Tuesday, December 25, 2007

A Desperate Triage

Go read this. Go on now, go:

As a journalist turned graduate student in public health, I am in Uganda for five weeks as part of a research team investigating whether “food insecurity” — a persistent difficulty in finding enough to eat — undermines the effectiveness of H.I.V. treatment.

I am interviewing dozens of patients — anonymously, as is standard in such qualitative research — about what they eat, how much food they have, whether they grow it or buy it and whether the side effects from the medications are worse if they take the pills on an empty stomach. Our team also wants to know whether costs related to treatment limit their ability to cover basic foods and whether hunger forces women to offer men “live sex,” or intercourse without condoms, in exchange for food or money.

. . . . . . .

To make ends meet, parents have to engage in a desperate triage, navigating between bad choices and worse ones.

If they let their hungry children eat everything that the family grows, they will have nothing to sell at the market. If they do not sell part of the harvest, they will not have cash for the monthly clinic trip for the medication that keeps them alive.

But every time they go to the clinic, they lose a whole day of gardening or other work and spend cash they could otherwise use for the children’s diets.

“I feel bad that I have to spend that money for transport when I could have spent it on something else,” one mother says. “And then the days I’m at the clinic, of course, I come knowing that I won’t do anything that day.”

Listening to the accounts of poverty and deprivation, I feel helpless and miserable. I promise myself I will never again take a decent meal for granted.

I want to empty out my pockets and shove dollars at every patient I interview. Instead, I buy them a cup of chai, a milky African tea, from the clinic canteen. The chai costs 300 Ugandan shillings, or 18 cents in dollars. For most, that is a luxury beyond their means.

I wonder sometimes what is the point of researching this? Why not just give food to people so obviously in need? But international donors demand data and documentation. They want proof that an intervention will reduce the total misery index before they will shell out millions of euros for new programs, even if the need appears self-evident.

I get to return home when my work here is done. I will analyze my data, write up my findings and hope that what I have done makes some small contribution to change.

The women and men I have met will trek to the clinic month after month, if they can scrape together $5 or $8 for the bus fare. They will consult with the doctor, grab their drugs from the pharmacy and wonder where they will find enough beans and matoke to feed the kids tomorrow.

Monday, December 24, 2007

Bootleg Teeth

From the Times:

BARBOURVILLE, Ky. — In the 18 years he has been visiting nursing homes, seeing patients in his private practice and, more recently, driving his mobile dental clinic through Appalachian hills and hollows, Dr. Edwin E. Smith has seen the extremes of neglect.

He has seen the shame of a 14-year-old girl who would not lift her head because she had lost most of her teeth from malnutrition, and the do-it-yourself pride of an elderly mountain man who, unable to afford a dentist, pulled his own infected teeth with a pair of pliers and a swig of peroxide.

He has seen the brutal result of angry husbands hitting their wives and the end game of pill-poppers who crack healthy teeth, one by one, to get dentists to prescribe pain medications.

But mostly he has seen everyday people who are too busy putting food on the table to worry about oral hygiene. Many of them savor their sweets, drink well water without fluoride and long ago started ruining their teeth by chewing tobacco and smoking.

Dr. Smith has a rare window on a state with the highest proportion of adults under 65 without teeth, where about half the population does not have dental insurance. He struggles to counter the effects of the drastic shortage of dentists in rural areas and oral hygiene habits that have been slow to change.

“The level of need is hard to believe until you see it up close,” said Dr. Smith, who runs a free dental clinic at a high school in one of Kentucky’s poorest counties. He also provides free care to about half of the patients who visit his private practice in Barbourville.

Kentucky is among the worst states nationally in the proportion of low-income residents served by free or subsidized dental clinics, and less than a fourth of the state’s dentists regularly take Medicaid, according to 2005 federal data.

Until August 2006, when the system was revamped, the state’s Medicaid reimbursement rate was also one of the lowest in the country. Experts say this contributed to the shortage of dentists in poorer and more rural areas.

The state dental director, Dr. Julie Watts McKee, said that last year, Medicaid reimbursement for children’s dental services was raised by about 30 percent.

But even with this increase, which was paid for by cutting orthodontic benefits, reimbursement fees remain about 50 percent below market rate, said Dr. Ken Rich, the state’s dental director for Medicaid. And for adults, Dr. Rich said, they are about 65 percent below market rate.

“Not much has changed over the years here, really,” said Glen D. Anderson, who for two decades has made dentures in Corbin, Ky. He sells a pair of dentures for $400 that many dentists sell for more than $1,200. Like his brother, father and grandfather, he makes them without a license.

“Bootleggers exist here for a reason,” Mr. Anderson said. “People need teeth, but they can’t afford to go to dentists for dentures.”

