Treatment, Not Prison: Reforming Sentences for Low-Level Crimes Will Boost Health and Safety for All Californians
By Kim Gilhuly
Reforming California’s sentences for low-level crimes would alleviate prison and jail overcrowding, make communities safer, strengthen families, and shift resources from imprisoning people to treating them for the addictions and mental health problems at the root of many crimes, according to a study by Human Impact Partners.
Rehabilitating Corrections in California, a Health Impact Assessment of reforms proposed by a state ballot initiative, predicts the changes would reduce crime, recidivism, and racial inequities in sentencing, while saving the state and its counties $600 million to $900 million a year – but only if treatment and rehabilitation programs are fully funded and implemented properly.
Human Impact Partners conducted an in-depth assessment of the public health and equity impacts of reclassifying six non-serious offenses – crimes of drug possession and petty theft – to misdemeanors. The Safe Neighborhoods and Schools Act, Proposition 47 on the November 2014 state ballot, would also allow people currently in prison for those crimes to apply for reduced sentences and possible release, if deemed eligible by a judge, and redirect savings from the reduction in the prison population to mental health and substance abuse programs, truancy and dropout prevention, and services for victims of violent crime.
If Proposition 47 passes, California would become the latest state to embrace the idea that prisons should be reserved for those who commit serious crimes – not those whose non-violent, non-sexual offenses stem from addictions and mental health problems. Perhaps surprisingly, many of those are so-called red states known more for conservative politics than “progressive” public policy.
Since 2003 Texas, Georgia, Kentucky, Mississippi, Missouri, Oklahoma, Ohio and Pennsylvania have all enacted similar reforms. No less a conservative icon than former House Speaker Newt Gingrich recently wrote in the Los Angeles Times: “It makes no sense to send nonserious, nonviolent offenders to a place filled with hardened criminals and a poor record of rehabilitation — and still expect them to come out better than they went in.”
Looking at corrections through a public health lens starts with the fact that fundamentally, prison is not a healthy environment. Every day, conditions in California’s dangerously overcrowded prisons and jails causes physical and mental harm to thousands of incarcerated men and women. Many of these people were convicted of crimes that pose no serious threat to others, but can be traced to their own substance abuse and mental health problem. We’d all be better off if they were given treatment and held accountable in their own communities, instead of being sent to prison.
A shift in how we charge and sentence people who have committed non-serious, non-violent, and non-sexual crimes has far-reaching implications for the health and well-being not only of those who commit those offenses, but of their families, their communities, and the public. HIP’s assessment found that full implementation of the Safe Neighborhoods and Schools Act would:
- Decrease state corrections spending by $200 million to $300 million a year and county corrections spending by $400 million to $600 million a year. It would increase state funding for mental health and substance abuse programs, school truancy prevention, and victim services by $200 million to $300 million a year.
- Reduce the number of people convicted of felonies by more than 40,000 a year, and the number sentenced to prison by more than 3,000 a year. It would also allow more than 9,000 people now in prison for felonies for low-level crimes to apply for reduced sentence and release.
- Provide mental- health and substance-abuse treatment to those leaving prison, to help position them for success and reduce the likelihood that they will commit additional crimes.
- Reduce the rates of incarceration of African-Americans and Hispanics, who are more likely than whites to be sentenced to prison, county jail, or probation for low-level crimes. African-Americans are only 7% of California’s population, but they represent almost one-fourth of prison admissions. Hispanics are arrested and imprisoned at slightly higher rates than their share of the population, and are 60% more likely than whites to be jailed.
“Evidence is overwhelming that providing treatment to offenders who have substance abuse problems or mental illnesses reduces crime and recidivism,” said Rajiv Bhatia, M.D., former environmental health director for the City and County of San Francisco. “Treatment instead of prison not only benefits their health and well-being, but that of their families and the entire community.”
According to the study, the benefits of sentencing reform would reach far beyond prison walls.
- Almost 4,900 parents in prison, currently separated from more than 10,000 children, could apply for release and return to their families or serve their sentences in a county jail closer to home.
- More than 40,000 people a year would avoid the additional punishments of a felony conviction – restricted access to jobs, housing, voting and other benefits – and tens of thousands could have their felony records cleared, making it easier for them to access the resources they need and not commit additional crimes.
- Truancy and dropout prevention programs keep children in school, greatly reducing the chance that they will run afoul of the justice system. A 10% increase in California’s high school graduation rate could lead to a 20% decrease in violent crime.
