A few of the recent pieces I’ve liked:
Two related pieces at ReportingonHealth.org: Rita Beamish, “Older Americans Act limps along at 50” and Ryan White, “Intensive program keeps elderly at home out of nursing home”
Gillian B. White in The Atlantic: Unplanned Births: Another Outcome of Economic Inequality?
Mike Paarlberg in the Washington City Paper: Workers’ Fights (“Unpaid wages, uncompensated injuries, and unjust firings: A look at the margins of the DC labor market”)
Nikole Hannah-Jones in Politico Magzine: A Letter from Black America: Yes, we fear the police. Here’s why.
Erika Check Hayden in Nature: Maternal health: Ebola’s lasting legacy
And Celeste already blogged about this one, but the excellent and terrifying ProPublica-NPR series Insult to Injury: America’s Vanishing Worker Protections is a wake-up call to anyone who assumes the workers’ comp system will support you if you’re injured on the job. Simultaneously with this series’ publicaiton and airing, OSHA released the report Adding Inequality to Injury: The Costs of Failing to Protect Workers on the Job, and Lydia DePillis covered it for Wonkblog.
Read the interview.
In Boston, you’re never too far away from a Dunkin’ Donuts. In fact, the Massachusetts-based company inspires a fiery sense of loyalty in many Bostonians. It’s kind of hard to give up the city’s ubiquitous fast food staple, but Paul Drake is committed.
“As somebody who’s pretty poor at fasting, it’s been hard,” said Drake, executive director and lead organizer at Massachusetts Interfaith Worker Justice. “Here in Boston, there’s a Dunkin’ Donuts on every corner…it’s easy to see the convenience that is fast food. But it’s actually been a really good teaching moment for me — I do this work every day, but the simple act of fasting reminds you how much hunger is a reality for many working people.”
Drake is among the many people nationwide participating in the Fast from Fast Food, a 40-day fast that coincides with the Christian season of Lent and is being organized in support of fast food workers. From Feb. 18 through April 4, faith leaders along with worker advocates and supporters are pledging to give up fast food to help bring attention to the struggles of working families and the impact of poverty wages. In particular, the fasting campaign is in support of Fight for $15, a growing movement of fast food workers nationwide who are taking to the streets to fight for living wages, better working conditions and the right to form a union without fear of retaliation.
According to a 2013 report from the University of California-Berkeley Labor Center, fast food workers are more likely to live in or near poverty, with more than half of families of front-line fast food workers eligible and enrolled in one or more public assistance programs, compared to just 25 percent of the nation’s overall workforce. Another 2013 report found that despite the fast food industry’s billion-dollar profits, low wages and lack of benefits at the 10 largest fast food companies in the U.S. cost taxpayers about $3.8 billion every year in public assistance programs to help workers and their families meet their most basic needs.
Rudy López, executive director of the national office of Interfaith Worker Justice, said Lent — a time of sacrifice, reflection and prayer — was the perfect opportunity to elevate and highlight the struggles of workers. He emphasized that people of all faiths are encouraged to join the very first Fast from Fast Food. On the Interfaith Worker Justice website, it reads: “People of all faith traditions are invited to join in the fast by committing to Fast from Fast Food and ‘go without’ for 40 days. By doing so, we are also choosing to walk hand-in-hand with our brothers and sisters who are leading the struggle that would lift millions of working families out of poverty and put us all on a road back to prosperity.”
People of faith are familiar faces in the fast food worker movement. For example, local faith leaders often volunteer to accompany fast food workers back to their places of work following organized strikes. The move sends a pointed message to management that workers have the support of community members and can help prevent retaliation against the striking worker.
“We believe very strongly in the power of not just being able to bring attention to the issue from a mass of people saying we’re not going to participate in consuming fast food…but also when people agree to pray along with it,” López told me. “We believe that fasting without prayer is just going hungry, so we want people to really see how this connects with their own values system. Even for people without a faith tradition, it’s a good time for reflection — to take a moment and pause and think about how our individual actions can raise the profile of what’s happening here.”
As of early March, more than 1,500 people had signed an online pledge to participate in the first Fast from Fast Food. López said in addition to reaching out to people online, members from Interfaith Worker Justice’s more than 50 affiliates are going to their own places of worship and inviting people to participate. López noted that the fast is also sparking dialogues on how to incorporate worker justice into other faith-based fasting traditions, such as Ramadan.
“This isn’t just about dollars and cents, it’s about greater respect and dignity and value,” López said. “It means supporting people who serve our food, pick our food and make our beds and valuing their work. …Values of justice are faith values — they’re one in the same.”
