Posts Tagged ‘297’

Equality Forum: Picking up an Important Piece on Health Services

May 4th, 2009 No comments

On the day after Equality Forum’s week-long stampede finished trampling me, I’m able to stagger back to my computer and pick up a piece from last Saturday’s collaborative programming that I didn’t want to leave behind. (Tomorrow I hope to be able to post on the National Equality Rally that took place on Sunday.)

One of the panels I stopped in on, Health Care Reform: What Does it Mean for the LGBT Community?, ended up ranging over a wide swath of issues concerning the community. This wasn’t surprising, because the panel was conducted by the Mazzoni Center, an organization that delivers a staggering array of health-related services to the community; mostly for free. In addition to primary care, the Center: does anonymous HIV testing (and services for those infected with the virus); offers mental health counseling; provides a smoking cessation program as well as an array of support  groups; and has a number of education outreach programs, importantly including “The Collective.” This is a collaborative effort that does culturally targeted HIV prevention and services for gay and non-gay identified men who have sex with men (MSM, in the accepted public health acronym). This approach is generally recognized as the only one with a decent chance of working in communities that, for historical reasons, harbor a deep distrust of public health.

In short, the Mazzoni Center stands at the intersection of private health care and public health, recognizing that the prevention and education efforts at the center of the public health mission can reduce the need for chronic and acute medical care that consumes much of the health care time and dollar. So it was natural that the conversation was similarly expansive.

Listen to Nurit L. Shein, Executive Director, speaking of the need for coverage of services that are specific to the transgender community: “This is an issue that the LGBT community needs to coalesce around.” Is it reasonable to believe that whatever health care reform is on the table at the federal level will address this issue? Not unless advocates, like the Mazzoni Center and those they serve, get in touch with their officials, show up at public hearings, and agitate. Thus far, the LGBT response has been, too often, to let the “T” kind of dangle from the end of the alphabet string.

Mazzoni’s vital work, though, is often frustrated by the failures of public and private health elsewhere. Robert Winn, the Center’s Medical Director, somewhat surprised me by stating that he’d lost track of how many times patients had come to him after being informed by their former primary care providers that they didn’t want to care for gay people. (I  just checked my iPhone’s calendar; yes, it’s 2009.) Of course, this is a strictly illegal position in Philadelphia, but most people don’t sue: they just find another doctor. But until those with a public health, population-based approach combine with the AMA to drive these homophobic views out of existence, private prejudice will continue to negatively influence the medical and mental health outcomes of the community.

It’s well known that sexual, racial, and other minorities have much worse health outcomes than the majority. Every day, Mazzoni’s dedicated workers try to push a very large boulder up a very steep hill.

Equality Forum Day 1: From VIP Kickoff to the Margins

April 27th, 2009 2 comments

Imagine this life: You’re not safe at school. The very sight of you makes people uncomfortable, sometimes angry. Your family disowns you, but no one else will adopt  you or take you in for foster care. Without mooring, and unsure of your own identity, you turn to drugs and alcohol, perhaps landing in jail. You can’t find a “legit” job, so sex work becomes your “best” option. You contract HIV, or Hepatitis, but have no access to health care to pay for your treatment. Low-level bureacrats decide whether to honor your chosen gender on identity documents, making routine transactions an occasion for recurring humiliation.

This nightmare is reality for many transgendered people. Even the “mainstream” gay and lesbian community has only recently begun to wake up and recognize these realities. The National Transgender Panel — significantly, the first substantive program of this year’s Equality  Forum — was an energizing, often moving conversation about the legal, social, and political obstacles that block the full citizenship and dignity of the transgender community. Indeed, the story told  above was pieced together from the comments made by both panelists and audience members, whose input the panelists constantly sought — and received in effective abundance.

The panelists, themselves all members of the community, spoke authoritatively about legal issues (Benjamin Jerner); the national political landscape (Kathy Padilla) and the hugely complex public health challenges faced by this community (Ben Singer).

Perhaps because of my own interest in public health and the legal issues relating to it, I  found Singer’s presentation particularly compelling. He’s a smart activist who understands the need for data-driven results; as he puts it, if you’re not on the public health radar (and you get there by showing a problem affecting a population), you don’t exist. But the issues facing the transgender community are more than a “blip” on any morally defensible radar; they amount to an on-going emergency. A few of the sobering examples confronting this community will have to suffice here: (1) Violence against them is epidemic, and the situation becomes graver as the categories of oppression pile up. Thus, transgendered women of color are at the greatest risk. (2) HIV/AIDS are at levels otherwise associated with sub-Saharan Africa. (3)The community faces high levels of medical uninsurance, a problem connected to joblessness and homelessness, themselves endemic.

