1. Overview of Economic, Health, and Human Rights Issues of Racial and Ethnic Minorities Martin Donohoe

2. Outline Exploitation Economics, Education, Environment, Health Care, Criminal Justice System International Perspective Solutions

3. Colonial Exploitation Christopher Columbus’ log entry upon meeting the Arawaks of the Bahamas: “They…brought us…many…things…They willingly traded everything they owned…They do not bear arms…They would make fine servants…With fifty men we could subjugate them all and make them do whatever we want.”

4. Colonial Exploitation Sir Jeffrey Amherst (French and Indian Wars - smallpox): –“You would do well to try to inoculate the Indians, by means of blankets, … to extirpate this execrable race”

5. Colonial Exploitation Winston Churchill (speaking in favor of RAF’s “experimental” bombing of Iraqis in 1920s, which killed 9,000 people with 97 tons of bombs): “I am strongly in favor of using poisoned gas against uncivilized tribes to spread a lively terror…against recalcitrant Arabs as an experiment”

6. Colonial Exploitation Cecil Rhodes (Rhodesia, Rhodes Scholarship, DeBeers Mining Company): “We must find new lands from which we can easily obtain raw materials and at the same time exploit the cheap slave labour that is available from the natives of the colonies. The colonies would also provide a dumping ground for the surplus goods produced in our factories.”

7. Historical and Contemporary Exploitation Slavery Built U.S. infrastructure Apartheid Civil Rights Movements (U.S. and international) Native American and immigration policies

8. Exploitation leads to: Maldistribution of wealth and resources Environmental degradation Wars

9. Racial Disparities: Economic Median income of black U.S. families as a percent of white U.S. families: –60% in in 1968 –62% in 2002 –62% in 2011 (69% for Hispanic families)

10. Racial Disparities: Economic Recession, housing crisis has hit black and Latino families harder than white families –Home ownerships rates: whites (73%), Latinos (48%), African-Americans (43%) –7.5% on Blacks live in substandard housing (vs. 2.8 % of Whites) Minorities face higher levels of unemployment

11. Poverty and Hunger U.S.: 14.3% of residents and 20% of children live in poverty –Rates of poverty in Blacks and Hispanics = almost 3X Whites Poverty associated with worse physical and mental health

13. Income Inequality Lower life expectancy Higher rates of infant and child mortality Short height Poor self-reported health AIDS Depression Mental Illness Obesity

14. Voltaire “The comfort of the rich rests upon an abundance of the poor”

15. Hudson River, 2009

16. Functional Apartheid Segregated communities Stress consequent to ongoing racism and poverty Undocumented immigrants face constant threat of deportation, disruption of family and social relationships

17. Functional Apartheid: Voter Restriction Measures Photo ID requirements Limits on number of polling sites and poll hours Elimination of Sunday voting Long waits Limits on early voting Gerrymandering districts Intimidation

18. Functional Apartheid: Voter Restriction Measures Stated aim: eliminate voter fraud –2000-2010: 643 million ballots cast in general elections, 441 killed by lightning, 13 credible cases of in-person voter impersonation –Recent study of 146 million registered voters found 10 cases of voter impersonation Result: potential disenfranchisement of tens of millions of voters, mostly poor, elderly, and racial minorities

19. Undocumented Immigrants 25 million non-citizens in U.S. –11-12 million undocumented 80% of these in labor force –2/3 lack insurance, source of non-emergency care (and many afraid to visit emergency rooms) –Children particularly affected

20. Functional Apartheid Undocumented immigrants pay taxes: –State and local income –Property –Excise taxes –Employer’s share of Social Security –Medicare –Unemployment taxes

21. Functional Apartheid BUT, they are not eligible for many public services: –Medicaid –Supplemental Nutritional Assistance Program –Social Security –Medicare All immigrants heavily subsidize Medicare’s Trust Fund (reducing immigration could seriously undermine Medicare) –Unemployment benefits –Temporary cash assistance

22. Educational Apartheid High levels of de facto school segregation by race and SES Gross discrepancies in per-pupil spending and teacher salaries Achievement and graduation gaps growing

24. Benefits of Education For every $1 spent on early childhood education, up to $17 are saved from increased school achievement, improved health, reduced crime, and reduced reliance on public assistance Income increases 11% for every year of education

25. Benefits of Education College graduates live 5 years longer than high school dropouts Eliminating educational inequities would have saved 8X as many lives as medical advances from 1996-2002

26. Environmental Racism Polluting factories/waste dumps/incinerators more common in lower SES neighborhoods “Cancer Belt” (Baton Rouge to New Orleans) Poor, African-Americans, and Hispanics more commonly exposed to lead, other toxins

27. Pesticides EPA: U.S. farm workers suffer up to 300,000 pesticide-related acute illnesses and injuries per year –25 million cases/yr worldwide NAS: Pesticides in food could cause up to 1 million cancers in the current generation of Americans WHO: 1,000,000 people killed by pesticides over the last 6 years

28. Racial Disparities in Health Care Coverage Percent uninsured: –Hispanics = 24% –African-Americans = 16% –Asians = 15% –Whites = 10% –Undocumented immigrants = 100% (emergency care exception) CA Proposition 189

30. Racial Disparities: Health Care Higher maternal and infant mortality Higher death rates for most diseases Shorter life expectancies for African-Americans –Not for Hispanic Americans (healthy immigrant effect and Hispanic paradox may be relevant, but largely due to decreased tobacco use) Fewer diagnostic tests / therapeutic procedures / pain medications

32. Health Disparities Among Latinos Higher rates of: –Overweight and obesity –Certain cancers –Stroke –Diabetes –Asthma/COPD –Chronic liver disease/cirrhosis –HIV/AIDS –Homicide

