Sanjeev K. Sriram, MD, MPH is Dr. America for We Act Radio. His podcasts cover the intersections of public health, social justice, and activism. Episodes are available here.
Many of us might feel like 2016 can not end soon enough, and some of us wonder if 2017 will be better. With respect to all of those doubts and fears, I present some of our best accomplishments and worst shortcomings in health justice this past year:
Let’s start with the Worst in Health Justice for 2016 because yeah, things got kinda sucky this year, to put it lightly:
4. The 21st Century Cures Act rewards Big Pharma:
A lot of medical and public health advocates are celebrating Congress’ passage of the 21st Century Cures Act because it addresses the opioid crisis, mental health services, research at the National Institutes of Health (NIH), and cancer research. What’s not to love? Senator Elizabeth Warren said it best:
“This final deal has only a tiny fig leaf of funding for NIH and for the opioid crisis. And most of that fig leaf isn't even real. Most of the money won't really be there unless future Congresses passes future bills in future years to spend those dollars. Why bother with a fig leaf in the Cures bill? Why pretend to give any money to NIH or opioids? Because this funding is political cover for huge giveaways to giant drug companies.”
With the 21st Century Cures Act, the Food and Drug Administration’s safety standards will be lowered so drug corporations can push new products on the American people and their old products can be used for untested (“off-label”) purposes. While reaping even more skyrocketing profits, Big Pharma will try to market dismantled regulations as “better access” to drugs and devices. Let’s look past their distractions to ask tough questions: Are these products safe? Do they really work as intended? And the most important question 21st Century Cures completely ignores: How do we get fairer prices for prescriptions?
3. States Attack Women’s Health:
Over 60 new laws against women’s reproductive health rights were passed in state legislatures across the country. Idaho, Indiana, Kentucky and several other states developed laws requiring abortion providers to give their patients misinformation in the form of “counseling.” Forcing healthcare providers to share junk science rooted in misogynist ideologies or to perform medically unnecessary ultrasounds are assaults on the doctor-patient relationship. Fortunately, lawsuits have been raised by groups like Planned Parenthood and the ACLU to stop these policies, many of which can not be implemented until courts rule. In states like Georgia, Michigan, Missouri, and North Carolina taxpayer dollars were redirected from women’s health centers practicing evidence-based medicine to “crisis pregnancy centers” that peddle junk science and undermine a woman’s right to choose. Abortion is healthcare. Women and public health suffer when state laws mandate misinformation and/or fund shams with taxpayer dollars.
2. The Slow Response to Flint’s Water Crisis:
Because of failed leadership forced upon Flint, MI, the community’s water supply was changed from Lake Huron to the Flint River in April 2014. Very shortly after that change, residents of Flint noticed strange colors, odors, and tastes in their drinking water. For the next 18 months, despite a growing body of evidence that the water was contaminated, officials at various levels of government downplayed the problems and/or shifted blame. In September 2015, Dr. Mona Hanna-Attisha and her team of health professionals found proof that children were suffering of lead poisoning and demanded the water supply be changed from the Flint River. Flint declared an emergency in December 2015, followed by Michigan Governor Snyder’s declaration, then President Obama’s in January 2016. It took Congress until the first weeks of December 2016 to finally approve funding for infrastructure repairs and healthcare costs. Some of the right steps are finally being taken at local, state, and federal levels, but more could have and should have been done sooner. The Flint water crisis was preventable, and the lack of urgency has been unacceptable.
1. The Rise of Trump:
Despite losing the popular vote, Trump won the Electoral College, a vestigial organ of white supremacy in American democracy. With no mandate from the American people, Trump’s cabinet and his allies in Congress intend to demolish much of American healthcare: they plan to privatize Medicare, turn Medicaid to block grants, and repeal the Affordable Care Act. With no mandate from the American people, Trump and company want to end the work of health care as a basic human right and make it a privilege only for those who can afford it. With no mandate from the American people, the Trump fraternity will try to stop reproductive health rights for women, veiling their misogyny as “religious freedom.” Trump’s occupation of the Oval Office is an assault on health justice that must be resisted throughout 2017 and the years to come.
