Category: Social Determinants of Health

Houses.

Author Q&A: State Preemption of Inclusionary Zoning Policies and Health Outcomes

Temple University Center for Public Health Law Research Leave a comment
Courtnee E. Melton-Fant, PhD

Historically, federal and state governments have been primarily responsible for increasing and maintaining the supply of affordable housing. But as budgets decrease, the burden has fallen more and more to local governments. Inclusionary zoning policies, which seek to reverse the negative, exclusionary effects of conventional zoning, are one tool local governments can use to increase affordable housing stock.

Courtnee Melton-Fant, PhD, an assistant professor at the University of Memphis School of Public Health, recently published research in Housing Policy Debate that explores the growing trend of preemption as it relates to these inclusionary zoning policies.

Dr. Melton-Fant’s research used policy surveillance data produced by the Center for Public Health Law Research with the National League of Cities to examine the relationship between state preemption of inclusionary zoning policies and health outcomes among different demographic groups — particularly among people of color.

We asked Dr. Melton-Fant a few questions about her work.

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Medicine law concept. Gavel and stethoscope on book close up

Addressing Racism through Medical-Legal Partnerships

The Petrie-Flom Center Staff Leave a comment

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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Man holds up a sign at the Black Lives Matter protest in Washington DC 6/6/2020.

How Social Movements Shape the Law to Address Health Disparities

The Petrie-Flom Center Staff Leave a comment

By Aziza Ahmed

We are facing a health crisis in America. In thinking through the causes of health disparities, a now well-developed body of public health law scholarship focuses in on the central issue of law as a social determinant of health. This scholarship examines the issue of how legal rules can determine health outcomes. Property laws that explicitly or implicitly discriminate against minorities, for example, often result in poor Black communities living in neighborhoods in which they may be more exposed to pollutants, resulting in higher rates of breast cancer or asthma. Or, immigration practices, including ongoing profiling at the border, as well as detention practices, may have mental and physical health impacts.

What is missing from legal scholarship on the social determinants of health is an account of how communities respond to change the legal environments that have the effect of producing poor health outcomes. In other words, how do communities demand a better legal system with regard to health inequality? Here, we must turn to social movements who often drive our national conversation on access to health care by doing the hard work of identifying, naming, and drawing attention to the complexity of issues that people face.

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Syringe and vials of vaccine.

Racial Inclusivity in COVID-19 Vaccine Trials

The Petrie-Flom Center Staff Leave a comment

By Colleen Campbell

Recent calls for racial inclusivity in vaccine trials, which often rely on genetic rationales while emphasizing medical distrust among African Americans, unfortunately lack an equally robust critique of medical racism and the ongoing reasons for this distrust.

Even though race lacks genetic meaning, the COVID-19 discourse is rife with biological notions of race. Because of “[g]enetics related to racial differences” African Americans must be involved in clinical trials, said Dr. Larry Graham in an NBC News article. He continued: “We must be sure it works in Black folks.” For this reason, companies like biotech firm Moderna are enlisting Black religious leaders to heavily recruit African American participants. They are also exploiting networks previously used for HIV clinical trials.

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Civil rights march on Washington, D.C. Film negative by photographer Warren K. Leffler, 1963. From the U.S. News & World Report Collection. Library of Congress Prints & Photographs Division. Photograph shows a procession of African Americans carrying signs for equal rights, integrated schools, decent housing, and an end to bias. https://www.loc.gov/item/2003654393/

Structural Racism: The Root Cause of the Social Determinants of Health

The Petrie-Flom Center Staff Leave a comment

By Ruqaiijah Yearby, J.D., M.P.H.

In 1906, W.E.B. DuBois noted that social conditions, not genetics, impacted the health of Blacks, causing racial disparities in mortality rates. In 2010, the federal government formally recognized that social conditions, specifically the social determinants of health (SDOH), were responsible for racial health disparities.

Racial health disparities, estimated to cost the United States $175 billion in lost life years and $135 billion per year in excess health care costs and untapped productivity, persist because of the failure to address their root cause: structural racism.

Structural racism describes the way our systems are structured to produce racial inequalities between whites and racial and ethnic minorities in the SDOH, leading to racial health disparities.

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Austin, Tx/USA - May 23, 2020: Family members of prisoners held in the state prison system demonstrate at the Governor's Mansion for their release on parole due to the danger of Covid-19 in prisons.

Jails and COVID-19: An Overlooked Public Health Crisis in Philadelphia

Temple University Center for Public Health Law Research Leave a comment

By Katherine Zuk

Since the start of the pandemic, jails and prisons have continuously struggled to stop the spread of COVID-19 cases.

