Gun violence is a public health problem

By Eric Feigen, NCL Health Policy Summer 2022 Intern

We live in a nation where children fear for their lives at school, racially motivated killings are pervasive, and mass shootings have become commonplace. The United States is in the midst of a gun violence epidemic. One promising avenue that could help address this crisis involves approaching gun violence from a public health perspective. By developing strategies aimed at protecting the health and safety of people and communities, we can develop a policy framework for reducing incidences of gun violence and suicide.

Of the 24,897 people who have died from gun violence in 2022, 13,530 people have lost their lives to suicide. To compound this loss, National Institutes of Health (NIH) estimates that 45 percent of people who take their own lives visit their primary care physicians within a month of their death. Many Americans are reaching out for support. However, due to the inaccessibility of mental health services, people cannot receive the help they desperately need. According to the American Psychological Association, in 2018, 39 percent of people could not afford the cost of receiving mental health services. Even for those with healthcare coverage, 26 percent choose to forgo treatment because their copays are too high.

There are a wide range of public health policies that could be implemented to remedy this issue. The first task is improving accessibility. A survey by the Health Resources and Services Administration indicates that the demand for mental health services far exceeds the number of professionals in the field and some primary care professionals receive no training in suicide assessment or management. In addition, many Americans have to travel immense distances to receive mental health treatment. The pandemic has illustrated the effectiveness of telehealth as a solution to this issue, however programs such as fellowships, outreach seminars, and more must be put into place to increase the number of health professionals in the field.

Gun violence in America is also an equity issue, disproportionately affecting communities of color. This has created a cycle of violence which places children at an increased risk for gun violence exposure earlier in life. A NIH study indicates that the prevalence of gun violence during childhood increases interactions with firearms later in life to a medium to large effect. This leads to the second policy issue that must be addressed: improving access to quality mental health services in order to break cycles of violence.

To accomplish this, policies designed to incentivize and increase the number of psychiatric practitioners of color must be put into effect. Not only do Black and Brown mental health professionals have a better understanding of the challenges their communities face, but studies indicate that white mental health workers often misdiagnose minority patients leading to counterproductive treatment. In 2019, racial/ethnic minorities made up only 17 percent of the psychologist workforce, illustrating how marginalized communities have disproportionately less access to quality mental health services in comparison to their white counterparts.

The social determinants of health; healthcare, housing, economic mobility, and more are inescapably linked to the root causes of gun violence. In addition to those listed above, policy solutions include:

  • Expanding healthcare coverage to include mental health services
  • Tightening regulations on opioids and other dangerous prescription drugs to create safe and healthy environments
  • Including safeguards against measures intended to limit an individual’s right to treatment such as the lack of affordability of clinically prescribed medication
  • Ensuring that for those currently receiving effective treatment, their medication is not switched to a less effective alternative just because it is cheaper
  • Expanding Extreme Risk Protection Order laws
  • Promoting health equity as those facing adverse health conditions are at higher risk for experiencing violence. This includes increasing access to:
  • vaccines, including COVID-19
  • treatment for chronic conditions, such as diabetes
  • healthy fresh foods and vegetables
  • Increasing research devoted to tackling gun violence as an investment in national public health

While many forms of gun control legislation have been written off as politically impossible, there are other solutions Congress can enact to mitigate the gun epidemic. Approaching the issue from a public health perspective is an effective avenue policymakers can take for ensuring that the gun-related tragedies, which now seem omnipresent in America, harm fewer people in the future.

My Juneteenth federal holiday didn’t turn out the way I hoped. It was even better!

By Sally Greenberg, NCL Executive Director

This week we celebrated the Juneteenth federal holiday and one that the National Consumers League will continue to honor into the future.

Juneteenth marks the date in 1865 when a union general and his soldiers rode into Galveston, Texas to tell the enslaved community that they had been emancipated from slavery; the plantation owners didn’t bother to give them the news.

At last, these Texans were free human beings.

Sadly, this happened two years after the 1863 signing of the Emancipation Proclamation by President Abraham Lincoln.

