The color of health: Racial disparities abound

[QueEx]

States that decline to expand Medicaid give up billions in aid​

McClatchy Washington Bureau
By Tony Pugh
September 2, 2014


WASHINGTON — If the 23 states that have rejected expanding Medicaid under the 2010 health care law continue to do so for the next eight years, they’ll pay $152 billion to extend the program in other states _ while receiving nothing in return.

This massive exodus of federal tax dollars from 2013 through 2022 would pay 37 percent of the cost to expand Medicaid in the 27 remaining states and Washington, D.C., over that time.

Most of the money, nearly $88 billion, would come from taxpayers in just five non-expansion states: Texas, Florida, North Carolina, Georgia and Virginia.

The findings are part of a McClatchy analysis of data from the Urban Institute, a nonpartisan research center that’s advised states on implementing the health care law, the Affordable Care Act.

Non-expansion states would see direct benefits from their $152 billion only if they reversed course and expanded eligibility for Medicaid, the state and federal health program for low-income Americans. The health care law provides financial incentives for states to extend Medicaid coverage to adults who earn up to 138 percent of the federal poverty level.

If the non-expansion states did so, they’d still have to pay the $152 billion. But the 23 states also would split nearly $386 billion in federal Medicaid funding from 2013 to 2022, according to Urban Institute estimates.

The money would cover all medical costs for newly eligible Medicaid enrollees from 2014 through 2016, and no less than 90 percent of their costs thereafter.

“Here is money that is pretty much there for the asking, and these states are turning it down. And in the meantime, their taxpayers are paying taxes that fund expansions in states that are moving forward. It just doesn’t make any sense,” said Sherry Glied, the dean of the Robert F. Wagner Graduate School of Public Service at New York University.

The federal funding under Medicaid expansion also would stimulate economic activity, boost tax revenue and create hundreds of thousands of jobs in the non-expansion states, experts say.

“This additional use of medical services not only brings more federal dollars, but hospitals, physicians and pharmacies would likely hire more people, keep longer hours and probably raise wages. All of which leads to indirect spending and subsequent rounds of spending that generate tax revenues and, in general, the expansion of the economy within states,” said Michael Morrisey, a health economics professor at the University of Alabama at Birmingham.

Expansion opponents doubt the federal government’s long-term ability to fund 90 percent of the cost for new enrollees. They also worry that their states can’t afford the increased Medicaid costs that come with expansion.

“We’re already struggling as a state, financially, to find the money to support our existing Medicaid system,” said Georgia Republican state Rep. Jason Shaw. “It’s really tough times for the state. It just wouldn’t be fair to the taxpayers if we just accepted the expansion.”

Some critics think the expansion encourages government dependency by providing free and low-cost health coverage for some while requiring those with higher incomes to pay full price. Those concerns have made expansion a tough sell in the holdout states, where Republican lawmakers want to curb enrollment growth in Medicaid no matter how sweet the financial incentives may be.

Last week, Pennsylvania became the ninth state with a Republican governor to accept the expansion. Like Arkansas and Iowa, Pennsylvania won approval from the Obama administration to bypass the Medicaid program and use the federal funding to help low-income residents buy private coverage instead.

Indiana and Utah, two other states with Republican governors, also are working with the Obama administration to enact their own versions of the Medicaid expansion. Many experts think that kind of federal flexibility will help Medicaid expansion work in most red states one day.

But in the run-up to the first midterm elections since the health law was fully implemented, expansion remains a hot-button issue. While polls show the Affordable Care Act remains largely unpopular, Democratic candidates in Republican-led states are campaigning for the expansion, citing the financial benefits.

In Georgia, Democratic gubernatorial candidate Jason Carter has made it a key issue in his race against Republican Gov. Nathan Deal.

“Every single day, our governor takes $9 million in our taxpayer money – our tax dollars that we pay to the federal government, $9 million a day – that he sends off to other states to give health care to those people, and denies it to 600,000 people in Georgia,” Carter, grandson of former President Jimmy Carter, said at a recent campaign stop in Savannah.

Parker Griffith, the Democratic gubernatorial candidate in Alabama, has chided Republican Gov. Robert Bentley for his refusal to expand Medicaid.

“We’re making a very big mistake in Alabama by not accepting and expanding Medicaid,” said Griffith, a retired radiation oncologist. “It just doesn’t make any sense, both economically and in the loss of human lives due to delayed diagnoses. For an investment of about $1 billion over 10 years, Alabama stands to return $14 billion” in federal Medicaid funding.

Bentley’s office and campaign staff didn’t respond to a request for comment.

Virginia forgoes $5.2 million in federal funding every day that state lawmakers don’t agree to expand Medicaid, Democratic Lt. Gov. Ralph Northam said. By his account, that’s well over a billion dollars already.

“That’s money we’ll never be able to get back,” Northam said.

Medicaid is a key element of the Affordable Care Act’s goal to provide near-universal coverage for millions of Americans. Since last October, more than 7.2 million people have gained Medicaid coverage, largely through the expansion.

In the 27 expansion states, single adults who earn up to $16,105 a year are eligible for Medicaid coverage, as are families of four that earn up to $32,913.

But pursuing expansion based on a state’s potential loss of funding “assumes federal funds come from nowhere,” said Drew Gonshorowski, a senior policy analyst at the Heritage Foundation, a conservative policy research group. “We have to think about this as redistribution rather than creation of new funds for the state.”

Since taxpayers nationwide fund each state’s Medicaid expansion, non-expansion states are serving the fiscal interests of the nation by helping to reduce federal spending, Gonshorowski said.

Expanding Medicaid coverage in the 23 remaining states would increase their state budget costs by $28.8 billion from 2013 through 2022, the Urban Institute reports. Expansion in Georgia, for instance, would hike its expenses by $2.5 billion over the 10 years, according to the institute.

“We simply cannot afford the $2.5 billion in new spending that expansion would require,” said Sasha Dlugolenski, a spokeswoman for Gov. Deal. “I think everyone can agree on one thing: The expansion costs money the state does not have.”

But experts say the increased revenue a state would see from expansion would more than make up for the state’s additional Medicaid spending.

Revenue gains for Alabama and Mississippi would exceed their expansion costs by $935 million and $848 million, respectively, according to a study co-authored by Morrisey, of the University of Alabama.

Those kinds of projections have led Republican state Rep. Steve Clouse, the chairman of the Alabama Legislature’s Ways and Means General Fund Committee, to support expanding Medicaid, even though he favors repealing and replacing the Affordable Care Act.

“We’ve got to deal with the hand we’ve been dealt by the feds,” Clouse said.

He wants Alabama to expand Medicaid with the stipulation that the state could pull out of the deal if the federal government ever pays less than 90 percent of the medical costs for newly eligible enrollees. Arizona has enacted a similar provision.

