• The Washington Post reports that the government's reckless overspending over the last few years, is now directly affecting the health of America's disabled and elderly.  The Republican-led Congress of 2003 created a "doughnut hole" in drug benefit coverage in order to make it more affordable for the federal government.   Nearly 3.4 billion people were affected in 2007, having to pay the entire cost of their medication until they spent, out of pocket, $3,850.  Many people in Medicare have diabetes, high blood pressure and other chronic conditions.  The result?  15 percent stopped taking their medications when forced to pay for the entirety of their prescriptions.  For example, 10 percent of diabetes patients stopped buying their medication, while 16 percent of high blood pressure patients and 18 percent of osteoporosis patients stopped as well. 

• In its opinion section, USA Today has a posting by a primary care physician, blogging at www.kevinmd.com.  He writes about Medicare's call for a formula that would have regular decreases of more than 20% in physicians' payments by 2010.  Medicare hopes to curb the exorbitant expenses of the US health care system which now exceeds $2 trillion annually and is the most expensive system in the world.  But cutting doctor's pay by 20%, according to the author, would only cut spending by 2%, and would only drive doctors away from caring for Medicare patients.  For example, in states like Texas, the number of physicians NOT accepting Medicare exceeds 40%.

• The Kaiser Family Foundation's blog reports on a story that appeared in the Atlanta-Journal Constitution on how HIV/AIDS advocates from Georgia, craft messages towards "urban, white, gay men" whereas "black, rural, women and young people" are the group that are at high-risk for acquiring HIV/AIDS in Georgia.  In 2006, blacks comprised 30% of the state's population, yet 71% of the state's HIV/AIDS population. 

• Texas' Rio Grande Valley Region may be a microcosm for a potential trend in a diabetes outbreak for the U.S.'s growing Hispanic population.  Written up in The Monitor on August 18, the Rio Grande Valley region has a diabetes rate three times the national rate.  According to the chair-elect of the American Diabetes Association, "Hispanics, American Indians and blacks have a higher prevalence of the disease than other ethnic groups," while Texas state Senator Eddie Lucio said, "as many as half of minority youth across the nation will develop diabetes at some point in their lives." This statistic is compared to 8% of people nationwide that have diabetes.  Moreover, the region's medical expenses associated with diabetes neared $1.5 billion in 2007, while such costs were $74 billion nationally in the same year.  It is believed that lack of access to healthy food options is a primary factor causing this spike in cases. 

• The New York times ran a story on economic inequalities in access to treatment for obese children, of which there are nine million in the United States.  While this figure has tripled since 1980, there is a dearth of comprehensive, effective, or affordable programs to address the issue. Summer weight loss programs are generally costly (some cost over $1,000 a week) as most seek to turn a profit.  Furthermore, most insurance providers do not cover this cost. Dr. Walter J. Pories, a gastric bypass surgeon, calls the lack of insurance and government financing for such programs "the single most frustrating problem in dealing with childhood obesity."

• The Kaiser Health Disparities Report included three interesting developments:

• The TriCaucus, comprised of the Congressional Asian Pacific American caucus, the Congressional Black Caucus and the Congressional Hispanic Caucus, sent House Speaker Pelosi a letter urging the inclusion of two provisions in the SCHIP reauthorization bill to improve health care access for immigrant children: one eliminating a five-year waiting period for documented immigrants to receive government benefits and another eliminating proof of citizenship as a requirement to receive these benefits. According to the TriCaucus, the proof of citizenship requirement has led to hundreds of thousands of U.S. citizens to be denied coverage because parents could not find the required documentation. The TriCaucus wrote to Pelosi, "We urge you to include provisions in this bill which address the needs of children in communities of color and respectfully request a meeting with you to discuss this critical issue."

• A study released last Wednesday by the Pew Hispanic Center and the Robert Wood Johnson Foundation reported that 27% of Hispanic adults in the U.S. do not have regular health care providers, although many spoke English and 45% had health insurance.  Hispanic men, younger adults, and those with little education or without health insurance were found most likely to not have regular health care providers, as reported in the Newark Star-Ledger. 41% of Hispanic adults without regular providers identified "seldom [being] sick" as the primary reason.  Given that Hispanic adults actually have disproportionate rates of diabetes and obesity, this presents a unique challenge to providing Hispanics with access to health care that demands real solutions. The authors of the article wrote that the results of the study indicate a "need for providers to encourage Hispanic adults to seek routine health care."

