on the bill. I also heard the term “all the stakeholders”.  However, there did not seem to be any representation of incarcerated or formerly incarcerated men and women on the committee that crafted the bill. Surely “all the stakeholders” include the people most directly affected by these policies. Indeed, I’d argue that they – not politicians or bureaucrats — have the most at stake in decisions regarding prison policy.

Though many people involved with the court and prison systems had hoped for far-reaching recommendations from this review and committee, the bill focuses rather narrowly on reducing recidivism. While that certainly is an important goal, it does not speak to disrupting the school-to-prison pipeline or to other policies and social conditions that send people into the prison system to begin with.

The recommendations to reduce recidivism center on prisoner education, opportunities for early release for good behavior, and post-release supervision. A centerpiece of  the bill calls for rewards for good behavior (for example, completing vocational training programs). The rewards consist of shaving days off the sentence and adding them to the period of parole (community supervision). I strongly support efforts to reduce incarceration rates, but I am concerned that lengthy and intensive supervision on parole can lead to re-incarceration due to technical violations of the conditions of parole. In my own ongoing research with criminalized women in Massachusetts, I’ve seen intensive supervision with requirements for frequent meetings with parole officers, urine tests, proof of attending programs, etc. interfere with the ability to hold down a job and manage the myriad other responsibilities that are part of modern life.

H.74 emphasizes expanding programs of various sorts: pre-trial, during incarceration and post-incarceration. Programs can be good, bad or indifferent, but programs are not a substitute for the material resources most justice-involved people desperately need: Housing, decent jobs that pay living wages, family reunification. I am particularly troubled by a lack of clarity regarding mandatory program attendance for pre-trial individuals. Given that people who are awaiting trial have not been found guilty of a crime, it is be problematic to require them to attend any sort of program.

The consensus at the hearing is that the measures to reduce recidivism outlined in this bill should be the start, not the totality, of criminal justice reform in Massachusetts. No one testified against the bill but many said in their testimony that it did not go far enough.

S819 and H741 – bills eliminating mandatory minimum sentences for low level drug crimes

More substantively, Senator Creem spoke to S819 and H741 – bills eliminating mandatory minimum sentences for low level drug crimes. She, and other supporters of the bills, made the important points that mandatory minimums have not been effective in reducing drug use; they have led to mass incarceration; they have ruined lives of young people locked up for years on trafficking chargers for what essentially amounted to sharing illicit substances with friends; and they clearly have disproportionately impacted racial minorities. There were also panels of sheriffs, defense attorneys, impacted people, and Senators Evandro Carvalho and Sonia Chang-Diaz, both who represent districts where mandatory minimums are levied with unrelenting consistency.

Collectively, they made the point that mandatory minimums undermine the American system of justice by putting power in the hands of prosecutors rather than judges. Prosecutors decide whether the charge will be one that automatically triggers a mandatory minimum or not. And prosecutors can use the threat of mandatory minimums to encourage people to “choose” to plead guilty to a lesser charge. Opponents of this practice argued that prosecutors in essence function as judges, taking away from individuals the right to a trial in front of a judge who hears arguments both from the prosecution and the defense, and who can evaluate the particular circumstances of the individual and the case.

The only opposition to ending mandatory minimums came from DA Conley of the District Attorney’s Association. Conley argued that judges are “out of touch with what goes on in communities” and that prosecutors should properly have sentencing discretion. Many people testifying after the DA rebutted his claims, some of which were not based in fact.

House Bill 3121, Senate Bill 779, An Act Related to Parole

A panel of lawyers, activists, and two formerly incarcerated testified about the importance of reforming the broken parole process in Massachusetts without which packed prisons keep expanding. They spoke of how the Parole Board needs more expertise from sociologists, psychologists, addiction and mental health specialists, and juvenile justice experts. In other words, to judge the fate of our prisoners, our Board needs more than criminal justice backgrounds. Two formerly incarcerated men talked of how the process had been daunting and almost impossible to deal with without attorneys. Massachusetts currently has a dismal paroling rate which is also costing the state $53,000 for each prisoner who could be concluding their sentence in the community, going to school, working, and at least aiming to give back to their communities.