“That way, we don’t have our hands tied if we were to go in,” Clouse explained. “If the costs were spinning out of control, we could come out. There’s a lot of states that are just sort of tipping their toes in the water trying to figure this thing out.”
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Read more here: http://www.mcclatchydc.com/2014/09/02/238367/states-that-decline-to-expand.html#storylink=cpy

 

[QueEx]

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[QueEx]

New Report Says U.S. Health Care
Violates U.N. Convention on Racism

​

A report released in August by the Center for Reproductive Rights, the National Latina Institute for Reproductive Health and Sistersong Women of Color Reproductive Justice Collective paints a distressing picture of the health conditions facing black and Latina women in the United States. The report, “Reproductive Injustice: Racial and Gender Discrimination in U.S. Health Care,” was written for U.S. government officials and the United Nations committee tasked with reviewing compliance with the International Convention on the Elimination of All Forms of Racial Discrimination (ICERD). It makes a compelling case that the U.S. is in direct violation of ICERD based on the health care access and health outcomes associated with certain populations in the U.S.

One of the more frightening findings in the report, which focuses on black women in Georgia and Mississippi and Latinas in South Texas, is one that has received increased attention in recent years—the continued crisis of maternal mortality in the United States, particularly for black women. I’ve written about this topic before for Colorlines, but the situation continues to worsen with each new examination of our statistics.

Between 1990 and 2013, the overall maternal mortality ratio grew by 136 percent, from 12 maternal deaths for every 100,000 live births to 28 for every 100,000 live births. That increase coincides with a period during which a majority of other countries dramatically reduced their mortality rates. Our rates put us way behind most other developed nations. For instance, we have twice the rate of Saudi Arabia and three times that of the United Kingdom.

When you look at these statistics based on race and geography, the picture becomes even bleaker. According to “Reproductive Injustice,” over the last 40 years, the rate of black women dying in childbirth has been three to four times the rate of their white counterparts. And in many places where the white maternal mortality rate is so insignificant it can’t even be reported, black maternal mortality rates are way above the national average. For example, in Fulton County, Georgia, which includes Atlanta, there are 94 maternal deaths per 100,000 live births for black women—three times the national average. The white maternal mortality rate in the same county is essentially zero—too insignificant to report. In Chicksaw County, Mississippi, the maternal mortality rate is higher than those in countries of Sub-Saharan Africa, including Kenya and Rwanda.

“Reproductive Injustice” names various factors as contributing to the problem. There’s poverty: Citing a 2010 Amnesty International report, it says that high-poverty states had maternal mortality rates that were 77 percent higher than states with a higher percentage of people living above the poverty line.

According to “Reproductive Injustice,” women of color are much more likely than white women to live in poverty and lack health insurance—barriers to health care that can lead to diabetes and heart disease, chronic health conditions that put women at greater risk for dying in childbirth.
​

Read The Full Story Here

 

[Greed]

White privilege is the best medicine

White privilege is the best medicine
Updated by Julia Belluz and Steven Hoffman
on August 25, 2014, 7:00 a.m. ET

With the eyes of the world on Ferguson, Missouri, our collective attention is focused on the different treatment of black and white people at the hands of America's criminal justice system. The focus is well deserved. More than 50 years after the Civil Rights movement, it's still true that half of the black men in the US wind up arrested at least once by the age of 23, and are ten times more likely to be murdered than white men.

But every single day, there are many more race-related deaths that result from a quieter but arguably even more violent act: systemic discrimination in the US health system.

The truth is this: even today, in America, white privilege works better than most medicine when it comes to staying healthy. Racial health disparities may be a more subtle killer than gun violence or murder, but they're arguably a more violent one. They infect every part of the body and they strike at literally every stage of life, from cradle to grave.

The gap starts with birth

Simply put, black babies don't have a fair start. Pre-term delivery — coming into the world at less than 37 weeks — is one of the key causes of infant death in the US. These early births lead to a host of health complications, both short and long term, from vision and hearing impairment to cerebral palsy. Black women have a 43 percent higher risk than white women for delivering their babies prematurely. They are also between two and three times as likely to have babies dangerously early, in less than 32 weeks.

When it comes to nursing, black mothers are consistently less likely to breastfeed than white mothers, despite the guidelines suggesting all mothers do so because of well-documented health benefits. This gap has been explained by everything from preference to a lack of access and education about health benefits, to a dearth of support for new moms. The latest data from the CDC showed that hospitals in predominantly black neighborhoods also do less to promote breastfeeding than mostly white hospitals.

The black-white health divide continues throughout life

In childhood, black kids are more likely to suffer asthma and obesity. They have poorer oral health than white people. The health problems trickle into adulthood, when diabetes strikes black people much more often than it does white people: in 2010, the prevalence of obesity in black people was nearly twice that of white people.

Of all racial groups, African Americans suffer the most from HIV. Of all racial groups, black women have the highest breast cancer death rates and they're 40 percent more likely to die of the disease than white women.

The number of new HIV infections in the US by demographic group. Note, MSM means "men who have sex with men" and IDUs means "injection drug users." (Chart courtesy of the CDC.)

This disparity isn't only explained by differences in access to care. Even when black and white people have the same cancer screening, black people are more likely to die from the disease. The latest study on this issue examined the differences in cervical cancer treatment of black and white women in Maryland. Maryland was a good place to test that hypothesis, since they have a state-sponsored screening program to support women, and black and white women are being screened at the same rate.

After accounting for stage of cancer at diagnosis, the treatments received were still different. White women got surgery more, while black women were more likely to get radiation or chemotherapy combined with radiation. Such a treatment disparity may be what's driving the fact that, in the US, black women are more likely to have cervical cancer (chart below) and twice as likely to die from it than white women.

Near the end of life, the disparities persist. Black people have the highest death rates from stroke and hypertension, and the largest incidence and highest death rates from colorectal cancer. Compared with white patients, black patients are much less likely to get the life-saving organ transplants they need.

One study looked at people with end-stage kidney disease in six states, examining their likelihood of being placed on a waiting list for a donor organ and whether they wanted a referral in the first place. The results are deeply disturbing. "In contrast to the relatively small differences in preferences and expectations about transplantation," the study authors wrote, "black patients were much less likely than white patients to have been referred to a transplantation center for evaluation; they were also much less likely to have been placed on a waiting list or to have received a transplant within 18 months after the initiation of dialysis."

Black women are treated the worst

One theme in this damning body of evidence is that black women are affected most by this disparity: they're the population that suffers from both a racial and gender effect. Take this classic study published 15 years ago in the New England Journal of Medicine. Researchers presented 720 physicians from across America with one of eight random videos of an actor conveying symptoms and asked them to make health care recommendations. The eight videos were exactly the same — identical script, identical emotions — except that the actors differed in their age, sex and race.

Unfortunately, the physicians did not do so well. When the actors were women or black, the doctors were less likely to refer them for cardiac catheterization. Black women fared worst of all as the least likely group to benefit from doctors' recommendations to seek follow-up care. The study demonstrated that doctors sometimes carry deeply ingrained racial biases into the clinic and this can have a harmful effect on patients.

