Health Inequality And Modern Day Slavery

“They never took me to the doctor when I was ill.” These are the words spoken by Merieme Mint Hamadi when asked about her life as a slave. Merieme, one of an estimated half a million people in Mauritania who are enslaved, lives in some of the world’s worst conditions. Her country, which has a population estimated to rival Chicago, was the last country in the world to make slavery a crime. However, since that 2007 law was passed – almost 150 years since Abraham Lincoln issued the Emancipation Proclamation in the US – only one person has been successfully prosecuted for owning another human in Mauritania. The health and human rights violations that exist there today have led to the UN ranking Mauritania at 155 out of 187 countries on its 2013 inequality-adjusted Human Development Index.

The UN estimated that in 2012 for every 100,000 live births in the country, 510 women die from pregnancy, with significant disparities between the death rates of Black slaves and Arab owners. Of even greater concern is that due to female slaves being forced to have children with owners, an estimated 71.3 births per 1,000 live births are to adolescents who suffer extreme mental and physical abuse. In John Sutter’s captivating CNN coverage of oppression, Slavery’s Last Stronghold, he reports that, “In Mauritania, the shackles of slavery are mental as well as physical.” He goes on to describe the political and societal methods through which the lighter-skinned Arabs maintain their ownership of the dark-skinned peoples.

Kevin Bales, an expert on modern day slavery, wrote in his book Disposable People that even if someone of bondage attempts to leave an owner, “for most, freedom means starvation.” He claims that because slaves are, “immediately recognizable by color, clothing and speech” they will not be given shelter or proper care by others. Further, Mr. Bales asserts that on the streets of Mauritania, “ there are already a good number of beggars, many of them disabled, to remind slaves of where they almost certainly end up” if they were to leave their masters.

“Mauritania is a country with scarce resources – including access to medical care. The health needs of slave owners come first in Mauritania; the health needs of slaves come last. Slave children are chronically malnourished. Slave women are frequently victims of sexual assault by their owners and the devastating health problems that result.” says Sean Tenner, Co-Founder of the Abolition Institute, an organization focused on ending Mauritanian slavery and a veteran of numerous public health campaigns.

Despite the country’s open system of ownership, to date, the US has not taken a stance against the practice. The country, located on the western fringe of the Sahara, is not densely populated, and therefore practices of the owners are not easily monitored by the government. Further, the country’s ruling elite makes no attempt to fight slavery, as they claim to the UN that slavery does not exist.

However, what is most surprising in 2013 is not the lack of Mauritanian action against their own traditions, but the lack of American recognition and action. At a time when the US tries to face its own challenges with inequality, health, human rights and foreign policy, it is saddening to know we also neglect others.

Mauritania is also deeply divided by access to basic human rights such as health. In 2000, it was estimated that only 37% of the country had access to safe drinking water and 33% to adequate sanitation. Life expectancy has hovered around 57 for both sexes for many years, but with great disparities between the slaves and owners.

The US has done nothing to date but overlook the unlivable health conditions and human rights violations in the region for those that are born into bondage.

In the United States however, one group is taking action to make Americans aware of the atrocities faced by the Mauritanian slaves, and the health and human rights violations that exist. The Abolition Institute, founded in Chicago by Mr. Tenner and former Mauritanian slaves, was recently formed to end the practice of slavery in Mauritania, and bring freedom to those suffering under the inhumane circumstances of maltreatment, malnourishment and abuse.

The organization does everything from educating the public on the religious aspects of modern day slavery to informing about the living conditions and health of slaves through noting disparate practices such as “gavaging” in Mauritania, where women of Arab decent try to gain weight to show that they are wealthy elite and not poor slaves with emaciated frames.

However, the devastating effects of slavery run much deeper than the physical effects. The extreme consequences the effects of slavery have on mental health know no bounds.

In Slavery’s Last Stronghold, a leader of an abolition group tells Sutter that many similarities exist between modern slavery in Mauritania and that in the United States before the Civil War, but that the one fundamental difference between the two in his mind is the use of physical restraint. “Chains are for the slave who has just become a slave, who has . . . just been brought across the Atlantic,” Boubacar said. “But the multigeneration slave, the slave descending from many generations, he is a slave even in his own head. And he is totally submissive. He is ready to sacrifice himself, even, for his master. And, unfortunately, it’s this type of slavery that we have today” — the slavery “American plantation owners dreamed of.”

 

Closing Racial And Ethnic Disparity Gaps: Implications Of The Affordable Care Act

For all intents and purposes, the Affordable Care Act (ACA), the President’s signature piece of legislation, will provide more health care coverage to poor and underserved populations. Persistently disadvantaged communities have much further to go than those with insurance, and new means of accessing and paying for care will benefit them disproportionately. Nevertheless, with more than 20 percent of the nation’s Black population uninsured, more than 30 percent of Hispanics uninsured and a country still grappling with understanding and properly addressing disparities, just how far does the ACA take us?