Fast forward to June 20, 2022. While watching the Today Show, I saw a 95-year-old inspiration named Miss Opal Lee, appropriately from Texas, who made it her life’s work to make Juneteenth a federal holiday. The piece featured Miss Opal’s photos from her childhood when she had celebrated Juneteenth in Texas.

Most of the U.S. didn’t know about the importance of this date, but, in Texas, the black community has been honoring Juneteenth for decades – with parades and music and traditional foods. The Today Show clip featured Miss Opal in 2021 when President Joe Biden signed the bill creating the federal holiday; she is standing next to him surrounded by members of Congress.

This heroic former schoolteacher was nominated for a Nobel Prize. Not only did she march to Washington with more than one million signatures to get Juneteenth recognized, but she created a food bank out of her kitchen that has grown into a huge warehouse. She launched a farm to feed thousands in the community.

I was in awe of this incredible woman and was so grateful to learn about her role in the adoption of this federal holiday.

Later that day, I was looking forward to celebrating local events around D.C., and headed down to the National Museum of African American of History and Culture. Sadly, I couldn’t get in because the museum had sold out of timed passes. I was so disappointed.

On the ride home from the museum, I happened to see horses being put back into a trailer by African American men dressed as union soldiers. I stopped and got out to see what was happening; they told me this was the end of a parade from 14th street down to Howard University.

Then they said, “Miss Opal came too.”

“Miss Opal?”, I asked. Was this Miss Opal the same amazing lady who made it her life’s work to make Juneteenth a federal holiday?

“That is her over there,” they told me.  I asked if I could meet her – it turned out she was in a car near the food trucks. She rolled down her window and we talked for a few minutes about how she made Juneteenth happen. I shook her hand and thanked her for being a true American hero; for finally getting this most important federal holiday on the calendar; for teaching school and; for her incredibly uplifting spirit. She was just as inspiring in person. I hope I have her energy and spirit when I’m 95 years old!  She invited me to come down and see her in Fort Worth, which I might just do!

Serendipity in Washington, D.C.

Juneteenth didn’t turn out like I thought it would, but I feel so honored to have met this towering figure in American history. Go Miss Opal Lee!

Dispatches from Durban: May 15-20, 2022

Reflections on the 5th Global Conference on the elimination of child labour in Durban, South Africa: May 15-20, 2022

Reid Maki is the director of child labor advocacy at the National Consumers League and he coordinates the Child Labor Coalition.

The recently-concluded week-long “5th Global Conference on the Elimination of Child Labour” in Durban, South Africa was convened against the backdrop of the announcement last July of an alarming rise in child labor numbers after two decades of steady and significant declines in global child labor totals.

The global conference, which typically comes about every four years, brought together an estimated 1,000 delegates from foreign governments and small number of representatives of NGOs. It also brought together for the first time at one of the quadrennial child labor conferences dozens of participant youth advocates as well as a number of child labor victims and survivors.

The conference had the difficult mission of righting the ship and trying to reverse the rising child labor numbers, which seem destined to rise further as the COVID pandemic’s impact will continue to be felt for years. Sadly, the pandemic threw 1.6 million children out of school, often for prolonged periods and some of those children entered work and may never return to school.

We would first like to thank the South Africa government for the herculean task of organizing a global conference during a still raging pandemic, all against a backdrop of devastating floods in April that savaged the provinces of KwaZulu-Natal and Easter Cape and killed nearly 500 people, destroyed 4,000 homes and displaced 40,000 people.

As the conference opened, Guy Ryder, the Director General of the International Labour Organization, which helped advise the government of South Africa on the organization of the conference, suggested that the rise in 8 million child laborers from 152 million to 160 million likely represented complacency and a loss of focus by global governments on the child labor problem and must be rectified. He noted increases in child labor impacting children under age 11 and urged delegates to redouble their efforts. “We need to increase our efforts, and pay particular attention to child labor in agriculture,” said Ryder, who added that child labor advocacy is threatened by a “perfect storm” created by COVID’s enduring impact, rising food insecurity, and debt crises that are expected to impact 60 nations in the coming years.

