America’s border towns are often health care black holes
Filed under: Hot Health Headline, Public health, oral health
Colonias, underserved, poverty-riddled communities along America’s southern border populated mostly by American citizens of Mexican descent, have long remained uncomfortably disconnected from mainstream government and social services. In a two-part series in the Texas Tribune, Emily Ramshaw takes stock of life in the colonias, then focuses on the health issues created by their unique circumstances.
Ramshaw paints a vivid picture of these forgotten settlements, home to at least 400,000 folks in Texas alone, and no summary would do her writing justice. Here’s an excerpt from the first installment.
In Del Mar Heights, on the outskirts of Cameron County, residents live on a devastated stretch of scrubland littered with dilapidated trailers and dotted with listing telephone poles. There are no paved streets or sewers, basic infrastructure that developers promised the Mexican immigrants who purchased land here 30 years ago and often live three families — and several bleating goats — to a lot. Floodwaters and wayward hurricanes routinely sweep through the area, battering roofs patched with tarps and campaign signs.
Despite hundreds of millions of dollars of local, state and federal investment in infrastructure and services in the colonias, they still clearly lag behind much of the country. As a curious aside, some of the areas Ramshaw profiles happen to sit just miles from the notorious health care consumers of McAllen, Texas, yet the care they are offered could hardly be any more different.
At last count, nearly 45,000 people lived in the 350 Texas colonias classified by the state as at the “highest health risk,” meaning residents of these often unincorporated subdivisions have no running water, no wastewater treatment, no paved roads or solid waste disposal. Water- and mosquito-borne illnesses are rampant, the result of poor drainage, pooling sewage and water contaminated by leaking septic tanks. Burning garbage, cockroaches, vermin and mold lead to high rates of asthma, rashes and lice infestations. And the poor diet so intrinsically linked to poverty contributes to dental problems, diabetes and other chronic conditions, which residents of the colonias rarely have the health insurance, money or access to regular health care to treat.
Ramshaw writes that cultural and geographic barriers, as well as a general distrust of the federal government in a community where not all residents are legal migrants, have hampered adoption of available programs, but there have been signs of improvement in recent years.
The series was made possible by a grant from the Dennis A. Hunt Fund for Health Journalism, and produced as part of the California Endowment Health Journalism Fellowships, a program of the Annenberg School for Communication & Journalism at the University of Southern California.
Blame trucks, not just factories, for industrial pollution in Seattle
Spurred by a few recent studies, InvestigateWest’s Robert McClure and KCTS-Seattle’s Jenny Cunningham launched an investigation to figure out just what has made Puget Sound’s air some of the most toxic in the nation. Their work centered on the heavily polluted, industrial Seattle neighborhoods of Georgetown and South Park, where residents “face an onslaught of toxic airborne pollutants that according to a recent study exceed regulatory caution levels by up to 30 times.”
Where is this toxic air coming from? The answer may surprise you. The majority of the pollution, government regulators and scientists say, comes not from the large concentration of industrial facilities in South Park and Georgetown. Rather, it’s from the cars, trucks and buses whizzing by these neighborhoods – especially those with diesel engines. Fumes from ships in Elliott Bay and the Duwamish, as well as diesel-powered equipment at the Port of Seattle and elsewhere, add to the toxic mix. In the fall and winter, wood smoke from fireplaces becomes a significant contributor.
The problems here have implications in other neighborhoods, too: Anywhere people are living close to major roadways, they’re likely breathing unhealthy air, studies show. Anyone living within about 200 yards of a major roadway is thought to be at increased risk, with the first 100 yards being the hottest pollution zone.
Watch the full episode. See more KCTS 9 Connects.
Reporters looking to localize the story will probably want to scroll first to the “The Effects” section, which gets into the practical science of how this sort of pollution takes its toll. You’ll probably also enjoy Cunningham’s sidebar on what she learned in reporting the piece (it’s at the bottom of the page). If you’re also looking to understand the regional and national regulatory structure which governs diesel and related emissions, the “Solutions” subheading is also worth a pit stop.
For more on the big picture issues impacting health in South Seattle, see Carol Smith’s recent piece on the related Superfund site.
New life expectancy data can add context
to reporting on local health
A new data release today from the Institute for Health Metrics and Evaluation gives journalists some unique tools to help depict the health of a local population.
Emmanuela Gakidou, M.Sc., Ph.D., the director of education and training for IHME, told a Health Journalism 2010 audience that the institute was working on a project to show health information to the county level.
Just over a year later, the data allow the user to analyze life expectancy for every county in the United States and compare those numbers worldwide.
For example, the data could add context for a journalist following up on a tip from a speaker in an entirely different AHCJ event. In the recent Rural Health Journalism Workshop in St. Louis, Ellen Barnidge, Ph.D., M.P.H., of St. Louis University, discussed efforts in Missouri’s high-poverty Pemiscot County. A quick filter of the spreadsheet data shows men in that county share the same life expectancy – 68.5 – with Mauritius and Indonesia.
