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A Writing Teacher’s Take on the Seven Words Controversy

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                    [post_content] => The public health community was catapulted into a state of righteous indignation last December after the Washington Post reported that seven words (diversity, entitlement, evidence-based, fetus, science-based, transgender, and vulnerable) had been prohibited by the U.S. Department of Health and Human Services from appearing in budgets submitted by the Centers for Disease Control. The reporters used the words prohibit, forbidden, and banned frequently (12 times in all) and interchangeably throughout the story.

The next day, a New York Times article reported that no words had been banned, but some style guidelines had been given to improve clarity and reduce the potential for negative reactions on the part of some Republicans. Policy analyst, Yuval Levin, parsed the likely intentions behind the unpopular words. Diversity, entitlement, evidence-based, science-based, and vulnerable are over-used and sometimes inappropriately used. They are vague buzz words easily replaced to improve clarity. Fetus and transgender, Levin argued, have a high likelihood of triggering “retrograde Republicans” into cutting budgets for projects associated with reproductive and transgender health.
I warn students away from empty aspirational words like empowerment and impactful. I tell anyone who will listen that they should purge the noun issue whenever possible.  
All of this got me thinking about the difference between choosing language strategically based on knowledge of your audience and self-censorship. As a writing teacher and editor, I understand the compulsion to give language guidelines. I spend an inordinate amount of time to trying to squeeze unnecessary and vague jargon out of other people’s writing. I try to do the same in my own writing. I warn students away from empty aspirational words like empowerment and impactful. I tell anyone who will listen that they should purge the noun issue whenever possible. I do this because it is overused to the point of being meaningless. Everything in public health is an issue. We have water issues, political issues, legal issues, structural issues, emotional issues, and we take issue with them all. This is known as semantic bleaching. Consider this compact sentence rich in jargon but devoid of meaning:

Evidence-based and science-based entitlements can make people less vulnerable and improve diversity.

You may be wondering: What kind of evidence? Science conducted in what way? Which entitlements? What kind of vulnerability and diversity? Arguably, each of these words carries more symbolic than semantic value. I read sentences like this in journal articles, grant-proposals, and student papers every day. Sentences that read as if they come from a random jargon generator. Sometimes we need our jargon. Often we do not, but we still use it. By contrast, transgender and fetus have clear definitions and expansive interpretations. Fetus is a standard clinical term associated with abortion debates and the in utero health risks posed by the Zika virus. Transgender is more than just an adjective embraced by individuals who live outside of binary gender roles. It is an identity. If I want a conservative congress to fund programs that promote reproductive or trans health, I may need to use alternative language to avoid tripping political alarms. This would entail self-censorship and a lot of soul-searching, but it may also be pragmatic and strategic. Ultimately, a recommendation not to use the word transgender is very different from being told to avoid a buzz word like vulnerable. This is a key reason that the HHS budget guidelines were so confusing. Describing exactly what it means to be vulnerable in a specific context is the opposite of self-censorship. It’s an invitation to say what we mean. “Words matter” has been a common refrain in the passionate responses to the seven words controversy. They do, but some matter more than others. PHP wants to hear your thoughts about public health language, jargon, and the difference between knowing your audience and self-censorship. Write to us at phpost [at] bu.edu. Word Cloud Made Using: https://wordart.com/create [post_title] => A Writing Teacher’s Take on the Seven Words Controversy [post_excerpt] => Public health, scientific, and academic writing are plagued by jargon and words that are so overused they become meaningless. PHP’s Associate Editor, Jennifer Beard offers a new spin on the recent “seven words” controversy. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => writing-teacher-take-on-seven-words-controversy [to_ping] => [pinged] => [post_modified] => 2018-03-14 06:47:27 [post_modified_gmt] => 2018-03-14 10:47:27 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.publichealthpost.org/?post_type=bu_viewpoint&p=3962 [menu_order] => 0 [post_type] => bu_viewpoint [post_mime_type] => [comment_count] => 0 [filter] => raw ) [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [view] => BUPHP_Post_View Object ( [multipage] => [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [extra_args] => Array ( ) [owner] => [_trigger_error:WPLib_Base:private] => 1 )

Public health, scientific, and academic writing are plagued by jargon and words that are so overused they become meaningless. PHP’s Associate Editor, Jennifer Beard offers a new spin on the recent “seven words” controversy.

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Chemical Endangerment Laws Hurt Pregnant Women

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                    [post_content] => Multiple pregnant women  in Etowah County, Alabama have been arrested after testing positive for amphetamines. These women were charged with “chemical endangerment” of their fetuses—a relatively new interpretation of existing child abuse statutes. Those laws were originally meant to prevent exposure of children to drug-related environments such as methamphetamine laboratories, but the Alabama Supreme Court expanded the definition of child to include “fetuses,” meaning that pregnant women could be charged for using drugs (Kimbrough v. Alabama; Ankrom v. Alabama).