Black people have fewer years on this earth than white people

By the end of a life, all these health disadvantages add up to a lifespan that's cut short: black men can still expect to live five years fewer than white men, and black women can expect to live four years fewer than white women. There are no biological or genetic explanations for this difference. Four and five years is a lot of life: it's the length of time it takes to complete college or to see your child through to kindergarten.

Why the persistent gap?

Thomas LaVeist, director of the Hopkins Center for Health Disparities Solutions at the Johns Hopkins Bloomberg School of Public Health, has been studying racial disparities for decades. When he did his PhD dissertation in the 1990s, he calculated how many infant deaths were associated with being black, and the stunningly high numbers drained him. Since then, he says, not much has changed.

Even when you control for education and income, black people still fare more poorly than white people, and he thinks one key cause is everyday racism.

"These little microaggressions include things like going to a reception and sipping a glass of wine, and no one talks to you; trying to go into an elevator and someone doesn't hold the door from you; or walking into the elevator and someone moves further away as if they're concerned about you snatching their purse. These things are happening at a subconscious level, and they have a physiological and psychological response. That degrades your health, and it has been shown to degrade the strength of the immune system."

For years now, researchers like LaVeist have been meticulously documenting the ways black patients get inferior care and have worse health outcomes than other racial groups. Over a decade ago, the Institute of Medicine even published a definitive report on the subject, concluding that many of the differences in health care received between white and black Americans was the result of unacceptable discrimination.

The evidence is clear

We don't need more evidence about the existence of these unacceptable racial disparities and discrimination. When you look at the fullness of a life, and all the points at which that life intersects with the health system and then how much worse off black people fare every time, you can see there is a violence and injustice here.

That's something we should all fight against. LaVeist says some are already taking the first steps to address the problem. He's putting together a documentary about the black-white health gap, which highlights solutions. On the community level, he found educators in Los Angeles who are trying to teach people how to grow their own healthy food. In Mississippi, he found a pastor who banned soul food in his church. One woman in Nashville goes door to door, teaching people how to do CPR because so many studies have shown that African Americans are less likely to know CPR.

On the policy level, the Affordable Care Act has expanded access to more then 30 million people. "It's not sufficient to address the health disparities problem," says LaVeist, "but it's an important and necessary condition."

Still, evidence suggests that the ACA isn't working as well for black Americans as it is for other racial groups: their uninsured rates have only dropped from 21 percent to 20 percent since the legislation was introduced. So the ACA is a start — it's foundational — but it's still failing African Americans.

Right now, in 2014, despite all the advances of medicine in the last 100 years, despite this groundbreaking health-care legislation, despite having a black president in the White House, the black-white health gap isn't going away.

We often focus on medicine and the latest technology in health. Yet as the people of Ferguson, Missouri know, what dictates how healthy you'll be throughout life — and all the promise and opportunity that cascades from that — is something a lot more basic. In America, it's still the color of your skin.

http://www.vox.com/2014/8/25/6052871/why-white-skin-works-better-than-most-medicine

 

[Greed]

Managed Care Plans Make Progress In Erasing Racial Disparities

Managed Care Plans Make Progress In Erasing Racial Disparities
Lisa Aliferis
December 17, 2014 1:30 PM ET

Years of efforts to reduce the racial disparities in health care have so far failed to eliminate them. But progress is being made in the western United States, due largely to efforts by managed care plans to identify patients who were missing out on management of chronic diseases like diabetes and heart disease.

While management of blood pressure, cholesterol and blood sugar improved nationwide, African-Americans still "substantially" trailed whites everywhere except the western U.S., an area from the Rocky Mountains to the Pacific as well as Alaska and Hawaii.

"We were certainly hoping we would see indications of progress in eliminating disparities in the country as a whole," said Dr. John Ayanian, who heads the Institute for Healthcare Policy and Innovation at the University of Michigan and was lead author of the study. While it was "disappointing" that disparities persisted, he said, "it's also heartening to see that ... in the West, the disparities had been eliminated, and that was both surprising and encouraging."

To find that out, Ayanian and his colleagues looked at 100,000 Medicare patients who were enrolled in HMOs, called "Medicare Advantage" plans, from 2006 to 2011. The study was published last week in the New England Journal of Medicine.

Disparities in health care have long been noted in American health care. The researchers wrote that, in 2008, "life expectancy was 5.4 years shorter for black men and 3.7 years shorter for black women than for white men and white women." Heart disease and diabetes — diseases that can be better managed by controlling blood pressure, cholesterol and blood sugar, the risk factors measured in the study — accounted for 38 percent of the gap in mortality between black and white men, and 54 percent of the gap among women, the researchers said. That's why closing the racial gap on these measures is so critical.

"It's one of the first large studies to show that it's possible to eliminate deeply ingrained racial disparities in important risk factors," Ayanian said. He said that outcomes for Hispanics, and Asians and Pacific Islanders were "also encouraging."

Nationwide, black enrollees in the study were substantially less likely than white enrollees to have adequate control of blood pressure, cholesterol and blood sugar, trailing whites by about 10 percent.

Hispanics were 1 to 3 percent less likely than whites to have blood pressure, cholesterol or blood sugar under control. Asians and Pacific Islanders were more likely than whites to have good control of blood pressure and cholesterol. Blood sugar control was about the same.

Specifically, the researchers pointed to Kaiser Permanente health plans as being successful in eliminating disparities. Kaiser includes "nearly half" of Medicare HMO enrollees in the western region of the U.S., Ayanian said.

"Our findings in the West of nearly identical control of three major risk factors among black Medicare enrollees and white Medicare enrollees in Kaiser health plans and control of (blood sugar) in other health plans show the potential to achieve equity in these key health outcomes," the researchers wrote.

Kaiser representatives said they did not have any advance knowledge of the publication of the study.

Dr. Joseph Young, who leads Northern California Kaiser's clinical hypertension program, said that Kaiser adopted a population management approach to managing chronic conditions in 2006. Kaiser has created registries for people with various kinds of conditions, so that patients who might be missing preventive care or better management of disease can be easily identified.

In the area of blood pressure control, Kaiser changed its drug formulary to allow a "combined pill — a single pill that includes two drugs, to make it easier for patients to take their medication.

These population-based strategies resulted in big improvements in overall outcome for Kaiser patients. Young said that during the 2000s, very serious heart attacks ... fell by 62 percent, and our stroke mortality fell by 42 percent.

Kaiser does have some remaining racial disparities in its non-Medicare population, and Young said they are "actively focusing" on closing those remaining gaps.

"We want clinicians to do what Kaiser is doing and take seriously to provide high quality race-blind clinical care," says Dr. Anthony Iton, who leads the Healthy Communities initiative at the California Endowment. "Kaiser is showing it can be done." He called the study "very hopeful" and believes that Kaiser's approaches are replicable elsewhere.

"Any other system that says it's not doable has to explain how they can justify not providing the same high-quality care to everyone that comes in the door," Iton said.