33. Racial Disparities in Health Care: African-Americans Equalizing the mortality rates of whites and African-Americans would have averted 686,202 deaths between 1991 and 2000 –Whereas medical advances averted 176,633 deaths AJPH 2004;94:2078-2081

34. Diseases Responsible for Illness and Death Deaths in 2000 attributable to: –AMI – 193,000 –CVD – 168,000 –Lung CA – 156,000 –AJPH 2011;101:1456-1465

35. Social Factors Responsible for Illness and Death Deaths in 2000 attributable to: –Low education: 245,000 –Racial segregation: 176,000 –Low social support: 162,000 –Individual-level poverty: 133,000 –Income inequality: 119,000 (population-attributable mortality – 5.1%) –Area-level poverty: 39,000 (population-attributable mortality – 1.7%) –AJPH 2011;101:1456-1465

36. Deaths per year Tobacco = 400,000 (+ 50,000 ETS) Obesity = 300,000 Alcohol = 100,000 Microbial agents = 90,000 Toxic agents = 60,000 (likely higher) Firearms = 35,000 Sexual behaviors = 30,000 Motor vehicles = 25,000 Illicit drug use = 20,000

37. Exploitation: Post-WW II Human Subject Experimentation Tuskegee Syphilis Study Guatemalan Syphilis Experiment

38. Exploitation: Contemporary Research Imbalances Unethical research on special populations (cultural minorities, prisoners, developing world, etc.) 90% of research dollars spent on diseases affecting 10% of the world’s population Limited access of developing world to results due to scarcity of open-access publications

39. Medical Care 50% of global health care budget spent in the U.S. Per capita expenditure on health care: –U.S. = $8,160 –Typical poor African/Asian country = $5-10

40. Exploitation: The Medical Brain Drain Five times as many migrating doctors flow from developing to developed nations than in the opposite direction “Inverse care law”: –Those countries that need the most health care resources are getting the least

41. Racism in the Criminal Justice System Violent crime associated with poverty, not race Persons of color are more likely than whites to be: –Stopped by the police (e.g., “Driving while black”, “Stop and frisk”) –Abused by the police –Arrested –Denied bail –Charged with a serious crime –Convicted –Receive a harsher sentence

42. Race and Detention Rates African-Americans: 1,815/100,000 –More black men behind bars than in college –13% of black men currently have no voting privileges Latino-Americans: 609/100,000 Caucasian-Americans: 235/100,000 Asian-Americans: 99/100,000

44. Outside the U.S. Racial and cultural inequalities Poverty, famine, war Governments/corporations promoting poverty and worsening maldistribution of wealth and resources through trade agreements, internalization of profits and externalization of costs

45. The Third World Debt Crisis Each African child inherits approximately $379 in debt at birth Countries spend more each year repaying debt than on education and healthcare

46. Consequences of Debt Repayment Agreements Government spending on food, fuel and farming subsidies reduced Social service (healthcare/education) program spending cut Countries strip and sell their natural resources

47. Foreign Aid In total dollars: U.S. #1 As a % of GDP, U.S. #21 U.S. Aid: Over 1/3 military, 1/4 economic, 1/3 for food and development

48. Foreign Aid Americans think that 24% of the federal budget goes toward foreign aid 0.19% of the total federal budget, vs. UN target of 0.7%

49. U.S. Charitable Giving Approximately $250 billion/year – 2.5% of income –2.9% at height of Great Depression

50. U.S. International Non- Cooperation/Isolationism Failure to sign or approve: –Kyoto Protocol on Climate Change –International Covenant on Economic, Social, and Cultural Rights

51. U.S. International Non- Cooperation/Isolationism Failure to sign or approve: –Convention on the Rights of the Child –Convention on the Elimination of Discrimination Against Women –UN Convention on the Rights of Disabled Persons

52. U.S. International Non- Cooperation/Isolationism Failure to sign or approve –UN Declaration of the Rights of Indigenous Peoples –The Stockholm Convention on Persistent Organic Pollutants –WHO International Code of Marketing of Breast Milk Substitutes

53. U.S. International Non- Cooperation/Isolationism Failure to follow World Court Decisions Failure to recognize International Criminal Court

54. Primo Levi “A country is considered the more civilized the more the wisdom and efficiency of its laws hinder a weak man from becoming too weak or a powerful one too powerful.”

55. Solutions More equitable distribution of medical research funds and health care dollars Living wage laws –E.g., NY, LA, Chicago, and Philadelphia Education reforms

56. Solutions Creation of healthier communities Stronger environmental and occupational and safety laws / enhanced enforcement Single payer health care –Canadian blacks are as healthy as Canadian whites

57. Solutions Improve status of women / access to reproductive health care Increase racial and ethnic diversity of physician workforce Overhaul immigration policy –Pass Dream Act Reparations Changes in law enforcement and sentencing

58. Fyodor Dostoyevsky “A society should be judged not by how it treats its outstanding citizens but by how it treats its criminals”

59. Solutions Publicly financed campaigns and campaign finance reform Proportional representation Instant runoff voting/cumulative voting/range (rating) voting

60. Solutions Increase U.S. voter turnout –U.S. 139/172 worldwide –Wealthy vote at almost twice rate of poor –Whites > Blacks > Hispanics –Old > Young –Property owners > Renters Activism / Protesting / Whistleblowing Halt disenfranchisement, overturn voter restriction laws Work in Groups

61. Günter Grass “The first job of a citizen is to keep your mouth open.”

62. Anita Roddick "If you think you are too small to have an impact, try going to bed with a mosquito in your tent"

64. Public Health and Social Justice Website http://www.publichealthandsocialjustice.org http://www.phsj.org martindonohoe@phsj.org