The data go back to 1987, allowing a journalist to look at changes over time as well for more than 3,000 counties.
Project researchers found that, while people in Japan, Canada and other nations are enjoying significant gains in life expectancy every year, most counties within the United States are falling behind.
The researchers, in collaboration with researchers at Imperial College London, found that between 2000 and 2007, more than 80 percent of counties fell in standing against the average of the 10 nations with the best life expectancies in the world, known as the international frontier.
Women have been especially affected. More than 850 counties in the U.S. have seen life expectancy remain static or go backwards for women since 1997.
The data also offers a breakdown of life expectancy by selected race – black and white – for each county.
The institute is an independent global research center at the University of Washington providing sound measurement of population health and the factors that determine health, as well as rigorous evaluation of health system and health program performance.
Should Seattle Superfund site address health as well as pollution?
Filed under: Government, Hot Health Headline, Public health
InvestigateWest’s Carol Smith writes in the Seattle Post-Intelligencer and InvestigateWest.org that the focus on the environmental disaster of Seattle’s industrial Duwamish River obscures another, equally potent, long-simmering health crisis. For the folks who live near the Superfund site, pollutants from the river are just one of many health risks. Access to groceries and health care is limited, and obesity and poverty rates are higher than surrounding neighborhoods while expected lifespans are years shorter. As Superfund recommendations begin to take shape, the health side of the cleanup is bubbling to the forefront.
While there’s been exhaustive analysis of the environmental impact of historical polluters on the river and the health of creatures that live in it, as well as theoretical risk assessments of individual pollutants on human health, relatively little attention has been paid to the actual health status of residents living within the 32-square-mile Superfund site. Nor has there been consideration of the cumulative impact of the many health hazards they face.
The big question, Smith writes, is “Should the area be held to a higher cleanup threshold because the people living in its midst are already more vulnerable to the health risks posed by the toxic chemicals in their environment? ”
The answer might lie in the area’s status as an “environmental justice neighborhood,” which means it is “subject to the 1994 executive order by President Clinton that directed federal agencies to address inequities in communities where low-income or minority communities were experiencing health disparities caused by their environment.”
Reporter looks at black infant mortality in Wis.
Filed under: Children, Health data, Hot Health Headline
The Milwaukee Journal Sentinel’s Crocker Stephenson took a look at disparities in infant mortality in that area and explored both their cases and ramifications. In Wisconsin, black babies die at twice the rate of white babies, a finding which may just be the tip of the iceberg. For national and international comparisons, see the companion infographic. According to Stephenson, infant mortality rates are an early indicator of a community’s degeneration. When mortality rises, so do other dire indicators.
The bottom third - the group of ZIP codes with the most poverty and lowest college graduation rates - had the highest infant mortality rate.
It also had the highest premature death rate, chlamydia rate, HIV rate and teen birthrate.
It had the greatest percentage of low birth weights; preterm births; uninsured adults; people who hadn’t seen a dentist in a year; births to mothers who received no prenatal care during their first trimester; smokers; pregnant smokers; obesity; violent assaults within the past year; single-parent households; and children who tested positive for lead poisoning.
Milwaukee’s health commissioner called it a “crisis,” one that Stephenson found is as much a social matter as it is one of access to proper care. For more, see the “Problem Areas” section of the story.
Holtz prescribes behavior modification for ‘White Coat Myopia’
Every year end brings a flood of stories about the “Top Medical Breakthroughs.” Over the rest of the year there is no shortage of front page headlines announcing new drugs, devices and clinical trial results.
But independent journalist Andrew Holtz, a member of AHCJ’s board of directors, thinks the intensive cultivation of medical news reports leaves fertile acreage of health stories untilled.
If you expand your perspective from a narrow focus on medical interventions, you will find studies, policies and events that relate to health in ways that connect directly to the daily lives of many more people.
In this article, he suggests fresh stories and approaches to health coverage for the new year, with plenty of resources to help you stick to a resolution of powerful, relevant health coverage. (Note: This article is one of the many resources and benefits available exclusively to AHCJ members.)
Community-led effort sparks public health wave
Filed under: Health policy, Hot Health Headline, Public health
Writing in The New York Times, Jessica Reaves writes about how a 2000-06 Chicago community survey embodies the block-by-block, community-reliant approach to public health that it helped inspire.
In the heavily Puerto Rican Humboldt Park neighborhood, researchers worked with community leaders to write study questions, then relied on community members to conduct the actual survey. From these roots, the level of community participation snowballed, and locals demonstrated an interest and investment in public health that researchers hasn’t seen before. Today, initiatives born out of that study still provide residents with access to fresh produce, free diabetes screenings, fitness classes and more.