Alabama is not alone, as other jurisdictions have enacted measures to criminalize substance use during pregnancy. Recently, there has been a growing trend in pregnancy control measures in the United States and an increase in punitive policies toward women who use alcohol during pregnancy. These measures signal a growth in restrictions on sexual and reproductive health in general. According to the Guttmacher Institute, 30% of all such restrictions enacted since 1973 have only been established in the past six years. More than one-third of states punish pregnant women for substance use through pre-existing laws, erecting barriers to treatment. For example, in New Jersey, a pregnant woman using methadone prescribed to treat her opioid addiction—the accepted standard of care—faced a child abuse/neglect charge and her newborn subsequently was taken into custody (N.J. Division of Youth and Family Services v. Y.N.). In other states, by contrast, pregnant women who use substances have been civilly committed for declining similar addiction treatment. Currently, seventeen states hold that substance abuse during pregnancy qualifies as child abuse under civil child welfare statutes.
Punitive measures mistakenly pit the interdependent interests of the mother and fetus against each other.  
Punitive measures mistakenly pit the interdependent interests of the mother and fetus against each other. To our knowledge, there is no credible medical evidence that punitive measures lower rates of substance abuse in pregnancy. Instead, punishment may drive women away from prenatal care and treatment for fear of arrest or loss of child custody. Even when rehabilitation is available as an alternative to prison, few treatment facilities provide adequate services to mothers. Only 17% of centers have programs specifically for pregnant and postpartum women. These strict policies also turn physicians into agents of the state and undermine the crucial patient-physician relationship, a major foundation of therapeutic change. Eighteen states mandate reporting of suspected prenatal substance use and four mandate testing, despite concerns from numerous medical organizations. Alarmingly, physician reports are carried out in a discriminatory manner with low-income and minority women disproportionately affected. Although rates of substance use during pregnancy are similar across racial and socioeconomic groups, women of color are more likely to be reported to child protective services, even when drug screening policies are in place to universally test all women.
There is no evidence that punitive measures improve maternal or fetal outcomes.  
[ictt-tweet-inline]There is no evidence that punitive measures improve maternal or fetal outcomes. [/ictt-tweet-inline] More effective interventions would address the complex factors that contribute to substance use during pregnancy. Carrots, rather than sticks, should be used. One option is the expansion of contingency treatment programs, which offer rewards for abstinence and promote long-term abstinence and retention in treatment. Other approaches also hold promise, including investment in family and community supports and promoting contact with healthcare and social support services. We do not lack for better alternatives to punishment, which only perpetuates the medical and social problems facing these vulnerable women and their newborns. Chemical endangerment laws create barriers for countless women in need who might otherwise engage with treatment and fundamentally counterproductive in the battle against addiction. Feature image: Elena Saulich/Shutterstock [post_title] => Chemical Endangerment Laws Hurt Pregnant Women [post_excerpt] => Laws originally meant to prevent exposure of children to drug-related environments such as meth labs are being expanded to criminalize substance use during pregnancy. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => chemical-endangerment-laws-hurt-pregnant-women [to_ping] => [pinged] => [post_modified] => 2018-03-13 12:43:38 [post_modified_gmt] => 2018-03-13 16:43:38 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.publichealthpost.org/?post_type=bu_viewpoint&p=3929 [menu_order] => 0 [post_type] => bu_viewpoint [post_mime_type] => [comment_count] => 0 [filter] => raw ) [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [view] => BUPHP_Post_View Object ( [multipage] => [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [extra_args] => Array ( ) [owner] => [_trigger_error:WPLib_Base:private] => 1 )

Laws originally meant to prevent exposure of children to drug-related environments such as meth labs are being expanded to criminalize substance use during pregnancy.

