How are the current proposals for health insurance reform treating an industry that siphons off roughly $10 billion in annual profits? We now have two health reform bills reported out of congressional committees (”America’s Affordable Health Choices Act” in the House and the “Affordable Health Choices Act” in the Senate – using terminology pushed by Democratic pollsters, no doubt). Neither of them meets key human rights standards, and both cast private insurance corporations in the role of gatekeepers that control people’s access to care. At the same time, opposition is mounting against all and any reform measures.

Yet there continues to be great hope among many long-time health policy advocates that will we see meaningful health reform later this year. Advocates count on this reform to solve or at least alleviate the current health care crisis, which results in an estimated 22,000 preventable deaths due to lack of insurance each year, as well as skyrocketing costs that bankrupt families and public budgets alike. Pundits optimistically point to the many new measures the reform bills introduce: reining in the “free” insurance market through tougher regulation, including through a so-called Exchange mechanism; setting up a public insurance plan; expanding Medicaid; requiring employers to contribute to costs; and mandating everyone to buy insurance. All Americans (though not all immigrants – documented or not) will get health insurance – or so the hopeful want to believe.

Their hope is born out of desperation. Most advocates are painfully aware that health care is treated as a market commodity in the United States, and that market rules are stacked against those with little purchasing power. And these are usually the very people who need health care the most: poor people and people with serious health issues. In a blatant affront to the basic human rights principle of equity, minority groups and poorer communities in rural and inner city areas suffer disproportionally from market barriers to health care.

Reminders of the insurance industry’s power are everywhere: people who lack insurance, people whose claims are denied, whose coverage is rescinded, or who pay exorbitant premiums that may – or may not – preempt catastrophic bills but do not cover actual visits to the doctor. The business model of insurance companies only works if as many healthy people as possible buy policies and pay premiums that are as high as possible, and if those same people then forgo actually using the health care covered by that policy. None of this is news to mainstream health reformers, yet hardly anyone points to the emperor without clothes: because insurance corporations can profit only by restricting access to care, they act as hostile gatekeepers rather than as vendors of a value-adding service. In one of our news media’s rare instances of bluntness, a Paul Krugman blog in the New York Times explains that “private insurance basically spends a lot of money on socially destructive activities.”

Yet both Obama and congressional leaders remain worryingly silent on the role of the insurance industry, despite their rhetorical shift from health care to health insurance reform. Hence they struggle to devise a sustainable cost trajectory for their proposed reforms, which are weighted down by the immense costs of keeping private insurance corporations in business. These costs include profits and corporate salaries, plus the even greater amounts wasted on underwriting and marketing to exclude people who might actually need care, and on claims administration to deny care to those who have already paid for it. To help meet those costs, reformers have proposed a requirement on all individuals to purchase an insurance policy, which amounts to a massive bailout for an industry that has continued to make record profits and is accountable only to its shareholders. Such public subsidies to the industry, via policyholders, constitute the greatest cost factor in any of the bills under discussion, yet they fail to guarantee access to health care for all. Even under the best proposal, people would still have to pay up to 11% of their income in premiums for a skimpy policy, on top of co-pays and deductibles. These provisions illustrate that the economic costs of sustaining the private insurance industry can only be paid through the social costs of restricting access to care to those able to pay.

Always on public relations alert, all key industry players – hospitals, pharmaceuticals and insurers – claim to have made concessions that would curb the excesses of the market and sustain the policy consensus for commodified health care. Yet smoke and mirrors cannot hide that market-based health care is inherently unable to contain costs at the same time as ensuring access to quality care for all. Even the President accepts that universal coverage is not possible without a publicly funded and administered system, such as single payer, that automatically includes everyone. Such a system would treat health care as a public good rather than a market commodity, and enable access on the basis of need, not payment. Guided by the principle that basic human needs give rise to government human rights obligations, such a public health care system would be financed collectively in order to meet people’s health needs with equitably shared resources. Instead of providing profits and benefits to a few, a rights-based system would enrich everyone living in a healthier society.

This report, which compiled past scientific work on the effects of climate change, also warned that severe weather events, along with the physical and mental health problems associated with them, are likely to increase, especially in countries with less developed public health systems. In general, vulnerable groups such as the elderly, children, and people living in poverty experience more severe health effects from climate change. The report states that “[t]he greatest health burdens related to climate change are likely to fall on the poor…” because they often lack resources and choices in their ability to avoid harm. In particular, the report noted that the poor and elderly faced the most severe circumstances during Hurricane Katrina, and that Native Americans are uniquely vulnerable to global warming because they often rely on reservation land for their livelihood and cannot easily relocate.

