Welcome to the Archive Space/E-special for Social & Economic Inequalities. Here you will find articles from the archive of International Sociology and Current Sociology related to this theme.

You can participate.

Simply post your comments or links to other articles related to the theme of Social & Economic Inequalities below for others to access and share.

Racism impacts your health

 

Outside in public: Smiling, dressed real fine, manners on point. I am well schooled on how to be respectful, how to take up space, how to use silence when necessary. Travelling home on transit listening to music to drown out my day — filled with injustices from the minute I left my “sanctuary” ten hours earlier. Fumbling for keys, nearly pushing the door down to my home. All I experienced outside threatens to crash down my door and engulf my insides and swallow me whole. My breath struggles to calm itself. Grief shadows me through the hallway. I self-talk my way into the kitchen, slipping my armour off; my thick silver bangle hits the floor, the sound awakening me to reality. I am home. I sit still for a minute and contemplate how I will go out again to face the monster of anti-Black racism. I drink my tea quickly, and begin to make dinner. – Feb 9, 2018, author’s journal

Witnessing and hearing stories about racism can impact your health. The feelings evoked can make you ill if not processed.

The recent news of Tina Fontaine’s trial

and the acquittal of Gerald Stanley, a white farmer accused of killing a young Indigenous man, Colten Boushie, of the Red Pheasant First Nation are examples of the Canadian legal system’s commitment to the Indian Act and colonial dominance.

This ongoing colonial dominance has a transgenerational trauma impact on the health of Indigenous and colonized peoples.

Two recent examples that indicate the kind of violence that Black people experience: A school that allowed police to shackle a Black six-year old girl’s wrists and ankles; a children’s aid system that put a child refugee from Somalia into foster care yet never applied for his Canadian citizenship, so years later he received deportation orders to a country where he does not speak the language.

The impact of this colonialism and anti-Black racism on the health of Black and Indigenous peoples is elongated and insidious. We navigate systems, structures and communities that perpetuate abhorrence towards us in all aspects of our lives.

Experiencing and fighting such systems for justice for our children, ourselves and our community members has devastating effects on our health.

As a health and human rights researcher, therapist and professor who has explored the deep implications of racism, I would like to share some insights into the impacts of racism on our health.

My hope is that by doing so I create dialogue and encourage communities to continue to voice their experiences of violence and racism — in order to demand changes and ultimately create more supports.

Violence is a continuum

Health indicator statistics of Indigenous communities report increasing disparities between Indigenous and settler populations. Systemic racism affects Indigenous population’s health in various ways, this includes limited healthy food choices, inadequate living conditions and substandard health care. The infant mortality rate within Indigenous communities is almost 12 times that of settler communities.

The statistics, usually presented by state authorities, come without context or consideration to the broad range of causes — one of which is the continued exposure to state violence on a daily basis.

We have anecdotal evidence: We see loved ones, friends, ourselves and respected community leaders struggle with the emotional and physiological impacts of racism on a daily basis. While anti-Black racism’s effect on the health of Black communities is documented, studies from the U.S. are more illustrative.

In one U.S. study, researchers studied 1,574 Baltimore residents of which 20 per cent reported that they had been racially discriminated against “a lot.” This same group had higher systolic blood pressure than those who perceived they had been discriminated against very little. Additionally, over a five-year period the group that felt they had been discriminated against “a lot” had higher declines in kidney function.

In a 1997 to 2003 study on racial discrimination and breast cancer in U.S. Black women, researchers found that perceived experiences of racism resulted in increased incidents of breast cancer, especially among young Black women. In 2011, a pivotal study on the impact of racism on health scholars linked lifetime experiences of discrimination to higher prevalence of hypertension in African Americans.

Biases in research

These are just a few examples of some studies being done on the impact of racism on health. However, most studies have been conducted in the U.S., the U.K., New Zealand and Australia. Canada does not yet collect race-based health or experiences of racism on health data through any formal mechanism. This poses a problem when scholars are asked to produce “scientific data” to prove that racism impacts health inequities and disparities. How do you provide “statistically significant evidence” on the impact of anti-Black racism when systemic issues limits your access to collecting this same data? My future research proposes to support the collection of increased health data on the impact of anti-Black racism in Canada and globally.

In Black communities no one is immune from racism — from our unborn to our school age children to our elderly. Consciously and unconsciously our health becomes obstructed.

The impact on health intensifies for those in Black communities who are women, working class, lesbian, gay, bisexual or trans (LGBT), dis(abled), refugees or newcomers. Here, the combination of oppressions creates additional stress on mental and physical health and well-being. I call this intersectional violence.

For example, the massacre of Muslims in a Québec mosque and anti-Islam policies continue to further impact the health of marginalized, often surveilled communities. Two victims of the Québec massacre were Black. This fact is hardly mentioned. This is an example of anti-Black racism within communities of colour.

Health impacts from anti-Black racism and anti-Indigeneity are often dismissed or kept silent by health scholars and health-care workers. The findings challenge the illegitimacy of systems of dominance and question the humaneness and accountability of colonial power. As such, research on the health impact of anti-Black racism is underfunded and under researched.

The “realness” of health impacts related to racism interrupts narratives of the “disadvantaged,” the “poor,” the “lazy” and the “needy.” Such stereotypes re-victimize and further aggregate health inequities. Yet understanding racism as a determinant of health is important to understanding economic and social barriers to success.

When we fail to address the real impact of racism on Black communities’ health, we not only lose our community members to often preventable disease, illness, institutionalization and ultimately death, we also lose our opportunity for redress and to energetically participate in transnational anti-oppression movements.

Health impacts

Experiencing racism throughout our lifespan can overwhelm our health functionality. Repetitive acts of untreated trauma and violence lead to debilitating health issues.

The impact of anti-Black racism within our educational system is well documented by our lived experiences and “unexplained” drop-out rates. The effect of prolonged injustice from junior kindergarten through to post-secondary education, can lead to exacerbated health conditions.

The under-recruiting and under-hiring of African/Black and Indigenous peoples in medicine, psychology, education, health and in academia directly affects the impact of racism on these same communities.

Adversely, the over-hiring of African/Black community members as personal support workers, health aids and child care workers with little opportunity to move into positions of power in these fields directly establishes a division between the “helper” and “the helped,” resembling enslavement roles where Africans served whites while living in conditions that gravely impacted their own health.

The impact of the over-representation of our children in state care on the health of Black families due to separation and transgenerational trauma is never measured.

As our children and elders endure acts of violence during vulnerable times in their lives, without protection or support, their grief response becomes hidden or dissociated. This leads to challenges in seeking and receiving health care which increases despairing health results.

The myth that Black people do not seek mental health therapy comes from a falsified notion of “super resiliency” instead of the reality of under-funded and purposely delayed services that prevent health and wellness in our communities. This leads to many community members suffering and seeking services in silence and isolation.