California probably has "less of a socioeconomic spread between whites and blacks than you do in the southeastern United States," Iton noted. "It's a heavier lift in the Southeast than in the West. But despite that, it's clearly doable."

http://www.npr.org/blogs/health/201...s-make-progress-in-erasing-racial-disparities

 

[Helico-pterFunk]

I've always been concerned about heart health in the fam'. Dad's side of the fam' especially. Great grandfather passed at 50. Grandma suffered a number of strokes and heart attacks from 55 - 80. Her brother suffered a heart attack at 50, but didn't get it properly assessed/addressed, and passed suddenly of a massive one at 58 (1997). His son (very healthy) has had irregular heartbeat issues and chest pains in recent years (he's 39). He's had a few hospital visits & testing done and things have improved, but he isn't out of the woods (his mom passed of stomach cancer in her late-60s two years ago), etc.

 

[Greed]

Racial gaps in diabetes not tied to social, economic status

Racial gaps in diabetes not tied to social, economic status
Reuters
By Kathryn Doyle
February 16, 2015 3:55 PM

Reuters Health - Social and economic status does not explain the racial gaps in the care and outcomes of kids with type 1 diabetes, according to a new study.

The finding suggests researchers look to other factors that may explain the racial gap in type 1 diabetes care, such as the perceptions of doctors and families, write the researchers in the journal Pediatrics February 16.

Previous studies done in much smaller populations have had somewhat similar findings, wrote lead author Dr. Steven Willi of the Children’s Hospital of Philadelphia in an email to Reuters Health.

More than 29 million Americans have diabetes, 5% of who have type 1, according to the Centers for Disease Control and Prevention.

Willi and his coauthors used data from more than 10,000 kids under age 18 in a type 1 diabetes registry, following them for at least a year. The majority of the kids were white, but 11% were Hispanic and 7% were black.

The researchers say children who were black tended to have worse control over their diabetes, compared to white and Hispanic children.

Mean hemoglobin A1c should be below 7.5% among children younger than 19 years with type 1 diabetes, according to the American Diabetes Association.

That measure was 9.6% among black children. That compared to 8.4% among white kids and 8.7% among Hispanic kids.

Black children also had more complications from type 1 diabetes, compared to white and Hispanic children, the researchers found.

The racial gap in diabetes management remained even after the researchers adjusted for factors that may influence diabetes management, including the social and economic status of the children’s families.

The researchers also found that black children were less likely to have insulin pumps, compared to white and Hispanic children after adjusting for their families’ social and economic status.

Willi said other possible explanations for the racial disparity in diabetes care and outcomes include cultural differences in acceptance of insulin pumps, the interaction between black diabetes patients and their primarily white healthcare providers, or in fact that providers have a racial bias in the diabetes care relationship.

“I do not feel that diabetes care providers are overtly racist in any way,” Willi stressed. “However, I do have lingering concerns that subliminal racial bias still exists in this country, and the medical community is not immune to this.”

There may be another explanation, according to Dr. Stuart Chalew of Children’s Hospital of New Orleans, who wrote an editorial accompanying the results.

“What is hemoglobin A1c?” Chalew said. “Doctors will say it’s the mean blood glucose,” but that’s a simplified way to look at it, he said. In previous studies, even when black and white patients have the same blood sugar levels, they can have higher A1c, which may be due to genetic differences, he said.

That issue wasn’t really assessed in the new paper, although the results are still valuable since the sample of kids was so large, he told Reuters Health by phone.

A1c measurements may be overestimating blood sugar for black patients, leading them to take more insulin and inadvertently push their blood sugar too low, which would explain the higher rate of complications, he said.

Closing the racial gap among people with type 1 diabetes will hinge on uncovering the root cause.

“Of course, healthcare providers should continue to strive for cultural sensitivity in their practice,” Willi said. “Finally, if this gap is due, in part, to subliminal racial bias, it will be helpful to recognize that this bias exists, and actively work toward its eradication.”

https://news.yahoo.com/racial-gaps-diabetes-not-tied-social-economic-status-204840766.html

 

[Greed]

Death rate in US blacks infected with HIV drops 28%

Death rate in US blacks infected with HIV drops 28%
AFP
February 5, 2015 5:47

Washington (AFP) - The mortality rate of African-Americans infected with HIV has dropped sharply in recent years and the gap between whites and blacks is narrowing, new figures show.

A new report by the US Centers for Disease Control and Prevention found that the death rate for blacks infected by the HIV virus dropped 28 percent from 2008 to 2012, a greater decrease than other races and ethnicities.

The CDC gave no explanation for the drop, but various groups have launched vigorous information campaigns in recent years targeting high-risk groups.

In 2012, the latest year for which data was available, blacks still had the highest death rate overall, with 20.5 percent, compared with 18.1 percent for whites and 13.9 percent for Hispanics or Latinos.

Blacks are infected with HIV at higher rates than other groups.

The CDC noted that African Americans living with HIV were less likely to get diagnosed, with 15 percent unaware of their infection in 2011, compared with 12 percent of whites.

"Focusing prevention and care efforts on minority populations with a disproportionate HIV burden could lead to further reduction, if not elimination, of health disparities, such as higher mortality and help achieve the goals of the National HIV/AIDS Strategy," the report said.

https://news.yahoo.com/death-rate-us-blacks-infected-hiv-drops-28-224717189.html

 

[Greed]

#BlackLivesMatter: Is Our Health Care System Fundamentally Racist?

#BlackLivesMatter: Is Our Health Care System Fundamentally Racist?
Jennifer Gerson Uffalussy
March 18, 2015


Exhibit A:

A young white woman visits a medical clinic with acute pain in her lower abdomen. She’s preliminarily diagnosed with appendicitis.

A young black women visits the same clinic with identical symptoms. She’s given a diagnosis of pelvic inflammatory disease, which usually is the result of an untreated sexually transmitted disease.


Exhibit B:

Among women diagnosed with breast cancer, African-American women are the most likely to die from the disease.

Exhibit C:

In New York City, the rate of premature death is 50 percent higher among black men than among white men.

The Verdict:

The #BlackLivesMatter movement — which began in 2013 as a hashtag when George Zimmerman was acquitted in the shooting death of Trayvon Martin, and gained momentum after the deaths of Michael Brown and Eric Garner in 2014 — needs to extend to the American health care system.

That’s the message of three experts in Thursday’s edition of the New England Journal of Medicine — that it’s essential to recognize racial disparities in access to and quality of health care, the disproportionate number of preventable deaths and illness within the African-American community, and the overall underrepresentation of people of color within the medical establishment.

In her piece “#BlackLivesMatter – A Challenge to the Medical and Public Health Communities,” New York City’s health commissioner Mary Bassett, MD, MPH, says that “[t]here is great injustice in the daily violence experienced by young black men. But the tragedy of lives cut short is not accounted for entirely, or even mostly, by violence. In New York City, the rate of premature death is 50 percent higher among black men than among white men…and this gap reflects dramatic disparities in many health outcomes, including cardiovascular disease, cancer, and HIV. These common medical conditions take lives slowly and quietly — but just as unfairly.”