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Viewpoint

Beyond Marginalization: Supporting Life in the Community

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                    [post_content] => Marginalization from community life, stemming from stigma and other structural factors, is a common experience among people living with serious mental illnesses. It also emanates from a shield and protect framework implemented by well-meaning service providers, who endeavor to protect clients from those very factors or risks. This type of clinical intervention can create a gatekeeping dynamic that dampens social agency and prevents independent exploration of one’s rightful place in the community. One reason for perpetuating this dynamic is that individuals with serious mental illness are often seen as vulnerable and unable to participate in the complex social dynamics of their communities. Though well-intentioned, this can be tallied as one failure of the community mental health system. Project Connect in New Haven, Connecticut seeks to address this failure by operating on the edges of the mental health system and providing individuals with serious mental illness opportunities to develop community connections that build confidence through self-determination and pursuing their personal interest.
...individuals with serious mental illness are often seen as vulnerable and unable to participate in the complex social dynamics of their communities. Though well-intentioned, this can be tallied as one failure of the community mental health system.  
[ictt-tweet-inline]Project Connect recognizes participants as experts and staff as contributors.[/ictt-tweet-inline] This is quite different from more traditional community interventions that address client needs through a hierarchical framework in which clinician is expert and client is contributor. This is founded in a fundamental principle of the program: individuals with serious mental illness should not be defined only through their illness. When community integration is addressed through a mental health clinic, the integration is sensibly rooted in the person’s reason for coming to that clinic. Project Connect aims to work on the fringes of the traditional mental health system by recognizing these same individuals through their own expressed identities—their passions, talents, interests, and areas of curiosity. To this end, Project Connect does not use tools typical of treatment settings like referrals or applications. Instead, it relies on the typical connective tools of community settings, like networking and basic person-to-person introductions. Inspired by the work of Project Friendship in British Columbia, Project Connect staff leverage relationships with neighbors, friends, community activists, and even extended family to find connection opportunities. This maximizes the ability to find something that a participant wants to pursue, rather than falling into the pattern of creating a menu of activities, the contents of which are determined by the service provider rather than the person seeking community connection on his or her own terms.
Project Connect staff members deliberately have one foot in the mental health system and one foot in the community at large, as a way of bridging what is often experienced as a divide.  
Project Connect staff members deliberately have one foot in the mental health system and one foot in the community at large, as a way of bridging what is often experienced as a divide. They are employed within the mental health system and are active, long-time residents of the community in which most Project Connect participants reside. Some also have their own experiences with serious mental illness. This unique position allows staff members to navigate and broker communication between the worlds of the service system, the loose community of people living with mental illness, and the community at large, with a firm foothold in each. Project Connect has supported people in defining community engagement based on their own interests, including riding bikes with other cycling enthusiasts, joining in common cause with fellow activists, and teaching craft classes at a community center. In this configuration, service providers’ apprehension about the settings in which the social interactions occur cannot take precedence. Rather, the terms are determined by participants, community partners, and the resources of a given organization or neighborhood. This necessitates a realignment of the roles professionals play to support community participation. Policy makers and program developers bring people living with serious mental illness to the table as experts in their own aspirations, and include community partners as essential collaborators. Feature image: lee robertsCommunity, used under CC BY-SA 2.0 [post_title] => Beyond Marginalization: Supporting Life in the Community [post_excerpt] => Project Connect operates on the edges of the mental health system by providing individuals with serious mental illness opportunities to develop community connections. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => beyond-marginalization-supporting-life-community [to_ping] => [pinged] => [post_modified] => 2018-03-01 07:08:51 [post_modified_gmt] => 2018-03-01 12:08:51 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.publichealthpost.org/?post_type=bu_viewpoint&p=3853 [menu_order] => 0 [post_type] => bu_viewpoint [post_mime_type] => [comment_count] => 0 [filter] => raw ) [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [view] => BUPHP_Post_View Object ( [multipage] => [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [extra_args] => Array ( ) [owner] => [_trigger_error:WPLib_Base:private] => 1 )

Project Connect operates on the edges of the mental health system by providing individuals with serious mental illness opportunities to develop community connections.

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Viewpoint

Tomorrow in Mind: Corporate Social Responsibility

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                    [post_content] => Corporations, with all the power they wield in the U.S. and abroad, have a moral, ethical, and quasi-legal obligation to respect, protect, and fulfill human rights. This obligation mirrors the stringent and codified legal obligations of governments to ensure human rights for their people. Opportunity to do more is abundant.

The simple reason public health must increase advocacy for corporate social responsibility to uphold human rights is clear: when you elevate human rights, you elevate population health and prosperity. Dr. Jonathon Mann, former World Health Organization official who pioneered global AIDS research and response in the 1980s, once said, “[W]e have the responsibility to move forward by recognizing that true interdependence and real interconnectedness requires that we—from health and from human rights—advance together: equal partners in the belief that the world can change.”

The Coca-Cola Company

The Zambian government ratified the United Nations Convention on Economic, Social, and Cultural Rights in 1984, ensuring the right to the highest attainable standard of health for its citizens. But, thirty-four years later, the country still struggles to provide even basic primary care. As Dr. Joseph Kasonde, the Minister of Health in Zambia, has said: “You will find Coca-Cola in any village at any time in the course of the year, but you’ll not find medicines.” Without practical access to essential medicines, the right to health for the people of Zambia means nothing. Armed with this understanding the NGO Colalife worked to bring oral rehydration kits to Zambian villages, where UNICEF reports that “…It is expected that 60 per cent of babies born will not survive to the age of 40…[and]…Malaria is responsible for one third of under five deaths, with many others caused by respiratory infections, diarrhoea and neo-natal conditions.” The NGO turned to Coca-Cola to help them understand the distribution channels they rely on, and “the drinks giant responded, with advice, insight, detail, discussion and questions.” Within the UN system is a legal principle called ‘progressive realization.’ What it means is that although countries may not have the capacity to ensure human rights immediately, steps must be taken toward them. World Bank GDP rankings put Zambia at 131st in the world. While the country is improving infrastructure and is on an upward trajectory, achieving lower-middle income status in 2011, the country’s economy is still dependent on foreign assistance. Zambia would have significantly less ability to tackle health and human rights challenges without these external contributions. The lent capacity of the NGO partnership with Coca-Cola facilitated the movement of oral rehydration, saving lives and further realizing the right to health in Zambia.