• According to a recent study published in the journal Cancer Epidemiology, Biomarkers and Prevention and reported in Reuters Health, members of minority groups who have felt discriminated against by their health care providers are less likely to be screened for breast or colon cancers.  Of the 11,245 black, Hispanic, Asian and Native American adults aged 40-75 surveyed, 9% of women and 6% of men said they experienced discrimination from their health care providers in the last 5 years.  These women were approximately half as likely to have had a mammogram and only two-thirds as likely to have a colorectal cancer screening.  Men who had perceived discrimination were 70% less likely to have had a colorectal cancer screening.

• Congress has passed a few bills targeting immigration: E-Verify, a voluntary government program for employers to verify whether or not employees are legally able to work, was re-authorized by the House for only five years.  This suggests that the House feels E-Verify may be a flawed system.  The House Immigration Subcommittee passed a bill recapturing employment and family-based immigrant visas that had not been allocated under existing ceilings due to bureaucratic inefficiencies. It also passed a bill that could make it easier for military personnel and their families to be naturalized.
• ICE conducted its latest raids in Lowell, MA in the form of home arrests with warrants. Targets were green card holders with criminal records. Sweeps have been going on throughout the country under various types of programs, such as Operation Community Shield and Fugitive operations teams.
• The Center for Immigration Studies, "an independent research institute which examines the impact of immigration on the United States," published a report documenting the impact of immigration on global CO2 emissions. The report is titled "Immigration to the United States and World-Wide Greenhouse Gas Emissions." According to the study, immigration to the US significantly increases global CO2 emissions in that immigrants move from a lower-polluting region of the world to a higher-polluting country.  While the estimated CO2 emissions of the average immigrant are 18% lower than those of native-born Americans, their emissions are estimated to be four times what they would be in their home countries.
• The New York Times published a story responding to the release of the legal blueprint in the Postville hearings.  The blueprint, made available online by the ACLU, is a 117 page compilation of scripts that laid out step by step how the hearings should proceed.  While these documents were not binding and were framed as providing assistance to defense lawyers, many critics argue that the scripts indicate that the court endorsed the prosecutors' push to secure guilty pleas before the hearings even began. The scripts went so far as to include a sample statement the judge could make after accepting a guilty plea.  According to Lucas Guttentag, director of the Immigrants' Rights Project of the A.C.L.U, "this was the Postville prosecution guilty-plea machine. The entire process seemed to presume and be designed for fast-track guilty pleas."
• The Times also covered the story of Hiu Lui Ng, a 34 year old immigrant who died in US custody after being systematically denied medical care in the previous months.  Mr. Ng had overstayed a visa years earlier and had been sent a letter ordering him to appear in court.  This letter was mistakenly sent to a nonexistent address and due to his inevitable failure to appear in court, ICE arrested him last summer when he went to immigration headquarters in Manhattan to apply for a green card.  Since then he has been held in various jails in three New England states.  In April Mr. Ng began to complain of debilitating back pain, however these complaints were written off as "faking it" and it was not until a judge order he be taken to the hospital in early August that he received medical attention.  This exam revealed that his spine was fractured and he had terminal cancer that had been undiagnosed and untreated for months.  He died in the custody of ICE five days after arriving at the hospital. Mr. Ng's case is not isolated, it is situated in a series of cases that have "drawn Congressional scrutiny to complaints of inadequate medical care, human rights violations, and a lack of oversight in immigration detention." Mr. Ng's case and others call for real solutions to a very real problem. Presently before the House Judiciary Committee is legislation to set mandatory standards for care in immigartion detention.

Our friends at the American News Project have posted a video on the usage of tax shelters by the super-rich.  "Super-Rich Tax Cheats" shines a spotlight on the $1.5 trillion currently estimated to be hidden off-shore from the IRS by the very wealthiest of Americans.

