Thursday, December 23, 2010

Wednesday, December 8, 2010

Concerns about Facts and Infant Mortality

Re: " 'Safety net' can be a trap for poor women" (My View, Dec. 5).
Published: December 08. 2010 in the Tallahassee Democrat

Public health issues, such as infant mortality rates (IMR), cannot be explained away with personal anecdotes. The health of a community cannot be reduced to the hundreds of separate decisions an individual makes in a lifetime. Numerous factors — policies and trends often beyond the control of the individual — contribute to racial health disparities in America.

It's hard to imagine how abuse of Medicaid by poor black mothers could be one of them. Less than a year's worth of free insurance seems an unlikely motivation for pregnancy. The Office of Minority Health reports that even when IMR is stratified by income and education of the mother, race is still a risk factor. This means that black women with the same salary and years of education as white women in their peer group are still at greater risk of having their babies die before they reach the age of 1. Even the Centers for Disease Control cannot explain this, but a history of racism surely plays a role.

For this reason it is unhelpful when respected professionals perpetuate myths about welfare abuse within the African-American community during a dialogue about IMR.

HEATHER JORDAN, MPH

Related Posts:

Florida's F grade hardly a surprise
Safety net a trap for poor women

Ellen Hamilton: 'Safety net' can be a trap for poor women

Re: "Florida's F grade is hardly a surprise" (My View, Nov. 28).
Published: December 05. 2010 in the Tallahassee Democrat

It was the shards of glass on the ground that kept getting my attention. I was standing on the playground of a housing project, spending time with a young African-American girl whose social/emotional/psychological needs I was there to assess. As I observed this child, described as belligerent by her teacher and hard to manage by her mother, I was distracted by the dangers in the grass.

Why didn't someone pick up that glass, so the children could be safe? Were residents of the project waiting for the management to do it? The playground itself looked shabby, with much of the equipment broken, missing or unusable.

I stood there, wondering what could be done to truly improve the circumstances of people of the projects, people who are our neighbors.

Better brains than mine have attempted to unravel this rough, tightly woven fabric of racial, social, economic, political and psychological threads we call poverty. How do we alter the cycles in which poor people find themselves?

Dr. Edward Holifield made an impassioned plea that more attention be given to the issue of black babies and the appalling number born prematurely and those who die as infants. He notes social and political causes, citing "contempt for poor children in general and black children in particular." He reports that the "dysfunctionality" of Medicaid is "considered by some to be a risk factor for infant mortality." "In 2008, 42 percent of the births in Leon County were covered by Medicaid, which means that Medicaid must share the blame for such terrible birth outcomes, especially in regard to black infant mortality," he wrote.

This last statement is poisoned by a stark contradiction. The large number of Medicaid-paid-for births indicates that many women, without adequate income and insurance, are having babies. Whether Tea Partiers, conservatives, moderates or liberals, many people bristle, and some bleed, at this reality. Surely, the medical services paid for by Medicaid can do only so much to ensure the safe arrival and survival of black babies.

They represent hope for families, and I have heard many young, black mothers, no matter how dire their circumstances, refer to their babies as joys, blessings, the inspiration that keeps them going.

We all need hope. However, as long as young women and men have no cause for hope, other than having a baby, we have no chance of stopping the generational cycles of poverty.

The absence of black fathers has been noted as a factor in the health of black babies. Drug and alcohol addiction, incarcerations and poor education are rampant in the poorer families of our society. Self-esteem is compromised for many young people of all races, and depression lurks as an unrecognized, undiagnosed condition that is both cause and effect in the cycle of poverty.

It is illogical and dangerous to blame Medicaid, cracked and flawed though it is, for the terrible sadness of black infant mortality, without also looking at other issues. The binding and blinding truth is that the availability of Medicaid, intended to be a safety net for girls, women and infants — a critical, compassionate net we should be proud to have — is also a potential trap. Teenagers and young women often trade in their youth, sacrifice their educations and have multiple babies they can ill afford for reasons we must come to understand.

The hard-to-speak truth is that the contempt Dr. Holifield and others witness toward poor, black children is a contempt for the circumstances of individuals perceived to be using a system designed as a safety net, which has become the ground on which their lives and their children's lives are based.

While Aid to Families with Dependent Children is no longer available, young mothers can still receive housing subsidies, food stamps and other services. Extremely alarming is the trend of some parents invested in having their children labeled with a disability in order to receive disability benefits. For some families, this is the new welfare.

As long as young, black men leave, literally, their pants on the ground, and young, black women do not see for themselves a role, a life, a dream that takes them into young adulthood before they become pregnant, babies will continue to carry the burden of a community of people that is hurting and wants hope and a society and political system that are ambivalent, at best, about providing support to people seen as irresponsible.

The playground on which I stood a couple of years ago is no longer littered with glass, and new equipment is in place. At least, this has changed.

When I last contacted the young mother of the child mentioned above, she reported that her daughter's behavior had become less problematic. She no longer needed my services, and she was happy. She was pregnant, again.

As we lobby for better services for babies, we must also examine the effects of those services on the people who brought the babies into being, and be aware that, as we hold the net, we may also be setting the trap, as subtle and dangerous as those shards of glass on the playground.

As a society grappling with painful and knotty issues — fear, ignorance, racism and the legacies of the sin that was slavery — we must recognize, with heart and mind, the legitimate concerns of all segments of our society.