In Madison, Wisconsin, a worker making minimum wage would have to work 90 hours a week to sustain a one-bedroom apartment, Sarah Smoot, clergy and congregation organizer at Interfaith Coalition for Worker Justice of South Central Wisconsin, told me. Such inequality is what drives the coalition, which is encouraging its members and supporters to participate in the Fast from Fast Food. Smoot said because she didn’t eat much fast food anyway, she decided to fast from all food once a week throughout Lent in support of workers and to pray for workers throughout that day.
“It’s a reminder that our faith isn’t just about our personal relationship with God,” Smoot said. “It’s also about trying to make the world a place that God would find pleasing. Lent is often construed as an internal journey, but our inward faith needs to be lived out in the world as well.”
Smoot also emphasized that the Wisconsin coalition hopes people of all faiths will participate in the fast. This week in honor of the Jewish holiday of Purim and in support of the Fast from Fast Food, Rabbi Renee Bauer, director of the Interfaith Coalition for Worker Justice of South Central Wisconsin, posted an online reflection about the Fast of Esther. (According to the Hebrew Bible, Esther was a Jewish queen who courageously spoke out to save the Jewish people from slaughter.) Bauer writes:
In our day and in our land, fast food, retail and home care workers like Queen Esther are taking the risk to speak out even when they fear losing their livelihood. They are speaking out in order to stop the injustice of low wages that has spread throughout our land. Today let us, just as the Jews of Shushan did, fast in solidarity with those courageous workers, so they know they are not alone as they walk the path towards fairness and justice.
Back in Boston, Drake said he hopes the Fast from Fast Food will help build momentum toward the nationwide April 15 day of action, when fast food and low-wage workers will take to the streets for better wages and the right to unionize. (In Boston, the Fight for $15 rally and march will take place on April 14, so as not to coincide with the anniversary of the Boston marathon bombing.) Drake told me that whether or not someone identifies as a person of faith, “fasting is a spiritual ritual that has power regardless of personal affiliation.”
“This is an invitation to think more about the nature of our consumption, the people who feed us and how we can share in their humanity and be in solidarity with them,” he said.
Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.
A quick way to lose someone in a conversation is to mention workers’ comp. No doubt I’ve already lost readers because my headline included the phrase. But you’ll think differently about the topic if you take a look at this week’s reporting by ProPublica and National Public Radio. Read just the first 400 words of “The Demolition of Workers’ Comp” and you’ll be hooked on the story.
Yesterday morning, investigative reporters Michael Grabell and Howard Berkes discussed their reporting with NPR host David Greene. In the interview they noted:
- “Since 2003, more than 30 states have passed laws that either reduce benefits, created hurdles to getting medical care or simply made it harder for workers to qualify.”
- “Employers are actually paying the lowest cost for workers’ compensation insurance since the 1970s. And insurers are doing fairly well too. In 2013, they had an 18 percent profit – their best year since the 1990s.”
In the full ProPublica piece, they describe the degeneration of workers’ comp protections over the last 40 years:
- “Only seven states now follow at least 15 of the  recommendations made during the Nixon administration [for minimum standards for workers compensation benefits.] Four states comply with less than half of them.”
Most importantly, Grabell and Berkes introduce us to several injured workers. In different ways, each are dealing with the consequences of their states’ successes in creating business-friendly ‘reforms’ to their workers’ compensation system. John Coffell , 30, Joel Ramirez, 48, and Dennis Whedbee, 53—and their families—are on the dirt-side-down of those policy changes.
There are consequences for taxpayers, too. Grabell and Berkes report that Social Security, Medicare and Medicaid are filling the gap for costs that should be paid by workers’ compensation. It’s a hefty $30 billion price tag.
When NPR host David Greene kicked off his interview yesterday, he invited listeners to:
“…imagine you’re on the job and you suffer a serious injury. Your expectation is that workers’ compensation is going to serve as your safety net.”
NPR’s listeners and ProPublica’s readers will be learning that the safety net is in tatters.
It’s a rare thing on Capitol Hill when a member of the Administration is on the hot seat from both sides of the aisle. But that’s what happened on Tuesday when President Obama’s regulatory czar, Howard Shelanski, JD, PhD, testified at a joint hearing of two subcommittees of the House Committee on Oversight & Government Reform.
The Republican Chairman Mark Meadows (R-NC) and Ranking Member Gerry Connolly (D-VA) and other subcommittee members, peppered him with questions about OIRA’s lack of transparency in numerous arenas. Their motivations were different, but they were equally tough in their questioning. Republicans don’t think OIRA is doing enough to reign in regulatory agencies, while Democrats want OIRA to complement, not impede, agencies’ work.
