By Sara Satinsky
Should pregnant women who use drugs be charged as criminals or given help? From a public health perspective the choice is clear: provide treatment to help women quit drugs before their use harms their child.
Less than a year ago, Tennessee adopted a progressive policy to provide such treatment, but now is on the brink of taking a big step back. It could become the first state to criminalize pregnant women whose drug use harms a fetus or newborn baby.
The state legislature has passed a bill that, if signed by Gov. Bill Haslam, would authorize the filing of criminal assault charges against a mother if it is determined that she has harmed her fetus or newborn by using illegal drugs.According to The Guardian, the bill says charges can be brought against a woman for “the illegal use of a narcotic drug while pregnant, if her child is born addicted to or harmed by the narcotic drug or for criminal homicide if her child dies as a result of her illegal use of a narcotic drug taken while pregnant.”
Curbing the use of illegal drugs by pregnant women is a worthy public health goal, as are efforts to reduce the numbers of children born with symptoms of withdrawal from drugs. But a groundswell of medical, health, substance abuse, and women’s rights professionals and advocates are in emphatic agreement that the bill would do more harm than good. Here’s why:
- If a pregnant woman fears getting busted for drug use, she may avoid medical care. Research published in the journal Drug and Alcohol Dependence found that when faced with a punitive law, some women will “go underground,” for fear of incarceration and losing custody of their child. By compelling a mother who is using drugs to avoid seeking care, the bill could cut pregnant women off from resources that would help them overcome their addictions — even though the bill ostensibly aims to reduce addiction.
- The bill could mean prison terms for women for whom treatment is a healthier option, at the expense not only of the mother’s future but that of her child. The bill carries a sentence of up to 15 years – a penalty that would also sentence children to growing up without their mothers. Long-term separation of parent and child can trigger a lifetime of mental and physical health problems for children. A 2012 Health Impact Assessment by Human Impact Partners found that sending non-violent offenders to treatment rather than prison would mean healthier lives, stronger families, and safer communities.
- The bill does not give equal opportunity to all women. It allows a woman to avoid a sentence if she commits to completing a drug treatment program. But programs are not available in all parts of the state, and less so to women in communities of color and rural areas, potentially creating a funnel to prison for these women who may lack access to treatment programs. “It’s poor women, black and brown women, rural women who will be criminalized,” said Cherisse Scott, chief executive of SisterReach, one of the groups calling for the governor to veto the bill.
- The bill would mark a serious retreat from state policy designed to encourage pregnant women who are using drugs to seek treatment. Less than a year ago Tennessee enacted the landmark Safe Harbor Act, put forward by the Tennessee Medical Association, to address an alarming increase in the state of children born with symptoms of withdrawal from illegal and legal drugs – a tenfold increase over a decade, according to the state Department of Health. The Safe Harbor Act amended the previous law that allowed prosecution of women whose babies were born with withdrawal symptoms, and instead put pregnant women “to the front of the line” to receive drug treatment if they admitted use. Only 11 months have passed – not enough time to see if the Safe Harbor Act is working.
Proponents of the bill say their motivation is to support mothers in getting help for drug use and protecting children. This bill will do the opposite. And that’s why experts are calling on Gov. Haslam to weigh the evidence and veto the bill.
Sara Satinsky, MPH, is a senior researcher at Human Impact Partners, an Oakland, Calif., nonprofit that studies the health and equity impacts of public policy.
to avoid the worst impacts of future climate change. It was the final interim report before the IPCC’s major Fifth Assessment Report due to be released in October. Yale Environment 360 asked Rajendra Pachauri, who has served as IPCC chairman since 2002, five questions about the latest report and about the prospects that the international community will finally take decisive action to address climate change at talks scheduled in Paris in 2015.
[Updated: 3 hours after I posted it. See below]
Black lung—-now referred to by experts as coal mine dust lung disease (CMDLD)— was back in the news last week courtesy of the Pulitzer Prize. The Center for Public Integrity’s Chris Hamby received the prestigious recognition for his reporting on the steep hurdles faced by coal miners who seek black lung disability compensation. Hamby’s piece focused on the back end of the problem. On the front end is preventing CMDLD in the first place. Coal miners wouldn’t have to maneuver the legal obstacle course for disability benefits if CMDLD became a thing of the past in the U.S.
The Labor Department’s Mine Safety and Health Administration (MSHA) proposed a new regulation in October 2010 designed to set the course for doing just that: eliminating CMDLD. The disease is 100 percent preventable if coal mine operators implement and maintain effective dust controls. MSHA took public comment on the proposal for seven months. Last August, MSHA submitted its final regulation to the White House’s Office of Information and Regulatory Affairs (OIRA) for review. There it sits.
