Category Archives: Capitalism

Medicine and Sustainability

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Two important stories that will make sense to all of you, but specifically to those “I wanna be a doctor” folks among us.  As you’ll learn in the California story, doctors get paid by the task — office visit, exam, surgery, etc.  This is not sustainable given where health care may be headed; it’s certainly not beneficial to the consumer.   Also as you’ll hear, given the cost of medical school and the loans MD’s have to pay back after graduation, specialization in the system drives doctors away from where they are indeed needed — primary care.

In California, Facing Down a Family Physician Shortage

In another story that shows us how wonderful we are, this is concerns Global Health.  In fact, this link will take you to several stories concerning Global Health — cholera perhaps spreading to the DR and Miami, organ trafficking, and a global food crisis.

As you ponder your last “mini” essays, think about some of these challenges.

Who Will Stand Up to the Superrich?

Frank Rich wrote an interesting article, today, in The New York Times, Who Will Stand Up to the Superrich?

Rich tells us that Americans don’t hate the rich; in some cases even admire the rich.  The wealthy who lost elections, he goes on, also provided jobs for people.  Rich, though, tells us that we should worry about another kind of rich American, the unseen:

The wealthy Americans we should worry about instead are the ones who implicitly won the election — those who take far more from America than they give back. They were not on the ballot, and most of them are not household names. Unlike Whitman and the other defeated self-financing candidates, they are all but certain to cash in on the Nov. 2 results. There’s no one in Washington in either party with the fortitude to try to stop them from grabbing anything that’s not nailed down.

This is serious because a democracy requires an informed citizenry; however, if this citizenry can’t see, we therefore aren’t ever sure where ideas and their motivations come from, thus trust suffers a serious blow.

As Rich suggests, “The bigger issue is whether the country can afford the systemic damage being done by the ever-growing income inequality between the wealthiest Americans and everyone else, whether poor, middle class or even rich.” Are we prepared to live in a country where the evidence — physical and otherwise — will uncover an abyss between the superrich and rich and the working class, and by working class I mean, as is evident in Rich’s column, people earning less than $200,000 and below? (Believe me, this isn’t a lot of money)

What happens in this world, this “new normal,” as we like to say, is that we lose our narrative, we can’t trust it; we also begin to sense that perhaps it’s never exited. Rich says, “That burden is inflicted not just on the debt but on the very idea of America — our Horatio Alger faith in social mobility over plutocracy, our belief that our brand of can-do capitalism brings about innovation and growth, and our fundamental sense of fairness. Incredibly, the top 1 percent of Americans now have tax rates a third lower than the same top percentile had in 1970.” The entire American concept is Romantic — it’s a romantic story that grows out of Enlightenment thinking.  The trick, actually, is to reach for the Romantic sense of authenticity that shuns aristocratic values for real experience but never quite really getting there; this keeps us going or moving towards a vision of what’s real, what’s truthful. In my mind, this is what Rich is pointing to — the erosion of this Romance with the real, the lived experience, the authentic self and the journey towards that self.

I read Rich’s editorial as an explanation of the law of unintended consequences — that is, as the rich, those unseen ones especially, continue to garner more of our resources to sustain their lives, we, the workers of America, begin to realize that we’re in fact working to sustain that small percentage of citizens that reap the rewards of our labors.  Thus, a percentage, an increasingly larger percentage of our value — our worth — is determined, according to Rich, by people we don’t know and people who are pulling at strings we don’t see.

How do we work through this? What do we have to do to better understand our roles in the world of labor (yet to come for you)?  How does Rich make you feel?  What is the relationship between Rich’s editorial and McKibben’s Eaarth?

Understanding Social Determinants of Health

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Understanding the Social Determinants of Health: Breaking the Link between Poverty and Health

Brown graduates working with Project Health (program where college students work in local health clinics) based in Providence, Rhode Island. Samantha Murder (Program Manager) and Hanna Nichols (National Talent and Technology Coordinator)

Cycle of Poverty

  • MONEY is needed for healthy food, healthy housing, childcare (so you can go to work), education and school, clothing (job interviews), health care, utilities, medicine
  • in order to get money you need a JOB
  • in order to have a job, you need EDUCATION

Need education and a good job for money, but need money for education and chance for a job! Not a linear path and a difficult cycle to enter.

Project Health works to provide resources and knowledge.

Social Determinants of Health- “economic and social conditions under which people live which determine their health”

  • The Big Five: Food, housing, energy, education, and employment/insufficient income.
  • Shaped by the distribution of money, power, and resources (influenced by policy choices)
  • Social determinants are mostly responsible for health inequities

What do we mean by Poor?