South Africa’s president Cyril Ramamphosa delivered a stirring welcome. He noted that his country’s embrace of child rights is not just a matter of principle. “The assertion of the rights of children was a direct response to the deprivation, discrimination and deliberate neglect that had been visited on the black children of this county by successive colonial apartheid administrations,” said Ramamphosa. “Child labor perpetuate the cycle of poverty, denying young people the education they need to improve their circumstances. It condemns communities to forms of economic activity and labor that limit any prospect of advancement or progress.”

Nobel Peace Prize laureate Kailash Satyarthi noted the particular challenge that the sub-Saharan African region is facing with the highest rates of child labor and one in five children are in child labor.

Satyarthi urged listeners to embrace the idea that every single child can be protected from child labor. “Let us march from exploitation to education,” he urged, calling for children to have a “fair share” of resources. The amount needed to ensure all children have access to needed resources is only $53 billion – not much considering the wealth of many nations, said Satyarthi who also noted that the G7, which is about to meet on June 26th, has never focused attention collectively on child labor. “This needs to change,” he urged.

The conference opened with a pledge by European Union (EU) Commissioner Jutta Urpilainen that the EU will create a new $10 million euro initiative to reduce child labor in agriculture. Child labor must return to the political agenda, she urged.

The six-day conference, attended by 1,0000 delegates in person and an estimated 7,000 online, according to organizers, featured workshops and side events, and included three meetings every other day by separate groups of employers, workers, and governments. Readers can find a conference agenda here with video links to many sessions.

Twenty-four side events focused on many related topics including child labor in supply chains, a decent work agenda, youth-led activism, small-scale mining, livelihoods skills development, African priorities, partnership in Latin America to end child labor, due diligence legislation, data and research needs, labor inspections, artisanal fisheries and aquaculture, and a child-labor-free zone in Ghana. For a complete list and to view specific side events, please go to agenda, scroll each day’s offerings and click links to the videos.

Attendees learned a lot about specific intervention efforts, and the struggles many nations are engaged in, including Malawi, which has recently been hit by two cyclones and where there is a shortage of 50,000 schools – less than half of the children have access to education, said the nation’s Education Minister Agnes Nyalongje. She pleaded for international help, noting that 12 years of sustained aid could create generational change in Malawi and fix its troubled education system.

It’s difficult to summarize the hundreds of hours of content but readers may get a sense from the CLC’s twitter stream which included four to five dozen original tweets at @ChildLaborCLC.

The conference’s concluding “Call to Action” document emphasizes the need for urgent action, because “the consequences of the COVID-19 pandemic, armed conflicts, and food, humanitarian and environmental crises threaten to reverse years of progress against child labour”. The document includes commitments in six different areas:

  • Make decent work a reality for adults and youth above the minimum age for work by accelerating multi-stakeholder efforts to eliminate child labour, with priority given to the worst forms of child labour.
  • End child labour in agriculture.
  • Strengthen the prevention and elimination of child labour, including its worst forms, forced labour, modern slavery and trafficking in persons, and the protection of survivors through data-driven and survivor-informed policy and programmatic responses.
  • Realize children’s right to education and ensuring universal access to free, compulsory, quality, equitable and inclusive education and training.
  • Achieving universal access to social protection.
  • Increasing financing and international cooperation for the elimination of child labour and forced labour.

As is often the case at conferences, many of the side conversations are of great interest. We had many great conversations with Simon Steyne, who recently retired from the International Labour Organization but continues his child labor advocacy. Simon is campaigning to bring about a child-labor-in-agriculture conference in the coming year. With 70 percent of global child labor in agriculture and rising child labor rates, a focus on agriculture at this time is absolutely essential, Steyne argued.

What might have been improved at the conference? It seems that a relatively small number of Civil Society participants were invited to the conference, included few from the Americas and Asia. The pandemic and travel distances certainly impacted in-person attendance. And we know a lot of NGO participants were able to join online. We hope that a broader spectrum of Civil Society is invited to future global child labor conferences. NGO delegates often possess in-the-field, grass roots knowledge lacked by government and employer groups and NGO presence is a key element in the fight to reverse accelerating incidence of child labor.