Now, researchers are further localizing and intensifying their effort with a block-by-block approach. The Humboldt Park model has become one that others are working to replicate across the country.
The specifics of the Sinai approach (In Humboldt Park) — change-oriented and invested in the fate of a neighborhood — are distinctive, but they also reflect a sea change in the overall strategy of public health professionals, said Janine Lewis, executive director of the Illinois Maternal and Child Health Coalition, a nonprofit advocacy organization in Chicago.
“I think the field is becoming more responsive to the idea of community-based participatory research,” Ms. Lewis said. “Those of us in the field realize that community members are experts on the needs and gifts in their communities, and should be consulted” at every phase of research.
This approach, she added, not only helps investigators devise more meaningful questions, but also means residents feel a part of the process and motivated by the results.
Ky. program a model for improving rural access
Filed under: Health care reform, Hot Health Headline, Public health, oral health
As part of his series on rural health, the Wisconsin State Journal’s David Wahlberg traveled down to Appalachian Kentucky to see how state-funded “navigators” had helped improve access to health care in the region with the lowest life expectancy in the nation. There, they help guide the rural poor through the byzantine system and toward free or low-cost care. They’re part of a program called Kentucky Homeplace.
…lay workers live in the communities they serve, which includes most of Appalachian Kentucky. The workers, who receive basic medical training and earn about $25,000 a year, make home visits and address a variety of needs, such as finding low-cost prescription drugs, arranging transportation to doctor’s offices and helping patients follow up on medical tests.
They also make sure homes have heat and running water — and people have food and clothing.
The lay workers get 40 hours of training, and specialize in navigating the local culture and translating medical terminology into words and concepts the locals find more familiar. Their primary role is helping residents find more affordable prescription drugs. According to one of Wahlberg’s sources, “The program, which operates on $2 million in state money a year, helped clients get $28 million worth of free or discounted medications last year.”
The program, started in 1994, “has linked tens of thousands of rural Kentuckians with medical, social and environmental services they otherwise might have done without,” according to the National Rural Health Association, which named Kentucky Homeplace its outstanding rural health program of the year in 2008.
Myths obscure lack of health care for some Asians
Filed under: Health journalism, Hot Health Headline
A focus on “ethnic disparities” can obscure the fact that racial designations are so broad that the disparities within them are just as great as those without.
The latest example? The paper “Barriers to healthcare among Asian Americans,” [press release] by two SUNY Buffalo sociologists. The paper takes on the myth that Asian-Americans are a well-adjusted, monolithic “model minority,” particularly when it comes to access to health care. Instead, language, health literacy, health insurance and immigrant status all conspire to push certain groups of Asian-Americans well below the national average.
Tapped’s Jamelle Bouie discusses the post, then adds a demographic summary to point out how Asian-American economic status can vary based on country of origin.
While Chinese, Japanese, and Korean Americans tend to do well when compared to their white counterparts, the same can’t be said of Vietnamese, Pacific Islanders, and Cambodians, as well as Hmong and Laotians. Among Vietnamese, for example, per capita income is $23,080 – compared with just over $30,000 for whites – with an overall poverty rate of 13.3 percent, compared to 10.5 percent for whites. Likewise, only 13.3 percent of Cambodians and a scant 9.3 percent of Laotians have a bachelor’s degree or higher, compared to nearly 30 percent of whites.
California’s doctors: Aging, white and specialized
Filed under: Health data, Hot Health Headline, Studies
In California Watch’s blog, Joanna Lin breaks down the California HealthCare Foundation’s latest report on the state’s physician supply. Nationwide, a quarter of physicians are over sixty. In California, which leads the nation in doctors nearing retirement, that number is 29 percent. In addition to aging, the state is also faced with particular ethnic disparities among caregivers.
… Latinos represent 37 percent of the state’s population, but 5 percent of its doctors. The disparity is even greater in the Central Coast, Inland Empire and San Joaquin Valley regions, and most severe in Los Angeles County, where 47 percent of the population and only 5 percent of doctors are Latino. Statewide, 18 percent of doctors speak Spanish.
While California led the nation in retention of graduating state medical students, a “substantial proportion” of California doctors come from other states and countries, Lin writes. That number may shrink as the UC system plans to add two more medical schools in the next five years, budget willing. For more specifics, take a look at the report itself. It’s loaded with easy-to-understand summary statistics and beautiful charts and graphs.
-
Join us in Omaha to find untold rural health stories
New at HealthJournalism.org
- AHCJ offers financial data about nonprofit hospitals
- Diversity in aging: Putting gray in the rainbow
- Southeast journalists eligible for regional fellowship program
- AHCJ-NLM Health Journalism Fellowship offers hands-on medical research training
- AHCJ announces 2011 winners of top health journalism awards