H.2248 and H.2249 – bills limiting the use of solitary confinement

Speakers testified regarding a bill to reform (oversee, control and minimize) the use of solitary confinement in Massachusetts jails and prisons. Attorneys, advocated and families of prisoners described its overuse in the Commonwealth; to the long-lasting damage it causes prisoners; and to its utter failure to make prisons or communities safer.

A representative of Maine’s ACLU testified that six years ago Maine passed solitary confinement reforms similar to those proposed in Massachusetts. In that time, Maine reduced the use of solitary confinement by 90%; prisons have become safer; and medical and emergency rooms visits have been reduced.

H719, H720, H721, H2248, H2249 – bills regarding treatment of mentally ill prisoners

Rep. Ruth Balser introduced five bills regarding the treatment of mentally ill and addicted prisoners. Among other measures, she called for Department of Mental Health oversight of mental health services in Department of Corrections facilities.  (These services currently are outsourced to private companies.) The bills generated little discussion. I’d like to believe that this reflects a clear consensus regarding the important issues addressed in the bills.

H 3494 — creating a medical parole board to consider medical release from prison

This bill would allow for early release of people with extremely serious or terminal conditions. Physicians testifying in favor of the bill spoke of paraplegic prisoners, prisoners undergoing intense chemotherapy, and prisoners with blood terminal disorders developing infected sores from the use of shackles. No opposition to the bill was voiced at the hearing.

Two bills regarding women were heard

H.3586 – An act relative to justice-involved women

Representative Kay Khan presented H.3586 which brings together a call for careful collection and analysis of data, policies and programs for justice-involved women.

The bill requires the commissioner to evaluate the program delivery system for existing programming for parenting skills and related training for incarcerated women and the effectiveness of these programs. In my own research I see women repeatedly cycle through programs of various sorts. I have found it near impossible to learn whether these programs are proven effective. Often, no data are available at all. At best, data regarding the completion rates of programs are available. Completion rates, however, do not get at whether programs actually contribute to individuals going on and implementing the skills taught in the program.

The bill also calls on the commissioner to develop programs with a focus on family preservation and reunification. In my research I have seen that a great deal of the programming for justice-involved women encourages women to “put yourself first” and “do you!” Given that the vast majority of justice-involved women are mothers – and that all justice-involved women are daughters, sisters, cousins, etc. – it is appropriate for program emphasis to be placed on family preservation and reunification. Let me be clear, these goals are not simply a matter of instilling the right attitude in women or even teaching them skills. These goals require that concrete, material resources such as appropriate housing are put into place for justice-involved women and their families. Many of these women need affordable housing, comprehensive day care and after school programs, and hiring practices that make it feasible for parents with criminal records to be become employed.

 Senate Bill 770, An Act providing community-based sentencing alternatives for primary caretakers of dependent children who have been convicted of non-violent crimes

Late in the day, way past school pick-up time, dinner time, kids’ bath time and homework time, we got to hear testimony from formerly incarcerated mothers and their children.

When mothers are sent to prison, their children become collateral captives, following their mothers into the institutional circuit and often ending up in foster care or living with an extended family member who may be less able to parent than the incarcerated mother.

In many cases, the children of incarcerated mothers are given into the custody of family members, a scenario that is not without problems. Often, the caregiver is a grandmother who, while well-intentioned, is not physically able to keep up with young children.  Children hear relatives speak ill of their incarcerated mothers, or feel forced into choosing loyalty to their mother or to another family member. In a few cases, custody actually has gone to a family member who sexually abused the mother when she was a child, or who implicitly or explicitly allowed that abuse to go on.

Foster care, of course, carries its own set of problems, ranging from frequent changes and churns to the well-documented overuse of prescribed psychotropic medications. For mothers, separation from children is experienced as a severe and ongoing trauma. These mothers frequently describe feelings of extreme helplessness, powerlessness, guilt, anxiety and panic, often leading to increased prescriptions of psychotropic medication.

The testimony of formerly incarcerated mothers and the testimony of children of incarcerated parents made it clear that it is in the interests of families to keep mothers at home, in the community, with adequate support (except, of course, in those few cases where mothers have engaged in acts of violence.) Creating community based sentencing alternatives for primary caretakers of dependent children will allow many more children to benefit from the on-going presence of their mothers at the same time as it will allow mothers to develop the resources, skills and support networks that they need in order to be effective parents.