Continuing the Push for Social Responsibility

Numerous multinational corporations support corporate social responsibility initiatives focused on improving health around the world. These include the Coca-Cola Foundation’s global HIV programming, Pfizer’s trachoma initiative, and John Deere’s agricultural and educational support to partner villages in India. But programs like these remain an exception, not the rule. Public health must be a leading force and continue to build partnerships with corporations to :

1.)   Influence corporate social policy to promote the wellbeing of populations. This must include advocacy and activism, as well as a strong push from inside companies to behave more outwardly responsible.

2.)   Push leaders to follow in the steps of CEOs like Blackrock’s Larry Fink and “contribute to society.”

3.)   Better educate public and private entities about the social determinants that affect health, and how improving indicators (like average family income) can improve health drastically.

Feature image: Hernán Piñera, Coca Cola, used under CC BY-SA 2.0 [post_title] => Tomorrow in Mind: Corporate Social Responsibility [post_excerpt] => PHP Fellow Gilbert Benavidez writes on corporate social responsibility to respect and protect human rights, and how public health must be a leader in building partnerships with corporations to influence social policy. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => tomorrow-mind-social-responsibility-corporations [to_ping] => [pinged] => [post_modified] => 2018-02-23 05:45:18 [post_modified_gmt] => 2018-02-23 10:45:18 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.publichealthpost.org/?post_type=bu_viewpoint&p=3768 [menu_order] => 0 [post_type] => bu_viewpoint [post_mime_type] => [comment_count] => 0 [filter] => raw ) [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [view] => BUPHP_Post_View Object ( [multipage] => [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [extra_args] => Array ( ) [owner] => [_trigger_error:WPLib_Base:private] => 1 )

PHP Fellow Gilbert Benavidez writes on corporate social responsibility to respect and protect human rights, and how public health must be a leader in building partnerships with corporations to influence social policy.

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Viewpoint

A History of Work Requirements

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                    [post_content] => The state of Kentucky recently grabbed headlines for their plans to implement work requirements for Medicaid recipients. The Kaiser Family Foundation reports that, in addition to Kentucky, nine states have pending waiver requests that would require work as a condition for receiving Medicaid benefits. Indiana’s waiver was officially approved this month.

Requiring work as a condition for Medicaid is born from a history of politicians attempting to implement work requirements for all public benefit programs. Most often favored by Republicans and other conservatives, work requirements were first proposed for food assistance programs in the mid-1980s, and they have been proposed for subsidized housing programs since the 1990s. Neither of these proposals has passed so far; however, politicians were successful in making work a required condition for welfare programs. This is commonly known as “Welfare to Work.”
Democrats and Republicans alike have participated in the “welfare to work” phenomenon.  
Democrats and Republicans alike have participated in the “welfare to work” phenomenon. Beginning in the early 1990s, conservatives led a push to “end welfare as we know it” by reforming the federal welfare program known as Aid to Families with Dependent Children (AFDC). Sixty years earlier, AFDC was established in the Social Security Act of 1935 to provide “guaranteed cash assistance to needy families with children.” The Bush administration granted waivers to states which allowed them to independently change their AFDC programs, including waivers that implemented work requirements for welfare recipients. When Bill Clinton was elected in 1992, his administration continued to grant state waivers, but turned its focus to health care reform. Congressional Republicans, led by new Speaker of the House, Newt Gingrich, promoting their Contract with America, made passing a welfare reform bill one of their highest priorities. By 1995, 40 states had used waivers to implement work requirements, and one year later the AFDC was replaced with Temporary Assistance to Needy Families (TANF) through the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA). Work requirements are a hallmark of the TANF programs created by each state after the passage of PRWORA.
Using these human capabilities as a metric, the success of work requirements is not clear even after 20 years of research and reflection.  
The success of “Welfare to Work” is a popular talking point among politicians who invoke the success of TANF programs as evidence that work requirements should be exported to other public benefit programs, such as Medicaid. Success in this case is usually defined as decreased program administration costs and/or fewer cases. Indeed, the U.S. saw steep declines in welfare caseloads almost immediately after the enactment of the PRWORA. States were also free to set benefit levels, and most lowered them substantially. In 2017, most states’ benefits were below 30% of the poverty line. Low caseloads and inadequate benefits persist even during hard economic times when public benefit programs should buoy families. A more meaningful way of measuring success may be the extent to which policies help families meet their basic needs and give their children a better future. Using these human capabilities as a metric, the success of work requirements is not clear even after 20 years of research and reflection. The evidence strongly suggests that work requirements at best do not improve the quality of life for low-income families and, at worst, result in harmful effects on income, material well-being, and health. Work requirements for welfare benefits have contributed to an increase in extreme poverty in the U.S. since 1996. Work requirements are not a new policy idea. Politicians, especially conservatives, have been proposing the addition of work requirements to every existing type of public benefit program for decades. Given the consequences of work requirements for welfare, states like Kentucky and Indiana might see fewer individuals receiving Medicaid after implementing work requirements. Given those same consequences, it is also very likely that individuals and families who lose Medicaid coverage will not replace it with other health insurance. Instead, even fewer public resources will be available to help families make ends meet, survive, and serve as a safety net to catch them if they experience misfortune and tragedy. Feature image: aaron gilson, working hands, used under CC BY-NC-ND 2.0  [post_title] => A History of Work Requirements [post_excerpt] => Nine states have pending waiver requests that would require work as a condition for receiving Medicaid benefits. Work requirements are not a new policy idea. Politicians, especially conservatives, have been proposing the addition of work requirements to every existing type of public benefit program for decades. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => history-of-work-requirements [to_ping] => [pinged] => [post_modified] => 2018-02-14 07:09:11 [post_modified_gmt] => 2018-02-14 12:09:11 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.publichealthpost.org/?post_type=bu_viewpoint&p=3794 [menu_order] => 0 [post_type] => bu_viewpoint [post_mime_type] => [comment_count] => 0 [filter] => raw ) [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [view] => BUPHP_Post_View Object ( [multipage] => [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [extra_args] => Array ( ) [owner] => [_trigger_error:WPLib_Base:private] => 1 )

