Wait... So These People Are The Threat?

"Fidelity": Don't Divorce... from Courage Campaign on Vimeo.

Anyone who voted for or supported Proposition 8 should be ashamed. How could the love and cheer expressed by these families be a threat to anything except intolerance and bigotry? I, for one, believe that justice must not be denied. People should have the right to live a life they have reason to value, free from violence and hatred. Like all policies based on hate and ignorance, Prop 8 will eventually be overturned and will fall into memory. Don't believe you have all the answers. Don't be on the wrong side of history. Denying rights to a group based on outdated biases never remains unchallenged. Respect the rights of others to live a life that challenges yours, its the only way the world ever changes for the better.

Coincidence?

With the Republican Party flailing and try to find its way in an evolving political landscape, the election of Michael Steele, the first African-American to lead the party, smacks of the Palinism (picking someone because they bare a superficial resemblance to some popular candidate) that seems to be pervading Republican decisions. While I hope the move is a genuine sign of change, I hesistate to imagine that being likely. With around 95% of African-American voters voting for Obama and, similarly, an overwhelming majority of Latinos (around 66%), Republicans have a lot of work to do in order to appeal more widely. As the U.S. demographically shifts to being a minority majority country, the increasingly white, rural, ultra-conservative, and xenophobic GOP of people like Rush Limbaugh will not suffice. At this point I honestly can't imagine how this change would take place, and it will take a lot of soul-searching on behalf of Republican leaders to bring about such a large change in strategy. 

However, though Democrats clearly came away with a huge victory this year, supporters need to be wary here as well. While many in the Democratic party speak of grassroots change and reference progressive issues, when the time comes to defend those issues, they are often forgotten. The most recent example was a provision in the stimulus package that would have subsidized birth control and family planning services for the poor. This measure was lambasted as shelling out millions of dollars, when in actuality, all real estimates highlighted that it would save the U.S. far more money than it would cost. At the first sign of protest, Democrats dropped this provision from the bill without so much as a fight, only to not even be able to garner ONE Republican vote for the stimulus in the house. This rapid capitulation doesn't bode well for the rest of the session, I hope I am proved wrong.

I guess it doesn't take long for optimism to die...

Fairness vs Injustice

Issues of race, gender, and ethnicity have been a hot issue in recent weeks. Many in the media are writing about whether the election of Barack Obama represents the beginning of a "post-racial" America. This notion, that race no longer defines a person's status and trajectory, is in theory interesting but in reality serves only to further marginalize those who suffer under the yoke of injustice. The very fact that it is such a big deal to elect an African American president speaks to the fact that we have not come as far as many seem to hope. 

Race and ethnicity have always been tricky and taboo subjects not only in the U.S. but around the world. Most people take race as a given category that people fit into, largely ignorant of the fact that races and ethnicities are socially constructed. By socially constructed I am referring to their origin in the historical context in which the categories are created and then changed over time. For example, in many countries in Latin America, race is viewed extremely differently. In some countries there are fifty or more gradations of perceived ethnicity on a spectrum of white, black, and indigenous. In many of these countries, while skin color is taken into account, other factors like wealth, dress, and social status serve to determine a person's "true" ethnicity.

We often lose sight that when we talk about someone being African-American or White, that these categories lack real meaning and are just the most current incarnation of labels. To try to homogenize such diverse groups of peoples into simple categories often leads to spurious assumptions. For example, the issue of hypertension in African Americans is often tied to a variety of things, from genetics to adaptive selection during slavery. However, these simple notions break apart when we understand that genetic differences between any two given African Americans are larger than between any given African American and a person of any other race. We know definitively that the genes that affect skin color have nothing to do with hypertension, particularly on the large scale that is proposed. However, social forces have been found to be the most likely candidate for being the reason for higher rates of hypertension. Feelings of stress/anxiety and perceptions of discrimination have been found to play a major role in creating higher rates of hypertension among almost all populations. This has been found to be particularly true among African Americans. I don't for a moment want to imply that just because these categories are socially created that they do not have power. They have real power in how people are treated, how they are perceived, and even how they perceive themselves. However, their overwhelming power does not mean that knowing they are socially constructed is fruitless. It allows for a better understanding of what can and must be done to bring about a more just and equitable system.  

