PI's Weekly Media Digest: Gentrification and criminalization; tax bill passes Congress; and 'linguistic battles' underway in public health field

The Washington Post reported on a “linguistic battle” unfolding between the Trump administration and agency staff, attempting to shape the conversation about climate change, public health, inequities, and other sensitive subjects: “Climate change, for example, has for months presented a linguistic minefield; multiple references to it have been purged repeatedly at the Environmental Protection Agency and the Interior Department. In late summer, the Office of Juvenile Justice and Delinquency Prevention issued a document to employees and contractors bearing a column of words and phrases to be avoided, alongside a column of acceptable alternatives. The one-page "language guidance" document recommends using "all youth" instead of "underserved youth," referring to crime as a "public issue/public concern" rather than a "public health issue/public health concern" and describing young people who commit crimes as "offenders" rather than "system-involved or justice-involved youths," according to a copy of the document obtained by The Washington Post.”

A tax overhaul passed the House and Senate this week (with no Democratic support in either chamber). The bill threatens to exacerbate income inequality in the US, which is associated with a wide range of consequences for physical and mental health, trust and social cohesion, and educational and economic opportunity. According to NYU professor Lily Batchelder, the bill “leaves low- and middle-income workers with even fewer resources to invest in their children, and increases the number of Americans without health insurance… The bill makes the economic playing field even more tilted toward the most fortunate, which means over time the distributional effects of the bill will be even worse than these estimates suggest.” The tax overhaul – which is projected to add over $1 trillion to the deficit – is also likely to be used to justify steep cuts to social programs like Medicaid, Medicare, and Social Security. As the 2018 World Inequality Report, released this week, powerfully shows, “inequality isn’t an economic inevitability, but a political choice — and American policy makers have chosen to accelerate its growth.”

Vox reports on the ways the #MeToo movement has left out women of color working in low-wage industries, who are disproportionately likely to experience sexual harassment and assault on the job. “The unique issues facing marginalized people — already less likely to be working in the types of high-profile workplaces currently getting attention — have been largely relegated to the sidelines. If the current conversation has failed both women of color and low-income women, it has completely ignored those who live at the intersection of these identities. According to the Center for American Progress, industries that disproportionately employ women of color in low-wage jobs, like hospitality and retail, report some of the highest levels of sexual harassment. But it’s rare that we hear about them, or share their stories in the media. Seeking systemic change in how we deal with workplace sexual harassment without acknowledging these groups threatens to keep progress limited to a subset of women, perpetuating a system in which minorities, especially poor women of color, are left without many options…. If left unchecked, advocates say, the current structure of domestic work and other low-wage industries will continue to leave the vulnerable open to abuse. Some domestic workers are employed and managed by agencies, but many are directly employed by people or families and often lack employment contracts. Because of their intimate work environments, domestic workers — a group largely composed of immigrant women — are rarely able to bring federal Equal Employment Opportunity Commission (EEOC) claims, and 42 states have no protections for them on the books.”

Writing in Vox, reporter German Lopez, who dedicated much of the past year to covering the opioid epidemic, reflects on what he has learned, including from readers’ responses to his coverage. He concludes the biggest obstacle to addressing the epidemic is stigma; the persistent perspective of substance misuse as a moral failing rather than a disease. He writes: “Before this year, I just didn’t appreciate how much stigma towards addiction still colors America’s approach to drugs. That’s not because I didn’t know that stigma plays a big role, but because I didn't expect stigma to be nearly as all-consuming as it really is.” The consequences of this stigma include a reluctance to adopt effective interventions such as medications to address addiction and needle exchanges, and a tendency to funnel people with substance misuse to prison rather than treatment.

An in-depth report in the Los Angeles Times investigates decisions to site low-income housing near freeways, despite health risks. “If policymakers put low-cost housing next to freeways, they will place some of their poorest constituents in locations where pollution can be five to 10 times higher, saddling them with the health consequences. But if they prohibit new construction in those areas, they could make things tougher for people trying to get off, or stay off, the streets. Of the roughly 2,000 affordable housing units approved in Los Angeles in 2016, 1 in 4 was within 1,000 feet of a freeway, according to figures from the Department of City Planning. Officials are weighing whether to build homeless housing on at least nine city-owned properties within 500 feet of freeways — including one that’s less than 200 feet from the sprawling 110-105 freeway interchange. …  Regulators say decades of tough clean-air rules have slashed tailpipe emissions, reducing risks to people near freeways. But some scientists warn those health improvements will be undercut by the state’s push to concentrate high-density housing near transit hubs, which often sit near major roadways. A 2016 study projected state climate policies would increase the number of preventable deaths from heart disease in Southern California by placing more people near traffic pollution. Establishing buffers between homes and heavy traffic, in contrast, would decrease heart disease deaths, especially among the elderly, according to the study by researchers from USC, the California Department of Public Health and several other institutions.”

