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Sweltering Temperatures Take Toll on the Most Vulnerable

V. Kelly Turner, associate director of the UCLA Luskin Center for Innovation, spoke to NBC4 News about the impact of Southern California’s heat wave on groups that are particularly vulnerable due to age, disability, low income and access to transportation. “I think about the sensitive populations who lack the resources or capacity to adapt when it gets really hot,” said Turner, who leads a research group focusing on policy approaches to protect people from extreme heat. “But I also think about people who are spending a lot of their time in settings where they’re exposed to too much heat. So that could be something like taking public transportation and being at a bus stop with no shelter.” In sweltering temperatures, she said, “we know that women are more likely to have preterm births. We know that children’s learning outcomes are degraded. We know that elderly are more likely to fall down.”


 

Gilens on Medical Debt and the ‘Centuries-Long Suspicion of the Poor’

UCLA Luskin’s Martin Gilens spoke to KFF Health News and NPR about hesitation among some members of the Black community to use crowdsourcing sites for help covering medical debt. An estimated 100 million people in the United States are burdened by health care debt, with Black Americans at particular risk — yet they are far less likely to seek assistance from sites such as GoFundMe, the news organizations found. Pride and a reluctance to reinforce negative stereotypes are among the reasons. As Gilens, author of “Why Americans Hate Welfare,” explained, “There’s a sort of a centuries-long suspicion of the poor, a cynicism about the degree of true need.” In recent decades, poverty has been cast as a Black problem, even though there are far more white Americans living in poverty, according to census data. This helped drive a backlash against government assistance programs in the 1980s and ’90s, said Gilens, a professor of public policy, social welfare and political science.


 

Lifting of Blood Donation Ban Will Save Lives, Address Stigma

Ayako Miyashita Ochoa of the UCLA Luskin Social Welfare faculty wrote an article for The Conversation on the U.S. Food and Drug Administration’s easing of restrictions on blood donation by gay and bisexual men. The last documented HIV transmission through a U.S. donor’s blood occurred nearly 15 years ago, Miyashita Ochoa wrote. While precautions around HIV exposure were reasonable in the 1980s, “the science has changed,” she said. The lifting of the ban will lead to an estimated 2% to 4% increase in the blood supply, potentially saving more than a million lives. She added, “Removing gender and sexual orientation from the risk assessment for blood donation will take the U.S. one step further in addressing stigma and discrimination against men who have sex with men.” Miyashita Ochoa also discussed the issue on WOSU’s “All Sides” (beginning at minute 37), commenting that COVID-19-era blood shortages spurred the move toward science-based policies that ensure that supplies are safe and sufficient for the nation’s health needs.


 

Lens on Mixed Results of Efforts to Combat Housing Segregation

Michael Lens, associate professor of urban planning and public policy, co-authored a Health Affairs policy brief about the effectiveness of different programs designed to combat residential segregation. Over more than a century, exclusionary policies embedded in land use and housing codes have kept Americans separated by race, ethnicity and income, leading to significant health disparities. The authors review the historical impact of several interventions, including housing vouchers that allow residents to move to more advantaged neighborhoods; local and state policies to expand the housing stock by increasing density in resource-rich communities or redeveloping public housing; and federal legislation and regulations to compel fair housing practices. “There are many policies, programs, laws and lawsuits that have tried to chip away at segregation in America’s cities and towns,” but many have been underfunded or deprioritized, the authors wrote. While some progress has been made, they conclude that the fight against residential segregation has yet to see consequential gains.


 

Shining a Light on Hidden Corners of Environmental Injustice Catherine Coleman Flowers fights for the health and dignity of rural communities where water and sanitation systems are failing

By Mary Braswell

Catherine Coleman Flowers calls it “America’s dirty secret” — the lack of decent sanitation systems in many rural communities where residents must live alongside their own sewage.

It’s a public health calamity that takes the highest toll on poor people of color, and Flowers has made it her life’s calling to shed light on these appalling conditions found in one of the world’s wealthiest nations.

Her work, which began in Lowndes County, Alabama, where she grew up, has now become a national movement with echoes around the world, vaulting her into the top tiers of environmental advocacy and U.S. policymaking. Flowers shared the triumphs and frustrations of her journey, and the work yet to be done, with a UCLA audience as part of the Meyer and Renee Luskin Lecture Series on April 27.

“Catherine has found that the problems of inadequate water and sanitation infrastructure reach across rural America, including California, and these problems … are tied deeply to systems of racial and class oppression,” said Megan Mullin, professor of public policy and faculty director of the UCLA Luskin Center for Innovation, as she introduced Flowers to a packed room at the university’s Kerckhoff Hall.