The burden on Black and colonized folks’ bodies, minds, spirits, health and wellness is all-encompassing.

Possibilities for change

Having a provincial anti-racism directorate and local Toronto anti-Black racism action plan indicates a way forward. Much activism over many years resulted in these strategies getting put into action.

The directorate’s effectiveness will be measured in its implementation, the diversity of its members and its power to eliminate health disparities and address the health impacts of racism and violence on the daily lives of Black, Indigenous and racialized peoples.

Research funding needs to be increased. Universities need to hire scholars from communities who are directly impacted by racism and whose work address these health inequities — to support communities impacted by these same injustices.

What if the Afrocentric Alternative school, the only one in Canada, was well resourced and supported as a health strategy to combat the early stigmatization and violence experienced by school-aged Black children?

What if, in the case of the killing of the late Colten Boushie, the jury was not all white?

What if we looked to Black Live Matters as a public health racial justice movement trying to prevent further health atrocities?

What if we collected health data on the impact of racism – using both informal and formal research methods – empowered, developed and implemented by Black and colonized communities to create health equity programs and strategies to address our health disparities?

 

By            :               Roberta K. Timothy (Assistant Lecturer Global Health, Ethics and Human Rights School of Health, York University, Canada)

Date         :               March 1, 2018

Source     :               The Conversation

https://theconversation.com/racism-impacts-your-health-84112

Posted in Latest Post, Social and Economic Inequalities | Leave a comment

Economic Equality Is Key to Solving Climate Change, Report Shows

 

Economies need to reduce inequality and promote sustainable development for the world to avert the perils of runaway global warming, according to new research.

The risk of missing emissions targets increased dramatically under economic scenarios that emphasizes high inequality and growth powered by fossil fuels, according to research published Monday by a team of scientists in the peer-reviewed Nature Climate Change journal.

“Climate change is far from the only issue we as a society are concerned about” said Joeri Rogelj, the paper’s lead author and a research scholar at the International Institute for Applied Systems Analysis outside of Vienna. “We have to understand how these many goals can be achieved simultaneously. With this study, we show the enormous value of pursuing sustainable development for ambitious climate goals in line with the Paris Agreement,” he said.

The paper bridges two of the most intractable challenges facing policy makers across the globe. Scientists predict higher frequencies of floods, famines and superstormsunless the world keeps temperature rises well below 2 degrees Celsius (3.6 degrees Fahrenheit) this century. At the same time, growing income inequality has been robbing advanced economies of dynamism needed to boost their resilience to change.

The IIASA researchers modeled six different scenarios in order to determine conditions that would limit warming to 1.5 degrees Celsius, according to the paper.

“Our assessment shows particularly the enormous value of pursuing sustainable development for reaching extreme low climate change targets,” said Keywan Riahi, a coauthor of the paper. “On the other hand, fragmentation and pronounced inequalities will likely come hand-in-hand with low levels of innovation and productivity, and thus may push the 1.5 degrees Celsius target out of reach.”

Greenhouse gas emissions should peak before 2030 after which they’ll “decline rapidly” with a combination of phasing out of industry and energy related CO2 combined with an “upscaling” carbon capture and carbon dioxide removal, according to the report. An estimated 37 billion metric tons of carbon dioxide was released last year, 2 percent more than 2016, according to researchers in the Global Carbon Project.

“Bioenergy and other renewable energy technologies, such as wind, solar, and hydro, scale up drastically over the coming decades in successful scenarios, making up at least 60 percent of electricity generation by the middle of the century,” according to the researchers. “Traditional coal use falls to less than 20% of its current levels by 2040 and oil is phased out by 2060.”

— With assistance by Eric Roston

 

By            :               Jeremy Hodges

Date         :               March 6, 2018

Source     :               Bloomberg

https://www.bloomberg.com/news/articles/2018-03-05/economic-equality-is-key-to-solving-climate-change-report-shows

Posted in Latest Post, Social and Economic Inequalities | Leave a comment

The Cancer Threat to Africa’s Future

 

While significant progress has been made in halting the spread of communicable diseases in Africa, rates of non-communicable illnesses, especially cancers, are rising. With just 5% of global funding for cancer prevention spent in Africa, a new global strategy is needed to help manage a looming health crisis.

CHICAGO – One of the most pressing public-health challenges in Africa today is also one of the least reported: cancer, a leading cause of death worldwide. Every year, some 650,000 Africans are diagnosed with cancer, and more than a half-million die from the disease. Within the next five years, there could be more than one million cancer deaths annually in Africa, a surge in mortality that would make cancer one of the continent’s top killers.

Throughout Sub-Saharan Africa, tremendous progress has been made in combating deadly infectious diseases. In recent decades, international and local cooperation have reduced Africa’s malaria deaths by 60% , pushed polio to the brink of eradication, and extended the lives of millions of Africans infected with HIV/AIDS.

Unfortunately, similar gains have not been made in the fight against non-communicable diseases (NCDs), including cancer. Today, cancer kills more people in developing countries than AIDS, malaria, and tuberculosis combined. But, with Africa receiving only 5% of global funding for cancer prevention and control, the disease is outpacing efforts to contain it. Just as the world united to help Africa beat infectious disease outbreaks, a similar collaborative approach is needed to halt the cancer crisis.

Surviving cancer requires many things, but timely access to specialists, laboratories, and second opinions are among the most basic. Yet, in much of Africa, a lack of affordable medications, and a dearth of trained doctors and nurses, means that patients rarely receive the care they need. On average, African countries have fewer than one trained pathologist for every million people, meaning that most diagnoses come too late for treatment. According to University of Chicago oncologist Olufunmilayo Olopade, a diagnosis of cancer in Africa is “nearly always fatal.”

Building health-care systems that are capable of managing infectious diseases, while also providing quality cancer care, requires a significant investment in time, money, and expertise. Fortunately, Africa already has a head start. Past initiatives – like the Global Fund to Fight AIDS, Tuberculosis, and Malaria, the US President’s Emergency Plan for AIDS Relief, and the World Bank’s East Africa Public Health Laboratory Networking Project – have greatly expanded the continent’s medical infrastructure. National efforts are also strengthening pharmaceutical supply chains, improving medical training, and increasing the quality of diagnostic networks.

Still, Africans cannot face down this threat alone. That is why the American Society for Clinical Pathology, where I work, is cooperating with other global health-care innovators to attack the region’s growing cancer crisis. We have teamed up with the American Cancer Society (ACS) and the pharmaceutical company Novartis to support cancer treatment and testing efforts in four countries: Ethiopia, Rwanda, Tanzania, and Uganda. Together, we have brought immunohistochemistry, a key diagnostic tool, to seven regional laboratories, an effort we hope lead to more timely cancer diagnoses and greatly improve the quality of care.