The trickle-down inequalities of health care in the black community are not just limited to men. “Black women in New York City are still more than 10 times as likely as white women to die in childbirth,” Bassett points out.

According to data from Young Invincibles, a policy group focused on health care reform for young adults, African-Americans ages 18 to 34 have, historically, been disproportionately uninsured — and one of the populations most significantly impacted by the Affordable Care Act (or ACA, known by many colloquially as Obamacare). Since the implementation of ACA, about half a million young African-Americans have gained access to health insurance because they are now able to remain on their parents’ plan through age 26. An additional 1.8 million uninsured young adult African-Americans could be eligible for tax credits for lower premiums and an additional 1.7 million could be eligible for free or low-cost Medicaid coverage if all states were to participate in the ACA’s Medicaid expansion program (currently just 27 do).

The lack of health insurance among this demographic contributes to poor health outcomes compared to other groups (and white peers especially): African-Americans are more likely to die from chronic diseases and heart disease; experience negative health effects from poverty such as asthma, obesity, and infectious diseases; and are 12 percent less likely than white adults to receive a flu vaccine. Furthermore, a disproportionate number of these deaths are the result of pregnancy complications in young African-American women and chronic lower respiratory diseases in young African-American men.


Racial disparities in the American healthcare system impact children, too.

A 2009 report published by First Focus, a bi-partisan advocacy group, found that not only are African-American children more likely to suffer from asthma, skin allergies, speech problems, and unmet prescription needs, but that African-American children are at a 12 percent greater risk of being uninsured — and thus left with sub-optimal health care. And yet, many of these children are eligible for, but not enrolled in, Medicaid of the Children’s Health Insurance Program (CHIP).

The report concludes that providing insurance to these children would result in “significant reductions in unmet needs for medical care” and “increased visits for preventive specialty care; improved quality of care…higher immunizations rates…reduced emergency department visits for asthma and reduced hospitalizations.”

Young women face their own unique challenges; a spokesperson for Planned Parenthood notes that black teens ages 15-19 have higher rates of pregnancy, birth, and abortion than non-Hispanic white teens. While at a historic low, the birth rate for African-American teens is more than twice that of non-Hispanic white teens.

In January of this year, Cecile Richards, President, Planned Parenthood Federation of America, addressed the National Press Club to call attention to disparities in women’s healthcare. In her remarks, Richards urged Congressional leadership to address these inequalities by expanding access to publicly funded family planning services; support medically accurate, age-appropriate sex education nationwide; make birth control available and accessible; and support efforts to strengthen and protect Medicaid.

A study out today in the Journal of the American Medical Association (JAMA) found that while they did not ultimately impact clinical decisions, unconscious race and social class biases were present in most trauma and acute-care clinicians. 215 clinicians were surveyed; almost all were found to have moderate racial biases, and strong social class biases, regardless of the clinician’s respective age, race, and clinical specialty. One particularly startling finding was that respondents were more likely to diagnose a young black woman with pelvic inflammatory disease rather than appendicitis when presented with the same set of symptoms among black and white patients.


This data speaks strongly to a second piece regarding black lives and healthcare in Thursday’s New England Journal of Medicine. In it, David Ansell, MD, MPH, and Edwin McDonald, MD, write about the “White Coats for Black Lives” die-ins held at medical schools across the country this past December, “the largest coordinated protests at U.S. medical schools since the Vietnam War era,” a movement that set out to call attention to “the explicit and implicit discrimination and racism in our communities and reflect on the systemic biases embedded in our medical education curricula, clinical learning environments, and administrative decision-making.”

Ansell and McDonald reiterate the findings of the JAMA study, noting that implicit racial biases often impact the kind of care a patient receives. A 2002 Institute of Medicine (IOM) study found that “for almost every disease studied, black Americans received less effective care than white Americans. These disparities persisted despite matching for socioeconomic and insurance status.”

Ansell and McDonald also point out that while “black medical students are more than twice as likely as white students to express a desire to care for underserved communities of color,” the number of African-American men graduating from American medical schools has declined over the past twenty years. Perhaps not coincidentally, “only 2.9 percent of all faculty members at U.S. medical schools are black” and “black faculty members are less likely than their white counterparts to be promoted, to hold senior faculty or administrative positions, and receive research awards from the National Institutes of Health.”

The authors conclude that the racial disparities that exist in our healthcare system cannot be fully addressed until the biases happening in medical education are first addressed.

https://www.yahoo.com/health/blacklivesmatter-racial-disparity-in-healthcare-113976779082.html

 

[Greed]

Battling America’s other PTSD crisis

Battling America’s other PTSD crisis
Research shows that inner-city violence can be as traumatizing as war. A program in Philadelphia is pioneering new ways to treat the urban wounded
By Tina Rosenberg
March 6, 2015 5:28 AM Yahoo News

The fight that started Keith Davis on a path to a new life began when he was buying marijuana. It was early afternoon on Aug. 8. As he tells it, he was in at his usual hangout in North Central Philadelphia, in front of an abandoned church at 18th and Ridge. He was taking too long mulling over his purchase, and another man got impatient and told him to go buy his stuff somewhere else.

“I go wherever I want to go,” said Davis. The man said some things back. A fight broke out, which ended when the man pulled out a knife and stabbed Davis in the abdomen and left arm.

Davis, who was 21, was still punching at the man even as he watched the knife go in. He saw the blood, but he felt no pain. He thought about calling an ambulance. “But I don’t want to pay $2,000 for an ambulance,” he said. And an ambulance would probably mean police — nobody wanted that. “I ain’t no snitch,” Davis said in December, recalling his thinking. Hahnemann University Hospital’s emergency department, a place well known to Davis and his friends, was a little over a mile away. He started to walk.

This was Davis’ corner. He grew up a few blocks away in the Francisville neighborhood, and these were his people. But no one volunteered to come with him. “I didn’t ask nobody, and they know what kind of person I am,” he said — one who can take care of himself. As Davis walked, holding his stomach wound, the bloodstain bloomed across his shirt and began to drip onto the sidewalk. Strangers offered help, but Davis shrugged them off and kept walking. He got to the emergency room. He remembers one gentle doctor calming him down. “Let’s call your mom,” the doctor said, “and then we’re going to put you to sleep.” Nurses took off his sneakers, cut off his clothes and stuck a needle in his arm. He woke up a day later with 72 stiches in his left arm and more than 30 staples in his stomach.

It was the type of crime that kills more young men in America than any other: The ingredients are an argument over nothing, an audience (ensuring that neither man can back down) and a weapon. The weapon was a knife, so Davis woke up. It’s usually a gun, and often they don’t wake up.