- A statewide network of trauma recovery centers will help 12,000 to 18,000 people a year heal from the physical and emotional impacts of being a victim of violent crime.
(Kim Gilhuly, MPH, is a program director at Human Impact Partners, an Oakland, Calif., nonprofit that studies the health and equity impacts of public policy. Neither HIP nor funders of the study are endorsing Proposition 47.)
by Michael Lax, MD, MPH
The news that almost one third of NFL football players can expect to suffer the effects of brain trauma made headlines in major media. While it is not surprising that large men, often leading with their heads, bashing each other week after week suffer some consequences, what was unexpected was how many players are likely to be injured, and that the NFL actually acknowledged this reality.
Obviously, the findings lead to the question of what to do about it besides compensate the injured. In the context of workplace injuries the injury rate in this industry is tremendously high and the severity of the resulting health conditions, including life altering and shortening conditions such as Alzheimer’s disease, chronic traumatic encephalopathy, and Parkinson’s disease should raise serious alarm bells and initiate efforts to reduce the injury rate.
A major question is whether players can really be protected from head trauma given the way the game is played and the personal protective equipment that is available. The League put administrative controls in place a year or two ago, trying to limit certain types of contact to avoid butting heads, but injuries continue to occur. Helmets, the primary protective gear are technologically limited and cannot be designed to really protect the brain from serious trauma. Professional football is an example of work that cannot be made safe, at least without fundamentally altering the way the game is played.
As might be expected, some (many?) voices are calling for the game to be banned, and parents are being urged not to let their kids play tackle football. Others are defending the game and a common argument the defenders use is that professional football players are highly paid and knew the risks going in. They freely chose to take the risk, and others should not be denied from making the same choice.
Our freedom to choose in all areas of life is an idea that is American as apple pie. But the idea of “choice” requires closer examination. Although we like to think of ourselves as individuals who are capable of objectively analyzing every situation and making choices through our reasoning ability, the reality is that our choices occur in a context. That context allows us to see some things and not others, filtering our reason through personal experience, emotional response and who knows what other influences.
To illustrate: how does an NFL football player “choose” to become an NFL football player? To be an NFL player is to join the ranks of an elite group who enjoy all the perks of being a celebrity: fame, fortune, prestige, admiration. If a kid is big and talented, dreams of an NFL future can be stoked early on and nurtured through a long march through high school and college. Other less glamorous possibilities pale in comparison, especially for kids who don’t see other avenues for themselves, or without a scholarship wouldn’t be going to college. Dazzled by the promise of such a glamorous future, how likely is it that a kid is going to listen to the statistics regarding head injuries and future health problems and make a decision to seek some other less traumatic, and much less exciting career path? In this context can a young person ever really be said to ‘understand’ the risks? He is too busy trying to rationalize the risk away because that NFL future is just too hard to let go of.
NFL football is a multi billion dollar business and the owners, team employees, uniform and equipment manufacturers, merchandise makers and sellers, stadium food vendors, sports media, cities collecting tax and other revenue, and the rest of the massive enterprise are all depending on the continuing popularity of the game to keep the money and profits flowing. Toward this end, the product has to continue to satisfy the audience, which has come to expect the excitement of tough men hitting each other as hard as they can. Maximizing the violence, maximizes the excitement and maximizes revenue.
In this enterprise, the players are simultaneously central and peripheral. Obviously the players make the game what it is and star players are celebrated endlessly. But once a player gets old and loses a step, or gets injured they are unceremoniously dumped in favor of someone else who will get the job done better. The game depends upon a continuous pipeline of fresh young players to replenish the ranks thinned by those cast aside. The point is that professional football is not only responsible for ignoring the epidemic of head injuries for so long, but also for painting the picture and creating the system that entices young people into the pipeline, knowing full well that the dream is unachievable for the vast majority who try, and that many will suffer head injuries along the way, often long before they even get close to the NFL. Untold numbers of young people, their lives altered forever, are unmentioned by the NFL’s late epiphany.
The result is an as yet unknown number of high schoolers, college players, and professionals suffering the effects of football induced brain trauma. And likely all of them, after they are injured, will lament the ‘choice’ they made to chase the dream.
So what should be done?