Just a couple of months earlier, Howard Shelanski, JD, PhD was confirmed by the Senate to be the OIRA director. OIRA is responsible for reviewing proposed and final regulations, such as MSHA’s regulation to prevent CMDLD. The OIRA reviews, as prescribed in Executive Order 12866, are supposed to take no more than 90 days (with no more than a 45 day extension.) MSHA’s rule to address respirable coal dust has been stuck in OIRA, under Dr. Shelanski’s watch, for eight months (240 days.)
Habitual delay in regulatory reviews by OIRA is not a new problem. Shelanski was probed about it during his confirmation hearing. Senator Carl Levin (D-MI) noted:
“We have now a situation where delays of agencies’ [rules] are chronic. They [delays] fundamentally undermine the agencies’ ability to effectively execute the responsibilities that those agencies have. Under the Executive Order which is in effect, EO 12866, OIRA has 90 days to review a draft of a proposed or final rule, there’s one 30 day extension that’s available. As of May 14, 87 rules have been under review for more than 90 days, 51 have been under review for more than a year.”
Nominee Shelanski responded by insisting that timeliness of the reviews was one of his top three priorities. Specifically, he said his goal was
“to ensure that regulatory review at OIRA occurs in as timely a manner as possible.”
Levin prodded, by asking Shelanski his plan to meet those deadlines. The nominee responded:
“I absolutely share the concern you just raised about timeliness. …I recognized that EO 12866 establishes the initial 90 day review process, and it would be one of my highest priorities, should I be confirmed as Administrator, to try to improve the timeliness.”
Looking back, when Dr. Shelanski told Senator Levin he would “try to improve the timeliness,” I wish the Senator would have channeled Yoda and said:
“Do or do not…there is no try.”
How much longer will the Obama Administration take to issue a regulation to prevent miners from developing CMDLD?
[Update 4/22/14 (3 hours after I posted the above): Labor Secretary Tom Perez, MSHA chief Joe Main, and NIOSH director John Howard will be announcing the release of new regulations designed to protect miners from developing coal mine dust lung disease. I'm eager to read the final rule, and will report on The Pump Handle what the new requirements will be for coal mine operators.]
April 2010 saw two major workplace disasters: The April 5th explosion at the Upper Big Branch Mine in West Virginia, where 29 workers lost their lives, and the April 20th explosion at the BP Deepwater Horizon oil rig that killed 11 workers. Four years later, Ken Ward Jr. of the Charleston Gazette reminded us that “for those who lost loved ones, April 5 is now forever the day that they became a widow or an orphan, the day they lost their son or their best friend.” He posted the names of the 29 miners and a slideshow memorial about them at his Coal Tattoo blog.
The BP Deepwater Horizon explosion also resulted in a massive oil spill in the Gulf of Mexico, where its effects are still being felt today (see the New Orleans Times-Picayune’s site for articles). Among those suffering four years later are many of the thousands of cleanup workers who labored to remove oil from water, beaches, and other affected areas. Scientists with the National Institute of Environmental Health Sciences are studying the health of nearly 33,000 cleanup workers, and The Times-Picayune’s Jennifer Larino reports on their latest update:
Dale Sandler, a principal investigator with the National Institute of Environmental Health Sciences epidemiology group and leader of the research effort, said early data show symptoms of depression are prevalent among cleanup workers. The study group reported symptoms at a rate 30 percent higher than other people in areas affected by the oil spill.
Sandler said the findings are “not a surprise” given the stressful and dirty work most cleanup workers were involved in. Most were residents of communities impacted by the spill, which prior research show are prone to higher rates of depression and anxiety, she said.
Still she said there is no definitive link between the spill and mental and physical health problems.
Sandler said her team is still gathering key data, including how much oil and dispersants each participant was exposed to.
“It will be many years before we can know if the oil spill had an impact on the risk of developing chronic disease such as lung disease or cancer,” Sandler said.
In other news:
Washington Post: After OUR Walmart and A Better Balance pressured the retail giant over its lack of a policy assuring accommodations (like switching to lighter-duty jobs) for pregnant workers who need them, Walmart issued a new policy saying a woman employee with “a temporary disability caused by pregnancy” may be eligible for “reasonable accommodation.” Advocates say the policy doesn’t go far enough and the emphasis on the word “disability” is problematic. And, Salon spoke to Tiffany Beroid, a Walmart worker who was refused lighter-duty work while pregnant and became a poster child for the OUR Walmart campaign, who says she faced retaliation at work the day the Washington Post piece was published.