In addition to founding the nonprofit Center for Rural Enterprise and Environmental Justice, Flowers has received a MacArthur Foundation “genius” award and serves as vice chair of the White House Environmental Justice Advisory Council. A week before her Luskin Lecture, she introduced President Joe Biden as he signed an executive order making environmental equity a priority of federal agencies.

Flowers works with policymakers, researchers and advocates around the country, earning her a spot on Time magazine’s list of the 100 most influential people in 2023. But she told the UCLA audience, “I’m better being out in the community because that’s where my strength is, to help people tell their stories when they wouldn’t be listened to otherwise. …

“Who wants to talk about sewage coming back into your home? Most people won’t do that,” she said. “But now we have to because we don’t have a choice.”

‘Is it possible that there could be diseases in the United States that American doctors are not trained to look for? Because we have not even acknowledged that we have a problem of sanitation in this country.’

Flowers told of impoverished rural communities where residents are by law responsible for disposing of their sewage. Some people own septic tanks that have fallen into disrepair, pushing waste back into sinks and bathtubs. Others simply cannot afford the systems and instead pipe their sewage underground or onto nearby land.

At times, those with substandard waste systems are hit with fines or imprisonment in a system that reveals the interplay of economic, health and criminal justice inequities.

The sanitation emergency has been made more acute by climate change, with its flooded coasts and rising water tables, Flowers said. And the COVID-19 pandemic has highlighted public health risks that threaten rural and urban areas alike.

“One of the things that COVID has taught us is that we have to deal with these issues or the next disease is not going to come from China and a wet market, it’s going to come from somebody’s wet backyard that has sewage on the ground,” she said.

Flowers told of a rash she developed after being bitten by mosquitos near a pool of untreated sewage. Her doctor and a dermatologist could find no cause and offer no relief, so she contacted an infectious disease expert.

“Is it possible that there could be diseases in the United States that American doctors are not trained to look for?” she asked him. “Because we have not even acknowledged that we have a problem of sanitation in this country.”

The experience led Flowers to partner with researchers on a peer-reviewed study of the health of Lowndes County residents. It revealed that a third of those tested had been infected by hookworm, an intestinal parasite associated with poor sanitation and thought to have been eradicated in the U.S. decades earlier. The findings were covered by media around the world, and the United Nations special rapporteur for extreme poverty and human rights came to Alabama to investigate.

“The people of Lowndes County, by speaking up and telling the truth, have given a lot of other people permission to talk about these problems as well,” Flowers said.

Her Luskin Lecture was followed by a dialogue with Mullin and Joaquin Esquivel, chair of the California State Water Resources Control Board, who shared both his professional expertise and lived experience as a native of the rural Eastern Coachella Valley.

The panel spoke about the key role of research and data in shaping equitable policies, and the new technologies that could lead to solutions in places where water and sanitation infrastructure is failing.

Esquivel described the state’s decision to pay off hundreds of millions of dollars in water bill debt that built up during the pandemic in low-income households. The stakes were too high to ignore, he said.

“That lack of access to sanitation and drinking water could actually create a system where you could lose your house, you could lose your kids if your water is shut off,” Esquivel said. “There are huge consequences for those at the bottom of the system.”

Flowers said her organization is speaking with NASA engineers to determine whether technologies used to create waste management systems in space could inspire new innovations on the ground.

“We decided that we’re not going to just wait on someone to change policy. We’re going to reengineer the septic tank. And we’re looking to collaborate,” she told the UCLA audience.

“We need your ideas. Because this is not just an Alabama problem. It’s a California problem too.”

View photos from the lecture on Flickr.

 

Coleman Flowers Luskin Lecture

Telehealth, Key Part of Pandemic-Era Care, Should Be More Accessible, Study Finds

A study by the UCLA Latino Policy and Politics Institute found that since COVID-19 emerged, language barriers have prevented Latino and Asian patients in Los Angeles from making full use of telehealth services. The research also revealed that Black and white patients had greater ease with video visits — and that some older patients and those with limited access to technology, particularly Latinos, relied on family members to help them access telehealth services. The study is based on data from a Los Angeles County health care system: Researchers analyzed patient visits from January through December 2020 and conducted surveys and interviews with 39 health care providers at seven of the health system’s clinics between August 2021 and April 2022. The findings underscore the need for care providers to take into account the roles that patients’ race, ethnicity, age and primary language play in how telehealth services are adopted. This study is timely because in July 2022, the U.S. House of Representatives approved a bill to extend Medicare reimbursements for telehealth visits through the end of 2024, and the U.S. Senate is currently considering legislation that would direct more funding for telehealth visits to Medicare beneficiaries. The study’s authors recommend that health care systems and providers address the digital literacy and technology barriers that patients face by investing in programs that provide technology support, both in person and remotely, to people who have trouble navigating telehealth on their own. Further, they urge providers to support efforts to allocate technology devices and internet services to their patients. 