To complement these technical efforts, the ACS is also training African health-care professionals how to carry out biopsies and deliver chemotherapy. That initiative, funded by Novartis, is viewed as a pilot program that could expand to other regional countries.

Finally, our organizations are advocating for enhanced cancer-treatment guidelines in national health-care planning efforts, protocols that we believe are essential to improving health outcomes. These initiatives are in conjunction with other undertakings, such as a joint ACS-Clinton Health Access Initiative program to broaden access to cancer medications.

When the world took notice that infectious diseases like HIV/AIDS, polio, and malaria were ravaging Africa, action plans were drawn up and solutions were delivered. Today, a similar global effort is needed to ensure that every African with a cancer diagnosis can get the treatment they need. Now, as then, success depends on coordination among African governments, health-service providers, drug makers, and non-governmental organizations.

There is no place on Earth that is immune from the dread of a cancer diagnosis; wherever the news is delivered, it is often devastating to recipients and their families. But geography should never be the deciding factor in patients’ fight to survive the disease. Cancer has been Africa’s silent killer for far too long, and the global health community must no longer remain quiet in the face of this crisis.

 

Danny A. Milner, Jr., is Chief Medical Officer of the American Society for Clinical Pathology.

 

By            :               Danny A. Milner

Date         :               March 2, 2018

Source     :               Project Syndicate

https://www.project-syndicate.org/commentary/african-cancer-health-care-crisis-by-danny-a-milner-2018-03?a_la=english&a_d=5a995c5078b6c709384d6b44&a_m=&a_a=click&a_s=&a_p=homepage&a_li=african-cancer-health-care-crisis-by-danny-a-milner-2018-03&a_pa=opinionthatmoves&a_ps=secondary-articles

Posted in Health, Latest Post, Social and Economic Inequalities | Leave a comment

Its poverty, not individual choice, that is driving extraordinary obesity levels

 

The statistics point remorselessly towards obesity being a symptom with an underlying social cause. That should completely change the approach to dealing with it.

The “obesity epidemic” deserves much more serious attention than it is getting. It is, after all, thought to be killing nearly three million people a year worldwide. It is putting huge pressure on health services, yet the public policy response in developed countries such as the US and UK is pitiful, largely confined to finger-wagging at children’s sugary treats.

The story that has not been getting out is that there is a clear and extraordinary correlation between obesity and social inequality.

Obesity is invariably presented as a diet issue for nutritionists, whereas social inequality is deemed the domain of sociologists and economists. Put another way, even as the inequality gap becomes more and more obvious there’s been a medicalisation of a social problem. Yet obesity is not just a matter for nutritionists: rather, it is a product of social inequality and requires a collective social response.

This failure to face up to the underlying causes of obesity is all the more striking as issues of social inequality and justice are dominating the news agenda. Despite vast increases in total wealth in the world today, the health issue remains a marker for a general political problem about inequality in society, even in the most affluent societies.

The tragedy is that obesity is usually treated as a problem and responsibility of individuals or families – not as a social problem like, say, low-educational achievement or delinquency. And so the solutions are pitched at that individual or family level.

And yet the statistics point remorselessly towards obesity being a symptom with an underlying social cause. That should completely change the approach to dealing with it. But so far, it hasn’t.

Vital statistics

Take the US. There, the most “obese” state, Arkansas, is also the fourth poorest state overall, whereas the poorest state, Mississippi, is also the third most overweight.

The picture in the nation’s second poorest state, New Mexico, is less clear because there it is complicated by another factor: ethnicity. New Mexico has “only” the 33rd highest adult obesity rate – apparently bucking the trend. Yet even in “The Land of Enchantment”, the correlation of wealth and health still leaves its unmistakable fingerprint. There, the adult obesity rate is 34.4 per cent among black adults, 31.3 per cent among Latino adults and a comparatively sprightly 23.9 per cent among white adults, again reflecting wealth distribution.

Recall that in terms of relative income, a study last year found that it would take 228 years for the average black family to reach the same level of wealth that white families have today, while for Latino families, it would take 84 years. Meanwhile, colour correlates to poor health and reduced life expectancy.

Recent studies in England also illustrate this link between obesity and income. Of the 10 worst areas in terms of overweight or obese children, half are also in the worst 10 for child poverty. England’s most obese council, Brent, is also its ninth poorest, whereas England’s wealthiest council, Richmond, despite being a neighbouring council in London, is one of the sprightliest, with a relatively low rate of obesity. And England’s poorest council? Another London borough, Newham, is also the eighth most affected by childhood obesity.

In its way, these figures are as disgraceful an indictment of social priorities and inequality as the 19th century mortality levels due to epidemics of rickets or typhoid. And the solutions needed are every bit as collective rather than individual.

Victorian parallels

Imagine that the Victorians had tried to tackle typhoid by advising everyone to live in the countryside near clean wells, rather than by building sewers and water treatment plants. Today’s response to an epidemic that kills so many people around the world that it has become the fifth leading cause of early death, is just as unrealistic.

In the early years of the 19th century, the industrial towns of the West were characterised by overcrowding, poor housing, bad water and disease. Epidemics, even in the modern cities of New York and London, were – it was assumed – a part of life. The fact that they caused significantly greater suffering in the poorer, slum neighbourhoods only contributed to the blase responses of city leaders. Epidemics were interpreted as punishments for moral turpitude – in much the same way that today’s illnesses linked to being overweight are. It was only very slowly that such attitudes – deeply rooted in religious notions of individual guilt – gave way to public health measures.

But then this was an era before the mechanisms for the transmission of diseases was understood, indeed in an era before even the idea of germs as tiny, invisible life-forms was fully accepted. And so it seemed only reasonable to middle-class New Yorkers that diseases like cholera would hit working-class neighbourhoods the hardest. It was seen as proof of their moral depravity.

Meanwhile, businesses fought against public sanitation proposals fearing increased costs – in much the same way that the food industry resists or subverts public health initiatives as the investigative journalist, Michael Moss, in particular has detailed. And like today, the business interest was often backed by politicians. The hazards back then were not ambiguous things such as sugary fizzy drinks or ready meals, but rotting animal carcasses and mountains of refuse. Yet the opposition to change was similar – every improvement had to be fought for.

So what are the factors that push poorer people towards unhealthy eating? Food and health policy expert Martin Caraher explains that food choices are massively influenced by factors such as income, knowledge and skills. Others have highlighted the fact that eating well invariably involves more food preparation time. Yet such explanations don’t fit many cases, indeed seem dangerously retrospective. What is sure is that you cannot deal with the obesity epidemic by taxing popular snacks, anymore than you could deal with rocketing suicide rates by taxing sales of rope.

The point is that we need to collectively tackle the places where obesity germs breed – in stressed communities characterised by insecure and erratic employment, inadequate education, stress, depression and a lack of social cohesion. That this requires an enormous shift in public priorities is only to be expected – but the consequences of not acting are far worse.