Against this backdrop,  many of the issues of formal equality that many of us (including your humble blogger) most often concern ourselves with seem less vital. Really, do you think people facing the kinds of issues I’ve just mentioned have marriage equality on their plate? Again, Singer:  “We talk more about these grand legal issues and not these other ones.”

But “these other” issues were thoroughly chewed over — by the audience. In a wonderfully  generous move, Singer invited the audience to answer a question about the kinds of problems routinely faced by transgendered youth. The answers should pain any person with a halfway developed sense of empathy. One young woman was thrown out of her home and not adoptable. A young man ended up abusing drugs and doing time in prison. Several regarded every day of school as a kind of torture. Of course, any kid growing up gay — or different in any way, really — can share painful experiences. But these really did seem different in kind, not  just degree.

“Every spark of friendship and love will die without a home.”

Yet not all transgendered people are in the desperate situation Singer describes, and, for some at least, it would be very helpful if the state were to grant them basic legal rights, including the recognition of their marriage. Jerner discussed a case with which I’m familiar, in which the Kansas Supreme Court idiotically declared null a long-term marriage between an opposite-sex couple (where the wife had been born a male), thereby disinheriting the surviving spouse in favor of an evil offspring. Although I have a quibble with his reading of the case,1 his point about the need for legal remedy is sound.

The panel ran over time. The audience was large; about 100, I’d guess, many of them young, bright activists.  They didn’t seem to want it to end, and that’s not surprising. There was a great deal to be said. Afterwards, I had a chance to speak to Singer, Padilla, and moderator Joelle Ruby Ryan, a warm and gentle giantess who ran an open and generous forum. Singer and Padilla are very interested in the untold story of transgender activism (newsflash: Stonewall wasn’t the first time members of the GLBT community rose up in protest). Padilla showed me some of her materials, and I’m sure I’m only one of many encouraging her to turn these into a book, or at least a long article. In the meantime, I’m hoping to do a follow-up blog on this issue of the history of transgender resistance — with help from Singer and Padilla,  who are enthused, knowledgeable, and in possession of all kinds stuff that’s by turns really cool and very moving.

I couldn’t have asked for a better blogging assignment to get me excited about the rest of the week.


Before this amazing panel, Equality Forum kicked off, as always, with the VIP Party in City Hall. This year’s event was staged, aptly, in the grand Conversation Hall. Probably a couple of hundred folks were VI enough to have garnered invitations, and most of the people I spoke to were impressive leaders of various organizations, or were directly involved with Equality Forum.

Dwight Evans, the Pa. State Representative who received a distinguished service award for his legislative efforts on behalf of the LGBT community, is a gregarious man with an expansive view of equality and opportunity. His charter school has been around for more than a decade, and he’s been a consistent advocate for GLBT rights in Harrisburg, where  the political winds don’t reliably blow in a favorable direction. I enjoyed a brief conversation with him, in which he showed himself to be a member of a rare and beautiful species: the pol without affect. His view of equality? “You don’t have to convince me.” His acceptance speech spoke to the need to “get past typical barriers and walls,” and concluded, quite sensibly (yet somehow movingly) with: “Thanks. And let’s move on.”

Also effective was Mayor Michael Nutter, the poor guy stuck with a job that no reasonable person would have taken had he known of the economic collapse to visit the city within nanoseconds of his inauguration. On radio, he comes across as bright and logical, but a bit stiff. In person, he’s witty and relaxed – but just as compelling. The short: He’s on our side. And Equality Forum founder and Executive Director Malcolm Lazin, to whom I must give props for giving me this “forum” to blog about the event, closed the proceedings with an inspiring call to take part in this Sunday’s Equality Rally and March, linking these events to a courageous march here in Philadelphia forty years ago led by gay pioneers Frank Kameny and the late Barbara Gittings. Very effective — now let’s hope the event is the success it needs to be.

Well, it’s late and I’m almost blogged out. But here’s a light moment from the Kickoff Party. Having just speared an unwilling olive after a too-epic struggle at the hors d’oeuvres table, I was standing near it (catching my breath), when a jovial fellow spun around and bumped into me. He was so apologetic that I didn’t have the heart to tell him he’d sent my only olive spinning out of my hand and through the air. I was reminded of the Seinfeld “Junior Mint” episode, and only hoped that the escaped refreshment hadn’t had a similarly calamitous result. Alas, I believe (but do not know for sure) that it landed in a scoop of perfect, high hair — unknown to the “victim.” If so, I’d like it back. No questions will be asked.

  1. He says the court declared that transgendered people couldn’t marry anyone — I think that reading is possible but not compelled. The case is In re Estate of Gardiner,42 P.3d 120 (Kan. 2002).