By mandating individual health insurance coverage and expanding the list of covered preventative services, ACA legislation should, theoretically, improve the quality of health care for those populations at disproportionate risk of being uninsured and having low incomes. In advance of the January 2014 start of major health reform initiatives, some estimate that more than half of the uninsured will gain insurance coverage.

However, research has shown that having health insurance itself does not have a substantial impact if people cannot find a doctor to see them, do not have proper information about accessing resources, or are not treated in a culturally and environmentally competent manner. Moreover, when the number of uninsured could be decreased by more than half, but being uninsured is not equitable across racial and ethnic groups in the US, what happens to our countries most vulnerable?

It has been well documented that low-income individuals and those without employee-sponsored insurance (ESI) are more likely to be people of color. Kaiser and US Census estimates indicate that there are significant differences in insurance rates by race and ethnicity, with national averages approximating there are almost three times as many uninsured Hispanics as Whites. In Louisiana, for example, it is believed that more than 50% of the state’s Hispanics are uninsured, while only 18% of Whites are. In the same state, it is estimated that 30% of Blacks are uninsured, reiterating just how unbalanced our country remains and how terribly far we have to go to eliminate inequalities.

The oft-cited example of health reform success is Massachusetts, where Blue Cross Blue Shield 2013 estimates indicate that about 97 percent of the state’s population has health insurance thanks to health reform. While this is a grand feat for gaining an insurance card, insurance alone does not constitute affordable, quality care, or improved long-term health and equity. The real successes come from improved statistics on accessing care, preventative care and disease reduction.

For those looking to Massachusetts, data does support a slight improvement in overall access to care by showing that Whites, Blacks and Hispanics all had increases in the number of insured, and further that the percentage of the state’s population that had “any doctor visit in prior year” between 2006 and 2009 rose by more than five percent.

Unfortunately, as many have argued, those for and against health reform, Massachusetts is not necessarily a good representation of other US states or populations, as anyone who has been to Massachusetts knows that the state population looks and behaves very differently from places such as southern California or the Southside of Chicago. Furthermore, even in Massachusetts the number of Blacks and Hispanics that remain uninsured is two and three times that of Whites, respectively.

Many of those who will be left uninsured will be Blacks, immigrants and Hispanics, who will continue to use Emergency Departments for critical care or, worse, go untreated.

Additionally, there are those who are lower middle class (a growing group in this nation) who fall into the economic gap where they cannot afford the employer/exchange insurance offered to them, but earn too much to receive subsidies for offsetting the mandatory cost of insurance, which are often people of color.

Other groups of concern are those minorities who do not have the knowledge of where to access care, do not have the financial or transportation means to access care or still distrust the system due to systemic problems with culturally competent care.

Although the ACA takes us a step forward in giving many of the countries uninsured an insurance card, the US must address what to do about probable provider shortages that will result from a lack of primary care physicians and different utilization in care. We must be prepared to understand both to cultural differences in demand and pent-up demand of the previously uninsured, as well as start to really face how to deal with persistent racial and ethnic inequality in this nation that shows itself in our health care system every day.

In the coming weeks, months and years the US citizens have to do more than champion or attempt to repeal the ACA. Party lines and moderate attempts at change will never fix our broken health care system. We have to start addressing the real issues our country faces, those of injustice, unequal access and treatment and how we properly care for and address the needs of those who are not White and wealthy.

 

Would More Americans Support Health Reform If Obama Was White?

Would more Americans support health reform is President Obama was white? According to a recent study conducted by Michael Henderson of the University of Mississippi and D. Sunshine Hillygus of Duke University, the answer is yes. The researchers modeled changes in support of health reform between 2008 and 2010, and what they found was striking. According to Henderson and Hillygus, among a group who supported health reform in 2008, whites were 19 percentage points more likely than blacks to be opposed to health reform by 2010. Keep in mind that this race effect is seen after controlling for party affiliation and political ideology. It also controls for income, age, gender, education, and worry over the cost of health care. Said another way, this race effect isn’t likely to be biased by the usual suspects.

Moreover, the researchers included a measure of racial resentment, and those with the highest levels of racial resentment were 29 percentage points more likely to go from supporting health reform in 2008 to opposing it in 2010. These effects are additive. That means that whites with high levels of racial resentment are a whopping 48 percentage points more likely to switch from supporting to opposing health reform in the course of two years, compared to their black counterparts with low levels of racial resentment. That’s a big deal, to paraphrase Joe Biden for a general audience.

That doesn’t mean that people’s concerns over health reform aren’t legitimate. It’s perfectly reasonable to be opposed to an individual mandate, for example. The question opponents of health reform need to ask themselves, though, is how they would feel about the Affordable Care Act if the man who signed it into law looked like them. I don’t think opposition to reform would disappear–after all, when Clinton tried to pass reform legislation in the 1990s, it failed spectacularly–but I do think the tone of the debate would have been a little different, and I don’t think we’d be seeing the continued opposition after passage that we’re seeing now. Just look to the recent past for proof: Medicare Part D is all the evidence you need that a white President can pass a budget-busting piece of legislation without so much as a second glance from the American people. If George W. Bush had been black, perhaps America’s seniors would still be without adequate prescription drug coverage.