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Peterson on Prop. 29 and Voter Skepticism

Public Policy interim chair Mark Peterson spoke to the Los Angeles Times about controversies surrounding Proposition 29, which would require a licensed medical professional to be present while dialysis patients are receiving treatment at the state’s 600 dialysis centers. The measure would also require centers to disclose physician ownership interests and patient infection data. Peterson said voters are often skeptical about issues that they are not properly informed about — in this case, the “high levels of technical detail” about the treatment and care that dialysis patients need. That skepticism is heightened when private interests are involved, he said. “When there is a special interest from one side or the other that’s really pushing a particular ballot initiative, voters add on to their underlying suspicion this general skepticism of why is the ballot initiative process being used by a special interest?”


 

Turner on the Urgent Work of Chief Heat Officers

V. Kelly Turner, co-director of the UCLA Luskin Center for Innovation, co-authored a CalMatters opinion piece offering guidance to chief heat officers, the government officials tasked with coordinating a strategic response to extreme heat. Los Angeles appointed its first chief heat officer in June, and a statewide position is also under consideration. Turner and co-author David Eisenman of the UCLA Center for Healthy Climate Solutions wrote that heat waves are becoming longer and hotter and the most vulnerable people need cooling immediately. They urged policymakers to base their interventions on science, pointing to research that shows the effectiveness of urban cooling tools such as tree canopies and reflective roofs. And they urged heat officers to act with urgency to coordinate heat-action efforts across many agencies. “We cannot wait for extreme heat policies to evolve across bureaucracies over decades,” they wrote. “Chief heat officers must get many pieces moving quickly. They must convene, collaborate and cajole.”


 

MPP/MD Student Wins Health Equity Challenge

The inaugural Health Equity Challenge, a competition among UCLA graduate students aimed at developing community-based solutions to health equity issues in California, has given one of two grand prizes to Alma Lopez, who is pursuing a dual master of public policy and doctor of medicine degree. Lopez partnered with the South Los Angeles nonprofit SHIELDS for Families to develop a proposal to provide online peer support, in English and Spanish, for mothers of color who are experiencing perinatal depression. Thanks to the Health Equity Challenge, made possible by the UCLA Center for Health Policy Research and the MolinaCares Accord, SHIELDS will receive $50,000 to implement the pilot program. “If successful, this could serve as a model for group interventions to address maternal mental health conditions in other urban communities of color,” said Lopez, an aspiring OB-GYN. The competition invited graduate students to submit applications proposing innovative interventions to address health equity issues in the state. Ten finalists received $2,500 stipends and 10 weeks of mentorship to develop a full project proposal. The two grand prize winners, Lopez and UCLA medical school student Angelica Johnsen, were announced in June. Other finalists with connections to UCLA Luskin include Lei Chen, a social welfare doctoral student whose proposal sought to meet the needs of older immigrant adults seeking health care and social services; and Annalea Forrest MSW/MPH ’22, who proposed building an integrated health platform to bring psychotherapeutic services, trauma-informed exercise and nutritional counseling to marginalized communities Los Angeles.

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On Protecting the Rights and Dignity of Disabled Americans

Judith Heumann, a lifelong advocate for the rights of disabled people, joined Fernando Torres-Gil, professor of social welfare and public policy, for a wide-ranging virtual conversation focusing on the ongoing fight for universal accessibility. Hosted by the UCLA Luskin Undergraduate Program, the Feb. 8 dialogue came during Heumann’s weeklong appointment as a UCLA Regents’ Lecturer. Heumann and Torres-Gil spoke about their work shaping legislation and policies to protect the rights and affirm the dignity of disabled Americans. Both speakers have spent decades serving in key government and nonprofit positions focusing on health and aging, and both bring a personal perspective on living with disability as survivors of polio contracted as young children. Torres-Gil, director of the Center for Policy Research on Aging at UCLA Luskin, said making education, housing and health care more accessible will have a broad impact, as people young and old may face unexpected physical or cognitive decline and as the long-term health effects of COVID-19 become clear. Heumann also spoke about her work as a Ford Foundation fellow studying depictions of disabled people in the media. “The paper that we produced was a roadmap to inclusion,” she said. “It is making it normal that you could be blind, you could be deaf, you can have a physical disability, you can have an intellectual disability, you can have a memory issue — all these different things. They need to be built into the way we experience life.”

View a video or read the transcript of the conversation between Heumann and Torres-Gil, “Beyond Allyship: Disability Rights and Public Service.” 

View a video of Heumann’s UCLA Regents’ Lecture, “Disrupting Ableism in Higher Education and Beyond.”