The Civil Society advocates and experts who were there enhanced the conference greatly, mostly through the two dozen side events. We were delighted to be joined at the conference by CLC members Bank Information Center and GoodWeave, which organized the side event “Child Labour Free Supply Chains: Tackling Root Causes from Maker to Market” — included panelist Thea Lee, the deputy undersecretary for International Affairs at the U.S. Department of Labor, who was ubiquitous at the conference. CLC-member Action Against Child Exploitation (ACE) also presented a side event: “Promoting an Integrated Area-based Approach to the Elimination of Child Labour: A Case of the Child Labour Free Zone in Ghana,” with Yuka Iwatsuki, president of ACE among the panelists.

In addition to thanking our gracious South African hosts and the ILO for its organizing role, the CLC also wishes to express appreciation to our valued partners the Global March Against Child Labour and the Kailash Satyarthi Children’s Foundation for enhancing the conference significantly through organizing side events and bringing the voices of youth advocates to Durban.

Tara Banjara. 17, was among the youth advocates who appeared as a panelist. Tara said she is from a community in India where there are no schools and “no one had an idea about what education is.” She was four and half when she went to work on roads with her mother. They cleaned garbage and rubble out of potholes. The work was exhausting and difficult and went on till she was rescued by Bachpan Bachao Andolan’s Bal Ashram.

Today, Tara is the first girl to complete grade 12 exams in her entire family. She asked attendance participants gathered in Durban and the thousands on line: “Is this our fault that if we are born in a small village, we do not have the right to live our childhood with freedom?” She asked.

“We want freedom. We want the right to education,” Tara said, sharing her dream of becoming a police officer some day and working at the grassroots level to ensure that all children have equal rights and freedom. In one of the conference’s emotional high points, Tara asked attendees to stand and make a pledge: “Let us all pledge to create a world where every child is free from slavery; every child gets an education and an opportunity to fulfill their dreams.”

Jeanette Contreras portrait

Leaders in Congress support safe OTC hearing aid standards

By NCL Director of Health Policy Jeanette Contreras

Mild to moderate hearing loss is a difficult reality that millions of Americans struggle with, which is why the availability of over-the-counter (OTC) hearing aids is exciting for those who are impacted by hearing loss. While making OTC hearing aids more accessible is a promising step for consumers, we at NCL would be remiss if we didn’t underscore our concerns around the Food and Drug Administration’s (FDA) proposed OTC hearing regulations as they currently exist.

In December of last year, NCL was one of hundreds of organizations who submitted a comment to FDA’s public docket on the issue; and last month we submitted a letter voicing our concerns to the FDA that was supported by 29 not-for-profit, public health organizations across the country. These organizations collectively represent the concerns of millions of consumers, patients, and individuals impacted by hearing loss.

We want to reiterate our enthusiasm for OTC hearing aids, but as the gold standard of safety in our country, it is imperative that the FDA make sure these devices are safe for consumers and do not worsen a problem they are intended to mitigate. As written, the draft regulations would allow for a maximum sound output level of 120 dBA – equivalent to the volume of a chainsaw or fire engine siren. This is concerning, as exposure to sounds at 120 dB can be dangerous in as little as nine seconds according to the CDC. This is why NCL, along with other leading consumer and healthcare voices, encourage the FDA to follow the recommendations of hearing care professionals, including the American Academy of Otolaryngology–Head and Neck Surgery that recommend a maximum output of 110 dB and a gain limit of 25 dB. Without a limit on gain, OTC hearing aids users will be able to amplify sounds to dangerous levels, and far beyond what Congress authorized when it said these devices must be limited to adults with moderate hearing loss or less.

The safety parameters we are recommending would in no way compromise the efficacy of OTC hearing aids intended for individuals with perceived mild to moderate hearing loss. In fact, a recent study concluded that commercially-available hearing aids programmed according to parameters typical of those used for individuals with mild to moderate hearing loss yield effective output and gain levels and are within the recommended limits specified by leading hearing care organizations and medical experts.