That knife, though, did not just wound his stomach and arm. It also altered his brain. When he woke up in the hospital, he was surrounded by his family, but his first thoughts were new worries: Who can I trust? It now seemed too dangerous even to walk to the store. “I can’t let my guard down when I go around the neighborhood.” And then, “I need to retaliate.”

Just after he got out of the hospital, the demon arrived. Davis was alone; his girlfriend, Regina Stewart, was out at the store. He was on the border of sleep when he noticed a shadowy figure in the room. He was terrified. He told himself it wasn’t real, but it looked real. He felt like he was falling, but his body was paralyzed. He couldn’t talk or move, couldn’t save himself from the intruder. He fell for what seemed to him like 20 minutes. He screamed and screamed, and then Stewart tapped his arm and he woke up.

The intruder returned again and again. Sometimes it looked to Davis like an alien, sometimes a monkey sitting on his chest, sometimes a demon. “My mom told me the devil is riding on my back,” he said.

His body was slow to heal. He felt his wounds were on fire, and the Percocet he was given wasn’t enough. His abdomen wound kept him from standing straight, and he used a walker. His staples got infected, and he had to take courses of two powerful antibiotics. He spent six weeks hardly able to get out of bed or off the couch.

But gradually his physical wounds healed (although enormous bills remain; he has no insurance). The infection went away, and he started standing up straight and walking. By the usual standards of the emergency room, this is what we call “recovery.’


But to Theodore Corbin, an emergency department physician at Hahnemann, it wasn't enough. It was clear to him that patients like Davis, who land in the hospital with knife or gun wounds, can have more than bodily injuries. They often also suffer the psychological trauma we normally associate with war or catastrophic natural disasters. But our health care institutions have been slow to react to this phenomenon.

“So many young people come through the ED — shot, stabbed, assaulted,” said Corbin. “The status quo is to patch them up and send them out.” Doctors know it as “treat ’em and street ’em.”

“Medical science — up to a point — is good at physical needs,” said Corbin. “Mental, not so much.” Even as Davis’ body recovered, the devil stayed firmly on his back.

Corbin, who also teaches emergency medicine at Drexel University’s School of Medicine, was trying to do something about “treat ’em and street ’em.” Hospitals didn’t try to fix psychological trauma. The vast majority didn’t even look for it. But Corbin realized that his patients’ psychological injuries fueled more violence, landing them in the emergency department again and again. People suffering severe psychological trauma live on a hair trigger. Davis jumps when someone opens a soda bottle. Some crime victims who never carried a gun start carrying after they are attacked, determined that next time they will shoot first.

In 2007, Corbin founded a program at Hahnemann — Healing Hurt People — to offer something new to victims of violent assault: treatment for the full spectrum of trauma.

*****

Forty-five years ago, the medical establishment in America grasped the severe psychological injury that soldiers could sustain from exposure to the violence of war. We are just now starting to understand that the same is true of residents of violent urban neighborhoods, and that their trauma is both a public health and a public safety issue. Numerous academic studies have found rates of PTSD among people who live in violent neighborhoods higher than those of soldiers returning from Iraq and Afghanistan. Some research concludes that 46 percent of people in these neighborhoods will develop PTSD in their lifetime.

Corbin and his colleagues are pioneering a new form of treatment that could help stop a cycle of death and dysfunction that has resisted other approaches. In doing so, they are showing Philadelphia how to offer a measure of hope to its own inner-city battle zones.

*****

This is what we think we know about PTSD: It is the product of an event so overwhelming that the brain cannot integrate it into the normal stream of memories. When in “fight, flight or freeze” mode, the brain concentrates on what is necessary to survive, and can fail to correctly place an event in context; later, the brain doesn’t know the event is in the past. Unless PTSD is treated, sounds, sights, touches or smells that remind a person of the traumatic event can trigger the perception that it is occurring all over again.

For decades, the medical establishment has understood that experiences like war, sexual assault or child abuse can produce PTSD. Why, then, are we only starting to focus on PTSD in people like Davis?

The most important reason is that society doesn’t view men like Davis as true victims of crime. Instead, we see them as people who involve themselves in criminal activity despite knowing the risks. “Somehow we’ve accepted the idea that young black men don’t get shot — they get themselves shot,” said John Rich, professor of health management and policy in Drexel University’s medical school and co-director of the university’s Center for Nonviolence and Social Justice. That view is common among doctors and nurses, Rich said. It used to be in the back of his mind as well.

From 1998 to 2005, Rich was the medical director of Boston’s Public Health Commission and a primary care doctor at the Boston Medical Center, where he founded and ran the Young Men’s Health Clinic. Even for patients who came in for routine exams, violence was pervasive: They lifted their shirts to reveal the scars of gun or knife wounds. Rich spent several years talking to men who landed in the emergency department with these wounds.

His 2009 book about the lives of the men he met in the hospital, Wrong Place, Wrong Time, traces Rich’s journey away from the “they get themselves shot” point of view — and there is data to back him up. A Chicago Police Department analysis in 2011 showed that only about 10 percent of homicides were the cold-blooded strategic killings for drug turf that we assume to be widespread. Another 4 percent were retaliation — and some of the victims were relatives, friends or neighbors of the target, or simply got in the way of a bullet.

More than 70 percent of the homicide victims, meanwhile, died as a result of the same thing that injured Davis: a senseless altercation. The code of the streets demands that every perceived disrespect be answered, as those who don’t retaliate invite future victimization. And guns are ever present.

That doesn’t mean the victims were innocents. Most of the Chicago murder victims had a prior arrest history. Davis did as well. But the only infraction his stabbing had to do with was an attempt to buy weed. The vast majority of victims don’t “get themselves shot.” They are trapped in a culture that turns what might be a punch in the face elsewhere into second-degree murder.

Making matters worse is the fact that while urban violence may not be as intense as what soldiers face in Iraq or Afghanistan, it’s much longer-lasting. In a real war zone, a soldier can leave the battlefield. Keith Davis continues to live in his. In a place like Francisville, there is nothing “post” about posttraumatic stress.

This is dangerous. Violence creates trauma, but trauma also creates violence. Hurt people hurt people. People with PTSD are hypervigilant, seeing disrespect where none exists. They self-medicate with alcohol and drugs. They are emotionally numb, indifferent to death. They turn away from the comfort and stability offered by family or friends. All those things lead to violence. And with PTSD, it is hard for them to leave the streets and create new lives.

“You feel: ‘I’m not going to allow myself to be vulnerable to this situation ever again,’” said Tony Thompson, a social worker with Healing Hurt People. “You look at the world differently: Every action, every movement is about creating a sense of safety. Instead of waiting for somebody to hurt me, I’ll be ready for them when they come.”

*****

When Theodore Corbin went to medical school, he chose emergency medicine because it was the only department that takes everyone, regardless of ability to pay. By the time he graduated in 1997, he knew he wanted to focus on the health of young men of color. But he soon realized that his traditional emergency room work wasn’t enough. For every victim of violence who dies, there are 94 nonfatal violent incidents. Even with gunshot wounds, four victims survive for every one who dies.