San Gabriel Valley Tribune (California): On the same day, two nurses at separate UCLA hospitals were stabbed; one of them has been hospitalized in critical condition, and the two alleged attackers are in custody. In February, SEIU Local 121RN and SEIU Nurse Alliance of California petitioned the state’s Occupational Safety & Health Standards board for a workplace violence prevention standard for healthcare workers.
Slate’s The XX Factor: In the past, judges have dismissed assault and harassment suits filed against employers by interns, because unpaid workers don’t meet the definition of employees. A new law in New York City extends existing human-rights protections to include unpaid workers, which gives them the right to sue their employers for harassment and discrimination. Oregon and Washington, DC already have similar laws, and a bill is in committee in California. (For more on the distinction between employees and interns, see ProPublica and the Department of Labor.)
NIOSH Science Blog: Researchers from the Washington State Department of Labor and Industries and the National Institute for Occupational Safety and Health analyzed Washington state obesity rates by occupation, and found that while 24.6% of all Washington state workers are obese, obesity prevalence in specific occupations ranges from 11.6% to 38.6%. Truck driving was the occupation with the highest percentage of obese workers.
CIDRAP: Healthcare workers are among those diagnosed with the Middle East respiratory syndrome coronavirus (MERS-CoV), for which the World Health Organization reports 212 lab-confirmed cases, 88 of them fatal. The United Arab Emirates has announced that six paramedics have been found to have MERS, and one of them has died from it.
Women aren’t the only ones at risk for depression and in need of screening services when a new baby comes into their lives. Young fathers face significant mental health challenges as well, according to a new study.
Published in the May issue of Pediatrics, researchers found that fathers who live in the same households as their children experience a decrease in depressive symptoms in the period immediately before their children are born. However, depressive symptoms among young fathers, who were around 25 years old when they became fathers, increased an average of 68 percent throughout their children’s first five years of life.
The study notes that depressed fathers are more likely to experience parenting-related stress, more likely to use corporal punishment and neglect their children, and less likely to interact with their sons and daughters. As a result, their children may be at higher risk of social problems throughout life, psychiatric problems later in life, and of experiencing delays in language and reading development. According to lead author Craig Garfield, of Northwestern University Feinberg School of Medicine, the study is the first to pinpoint when young fathers face an increased risk of depression, which could help inform more precise and targeted interventions.
“It’s not just new moms who need to be screened for depression, dads are at risk, too,” Garfield said in a news release. “Parental depression has a detrimental effect on kids, especially during those first key years of parent-infant attachment. We need to do a better job of helping young dads transition through that time period.”
To conduct the study, Garfield and his colleagues examined data from more than 10,600 young men who participated in the National Longitudinal Study of Adolescent Health. The Pediatrics study found that young fathers who do not live with their children experienced high levels of depressive symptoms before their children are born, with such symptoms decreasing during the years of early fatherhood. That’s in contrast to fathers who live with their children — described as resident fathers in the study — who experience fewer symptoms before their children arrived and higher levels in the years after birth. Black and Hispanic young fathers experienced more depressive symptoms than white fathers — a finding that study authors warned may result in a “clinically significant rise” and may merit special attention.
Identifying and helping fathers struggling with depression could have a positive domino effect, improving health for the entire family, writes Garfield and co-authors Greg Duncan, Joshua Rutsohn, Thomas McDade, Emma Adam, Rebekah Levine Coley and P. Lindsay Chase-Lansdale. However, reaching such fathers and getting them into appropriate treatment is a challenge, as the study notes that men ages 18 to 44 years old are less likely than women to interact with the health care system, have a primary care doctor or have health insurance. Though, the Affordable Care Act could start improving those numbers. Plus, the study noted that fathers often accompany their children to pediatric visits, which could make such clinical settings an ideal place for reaching young fathers at risk.
“This is a wakeup call for anyone who knows a young man who has recently become a new father,” Garfield said. “Be aware of how he is doing during his transition into fatherhood. If he is feeling extreme anxiety or blues or not able to enjoy things in life as he previously did, encourage him to get help.”
To read the full study, visit Pediatrics.
Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.
Going to a job and getting paid appropriately for your time is how it is supposed to work. Doing your job and getting ripped off by not getting paid is wrong and illegal. The economic consequences of wage theft for the victims and their families are profound: the threat and reality of losing utilities, food and housing. One of the single biggest risk factors for ill health is poverty. That makes wage theft a public health problem.