Any other industry found to be this hazardous to its workers would probably be shut down. Since that’s not likely to happen (though maybe a player should file an OSHA complaint and see what happens), other actions are possible. First would be an aggressive campaign to reduce the legitimacy of NFL football as a sport, and to characterize it for what it really is, gladiatorial combat to entertain the masses. Parents might think long and hard before giving permission for their kids to participate, communities might pressure their schools to get rid of their football programs, and people could stop going to NFL games. This would have to be coupled with efforts that are serious and effective in opening up other avenues to fame and fortune, or at least a decent living, for kids who otherwise might see chasing the NFL dream as their only way out of poverty and what they see as dead end lives.
Michael Lax, MD, MPH is medical director of the Occupational Health Clinic Centers and based in Syracuse, NY.
These satellite images, taken from July 1984 through May 2011, reveal the development of the Athabasca oil sands, commonly called "tar sands," which lie at the heart of Alberta’s oil deposits. Tar sands mining, which has become a significant issue for environmentalists, has been rapid and extensive, growing to cover nearly 260 square miles of the Canadian province by 2011. Nearly 2 million barrels of oil are produced every day, according to the Alberta government, with production expected to grow to nearly 4 million barrels per day over the next decade.
View the images.
Last week, an Institute of Medicine panel released a report that critiques US handling of end-of-life healthcare and suggests improvements. Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life recommends improved communication between patients and providers so that patients can decide what kind of end-of-life care they want, and then receive it. Many people would prefer to die at home, with their care focused on making them comfortable — not in a hospital undergoing tests and procedures that might prolong their life but diminish the quality of their remaining time. Under our current system, the latter option tends to be the default, rather than one of multiple options from which patients can select.
The New York Times’ Pam Belluck highlights some of the IOM recommendations that can be accomplished with and without legislation — and the difficulty of getting any relevant laws passed in the current political environment:
Many of the report’s recommendations could be accomplished without legislation. For example, the panel urged insurers to reimburse health care providers for conversations with patients on advance care planning. Medicare, which covers 50 million Americans and whose members account for about 80 percent of deaths each year, is considering doing just that, prompted by a recent request from the American Medical Association. Some private insurers are already covering such conversations, and many more would if Medicare did.
But some recommendations — like changing the reimbursement structure so that Medicare would pay for home health services instead of emphasizing hospital care, and so that Medicaid would provide better coverage of long-term care for the frail elderly — would require congressional action.
“We know that there may be a need for new legislation to be introduced to accomplish that, and we recognize that that’s harder to accomplish in a politically charged environment,” said Dr. Philip A. Pizzo, a former dean of the Stanford University School of Medicine and the committee’s other chairman.
Regardless of insurer coverage decisions, we should all be having conversations with our loved ones about how we’d like to die, and what kinds of criteria we each want to use for decisions about life-prolonging interventions. In a 2010 New Yorker piece on end-of-life care, Atul Gawande gives the example of a patient who told his daughter, “Well, if I’m able to eat chocolate ice cream and watch football on TV, then I’m willing to stay alive. I’m willing to go through a lot of pain if I have a shot at that.” We each have our own preferences, but in order for those preferences to be honored, we have to articulate them, preferably to both our family members and our physicians.
Ezekiel Emanuel, director of the Clinical Bioethics Department at the US National Institutes of Health, shares his personal criteria in The Atlantic, in a provocative piece entitled “Why I Hope to Die at 75.” He states up front that he does not advocate for the free availability of euthanasia, and repeatedly emphasizes that this is his own personal preference, rather than a prescription for the US population. What he intends to do, he explains, is stop receiving several kinds of healthcare once he reaches age 75, and leave himself open to dying from cancer, pneumonia, flu, or another such disease. I imagine most people will have different views about how long they want to live, but it’s an interesting way to start individual and national conversations that we need to be having.
Today in Mother Jones, reporter Stephanie Mencimer writes a great piece previewing an upcoming Supreme Court case that could transform how pregnant women are treated in the workplace. In fact, the case has attracted the attention and support of some very strange bedfellows. Mencimer writes:
It’s a rare day when pro-choice activists, anti-abortion diehards, and evangelical Christians all file briefs on the same side of a Supreme Court case. But that’s what happened recently when the National Association of Evangelicals, Americans United for Life, Democrats for Life of America, and the National Women’s Law Center joined forces to support Peggy Young, a Maryland woman alleging that she was the victim of pregnancy discrimination.