 

Martin Cohen is a visiting research fellow in philosophy at the University of Hertfordshire. This article first appeared on The Conversation (theconversation.com).

 

By            :               Martin Cohen

Date         :               February 27, 2018

Source     :               The Independent

http://www.independent.co.uk/life-style/health-and-families/poverty-individual-choice-driving-obesity-health-a8219831.html

Posted in Health, Latest Post, Social and Economic Inequalities | Leave a comment

Why Amartya Sen remains the century’s great critic of capitalism

 

Critiques of capitalism come in two varieties. First, there is the moral or spiritual critique. This critique rejects Homo economicus as the organising heuristic of human affairs. Human beings, it says, need more than material things to prosper. Calculating power is only a small part of what makes us who we are. Moral and spiritual relationships are first-order concerns. Material fixes such as a universal basic income will make no difference to societies in which the basic relationships are felt to be unjust.

Then there is the material critique of capitalism. The economists who lead discussions of inequality now are its leading exponents. Homo economicus is the right starting point for social thought. We are poor calculators and single-minded, failing to see our advantage in the rational distribution of prosperity across societies. Hence inequality, the wages of ungoverned growth. But we are calculators all the same, and what we need above all is material plenty, thus the focus on the redress of material inequality. From good material outcomes, the rest follows.

The first kind of argument for capitalism’s reform seems recessive now. The material critique predominates. Ideas emerge in numbers and figures. Talk of non-material values in political economy is muted. The Christians and Marxists who once made the moral critique of capitalism their own are marginal. Utilitarianism grows ubiquitous and compulsory.

But then there is Amartya Sen.

Every major work on material inequality in the 21st century owes a debt to Sen. But his own writings treat material inequality as though the moral frameworks and social relationships that mediate economic exchanges matter. Famine is the nadir of material deprivation. But it seldom occurs – Sen argues – for lack of food. To understand why a people goes hungry, look not for catastrophic crop failure; look rather for malfunctions of the moral economy that moderates competing demands upon a scarce commodity. Material inequality of the most egregious kind is the problem here. But piecemeal modifications to the machinery of production and distribution will not solve it. The relationships between different members of the economy must be put right. Only then will there be enough to go around.

In Sen’s work, the two critiques of capitalism cooperate. We move from moral concerns to material outcomes and back again with no sense of a threshold separating the two. Sen disentangles moral and material issues without favouring one or the other, keeping both in focus. The separation between the two critiques of capitalism is real, but transcending the divide is possible, and not only at some esoteric remove. Sen’s is a singular mind, but his work has a widespread following, not least in provinces of modern life where the predominance of utilitarian thinking is most pronounced. In economics curricula and in the schools of public policy, in internationalist secretariats and in humanitarian NGOs, there too Sen has created a niche for thinking that crosses boundaries otherwise rigidly observed.

This was no feat of lonely genius or freakish charisma. It was an effort of ordinary human innovation, putting old ideas together in new combinations to tackle emerging problems. Formal training in economics, mathematics and moral philosophy supplied the tools Sen has used to construct his critical system. But the influence of Rabindranath Tagore sensitised Sen to the subtle interrelation between our moral lives and our material needs. And a profound historical sensibility has enabled him to see the sharp separation of the two domains as transient.

Tagore’s school at Santiniketan in West Bengal was Sen’s birthplace. Tagore’s pedagogy emphasised articulate relations between a person’s material and spiritual existences. Both were essential – biological necessity, self-creating freedom – but modern societies tended to confuse the proper relation between them. In Santiniketan, pupils played at unstructured exploration of the natural world between brief forays into the arts, learning to understand their sensory and spiritual selves as at once distinct and unified.

Sen left Santiniketan in the late 1940s as a young adult to study economics in Calcutta and Cambridge. The major contemporary controversy in economics was the theory of welfare, and debate was affected by Cold War contention between market- and state-based models of economic order. Sen’s sympathies were social democratic but anti-authoritarian. Welfare economists of the 1930s and 1940s sought to split the difference, insisting that states could legitimate programmes of redistribution by appeal to rigid utilitarian principles: a pound in a poor man’s pocket adds more to overall utility than the same pound in the rich man’s pile. Here was the material critique of capitalism in its infancy, and here is Sen’s response: maximising utility is not everyone’s abiding concern – saying so and then making policy accordingly is a form of tyranny – and in any case using government to move money around in pursuit of some notional optimum is a flawed means to that end.

Economic rationality harbours a hidden politics whose implementation damaged the moral economies that groups of people built up to govern their own lives, frustrating the achievement of its stated aims. In commercial societies, individuals pursue economic ends within agreed social and moral frameworks. The social and moral frameworks are neither superfluous nor inhibiting. They are the coefficients of durable growth.

Moral economies are not neutral, given, unvarying or universal. They are contested and evolving. Each person is more than a cold calculator of rational utility. Societies aren’t just engines of prosperity. The challenge is to make non-economic norms affecting market conduct legible, to bring the moral economies amid which market economies and administrative states function into focus. Thinking that bifurcates moral on the one hand and material on the other is inhibiting. But such thinking is not natural and inevitable, it is mutable and contingent – learned and apt to be unlearned.

Sen was not alone in seeing this. The American economist Kenneth Arrow was his most important interlocutor, connecting Sen in turn with the tradition of moral critique associated with R H Tawney and Karl Polanyi. Each was determined to re-integrate economics into frameworks of moral relationship and social choice. But Sen saw more clearly than any of them how this could be achieved. He realised that at earlier moments in modern political economy this separation of our moral lives from our material concerns had been inconceivable. Utilitarianism had blown in like a weather front around 1800, trailing extremes of moral fervour and calculating zeal in its wake. Sen sensed this climate of opinion changing, and set about cultivating ameliorative ideas and approaches eradicated by its onset once again.

There have been two critiques of capitalism, but there should be only one. Amartya Sen is the new century’s first great critic of capitalism because he has made that clear.

 

By            :               Tim Rogan

Source     :               Aeon

https://aeon.co/ideas/why-amartya-sen-remains-the-centurys-great-critic-of-capitalism

Posted in Latest Post, Social and Economic Inequalities | Leave a comment

When will men live as long as women? By 2032, say experts

 

Women in developed countries have historically outlived men. But the life expectancy gender gap is closing.

In developed countries, the gender gap has long favoured women by one measure at least: life expectancy.

Throughout the past 100 years women have significantly outlived men, on whom war, heavy industry and cigarettes – among other things – have taken a heavier toll.

But this gender gap is closing – and a new statistical analysis of life expectancy in England and Wales since 1950 suggests that, by the year 2032, men can expect to live as long as women, with both sexes sharing an average life expectancy of 87.5 years.

