Overview of Economic, Health, and Human Rights Issues of Racial and Ethnic Minorities

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

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

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

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

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

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

7. Historical and Contemporary Exploitation • Genocide of Native Americans • Slavery • Built U.S. infrastructure • Boarding schools, “stolen children,” destruction of indigenous cultures

8. Historical and Contemporary Exploitation • Apartheid • Civil Rights Movements (U.S. and international) • Immigration policies • Hate crimes against Muslims, other groups

9. Historical and Contemporary Exploitation • Rise of Trump/alt-right/militias/neo-Nazis/KKK • Pardoning of racist/profiling/ex-sheriff/ convicted felon Joe Arpaio • Increasing civil unrest • Militarization of police

10. Historical and Contemporary Exploitation • Statues/memorials to colonizers/ racists/Confederates • Over 1,500 Confederate symbols in U.S. • Columbus Day (vs. Indigenous Peoples’ Day) • 4 states, multiple cities celebrate Indigenous Peoples’/Native Americans’ Day

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

12. Racial Disparities: Economic • Full-time African-American and Latinos earn 75% of what whites earn • Median income of black U.S. families as a percent of white U.S. families: • 60% in in 1968 • 62% in 2002 • 62% in 2011 (69% for Hispanic families) • Median net worth of white households 13X higher than black households; 10X higher than Latino households

13. 2015

14. 2015

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

16. 2015

17. Poverty and Hunger • U.S.: 15% of residents and 22% of children live in poverty • Rates of poverty in Blacks and Hispanics = 2.5X Whites • Poverty associated with worse physical and mental health

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

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

21. Hudson River, 2009

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

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

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

25. Undocumented Immigrants • 25 million non-citizens in U.S. • 11-12 million undocumented • 80% of these in labor force • Constitute 30-50% of agricultural and 20% of meat processing/food service workforce • 40% lack health insurance, 2/3 lack source of non-emergency care (and many afraid to visit emergency rooms) • Children particularly affected

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

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

28. Functional Apartheid • 2014: Obama issues executive order allowing certain immigrants to apply for temporary legal status • 25 states sue federal government, blocking executive order • SCOTUS to decide

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

31. 2015

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

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

34. Physician Salaries and Race • White/black female physicians earn similar salaries (less than men), but white physicians make average 25% more than black physicians (after adjustment for specialty and years in practice) • May be due to racism, practice location, patient population, etc.

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

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

37. Racial Disparities in Health Care Coverage • Percent uninsured: • Whites = 7% • Asians = 8% • African-Americans = 11% • Hispanics = 16% • Undocumented immigrants = 40% (emergency care exception) • CA Proposition 189

39. Racial Disparities: Health Care • Higher maternal and infant mortality • Lower rates of breastfeeding • Higher death rates for most diseases • Shorter life expectancies for African-Americans • Not for Hispanic Americans (healthy immigrant effect and Hispanic paradox may be relevant, but largely due to decreased tobacco use)

40. Racial Disparities: Health Care • Fewer diagnostic tests / therapeutic procedures / pain medications • US spending on cystic fibrosis R & D/patient advocacy = 3X spending on sickle cell disease • CF afflicts 1/3 as many US citizens as SCD

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

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

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

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

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

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

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

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

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