According to the article, after Young, a driver for UPS, became pregnant, she provided her employer with a note from a doctor and midwife about appropriate work restrictions, including the recommendation that she not lift more than 20 pounds while pregnant. UPS responded by saying that Young wasn’t fit to perform her job duties and that the company wasn’t obliged to accommodate her needs. Young was forced to take six months of unpaid leave, eventually losing her health insurance and other benefits.
Young sued UPS claiming a violation of the Pregnancy Discrimination Act (PDA), but she lost. Now the Supreme Court is taking up the question of whether the act requires employers to accommodate pregnant workers. (UPS claims that it’s treating Young the same as other workers who request job changes — that it’s “pregnancy neutral,” as was reported in another article published in the Economist.) But Mencimer writes:
Therein lies the rub: Employers aren’t treating their workers especially well. One of the questions for the court, as a result, is whether 40 years after the passage of the PDA, pregnant women have only won equal rights to get screwed over on the job.
Mencimer also delves into the 1976 Supreme Court case that led to Congress establishing the Pregnancy Discrimination Act and advises readers to expect some “fireworks at oral arguments, particularly from Justice Ruth Bader Ginsburg,” who authored an ACLU amicus brief in the 1976 case that helped prompt Congress to take action.
In other news:
Buzzfeed: Reporter Chris Hamby writes about new legislation designed to stop coal companies’ under-handed efforts to deny compensation to workers suffering from black lung disease. The federal legislation, which was proposed by Sens. Robert Casey, D-Penn., and Jay Rockefeller, D-W.V., would “root out” systematic bias in X-ray readings, allow workers to reopen their cases due to the involvement of discredited doctors, and help level the legal playing field between miners and coal companies. Hamby writes that the “bill’s prospects for passage this year look dim because toxic partisan battles have made it hard to pass almost any legislation. Still, the bill marks a major milestone in the fight of mine workers to secure much-needed benefits.” In related and unfortunate news, rates of black lung disease are soaring.
The New York Times: About 2,000 Amazon workers in Germany walked off the job this week in a wage dispute with the online giant. Writer Melissa Eddy reports that workers want Amazon to recognize itself as a retailer, which would mean the company would have to abide by labor laws that require wages be set through collective bargaining. According to Eddy, the company employs about 9,000 full-time workers in Germany as well as thousands of additional temporary workers.
Boston Globe: In an opinion piece, writer Anne Skomorowsky, a psychiatrist with Columbia University, writes about the dangers that many health care workers face on the job. She cites previous research finding that a majority of nurses and doctors working in emergency rooms report physical and verbal abuse in encounters with patients, noting that “workplace violence should never be considered an unfortunate part of the job; it’s an abuse of the worker’s liberty and security.” Skomorowsky writes that hospitals can benefit from taking a human rights approach to health care that protects both patients and workers.
Huffington Post: Congressional Republicans have proposed a bill that would bring big changes to the National Labor Relations Board. Labor advocates, however, say the proposal would lead to even more gridlock. Reporter Dave Jamieson writes about a proposal from Sen. Lamar Alexander, R-Tenn., that expands the board’s members from five to six, evenly divided between three Democrats and three Republicans. (Traditionally, the board has five members, with three members coming from the current president’s party.) Jamieson writes that a board evenly split between party lines could mean the most contentious cases go unresolved for years. He quoted Larry Cohen, president of the Communications Workers of America, as saying: “This is the destruction of the NLRB, and they know it. It is a disgrace. Lamar Alexander is a disgrace.”
Bloomberg Businessweek: Reporter Josh Eidelson writes about new OSHA rules going into effect in January that will require employers to report within 24 hours incidents in which a worker loses an eye, undergoes amputation or gets admitted to a hospital with a work-related injury. The injury data will be made public as well. Eidelson quotes OSHA head David Michaels as saying: “We believe that the possibility of public reporting of serious injuries will encourage—or, in the behavioral economics term, nudge—employers to take steps to prevent injuries so they’re not seen as unsafe places to work. After all, if you had a choice of applying for a job at a place where a worker had just lost a hand, vs. one where no amputation has occurred, which would you choose?”
Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.