Nine states have pending waiver requests that would require work as a condition for receiving Medicaid benefits. Work requirements are not a new policy idea. Politicians, especially conservatives, have been proposing the addition of work requirements to every existing type of public benefit program for decades.

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Viewpoint

The Health of DREAMers

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                    [post_content] => In a recent defense of the now rescinded Deferred Action for Childhood Arrivals (DACA) program, Barack Obama remarked, “These Dreamers are Americans in their hearts, in their minds, in every single way but one: on paper.” In 2009 President Obama used executive power to establish the DACA program, in an effort to protect an especially vulnerable sub-group of the undocumented population. Hundreds of thousands of undocumented children were able to come out of the shadows and work, go to school, and live their lives with a semblance of normalcy and peace.

DACA recipients, often called DREAMers (Development, Relief, and Education for Alien Minors), present as high school valedictorians and service workers alike; they are unique human beings who are looking to succeed in a country they consider their home. And currently, their status is in jeopardy with the President’s rescindment of DACA.

They are also becoming sicker as a result. Physical and mental health outcomes have been clearly linked with immigration status. The health and wellbeing of DREAMers is influenced by politics, culture, racism, xenophobia, and discrimination. The health needs of these young people often go beyond lack of access to medical care.

Informing Immigration Policy with Research

“There is no [medical] help out there and if there is, it’s really hard to find,” remarked one DREAMer in an article by Raymond-Flesch, et al. published in the Journal of Adolescent Health. In the authors' study, 61 DACA-eligible Latinos aged 18-31 were recruited from the Los Angeles and Bay areas during the summer of 2013 to participate in qualitative interviews. The goal of the study was to assess the general health of DREAMers and their access to health care. Study participants were self-identified Latinos age 18-31 eligible for DACA.  Not much is known about this understudied population because they often live in the shadows.