The study, led by Les Mayhew, professor of statistics at Cass Business School, calculated how long a sample of 100,000 people aged 30 would live if they experienced the average mortality rates for each ensuing year, projecting forward until the male and female life expectancy curves intersected.

There are a number of factors that explain the narrowing gap, according to Mayhew. “A general fall in tobacco and alcohol consumption has disproportionately benefited men, who tended to smoke and drink more than women.

“We’ve also made great strides in tackling heart disease, which is more prevalent in men,” Mayhew said. “And men are far more likely to engage in ‘high-risk’ behaviours, and far more likely to die in road accidents, which have fallen too.”

The life expectancy gender gap appears to be closing faster than was previously thought: research published in 2015 by Imperial College had indicated it would narrow to 1.9 years by 2030. The UK as a whole has slightly lower lifespan averages, as life expectancy tends to be higher in England than the other constituent nations.

In the years immediately after 1950, women’s life expectancy increased faster than men’s in England and Wales, with the gender gap peaking in 1969, when women lived on average 5.68 years longer.

Majid Ezzati, professor of global environmental health at Imperial College, said the gap can be attributed largely to social rather than biological factors: “It’s actually the existence of the gap that is unusual, rather than the narrowing. It’s a recent phenomenon which began in the 20th century.”

In addition to the heavy male death tolls caused by two world wars, men started to smoke in large numbers before women did and women’s consumption never outpaced men’s. Male cigarette consumption peaked in the 1940s when tobacco industry figures revealed that more than two-thirds of men smoked. Female consumption peaked later, in the 1960s.

As well as changing attitudes to cigarettes and alcohol, the loss of heavy industry jobs – statistically more dangerous in both the short- and long-term – also disproportionately affected men.

“As the [life expectancy] gap narrows, our understanding of what it means to be a man and a woman changes,” said Danny Dorling, professor of geography at the University of Oxford.

“The difference between the genders also narrows because of the introduction of contraception and female entry into the labour market. But the really interesting thing is it’s actually a kind of reverse inequality: women have lived longer than men who are paid more throughout their lives and are structurally advantaged in any number of ways. We haven’t entirely worked out why that might be.”

Postcodes and poverty

While life expectancy is projected to improve for everybody in the coming decades, the rate of improvement varies significantly depending on where you live.

The Cass analysis projects that by 2030, men in the most deprived areas of England and Wales will on average die 8.8 years earlier than those in the least deprived. For women, the gap between rich and poor will be 7.3 years – with both these lifespan inequalities worsening from their current levels.

The research made use of mortality rates after age 30 in order to exclude instances of early death, which are becoming increasingly unusual. But dying young is also much more likely if you’re from a poor background.

“Early death will certainly become a rarer event, but higher mortality rates for younger ages will still be the norm in the most deprived decile in England and Wales, unless something radically changes,” Mayhew warned.

Even in wealthy areas, however, the rate of improvement in life expectancy appears to be slowing. In May, consultants at PricewaterhouseCoopers (PwC) predicted that pension funds – which consider mortality rates when estimating future payouts – might be able to wipe £300bn off their deficits.

“In the first decade of this century, there was a clear trend for improvements in life expectancy,” Raj Mody, global head of pensions with PwC, told the Financial Times. “Pension funds have typically been assuming this trend will continue when forecasting deficits. But over the last five years, that trend has changed and there is a growing view that it is not just a blip.”

As life expectancy increases, the number of deaths per year tends to fall. Since 1980 the number of deaths has fallen for both men and women, but the decrease has been greater for men.

However, in 2012 the number of deaths per year started to rise again, peaking at 529,655 in 2015 – an unprecedented increase of more than 28,000 deaths on the previous year. This was the biggest jump in percentage terms in almost half a century. The number of deaths in 2016 was down by 0.9% year-on-year, but still represented a significant increase from 2014.

The Office of National Statistics believes the upturn in deaths might be because of an ageing population. “As people are tending to live longer, leading to the population increasing in both size and age over time, we may also expect the number of deaths to increase,” a 2016 report said.

But a number of academics have attributed the slowdown in improvement to government spending cuts, particularly those affecting social care and the NHS.

“There is no biological reason why life expectancy in Britain should level out rather than keep on improving. The UK is still some way behind Japan, for example,” said Mayhew.

“But improvement in life expectancy is becoming increasingly difficult to sustain in an economic downturn with an ageing population,” Mayhew added. “Austerity in recent years has affected the supply of social care, for example, and this may have caused mortality to rise in some instances.”

 

By            :               Niamh McIntyre

Date         :               February 13, 2018

Source     :               The Guardian

https://www.theguardian.com/inequality/2018/feb/13/when-will-men-live-as-long-as-women-by-2032-say-experts

Posted in Latest Post, Social and Economic Inequalities | Leave a comment

How higher education in Hong Kong reinforces social inequalities

 

Paul Yip and Chenhong Peng say the sub-degree programmes that tend to attract youth from less-privileged backgrounds cost more to attend yet offer less wage potential than a full degree. It’s time for officials to do more to help those who fail to earn a government-funded university place.

The higher education sector in Hong Kong has experienced substantial expansion in the past 30 years. In the early years of the colony, university education was aimed primarily at the Chinese elite who could take up a public service role after graduation. In 1965, just 2.2 per cent of the university-age cohort were enrolled in a degree programme.

It was not until the late 1980s that the government decided to expand the higher education sector. The first wave of reform came about by raising the number of publicly funded degree places.

The Hong Kong University of Science and Technology was established in 1991. And, in 1994, three institutions – Hong Kong Polytechnic, City Polytechnic and Baptist College – were granted university status. As a result, the participation rate of students in publicly funded first-year, first-degree programmes grew from 8.8 per cent in 1989 to 18.1 per cent in 1996.

Then came the second wave of reform in 2001, in which private education providers were encouraged to offer self-financed sub-degree programmes. Including these associate degree programmes, the tertiary education participation rate nearly doubled, from 33 per cent in 2000 to 64 per cent in 2006.

On the whole, this expansion has raised the education level of Hong Kong society. But how has the huge increase in the supply of tertiary graduates affected wages? And how have the returns to tertiary education in Hong Kong – both at the degree and sub-degree levels – changed over the past 20 years?

To find out, we analysed data from the 1996, 2006 and 2016 population census reports, based on male workers aged 24 to 35. In 1996, holders of sub-degree certificates earned 40 per cent more than their secondary-school-educated counterparts. However, the earning difference slumped to 13 per cent in both 2006 and 2016. The decreased returns to a sub-degree tertiary education partially support the argument of credential inflation.

A sub-degree certificate also appears to confer little advantage in the labour market compared to a secondary-school certificate. This echoes the findings of the Education Bureau’s most recent survey of employer opinion on degree and sub-degree holders who graduated in 2013.