“Shift work refers to work that takes place outside of traditional 9-to-5 daytime hours. If you work nights or rotating shifts, you are a shift worker. Many people who work shifts are at risk for developing shift work disorder (SWD) and may experience excessive sleepiness (ES) on the job.” So says the website designed to market the drug known as Nuvigil, sold by Cephalon, a subsidiary of Teva Pharmaceutical Industries, Ltd. Approved by the US Food and Drug Administration (FDA) in 2007 to treat narcolepsy and obstructive sleep apnea and the excessive sleepiness that may come with working a night shift, sales of Nuvigil grew by about 20 percent between 2013 and 2014, bringing in $189 million in the first six months of this year. The company’s online advertising suggests that that “1 in 4” of the approximately 15 million Americans who work outside 9 to 5 hours “may have SWD” and that shift workers may include factory workers, security guards, retail workers, fire fighters, doctors, nurses and other hospital workers, hotel and restaurant employees along with accountants, stockbrokers and “other people with corporate jobs.”
“The main symptoms of SWD are excessive sleepiness (ES) during a work shift and trouble sleeping (insomnia) during sleeping hours,” says the Nuvigil marketing copy. Curious about both the drug and the number of US workers the company might have in its sights as a potential market, I went to see what I could discover.
Working outside daylight hours
When it comes to Americans who are on the job outside of daytime hours, most reports cite 15 million US workers – as do the Nuvigil marketing materials – a number derived from a special supplement to a 2004 Bureau of Labor Statistics (BLS) Current Population Survey. The questions added to this survey to determine hours of the day Americans are working have not been asked since, explained BLS press officer Gary Steinberg. It costs money to add additional questions to the survey, he noted. It’s been 10 years since BLS had funding to ask questions about work hours despite the fact that the labor market has undergone some significant changes in the past decade. It would be possible to compile an estimate from the BLS’s American Time Use Surveys but they look at a slightly different cross-section of the US population than that used by for the BLS employment data used to gauge health of the US labor market. So it turns out there is no officially compiled US Department of Labor figure for how many Americans are currently engaged in “shift work.”
The National Institute for Occupational Health and Safety (NIOSH), however, did have a more recent number to offer, from data gathered in the Centers for Disease Control and Prevention’s (CDC) 2010 National Health Interview Survey (NHIS), a representative sample of the U.S. population. Based on data for 27,157 adults, authors of a 2013 NIOSH study found that 28.7% of these people worked “an alternative shift.” In comparison, data collected in 2004 by BLS indicated that 17.7% of workers worked an alternative shift. The NIOSH study also found that the prevalence rate of alternative shift work for each industry group was higher than what the BLS survey sample found. “Prevalence rate differences may be due in part to the six year time difference between the two surveys and to the increased use of flexible or alternative work schedules in recent years,” explained NIOSH health communications specialist Stephanie Stevens in an email. While we still don’t have an official discrete number for how many Americans work outside daytime hours, we do have a snapshot that suggests that between one-quarter and one-third of US workers may be on the job outside “regular” business hours.
In the NHIS survey, those working “alternative” shifts tended to be younger workers (43% percent were under 29), and black and Hispanic workers together made up a striking approximate 60% of these workers. Those with a bachelor’s degree or higher, made up only about one-fifth of this workforce. In this survey – done when US manufacturing jobs were at a particularly low level, service industries – food service, security, retail and hospitality – reported higher rates of working these alternate hours than others.
Whether it’s nurses, police officers, long-haul truck drivers, manufacturing or retail workers, shift work is associated with a variety of health risks, not just risks of fatigue-related accidents and injuries. Some studies have found associations between night-shift work and increased risk for metabolic and cardiovascular disease and cancer risk. What these studies do not suggest is that working a night shift itself is a health disorder. The Nuvigil literature filed with the FDA does, however, explain that when diagnosed, the symptoms of “shift work disorder” are consistent with the American Psychiatric Association’s DSM-IV-TR criteria for Circadian Rhythm Sleep Disorder: Shift Work Type.
A dangerous drug?
Which brings us back to “shift work disorder” and the drug being marketed to combat it. Nuvigil is the trade name for a substance called armodafinil, which like its slower acting companion drug, modafinil, marketed as Provigil is, as FDA documents explain, “a wakefulness-promoting agent.” The precise biochemical mechanism by which the drugs work to promote wakefulness, writes FDA, “is unknown.” But the drugs appear to affect dopamine, a neurotransmitter and hormone released by the brain that plays a role in sleep, memory, mood and other neurological functions. In addition to promoting wakefulness, modafinil, writes FDA, “produces psychoactive and euphoric effects, alterations in mood, perception, thinking, and feelings typical of other CNS [central nervous system] stimulants in humans.”
