PI's Weekly Media Digest: Intergenerational trauma in Milwaukee, the high cost of segregation, Trump rolls back Clean Power Plan
The Milwaukee Journal Sentinel, as part of its series on the “50-Year Ache,” reporting back 50 years after the Civil Rights marches of 1967, reports on the epidemic of childhood trauma that “haunts” the city. “As jobs disappeared, so did many of the dreams that came with them. And just as during the Great Depression, people and their families began to break. A half century later, a Journal Sentinel analysis of previously unmined data reveals that many have never healed. Instead, poverty, joblessness and the social ills that accompany them deepened progressively within Milwaukee’s urban center, rippled across its 200-plus census tracts, and moved into its suburbs like a slow-motion shock wave. Few other American cities fell as far, as fast and as forcefully… Pittman-McGee has seen firsthand what an emerging network of public health and neuroscience researchers, community-minded foundations and law enforcement officials now believe: The primary challenge facing Milwaukee and similar high-poverty cities is not one of the usual suspects — education, crime, even the availability of jobs — although all those play a role. Instead, it is an epidemic of trauma passed from one generation to another, one neighborhood to the next.”
While people are living longer in most rich countries, the rates of early deaths are going up in the US, due in part to a rise in mortality among middle-aged white people linked to “diseases of despair,” according to an analysis by Princeton economists Anne Case and Angus Deaton. The Washington Post notes the analysis provides context for the authors’ research published in 2015 that showed high mortality rates among middle aged white people due to drug overdoses, suicides, and chronic alcoholism. “Ultimately, we see our story as about the collapse of the white, high school educated, working class after its heyday in the 1970s, and the pathologies that accompany that decline,” the authors write. Contributing to this collapse are a lack of economic opportunities for people without college degrees, and as a result, a lack of hope.
President Trump signed an executive order creating a high-level federal commission to address opioid misuse. The commission, which will be chaired by New Jersey Governor Chris Christie, is tasked with producing interim recommendations in 90 days. The commission will examine strategies for treatment, prevention and recovery. Mother Jones reports on skepticism about the usefulness of the commission, absence any commitments to take action, especially given the Surgeon General’s in-depth report on substance abuse released this January: "There is a massive gulf between President Trump's promises to tackle this crisis and the policies this administration has proposed during his first two months in office," said Sen. Jeanne Shaheen in a statement in response to Trump's roundtable. Vox summarized the criticism of the administration’s approach as such: “If this administration wants to have an impact on the epidemic, it would expand Medicaid in every state, it would increase funding for drug treatment, and it would spend the billion dollars allocated to the opioid problem through the 21st Century Cures Act. How to solve the opioid crisis isn’t a mystery. We know what to do. We don’t need more expert opinion. We need action.”
City Lab reports on the “high price of a divided city,” and what would happen if Chicago were not so segregated (even if segregation online declined to the median of the 100 most populous metro regions in the US): “It’s not just the city’s African-American population that would benefit; the entire region would be better off, a new study by the Urban Institute and the Metropolitan Planning Council finds. Authors Rolf Pendall, Gregory Acs, Mark Treskon, and Amy Khare crunch the numbers for Chicago: Per capita income for African Americans in the Chicago commuting zone (which broadly corresponds to the metro) would increase by 12.4 percent—that’s $2,455 more in each black Chicagoan’s pocket per year. For both black and white residents, educational attainment would rise. Around 83,000 more adults would graduate from college, of which 78 percent would be white. The homicide rate would fall by 30 percent compared to its 2010 level. That means in 2016, Chicago would have experienced 229 fewer homicides.”
Depression is the leading cause of ill health and disability across the world, now affecting more than 300 million people globally, the World Health Organization announced this week.
An article in the New York Times explores whether arts programs that are therapeutic for military service members and veterans may help make the case for preserving federal funding for the National Endowment for the Arts and the National Endowment for the Humanities. The article profiles an arts therapy program run partly by the National Endowment for the Arts at the Walter Reed National Military Medical Center that applies art, music and writing to help military service members deal with trauma.