This bill, too, has been heard before. Lining up to testify felt a bit like a reunion. Maybe this time we’ll see some real change.

 

The GOP’s Comprehensive Plan to Undermine Women’s Health Care

(Published June 20, 2017 in the Huffington Post)

As Senate Republicans continue to craft a healthcare bill behind closed doors, a Trump Administration’s reported plan  would exempt many employers from including contraceptive coverage in health insurance plans. While the Administration has framed their executive order as a protection of “religious freedom,” it is just one part of a frightening new wave of policies that will particularly harm women.

According to the Congressional Budget Office, millions of Americans will lose health insurance under the American Health Care Act (AHCA), already passed by the Republican House of Representatives. Low- and moderate-income Americans will lose the most because the plan decreases insurance subsidies and will eventually eliminate the Medicaid expansion.

This is especially troubling for women. Consistently, year after year, American women earn less than men. And according to the Department of Labor, women are more likely than men to be among the working poor. At the same time, women use more medical services and spend more on health care than men. They make more visits each year to primary care physicians and are more likely to take at least one prescription drug on a daily basis.

Under the House version of the AHCA and the Trump Administration’s order, women’s access to care through their insurance will decline. The bill eliminates the Affordable Care Act’s requirements for insurance plans to cover “essential benefits” like birth control and maternity care. Worse yet, this move will reduce the largest health safety net for women in the country. The Republican House plan singles out Planned Parenthood, prohibiting federal funding for one year after the law goes into effect.

Reduced access to birth control will lead to more unwanted pregnancies. Yet under the Republican House bill, qualified health plans cannot include abortion coverage except for pregnancies that present life-threatening physical risks and pregnancies that resulted from rape or incest. Not only does this reduce access to a needed medical procedure, but it also leaves questions about how to determine if a pregnancy is life-threatening or how to confirm if it’s a result of rape or incest. And it could potentially force women to prove—to the satisfaction of an insurance company—that she indeed was raped. This would certainly delay performing the abortion. Delays, in turn, present health risks to women.

The Republican House bill does allow insurance to pay to treat “any infection, injury, disease or disorder that has been caused or exacerbated by the performance of an abortion.” But legal abortions performed by a qualified medical provider in a suitable medical setting are extremely safe. While it is unlikely that the House’s intent is to encourage illicit abortions, this provision seems to acknowledge that an increase in unsafe abortions may be a consequence of the policy.

The Administration’s order and the Republican House bill will have devastating effects for women’s health in the United States. Our maternal mortality rate is already the highest among all developed countries.  And while this rate is decreasing in nearly every other nation, it continues to rise in the U.S. Our high maternal death rate is in part the result of unplanned pregnancies – more than half of all pregnancies in the U.S. – and a health system that makes accessing care difficult, especially for new mothers. The President’s order, together with Congress’s “repeal and replace” bill, will only lead to more tragedy. Now, the Senate has the chance to take out these harmful provisions and reaffirm the value of women’s health.

The “Price” of Health

 I’ve spent far too much time over these past months trying to understand why the current administration does not seem to understand (or care about?) basic health care facts:
  1. All people get sick and injured over their lives; all people feel pain; human experience is unpredictable and none of us knows when disaster will strike; and all (or at least most) people try hard to manage their pain, disabilities and illnesses so that they can continue to engage in the normal activities of daily life.
  2. All people need the help of medical experts in order to minimize the damage caused by disease and injury. In the twenty-first century, expert help and procedures and remedies involve substantial expenses.
  3. Even with careful planning, most Americans cannot save up enough money to cover these expenses, especially in cases of long-term or chronic health challenges.
  4. Health “insurance” that requires people to guess what care they will need (so-called “more choice for the consumer”) presumes that people can prophesy the future and / or avoid all illness and injury.
  5. When members of our communities cannot access appropriate health care there are consequences for everyone: Infectious diseases spread; people miss work and vital businesses and services become understaffed; production drops; kids fall behind in school; and some people turn to illicit substances (including alcohol) in order to self-medicate.
  6. See point #1.