Senator Norm Coleman (R-MN) estimates the resulting lost tax revenue at approximately $100 billion.  The video puts this number into context by showing what the government spends on other programs.  This is more than the federal government spends on education and training ($89.9 billion).  It's triple what is spent on the environment and natural resources ($33.1 billion) and almost five times more than what we spend on temporary assistance for needy families, or TANF ($20.9). Besides looking simply at people clearly breaking the law, the video also has a short segment with Warren Buffet, one of the world's wealthiest men, arguing for tax fairness.  This is key if our nation is to be stronger and we are to truly come together as a community.

You can watch the video at the Huffington Post.

*    An article titled "Immigrants Facing Deportation by U.S. Hospitals" appeared in the magazine section of The New York Times on Sunday.  By telling the story of Luis Alberto Jiménez, it documents the disastrous consequences that are the result of inherent failures in the American immigration and health care systems. Below is an excerpt from the article:

Many American hospitals are taking it upon themselves to repatriate seriously injured or ill immigrants because they cannot find nursing homes willing to accept them without insurance. Medicaid does not cover long-term care for illegal immigrants, or for newly arrived legal immigrants, creating a quandary for hospitals, which are obligated by federal regulation to arrange post-hospital care for patients who need it.

American immigration authorities play no role in these private repatriations, carried out by ambulance, air ambulance and commercial plane. Most hospitals say that they do not conduct cross-border transfers until patients are medically stable and that they arrange to deliver them into a physician's care in their homeland. But the hospitals are operating in a void, without governmental assistance or oversight, leaving ample room for legal and ethical transgressions on both sides of the border.

*    Various ICE policies have been scrutinized in a number of news articles this week.  A DMI Blog posting discusses the ICE policy of neglecting to inform local police of its decision to conduct a raid in an area.  This ICE policy is carried out completely inconsistently - sometimes ICE notifies local law enforcement, sometimes it does not.  ICE conducted its recent raid in Sante Fe, New Mexico (where it took 30 undocumented immigrants into custody) without notifying Sante Fe Mayor Cross beforehand.  According to the posting, Cross was completely opposed to the raid.  He said:

"We know what the right thing to do is. We have political leadership that wants to keep us from doing [the right thing] because the division works for them. But it doesn't work for us. And most people know that."

ICE's notification policy is not its only inconsistent policy.  According to the Associated Press, ICE's distribution of border patrol agents is a completely political process.  The article says that many people have suggested that ICE rewards friendly Congressmen with more border patrol agents in their district:

The 60-mile San Diego sector is at the southern end of a county with roughly 3 million people...

But the sector is already heavily reinforced: Two-thirds of the border is blocked by fences or vehicle barriers. The most populous part of the boundary has nearly 10 miles of double-layer fences with stadium lights...

San Diego is represented by Rep. Duncan Hunter, a Republican who has been among the most outspoken proponents of increased border security and fences.

The Huffington Post has also criticized ICE for supporting the discredited Center for Immigration Studies report that says border patrol has been the main reason immigration to the U.S. has fallen.  Many researchers have shown that the failing economy is the main reason immigration has been decreasing:

The US needs a practical, fair, and reasonable solution to immigration that includes smart enforcement measures. Political theater and gimmicks won't constrict the supply or demand for immigrant labor.

In addition, The Sanctuary is reporting that the ACLU has obtained a copy of the manual that the government distributes to attorneys who defend those who are arrested in immigration raids:

The manual contains prepackaged scripts for plea and sentencing hearings as well as documents providing for guilty pleas and waivers of rights to be used by both the judges and attorneys in expediting procedures as quickly as possible with little regard for due process.

The ACLU has made the manual publicly available.

*    Postville update: Standing FIRM has linked to a Chicago Tribune story on the allegations of child labor law violations at the Agriprocessors plant.  The government has finally begun cracking down on the company for the horrific abuse of its employees:

State officials say the types of child labor violations at the plant included minors working in prohibited occupations, exceeding allowable hours for youth to work, failure to obtain work permits, exposure to hazardous chemicals and working with prohibited tools.