While everyone agrees the opioid epidemic requires action, there is less agreement on the appropriate response, NPR reports. Some states have declared a public health emergency, for example, while others argue such a declaration can lead to panic and hastily drafted, ineffective laws. Some allow needle exchanges to reduce the spread of disease among those who are using drugs, but others believe the exchanges encourage drug use. And although many states have begun regulating and limiting prescribing practices, some health advocates suggest such a measure can drive people to more dangerous street drugs.

According to a study published in JAMA, the 2015 National Youth Risk Behavior Survey showed that lesbian, gay, bisexual, and “questioning” adolescents have substantially higher risks connected to suicide than heterosexual adolescents. Survey results showed that “sexual minority” adolescents were nearly 2.5 times more likely to consider, plan, or attempt suicide. 

In the journal VQR, Madeline Drexler, a writer who lost her brother to suicide, explores an increase in suicides in Bhutan, the Kingdom that measures its Gross National Happiness. Until recently, the Ministry of Health did not record deaths by suicide, and there is no word for suicide in the native language of the native Dzongkha language. But recent events have prompted more explicit consideration. A 2014 Royal Government of Bhutan study of showed two-thirds of deaths by suicide occurred in people ages 15-40; two-thirds were males; and the group most often affected were farmers. Speculation about the factors contributing to the increase varies; some blame the movement in recent decades to market capitalism and the attendant competition and focus on individual success; others note long-masked problems, from gender inequity to domestic abuse to substance misuse; and others point to the shame that can be prominent in collectivist societies.

The Atlantic reports on the wave of criminalization that often accompanies gentrification, particularly in communities of color that are undergoing gentrification, and the role law enforcement plays in “taking over” public spaces: “Over the past two decades, gentrification has become a norm in major American cities. The typical example is a formerly low-income neighborhood where longtime residents and businesses are displaced by white-collar workers and overpriced coffeehouses. But the conventional wisdom that image reflects—that gentrification is a result of an economic restructuring—often leaves out a critical side effect that disproportionately affects communities of color: criminalization. When low-income neighborhoods see an influx of higher-income residents, social dynamics and expectations change. One of those expectations has to do with the perception of safety and public order, and the role of the state in providing it. The theory goes that as demographics shift, activity that was previously considered normal becomes suspicious, and newcomers—many of whom are white—are more inclined to get law enforcement involved. Loitering, people hanging out in the street, and noise violations often get reported, especially in racially diverse neighborhoods.”

A federal committee formed as part of the 21^st Century Cures Act to improve treatment and support for people with serious mental illnesses and serious emotional disturbances has published a series of recommendations that focus on five areas:

• Strengthening federal coordination;
• Improving access to good care, including support for family members and caregivers;
• Providing more effective, whole-person treatment, including early screening, housing, and better integrated services;
• Increasing opportunities for diversion from criminal and juvenile justice systems; and
• Developing finance strategies to make care more affordable, including enforcing parity with physical health services.

STAT profiles programs that help students who have had to leave college because of mental health conditions transition back to school and work. Boston University’s NITEO program provides a peer support group, personal coaches, and supports ranging from wake-up texts to meal planning to help writing letters to be reinstated at school. The program emphasizes social connection and a holistic focus. With more than a third of incoming students reporting frequent feelings of anxiety, according to one study, and long wait lists at college counseling services, the programs are in high demand.

A new  report  from Georgetown University finds that 25 states (covering 1.9 million children) will run out of funding for the Children’s Health Insurance Program by the end of January, if Congress doesn’t act to reauthorize the program. At this point, it seems unlikely that Congress will fund CHIP before the holiday recess. Alabama is the first state to announce that it will stop enrolling children in CHIP as of January 1, unless funding is restored.

Two reports released by the Centers for Disease Control and Prevention on Thursday showed life expectancy in the US declined for the second year in a row (the first time since 1962-1963 that life expectancy has declined two years running) and that overdoses killed over 63,000 Americans in 2016, a 21% increase from 2015.

The Guardian investigated a common practice across US cities: giving homeless residents one-way bus tickets out of town. The Guardian compiled a database of 34,240 journeys and examined the effects of these bussing practices on homeless people and the cities that receive them: “People are routinely sent thousands of miles away after only a cursory check by authorities to establish they have a suitable place to stay once they get there. Some said they feel pressured into taking tickets, and others described ending up on the streets within weeks of their arrival…. ‘Once they get you out of their city, they really don’t care what happens to you.’”