Unmet Health Needs

Participants indicated that they had many unmet health needs, including stress and anxiety related to their immigration status and poor access to primary and specialty care. One participant speculated, “I think a lot of things get normalized, so stress, anxiety, working hours a week…I think a lot folks are in deep depression, but…don’t realize it.” Several other important barriers to care were identified by the authors. DREAMers identified challenges in transition to adulthood and poor physical health due to their inability to access preventive care like vaccination, reproductive care, and annual physicals. Twenty-three percent reported being depressed in the last month, 62% reported binge drinking, and 25% reported a history of smoking. DREAMers often sought alternative sources of care for all ailments except serious illness.  The most important barrier was cost. One DREAMer remarked, “Do I want to spend $40 or $35 on the checkup, or do I want to spend it on food?” Forty-three percent reported extreme poverty though most (80%) were employed. Health care literacy was the second major challenge. Fear and mistrust of medical professionals was also identified as a serious problem. A participant remarked, “[Doctors] don’t really know much about the status and what it means…so sometimes the alternatives that they offer…don’t work for you because you’re not eligible for them.” Despite all of this, DREAMers reported their circumstances were “inadvertently protective” by forcing them to be resilient despite the many impediments created by their immigration status.  One participant remarked, “I needed to find a way to progress pretty much on my own…I feel more empowered, like I did it by myself.” This study was published in 2014. Things have gotten much worse with the rescindment of DACA, but congressional intervention can play a major protective role in these hundreds of thousands of lives. As of this writing, Senate Majority Leader McConnell has promised debate on DACA and the President has said that DREAMers should be able to stay. Feature image: Ignatian Solidarity Network, DSC00333, used under CC BY-NC 2.0 [post_title] => The Health of DREAMers [post_excerpt] => DREAMers suffer from stress and anxiety related to their immigration status and poor access to health care including vaccination, reproductive care, and annual physicals. PHP Fellow Gilbert Benavidez writes on how congressional intervention can play a major protective role in these hundreds of thousands of lives. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => the-health-of-dreamers [to_ping] => [pinged] => [post_modified] => 2018-02-08 15:23:41 [post_modified_gmt] => 2018-02-08 20:23:41 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.publichealthpost.org/?post_type=bu_viewpoint&p=3753 [menu_order] => 0 [post_type] => bu_viewpoint [post_mime_type] => [comment_count] => 0 [filter] => raw ) [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [view] => BUPHP_Post_View Object ( [multipage] => [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [extra_args] => Array ( ) [owner] => [_trigger_error:WPLib_Base:private] => 1 )

DREAMers suffer from stress and anxiety related to their immigration status and poor access to health care including vaccination, reproductive care, and annual physicals. PHP Fellow Gilbert Benavidez writes on how congressional intervention can play a major protective role in these hundreds of thousands of lives.

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Viewpoint

But What Exactly is Public Health?

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                    [post_content] => When was the last time someone asked you: “But what do you actually do?” Did you have a clear and pithy answer? My mentor and colleague, the late Dr. Bill Bicknell, did: “Public health is the art of deciding who dies when and in what degree of misery.” His definition is intended to deflate the collective idealism of our profession. Bill wanted his students to know that, because public health focuses on populations rather than individuals, they are shouldering a weighty responsibility. His less cynical definition of public health as “the art and science of deciding who lives a longer, less miserable, and happier life” still lets some of the air out of our idealism but stops short of puncturing it.

Bill’s definitions were a spin on the optimistic explanations of public health offered by the World Health Organization in 1988 as “the art and science of preventing disease, prolonging life and promoting health through the organized efforts of society.” Historically, the focus of these efforts has been preventing disease and disability at a population level. John Snow taking the handle off the Broad Street pump to stop cholera transmission in London, childhood vaccination, and tobacco control are just a few examples. The definition has broadened over the years to include organizing and delivering health care, increasing access to effective treatment, understanding the contextual factors that produce health (including sex, race, economic status, and educational attainment), and advocating for social justice.

The American Public Health Association infographic below communicates all the positive things that our profession does, reinforcing the maxim that when public health is working you don’t know it’s there. The life and death responsibility of public health is visible only when it breaks down (the Flint water crisis comes immediately to mind).

In other words, public health is everything. PHP embraces this broad definition and we challenge ourselves and our readers to grapple with the positive and negative outcomes of our attention and, even more importantly, of our inattention. Personally, I prefer Bill’s first definition because it reminds me to be humble. Every decision we make to pursue positive gains for one population can have dire unintended consequences for another.

As PHP launches into 2018, we are eager to hear from our readers. Do you have a definition or example of public health in action that you would like to share? If so, please share your ideas with me at jenbeard[at]bu.edu.



 

Feature image: City of Minneapolis ArchivesPublic Health Truck, 1947, used under CC BY 2.0. Infographic from the American Public Health Association.
                    [post_title] => But What Exactly is Public Health?
                    [post_excerpt] => Our Associate Editor Jen Beard writes on the elusive and expansive definition of public health and asks readers to share their own examples of public health in action.  
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Our Associate Editor Jen Beard writes on the elusive and expansive definition of public health and asks readers to share their own examples of public health in action.

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Viewpoint

Where They’re At: Phones and Homeless Youth 

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                    [post_content] => Homelessness affects about one in ten youth ages 18-25 and one in 30 youth ages 13-17 in the United States. Nearly three quarters of unaccompanied youth “couch surf,” making them especially difficult to reach—and to count.



Before I arrived at Boston University’s School of Public Health, I was an outreach worker in central California. My co-worker and I walked the same three-mile route every day through the streets of one of the Sunshine State’s many wealthy, picturesque towns. We were looking for homeless or at-risk adolescents and young adults who travel up and down the Pacific Coast Highway. Our backpack held first-aid supplies, granola bars, socks, toothbrushes and water, and we encouraged anyone under age of 22 to visit our drop-in center. There, we supported clients as they wrote resumes, researched jobs, found housing, or sought out food or medical benefits.