These points are consistent with what most people observe and experience in their own families and communities and should, one might think, serve as the basis for health care policy. That, however, is not the case. As regarding many other issues, the current administration invokes an alternative set of “facts” regarding the nature of health and health care. These “facts” do not tend to be articulated in a coherent statement, yet they do emerge as a sort of sub-text in a variety of situations.

Ebola Winners and Losers

Last week newspapers reported on Health and Human Services Secretary Tom Price’s first trip overseas to Liberia, the West African country where more than 4,800 people recently died from the spread of the Ebola virus. A new Ebola outbreak seems to be emerging at this time but Secretary Price did not address that. Rather, he made a point of praising survivors of the earlier outbreak, declaring that: “We celebrate their victory over Ebola.” Now, from my perspective as a medical sociologist, it’s hard to see that those who survived Ebola are deserving of any particular praise. Is Price’s (unspoken) implication that these survivors somehow worked harder than those who died? That they were smarter or made better choices? That they were more morally deserving to live? And in praising the survivors was Price implicitly criticizing those who did not survive?

“Waging war” is not the solution this country needs

At the time of the first outbreak, I critiqued the U.S. rhetoric of “waging war” on Ebola. I voiced concern that we have come to rely on our military as the only governmental agency capable of responding to any sort of crisis. And I pointed out that our America inclination to frame social problems in terms of war underpins our troubled history of crusades to stamp out vices and diseases (the two words often are used interchangeably) ranging from alcoholism to obesity to cancer. Declaring war on disease sends the message that the sufferer is somehow at fault and wars on disease too easily turn into wars on those who embody the disease. Our racially driven “war on drugs,” more aptly described as a “war on drug users,” and has led to local police departments being armed with military equipment (including tanks) and to the highest rate of incarceration in the world.

Bleak Binary Terms 

In the era of Trump and Price the rhetoric of “victory” takes on whole new levels of significance. From the start, the Trump campaign framed the world, and the people of the world, in bleak binary terms of “winners” and “losers.” Famous Trump remarks include “Believe me. You’ll never get bored with winning. You’ll never get bored!” and “Work hard, be smart and always remember, winning takes care of everything!” Candidate Trump’s comment that best sums up the winners vs. losers world view concerned Senator John McCain: “I supported him, he lost, he let us down. But you know, he lost, so I’ve never liked him as much after that, because I don’t like losers…He’s not a war hero…He’s a war hero because he was captured. I like people who weren’t captured.”

The Price of Winning and Losing

In the world of health and health care, this paradigm is dangerous. It comes close to the rhetoric of the eugenics movement (developed in the United States and most famously and energetically adopted by the Nazis) – the idea that some people are inherently better than others (the winners) and that those people deserve social praise, resources, and encouragement to reproduce themselves. Losers, in contrast, should be marginalized and discouraged from reproducing.

Today, the Trump Administration unveiled its first budget – a budget that rewards strength and punishes weakness. According to the New York Times, “The document, grandly titled ‘A New Foundation for American Greatness,’ encapsulates much of the ‘America first’ message that powered Mr. Trump’s campaign. It calls for an increase in military spending of 10 percent … [It also] calls for slashing more than $800 billion from Medicaid, the federal health program for the poor, while slicing $192 billion from nutritional assistance and $272 billion over all from welfare programs [over the next decade].”

Winners and losers, indeed.

 

See  the following for more on winner/loser paradigm, the health care system, and the rhetoric of war on the Ebola outbreak:

Pink Ribbon Extravaganza

Health Insurance Roulette: The House Always Wins

Why Can’t the US Help Solve Ebola Outbreak without “Waging War” and “Sending Troops.”

Eulogy for Andrea

Andrea* was one of the most focused people I have ever known. From the first time we met at the Women’s Center at St. Francis House in Boston (she kindly participated in a five year project following the lives of women who have struggled with homelessness or incarceration) she clearly articulated her goals in life: She wanted an apartment of her own and she wanted to work in order to “keep busy.”