Corbin would patch up their physical injuries. Then they would be back out on the street — if they were lucky, with a referral in their pocket to a social service organization. Soon they would get shot or knifed again, a cycle that sometimes ended when the patient received an injury he didn’t survive.

In the winter of 2002-03, Corbin learned of John Rich’s work on the health of young black men. In 2005, Rich moved to Philadelphia. He and Corbin are now married.

At the same time, Corbin was talking to Sandra Bloom, a Philadelphia psychiatrist and a leader in the field of treating trauma, about what was practical for a clinic to do. Traditional psychotherapy was not an option — it was too expensive and took too long.

But Bloom had something else — a program called SELF, which is an acronym for four pieces necessary to heal from trauma: Safety, Emotional management, dealing with Loss and building a Future. Bloom had developed a curriculum for groups that, while not classic therapy, helped participants learn about what was happening to them and discover ways to get better.

Corbin, Rich and Bloom founded Healing Hurt People, which relies on the SELF curriculum for its trauma treatment. In January 2008 the program enrolled its first client, and the following year it opened in a second site at St. Christopher’s Hospital for Children, where it treats children together with their families. Today, both the Hahnemann and St. Christopher’s sites work in some way with about 35 clients every month and have to turn away many more. HHP is also the headquarters of the National Network of Hospital-based Violence Intervention Programs, with 26 members in the U.S., Winnipeg and London.

Healing Hurt People offers traditional services: connecting clients to schooling or drug treatment, resolving legal issues, finding housing, writing résumés. What makes it different from other programs is that it also diagnoses and treats PTSD, and takes trauma into account in all its other services. Not every client participates in the SELF groups, but all are invited to, and some do more than one round.

*****

Keith Davis might never have joined a SELF group if not for a cheerful young social worker named Meredith Gill. Gill uses a wheelchair herself, and has a Labrador/golden retriever service dog named Tom who accompanies her almost everywhere. Davis was working his way down the hospital hallway, bent over his walker, when he saw Tom and asked to pet him. Gill introduced herself and they went into Davis’ room to talk.

Everyone else in the hospital had asked Davis the same question: What happened? Gill didn’t. “It’s kind of comforting that I’m not interested in getting any information,” she said. What she asks people — and others in the hospital do not — is whether they will feel safe when they leave, and what they need.

A day later, Davis got a visit from Thompson, Gill’s colleague. Thompson tried to calm Davis, who was extremely anxious. He suggested that Davis stop by the program.

Davis considered it. “When I got stabbed, I thought it was the end of my life,” he said. “I didn’t know what I was going to do, and I had nobody to go to.” One of his friends who got shot afterward used to step out in front of moving buses and hold his hands up to make them stop. Davis didn’t want to be like that. “I’m not going to make myself crippled or crazy,” he said, shaking his head. He waited until he could walk normally again, and then he came in.

Healing Hurt People works out of a nondescript office in a Drexel medical school building around the corner from Hahnemann. On Mondays at 3, clients gather in the conference room for a support group using the SELF curriculum. At the meeting on Dec. 15, the conference table was laden with pizza, chicken wings, Coke and Diet Coke.

This meeting was the 10th of the series and would normally have been the last, but the leaders decided to add three more; the holidays are a rough time. Davis took a seat in front of a pizza, alongside six other clients (one of them female) and several program staff. Davis and Anthony Nuñez had been stabbed; the rest had suffered gunshot wounds.

Ruth Ann Ryan, a nurse who specializes in trauma treatment and worked with Bloom to develop SELF, led the group. She started by going around the table, asking everyone, staff included, how they were feeling and what their goal was for the week.

The men exuded bravado. “My goals are to finish doing what I got to do to survive,” said Davis, “and I don’t got no feeling right now.”

“I feel ... dehydrated,” said Nuñez, to general laughter. “I’ve been drinking beer.”

Most of the participants in this support group had spent a lifetime trying to avoid showing vulnerability. But then Ryan’s exercise started to prove its use.

“I’m procrastinating, putting off the job thing,” Nuñez continued. His goal for the week was to get back on track.

That allowed Ryan to lead into a discussion of small steps to build the future. The clients largely counseled each other. One of the men said his next big step was developing patience: “One job application and I’m done,” he said.

“You got to do five a day,” said Davis. “I got two jobs,” he said proudly.

“What steps did you take?” Ryan asked.

“I filled out 25 applications,” he said. “Then three people call you for interviews. I see people waiting on one application — why not fill out 50?”

The discussion about job applications, part of “F” for future, was perhaps the least personal topic of the whole process. But Thompson said the men had been eager to talk all along. “These young men are closed down, but they’re actually looking for reasons to talk,” he said.

“In your neighborhood people look at you like you're not tough enough. But you get them into a room with people who look like them, who have the same problems, and they speak.”

The SELF groups are therapeutic: Participants hear from others just like them that they’re not going crazy, their symptoms are normal. For many clients, this is enough. Some — perhaps including Davis — will need more. But one-on-one psychotherapy is nearly impossible to get. The SELF groups may be all there is.


*****

For most of the men, especially those with families, building a future and a normal life after trauma starts with a job. Just before Christmas, United Parcel Service was hiring extra help for the season. Davis applied and interviewed. But he had a record — all misdemeanors, but that still meant UPS wouldn’t hire him.

Thompson showed him the list. His infractions were light, and some were from before he was 18. “You can get these expunged,” Thompson told him.

An hour later, Davis called him from the courthouse. “I’m doing this right now,” he said. “I want a job, and I’m not going to wait for one to come to me.”

Davis had dropped out of high school just before his senior year, when a close friend was shot to death — so close that Davis now has the man’s name tattooed on his neck. He’s taking GED classes to get his high school diploma, and at the same time studying to be a nurse.

The 25 résumés paid off: He works for two cleaning companies. In the early evening, he buffs and polishes floors in a Jenny Craig weight loss center and a daycare center. Then late at night he takes the bus to the edge of town to do the same at a Rite Aid — on one day I saw him, his job started at 1 a.m. Then he gets a ride to two more Rite Aids before the night is over.

“I like this job — it’s just like hustling,” he said. “I got to make this trip to get that money. I’d rather take the slow money than be in jail, or be killed. I got a future now.”

The main reason is Kanye, his 9-month-old son. He and Stewart have been together since they were 15. Stewart studies business administration in college and works two jobs, one of them a bus ride away outside the city, in King of Prussia. When they were 18, Stewart got pregnant with triplets who shared an amniotic sac and died in the fifth month of gestation. “I delivered them,” said Stewart. “I still consider them my children.” Once when I met Davis he had just come from getting Kanye Christmas presents — he bought clothes, and the Salvation Army gave him toys.