Often, our clients just wanted to reach out to their families or friends. As soon they walked into the shelter, many would seek out an outlet to charge their phones. We would suspend our “no social media” rule if Facebook was the only way for them to make plans to go home or let someone know they were okay. If they did not have their own phone, ours was available for calls to social services, doctors’ offices, or prospective employers.

Research shows that youth experiencing homelessness still have significant access to cell phones and social media. One study found that 90% use Facebook regularly, and another found that 93% use technology at least weekly. Researcher Eric Rice found that 40% of the 169 homeless youth participants he interviewed owned a working cell phone.

Rice has headed several studies on technology, social networks, and resilience among this especially vulnerable, transient population. He and his colleagues have found that transient youth have more access to technology than most people would think. Social media and technology are a major source of social capital for youth. They use email to connect with parents and potential employers and social media to connect with peers. Ultimately, Rice has also found that connections with family, peers, and employers can improve health and social outcomes for these youth.
More and more, evidence shows that effective connections with clients struggling with homelessness—especially youth—can be made online. Tech developers and researchers have recently begun collaborating to design apps to meet clients’ health needs.  
More and more, evidence shows that effective connections with clients struggling with homelessness—especially youth—can be made online. Tech developers and researchers have recently begun collaborating to design apps to meet clients’ health needs. Electronic case management (ECM), for instance, allows case managers to stay in contact with highly mobile clients who move around too much for in-person meetings to be feasible. An organization called Hack4Impact teamed up with the University of Pennsylvania School of Social Policy and Practice, and Juvenile Law Center on an app called YouthMatters: Philly for youth and young adults who have aged out of foster care struggling to fulfill their basic needs. It provides maps, resources (e.g. where to access food, clothing, case management, mental health services, doctors), and information like hours, contact information, and quality of various services as rated by their peers. Phone ownership can also come with downsides, such as the harassment and theft many of my clients in California experienced on a regular basis. Many of our clients reported having their phones stolen as they slept. But researcher Larissa Jennings and colleagues explain that creative strategies can help to mitigate these threats: “integrating hidden phones, financial support, and safety management may improve homeless youth’s access to and engagement with Health strategies over time.” One of the first lessons I learned working in outreach was to “meet the client where they were at.” It’s a common maxim of the harm reduction approach, which seeks to mitigate the risks of certain dangerous behaviors like drug use and unprotected sex. We suspended judgment, provided health education, and offered support and referrals if the client expressed even a passing interest in changing their situation. And we took to the streets nearly every day—literally meeting them where they spent most of their time. Moving forward, meeting youth where they are at will require getting effective supports and educational resources online and into the palms of their hands. Feature image: abstrkt.ch, Texting at Pacific Beach, Pacific Beach, San Diego CA, used under CC BY 2.0  Graphic from Missed Opportunities: Youth Homelessness in America National, voicesofyouthcount.org [post_title] => Where They’re At: Phones and Homeless Youth  [post_excerpt] => Phones, social media, and technology are critical to connect homeless youth with parents, potential employers, peers and social services. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => phones-homeless-youth [to_ping] => [pinged] => [post_modified] => 2018-01-29 07:04:39 [post_modified_gmt] => 2018-01-29 12:04:39 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.publichealthpost.org/?post_type=bu_viewpoint&p=3617 [menu_order] => 0 [post_type] => bu_viewpoint [post_mime_type] => [comment_count] => 0 [filter] => raw ) [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [view] => BUPHP_Post_View Object ( [multipage] => [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [extra_args] => Array ( ) [owner] => [_trigger_error:WPLib_Base:private] => 1 )

Phones, social media, and technology are critical to connect homeless youth with parents, potential employers, peers and social services.

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Viewpoint

Following the Law while Improving Public Health

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                    [post_content] => Tens of thousands of people face the ice-cold New York City winters each year. Governor Andrew Cuomo used executive action to combat the issue, ordering the state to round up homeless people and place them in shelters on cold winter nights. This is a case of good intentions using a shaky legal foundation. Public health cannot do whatever it wants. Government interventions must be grounded in the law. The classic mode of paternalism will not be effective in the modern landscape and liberty protections must be adhered to.

Paternalistic Law vs. Individual Liberty

Governor Cuomo cites the 77,000 emergency shelter beds available and directs “all local service districts, police agencies including the New York State Police, and state agencies to take all necessary steps to identify individuals reasonably believed to be homeless and unwilling or unable to find the shelter necessary for safety and health in inclement winter weather, and move such individuals to the appropriate sheltered facilities.” Cuomo’s executive order makes an indirect reference to the state of New York’s police power, which with the Tenth Amendment to the United States Constitution, is a power not delegated to the federal government and thus retained by the state. The police power gives the state the authority to act on behalf of its citizenry to protect the health and well-being of its constituents. Therefore, Cuomo concludes that it is an obligation of the state to protect the particularly vulnerable, which includes the homeless population. But is this grounds for forcible placement of a homeless person in a shelter?