I don't want any of the above to take away from the overwhelming happiness I feel about Barack Obama being elected President, but we have to keep in mind the vast inequities suffered by African Americans and other marginalized populations. There is much work to be done, and understanding where we stand is a good place to start.

Books!!

It is an interesting time to be in Washington D.C., particularly working on issues of health and health care. I look forward to seeing how things play out with so much talk of health reform going around. I recently picked up a few books and reread some old ones that I think help create a good foundation of knowledge about the challenges and possibilities for health reforms in the coming years. I wanted to highlight four that I think are great reads:

The first and probably most approachable book is Critical: What We Can Do About the Health-Care Crisis by Senator Tom Daschle (with Greenberger and Lambrew). This book is a good primer for the upcoming health care debate, and is extremely timely (making it somewhat hard to find at a bookstore...) given that Daschle will likely be the next head of the Department of Health and Human Services. Daschle, an experienced former Senator, brings a unique perspective to the discussion and highlights the plight of real Americans using poignant and illuminating examples from people he has interacted with during his long career of public service. The book does a good job providing a clear overview of what must be taken into account and what reforms should be made. It is written in a very engaging manner and would be a great read for anyone even vaguely interested in one of the possibly largest overhauls to the U.S. government in history.

The second book is Health Care at Risk: A Critique of the Consumer-Driven Movement by Timothy Jost. Jost is a law professor but the book reads more like a thriller (well, maybe not for most people...). He paints a clear picture of the rise of the consumer-driven health movement and highlights its intellectual as well as political origins. While it would seem that consumer-driven health would be the focus of the book, in fact, that is only one part of the overall story. Jost constructs the most clear and concise narrative I have found about the rise of the current U.S. health care system and how truly exceptional (not in a good way, by most accounts) the American system is. He does a good job identifying the common conceptions that people have about health care and the possible solutions. His analysis questions many of these assumptions and forces us to think critically about the goals of health care and what those goals would mean for reforms.

The third book is Governing Health: The Politics of Health Policy by Weissert and Weissert. The book is the best source I have seen that lays out the different actors and interests that play a role in the health care debate. Each of the key players (Congress, the President, interest groups, etc.) is explored at length, including their often contradictory and nuanced stances and perceived interests. Written by two political scientists, the book provides an excellent overview of the factors that are likely to come into play during any health care debate, particularly one that would entail wide-ranging reforms to the system. The actual policy process is also highlighted, something that is often discounted when people talk about what should be done when it comes to health. Taking into account the feasibility of particular reforms will be key for the new administration and any advocates of reform.

The final book is Why Are Some People Health and Others Not? The Determinants of Health of Populations, edited by Evans, Barer, and Marmor. This classic book is a personal favorite. It expands the notions of health away from just health care by examining the importance of how society is structured and its implications for health. The book highlights growing congruence among a number of fields that identify health issues that cannot be explained simply by differences in care or sanitation or wealth. It highlights the importance of factors like hierarchy, genetics, and structural issues that play an important role in determining not just health outcomes but also opportunities for care and even understandings of what it is to be sick. Many of the ideas underlying this book played a key role in my graduate work.

If there are any books that you have found helpful to understand health or health care, please let me know as I am always looking for new sources on the subject.

Hard To Imagine How The NRA Can Spin This

A recent study which was underwritten by more than 300 U.S. mayors has uncovered some extremely damning evidence about the link between lax gun laws and legal guns ending up being used in crimes. The study makes clear that 10 states with lax gun laws are responsible for over 50% of guns used in crimes across the U.S. This number should be staggering and the repercussions swift. This sort of dangerous funneling of weapons to be used in crimes cannot be allowed to continue. While people will continue to argue that it is not the guns that commit the crimes, it is clear that access to guns is providing the ability to carry out many crimes. It is hard to imagine how anyone reading the report could come to the conclusion that gun control does not have a positive effect on reducing the amount of guns in the hands of criminals. Particularly deplorable was the cover-up pushed by the industry to keep this data from seeing the light of day. To know that such data exists and to try to censor it is despicable and calls into question how dedicated to safety those involved really are.