Beyond — Way Beyond — Rihanna

March 10th, 2009 1 comment

Yesterday, as I was returning my rental car after a mostly pleasant Florida vacation to visit both sets of grandparents, I witnessed a sickening scene that I was powerless to affect.

An SUV pulled in right behind our bare-bones Corolla. Out came mom, dad, and a boy of about three or four. Based on their clothing and the contents of the vehicle (as well as the vehicle itself), I’d guess the family to be at least comfortably middle class. The father, in response to something I hadn’t heard from the mother, stormed over to her side of the vehicle (near me) and shouted “Give me a f***kin’ minute!” He then told her: “Get out of my way!” With that, he pushed her away — hard — and reached into the SUV to pull out who-knows-what. The woman looked a bit startled, but not angry. She walked into the lobby of the rental car facility without argument, comment, or any kind of response. The son was right next to both parents as this creepy tableau unfolded.

While the sickening spectacle of Rhianna and Chris Brown (whoever they are) gets broad coverage, and elicits justifiable outrage , cases like the one I’ve just described may reflect a greater yet much less visible problem. Many women (and it’s almost exclusively women) live under what conditions of what Dr. Evan Stark has termed “coercive control,” in which the dominant partner makes the other’s life intolerable by exercising obsessive control over many aspects, large and small, of her life — and often, the lives of the children, as well. Such acts, in the aggregate, compromise the very personhood of the victim.

Consider this distressing account of one spouse’s daily degradations by Beverly Horsburgh in her article Lifting the Veil of Secrecy, (published in volume 18 of the Harvard Women’s Law Journal in 1995):

“He controlled absolutely everything. At our home…he wanted the air-conditioning at 72 degrees. If I changed it, he would scream, hit, carry on so. The radio station he liked had to be on in every room. I wasn’t allowed to touch it….We have six children. When [they] talked in bed past bedtime he would make them do push-ups. Those poor little kids, trying to do push-ups, so young….I couldn’t interfere. I would get such a smack across the face, my nose would bleed.”

After a short time, the very threat of violence makes the coercive control work. Was the scene I witnessed yesterday but one window into a situation of such control, or a non-representative case, the worst day of the man’s life? It’s hard to know, but if he’s willing to allow others to observe even this much, my guess is that her life (and maybe the son’s) is a frequent, perhaps constant, stay in hell.

But the case also highlights a big problem with acts of coercive control, which is that they often are invisible. Thus, law enforcement, which is now heavily involved in the Brown-Rihanna case, can typically exercise no power to prevent the destructive behavior. That’s why some, like Dr. Stark, propose using a public health approach rather than a criminal justice model to deal with domestic violence. The public health perspective focuses on the population rather than on individual cases, and emphasizes identifying and quantifying problems and issues, and then intervening through community education, outreach and awareness. Such measures would be supplemented by a criminal law approach that would target acts of intimidation and coercion. This multi-pronged approach may be more promising when trying to combat the distressing problem of coercive control.  

Of course, in situations of substantial violence, the criminal justice model has a major role to play. Rihanna’s reported request that the judge not bar Brown from having contact with her (as well as the “couple’s” supposed reconciliation) points to the importance of protecting women: If even celebrities, who typically suffer from no lack of confidence, have internalized the idea — even in 2009! — that their physical integrity can be violated with impunity by those who supposedly love them, then the legal system’s role in deterring and punishing offenders is no less important than it ever was.      

Categories: domestic violence, public health Tags: , , , , , ,

Progress Forgotten

February 18th, 2009 1 comment

Here’s a description of a deadly disorder that once afflicted children:

“At first children undergo subtle personality changes, their handwriting deteriorates, and they seem to forget things. Later, when the horror of the disease fully emerges, children are progressively less able to walk, stand, or talk; then they become combative, have seizures, lapse into a coma, and die.”

This quotation appears in Dr. Paul A. Offit’s book, “Vaccinated,” (pp. 44-45) where Dr. Offit, chief of the division of infectious diseases at the Children’s Hospital of Philadelphia, is describing a uniformly fatal disease that afflicted children who had contracted measles. This disease, subacute sclerosing panencephalitis, usually began years after the acute infectious stage of measles — but the acute phase itself could be deadly. Before vaccination became widespread, about eight million kids died every year from measles, while many more suffered deafness, blindness, brain damage, and damage to other vital organs.

And that’s just measles: Other diseases of childhood, including mumps, rubella, polio and pertussis accounted for many more deaths, permanent disabilities, and birth defects. I’m not even discussing smallpox, the early vaccination against which has saved countless millions of lives by this point.

This little historical reminder was brought to you by your Local Public Health Authority, in cooperation with the Centers for Disease Control and Prevention (“CDC” ) and the World Health Organization (“WHO”). It  turns out that these facts can’t be repeated enough.

