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

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

• Martin Donohoe

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Outline

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

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Colonial Exploitation

• Christopher Columbus log entry upon meeting the
  Arawaks of the Bahamas
• Theybrought usmanythingsThey willingly
  traded everything they ownedThey do not bear
  armsThey would make fine servantsWith fifty men
  we could subjugate them all and make them do
  whatever we want.

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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

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Colonial Exploitation

• Winston Churchill (speaking in favor of RAFs
  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
  terroragainst recalcitrant Arabs as an
  experiment

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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.

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Historical and Contemporary Exploitation

• Slavery
• Built U.S. infrastructure
• Apartheid
• Civil Rights Movements (U.S. and international)
• Native American and immigration policies

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Exploitation leads to

• Maldistribution of wealth and resources
• Environmental degradation
• Wars

9
Racial Disparities Economic

• 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)

10
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

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Poverty and Hunger

• U.S. 14.3 of residents and 20 of children live
  in poverty
• Rates of poverty in Blacks and Hispanics almost
  3X Whites
• Poverty associated with worse physical and mental
  health

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Income Inequality

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

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Voltaire

• The comfort of the rich rests upon an abundance
  of the poor

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Hudson River, 2009
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Functional Apartheid

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

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Functional ApartheidVoter 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

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Functional ApartheidVoter 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

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Undocumented Immigrants

• 25 million non-citizens in U.S.
• 11-12 million undocumented
• 80 of these in labor force
• 2/3 lack insurance, source of non-emergency care
  (and many afraid to visit emergency rooms)
• Children particularly affected

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Functional Apartheid

• Undocumented immigrants pay taxes
• State and local income
• Property
• Excise taxes
• Employers share of Social Security
• Medicare
• Unemployment taxes

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Functional Apartheid

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

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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

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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

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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

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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

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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

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Racial Disparities in Health Care Coverage

• Percent uninsured
• Whites 12
• Asians 18
• African-Americans 21
• Hispanics 31
• Undocumented immigrants 100 (emergency care
  exception)
• CA Proposition 189

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Racial Disparities Health Care

• Higher maternal and infant mortality
• 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)
• Fewer diagnostic tests / therapeutic procedures /
  pain medications

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Health Disparities Among Latinos

• Higher rates of
• Overweight and obesity
• Certain cancers
• Stroke
• Diabetes
• Asthma/COPD
• Chronic liver disease/cirrhosis
• HIV/AIDS
• Homicide

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Racial Disparities in Health CareAfrican-America
ns

• 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 2004942078-2081

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Diseases Responsible for Illness and Death

• Deaths in 2000 attributable to
• AMI 193,000
• CVD 168,000
• Lung CA 156,000
• AJPH 20111011456-1465

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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-attributabl
  e mortality 5.1)
• Area-level poverty 39,000 (population-attributabl
  e mortality 1.7)
• AJPH 20111011456-1465

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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

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Exploitation Post-WW II Human Subject
Experimentation

• Tuskegee Syphilis Study
• Guatemalan Syphilis Experiment

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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 worlds population
• Limited access of developing world to results due
  to scarcity of open-access publications

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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

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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

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Racism in the Criminal Justice System

• Violent crime associated with poverty, not race
• Persons of color are more likely than whites to
  be
• Stopped by the police (e.g., Driving while
  black, Stop and frisk)
• Abused by the police
• Arrested
• Denied bail
• Charged with a serious crime
• Convicted
• Receive a harsher sentence

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Race and Detention Rates

• African-Americans 1,815/100,000
• More black men behind bars than in college
• 13 of black men currently have no voting
  privileges
• Latino-Americans 609/100,000
• Caucasian-Americans 235/100,000
• Asian-Americans 99/100,000

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Outside the U.S.

• Racial and cultural inequalities
• Poverty, famine, war
• Governments/corporations promoting poverty and
  worsening maldistribution of wealth and resources
  through trade agreements, internalization of
  profits and externalization of costs

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The Third World Debt Crisis

• Each African child inherits approximately 379 in
  debt at birth
• Countries spend more each year repaying debt than
  on education and healthcare

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Consequences of Debt Repayment Agreements

• Government spending on food, fuel and farming
  subsidies reduced
• Social service (healthcare/education) program
  spending cut
• Countries strip and sell their natural resources

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Foreign Aid

• In total dollars U.S. 1
• As a of GDP, U.S. 21
• U.S. Aid Over 1/3 military, 1/4 economic, 1/3
  for food and development

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Foreign Aid

• Americans think that 24 of the federal budget
  goes toward foreign aid
• 0.19 of the total federal budget, vs. UN target
  of 0.7

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U.S. Charitable Giving

• Approximately 250 billion/year
• 2.5 of income
• 2.9 at height of Great Depression

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U.S. International Non-Cooperation/Isolationism

• Failure to sign or approve
• Kyoto Protocol on Climate Change
• International Covenant on Economic, Social, and
  Cultural Rights

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U.S. International Non-Cooperation/Isolationism

• Failure to sign or approve
• Convention on the Rights of the Child
• Convention on the Elimination of Discrimination
  Against Women
• UN Convention on the Rights of Disabled Persons

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U.S. International Non-Cooperation/Isolationism

• Failure to sign or approve
• UN Declaration of the Rights of Indigenous
  Peoples
• The Stockholm Convention on Persistent Organic
  Pollutants
• WHO International Code of Marketing of Breast
  Milk Substitutes

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U.S. International Non-Cooperation/Isolationism

• Failure to follow World Court Decisions
• Failure to recognize International Criminal Court

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Primo Levi

• A country is considered the more civilized the
  more the wisdom and efficiency of its laws hinder
  a weak man from becoming too weak or a powerful
  one too powerful.

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Solutions

• More equitable distribution of medical research
  funds and health care dollars
• Living wage laws
• E.g., NY, LA, Chicago, and Philadelphia
• Education reforms

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Solutions

• Creation of healthier communities
• Stronger environmental and occupational and
  safety laws / enhanced enforcement
• Single payer health care
• Canadian blacks are as healthy as Canadian whites

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Solutions

• Improve status of women / access to reproductive
  health care
• Increase racial and ethnic diversity of physician
  workforce
• Overhaul immigration policy
• Pass Dream Act
• Reparations
• Changes in law enforcement and sentencing

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Fyodor Dostoyevsky

• A society should be judged not by how it treats
  its outstanding citizens but by how it treats its
  criminals

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Solutions

• Publicly financed campaigns and campaign finance
  reform
• Proportional representation
• Instant runoff voting/cumulative voting/range
  (rating) voting

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Solutions

• Increase U.S. voter turnout
• U.S. 139/172 worldwide
• Wealthy vote at almost twice rate of poor
• Whites gt Blacks gt Hispanics
• Old gt Young
• Property owners gt Renters
• Activism / Protesting / Whistleblowing
• Halt disenfranchisement, overturn voter
  restriction laws
• Work in Groups

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Günter Grass

• The first job of a citizen is to keep your mouth
  open.

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Anita Roddick

• "If you think you are too small to have an
  impact, try going to bed with a mosquito in your
  tent"

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• Public Health and Social Justice Website
• http//www.publichealthandsocialjustice.org
• http//www.phsj.org
• martindonohoe_at_phsj.org