I could relate to Chairman Meadows when he pressed Shelanski about releasing documents related to OIRA’s review of an agency regulation. That’s a topic that is close to my heart as I’ve filed numerous FOIA requests—during both Democratic and Republican Administrations—to obtain such records.
Meadows read from Executive Order 12866 (EO) which directs OIRA’s activities.
“OIRA shall make available to the public all documents exchanged between OIRA and the agency during the review by OIRA under this Section.”
I’ve referred to that exact language when I’ve filed my FOIA requests. I did so, for example, when the Labor Department proposed a regulation for workers aged 15 years or younger to be prohibited from doing some of the most dangerous tasks on farms. OIRA’s review lasted more than 9 months and child safety advocates suspected that Tom Vilsack’s USDA, on behalf of the agriculture industry, was trying to stop the rule. We wanted to see the emails and other correspondence written during that time by OIRA, USDA, Small Business Administration and other agencies about the proposal. We wanted to know which agencies were trying to quash a regulation design to protect young workers’ lives?
I agree with Meadows that the language “shall make available to the public all documents exchanged…” is pretty darn clear.
Shelanski responded to Meadows, saying:
“That executive order has been interpreted across all Administrations –Republic and Democrat—to embody the deliberative process exception of staff level communications and we do not disclose those to the public. It is to protect the integrity of process.”
Obama’s guy was not budging on this one.
Ranking Member Connolly and Cong. Matt Cartwright (D-PA) were well prepped for the hearing. It was clear to me that they’d read some of the work by the Center for Progressive Reform (CPR) on OIRA’s improper influence over decision-making by our public protection agencies (e.g., Behind Closed Doors at the White House: How Politics Trumps Protection of Public Health, Worker Safety and the Environment.) At one point in the hearing, Shelanski bristled when a Democrat referred to a CPR report. He responded with a scowl:
“I’m familiar with the Center’s criticism.”
Connolly raised concerns about OIRA’s bad track record on completing reviews within 90 days as prescribed in the EO. The congressman noted that the OIRA website allows the public to see how long a proposed or final regulation has been with OIRA for review, but
“there’s no explanation for why the delay. Why not? And are you working on that?”
“…one of the things that happens very early in the review process is that the rule goes out for inter-agency comment. And we unfortunately do not have the authority to compel that commentary on as fast a timeline as we would often like, and when you’ve got a lot of agencies commenting on a particular rule, it can take some time to get that feedback. Moreover, once we incorporate that feedback and re-transmit it back to the rulemaking agency, we have no control over how long that agency takes to bring the rule back to us.
So, to be perfectly frank, long periods of time can go by when the rule, in fact, is not at OIRA. it is under review, but it has been passed back for further work, consideration and analysis by the agency.”
The section I highlighted is something I’d not heard previously. When I want to track the status of OIRA’s review of an agency regulation, I go to this page at RegInfo.gov. It shows which rules are being reviewed by OIRA and when they were submitted for review. It says “submissions under review.”
Is Mr. Shelanski saying that there may be regulatory actions on that list that are no longer under review because they’ve been retransmitted back to the agency? If that’s the case, why doesn’t the Administration just indicate that on the website?
Congressman Connolly seemed satisfied with Shelanski’s explanation of how the review process works. He said:
“That’s a perfectly rational explanation. So post it. …Saying ‘agency X is still reviewing it’ …you put a little pressure on them to maybe accelerate their review because they are now under scrutiny.”
“When I was chairman of my county, I started a multi-year transportation plan for spot improvements. I put up [on a website] every project we were going to fund, I put up how much it was going to cost, I put up when we were proposing to have it done, and if there was a delay, we posted why, to make myself accountable. And you know what? You’d be amazed at how quickly the bureaucracy moves when there is that public accountability.”
During the hearing, two OIRA staffers were sitting behind Shelanski and diligently taking notes. I hope they put a big star next to Cong. Connolly’s recommendation. If an agency rule has been “passed back for further work, consideration and analysis by the agency,” the RegInfo.gov website should indicate that. It could say:
“Returned to agency for further analysis. To be resubmitted again for review.”
Likewise, if the ball is in OIRA’s court, that’s what should be reflected for the public on the website. It is “under review.”