According to the survey report, employers gave sub-degree graduates a performance rating of 3.35 out of 5 on average. Among the nine major aspects of performance, they performed poorest in management skills (3.13 out of 5) and proficiency in English (3.15). Moreover, there was significant discrepancy between employers’ expectations and graduates’ performance in analytical and problem-solving skills, work attitude and interpersonal skill.

Degree holders fared marginally better than their sub-degree counterparts in terms of wage returns. In 1996, degree holders earned 70 per cent more than their secondary-school-educated counterparts. The earning difference fell to 42 per cent in 2006 and further dropped to 37 per cent in 2016.

In the employers’ survey, about 75 per cent of employers said they were satisfied with the performance of the degree holders they hired.

The transition from elite higher education to mass higher education in Hong Kong has primarily been achieved through the expansion of self-financed sub-degree programmes. The intake of full-time sub-degree students skyrocketed from 2,600 in 2000/2001 to 19,800 in 2014/2015.

A recent study found that in 2013, 30 per cent of the young people enrolling in a sub-degree programme came from families living below the poverty line. As sub-degree programmes are mainly self-financed and the annual tuition fee can be as high as HK$40,000 to HK$50,000, these young people would probably have to take out a loan to pay for their education. Despite such hefty investment, however, the returns are low.

By contrast, the increase in the publicly funded degree programmes has been rather stable. The student intake increased from 14,200 in 2000/2001 to 17,500 in 2014/2015. Almost half (48.2 per cent) of the young people enrolled came from the wealthiest 10 per cent of families, and only 7 per cent came from families living below the poverty line.

In summary, our analysis suggests that the higher education system, to some extent, exacerbates the level of inequality in Hong Kong. Students from rich families are more likely to enrol in publicly funded degree programmes and enjoy the higher returns they generate while students from poor families are more likely to enrol in a self-financed sub-degree programme, which only generates low returns.

It is the time for government to take a hard look at its higher education policy. It should try to improve the quality of self-financed sub-degree programmes, which would help to raise wage potential in the labour market.

Furthermore, some form of subsidy or compensation is necessary to enable children from disadvantaged families to enjoy greater access to publicly funded degree programmes.

In view of the substantial financial surplus this year, we should provide education and training for those who did not make the cut to a government-funded degree programme. Flexible financial support should be provided to the young people who want to improve their skills and education.

The window of opportunity for skills enhancement closes fast, especially for those aged 15 to 24. If they aren’t helped to improve themselves, they will find it hard to enjoy upward mobility. At the end of the day, Hong Kong will lose its edge if its young people don’t advance themselves.

 

Paul Yip is a chair professor (population health) and an associate dean (research) in the Faculty of Social Sciences at the University of Hong Kong. Chenhong Peng is a PhD student in HKU’s Department of Social Work and Social Administration

 

Posted in Education, Latest Post, Social and Economic Inequalities | Leave a comment

Persistent inequality: disputing the legacy of the pink tide in Latin America

 

Under the title ‘Persistent inequality’ we are launching a series of articles that analyses why the advances in the struggle against inequality in the pink tide cycle have been much more limited than expected.

In this election year in Latin America, when it is possible that the tide will confirm its turn and may strengthen conservative forces, time is ripe to reflect on how progressive governments failed to reduce inequality during the virtuous decade of progressive governments throughout the region that managed to remove millions of citizens from extreme poverty.

But new measurements, no longer based on household surveys but on income tax declarations, have shown that the impacts of leftist governments in Latin America on income redistribution and wealth were less than assumed.

It has been found that these governments were able to significantly reduce poverty, but not decrease the concentration of income and wealth among thesmall group of millionaires located at the peak of the social pyramid in each country. This argument has been used to undermine the credibility of the leftist governments, alleging that they were not efficient, not even in the objective for which they have said they are essential, which is the reduction of inequality.

To address this controversial question, and on the year of key presidential elections in major Latin American countries like Colombia, Mexico and Brazil,The Institute of Latin American Studies of the Freie Universität Berlin and DemocraciaAbierta are launching a series of articles.

The objective is to propose solid arguments and analysis to be considered and discussed in the Latin American and international public sphere in times of rapid political change that often neglect the lessons of the recent Pink Tide.

The pink tide and the struggle against inequality

It is true that inequalities and poverty have decreased more in the countries that, in recent years, were or continue to be governed by leftist forces, and particularly Argentina, Brazil, Bolivia, Chile, Ecuador, El Salvador, Nicaragua, Paraguay, Uruguay and Venezuela, than in the Latin American countries not governed by leftist forces.

Nevertheless, it cannot be denied that advances in the struggle against inequality in the pink tide cycle has been much more limited than expected from governments that were elected based on a promise of reverting inequalities accumulated since the colonial period.

The explanations for this modest performance normally combine external andinternal factors. In terms of external factors, it is alleged that the cycle of economic growth that helped finance spending on the social policies of leftist governments was based on the exports of raw materials and agricultural products whose volatile prices have been largely declining on international markets in recent times.

From an internal perspective, the social central policy adopted by practically all the leftist governments has been criticized, that is, cash transfers to the poorest. It is known that these policies, unlike policies aimed at the formation of long-lasting structures of a welfare state (quality education and healthcare provided by state, public investments in professional training, etc.) have by the strength of their own design, a very limited redistributive impact.

The tax question has also been highly debated. After all, except in isolated cases, the leftist governments were not able to create progressive tax structures that could redistribute income from the top to the base of the social pyramid.

These explanations are solid and pertinent and deserve to be considered. Nevertheless, they only reveal the surface of the phenomenon that they study and do not elucidate the ultimate reasons for which the leftist governments tonot have gone much beyond the programs for distribution of money to the poor.

To understand these reasons, it is necessary to articulate the analysis of social inequalities with the study of power relations in each case. That is, it is necessary to understand the political circumstances that caused the leftist governments to be unable to go further in their concern for promoting income redistribution.

Six factors to be addressed

  1. The exhaustion of grand national narrativesthat at other moments of recent Latin American history have allowed uniting a nation around common objectives: This was the case, for example, of the national-developmentalist discourse that in the mid twentieth century helped to legitimate the decisive participation of the state in the socio-economic development of countries such as Argentina and Brazil.

Something similar is observed during the democratization process at the end of the last century, when groups with quite diverse interests joined around the common objective of re-establishing democracies in countries such as Argentina, Brazil, Paraguay, Uruguay or Chile.

The leftist forces that reached power in the twentieth-first century, even if they had been capable of winning elections, were not able to transform the fight against inequality into a national hegemonic project.

  1.  The erosion of the national public spheres:In the context of democratization in the various countries, public spaces were formed that were capable of promoting the effective interchange of ideas, interpretations and arguments of various social groups.

These arenas of debate allowed the governments to both promote and defend their policies as well as re-adjust them according to public reactions.