A second report, from the Global Humanitarian Forum, calls climate change a “silent crisis” that kills 300,000 people each year and displaces 26 million more. The vast majority of these deaths occur in developing nations, although the world’s 50 Least Developed Countries contribute to less than one percent of global emissions. Women and children are hit particularly hard by displacement caused by climate change. Further, the report suggests, climate change threatens to undermine each of the eight global Millennium Development Goals. More than one third of the population is currently vulnerable to climate change, most of these people living in “the semi-arid dry land belt [of sub-Saharan Africa], easily flooded regions on the Equator, and glacier regions.” People in these areas are especially vulnerable to drought, melting ice sheets, floods, storms and sea level rise.

Climate change is also increasing the spread of diseases globally. For example, Lyme disease, once believed to be eradicated in the US and Europe, has now reappeared with warmer temperatures. Similarly, mosquitoes carrying malaria are now able to thrive in previously colder climates, where populations have little natural resistance.

The report also discusses how climate change is likely to increase and intensify poverty globally, as the poor have little access to safety nets such as insurance against damage or disaster. Changes that negatively affect agriculture, fishing or tourism can lead to significant loss of income, and it is estimated that over ten million have already sunk into poverty due to climate change.

The release of these reports coincided with the start of discussion in the US House of Representatives on the new climate and energy bill, the American Clean Energy and Security Act (see full act here).The House passed the bill on June 26 by a narrow margin, and it is now in discussion in the Senate. However, many environmental groups warn that, if passed as currently written, the bill will not go far enough in preventing catastrophic events.

See more:

Climate Change and Global Health: Quantifying a Growing Ethical Crisis

Suffering the Science: Climate change, people, and poverty

Climate-Change Report: From Bad to Worse

Study: A Fairer Way to Cut Global CO2 Emissions

CBO: Climate bill costs to be modest

The Human Cost of Climate Change

The Carbon Counter

During four visits to Haiti, Farrell documented the plight of victims who faced blow after blow of hurricanes and tropical storms, on top of existing suffering in the poorest country in the Western hemisphere. His photographs helped raise international awareness of the damage wreaked by the storms and of Haitians’ struggle for survival.

Since the storms, agriculture has far from recovered, children are severely malnourished, and heavy deforestation will allow hurricanes to continue to devastate the poor nation, according to IPS. Although people are no longer lying dead in the streets, the world should not forget about Haiti.

To view Farrell’s moving photographs, click here.

More links below the fold.After Hurricanes, How To Heal Haiti – NPR, Mar 2009

‘We are going to disappear one day’ – Guardian, Nov 2008

“Haiti’s Unnatural Disaster”, interview with Dr. Paul Farmer – Haiti Action Committee, Sep 2008

Read and hear coverage of this report from 89.3 KPCC, NPR Radio in Los Angeles!

Their call to action, Taming the Perfect Storm, is a unique, ambitious, and pragmatic example of “Health and Human Rights in Practice.” Beginning with the recognition that fundamental rights for individuals who are either homeless or at-risk for homelessness are not being fulfilled by the nation these residents call home, this collaborative report uses a human rights framework to its full advantage. The report moves from a broad understanding and comprehensive analysis of the problems faced by residents of South Los Angeles to specific recommendations to address the health – and human rights – needs of a vulnerable population.

The methods used in this report – analysis of interactions between local laws, economic policy, policing efforts, and other social determinants of health; extensive interviews and ethnography listening deeply to those in need; and clear recommendations based on a human rights approach – can be used by communities anywhere.

We hope you will read the full report (by clicking on the cover above), not only for what it specifically reveals but also for the methods and analytic approach used by the South Los Angeles Homelessness Prevention and Intervention Collaborative. This model can be used to understand and begin to address a wide range of problems, wherever human rights are a concern. As stated in the report, “Combining the treetops of international declarations and human rights law with grassroots advocacy and know-how, a South Los Angeles Human Rights Approach to Health can be transformative.”

We would like to draw particular attention to a novel advocacy tool, the South Los Angeles Declaration of Health and Human Rights. It is exciting to imagine human rights declarations coming from communities around the United States – indeed around the world – as they will come from South Los Angeles.

Rishi Manchanda, MD, MPH and Evan Lyon, MD

From the Executive Summary

This report is the product of a unique South Los Angeles-based coalition of health service providers, community health workers/promotoras, tenant organizers, and affordable housing and civil rights advocates. The complex problem of homelessness and poor health in South Los Angeles is shaped by key local housing, health and law enforcement policies and conditions, some of which we have identified in prior work and continue to address.

Service providers, organizers and advocates in our collaborative have all witnessed the deleterious health and human rights impact of a recent series of public ordinances and law enforcement initiatives in South Los Angeles and Skid Row which disproportionately and often unjustly affect extremely poor and homeless persons. These programs have combined with other powerful trends, including the scarcity of local permanent supportive and affordable housing, the displacement of homeless and low-income residents due to gentrification downtown and along the Figueroa Corridor, evictions and the foreclosure crisis, the closing of Martin Luther King Jr.-Harbor Hospital, the historic underfunding of South Los Angeles community clinics by the Los Angeles County Department of Health Services, and the weakening of the local public health safety-net. Together, these forces have created a perfect storm for the homelessness and health crisis in South Los Angeles. Now, as the federal banking and credit crisis unfolds, South Los Angeles has become a bellwether for the nation, highlighting the fundamental challenges facing America’s increasingly stressed communities.

