Monthly Archives: September 2009

Go Out & Make Me Do It

Below is an email about federal health reform circulated to the comm-org listserv by Peter Dreier, a very thoughtful scholar of urban inequality and community organizing, that is right on as far as our mission as progressive health advocates is concerned.  Please share this with your networks and do all you can in the coming weeks and months to ensure that we see meaningful health reform in the country and in our communities.

Friends and Colleagues:

I’ve posted this column, Go Out and Make Me Do It, on Huffington Post last night. It is an analysis of Obama’s speech on health insurance reform. I said it was a call to action, emphasizing that he opened the door for activists to mount a ground war to take on the insurance industry and push Congress — especially the handful of recalcitrant Democrats — to support a public option. The title is one of my favorite political quotes: FDR’s request, said to activists who lobbied him to be bold, to go out and make me do it.

Here’s the link to the article:

Also, here’s an op-ed column that Marshall Ganz and I wrote for the Washington Post two Sundays ago: We Have the Hope. Now Where’s the Audacity??

You will probably get lots of emails in the next few days from various organizations urging you to contact your Senators and Congressmembers, support organizations mobilizing people to push for reform, and spread the word among your friends and other contacts.

I encourage you to ramp up your activity in the next few weeks and months.

A great source of information about the grassroots campaign for health care is the website of Health Care for America Now (HCAN), the key coalition spearheading the organizing work. They will be looking for people to join the effort in many ways, from donating money, to contact Congress, to participating in rallies and vigils.

Please do what you can. We have an historic opportunity to bring about progressive change and make decent, affordable health insurance a right, not a privilege.


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Why Language Access Matters

This post, by NYLPI’s Health Justice Director, originally appeared on the blog of the National Campaign to Restore Civil Rights.

Every person who reads this likely speaks English, and speaks it well.  Whether we are people of color, people with physical disabilities, members of a religious minority, women, gay, working class or poor, we stand with the vast majority of America in that we enjoy “English privilege.”  Practically speaking, English privilege means this: For over 24 million people in the United States, it is difficult and sometimes impossible to get jobs, hold jobs, feed their families, vote in an election, be on a jury, make doctors’ appointments, take medication, use the courts, receive an education, get a home, keep a home—basically, participate in all of the ordinary and extraordinary features of American life—because they do not speak English.

Consider the experience of María Angela C., a Spanish-speaking woman from New York City who is in the process of learning English but hasn’t mastered it well enough to understand complicated health information.  One day, her 5-year-old son broke out in hives due to an allergic reaction.  She rushed him to the doctor, who wrote her a prescription but did not explain how to take the medication.  When María Angela went to the pharmacy to fill the prescription, the pharmacist also failed to explain how to take the medication and handed her a bottle with instructions in English only.  María Angela took the bottle home, opened it and saw a pink liquid that resembled “pepto,” so she surmised that the medication should be administered orally.  After her son took a spoonful, however, he reacted with extreme disgust, and María Angela became nervous.  She asked a neighbor to translate the label and learned that the medication actually had to be applied topically.  María Angela was devastated.  Her son risked another allergic reaction, or worse, due to the fact that the health care delivery system that she encountered operated in English only, and she did not (yet) have the English-speaking ability to navigate it safely.

María Angela and her son faced a barrier to equal health access, to a basic human need, that the rest of us take for granted.  Though many Americans have felt powerless and overwhelmed in the U.S. health care system, most of us have probably not felt silenced – quite literally unable to ask for or receive help because of the language we speak.  Fortunately, civil rights laws are in place to break this silence.  Title VI of the Civil Rights Act of 1964 prohibits discrimination on the basis of national origin, which includes language.  In the health care context, this means that hospitals and pharmacies must provide interpretation services and translated medication labels to ensure that individuals such as María Angela can access health services with the same hope as the rest of us: that it will improve well-being, not further compromise it.  Unfortunately, the Supreme Court has, in recent years, begun to interpret the law in such a way that this right to equal access does not have an adequate remedy.  In the 2001 decision of Alexander v. Sandoval, a case about an English-only amendment to the Alabama state constitution, the Court held that private individuals cannot sue in federal court for violations of Title VI unless they can show that they were the victims of intentional discrimination – that is, if they can point to something like a “Whites Only” sign on the front door of the pharmacy.

put the kibosh on virtually all federal litigation under Title VI in the health care arena, among many others.  Advocates have sometimes been able to work around the problem.  For example, our Health Justice Program (HJP) represents Make the Road New York, a Latino community-based organization in New York City, and has successfully approached  government agencies such as the state Attorney General’s office to compel investigations of and settlement agreements with national chain pharmacies that do not provide interpretation services and translated medication labels for their non-English speaking customers.  We have also drafted and lobbied for the passage of language rights laws that would compensate for the erosion of civil rights protections at the federal level.  In fact, this morning, New York City’s Mayor Bloomberg signed the Language Access in Pharmacies Act, which will ensure that, in the future, María Angela and her son can use pharmacies in the five boroughs and have their rights to language assistance services respected.