*    The National Center for Lesbian Rights has become involved in a case involving a gay HIV-positive Pakistani man who is seeking asylum in the U.S. on the grounds that he will be persecuted if he returns to his country of origin.  The Center filed an amicus brief in support of the plaintiff to the Board of Immigration Appeals:

Under Pakistani law, being gay is punishable by death and LGBT people are forced to live in secrecy and constant fear of exposure. The Immigration Judge ignored the serious risk of persecution that S.K. faces and denied his application for asylum.

*    ABC News has called attention to a recently released report on the human rights abuses that immigrants are subject to at detention centers run by private companies.  The report, conducted by the human rights group OneAmerica and the Seattle University School of Law, concludes that people held at these detention facilities, specifically one that GEO Group, Inc. runs, are routinely harassed, verbally and physically abused and subjected to poor to non-existent health care.

This is not the first time GEO has been accused of violating the rights of inmates in its care.  In 2000, when the company was known as Wackenhut Corrections Corporation, the U.S. Department of Justice sued them over "excessive abuse and neglect" of inmates at the Jena Juvenile Justice Center in Jena, Louisiana.

The public recently witnessed the lack of basic care that people are subjected to at Kings County Hospital Center in Brooklyn, New York.  A woman was left for dead in the middle of the hospital's psychiatric ward waiting room as staff did nothing but walk away.  The evidence in the New York Civil Liberties Union's lawsuit against the city proved that this was not an isolated incident (it just happened to be one of the only ones caught on tape).  Unfortunately, New York City's government is not learning from this catastrophe and taking sufficient steps forward to examine their hospitals - Women's eNews is reporting that the city is refusing to participate in a state review of maternal deaths and racial disparities, despite the fact that New York City has the highest number of maternal deaths and one of the largest populations of African-American patients in the country.

The New York City Health and Hospitals Corporation (the same agency that is named in the NYCLU lawsuit as the agency that is responsible for the negligence at Kings County Hospital Center), has refused to participate in the review the Safe Motherhood Initiative is conducting.  Pamela McDonnell, a spokesperson for Health and Hospitals Corporation (HHC) said:

We chose not to participate in the Safe Motherhood Initiative simply because we already participate in a number of established monitoring and review processes, measures and collaboratives.

However, one of the main points in the NYCLU's complaint was that the city had insufficient monitoring and oversight measures at its hospitals - it was this lack of oversight that led to last month's death at Kings County, and it could be part of the cause of numerous maternal deaths at city hospitals.

New York's American College of Obstetricians and Gynecologists, in conjunction with the New York State Department of Health, launched the Safe Motherhood Initiative in 2001.  The Initiative was established to conduct reviews that facilitate responses to pregnancy-related deaths and eliminate racial disparities in maternal mortality in New York State.  However, HHC's refusal to participate will lead to a great deal of information, particularly information on racial disparities among pregnant women in the hospitals, being left out of the review.

The first Safe Motherhood Initiative review that came out in 2005 interpreted 33 deaths over the course of 2 years - it found that 60% of those women who died were African American.  The review examined the deaths of these women in detail and sought to determine what the cause of the racial disparity was.  According to Women's eNews:

In 2004, black women were nearly four times as likely to die in childbirth as white women nationwide, and had a maternal death rate of 34.7 per 100,000 live births compared to 9.3 deaths per 100,000 live births for white women...

Designed to discover and interpret major risk factors, [director of New York's American College of Obstetricians and Gynecologists Donna] Montalto's State Maternal Mortality Review surveys--among many data--the deceased woman's occupation, primary language, education, insurance coverage, prenatal care, method of delivery and history of sexually transmitted diseases. It asks if the pregnancy was intended or unintended. It might also help explain why African American women represent a disproportionate amount of maternal deaths.

The Opportunity Agenda's report on New York City's health care system, Dangerous and Unlawful: Why Our Health Care System Is Failing New York Communities and How To Fix It, showed the unequal and inadequate access to health care that many communities, particularly communities of color, are faced with.  This lack of access and poor quality was most evident in the absence of primary care for many New Yorkers.  Incidentally, the last Safe Motherhood Initiative review found that inadequate prenatal care was one of the main causes of the racial disparity in maternal deaths in New York State.  Prenatal care is something that many women get through their gynecologist as part of their primary care; thus, the lack of decent primary care can lead to many women in communities of color having at-risk pregnancies.