As someone who has complained here about OIRA’s failure to meet its publication deadlines for the Administration’s semi-annual regulatory agenda, I chuckled when Chairman Meadows’ staff displayed a graphic. It show the publication dates for the last five regulatory agendas. Here’s what it showed:
- Fall 2012 agenda: published the Friday before Christmas
- Spring 2013 agenda: published the day before July 4th
- Fall 2013 agenda: published the day before Thanksgiving
- Spring 2014 agenda: published Friday of Memorial Day weekend
- Fall 2014: published the Friday before Thanksgiving
“If you truly want transparency, why are you rolling this out at a time when people wouldn’t really be focusing on it? That’s what we call the Friday afternoon data dump, but it is really what you are doing with the unified agenda. Why would you do that?”
Shelanski: “With all respect sir, the agenda remains posted.”
Meadows: “I understand, but when it comes out, it is newsworthy.”
I liked the chart with the holiday time releases, but Meadows failed to mention something else. The agendas are supposed to be published in April and October. None of them met that deadline.
James Goodwin with the Center for Progressive Reform offers some of his own views about Tuesday’s hearing. He observed the much-needed attention by Cong. Connolly and Cong. Cartwright on what James calls
“the absurdity of OIRA’s ‘open door’ meeting policy.”
I couldn’t agree more with James that the hearing was worthwhile, but only scratched the surface of the problems with OIRA—problems that have real consequences for people’s lives and health.
Stanford medical student Nathan Lo reportedly caused a stir at the Conference on Retroviruses and Opportunistic Infections (CROI) last week when he presented a new finding: After analyzing surveys completed by 800,000 people in 22 sub-Saharan African countries, Lo and his colleagues found “no evidence to suggest that PEPFAR funding of abstinence and faithfulness programs results in reduced high-risk sexual behavior.”
Using data from the US-funded Demographic and Health Survey, the Stanford researchers analyzed responses to questions about the number of sexual partners, age of first sexual experience, and teen pregnancy. They then compared trends in 14 PEPFAR-funded and eight non-PEPFAR-funded countries, and found no evidence to suggest PEPFAR abstinence and faithfulness programs were associated with significant reductions in numbers of sexual partners, lower age of first sexual experiences, or fewer teen pregnancies. The New York Times’ Donald G. McNeil Jr. reports on the audience’s response to Lo’s presentation:
Global health specialists came to the microphone to congratulate Mr. Lo. Advocates who had long opposed the American policy that sought to prevent AIDS by promoting abstinence and faithfulness applauded.
“That was fantastic,” said Dr. Gilles van Cutsem, medical coordinator for Doctors Without Borders in South Africa.
Staff members from the government program that Mr. Lo had accused of wasting money — Pepfar, the President’s Emergency Plan for AIDS Relief — came up afterward to quietly congratulate him. When they realized a reporter was present, they nervously asked that they not be named.
President George W. Bush’s global AIDS plan was enacted in 2003 and marshaled billions of dollars to treat Africans who had AIDS with lifesaving drugs. Conservative Republican leaders in the House of Representatives successfully included a provision that one-third of AIDS prevention money go to programs to encourage abstinence and fidelity. That campaign — known as ABC, for abstain, be faithful and use condoms — was part of the bargain made when Christian conservatives joined with liberals to pass the law.
Keith Alcorn reports at AIDSmap that abstinence funding accounts for a smaller portion of PEPFAR money than it used to:
In 2008, the legislative requirement changed: since then, programmes have been required to justify to Congress why they spend less than 50% of prevention funding on these programmes.
Funding for the programmes peaked at $200 million a year in 2008, but declined to around $50 million in 2013, as money has been directed to other measures with stronger evidence of effectiveness.
Programmes aimed to delay sexual debut in order to reduce the period of high risk during adolescence, especially for girls, and to reduce partner numbers. Although there may be epidemiological grounds for thinking that delaying sexual debut and reducing sexual activity might reduce opportunities for acquiring HIV, evidence for effective interventions was lacking when Congress earmarked funding.
PEPFAR has done a lot of good. If health advocates faced a choice between no global AIDS program and a global AIDS program with one-third of funding going to abstinence, supporting the compromise was the right choice. Changing funding priorities based on emerging evidence of effectiveness (or non-effectiveness) is something government-funded programs should do. Ideally, the legislation creating new public-health interventions will always contain requirements and funding for studying programs’ effectiveness, as well as mechanisms for altering programs in response to new evidence. We shouldn’t let the perfect be the enemy of the good, but we should also work quickly to perfect good programs.
The public health literature is pretty clear when it comes to income status and poverty and their profound effects on health, disability, disease and life expectancy. But what about income inequality? Does a rising gap in wealth and resource distribution affect people’s health too?
