Miami Downtown, FL, USA - MAY 31, 2020: Woman leading a group of demonstrators on road protesting for human rights and against racism.

Understanding the Role of Race in Health: Conclusions from the Symposium

By Craig Konnoth

In my introductory post to this symposium, I suggested that medicine and health tapped into a discourse of power that had the power to either harm or help. Medicine can trigger benefits in the law — what I call “medical civil rights,” where advocates rely on medicine’s language to trigger both formal legal rights and public advantage. At the same time, I acknowledged that black, indigenous, and people of color (BIPOC), are often left behind.

In a midpoint reflection, I theorized the problem through the lens of a double bind. On one hand, medicine erases the needs of BIPOC and the harms they experience — the health harms experienced by frontline medical workers, or caused by school and residential segregation — so that they cannot access medical civil rights. On the other hand, BIPOC are rendered hypervisible in contexts where medicine continues to oppress. They are used in clinical trials and tarred with xenophobia and narratives of genetic difference. What should be done?

Several authors offer solutions. I separate them into three categories: (1) community reform, (2) social and legal reform, and (3) medical reform. Of course, all of these solutions are interrelated. Legal and policy change drives medicine; medical research drives law, society, and policy — and both are driven through community activism and consciousness.

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Police cars.

Law as a Determinant of Police Violence

By Osagie K. Obasogie

One idea that distinguishes public health from medicine and other health sciences is the social determinants of health. This concept emphasizes the environmental conditions that give rise to health outcomes — poverty, lack of access to resources, exposures to contaminants, etc. — rather than locating disease solely in biological or physiological processes bounded by human bodies. Following this lead, public health interventions are often focused on community practices that can improve the spaces in which people live. The public health approach is refreshingly simple: healthy communities and environments produce healthy people.

A public health framework for understanding how police and policing impact community health outcomes is necessary as we continue to have wide-ranging conversations about excessive use of force. Improving the health of local communities involves rethinking the laws that govern how police interact with the people they serve.

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America divided concept, american flag on cracked background.

Can Psychedelics Help Save America?

By Shelby Hartman

Amid a fractured political landscape, an unprecedented pandemic, and a reckoning with the country’s racist past, psychedelics may offer some hope for healing in the United States. In recent decades, a renaissance of psychedelic drug research has grown at prominent institutions like Johns Hopkins, New York University, and Imperial College London, among others.

Psilocybin, the psychoactive component in psychedelic mushrooms, and MDMA, sometimes confused with its adulterated version, ecstasy, have both been given breakthrough therapy status by the Food and Drug Administration (FDA), because they’ve shown so much promise for treating conditions for which we currently have few effective options. Psilocybin for treatment-resistant depression and MDMA for post-traumatic disorder are projected to be legal within the next five years as drugs that will be administered under the supervision of trained therapists.

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Police cars.

The False Promise of City-Wide Psilocybin Decriminalization

By Kathryn Lucido

While city-wide decriminalization of psilocybin is a positive step toward decreasing the impact of the war on drugs, it also creates a false sense of security and progress.

Citing new research that illustrates the therapeutic promise of the drug, several U.S. cities have decriminalized psilocybin, a psychedelic compound that occurs naturally in some fungi. Though these cities have pledged not to spend resources prosecuting people for psilocybin possession, and, in some cases, limited distribution, the substance remains illegal at the federal, state, and city levels.

Psilocybin remains a Schedule I drug under the Controlled Substances Act. This classification means that — at least according to Congress and the Drug Enforcement Administration — psilocybin is a dangerous drug with no currently accepted medical uses and a high risk for abuse.

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A calculator, a stethoscope, and a stack of money rest on a table.

Telemedicine is No Cure for Fraud and Abuse

By Vrushab Gowda

The exponential growth of telehealth in recent years has revolutionized the delivery, access, and cost of care. Unfortunately, it is not immune to the fraud and abuse that divert nearly $70 billion from the health care system annually.

A rise in suspect practices has been accompanied by a concomitant escalation of Department of Justice (DOJ) enforcement, sending a clear signal to would-be fraudulent actors.

The ongoing Operation Rubber Stamp is one such enforcement thrust. A joint initiative of the of the Federal Bureau of Investigation (FBI) and the Department of Health and Human Services (HHS), it targeted an extensive network of telemedicine fraud totaling over $4.5 billion in false claims and yielding thirty guilty pleas to date.