The problems in the city's health care system was exemplified by last month's disaster at Kings County Hospital.  It is to the detriment of all New Yorkers that HHC is refusing to participate in the Safe Motherhood Initiative's review - it is crucial that we address health disparities and find real solutions to the problems in the state's health care system, but the city has to play a role in doing this. HHC says its mission is:

To extend equally to all New Yorkers, regardless of their ability to pay, comprehensive health services of the highest quality in an atmosphere of humane care, dignity and respect.

The death of Esmin Green last month showed that HHC is not succeeding in its mission.  Its decision not to participate in the Safe Motherhood Initiative review is another one that could lead to an unnecessary, preventable death at a city hospital.  The city needs to work to address these problems - until it does, our communities will suffer.

*   This past week there have been a number of news articles about the Black AIDS Institute study on the racial disparities among those living with HIV/AIDS in the United States.  The New York Times pointed to the part of the study that said that if one only counted the African American population in the U.S., the country would have the 16th highest rate of people with AIDS:

Nearly 600,000 African-Americans are living with H.I.V., the virus that causes AIDS, and up to 30,000 are becoming infected each year. When adjusted for age, their death rate is two and a half times that of infected whites, the report said. Partly as a result, the hypothetical nation of black America would rank below 104 other countries in life expectancy.

The Washington Post's coverage of the study focused on the Institute's criticism of the federal government's approach to addressing the AIDS crisis in black communities:

African Americans with HIV -- at least 500,000 -- are more numerous than in seven of the 15 "target countries" in the Bush administration's global AIDS initiative, which has spent about $19 billion overseas in the past five years.

A DMI Blog posting last Thursday also discussed the study and questioned whether the next President would choose to focus on tackling racial disparities in the American HIV/AIDS population, or would continue to ignore the issue:

The bottom line is that the HIV epidemic in the US continues to spread, and at a rate greater than was previously thought. The real measure of political leaders and the American people is if this bad news spurs good action - the establishment of a comprehensive and accountable national AIDS strategy that will eliminate barriers to effective prevention, generate adequate resources, and hold the government accountable for ending this epidemic.

The Black AIDS Institute study can be accessed here.  To learn more about the general prevalence of health disparities in the U.S., read The Opportunity Agenda fact sheet Healthcare and Opportunity.

*   The Kaiser Health Disparities Report has pointed out that new data from the Centers for Disease Control and Prevention shows the presence of racial disparities in the current U.S. infant mortality rates.  According to the new data, black infants are 2.4 times more likely to die before they turn one year old than white infants are:

CDC officials say the higher rates in large part can be attributed to low birthweights, shorter gestation periods and premature births. Experts say that it is difficult to identify a link between race and higher infant mortality but noted that higher rates of poverty, limited access to health care and dietary differences are possible contributors.

*    An editorial in last week's Los Angeles Times discusses how rising food prices are actually likely to increase obesity rates in the U.S., not decrease them.  In many other parts of the world, an increase in food prices leads to an increase in rates of hunger (not obesity).  However, the article points out that obesity has a lot to do with the type of food people consume, not just the amount:

Obesity isn't simply about too much food. It's about the type of food, how it's prepared and the balance of calorie intake with physical activity. Stress and social conditions can also play a role.

Obesity rates have long been more prevalent in poor communities in the U.S. - the article also points out that the states that have the highest rates of obesity also have the highest proportion of families living in poverty.  People living in poor communities, particularly poor communities of color, must have access to healthy food in order to prevent these health disparities from becoming more extreme.  To learn more about inadequate health care access in communities of color, read the CERD report to the UN, Unequal Health Outcomes in the United States.

*    An essay in The New York Times discusses how the American Medical Association's apology for its past racism towards black physicians and patients brought to light the historical split between the AMA and the National Medical Association, a group that represents black physicians.  The essay pointed out that while last month's apology was an important step in bridging the gap between the two organizations, more needs to be done to overcome the inadequate representation of black physicians in the medical profession:

Yet reminders of this rancorous history persist, and the A.M.A.'s apology remains pertinent, if long overdue. Consider this statistic: In 1910, when Abraham Flexner published his report on medical education, African-Americans made up 2.5 percent of the number of physicians in the United States. Today, they make up 2.2 percent.  