Andrea never liked lazing about, but the unfortunate combination of chronic heart disease, an employment landscape not suited to people with any sorts of disabilities, and dependence on social service bureaucracies that lacked the resources and the flexibility to help her find a long-term job placement kept her stuck in a cycle of short, dead-end, job training programs. “I have to stay focused,” she told me. “I’m forty-six. I don’t have time for [messing around] anymore. When you are sixteen or seventeen, bee-bopping around – that’s fun. But not at forty-six.”

Andrea was born in Mobile, Alabama, and moved to Massachusetts as a child. Raised by loving grandparents, she attended a school for kids with developmental disabilities. Andrea loved that school. One of the first times we met she told me that, “I wish I was back there now.” Looking back, I think she was longing for the sense of community and of having a place to go every day. Many times during the first years of our acquaintance she reminded me that her mother and grandparents had died and now she was alone. “I had four funerals in a row,” Andrea reiterated.

Andrea never seemed depressed, but she often felt sad or frustrated. “That is because my housing situation is messing with me. I don’t feel like myself. I’m lonely, discouraged. I sit down and cry and I see other people here [at the homeless shelter] get to leave and go home or go to different programs and I say ‘when am I going?’ I have nowhere to go. I pray to the Lord everyday to help me.” One time I asked her whether God gives her what she asks for. “He does, but on His timetable, not mine. But if I ask politely then I will get it, ‘ask and ye shall receive.’” I also remember her asking me to pass her concerns along to Mayor Menino. She was sure if he could hear her problems he would help her get housing!

Over the eight years that I knew her, Andrea completed numerous job training programs. Typically, these consisted of her being sent to work as a dishwasher or chambermaid for a few months, until the “training” ended. Then, after a waiting period, her social worker would send her to another training program. For the most part, Andrea saw these trainings for what they were: boring, somewhat exploitive, dead ends. But I recall one program that she loved. She worked for a few months in the cafeteria of a school for disabled children. She told me how much she liked going to work each day where people knew her and said good morning to her, and she liked asking the kids what they want to eat and serving them.  “I joke around with the kids and they joke around with me.” Like her other job training programs, this one did not lead to a “real” job. Still, for the months the job lasted she felt “lucky to have this job. I’m not bored.”

One of my favorite memories of Andrea came early in our acquaintance. Though she never was a drug user, she had been sentenced to drug court because someone staying in her apartment was arrested for selling drugs. The drug court protocol involved regular attendance as well as documentation of participation in Narcotics or Alcoholics Anonymous meetings. At drug court graduation each member of her drug court class was asked to stand up and say a few words. One by one, the others thanked the judge, parole officers, counselors, AA, family members and God for helping them in their recovery. Andrea, going last, thanked herself “for making it through this court.”

A few years ago Andrea finally moved into a studio apartment of her own. Still, she kept her eye on the prize – she wanted a “real” apartment, a one bedroom so that she could invite friends to sit in her living room.  But in the meantime she loved being able to watch television in her own space. Andrea was an avid exerciser and loved working out with exercise programs on television. She also loved to make up her own exercises, and often urged me to exercise more (she was quite right about that!) Back when she was in school she was quite an athlete: She even ran relays and hurdles in a local Paralympics. Up to the weeks before her death, Andrea continued to take great care styling her own hair and manicuring her nails. My own lackluster grooming was a frequent source of amusement to her!

As her health deteriorated, Andrea began to spend lengthy stints in the hospital and in nursing homes. I remember that one of the last times I visited her in the hospital she told me how much she liked being there: “They take good care of me. The nurse even said that if I’m bored I can come and sit by the nurses’ station.”  Andrea explained that she loves the food: “I can ask for whatever I want in my salad!” And while she rarely had a visitor, “the woman in the next bed told me that when I smiles it lights up the whole floor.”

A few months ago when I called her she told me that she was in a nursing home. “I hate to tell you, Susan, but my heart and lungs are not doing so well, so they brought me here. There’s nothing they can do for me at the other hospital. But I’m fine – I’m holding my own. I can still tell jokes and whatnot.”  A few weeks later she was sent back to her apartment. “No more hospitals. They can’t do anything for me. But I’m all right, Susan.” That was the last time we spoke.