Importantly, the FDA has already cleared several hearing aids for adults with perceived mild to moderate hearing loss that were found to be safe and highly effective during clinical trials. While these devices were authorized under a different category of hearing aids, these devices limit the maximum output to 115 dB or below and gain to 30 dB or less, lower than the amplification limits currently proposed by the FDA. At the very least, the FDA should incorporate these amplification limits in the final OTC hearing aid regulation.

Finally, as we await finalized guidance from the FDA, we applaud leaders in Congress who are standing behind consumers in supporting safe and effective amplification limits. Last month, Congresswoman Betty McCollum (D-MN) and Congresswoman Rosa DeLauro (D-CT) sent a letter to the FDA echoing their safety concerns. The letter states, “[The proposed rule] hurts consumers and patients in two ways. First, it means individuals suffering from greater levels of hearing loss could put off a needed visit with a licensed hearing professional. Doing so could lead to worsening their existing symptoms, delaying an accurate diagnosis and treatment, and even creating irreparable damage to their hearing. Secondly, it means those with perceived mild-to-moderate hearing loss would be exposed to harmful levels of noise that could result in further damage to their long-term hearing. In order to avoid these concerns, FDA should impose a gain limit of 25 dB and an overall output limit of 110 dB.”

Similar to the countless other experts that have also weighed in, we believe that establishing safe amplification limits would not reduce the efficacy of these devices or limit the advancement of innovative technologies. We thank Congresswomen McCollum and DeLauro for being a voice for consumers and patients on this important issue. To learn more about gain and output and how to protect yourself from hearing loss, check out our infographic.

Breyault and Amazon’s Alyssa Betz discuss policing fake reviews and counterfeits

 

By NCL Staff

 

This week, John Breyault, our Vice President of Public Policy, Telecommunications, and Fraud, sat down with Amazon’s Director of Public Policy, Alyssa Betz. On this episode of NCL’s We Can Do This! podcast, Alyssa and John discussed fake reviews, Amazon’s product liability, and more. This has been the latest collaboration between Amazon and NCL in our partnership towards improving consumer safety and online experiences.  

Fake Reviews 

With users increasingly relying on user reviews to make buying decisions, having access to trustworthy reviews is critical for consumers. Last month, Amazon sued a group of review brokers who were allegedly paying for fake reviews at large scale. In addition to discussing the suit, Betz outlined some of the steps they have taken to ensure that user reviews are trustworthy and accurately reflect consumers’ experiences. 

Counterfeits 

Given the vast number of products sold through nearly two million sellers worldwide, Amazon has an enormous responsibility to ensure consumer safety. Alyssa discussed some of the measures Amazon has taken to reduce criminals’ ability to operate on their platform, including investing over $700 million and employing more than ten thousand people to protect its store from fraud and abuse, including counterfeit products.

To hear the full episode, including John and Alyssa’s conversation about product liability and how to spot those phony Amazon delivery phishing texts, click here. 

If you have received suspicious communications or packages claiming to be from Amazon, you can find Amazon’s support page here. 

Why we need more Black health professionals in the workforce

By NCL Health Policy Associate Milena Berhane

A lack of diversity in the health care workforce has been a persistent issue in the United States, posing significant implications to health equity, particularly for the Black or African American community.

An estimated five percent of physicians identify as Black, despite making up 13 percent of the U.S. population. A recent study utilizing U.S. Census Bureau information found that the proportion of Black physicians in the United States has only increased by four percent in more than a century — from 1900-2018. This study also reported that the percent of Black male physicians has remained relatively stagnant since 1940. Diversity issues also exist in other health care professions, with an estimated 7.8 percent of nurses, 3.8 percent of dentists, and 2.5 percent of physical therapists being Black.

The education, testing, application, and interviewing process required to pursue a career in health care is rigorous and costly. In addition to a four-year degree, candidates are also required to take standardized exams, pay expensive application fees, and pay for travel to interview. Most medical students expect to spend up to $10,000 for the application process. Once accepted to a health professional program, the tremendous monetary and time costs of schooling are immense obstacles for many. Medical school attendees accumulate an average $200,000 of student loans by the time they are finished with their programs.