In recent years, the intensified concentration, and the increased partisan nature of mass communication media coupled with the rise of a multiplicity of forums and blogs that do not communicate with each other, have transformed the public sphere into a space of struggle in which insults and fake news have more weight than good arguments.

This new context creates insurmountable difficulties for the legitimation of proposals of substantive changes as are the profound programs for income redistribution that the Latin American left intended to implement.

  1. Volatile parliamentary base: Most of the leftist governments were only able to be established at the cost of alliances with conservative forces. If these alliances guarantee the formation of a legislative majority necessary to govern, they very often impeded projects for tax reform or bolder redistributive plans.
  2. Emergence of the so called new middle classesthat demonstrated greater commitment to individual upward mobility and to the broadening of their opportunities for consumption than with the promotion of social justice.

This obviously does not involve a moral condemnation of these strata for wanting material prosperity.

What it indicates is that the rise of the so-called new middle classes, typical voters for the leftist governments, forced these governments to correct their discourse and their more radical redistributive intentions, in favor of measures aimed at expanding the consumption possibilities and upward mobility of this segment.

  1. Resistance of the established middle classes: in many countries, the growing consumption capacity of the new middle classes was seen by the established middle classes as a threat to their class reproduction.

After all, their common marks of social distinction such as access to certain goods and services (cars, domestic employees, university education, etc.) were either no longer guaranteed or failed to be a privilege of the established middle classes.

This transformed the established middle classes into a large and powerful opponent of the leftist governments and their redistributive plans.

  1. Appropriation of the state and of politics by economic elites: in recent years, the wealthiest groups in Latin America were able to extend and consolidate their control over the states in the region, including those governed by the left.

Through strong and often corrupt influence over politicians and governments, these elites were able to instrumentalize portions of the state to serve their interests, as well as obstruct, in the legislative realm, laws and reforms that could limit their economic power.

This explains, at least in part, the inexistence in many countries of a fair taxation of capital gains or of large fortunes. It also explains why the peak of the social pyramid (the wealthiest 1% of each country) was able to broaden their participation in the appropriation of the wealth and income even in the countries governed by the left.

The combination of these six factors, and others that prove to be relevant for each country in particular, allow interpreting in a deeper and better-articulated manner the modest results of the leftist governments of Latin America in terms of the promotion of the distribution of income and wealth.

The meager results are not due to a lack of political will, technical incompetence or ignorance of the effective mechanisms for promotion of greater equality. Given the circumstances in which the governments took power, it seems that until now the leftist forces have lacked enough power to promote more radical reforms.

 

Sérgio Costa is Professor of Sociology at Institute of Latin American Studies and at the Instituite of Sociology of the Freie Universität Berlin.

Francesc Badia i Dalmases is Editor of DemocraciaAbierta. Francesc is an international affairs expert, author and political analyst. His most recent book, “Order and disorder in the 21st century”, has been published in 2016. He Tweets @fbadiad 

 

By            :               Sergio Costa & Francesc Badia I Dalmases

Date         :               January 22, 2018

Source     :               Open Democracy

https://www.opendemocracy.net/s-rgio-costa-francesc-badia-i-dalmases/persistent-inequality-disputing-legacy-of-pink-tide-in-latin-

Posted in Latest Post, Social and Economic Inequalities | Leave a comment

How Indonesia Can Use Urban Planning to Tackle Inequality

 

Gated communities in Indonesia have become a glaring example of how income inequality creates both spatial and social divides.

Income inequality creates both spatial and social divides and shows itself within cities in many ways. Gated communities in Indonesia have become a glaring example. However, legislation and urban planning can help bridge these divides and reduce inequality.

“Inclusionary planning instruments” are designed to do just that. But to be effective they need to be strongly enforced.

In Indonesia, there are two instruments that have the potential to create more inclusive societies. But power differences between rich developers and the urban poor, lack of expertise in how to implement inclusionary planning, and even insufficient awareness of relevant instruments, have hindered enforcement.

Rising inequality globally

A rise in inequality globally has been pointed out over the last five years by several organisations. Oxfam International has just published a report on inequality that highlights a significant difference in wages.

Between 1980 and 2016, the top 1% of the world population captured 27% of the total world income growth. The bottom 50% received only 12% of the income growth, according to the World Inequality Report 2018.

Indonesia is not immune to these global trends; both income and wealth inequality are rising in the country. The Gini index for Indonesia (a coefficient between 0-1 used to measure income inequality – the closer to 1, the more unequal) increased from 0.31 in 1990 (UNDP, 1990) to 0.41 in 2015.

What’s more, according to Oxfam, wealth inequality has increased to a level where the four richest men in the country have more wealth than the poorest 100 million people.

Inequality is one of our main concerns if we want to have harmonious and just societies. The mainstream international development agenda recognises this and the 2015 Sustainable Development Goals include a goal (SDG10) to “reduce inequality within and among countries”.

Inequality in cities

Income inequality manifests itself in cities. We can see clear differences between different social groups in terms of access to housing and basic services.

Houses for upper-middle-class families in Indonesia are spacious, built with good-quality materials and located in neighbourhoods with good services and infrastructure. In the case of gated communities, there are also security devices in place.

Conversely, poor housing lacks appropriate structural conditions. There is overcrowding, often with one family living in a single room. And there is no sanitation and access to basic services.

Gated communities are, especially in the Global South, the main housing option for upper-income groups. The rich justify living in gated communities to reduce insecurity and fear of crime. However, belonging and exclusion of the “unwanted” people are strong reasons behind living in closed enclaves.

Even when poor and rich groups might co-exist in the same territory they do not interact with each other, except for some formal work exchange between employer and employee, where there are strong power relations at play.

Residents’ access to services and infrastructure is also divided along lines of wealth. This creates patterns of “splintering urbanism”, reflecting the unequal distribution of services and infrastructure in the territory.

Indonesia’s planning instruments

Inclusionary planning regulations can serve to reduce the gap between rich and poor, including disparities in the services and infrastructure available to them. These instruments require private developers to incorporate social housing or/and services and infrastructure for less advantaged groups when building housing for upper-income groups.

Indonesia has two potentially inclusionary planning instruments for new private residential developments. The first is the “1.2.3 Ratio” scheme and is included in national regulation. It says that for each house built for high-income residents, private developers should also build two houses for middle-income families and three for low-income families.

The second instrument is called “socialisation”, included as a stage of the Environmental Impact Assessment. The assessment is required when seeking planning permission for a new housing project. The “socialisation stage” requires developers that plan to build a project in an already urbanised area to obtain permission from existing residents for the project to go ahead.

Both instruments represent attempts by the government to reduce inequalities in the cities and to enforce some sort of “planning gain”. These could be seen as a positive step towards redistribution, with incredible potential to create positive change in Indonesian cities.