Related Posts:

Florida's F grade hardly a surprise
Concerns about facts and infant mortality

Edward Holifield: Florida's F grade on babies is hardly a surprise

Re: "Fla. gets an 'F' for premature birth rates" (news article, Nov. 17)
Published: November 28. 2010 in the Tallahassee Democrat

None of us familiar with Florida's abysmal record regarding maternal and children's health were surprised by this article in the Tallahassee Democrat. This record documents a history of contempt for poor children in general and black children in particular.

It places Florida in the company of other states with an F rating that typically have neglected their poor, such as Mississippi, Alabama and Louisiana. Even West Virginia was ranked ahead of Florida in the annual report compiled by the March of Dimes.

Reality is even worse than the Democrat article suggested. For example, the article reported that 13.8 percent of Florida's babies were born too soon in 2008. This was a "provisional" statistic. The actual statistic was worse, at 14.2 percent. Further, 19.4 percent of black babies were born preterm in Florida in 2008, compared with 12.8 percent for white babies.

Thus black babies in Florida have a preterm birth rate more than 2.5 times the national government's objective of 7.6 percent. The black preterm birth rate in Florida is the same as the overall preterm birth rate for Puerto Rico.

The racial disparities regarding maternal and child health issues are extraordinary. A preterm rate of 13.0 percent was reported for Leon County. This obscures the black preterm rate of 16.8 percent, compared with the much lower white preterm rate of 10.4 percent.

The Democrat article reported that the preterm birth rate in Leon County has "decreased over the past three years." However, that rate decreased only modestly, from 14.3 percent in 2006.

Meanwhile, there has been no statistically significant improvement in infant mortality in Leon County during the past 20 years, according to state epidemiologist Bill Sappenfield. Black infant mortality in Leon County at 11.3 per thousand live births remains embarrassingly high when compared with white infant mortality at 4.3 per thousand.

These dismal results were predictable. Medicaid is so dysfunctional that it is considered by some to be a risk factor for infant mortality. Medicaid "reform" has turned into Medicaid repeal.

A pregnant woman in Florida is banished from the Medicaid rolls only 60 days after she delivers her baby. Thus, a sick mother is expected to be able to care for her infant child.

In 2008, 42 percent of the births in Leon County were covered by Medicaid, which means that Medicaid must share the blame for such terrible birth outcomes, especially in regard to black infant mortality.

During years 2006 through 2008, one out of five black women in Leon County received no prenatal care during their first trimester of pregnancy. By comparison, 91 percent of white women in Leon County received prenatal care during their first trimester of pregnancy.

Only 68.5 percent of black women in Leon County initiated breast feeding following delivery, compared with 85.8 percent of white women.

The black maternal mortality in Florida is 33.8 per 100,000, which is more than three times the maternal mortality rate for white women at 10.7.

These problems exist largely because the political power structure does not care. Leon County Commissioner Bryan Desloge in 2007 used the racially pejorative term "million dollar crack babies" when speaking of black infant mortality. Mayor John Marks and the city of Tallahassee spent more money in 2007 on the St. Francis Animal Hospital than on the Bond Community Health Center.

Florida in 2005 left unused $20 million in federal money that could have been spent on KidCare.

The problem is not money. Rather, it is a lack of political will, coupled with babies who cannot vote.

See responses to this article:

Safety net can be a trap for poor women
Concerns about facts and infant mortality

Saturday, December 4, 2010

Five Pitfalls of Gift Cards



You are going to get a few gift cards this holiday season. Chances are you are going to give a few too. This is a difficult post to write, knowing that many of my family and friends have given me such gift cards - so my point isn't to make anyone feel bad. My point is only to illuminate the pitfalls of gift cards, as there are many.


Why do I care? When I got married we received over $200 worth of gift cards to Home Depot and Lowes. They were even special wedding gift cards when a cute bride and groom on the plastic. The problem: we were moving into a second-story apartment in the metro New Orleans area. We had no reason to go to Home Depot - we wouldn't even have a yard. Our parents ended up buying the gift cards from us to be nice. Over the course of two years in New Orleans, we received around $50 worth of movie tickets to Regal Entertainment Cinemas from our family in Tallahassee. The problem: there isn't a Regal Cinema in the entire state of Louisiana. We could only use the tickets in Florida. In other words, we were given hundreds of dollars worth of gift cards that were worthless to us.

Here's a list of the pitfalls of gift cards that may make you think twice about giving plastic as a present. Alternatives: this Christmas give home-made gifts, make a donation to charity in your loved-one's name or just give cash.

Pitfall #1. What can you buy for exactly $20?

Nothing. You almost always have to purchase more than the value of the card to redeem every penny. Otherwise you are stuck with a card with 33 cents on it. Either way, you lose money. What kind of gift requires you to spend your own money?

Pitfall #2. What if that store doesn't exist in your town?

Well, you can always try to order something online. But when it's something like movie tickets....there's not much you can do. You can re-gift it to someone in another town, or the money is lost.

Pitfall #3. What if that store doesn't have anything you want?

Then you're REALLY out of luck. Very few cards are redeemable for cash. If you don't buy anything, the company gets to keep the gift-giver's money without selling any merchandise!

Pitfall #4. What if that store goes out of business before you use the card?

When Circuit City went out of business a few years ago, millions of dollars in gift cards went unredeemed, lost forever to the card holder. What a waste!

Pitfall #5. You should absolutely never buy a gift card with a credit card logo!

Above all, never give a gift card with a credit card logo. These often come with expiration dates or even activation fees. Why should anyone have to spend money only to spend more money?

Again, why not just give cash?

*The only thing positive I can say about gift cards is that I have been given cards to stores and restaurants that I never would have tried otherwise and in the end really enjoyed. Sometimes cards do encourage you to be adventurous and try new things. But in the big picture, gift cards benefit companies far more than they do consumers.