As difficult as it might be to see positivity this past year, there were many points of light to be celebrated. From those many, I picked some of what I think are the Best in Health Justice for 2016:
Dr. America Got Married!
Dr. America and Mrs. Dr. America
Ok, not quite a public health accomplishment, but I urge my fellow health justice activists to take time to celebrate the people for whom we fight. Sharing joy and laughter with friends and family is precious in itself, but also reinvigorates and refocuses efforts for health justice and equality. I’m still amazed this wonderful woman committed to my crazy this past year and for all the years to come. Looking forward to more South Indian food, Pixar movies, and old-fashioneds with you, Love.
4. A New, Effective Ebola vaccine = Science For the Win!
Teams of scientists from different parts of the world worked together to develop a vaccine against Ebola that proved to be astonishingly effective at protecting people who had contact with patients stricken with the deadly virus. This group of researchers with diverse backgrounds and scientific specialties shared their results in Lancet on December 22. Efforts are underway to verify the vaccine’s safety, how long immunity will last, and how to produce and distribute vaccines for communities in need. The 2014 Ebola outbreak in West Africa affected 28,000 people and ended 11,000 lives. As families and communities continue to rebuild, an effective Ebola vaccine represents a scientific breakthrough and proof that collaboration across cultures can save lives.
3. Washington, DC passes Paid Family Leave!
The City Council of Washington, DC passed a great set of paid family leave laws, giving peace of mind to families working in our nation’s capital. The laws cover 2 weeks for personal medical leave, 6 weeks to care for a sick family member, or 8 weeks for parental leave for a new biological or adopted child. Through a social insurance program funded by a 0.62 percent payroll tax, workers who make up to 1.5 times the minimum wage will get 90 percent of their usual weekly income while they are on leave (some caps apply). This is a triumph for public health because families without paid leave are too often facing a false choice: they can take care of their health (or the health of a family member) or they can keep a paycheck, but they can’t have both. DC now joins 4 other states with paid family leave policies, and the rest of our country needs to follow.
2. Reproductive Health won at the Supreme Court!
Earlier this summer, the Supreme Court struck down two TRAP (“targeted regulation of abortion providers”) provisions passed in Texas’ HB2 law aimed at making women’s access to abortion more difficult. These TRAP provisions failed women and public health, as proven by the plaintiffs from Whole Woman’s Health, who used a wide body of scientific evidence to make their case. Because of the victorious ruling of Whole Woman's Health vs Hellerstedt, all courts must now strike down abortion restrictions when the burdens on women are greater than perceived ideological benefits. Thanks to this Supreme Court ruling, it will be harder for state legislatures to rely on junk science when making abortion restrictions. Courts must give weight to credible scientific evidence and public health data presented by pro-choice advocates. The tactics used by reproductive health rights activists in 2016 will be critical in the struggles to come from the incoming Trump Administration.
1. Uninsured Rate was the Lowest Ever, Thanks to Obamacare and Medicaid!
According to the Centers for Disease Control and Prevention, only 8.9 percent of Americans are uninsured. This landmark is because of the Affordable Care Act, which extended health insurance coverage to Americans through several ways: people up to age 26 can stay insured under their parents’ plan; the federal and state health insurance exchange marketplaces offer affordable plans with comprehensive benefits; and states opting to expand Medicaid to adults making up to $16,243 (138 percent of the federal poverty level). There are 11 million Americans across 31 states and Washington, DC who have benefited from Medicaid expansion. These statistics barely scratch the surface of the progress made by Obamacare and Medicaid, both of which are being targeted for demolition by the Republicans in Congress. Rather than turning the Affordable Care Act into a political football to score cheap points, Senators and House Representatives need to respect the law’s tremendous contributions to American healthcare.
When assessing the setbacks and progress made in health justice this past year, a unifying theme is the value of everyday people standing up for their basic health rights. The disappointments of 2016 must not discourage health justice activists from their work. None of the accomplishments made in public health and medicine came easy. They all required persistence, collaboration, a commitment to putting patients first, creativity, and varying degrees of sacrifice. I look forward to seeing you all join these endeavors as we are tested, strengthened, and hopefully triumphant in 2017.