Last week, special masters in three cases brought by parents of autistic kids rejected claims that the children’s autism was brought about by the measles, mumps, rubella (“MMR”) vaccine or by a preservative, thimerosal, in the vaccine. In so finding, these special  masters were echoing a chorus of scientific research and population-based studies finding no link between vaccines and autism. One of the special masters, while expressing sympathy towards the child, went so far as to say that the family had been “misled by physicians who are guilty, in my view, of gross medical misjudgment.”

Don’t expect the effort to tie autism to vaccines to stop any time soon, though. A spokesperson for an organization called Generation Rescue called the decisions “an incomprehensible injustice.” The organization’s website, turning a dramatic public health success on its head, claims (without evidence) that the increase in autism and related disorders is related to a “tripling” of the number of vaccines given children in the last fifteen years.

Of course, the safety of new and existing vaccines needs constant monitoring. But this kind of irresponsible failure to accept widespread scientific consensus makes the work of physicians and public health more difficult by contributing to a culture in which increasing numbers of parents seek exemptions from vaccination requirements.

Speaking of the culture of scientific fantasy: On the premier episode of the goofy drama-dy “Eli Stone” last year, the vaccine-autism link was given pop credence when attorney Stone convinced a jury — to the tune of over $5 million — that his client’s condition was brought about by the mercury-based preservative in a vaccine. ABC responsibly posted discussion effectively refuting the link, but the show’s imagery and dramatic elements are likely to overwhelm the more reasoned discourse.

There are rare cases in which a child’s medical condition might counterindicate administering a particular vaccine for a period of time. Those aside, we should immediately do away with all exemptions — religious, philosophical and otherwise — to the immunization of our children. If we don’t, we run the ever-increasing risk of compromising the “herd immunity” that protects us all. If these diseases resurge, let’s see whether people will continue to object to vaccinations against them.

Only a safely vaccinated population has the luxury of manufactured hysteria.

Categories: autism, public health, vaccination Tags: , , , , , , , , , , , , , , , , , ,

First Post

January 6th, 2009 No comments

Here’s the problem with starting a blog: Since most of us who consider doing so are blog readers ourselves, we’re acutely aware that the challenge is daunting. There are more blogs out there than you can shake a cyber-stick at, and reading too many in any sufficiently short period of time leaves the indelible impression that the blogosphere is graphically best represented as a series of (possibly rabid) dogs chasing each other in a dusty, never-ending vortex. (I couldn’t find such an image on the internet, although I admit that I gave up after a few minutes. Will this inexplicable coffee table do?)

doggie coffee  table

Possibly because of the intimidating nature of the challenge, I’ve been generating posts for about a month now but haven’t yet committed any of them to public scrutiny. Well, today’s my birthday so I just decided: Sheesh, just start it, already.

One reason for you to read it is that it will shortly become the most read, most interesting and insightful, and most painfully funny of all known blogs. OK, probably not, but that’s really my goal – and, one would hope, the goal of every blogger. And why not? If I’m going to do this, I need to keep in mind that there are many excellent writers out there. I want to be able to say something in a different, or (from my perspective) a better way.

You’re wondering: Around what topics and themes will this blog cohere? I’m a law professor, so some of the posts will analyze legal topics in ways that I hope are accessible, interesting, and more than occasionally amusing, to everyone. (Some legal blogs do this very well. In this vein, consider my colleague Bobby Lipkin’s excellent work. His love of the format has inspired me.) Within the legal arena, I’m very interested in issues of rights (especially gay rights) and social justice, and the connection between law and public health and policy. (See my linked publications list for examples of my articles on these topics.) A bit further afield, politics, literature, (certain) sports, and investigative journalism are other interests that will either inform or be the subject of some posts.

A few words about the blogger: In addition to being a law professor (at the Widener University School of Law in Wilmington, DE), I teach at the Yale School of Public Health (lecturing on public health law). I’ve published a couple of dozen law review articles and a smaller number of general interest (i.e., magazine and newspaper) pieces, appeared and presented at a number of conferences and symposia, have been on radio (discussing California’s Prop 8 in an NPR show on Dec. 2, 2008) and television, and am one of the featured speakers in a new film about Hurricane Katrina and broader issues of infrastructure and compensating and caring for injured or unhealthy victims of tragedy. (Now available to educational institutions and soon to be scheduled for theatrical release.)

As for my personal life: To the extent it becomes relevant in future posts (and it will, because I’ve already written some of them), I will make due disclosure. I hope you enjoy the blog, and I welcome all serious – not necessarily somber – and civil criticism.

Tomorrow: What is marriage equality for, anyway?