While Kentucky may have some of the worse oral health problems in the nation, it is by no means alone. Residents in neighboring states across the region suffer similar dental problems for many of the same reasons — inadequate access to dental care or the inability to pay for a dentist, widespread use of chewing tobacco and a pervasive assumption that losing teeth is simply part of growing old. West Virginia, for example, which has the highest proportion of people over 65 without teeth, also has one of the lowest percentages of adults who visit the dentist at least once a year. . .

Read the rest. . . . .

Sunday, December 23, 2007

Technically, it's Satire

The Predatory Lending Association (PLA) is dedicated to extracting maximum profit from the working poor by increasing payday loan fees and debt traps. The working poor are an exciting, fast growing demographic that includes: military personnel, minorities, and most of the middle class.
Visit the site.

h/t Cogitamus.

Sunday, December 16, 2007

On Tyranny

From Glenn Greenwald:

There are several vital points raised by the new revelations in The New York Times that "the N.S.A.'s reliance on telecommunications companies is broader and deeper than ever before" and includes both pre-9/11 efforts to tap without warrants into the nation's domestic communications network as well as the collection of vast telephone records of American citizens in the name of the War on Drugs. The Executive Branch and the largest telecommunications companies work in virtually complete secrecy -- with no oversight and no notion of legal limits -- to spy on Americans, on our own soil, at will.

More than anything else, what these revelations highlight -- yet again -- is that the U.S. has become precisely the kind of surveillance state that we were always told was the hallmark of tyrannical societies, with literally no limits on the government's ability or willingness to spy on its own citizens and to maintain vast dossiers on those activities. The vast bulk of those on whom the Government spies have never been accused, let alone convicted, of having done anything wrong. One can dismiss those observations as hyperbole if one likes -- people want to believe that their own government is basically benevolent and "tyranny" is something that happens somewhere else -- but publicly available facts simply compel the conclusion that, by definition, we live in a lawless surveillance state, and most of our political officials are indifferent to, if not supportive of, that development.

Read the rest here.

Tuesday, December 11, 2007

Two on Food

From the Times:

Healthy eating really does cost more.

That’s what University of Washington researchers found when they compared the prices of 370 foods sold at supermarkets in the Seattle area. Calorie for calorie, junk foods not only cost less than fruits and vegetables, but junk food prices also are less likely to rise as a result of inflation. The findings, reported in the current issue of the Journal of the American Dietetic Association, may help explain why the highest rates of obesity are seen among people in lower-income groups.

The scientists took an unusual approach, essentially comparing the price of a calorie in a junk food to one consumed in a healthier meal. Although fruits and vegetables are rich in nutrients, they also contain relatively few calories. Foods with high energy density, meaning they pack the most calories per gram, included candy, pastries, baked goods and snacks.

The survey found that higher-calorie, energy-dense foods are the better bargain for cash-strapped shoppers. Energy-dense munchies cost on average $1.76 per 1,000 calories, compared with $18.16 per 1,000 calories for low-energy but nutritious foods.

The survey also showed that low-calorie foods were more likely to increase in price, surging 19.5 percent over the two-year study period. High-calorie foods remained a relative bargain, dropping in price by 1.8 percent.

Although people don’t knowingly shop for calories per se, the data show that it’s easier for low-income people to sustain themselves on junk food rather than fruits and vegetables, says the study’s lead author Adam Drewnowski, director of the center for public health nutrition at the University of Washington. Based on his findings, a 2,000-calorie diet would cost just $3.52 a day if it consisted of junk food, compared with $36.32 a day for a diet of low-energy dense foods. However, most people eat a mix of foods. The average American spends about $7 a day on food, although low-income people spend about $4, says Dr. Drewnowski.

And City Limits:

Holy Apostles Soup Kitchen in Chelsea claims the unwanted distinction of running the largest lunch feeding operation for the needy in the country. Serving nearly 1,200 meals each weekday, the program is bigger than at any other time in HASK’s 25-year history. At the same time, federal funding for its $2.5 million annual program has dropped to the lowest level in years. Emergency food programs across the city are grappling with similar unprecedented challenges as they confront greater demand combined with fewer or inadequate resources.

The numbers are staggering. About 1.3 million New Yorkers—or roughly one in six residents—currently rely on emergency food programs to eat, according to the New York City Coalition Against Hunger(NYCCAH). Since 2004, that’s an increase of 24 percent in reliance on EFPs, as they’re known, according to a recent report by the Food Bank for New York City. At the same time, the amount of food received by the Food Bank, which supplies more than 1,000 local food pantries and soup kitchens, is at an all-time low. Federal food aid has been cut in half, and overall supplies are down 12 million pounds just since 2004. EFPs are open an average of one day less per week than only a few years ago, and 12 percent of pantries and kitchens can’t even open every week.