The novel coronavirus has been ravaging the U.S. since late February, with over 6 million cases and 185,092 deaths. Emerging data shows alarmingly high rates of COVID-19 in jails and prisons nationwide, including over 85% of inmates testing positive at two facilities in Ohio. As of September 3, there have been at least 180,045 cases and 928 deaths in prisons alone – and many fear these numbers are severely underreported.

Philadelphia offers an unfortunate case study.

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Santiago, Chile - Crosswalk in long-exposure.

Chile’s New Constitution, the Right to Health, and Health System Reforms

The Petrie-Flom Center Staff Leave a comment

By Marco Antonio Nuñez

During these months of the COVID-19 pandemic in Chile, the need to align the constitutional process with long-postponed structural reforms to the health system has become evident among public health experts.

Capitalizing on this moment might avoid the possibility of a constitutional right to health becoming a dead letter or being reduced only to the prosecution of particular cases, postponing again the aspirations of the majority of Chileans.

Although the Chilean Constitution promulgated under the dictatorship in 1980 and subsequently reformed in several of its chapters recognizes “The right to the protection of health,” it has been tainted by authoritarianism from its origin, and promotes a subsidiary role of the state in health.

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gavel and stethoscope on white background

The Right to Health in the Upcoming Constitutional Debate in Chile

The Petrie-Flom Center Staff Leave a comment

By Veronica Vargas

At this unprecedented COVID moment, health has been revealed as one of our most precious possessions and protecting it has become imperative. The right to health was articulated by the WHO in the Declaration of Alma-Ata of 1978. The upcoming constitutional debate in Chile is an opportunity to re-examine this concept.

The Chilean constitution specifies the right to “free and egalitarian access” to health care. Simultaneously, the constitution guarantees that “each person has the right to choose the health system they wish to join, either public or private.”

These provisions have championed a prospering private health sector, with corporate clinics and a private insurance system that represents almost half of total health spending.

However, this private sector serves less than 20 percent of the population. Nearly 80 percent of the population utilizes public sector insurance. Although the public sector has been expanding its coverage of health services, and health indicators for those with public insurance have been improving, the public sector is chronically underfunded. Public sector health care spending represents only 4% of the GDP.

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New York City, New York / USA - June 13 2020 New York City healthcare workers during coronavirus outbreak in America.

COVID-19 and the ‘Essential’ Yet Underappreciated Front-Line Health Care Worker 

The Petrie-Flom Center Staff Leave a comment

By Kimani Paul-Emile

When considering those on the front lines of the coronavirus pandemic response, most people likely envision doctors and nurses. However, there is an often forgotten, front-line workforce comprised of orderlies, nursing facility workers, and nursing assistants (“NAs”) that earns very little money, has few protections, and is largely Black and Brown and female. Many individuals in this group are also subject to a unique form of discrimination: rejection on the basis of their race or ethnicity by some of the very patients they are assigned to aid.

The millions of people who make up this group of essential workers constitute a substantial portion of the health care workforce and earn an average of $13.48 per hour despite the risks they take. Their work, which involves bathing, dressing, and feeding patients; brushing their teeth, and assisting with their use of the toilet, puts these workers at high risk of contracting COVID-19. Nevertheless, early in the pandemic, many of these workers lacked or had inadequate personal protective gear due to the tiered system used for distributing this equipment. Doctors and nurses were first in line for smocks, masks, and other essential gear; last were members of this underappreciated group of front-line health care workers.

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Woman holding sign that reads "I can't breathe."

Black Women Can’t Breathe

Michele Goodwin 1 Comment

By Michele Goodwin

Years before George Floyd begged to be released from under the knee of Officer Derek Chauvin, Barbara Dawson, a fifty-seven year old Black woman, died begging a police officer, John Tadlock, not to remove her oxygen mask. Her death occurred right outside the Calhoun Liberty Hospital in Blountstown, Florida, shortly before Christmas in 2015.

Just before Officer Tadlock’s arrival, Ms. Dawson arrived at the hospital seeking oxygen. The hospital’s response to Ms. Dawson’s request was to call law enforcement. Photographs show Ms. Dawson slumped next to the police car. A police recording captures the tragic end of Ms. Dawson’s life. Officer Tadlock reprimands Ms. Dawson: “Falling down like this and laying down, that’s not going to stop you from going to jail.”

Ms. Dawson’s life ended on the pavement, feet away from the entrance of the hospital that phoned the police on their patient — because she refused to leave. She lay there nearly twenty minutes before being pronounced dead. It turns out she had a blood clot in her lungs.

In some sense, there is nothing extraordinary about the image of Ms. Dawson, or the interactions of the hospital and officer, which further complicates the deadly exchange. Indeed, the interaction was far too normal: Black women fear for their health and safety when they do not seek care and, troublingly, even when they do.

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