We conducted surveys of homeless individuals and service providers to document and define this perfect storm more clearly. Results from our work highlight the direct impact of damaging policies and trends on the health of homeless persons living in South Los Angeles.

Of the homeless persons we surveyed in South Los Angeles:

• Only 28% indicated that they had a usual source of medical care.
• 38% reported having a mental health condition.
• Nearly half (46%) reported a need for dental care in the past year. However, 59% of those who needed dental care did not receive it.
• 32% of those who reported receiving medical care at Martin Luther King Jr.-Harbor Hospital within the past two years indicated that the hospital’s closure decreased their ability to get medical care.
• An astonishing 42% of those who rented in the last five years became homeless because they were unable to afford a rent increase.
• Nearly 3 in 10 homeless individuals have experienced an eviction (27%).
• 1 out of every 3 (34%) homeless individuals reported having had an interaction with law enforcement in the past year.

This report from the South Los Angeles Homelessness Prevention and Intervention Collaborative (HPIC):

• Develops a common language to understand the health impact of current trends in housing availability, displacement, law enforcement policy, and health services in South Los Angeles
• Provides important evidence of the health needs and experiences of homeless individuals and service providers in South Los Angeles based on original community-based participatory research
• Offers a human rights approach to health to equip advocates, service providers, policymakers, and media to better address poor health and homelessness in South Los Angeles
• Offers specific recommendations to improve health and homelessness in South Los Angeles

(Note: For a description of the specific policy recommendations contained in the report, please click here or on the cover image above.)

From Solutions, concluding “Taming the Perfect Storm”

The perfect storm of homelessness and poor health in South Los Angeles requires a powerful human right to health approach that can engender the broad-based support and political will necessary to implement long overdue, desperately needed solutions. Using this rights-based framework, we highlight key policy changes, outlined below, that target each major element of the perfect storm. These changes must occur if health and human rights are to be protected in South Los Angeles.

Shift the Policy Debate and Generate Political Will to Tame the Perfect Storm in South Los Angeles

Outlining policy prescriptives alone is not sufficient for the pressing task of preserving and restoring a healthy community in South Los Angeles. If we hope to leverage our voices to implement these policies effectively and equitably, our collective approach to homelessness and poor health in South Los Angeles will require a catalyst to shift the policy debate.

Adopt a Human Rights Approach to Health

As our community of service providers, advocates, policymakers and patients begins to understand the determinants of health and homelessness outlined in this report, the human rights approach to health described in this report offers a powerful method to turn awareness into political will and take specific, much-needed action. Combining the treetops of international declarations and human rights law with grassroots advocacy and know-how, a South Los Angeles Human Rights Approach to Health can be transformative. Such an approach demands that stakeholders shatter stereotyped, dehumanizing views of poor and homeless persons and unproductive and unhealthy silo-based approaches and, in their place, construct sound health, housing and law enforcement policies that respect our shared rights and responsibilities.

Share and use a common language

Innovative and powerful strategies to accelerate current efforts to tame the perfect storm of homelessness and poor health in South Los Angeles are required. Our collaborative believes that the first step of any local strategy involves the building of a common language among varied South Los Angeles constituents. As outlined earlier in our report, providers, patients, policymakers, and advocates can begin by using the vocabulary of “social determinants of health” to address the economic and social conditions which determine health in South Los Angeles.

The South Los Angeles Declaration of Health and Human Rights

We propose that one of the first grassroots advocacy efforts of the Human Rights to Health Approach be the development of the South Los Angeles Declaration of Health and Human Rights. Loosely adapted from the Universal Declaration of Human Rights, we envision that the South Los Angeles version will be developed in a participatory process, informed by patient and client experiences and endorsed by local service providers, advocates, and policymakers. This process will help build a broad coalition to address homelessness and health in South Los Angeles and generate needed fresh political will, media attention, and broader support.

Conclusion

In the nation as a whole, persistent widespread homelessness and the health care crisis offer compelling evidence of a collective disregard for human rights. Few places exhibit the ill effects of this disregard like South Los Angeles. Conversely, no other community stands to benefit as much from a community-based human rights approach to health. With a firm understanding of the links between critical determinants of health like housing, public and community health resources, and law enforcement policy, we commit to build the political will and skills needed to tame this perfect storm of homelessness and poor health. In short, we commit to reclaim and redefine our community guided by the practical application of fundamental human rights principles. As an important stage of community dialogue on the right to health, housing, and security begins, we welcome all constructive comments and critiques of this report.