In a commentary published last week in the American Journal of Public Health, two researchers posit that growing income inequality is a contributing factor to poorer health among American workers. In “Squeezing Blood from a Stone: How Income Inequality Affects the Health of the American Workforce,” authors Jessica Allia R. Williams and Linda Rosenstock write that “because income inequality is inexorably linked to employment, a more complete picture of the effects of inequality on health emerges when analyzed through the lens of the working population.” In particular, the authors write that the characteristics of growing income inequality within the workforce and specifically among low-wage workers — such as less job security, fewer employment benefits and little control over one’s work — do pose adverse risks to workers’ health. They write:
Even though the data available to understand the relation between income inequality and health are limited, we believe there is enough evidence to demonstrate the need for concern beyond issues of fairness, social justice, and health care costs. There is a particular need for concern when the effects of inequality on adults spill over and affect their children. Moreover, changing patterns of work organization and divergent psychosocial working conditions put additional stress on workers whose work organization is changing. Income inequality can be seen as yet another social determinant of health, and when it is addressed much can be done to improve health status beyond access to health care.
The commentary cites research showing that income inequality is growing in the United States: In 2013, the top 5 percent of households accounted for more than 22 percent of all income, whereas the bottom 20 percent accounted for only little more than 3 percent of all income. Compare those statistics to 1980, when the top 5 percent accounted for 16.5 percent of all income and the bottom 20 percent accounted for 4.2 percent of income. Other measures of income inequality include wages, which have stagnated, as well as the wage gap between workers and CEOs. The commentary noted that the ratio of CEO cash compensation to average worker pay was 25 to 1 in 1970; 30 years later and that ratio is now 90 to one.
How work is structured and organized has changed dramatically as well, with many more people working more than 40 hours a week in multiple part-time or full-time jobs or working nonstandard shifts. Many such workplace and employment characteristics have been linked to poorer health, Williams and Rosenstock write. For example, they cited studies showing that poor psychosocial working conditions and long hours have been linked to heart disease and cardiovascular events, while job insecurity and job strain have been associated with increased mortality risk.
To illustrate the effects of income inequality and its associated working conditions, the commentary highlighted the health care workforce, in which there is a substantially large gap between the lowest earners, such as nurses aides, and the highest earners, such as surgeons. As the demand for efficiency increases in the health care industry, many low-wage health care workers are being asked to do more with less, even as they experience some of the nation’s highest work-related injury rates, higher health insurance premiums and pressures to work additional overtime. The workforce is also largely female and from communities of color, so they already face disparities in health care access and disease rates.
The example is a “microcosm” of the larger problem of income inequality and shifting workplace demands, the commentary stated. Williams, a Robert Wood Johnson Foundation Health and Society Scholar at the Harvard Center for Population and Development Studies, and Rosenstock, dean emeritus of the UCLA Fielding School of Public Health, write:
Workers in health care are also likely to work nonstandard shifts, to work overtime, and to face psychosocial hazards such as violence in the workplace that further contribute to poor health. The health care workforce faces a broad array of health problems directly related to work, but, as the vast majority of this workforce earns low wages, they face the increasing pressures of income inequality.
Williams told me that the big difference in studying health and its association with income status as opposed to income inequality is that the former exposes effects at an individual level, while the latter exposes the effects of income differences across a population and whether those differences impact certain groups more than others.
“We wanted to look at how income inequality and changes in work structures both hurt the health of the workforce and reinforce each other,” she said. “If you think about low-paying jobs, the patterns of income match up pretty closely with certain job characteristics. …It’s not just income inequality that matters, it’s also other pressures — these are (workplace) trends that tend to squeeze people from many angles.”
Income inequality is yet another social determinant of health, Williams said, and so understanding its impact may be another key to putting adults and children on a healthier trajectory. She said public health practitioners can help bring this issue to light, especially the nuances of low-wage working conditions that aren’t always considered. For example, Williams said asking a worker if she or he has access to proper safety equipment and training is only one part of the picture. To reveal a more complete picture, also ask the worker whether he or she feels pressure to overlook safety in favor of efficiency. For instance, Williams noted that a health care worker might have access to the type of patient-lifting equipment that prevents worker injuries, but the strains of understaffing create a workplace culture in which safety isn’t a priority.
“Over the past few years, we’ve seen growing attention to the issue of income inequality — people instinctively realize that it’s a problem related to many other issues we face,” Williams said. “Public health (practitioners) can help us in realizing that this is also an issue about health.”
To request a full copy of the income inequality commentary, visit the American Journal of Public Health. Read some of our recent stories on the experiences of low-wage workers and their efforts to organize for better working conditions here, here and here.
Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.
Read the interview.