There are many other possible side-effects, including a serious rash that can include Stevens-Johnson Syndrome and various psychiatric symptoms (among them aggression, mania, anxiety, suicidal thoughts and depression), shortness of breath and abnormal heart beat. Nausea, headache, dizziness and insomnia were the most common. Modafinil, writes the FDA, also “has reinforcing properties, as evidenced by its self-administration in monkeys previously trained to self-administer cocaine.” Nuvigil is a federally controlled substance because it can be abused or lead to dependence, says the drug’s medication guide. In contrast, information about the drug posted on the National Sleep Foundation’s website says, “These medications are not amphetamines and are not habit forming.”
Back in 2010, Cephalon applied to the FDA for approval of Nuvigil to treat jet lag but was turned down. More recently the company’s application for approval of the drug for bipolar disorder treatment was also declined. But the drug has been found effective at treating “shift work disorder” as described in published, peer-reviewed journal articles. Yet a close look at these studies quickly shows that many, including one investigating modafinil published in the New England Journal of Medicine – and their authors – were directly funded by pharmaceutical companies, including Cephalon for whom at least one of these scientists (listed as an author on numerous such studies) served as a consultant and speaker.
What is the real disorder?
At this point, what we don’t have a really good picture of is how many Americans work outside daytime hours and how many of these workers might be working night shifts as second or third jobs, which could contribute to fatigue factors if it prevents them from catching up on sleep. And because this information has not been gathered consistently over time, it’s hard to know how it has changed with other overall employment and economic conditions. This data seems important as part of assessing the health effects of working nights and who among US workers is most impacted. That people who work nights are sleepy and have their sleep cycles thrown out of balance does have serious consequences but urging a potentially habit-forming, psychoactive drug – free samples are available – on an economically stressed, overworked workforce, would seem to be a symptom, at the minimum, of a pharmaceutical industry gone awry. Shouldn’t we instead be figuring out other ways to reduce the occupational health risks of work schedules?
Elizabeth Grossman is the author of Chasing Molecules: Poisonous Products, Human Health, and the Promise of Green Chemistry, High Tech Trash: Digital Devices, Hidden Toxics, and Human Health, and other books. Her work has appeared in a variety of publications including Scientific American, Yale e360, Environmental Health Perspectives, Ensia, The Washington Post, Salon and The Nation.
About one in every 10 U.S. children is living with asthma — that’s closing in on 7 million kids. And while we have a good handle on what triggers asthma attacks and exacerbates respiratory symptoms, exactly what causes asthma in the first place is still somewhat of a mystery. However, new research points to some possible new culprits that are difficult, if not nearly impossible, to avoid.
Those culprits are phthalates, ubiquitous chemicals found in just about everything, from food packaging to shower curtains to vinyl flooring to personal care products such as fragrances and shampoos. (Phthalates are a group of chemicals that make plastics flexible and hard to break and are also used to help cosmetic products cling to the skin.) Just this week, researchers from the Columbia Center for Children’s Environmental Health at the Mailman School of Public Health published findings that children born to mothers who experienced high levels of exposure to two particular phthalates during pregnancy had a significantly higher risk of developing asthma. Specifically, they found that high maternal exposure to butylbenzyl phthalate (BBzP) and di-n-butyl phthalate (DnBP) resulted in a 72 percent and 78 percent increase, respectively, in the risk of a child developing asthma between ages 5 and 11 years old when compared to mothers with lower levels of exposure.
“Everyone from parents to policymakers is concerned by the steep rise in the number of children who develop asthma,” Robin Whyatt, study co-author and co-deputy director of the Columbia Center for Children’s Environmental Health, said in a news release. “Our goal is to try and uncover causes of this epidemic so we can better protect young children from this debilitating condition. Our study presents evidence that these two phthalates are among a range of known risk factors for asthma.”
To conduct the study, which is the first of its kind, Whyatt and her colleagues followed a group of 300 pregnant women and their children in New York City. All of the women were either African American or Dominican. Researchers measured the exposure to four different phthalates via urine samples taken during the woman’s third trimester and when the children were ages 3, 5 and 7. To control for confounding variables, the study excluded women if they used tobacco or illicit drugs or were living with diabetes, hypertension or HIV.