But catching and punishing employer-thieves is difficult. The federal and state enforcement agencies are under resourced and the laws weak. It’s also one thing to have a law on the books. It’s another to have that law enforced. A group of Houston workers fought several years for the former and succeeded last year in getting it. They took steps this week for the latter. The workers delivered their complaint to the City of Houston’s Inspector General (IG). That’s the first step to trigger a possible enforcement action under the City’s new anti-wage theft ordinance. The law took effect in January.
Thirteen workers allege that Hyland Construction, Bradley Demolition and BSP Construction hired them for jobs, which the workers completed, but the firms failed to pay them the wages owed. The workers say they are waiting for more than $200,000 in back pay.
The new ordinance provides workers with a formal process to lodge wage theft complaints and puts in place penalties for employers convicted of stealing workers’ wages. Businesses convicted of wage theft — either civilly or criminally — will be listed in a publicly accessible city database. They will also be ineligible for city contracts or subcontracts, and certain permits and licenses. That’s especially meaningful in this week’s complaint because the firms were engaged in projects contracted by the City of Houston.
One of the groups that was instrumental in getting the anti-wage theft ordinance passed was the Fe y Justicia Worker Center. Laura Boston, executive director of the worker-led organization, reported that the City’s IG, Robin Curtis, and her staff met personally with the workers to receive their complaint. “She seemed grateful,” said Boston, “and thanked the workers for coming forward.” The workers themselves, Boston added, “were proud that what they fought for [the ordinance] can work. It was not just a paper victory.”
The list of 2014 Pulitzer Prize winners announced earlier this week includes several journalists whose award-winning work addresses public health issues.
The Boston Globe Staff won the Breaking News prize for “exhaustive and empathetic coverage of the Boston Marathon bombings and the ensuing manhunt that enveloped the city, using photography and a range of digital tools to capture the full impact of the tragedy.” Among the many articles in the Globe’s extensive coverage of the April 15, 2013 attack and its aftermath are pieces on the first responders, hospital workers, and therapists who helped bombing victims – and on the drills and planning that prepared hospitals to deal with such an event.
Chris Hamby of the Center for Public Integrity won the Investigative Reporting prize for his “Breathless and Burdened” series, which “examines how doctors and lawyers, working at the behest of the coal industry, have helped defeat the benefits claims of miners sick and dying of black lung, even as disease rates are on the rise and an increasing number of miners are turning to a system that was supposed to help alleviate their suffering.” Hamby conducted a year-long investigation, reviewing thousands of pages of previously hidden legal filings and creating original databases. The Center notes on its website that the series got results:
Following the reports, Johns Hopkins suspended its black lung program, U.S. senators began crafting reform legislation, and members of Congress asked for a federal investigation. In addition, the Department of Labor announced procedural changes in the federal benefits system that deals with black lung claims, changes that could help miners navigate the complex benefits system.
Eli Saslow of the Washington Post won the Explanatory Journalism prize for “his unsettling and nuanced reporting on the prevalence of food stamps in post-recession America, forcing readers to grapple with issues of poverty and dependency.” The Washington Post summarizes and links to the stories in the series:
Saslow’s explanatory reporting on food stamps spanned six stories. The first begins with a look at Woonsocket, R.I., where one-third of the residents receive food stamps, detailing the astonishing transformation of a despairing town on the day each month when those food stamps arrive. Saslow’s subsequent stories focused on hungry senior citizens in Florida, needy children in rural Tennessee, a Florida Congressman’s push for an historic overhaul of the food stamp program, the effects of a government feeding program in Hidalgo County, TX, and finally, a 41-year-old mother of six in Washington, D.C., who has been on food stamps her entire life.
Will Hobson and Michael LaForgia of the Tampa Bay Times won the Local Reporting prize for “their relentless investigation into the squalid conditions that marked housing for the city’s substantial homeless population, leading to swift reforms.” In a Tampa Bay Times piece about the prize, Peter Jamison explains the work that went to the series and its impact:
The Times’ coverage of Hillsborough County Homeless Recovery represented a joint effort of the newspaper’s Tampa newsroom and its investigative team. Bolstered by sophisticated analysis of government records and vivid, first-hand observation, the stories led to the most significant reform of the county’s social-service programs in 20 years.
… Several ranking county employees resigned or were fired in the wake of the Times’ stories, which eventually led to the permanent dissolution of the Homeless Recovery program and the outsourcing of homeless services to local nonprofit groups.
David Philipps of The Gazette (Colorado Springs) won the National Reporting prize “for expanding the examination of how wounded combat veterans are mistreated, focusing on loss of benefits for life after discharge by the Army for minor offenses, stories augmented with digital tools and stirring congressional action.” Rich Laden writes in The Gazette about the “Other than Honorable” series:
The Gazette published “Other than Honorable” from May 19-21 in print and on gazette.com. The series used Army data to show that the number of soldiers being discharged for misconduct annually had surged to its highest level since 2009 at posts with the most combat troops.