But what about people living in areas where government agencies are not as receptive to the claims of linguistic minorities, and where local elected representatives do not have the same numbers of immigrant constituents holding them accountable?  What about people like Baltazar Cruz, who went to a hospital in Mississippi to give birth and ended up having her child taken away from her because she didn’t speak English?   In these cases, re-opening the doors of the federal courthouse is crucial.  Language rights are, fundamentally, civil rights, which should have a remedy in every part of our country.  And leaving your health care provider with an understanding of how to care for your child, with that child still in your arms, is a basic right; it should not be a privilege.

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Place Matters

A recent article in the American Prospect about the De-Facto Segregation of Health Care has been getting a lot of attention, at least in the media that we read, and for good reason.  It points out the uncomfortable truth that race matters in health care, which means, in part, that place matters too.  As the article notes:

Ongoing de-facto segregation has a profound effect on the quality of care to which people of color — insured or otherwise — have access. While the health-care bills being debated in Congress would expand access to and quality of care for people of color, ultimately racial health disparities can’t be eliminated without better distribution of health resources.

Consider a community in which we do a lot of work: Southeast Queens.  Take a look at this map, lifted from a website developed by our friends at the Opportunity Agenda:


This is a slice of Queens that represents the dividing line between the Northwest and the Southeast of the borough.  The darker an area is shaded, the higher the percentage of people of color living in that area.  De-facto segregation, anyone?  Now check out those little plus signs, which represent hospitals.  Notice how few–i.e. none–of them are actually located in the darker-shaded portion of the map.  And, in fact, one of the hospitals right on the border recently closed — a common occurrence in communities of color across the country.

Now compare the availability of hospitals and the demographics on the Southeast side of Queens to the east side of Manhattan:


The absence of hospitals in Southeast Queens, and their over-abundance in white communities of the city, would be less of a problem if people in the area could actually access the primary or preventative care they need to prevent hospitalizations and trips to the emergency room.   But, of course, the lack of hospitals isn’t the whole story.  The New York State Department of Health recently issued a report on health care services in Queens, which notes that Southeast Queens has the lowest ratio of doctors to population in the entire borough.  There are 48 full-time equivalent (FTE) primary care doctors per 100,000 population in Southeast Queens compared to 132 FTE’s per 100,000 in the Flushing/Clearview area.  This report also indicates that there are 75 primary care clinics in Queens, but of the 75 clinics listed only 40 could be confirmed as primary care clinics available to members of the community at large.  Several of the clinics are for special populations only (e.g. children, women), and of the remaining 40 primary care clinics, only 22 are located in Southern Queens.

Pointing out geographic and resource disparities like this isn’t just a complaint about who-gets-what; it is a matter of life and death for many.  As the American Prospect piece notes:

Even when people of color are covered [by insurance], their access to quality care is diminished heavily by ongoing segregation and poverty; in nonwhite neighborhoods, it’s simply harder to find a primary provider than it is in white neighborhoods. The facilities that exist are often of lower quality and lack the resources institutions located in primarily white areas have. What this means is that even when minorities are covered by health insurance, they’re less likely to have quality care and less able to afford the associated out-of-pocket expenses — and the results are staggering.  Children born to black women are more than twice as likely to die within their first year of life as are children born to white women. This disparity is unaffected by income or education level.

So, what can be done?  Well, many things, but in Southeast Queens the most immediate action is being taken by a community coalition we work with called Southeast Queens United in Support of Health Care (SQUISH).  When the State Department of Health published its report, it also announced that $30 million would be available in grants to develop health care services in the borough.  SQUISH is reaching out to elected officials, community residents, local health care providers and the media to raise awareness about the need for some of that funding to be directed toward Southeast Queens.  For a list of SQUISH’s asks, check out their talking points.  Because green shouldn’t always follow white, and where you live shouldn’t be one of the primary determinants for how soon you die.


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