 

Legal Authority

What, then, are the laws associated with the case? First and foremost, we must examine whether the governor is acting within the bounds of his own and the state’s inherent police power. Secondly, we must weigh this police power against Section One of the Fourteenth Amendment to the U.S. Constitution which guarantees to all citizens of the Unites States the protection from state laws that attempt to deprive the citizenry of life, liberty, or property without due process of law. Moreover, Section One guarantees any citizen within the state’s jurisdiction, including the homeless population, equal protection of the laws.

Cuomo defends his authority to put in to effect such orders by citing Sections 28 and 29 of Article 2-B of the New York State Executive Law, which sum up the governor's power pertaining to post-disaster recovery planning and the direction of state agency assistance in disaster emergencies. Section 29 explicitly states, “…the governor may direct any and all agencies of the state government to provide assistance” upon the declaration of a state disaster emergency. This assistance includes “…making such other use of [the state’s] facilities, equipment, supplies and personnel as may be necessary to assist in coping with the disaster…” Per Governor Cuomo’s description of the situation, it is obvious that he sees the winter weather as a potentially avoidable disaster for the homeless population. These sections of the Executive Law seem to parallel the state’s power to protect the health of its citizens. As aforementioned, the Fourteenth Amendment protects an individual from the seizure of liberty without due process of law. But if that person were a danger to themselves or others, forcible commitment for a mental health evaluation may be warranted. Under the state’s Mental Hygiene Law, a person’s mental competency must be judged to be compromised before they could be forcibly evaluated. As it pertains to legal precedence, the United States Supreme Court declared in Jacobson v. Massachusetts that the state had the power, in the face of “great dangers,” to restrict the individual liberty granted by the Fourteenth Amendment. It is notable that the Governor employed the state police to enforce the executive order. This requires improperly trained officers to do on-site, hastily performed evaluations to determine the mental competency of a homeless person, which is simply asking them to operate in a way that is far outside their skill set. As inane as a decision to stay out in the cold might seem, this is a historically underserved population who most often do not have a semblance of exercisable autonomy. This order is just another check on the list of events in the lives of homeless people that they do not have control over.

Future Interventions

If this order and others like it are to be put into effect in order to protect public health, it must be done with three major principles in mind:
  1. Proper adherence to the law: orders must adhere to limits on legal authority. Some flexibility and discretion exists in law but gross oversteps must be dialed back.
  2. Properly trained agencies: getting the right people for the job is critical.
  3. Adequate consideration of a citizen’s right to life and liberty: public health cannot operate in a purely paternalistic approach. Liberty cannot be restricted without due process of law; if a law like this is adjudicated and upheld public health must do the work of narrowly tailoring its approach.
Feature image: Young Sok Yun 윤영석, No cars and snow like stars, Astoria, NY, used under CC BY-NC-ND 2.0 [post_title] => Following the Law while Improving Public Health [post_excerpt] => Governor Andrew Cuomo used executive action to place the homeless in shelters on freezing winter nights, raising questions about paternalism and public health. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => following-law-improving-public-health [to_ping] => [pinged] => [post_modified] => 2018-04-04 11:17:48 [post_modified_gmt] => 2018-04-04 15:17:48 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.publichealthpost.org/?post_type=bu_viewpoint&p=3551 [menu_order] => 0 [post_type] => bu_viewpoint [post_mime_type] => [comment_count] => 0 [filter] => raw ) [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [view] => BUPHP_Post_View Object ( [multipage] => [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [extra_args] => Array ( ) [owner] => [_trigger_error:WPLib_Base:private] => 1 )

Governor Andrew Cuomo used executive action to place the homeless in shelters on freezing winter nights, raising questions about paternalism and public health.

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Viewpoint

Happy Holidays!

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                    [post_content] => Public Health Post is taking a publishing break for the holidays. Thank you for reading PHP and for joining us in conversation on social media. We’ll be back online on Monday, January 8, 2018. Best wishes for a festive holiday season, and see you next year!

Feature image: John Cooper, Hove Beach Snowman, used under CC BY-NC-ND 2.0
                    [post_title] => Happy Holidays!
                    [post_excerpt] => Public Health Post is taking a publishing break for the holidays. Thank you for reading PHP and for joining us in conversation on social media. We’ll be back online on Monday, January 8, 2018. Best wishes for a festive holiday season, and see you next year!
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Public Health Post is taking a publishing break for the holidays. Thank you for reading PHP and for joining us in conversation on social media. We’ll be back online on Monday, January 8, 2018. Best wishes for a festive holiday season, and see you next year!

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