However, our research data from Jakarta and Yogyakarta show that “Ratio 1.2.3” is hardly being enforced. Land is scarce in many Indonesian cities and it is not profitable for the private sector to build houses for middle- and lower-income families. Additionally, many government officers responsible for the “Ratio 1.2.3” application are unclear on the enforcement mechanism.

In the case of “socialisation”, it has become a very limited process. It has turned into economic negotiations between powerful private developers and less powerful local residents who live close to the proposed project. The latter are usually represented by the neighbourhood association leaders.

In the best situations, the local communities manage to obtain a few new sources of employment, as security guards, cleaners, gardeners or builders.

They may also receive some funding for annual community events, such as the Independence Day celebration. The local roads and mosque might get spruced up.

But these benefits are not enough to reduce the gap between the two groups, nor will they encourage any sort of social interactions between new and old residents.

The lack of enforcement of “Ratio 1.2.3” and the limited scope of the “socialisation” process are missed opportunities for Indonesian cities. These instruments have the potential to decrease urban income inequality by “forcing” those who have more money to contribute to the public good for the benefit of poorer families.

How to get more out of inclusionary planning

To improve the benefits from these inclusionary planning instruments, the government should:

  • develop clearer and realistic guidelines and instruments that can be applied
  • establish clearer mechanisms for public officers to enforce these instruments
  • make society more aware of these instruments and, in particular, of the potential benefits of more harmonious and just cities

Rising inequality globally

How to combat the inequality gap is often a heated topic for governments. International organisations say that while world leaders now acknowledge inequality, not enough is being done to efficiently reduce it.

Other measures to reduce inequality include more progressive tax systems, as suggested in the latest World Inequality Report. Under this system, people who earn more also contribute more towards public services and higher public. This covers spending to provide education, health care and social protection for all. Policies for equal salaries between female and male workers are also promoted as key to reducing inequality.

 

Sonia Roitman is Senior lecturer in Development Planning, at the University of Queensland.

 

By            :               Sonia Roitman

Date         :               February 13, 2018

Source     :               The Wire

How Indonesia Can Use Urban Planning to Tackle Inequality

Posted in Latest Post, Social and Economic Inequalities | Leave a comment

The hidden health inequalities that American Indians and Alaskan Natives face

 

I was an American Indian student pursuing a doctoral degree in clinical psychology in the 1990s, when I realized the stark contrast between my life experiences growing up on my home reservation and those of my non-Native peers.

Many incredible family members and friends had sacrificed and broken a trail for me to realize my academic dreams. My rich and generous native culture and traditional ways helped sustain my family over the years.

However, as each year of school unfolded, I lost family members due to early causes of death, including homicide, suicide, motor vehicle accidents, cancer and pneumonia. I had to drive over four hours to the nearest Indian Health Service provider for prenatal visits for my children and nearly lost one child due to lack of access to proper medical care.

Unfortunately, my story isn’t uncommon for most Native Americans. As a collective, American Indians and Alaska Natives live more challenging and shorter lives. These are statistics I’m acutely aware of as researcher in clinical psychology. Understanding the sources of and solutions to these inequalities is the focus of my career.

The Indian Health Service is in the position to change these trends for the better. Outside of Native communities, few Americans know what this agency does, that its leadership is under fire and that the current nominee to head this IHS is a controversial figure. There is much work to be done to reverse American Indian health problems.

Health inequality

The IHS is the primary health care provider for most American Indians. It is responsible for providing health care under historical treaty agreements between the federal government and tribes.

In many ways, American Indian health has improved under the IHS over the past 20 years. For example, infant mortality decreased 67 percent between 1974 and 2009.

But there are steep divisions between the health of American Indians and other Americans. American Indians continue to have lower life expectancies than other Americans and lose more years of productive life. They also have the nation’s highest rates of death due to suicide. High rates of premature death due to diabetes, cardiovascular disease, cancer and accidents plague Native Americans.

These disparities are shaped by social inequality, historical trauma and discrimination. Most American Indians live in chronic poverty, with limited access to health care, adequate housing, quality education and adequate law enforcement services.

Early exposure to traumatic events and losses, including sexual and domestic violence, are common for many American Indians. This childhood trauma can translate to a lower quality of life and a wide variety of poor health outcomes.

My home state of Montana includes seven reservations and multiple urban centers of American Indians, with tribal representation from many of the 657 federally recognized tribes. American Indians live on average 20 years less than whites in the state. Montana currently has the highest rate of suicide in the nation.

The IHS has historically been inadequately funded. Federal funding only provides for 54 percent of needed services. Recent estimates show increased patient use despite proposed funding cuts. What’s more, the majority of American Indians live in urban settings with very limited access to IHS facilities.

As a result, many American Indian patients receive health care that may be inadequate or of minimal quality. Others must wait a long time for urgently needed care. These experiences have collectively led to a distrust of institutions, including health care centers. Many will avoid or delay necessary screenings and care. It should be a priority to find better ways to create outreach and directly provide services.

Hope for health

These experiences have motivated many Native people to work toward health equity.

Native-led organizations like The National Council of Urban Indian Health, the National Indian Health Board and the National Congress of American Indians have worked to improve health for all Native people. The National Indian Health Board has a number of public health initiatives working to inform tribes on best practices in obesity, violence, suicide and substance abuse prevention. The National Congress of American Indians advocates policies to improve health by engaging elected tribal leadership.

To improve access to health care, some also call for change in the way tribal health is funded and provided. Many tribal communities have even taken over the health care provision structure.

Many tribes have worked to bring back traditional healing methods, education, languages and traditional foods. This revitalization is showing promise to improve health the entire family and community. For example, The Piegan Institute on the Blackfeet reservation created language and culture immersion schools to help restore these practices.

These efforts are important, due in part to the significant lack of Native American health care workers. Many Native patients respond better to Native providers. Some educational programs are working to increase Native health professionals, researchers and educators.

Personally, I have sought a career in public health to help communities explore potential solutions to the many challenges we collectively face as Native people. I sit in my office today, looking upon the photos of family members lost too soon, and reflect upon the hope of healthier futures for my daughters, my niece and all Native youth.

My late father wrote a poem some years ago, borrowing from the Minnie Louise Haskins’s poem “God Knows.” A portion of that prose resonates today:

I said to the old man who stood at the Door of the Lodge, “Give me a light that I may tread safely into the unknown.” He replied, “Go into the darkness and put your hand into the hand of the Creator. That shall be to you better than light and safer than any known way.”

It is my hope that leaders in health harness the many gifts we have as Native peoples to build a healthier future. Our children are worth fighting for.

 

By            :               Annie Belcourt

Associate Professor of Health Professions and Biomedical Sciences, The University of Montana

Date         :               January 25, 2018

Source     :               The Conversation

https://theconversation.com/the-hidden-health-inequalities-that-american-indians-and-alaskan-natives-face-89905

 

Posted in Health, Latest Post, Social and Economic Inequalities | Leave a comment
  • Youtube Channel