Another time, we met at a relative’s house. Davis was putting little jeans and sneakers on Kanye, getting ready to take him home. He lives with Stewart and Kanye most of the time. He’s worried for their safety, though, so he spends some nights at friends’ or relatives’ houses. “I don’t want people to know my whereabouts,” he said. He walked out the door and into the streets of Francisville, carrying baby, car seat and diaper bag.

*****

Left alone, PTSD can last for a lifetime; 40 years after the end of the Vietnam War, more than one in 10 Vietnam-era vets still have it. But PTSD is treatable — with various psychotherapies and some antidepressants, through coping skills such as meditation, mindfulness, yoga and acupuncture, with rapid-eye-movement therapy and, most controversially, with drugs like LSD and Ecstasy (administered correctly).

PTSD is more difficult to treat, however, when the traumatic event is simply the latest in a long line of traumatic experiences, and that’s more frequent in rough neighborhoods. If there is no posttrauma in many places, there is also no pretrauma.

“The people coming into the emergency room are much more characterized by complex PTSD — the recent trauma has inflamed previous trauma,” said Bloom. “When a kid grows up in poverty with chronic discrimination, and sometimes various forms of child maltreatment, and is also exposed to community violence, it’s a pile-on effect. It’s like they’re growing up in a war zone. It changes their developmental pathways.”

In the last few years, researchers have begun to realize just how profoundly exposure to such social ills — not to mention addiction, incarceration and violence in the home — affects long-term mental and physical health. These events have a name: adverse childhood experiences, or ACEs. They are common everywhere but rampant in low-income neighborhoods.

Corbin and the program staff screened their clients six weeks after their assault. They found that 75 percent of them had full-blown PTSD, and the median number of ACEs was 3.5. Nearly a fifth of the clients had seven or more ACEs.

These events sentence children to live in constant fight-or-flight mode, drowning them in cortisol and adrenaline, which wears down the body. ACEs also raise the risk of behavior and learning problems, depression, substance abuse, homelessness and crime — all behaviors that pass ACEs down to the next generation. And, when exposed to trauma, people with these childhood experiences are more likely to get PTSD.


*****

Sometimes very little treatment can help people make major changes in their lives. In November 2011, Jermaine McCorey was mugged and shot three times by a rival drug dealer. Over the next year he often imagined footsteps behind him. “I would be paranoid a great deal,” he said. “I’d find myself on edge all the time. I was reliving the whole situation in the middle of the day. My problem was with one guy, but I would think: What if there’s someone else?”

Although that neighborhood had proved its danger, McCorey went back again and again, to be ready for his attacker if he showed up. “I’d find myself standing there where I was shot, waiting with a pistol,” he said. “I wanted to retaliate.”

On one of his trips to the scene, a half block from where he was shot, he was shot again. He doesn’t know why. This time a bullet severed an artery in his leg. He couldn’t feel his leg for a long time. “I thought I wouldn’t walk again, and I wanted to die,” he said.

Now 25, McCorey started coming to SELF groups after he was shot the first time. “I took it as a way to get one foot out the door of the drug game,” he said.

But one foot only. “I was in contemplation mode: Do I want to change or not?” he said. The answer, apparently, was no. He had moved to a different neighborhood after the shooting. “But I still managed to take my butt down there and sold just about every drug: crack, coke, weed, pills,” he said.

“My pride kept me there,” he recalled. “You keep doing it until something happens.”

Things changed after he was shot again. He started to look at his life in a different way. “We normalize getting locked up, shooting guns as something that just happens.” He shook his head. “It’s not normal.”

McCorey started to spend more and more time at Healing Hurt People. He became an informal adviser to the program, then in January started to work there part time while he goes to college. It’s now his job to meet people in the emergency department, to tell them about the program — and he’s got the weekend shift, when violence is highest. His own PTSD is better. “I sometimes have nightmares — that’s the only thing that lingers,” he said. The flashbacks and paranoia are gone. He lives a normal life, he said.

Many cities are reforming their social services to take ACEs and acute trauma into account — “trauma-informed care” is the jargon. Philadelphia is among the most aggressive. Last month, Drexel announced that the city is financing the expansion of Healing Hurt People to all of Philadelphia’s other major trauma centers — a first in any city.

As the program rolls out, it will be formally studied, with clients of the program compared with a control group. As of now, Corbin and his collaborators lack the hard evidence to demonstrate the effectiveness of Healing Hurt People. But other hospital-based antiviolence programs (without the emphasis on psychological trauma) have been studied and found effective, and a Justice Department task force on children exposed to violence recommends that every hospital emergency department have a psychological counseling program. “We can’t wait five years for this study,” said Arthur Evans, Philadelphia’s commissioner of behavioral health. “We have to intervene on the information we have. “

Corbin said that the Hahnemann and St. Christopher’s sites each connect with at least 50 people a month, and about three-quarters of them start some aspect of the program. That’s about 450 people a year per site who use at least one service, and a fifth of them do everything the program offers. The cost for this, said Corbin, is $330,000 per year per site. Healing Hurt People could be cost-effective even if it keeps just a few people out of the hospital or prison — two very costly places. It could save more if clients also become better parents, students and employees, like McCorey.

*****

Can Davis change his life as well? When he first went in to Healing Hurt People, he hoped they might be giving out money. He was disappointed, he said — but quickly added that it’s helped him in many other ways.

He goes into the program not just for the Monday SELF meetings, but several times a week, “just to be around positivity,” he said. “I go to the meetings to let my feelings out. I can talk about what I want to do, like revenge, so I don’t actually do it.”

“When I first met him, he was very pessimistic, even cynical,” said Thompson. That has changed. “He takes a lot of initiative, and when he has trouble, he asks for help,” something he didn’t do before even while bleeding all over the sidewalk. He has plans for his own business — he priced used floor buffers, and concluded he could start his own cleaning company with $2,000.

Davis lives in two worlds now. When he goes back to his old corner, he pulls his jeans halfway down his butt before he greets his friends. It hurts that some of them never came to see him in the hospital. “Mom was right,” he said, shaking his head. “Some of them not my real friends. They on the corner and you walk by and say ‘wassup,’ and they be hating on you because you won’t stay on the corner with them.”

The demons are still with him. One recent episode spooked him enough that he went in to see Thompson about it. It was his mother-in-law, however, who put a name to what was going on: sleep paralysis, an established syndrome. (The common sensation that the creature is sitting on your chest comes from the inability to breathe deeply.) He worried he could die from it.

It is no accident he took a job that doesn’t let him sleep.

The forces pulling Davis backward are powerful: The lure of the corner and the life where he is known and respected. The knowledge that easy money is a phone call away. Medical bills. The demon on his chest, which might be exorcised only through psychotherapy he may never get.

Against that, though, there is the scar on his stomach to remind him, Kanye, Stewart, two close friends who also went through the program, and the challenge of testing himself with a different hustle. And there is how far he’s come: far enough to imagine himself another way, as a man who can stop on the corner, say “wassup” to his old friends — and then keep walking.

http://news.yahoo.com/battling-america-s-other-ptsd-crisis-194336514.html