President Trump unveiled his plan to roll back President Obama’s climate change actions, especially the Clean Power Plan, in an executive order released this week. Vox reports on the public health implications of this roll back: The Clean Power Plan, in other words, has been a big win for health. According to the EPA, cutting exposure to particle pollution in the order the CPP does would have averted up to 3,600 premature deaths, 90,000 asthma attacks in children, and 1,700 heart attacks each year. Which means that Trump’s plan “is a one-two punch to human health and the environment,” said Georges Benjamin, executive director of the American Public Health Association. “Greenhouse gases are an enormous risk to human health. So this means we’ll continue to be exposed to these gases, which exacerbate asthma, heart disease, strokes.”
The New Yorker profiles a syndrome in Sweden in which young refugees lapse into coma-like states upon learning their families are in danger of being deported. Doctors and emergency departments began noticing “apathetic children” in the early 2000s, and had reported more than 400 cases among children between 8 and 15 by 2005. Some children have been in bed for more than four years. Doctors theorize that the illness is a reaction to the traumas the children experienced in their home countries combined with a dread of returning. According to the article, a doctor who treats patients with the condition “believes that people cannot be truly healthy unless they have trygghet, a word that in English translates as ‘security’ but which has a broader meaning in Swedish: trust, a sense of belonging, freedom from danger, anxiety, and fear.” The most effective treatment: a permanent residency permit.
Current and proposed immigration policies could endanger our health and wellbeing, Lawrence O. Gostin and Katharina Eva Ó Cathaoir of the Georgetown University Law Center argue in an editorial in JAMA. Construction of a border wall, the proposed travel ban, and deportation and detention policies have the potential to heighten fear, reduce the supply of foreign physicians, and limit access to care, the authors write.
The ACA is still in place, but there’s plenty that legislators and/or the administration can do to hobble it, such as weakening the individual mandate, cutting off cost-sharing subsidies, and letting states have more say over “essential health benefits.” NPR breaks it down, as does the Atlantic.
Cuts to public health in Trump’s proposed budget are a threat to national security, says a STAT oped. “A nation cannot be great if it isn’t healthy. Public health, that often invisible science that promotes the well-being of families and communities, is a bulwark of strong defense. We need the hard power of health to keep Americans safe,” writes Ruth Katz of Aspen Institute. Epidemiologist Michael Osterholm also notes in the NYT that disease is the real national security threat, but the administration isn’t prioritizing it.
Rural health advocates in Texas say as much as $1 billion in funding cuts being weighed by the state legislature may worsen physician shortages, lower access to emergency care and hasten the spread of infectious diseases in outlying areas of the state, Politico reports. A Texas constitutional requirement for a balanced budget is squeezing Medicaid provider payments, public health spending and other services with the legislative session due to wrap up in May.
Stepping back the fight against climate change will be a massive loss to public health, says Vox, in response to Trump’s executive order this week directing the EPA to review Obama's Clean Power Plan, rescind the moratorium on coal mining on US federal lands, and find obstacles to “energy independence.” The chair of the EPA’s Clean Air Scientific Advisory Committee makes a similar point in the Philadelphia Inquirer. Meanwhile, Bloomberg BNA notes that Scott Pruitt hasn’t said the words “public health” at all --and has rarely said the word “health”-- in his first month of public speeches as EPA administrator. Significant work goes into messaging for these events and the missing words are a fair indicator of the agency’s direction, a former EPA comms director noted.
Trump announced he wants to merge the Agency for Healthcare Research and Quality with the National Institutes of Health, which itself faces a proposed $1.2 billion budget cut, STAT reports.
Attorney General Jeff Sessions claimed this week that sanctuary cities “make our nation less safe by putting dangerous criminals back on our streets,” and said that in order for sanctuary cities to continue to receive federal funding, they would need to demonstrate full compliance with federal immigration laws. California Senate leader Kevin De Leon described the administration’s efforts as “nothing short of blackmail.”