Due to generations of systemic racism in our country, Black Americans are less resourced — financially and in terms of social capital — than their white counterparts. The rigorous process of applying to and remaining in health professional programs creates a pipeline that excludes disadvantaged students from the ability to pursue careers in clinical care.

The barriers to enter the workforce have further negative impact on communities and health equity. Black patients face a variety of issues that can influence their ability to access medical care, including medical mistrust caused by historical unethical medical mistreatment faced by Black Americans, dismissal of health concerns that Black patients express to health care providers, and others. Time and time again, Black patients have shared their experiences of medical providers ignoring their health concerns, and therefore being undertreated and going undiagnosed for their conditions. In addition, research indicates that Black patients report poorer patient-provider communication and shared decision-making. These issues lead to Black patients receiving lower quality care from medical providers, further worsening health conditions that could be treated.

Racial bias and a lack of culturally competent medical care in the healthcare system has led to poorer health outcomes for Black patients. Black Americans of all ages already face higher rates of hypertension, asthma, diabetes, and other health issues due to systemic racism and how it has affected the environments they live in, the food they have access to, their education prospects, income, etc. These inequities compiled with a culturally incompetent and bias medical system leaves Black Americans with little ability to receive proper medical treatment and improve their health and well-being. Although medical schools are attempting to teach the importance of culturally competent care, it is crucial that Black patients are also able to access healthcare providers that look like them and come from their communities.

Clearly, the current make up of racial diversity of the health care workforce has failed to keep up with the demographic shifts in the United States. Although public health efforts are important in addressing and improving health equity, inequities within the medical system must be addressed simultaneously. The COVID-19 pandemic has only highlighted and exacerbated health inequities. Increasing the amount of Black health professionals across the United States is a critical step in ensuring better health outcomes for Black patients and their overall well-being.

COVID-19 increasing health concerns about obesity

COVID-19 increasing health concerns about obesity
By Nailah John, Program Associate

The pandemic has brought many countries to a standstill, restricting movement, necessitating social distancing, and impeding economic activities across a broad spectrum of nonessential occupations. It’s also resulted in many people changing their habits, including changes in food consumption, physical activity, and an increase in people working from home, which may exacerbate current levels of obesity.

Obesity is a major concern here in the United States and worldwide. The World Health Organization defines obesity as “abnormal or excessive fat accumulation that may impair health.” In 2016, the World Health Organization released data that showed 650 million adults were obese, and in 2019, an estimated 38.2 million children under the age of 5 were overweight and obese. In the United States, the Center for Disease Control and Prevention indicates that, in 2019, the obesity rate surpassed the 40 percent mark and reached 42.4 percent.

Since the pandemic began, there have been dozens of studies reported that many patients who become sick with COVID-19 are obese. In an article in the journal Obesity Reviews, an international team of researchers compiled data from scores of peer-reviewed papers capturing 399,000 patients. The findings indicated that individuals with obesity suffer from metabolic dysfunction and low-grade inflammation, which are considerable factors in the manifestation of severe lung diseases. The primary cause of COVID-19 mortality is susceptibility to acute respiratory distress syndrome (ARDS) which is more likely in obese individuals. The review goes on further to state that “being an individual with obesity independently increases the risk of influenza morbidity and mortality, most likely through impairments in innate and adaptive immune responses. Potentially the vaccines developed to address COVID-19 will be less effective for individuals with obesity due to a weakened immune response.”

The Wiley Public Health Emergency Collection found that obesity increases vulnerability to infections and is a risk factor to COVID-19-related mortality. Body mass index (BMI) was significantly higher in patients with a severe form of Covid-19 infections. Being obese increases the odds of COVID-19 patients being hospitalized. The Wiley Public Health Emergency Collection highlighted that COVID-19 patients with obesity were hospitalized more than those without obesity. According to a report that looked at 5,700 COVID-19 patients with obesity in New York City, whereas 22 percent of the population is obese, they make up 41.7 percent of hospitalized patients.

Prevalence of obesity in the United States is increasing yearly, and there is a dire need for this health issue to be curbed. It will take efforts at the federal, state, and local level. Therefore, it is paramount that each individual engages in healthy eating habits, eats the right portion sizes, engages in physical activity, and encourages others.