*    Department of Homeland Security officials have come out in support of a Center for Immigration Studies report that claims that border control measures are the cause of a decrease in immigration to the U.S.  However, the Center for Comparative Immigration Studies at University of California, San Diego has rebutted those claims and determined that the border patrol apprehends fewer than half of the undocumented immigrants that come into the country through the Mexico/U.S. border.  According to The Huffington Post, the Center for Immigration Studies (an anti-immigrant advocacy group) and the Department of Homeland Security failed to consider reasons other than border control measures that explain why immigration to the U.S. would naturally decline:

When citing the decrease in both apprehensions at the border and remittances sent by workers in the United States to family members in Mexico, Chertoff also failed to consider the fact that undocumented immigration naturally decreases when the U.S. economy is in recession. [Director of the Center for Comparative Immigration Studies Dr. Wayne] Cornelius' report shows that undocumented migration clearly responds to changing U.S. economic conditions, with significant decreases during economic downturns such as the one we are in now.

Moreover, Chertoff's border control measures are completely inconsistent with the fundamentally positive effect immigration has on American communities.  Providing opportunity for immigrants has been a core value in the U.S. since its founding.  To see more immigration myths dispelled, read The Opportunity Agenda fact sheet, Immigrants and Opportunity.

*    In one of last month's blog roundups on The State of Opportunity, a story about a sheriff in Maricopa County, Arizona appeared.  That same sheriff, Sheriff Joe Arpaio, is in the news once again.  An editorial in The Washington Post discusses how  "Sheriff Joe" and his officers have been continuing the "policing strategy" of locking up all Hispanic people they encounter, regardless of if they have any evidence that they are undocumented immigrants or have committed any crime.  According to Arizona Central, Phoenix Mayor Phil Gordon has had to resort to calling for a media mobilization against Arpaio:

"He (Arpaio) has become the false messiah," Gordon said. "But when the light is shined on him, people will see that he isn't helping to fight illegal immigration and he's just making the situation worse. You've got an individual with a badge and a gun who's breaking the law and abusing his authority."

We need real solutions, ones that are brought about by comprehensive immigration reform and promote opportunity for all, not a gross miscarriage of justice carried out by a rogue officer like Arpaio.

*    Thankfully, not all police officers feel the same way Arpaio does - George Gascón, a former assistant chief in the Los Angeles Police Department, has written this op-ed for The New York Times.  In it he argues that using local police officers as a means to enforce federal immigration policy will ultimately lead to the public, particularly in communities of color, distrusting the police department:

Here in Arizona, a wedge is being driven between the local police and some immigrant groups. Some law enforcement agencies are wasting limited resources in operations to appease the public's thirst for action against illegal immigration regardless of the legal or social consequences...

If we become a nation in which the local police are the default enforcers of a failing federal immigration policy, the years of trust that police departments have built up in immigrant communities will vanish. Some minority groups may once again view police officers as armed instruments of government oppression.

*    The effects from the ICE raid in Postville are still being felt, reminding us just how detrimental this raid was to the Iowa community and America as a whole.  The Des Moines Register is reporting that the new employees at the Agriprocessors plant have had a significant, negative effect on the local community:

The impact is evident: New laborers are changing Postville. The Agriprocessors Inc. meatpacking plant, the site of the immigration raid, once employed men and women with families. Now, its workers are mostly young, single people with no stake in the community and nothing to lose...

The rise in crime has strained Postville's tiny police department. One night in June, the calls were so numerous that police asked the local bar to close early.

A protest rally also took place in Postville last weekend - it was documented in a video, which is now available on YouTube.

*    In the past week, there have been numerous reports that call attention to the disparities among those living with HIV/AIDS in the U.S.  The Kaiser Health Disparities Report has linked to a CBS Evening News story on the disproportionate number of African Americans that have HIV or AIDS.  According to the story, blacks account for 49% of new HIV diagnoses, 69% of AIDS cases among ages 13 to 19 and 56% of AIDS cases among ages 20-24.  Despite these high percentages, blacks only make up 13% of the population:

"No matter how you look at it through the lens of gender or sexual orientation or age or socioeconomic class or level of education or region of the country where you live, black folks bear the brunt of the AIDS epidemic in this country," Phill Wilson, founder of the Black AIDS Institute, said. Wilson added that early HIV/AIDS advocates did not send the right HIV prevention and education messages to the black community. "The mischaracterization of the epidemic in the early days ... made black folks think we didn't have to pay attention to the disease," Wilson said.