Mentioned that the federal poverty line has been used a lot throughout the symposium as a measure of poverty. They stressed that people are struggling for money well above the federal poverty line. The federal poverty line for a family of 4 is $22,050, but, in suburban Illinois for instance, a family needs at least $58,000 for necessities (study done by NCCP -see budget calculator)

FOOD

Food insecurity greatly increases likelihood for poor health (ex. low birth weight for mothers)

Compared nationally, Vermont is doing well, subsidized lunches and breakfasts at school are critical (50% of kids in Essex county use this) Essex also has high levels of low birth weight.

What’s out there? Resources to combat food insecurity

ENERGY

Heat or eat?

Energy insecure households- 22% increased chance of being hospitalized since birth

What’s out there?

  • LIHEAP (covers a large amount of monthly winter heating bill, if you can’t meet cutoff your utilities will be shut off- difficult to pay back. Grants are getting smaller)
  • local neighborhood funds
  • Special protections for disabilities
  • Payment plans (utilites prefer some money)

HOUSING

Related to health. Household mold (makes you 2.2 times more likely to experience asthma!), cockroaches, cold, lead poisoning, unsafe housing conditions, stress from not being able to pay rent contribute to asthma and low nutrition, hospitalizations, poor health

Housing is considered not affordable when it costs more than 30% of income.

Housing in context- Vermont. Top 10 occupations in Vermont include retail salespeople, cashiers, janitors and cleaners- none of whom have a salary high enough to pay for housing. Not a livable salary! Poverty is “not just about getting a job”

What’s out there

  • public subsidized housing (projects)
  • private subsidized housing (contracted out)
  • housing choice voucher Program (Section 8)- pay up to 30% of income and government pays rest- HARD TO GET, 5 to 8 year wait for voucher in Rhode Island
  • shelters
  • transitional housing
  • rental assistance
  • legal action- something unsafe in house- legal pressure on landlord (less expensive than moving)

EDUCATION

They highly suggested the film “Waiting for Superman”! (check out the trailer)

What’s out there

  • GED classes
  • ESOL classes (English is 2nd language)
  • Adult basic education
  • Computer literacy
  • Child enrichment
  • Head start and early head start (includes literacy classes for parents, checkup for kids, losing seats right now)

INSUFFICIENT INCOME/ EMPLOYMENT

Related to obesity and other health issues. Not knowing what will happen raises stress and sickness- lack of locus of control.

People below the poverty line live an average of 9.6 health adjusted years less than Americans above the poverty line!

What’s out there

  • Child care subsidies
  • Food stamps

PROJECT HEALTH

Founder noticed underlying health problems involved with evictions

Doctors could do nothing for patients suffering from unemployment, poor housing.

Student in project health connect families to resources/volunteers. For example, they often connect families to food pantries or call utilities to arrange payment plans.

HOW THEY WORK

  • guided referrals
  • resource knowledge
  • identification of barriers
  • creative solutions
  • education
  • advocacy
  • connections

Conversations about food security and housing are important to both doctors and patients, but those conversations weren’t happening. Health services often don’t have the time or the knowledge to refer people, which is where Project Health steps in. Project Health also works to collect data that can be used in advocacy movements and campaigns.

Located in 6 cities, with 600 volunteers, and has helped over 5,000 families.

If you’re interested, check them out here!

The Corrosion of America

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Bob Herbert writes, in The Corrosion of America, that, “Aging and corroded pipes are bursting somewhere every couple of minutes. Dilapidated sewer systems are contaminating waterways and drinking water. Many local systems are so old and inadequate — in some cases, so utterly rotten — that they are overwhelmed by heavy rain.”

This is creating a very dangerous situation throughout the US.  And if you look at this “corrosion” and couple it to Fred’s post, below, about poverty, then

If this were a first-class society we would rebuild our water systems to the point where they would be the envy of the world, and that would bolster the economy in the bargain. But that would take maturity and vision and effort and sacrifice, all of which are in dismayingly short supply right now.

We can’t even build a railroad tunnel beneath the Hudson River from New Jersey to New York.

Improving water systems — and infrastructure generally, if properly done — would go a long way toward improving the nation’s dismal economic outlook. According to the U.S. Conference of Mayors, every dollar invested in water and sewer improvements has the potential to increase the long-term gross domestic product by more than six dollars. Hundreds of thousands of jobs would be created if the nation were serious about repairing and upgrading water mains, crumbling pipes, water treatment plants, dams, levees and so on.

Millions of jobs would be created if we could bring ourselves to stop fighting mindless wars and use some of those squandered billions to bring the nation’s infrastructure in the broadest sense up to 21st-century standards.