Phthalates were detected in 100 percent of maternal prenatal urine samples. Among the children, 154 had a history of reporting asthma-like symptoms and 94 were diagnosed with asthma. Since pretty much everyone tests positive for phthalates exposure, researchers compared women with the highest levels to those with lower levels. They found a significant association between concentrations of BBzP and DnBP metabolites during the third trimester of pregnancy and an asthma diagnosis among children ages 5 to 11 years old. However, the researchers reported their results with caution. Authors Whyatt, Matthew Perzanowski, Allan Just, Andrew Rundle, Kathleen Donohue, Antonia Calafat, Lori Hoepner, Frederica Perera and Rachel Miller write:
These findings may imply that prenatal exposure to some phthalates has effects on transient wheeze and/or nonspecific airway hyper-responsiveness. It is possible that the respiratory consequences of prenatal exposure to phthalates mimic what has been observed following prenatal exposure to cigarette smoke, where several large cohort studies have essentially established its role in recurrent wheeze in very young children. Alternatively, prenatal phthalates exposure may induce a nonspecific airway hyper-responsiveness, manifested as report of wheeze, use of asthma medication, cough or other breathing problems, that develops into clinical asthma during childhood only in a subset of children. The development of airway hyper-responsiveness is believed to have an environmental component, and develops at a very early age. Further prospective studies are needed to resolve these important clinical questions.
On the preventive side, avoiding phthalates is quite difficult, both because the chemicals are pretty much everywhere and because they’re rarely listed as an ingredient in the products we buy. The news release announcing the study results notes that several phthalates, including BBzP and DnBP, have been banned from many children’s products, but steps haven’t been taken to warn pregnant women about the possible health risks to their fetuses. This newest study builds on the researchers’ previous findings that child and prenatal exposure to certain phthalates is associated with a higher risk of asthma-related airway inflammation and childhood eczema. Like many environmental exposure risks, limiting exposure to phthalates in an effective way will likely take action from policy-makers and regulators.
“While it is incumbent on mothers to do everything they can to protect their child, they are virtually helpless when it comes to phthalates like BBzP and DnBP that are unavoidable,” said study co-author Rachel Miller, co-deputy director of the Columbia Center for Children’s Environmental Health. “If we want to protect children, we have to protect pregnant women.”
According to the American Lung Association, asthma is the third leading cause of hospitalization among children younger than 15 years old. Every year, the chronic respiratory disease results in about $50.1 billion in direct health care costs.
To read the full study, which was published this week in Environmental Health Perspectives, click 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.
Not an “accident”: Ernesto Rodriguez, 41, suffers fatal work-related injuries at southern Oklahoma oil rig site
Ernesto Rodriguez, 41, suffered fatal traumatic injuries on Wednesday, September 10 while working at an oil rig site in southern Oklahoma. Local news reports provide some initial information on the worker’s death:
- The incident occurred at an XTO Energy well near Mannsville, OK (about 2 hours north of Dallas, TX). Rodriguez was employed by Mercer Well Service. The company’s headquarters is in Gainseville, TX, which was also Rodriguez’s hometown.
- Sheriff John Smith reported “that a pipe was somehow forced out of a well hole and struck Rodriguez.”
- “Rodriguez was operating a workover rig drilling out frac plugs” when the blowout occurred. The sheriff reported that “the victim was knocked about 10 feet down a stairway due to the force of the blast.” Two workers, who were in a rig basket situated just above where Rodriguez was working, witnessed the event.
Mercer Well Services has a history of violating worker safety regulations. Since 2009, the company has been the subject of 17 OSHA inspections, primarily in Texas (but none in Oklahoma.) For more than 20 violations, including four repeat and six serious, OSHA proposed $169,200 in penalties. (As a result of settlement agreements, the firm actually paid $83,925 for those infractions.) Following a November 2011 inspection at an oil drilling worksite in the Midland, TX area, Mercer received a citation for five repeat violations. OSHA said in a news release announcing the citations:
“Repeated disregard of employee safety will not be tolerated.”
Despite their illegal behavior, Mercer Well Services did not meet OSHA’s criteria for the designation “severe violator.” Now that Ernesto Rodriguez has been killed on the job, maybe now they will. (As I’ve said before, OSHA’s threshold for the “severe violator” label is too steep.)
Each year, dozens of workers in Oklahoma are fatally injured on-the-job. The Bureau of Labor Statistics reports 86 work-related fatal injuries in Oklahoma during 2013 (preliminary data, most recent available.) Nationwide, at least 4,405 workers suffered fatal traumatic injuries in 2013.
The AFL-CIO’s annual Death on the Job report notes:
- Federal OSHA has 19 inspectors in Oklahoma to cover more than 90,000 workplaces.