Some of those soldiers who were discharged had come home from combat with post-traumatic stress disorder or traumatic brain injuries, then committed offenses that likely were linked to those “invisible injuries.” They then were denied benefits because their misconduct resulted in them receiving “other-than-honorable” discharges.
… The series prompted a call for action among some members of Congress. After the publication of “Other than Honorable,” Sen. Michael Bennet and Rep. Mike Coffman, both of Colorado, introduced amendments to study the surge of troops discharged from the Army for minor misconduct. However, those amendments were stripped out of the National Defense Authorization Act in December.
Author Dan Fagin won the General Nonfiction prize for his book Toms River: A Story of Science and Salvation, which “deftly combines investigative reporting and historical research to probe a New Jersey seashore town’s cluster of childhood cancers linked to water and air pollution.” Longreads has posted an excerpt of the book, and Elizabeth Grossman wrote about it for us last year.
Journalists, news organizations, and book authors and publishers play an essential role in advancing public health. They expose public-health problems while connecting readers with the people who face them, whichoften strengthens the push for change. They can also highlight the important work of the first responders, hospital workers, volunteers, and others who save lives when disasters strike. At a time when many news organizations are shrinking their reporting staffs, it’s wonderful to see so many examples of top-notch work on issues that matter for public health.
Congratulations to all of the Pulitzer Prize winners and finalists, and to their colleagues and organizations. You can view them all here.
Second in a series of blog posts from the Russian Arctic polar bears, wolves, reindeer, wolverines, walruses, Asia’s only population of snow geese, and 417 plant species. Joel Berger, a field biologist with the Wildlife Conservation Society and the University of Montana, spent several weeks on Wrangel Island this spring. In the second of three blog posts for e360, he describes the arduous conditions under which Russian and U.S. scientists collect data on the island’s odd assortment of creatures.
I often find myself trying to reconcile a company’s description of its safety program with what I hear from workers. One worker I met summed it up this way:
“Yeah, we have safety talks, but a talk is where it ends. It’s all talk, not real action on safety problems.”
Two recent incidents brought his remark back to life for me. It started with a recent news release from OSHA. The agency announced a proposed penalty of $50,600 to Grede Wisconsin Subsidiaries LLC at the firm’s Browntown, Wisconsin iron foundry. Funny thing is, the firm was touting its safety record last month at OSHA’s public hearing on its proposed silica regulation.
In its comments to the agency, Grede said
“safety is the top priority, with environmental, health and industry-leading safety policies and safety metrics that are best in class.”
Yet with “safety as a top priority” they didn’t offer a single provision of OSHA’s proposed regulation that they would support. And their OSHA inspection history also tells a different story. In just the two last years, the firm has received citations for five repeat and 31 serious violations at its foundries in Biscoe, NC; Berlin, WI; Browntown, WI; Columbiana, Alabama; Kingsford, MI; Omaha, Nebraska; and Radford, Virginia. One inspection at the Browntown foundry resulted in citations for 17 serious and three repeat violations. OSHA proposed a penalty of $274,500 which was settled by the company for $133,000. Just a few weeks ago, came the citations for one repeat and two serious violations, and the proposed penalty of $50,600. Their “safety is a top priority” talk sounds to me like it’s just talk.
The second incident comes courtesy of the American Meat Institute. It’s the trade association for U.S. packers and processors of meat and poultry industry. AMI announced this week the recipients of its awards for “high levels of worker safety performance.” AMI chairman and president and CEO of American Foods Group, Greg Benedict, said:
“Worker safety progress is one of our industry’s greatest success stories. During the last 19 years, injury/illness rates in the US meat industry have improved by nearly 80 percent. The rate of injury and illness in the meat and poultry industry continues to fall — and this is no accident.”
Let’s have a reality check. Both the meat and poultry industry are listed by the Bureau of Labor Statistics as those with the highest reported rates of injuries that require a worker to be on restricted duty or transferred from their regular work tasks. Out of 1,066 six-digit NAICS industry codes, both meat and poultry are on that illustrious list of just 17 industries. At one poultry plant which was recently evaluated by NIOSH, the researchers reported alarming results: forty-two percent of the workers (n=318) had physiological evidence of carpal tunnel syndrome. 42 percent! That’s no success story.
It’s true in foundries, in meat packing, poultry processing and every other industry. Firms will tout their safety records, but when a light is shown on them, we see a different story. It is, as the worker said, just safety talk.