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.”

 

As They Age: Women Know What They Do Not Know

The need for health care varies greatly over a lifespan, with older adults having significantly more health-related needs and costs than younger individuals. Women, in particular, often face a myriad of health problems as they transition through menopause. Sadly, despite the fact that every woman will go through menopause, very little is understood about the physical and mental changes that occur during this period of life. In addition, women may struggle to find pharmaceutical solutions, which can safely provide proven relief without the worry that those available will increase their likelihood of other health and mental complications.

Much is misunderstood about menopause and the changes that are associated with the hormonal fluctuations. This is largely due to the fact this inevitable transition is rarely apart of the conversation, particularly in the context of health care. Further, menopause is expected to be merely “bothersome”; not something one could attribute real health problems to. Although maternity care and issues related to younger women are required in the Affordable Care Act as essential health benefits, nothing of legislative note will improve the knowledge and acceptance of this natural life progression.

Most insurance companies do not even cover basic mediations associated with menopausal symptoms, and conflicting research has women scared about the potential long-term effects associated with hormone replacement therapy. Negative press, little medical literature and low financial assistance often leaves women to suffer through menopause silently, many of whom worry constantly about memory deficits they experience and potential long term changes.

A recent study focused on the memory complaints of midlife women has been receiving a lot of attention. The study, conducted at the University of Illinois- at Chicago (UIC), attempted to determine if women who are experiencing hot flushes during menopause were able to accurately predict their own memory performance.

According to the principal author, Lauren Drogos, “We found that a one-item question: ‘How would you rate your memory in terms of the kinds of problems that you have?’ was the best predictor of verbal memory performance on a list-learning task. We also found that many complaints were related to mood symptoms.”

In the US, the average woman becomes postmenopausal around the age of 51. Common symptoms that occur include hot flushes, sleep disturbances, mood changes and memory problems. However, until recently it was believed that women were unable to accurately describe the current state of their memory and the changes they experience as they progress through menopause.

Despite the difficulty in being taken seriously about the physical and mental challenges that menopause presents, this recent study from Drogos, along with other research, shows that woman are able to accurately describe their current memory abilities. Specifically, a group of sixty-eight women performed a series of memory tests and were then asked, to detail the types of memory problems they were experiencing. The study concluded that women were able to accurately rank themselves on a scale from no memory problems to severe problems.

Using recall of a short story, the deficits seen in memory did not indicate that women were suffering from dementia, nor were they experiencing shortfalls in memory that were impacting daily life. Instead, it was simply indicative that women who experienced memory deficits often recognized the changes occurring.

Previous research focusing on women’s transitions through menopause also found that hot flushes during the nighttime were the best predictors of memory performance in women. This leads researchers within the Women’s Mental Health Research Program at UIC, to believe that sleep disturbances and stress hormones may play integral roles in memory and hot flushes.

The good news for women concerned about the transition through menopause is that the cognitive decline that occurs appears to only be temporary, with performance rebounding early into post-menopause. Further, for those who want to keep both their minds and bodies at peak performance, research indicates that leading a non-sedentary lifestyle, keeping mentally active, and having a healthy diet can be the best preventers of cognitive decline.

 

Affordable Care Act See New Hurdles with Contraception

The Patient Protection and Affordable Care Act cleared two major hurdles in 2012: the Supreme Court ruling on constitutionality and the reelection of President Barack Obama. However, in 2013 there is a very good chance that Courts will see much more of the health care reform law due to objections regarding the contraception mandate. Despite the bills legal successes in the past, there are (at publication) more than 35 different cases on file against the contraception mandate submitted by individual companies and religious organizations.

The health care law requires that insurance plans cover birth control and other women’s preventive health services. Further, it reduces cost sharing by requiring that these services be provided with no co-payments, deductibles or coinsurance at the start of the next plan year. For proponents of the bill, this means more health plans come under the law’s influence, and that more women will be able to save money when they pick up their birth control. Moreover, preventative services that have “strong scientific evidence” of health benefits such as prenatal care, breastfeeding support, screening for domestic violence, cervical cancer screenings, well-woman visits and mammograms will be covered by health insurance plans.