It isn't just purchasing guns intended for use in crimes that is making headlines. In the same days as the above-mentioned report was released, this story came out as well. I cannot imagine how horrible all those involved must be feeling at this moment. It is difficult to imagine such a senseless thing, all because a weapon was being treated as a source of entertainment. Why an eight year-old would be allowed to fire such a deadly weapon is beyond me. I hope people learn to respect the dangers that guns pose and accept that they must be regulated for public safety. Together these two articles highlight what many researchers in a variety of fields (including public health, criminology, sociology, economics, and others) have found, that guns must be regulated and that protections must be in place to keep guns out of the wrong hands. Clearly many states are failing on this issue and must be brought to task.

Dangerously Heightened Expectations

With the election of Barack Obama, a international outpouring of support has increased the already immense pressure on the 44th President-Elect. Congratulations have come from the most unexpected places, including the President of Iran (who now feels spurned by the Obama camp's tepid response). Different groups around the world are placing expectations and ideas at the feet of Obama hoping that he will become involved and help solve problems. On one hand, this invitation to multilateralism is breathtaking. It is amazing to see that even the international community believes that America can and will be better under the leadership of Obama. However, together with the expectations domestically, it is hard to imagine how Obama can make all groups happy within the grace period of his early campaign. Obama stands on the cusp of being the most important president in America's history. The possibility of making the U.S. more accountable and multilateral is a dream that many have hoped for for decades, particularly during some of the recent dark years America has faced. People around the world have placed their hopes and dreams on his administration and it is difficult to imagine how it can meet expectations. 

A recent article by one of my favorite journalists, Ahmed Rashid, author of the recent book Descent into Chaos (which focuses on the war on terror in South Asia, primarily Afghanistan and Pakistan), sheds light on some of the massive expectations Obama faces. Reading through the article I was struck by just how much different factions in different conflicts are focusing on every word Obama says, in hopes of identifying what his presidential and international priorities will be. Particularly interesting was the quote by an unnamed European foreign minister that European countries will be unable to refuse anything Obama asks for in the first six months of his administration. There is such a massive amount of power in that statement. I cannot imagine any president in recent times being charged with such a great and also dangerous burden.

An America I Can Believe In

In what has to be the most historic election in a generation, Barack Obama has become the president-elect of the United States. It is hard to imagine how such an unlikely candidate had such a meteoric rise to success. I will be the first to admit I questioned Obama in the primaries. Initially I was a Kucinich supporter (a long shot, but one of the only beacons of true progressivism in a party bogged down by greed and avarice). After his withdrawal I changed my loyalties to Clinton. Having met her personally and believing that she had the strength, experience, and political capital needed, I felt she would also be the best to face whatever Republican was chosen. Now, unlike many Clinton supporters, I never fell into the rancorous denouncements of Obama and genuinely felt that either would do a reasonable, centrist job as president. I felt safe with either of them but not particularly inspired. Sure they were both historic candidates in a year the Democrats stood a good chance of actually winning, but it is always hard for me to vote for centrism. This country has been governed by the fifty-one doctrine for too long (playing to the middle in an attempt to eek out the election with just enough votes). This doctrine has often meant proving who was the most centrist, the most moderate. As a leftist progressive, this placation often struck me as dumbing down the election, and also hindering a genuine vision of a better future. I began to see that Barack Obama was trying to transcend the old language of elections. He spoke to the youth in a way that didn't seem placating or insulting. He gave people the opportunity to inform themselves on complex issues and expected that they would respond. He called for national service, in a country that is facing hard times and an uncertain future. He made me believe.

It is hard to sum up how amazed I am looking at the electoral map in today's Washington Post. Seeing how many states ended up blue and how many of the red states are closer than anyone could have imagined even two years ago. I was amazed to see Obama do so well in my home state, Montana, a rural homogeneous state. It makes me question my own and many other cynics' interpretations of the possibilities for a sustained grassroots movement in America. Many first time voters must feel empowered by the success of their campaign of choice. It will be important to keep these citizens involved in the process as it moves forward and to get them to understand that democracy is not just voting. Only through a sustained national movement can real change be accomplished. I feel optimistic about politics for the first time in a long time, and I am really excited that I will be in the middle of it.  Heather and I are already making plans to be at the inauguration. It will be exciting to play an important role in the health care debate and to have the real likelihood of actual reform. It is a historic time, and a great time to be in Washington D.C.  As one person who always had a hard time believing in hope, I say this with complete conviction: Yes, We Can!