Most of the food shortage has been caused by a holdup in passage of the mammoth federal Farm Bill, covering everything from crop subsidies to biofuel programs – and public nutrition. The U.S. Senate reached a deal last week that could allow the passage for the bill, including The Emergency Food Assistance Program (TEFAP). But even TEFAP's food supply has dropped by nearly 80 percent in recent years.The severity of the current emergency food shortage highlights the need to broaden the approach to hunger in New York City, some advocates and public officials say.

Thursday, December 06, 2007


From The Monkey Cage, a new blog worth popping in on now and again if you have any interest in links to some of the most recent (and most interesting?) research coming (mostly) from politcal scientists.

Are Whites More Likely to Support the Death Penalty When They Think Blacks Are Being Executed?

The answer, it seems, is yes. In a 2001 survey conducted by Mark Peffley and Jon Hurwitz, a random subset of whites was asked:

“Do you favor or oppose the death penalty for persons convicted of murder?”
Somewhat favor: 29%
Strongly favor: 36%

Another random subset of whites was asked:

“Some people say that the death penalty is unfair because most of the people who are executed are African-Americans. Do you favor or oppose the death penalty for persons convicted of murder?”
Somewhat favor: 25%
Strongly favor: 52%

It's worth visiting The Cage and checking out the full paper, and the comments section.

Tuesday, December 04, 2007

Bleak, Black

From City Limits:

When City Councilman Larry Seabrook took the podium at Thursday's unveiling of the report “The State of Black New York City 2007,” there was good news and bad news to talk about. Coming seven years after the release of the last such report, its completion was itself an achievement by the Black Equity Alliance and New York Urban League, which brought together leading intellectuals for a detailed analysis of where blacks stand. But the resulting report detailed persistent disparities in black New Yorkers’ access to the job market, affordable housing, health care and schools. So, Seabrook told the crowd at the JP Morgan Chase building on Park Avenue, "It's a pleasure to be here … to see how bad we're doing."

Statistics showing the challenges facing black New Yorkers are easy to find; they're often at hand in public discussions about school test scores, incarceration rates, incidence of asthma and so on. What's different about the State of Black New York City (which the Urban League has published off and on for 40 years) is that it presents a broad picture of the multifaceted disadvantages blacks face—and weds those indicators to a critique of what the report calls America's "race-constructed society." Explaining the study's purpose, New York Urban League chairman Noel Hankin told the room that "to monitor, measure and track the effects of racism is very important."

That's especially true when those effects can be multilayered, hidden within crises that also affect whites, or masked by cosmetic changes to a more visible problem. . . .

Read more here.

Sunday, December 02, 2007

What Atrios Said

I dream of the day when our political discourse isn't ruled by people who, sheltered from the real-world consequences of actual policy, see politics as nothing more than a show which is supposed to entertain them.

Saturday, December 01, 2007

World AIDS Day

World AIDS Day on Dec. 1 seems to mean less now than ever. We have collectively tired of mourning, and the number of people in this country who actually die from AIDS has dropped dramatically since the 1990s. Some HIV organizations have decided not to offer any special events at all this year for World AIDS Day.

Yet nearly 1 million Americans live with the HIV virus, according to the Centers for Disease Control and Prevention. We still need World AIDS Day to educate and hopefully prevent thousands more from contracting the virus.

The New York City Department of Health and Mental Hygiene released a report this fall showing that infection rates for people under the age of 30 in New York City have increased by 33 percent over a five-year period. Within this group, black and Hispanic men received twice as many HIV diagnoses as white men. Even more disturbing, the department reports that new diagnoses last year of black and Hispanic men accounted for more than 90 percent of infected male teenagers who had sex with men.

There's more. . . . .

Update: From the Washington Post:

New government estimates of the number of Americans who become infected with the AIDS virus each year are 50 percent higher than previous calculations suggested, sources said yesterday.

For more than a decade, epidemiologists at the Centers for Disease Control and Prevention have pegged the number of new HIV infections each year at 40,000. They now believe it is between 55,000 and 60,000.

The higher estimate is the product of a new method of testing blood samples that can identify those who were infected within the previous five months. With a way to distinguish recent infections from long-standing ones, epidemiologists can then estimate how many new infections are appearing nationwide each month or year.

The higher estimate is based on data from 19 states and large cities that have been extrapolated to the nation as a whole.

The CDC has not announced the new estimate, but two people in direct contact with the scientists preparing it confirmed it yesterday.

What is uncertain is whether the American HIV epidemic is growing or is simply larger than anyone thought. It will take two more years of using the more accurate method of estimation to spot a trend and answer that question.