- The average penalty for a serious OSHA violation in Oklahoma is $1,872.
Federal OSHA has until mid-March 2015 to issue any citations and penalties related to the incident that stole Ernesto Rodriguez’s life. It’s likely they’ll determine that Rodriguez’s death was preventable. It was no “accident.”
New data from the U.S. Census Bureau finds that the U.S. poverty rate declined slightly between 2012 and 2013, however the numbers of people living at or below the poverty level in 2013 didn’t represent a real statistical change.
Yesterday, the Census Bureau released two annual reports: “Income and Poverty in the United States: 2013” and “Health Insurance Coverage in the United States: 2013.” The agency found that between 2012 and 2013, the nation’s poverty rate declined from 15 percent to 14.5 percent. But the 45.3 million people living in poverty as of 2013 was not a “statistically significant change” from 2012. The 2013 poverty rate was still two points higher than it was in 2007, before the recession. It’s the third year in a row that the actual poverty numbers did not experience a statistically significant change.
Median household income didn’t change in a significant way either, increasing less than $200 from $51,759 in 2012 to $51,939 in 2013. In better news, the Census reported that the poverty rate for children younger than 18 years old declined from the previous year for the first time since 2000, falling from 21.8 percent, or 16.1 million, in 2012 to 19.9 percent, or 14.7 million, in 2013.
The income and poverty report also found that in 2013, real median household income was 8 percent lower than it was in 2007, just before the recession began. And while 2012–2013 changes in real median household income weren’t significant for most populations, it did increase by 3.5 percent among Hispanic households — and that’s the first annual increase in median income that Hispanic households have experienced since 2000. The 2013 male-to-female earning ratio (sometimes referred to as the gender wage gap) was about the same as the previous year at 0.78.
The Census found that income inequality between 2012 and 2013 didn’t change in a significant way; however, it did note that income inequality has increased between 1999 and 2013. The report stated that “incomes at the 50th and 10th percentiles declined by 8.7 percent and 14.3 percent, respectively, while there was no statistically significant decline in income at the 90th percentile between 1999 and 2013.”
In examining the job market, the Census found that the number of men and women working full-time and year-round increased by 1.8 million and 1 million, respectively, between 2012 and 2013, “suggesting a shift from part-year, part-time work status to full-time, year-round work status.”
The new poverty and income numbers attracted the attention of advocates, many of which called on policy-makers to address the issues facing working families. At the Center for American Progress, President Neera Tanden said:
The new Census data reveal that four years into the economic recovery, low- and middle-income families are still feeling the pain of unshared growth, stagnant incomes, and widespread economic insecurity. The economy is off kilter, with households at the top continuing to capture most of the gains from economic growth, while middle-class and struggling families are still waiting for the recovery to reach them.
Congress seems intent on making things worse. In 2013, Congress allowed across-the-board cuts to hit education, job training, and child care services, alongside reductions in nutrition assistance for families who can barely put food on the table. Today’s data should be a clarion call that Congress must change course to invest in job creation, raise the minimum wage, and enact measures to improve the economic security of struggling families.
In an article on MSNBC, writer Ned Resnikoff reported this quote:
“We’ve still got a large, ongoing crisis,” said Stephen Pimpare, a professor in Columbia University’s School of Social Work. “And it’s a crisis not just of economics and the Great Recession, which is the way a lot of people are going to talk about it. Because while it was true that poverty is greater than prior to the Great Recession, poverty is where it was in the early 1990s and early 1980s.”
And in a statement from the Center on Budget and Policy Priorities, President Robert Greenstein said:
In contrast with the 1960s, 1970s, and 1980s — when the benefits of economic recoveries were more broadly shared and poverty and median income improved more quickly when recoveries started — the recoveries of the past two decades have been much slower to generate income gains for middle- and low-income Americans. Part of the problem is the rising inequality of recent decades, which has meant that economic growth has not been widely shared.
Along with poverty and income data, the Census also released new health insurance numbers. The agency reports that in 2013, 42 million people, or 13.4 percent of Americans, didn’t have health insurance for the entire calendar year. That’s a big change from 2012, when the Census reported that 15.4 percent of Americans had no health insurance. Still, children living in poverty were less likely to have health insurance, as were black and Hispanics residents. Liz Borkowski offers additional insights into changing health insurance numbers in a post published yesterday.
Visit the Census Bureau to download the new reports and read highlights.
Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.