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Up close shot of an orange prison jumpsuit

COVID-19 and Women in the US Criminal Legal System

By Cynthia Golembeski, Carolyn Sufrin, Brie Williams, Precious Bedell, Sherry Glied, Ingrid Binswanger, Donna Hylton, Tyler Winkelman, and Jaimie Meyer

Health and economic inequities exacerbated by the COVID-19 pandemic disproportionately harm women, and particularly women of color, involved in the criminal legal system.

Structural racism, sexism, poverty, substandard healthcare in jails and prisons, and the health effects of incarceration worsen women’s health. The pandemic only compounds these effects. Often overlooked or less visible, incarcerated women are at significantly increased risk of acquiring infectious illness, including COVID-19.

Alternatives to incarceration, and care continuity for chronic health conditions, including substance-use and psychiatric disorders, which disproportionately affect women, are necessary within the current pandemic and beyond.

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an ambulance parked at the entrance of an emergency department

The Double Bind of Medicine for Racial Minorities

By Craig Konnoth

Medicine often falls short of helping black, indigenous, and people of color (BIPOC). While many individuals successfully invoke medical framing to offer some assistance to address the serious burdens they face — as I explain in a recent article — such efforts have fallen short in the context of racial justice. BIPOC are either subject to hypervisibility — where their medical trait is made a defining characteristic of their existence — or medical erasure, where their medical needs are left unaddressed and ignored.

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Empty classroom.

School Discipline is a Public Health Crisis

By Thalia González, Alexis Etow, and Cesar De La Vega

Education is well-accepted as a key social determinant of health. It serves as a strong predictor of chronic disease, social and economic instability, incarceration, and even life expectancy. For example, by age 25, individuals with a high school degree can expect to live 11 to 15 years longer than those without one. Despite such evidence, education policies and practices have not been public health priorities. Too often, policies and practices in schools that create and compound health inequities are narrated and re-narrated as falling outside health law and policy. This is a missed opportunity for collective action to positively impact the future health pathways of children and communities.

In the wake of national protests against racialized police violence and COVID-19’s disproportionate impact on communities of color, the time has come for the health community — from researchers, to public health organizations, to advocates, to health care professionals — to move from simply affirming that racism is a public health crisis, to actively exposing how structural discrimination in education has fueled disparities and deepened the persistence of health inequities.

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Medicine law concept. Gavel and stethoscope on book close up

Addressing Racism through Medical-Legal Partnerships

By Medha D. Makhlouf

Numerous studies have documented that racism is a social determinant of health (SDoH) that negatively impacts Black, Indigenous, and people of color (BIPOC). As such, racism is one of “the conditions in which people are born, grow, live, work, and age” that are “mostly responsible for unfair and avoidable differences in health statuses.”

The U.S. health care system was not designed to respond to SDoH, much less to address racial health disparities. In fact, U.S. health care institutions have racist legacies that continue to influence the way they operate today. When health care providers fail to confront racism within and outside their walls, they perpetuate the racial health disparities that have plagued our nation since before its founding.

Medical-Legal Partnership (MLP) is a model of collaboration and joint advocacy between lawyers and health care providers who seek to improve social conditions that affect health and well-being. MLPs aim to address SDoH on three levels: direct representation in civil legal matters, institutional change, and systemic advocacy. They typically employ legal interventions to ensure that people’s basic needs are met, such as nutritious food, health care, income, safe and stable housing, and uninterrupted energy and water utilities. Improving access to such resources is an important way of engaging with the work of health equity.

While some MLPs incorporate a racial justice lens in their work, many do not. MLPs are generally more oriented toward addressing the effects of racism as a SDoH, rather than as the cause of poor health. But considering the cross-cutting nature of racism as a SDoH, MLPs can and should address it directly. As Director of the MLP Clinic at Penn State Dickinson Law, whose faculty has resolved to incorporate discussions of racism and inequality in the curriculum, I have begun researching Critical Race Theory (CRT) as a framework to understand how MLPs can build on their core activities to further address racism as a SDoH and make explicit the connections between racism and poor health. This post describes how MLPs can address racism as a SDoH in at least four ways that align with the goals of CRT.

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