Of all of the women who participated in our research project, Andrea was the most consistent about calling and staying in touch. Despite struggles with literacy and the lack of secure housing, she never lost my phone number or forgot to make the monthly call to arrange a time to meet. Still, I don’t think I ever really got to know her. Andrea craved social relationships yet was an intensely private person. To this day I do not know whether she saw me solely as a hoop she needed to jump through in order to get the T (mass transit) passes we distributed to participants in our study, or whether she actually liked having the opportunity to chat with someone who really wanted to listen to her. I don’t know why it bothers me so much not to know, but it does.

Andrea left behind a brother, a son, several nurses who gave her excellent care over the years, and a few close friends. I do not know if she counted me among those friends, but I do know that I will never forget her.

_____________________________________________

*”Andrea” is a pseudonym. In consultation with the Institutional Review Board at Suffolk University, I maintain the confidentiality of study participants who have died.

Click here for more about Andrea and the other women of Can’t Catch a Break. Also see “Eulogy for Junie”  “Eulogy for Nicole”  “Orange Frosted Hostess Cupcakes (Eulogy of Linda)”   “Eulogy for Elizabeth”

2017’s Best & Worst States for Children’s Health Care

The following are responses I wrote as part of an article on children’s health care by Richie Bernardo in WalletHub, April 2014. The article includes wonderful state by state comparisons of a variety of indicators of children’s health.

What are the most important steps parents can take to help their children grow up healthy?
Unfortunately, parents tend to be blamed when their children grow up to have health problems, but most parents cannot control the economic and environmental factors that allow kids to grow up in good health.

I’d like to say: provide a healthy diet, make sure your kids get plenty of fresh air and exercise, keep them away from known pathogens. Yet it’s important to realize that many — perhaps even most — parents cannot afford a consistently healthy diet and/or are working too many hours in order to pay bills for them to have time to cook healthy meals everyday. Similarly, parents don’t control the levels of air pollution and water pollution that their kids are exposed to, and many parents raise children in neighborhoods in which there are no safe, green spaces for kids to play. And, given that most kids grow up in households where all adults need to work in order to get by, parents cannot avoid sending their kids to school when they are a bit sick.

I do think that most parents can restrict their kids’ access to the most nutritiously unsound foods (for example, sweet soft drinks, candy, processed meats) and can encourage kids to participate in gym and other school activities. I also think parents can and should make their voices heard in their communities and to politicians. If there is garbage on the streets in your neighborhood, bug the City to improve garbage pick-up. If nearby factories are shooting toxic chemicals into the environment, organize a protest.

Another piece of advice I’d give parents (and I am speaking as a mother of four as well as in my role as a sociology professor) is to help your kids find something that they love doing: drawing, singing, playing ball, doing math equations — whatever your kid likes. When we do things that we enjoy we feel better about ourselves and about the world, and that feeling leads us to want to make healthy choices. And something that nearly every American parent can and should do – vote, so that we can build policies that nurture kids’ health.

Do you believe children are prescribed too much medication in the US today?
Yes. I am especially concerned about the over-prescription of psychiatric medication in order to control the behavior of kids. While some kids are in fact deeply troubled and need medication, we shouldn’t be drugging kids for being “too” active or “too” disobedient. I also am concerned about the over-use of over-the-counter medication for colds and coughs. Oftentimes, what kids (and adults) need is rest and soup, but television ads encourage us to purchase quick fixes for ailments both major and minor.

Do you think the government should ensure all children have health insurance coverage?
Yes, absolutely. It is devastating for parents not to be able to take their kids to the doctor, and untreated illnesses cause kids to fall behind in school and in overall physical, emotional and cognitive development.

In evaluating the best states for children’s healthcare, what are the top 5 indicators?
Since S-CHIP is a federal program, there is not a huge amount of difference between the states in children’s access to care. However, there are enormous differences among the states in adults’ access to care. In states that expanded Medicaid eligibility under the ACA, most adults now have healthcare coverage. In those states that did not expand Medicaid, the numbers of uninsured adults have remained higher.

While all parents do their best to raise healthy kids, parents who are struggling with their own poor health have the cards stacked against them. So, I’d say the number one indicator at this time in the U.S. is the overall rate of health care coverage for all people — children and adults. Other factors that I see as important include well-resourced school nurse programs, strong immunization programs, strong oral health care programs, strong vision and hearing screening and programs.