Proponents of the Affordable Care Act further assert that gender equality in the US means women having complete control over their reproductive lives and that the new coverage guidelines developed by the Institute of Medicine ensures that. However, some organizations do not believe funding such services align with their organizational missions. Most filing amicus briefs are using the Religious Freedom Restoration Act, and it’s precedence of unanimous support by the Supreme Court, to say that the mandate violates religious organizations right to not pay for contraception. These organizations fail to meet the especially narrow exemption rule that group health plans sponsored by certain religious employers are exempt from the requirement if the “religious employer is one that: 1. has the inculcation of religious values as its purpose; 2. primarily employs persons who share its religious tenants; 3. primarily serves persons who share its religious tenants; and 4. is a non-profit organization under Internal Revenue Code section 6033(a)(1) AND section 6033(a)(3)(A)(i) or (iii).

The Religious Freedom Restoration Act, which most are using as the basis for fighting the mandate, requires that the federal “government may substantially burden a person’s exercise of religion only if it demonstrates that application of the burden to the person 1. is in furtherance of a compelling governmental interest and 2. is the least restrictive means of furthering that compelling governmental interest.”  Amicus briefs tend to argue that the present bill is not the least restrictive alternative and that the need to “primarily” employ and serve people of one religion is not a proper reflection of hiring practices allowed by organizations. Some additionally argue that being forced to pay for health care services that violate their core mission statements should not be legal.

Those in support of the mandate, like the American Civil Liberties Union (ACLU), believe that in the long game, the mandate will be upheld. The ACLU specifically states in their amicus brief that the plaintiffs are trying to “discriminate against women and deny them benefits because of [the employer’s] religious beliefs.” Other experts have suggested that the state-level Courts might take each case on its own merits leading to many different outcomes, with several being possible cases for the Supreme Court. One thing is certain for 2013 though, no matter where a woman falls in here beliefs about what the health reform bill should and should not require, the Affordable Care Act still has many hurdles before full implementation.

 

Medicare’s Sustainability and Disproportionate Impact on Women

In light of the recent election and the number of monumental decisions elected officials, government agencies, policymakers and health care providers have to make around health care reform, the Medicare program hasn’t been receiving much attention. However, given the sheer number of Americans covered by the program and the fiscal disaster looming for aging citizens, it is important to examine the state of the country’s care for the elderly and disabled.

In the United States, older women rely on the Medicare program disproportionality and significantly more than men. Not only do women make up more than half of the Medicare beneficiaries, they comprise about 70 percent of the oldest (over 85 years old) beneficiaries and are more likely to have multiple chronic conditions as they age. In 2010, the program, which is administered by the Centers for Medicare & Medicaid Services (CMS), covered 47 million elderly (age 65 and over) and disabled beneficiaries. Unfortunately for beneficiaries, the US Government Accountability Office (GAO) has designated Medicare a high-risk program due to its fiscally unsustainable path.

Because women have a greater likelihood of living longer than men, more health care conditions will accumulate and more health care costs accrue. This means that as women age increased cost sharing and out-of-pocket expenses directly impact them more. Therefore, given the importance of Medicare’s cost sharing with seniors, and its quickly dwindling resources, it is important to revisit how vital the program is to the elderly, especially older women.

Facts about older women on Medicare:

• In 2010, the average American woman over the age of 65 had an annual income of less than $15,072 (compared to male counterparts at $25,704)
• Women over the age of 80 made up 62% of all individuals with Medicare in 2010
• In 2011, older women paid an average of $115 for the Medicare Part B premium, plus deductibles that range from $162 to $1132 before their benefits kicked in
• In 2007, the average American women spent an estimated 18.7 percent of her income on out-of-pocket health care costs, with percentages increasing throughout the recession
• Nationally, 49% of women with Medicare report having three or more chronic conditions (compared to just 38% of men)
• Despite cost sharing measures, Medicare does not cover many common and costly health care needs such as eyeglasses, hearing aids and long-term care

Current approaches to prolonging the Medicare program include:

• Capping provider, hospital, devise and pharmaceutical reimbursement payments at 2012 levels
• Reducing Medicare reimbursement rates for health care providers to previous levels
• Raising the age of Medicare eligibility progressively from 65 to 67, or even higher, as people are living and working longer
• Replace Medicare as it currently functions with a Voucher system (also known as a Premium Support Model)
• Restructuring beneficiaries cost-sharing