*    Rates of HIV/AIDS are not only disproportionate in African American communities - The Washington Post is reporting that Hispanics represent 22% of new HIV/AIDS diagnoses, despite only making up 14% of the population.  While the Post notes that HIV rates are highest among blacks, it also claims it is harder to target enough resources towards Latinos, particularly those who are immigrants, who have been diagnosed with HIV:

Blacks still have the highest HIV rates in the country, but language difficulties, cultural barriers and, in many cases, issues of legal status make the threat in the Hispanic community unique. For those who arrived illegally, in particular, fear of arrest and deportation presents a daunting obstacle to seeking diagnosis and treatment.

*    On a more positive note, the Senate passed a bill that calls for a reauthorization of federal funding for a program that supports community health centers, the Deseret News reported last Tuesday.  The bill, sponsored by Senator Ted Kennedy (D-Mass.) and Senator Orrin Hatch (R-Utah), allows for continued support for health centers that provide affordable and quality care for many Americans, particularly  those with low income:

Hatch said that since 2001, increased funding has enabled community health centers to treat 4 million new patients in more than 750 communities across the nation. His bill reauthorizes funding for the program for five more years.

*    State governments were also discussing implementing health care measures this past week - in Massachusetts, the Council on Racial and Ethnic Health Disparities, chaired by State Senator Dianne Wilkerson and State Representative Byron Rushing, met on July 21 to discuss the recommendations of the Special Legislative Commission on Health Disparities.  According to A Healthy Blog, the Council discussed various successes and failures in the state's health care reform:

The presenters all pointed to the success of health care access expansion in Massachusetts as an important step in disparities elimination efforts, but also noted the need to continue working to address quality, cultural competence, and social context problems.

*    According to The Health Care Blog, The Century Foundation has announced that it is creating a working group to establish a blueprint for Medicare reform.  Maggie Mehar, author of HealthBeat Blog, will direct the group and plans to review issues such as:

Revising Medicare's physician fee schedule to pay more for primary care, palliative care, and co-ordination and management of chronic diseases.

Rethinking Medicare's fee-for-service system to reward doctors for quality, not volume.

Creating an independent Comparative Effectiveness Institute that reviews head-to-head testing of drugs, devices, and procedures to ensure that they are effective.

Identifying and rewarding hospitals that provide better outcomes and higher patient satisfaction at a lower cost while helping other hospitals meet benchmarks.

    On Tuesday, New York City Mayor Michael Bloomberg signed a ground breaking executive order requiring all city agencies to provide language assistance services for people who speak Spanish, Chinese, Russian, Korean, Italian or French Creole.  According to The New York Times, this is the first time that all New York City agencies will be forced to follow the same standard in providing translation and language interpretation services to people who do not speak English:

Immigrant advocates and city officials say it is the most comprehensive order of its kind in the country. The mayor refused to be specific about how much the services will cost, saying only that it was a "relatively small" amount given the size of the city's budget. He added: "This executive order will make our city more accessible, while helping us become the most inclusive municipal government in the nation."

The Opportunity Agenda fact sheet Immigration Reform: Promoting Opportunity for All details the need for immigrants to have access to language assistance services in order to achieve their full potential. In providing immigrant groups with this access, Mayor Bloomberg has taken the entire city forward and empowered communities throughout New York.

    Politicians have also been busy down in Washington, D.C. working to provide language assistance for immigrant families across the United States.  At noon today, Senator Hillary Rodham Clinton and Congressman Mike Honda are introducing the "Strengthening Communities through Education and Integration Act of 2008." In addition to providing English language literacy and civics education to immigrant families who are in the process of becoming citizens, the bill:

will help immigrant communities become a more integral part of the American fabric and maximize their social and economic contributions.

Legislation like this is crucial to aiding immigrants on their way to becoming U.S. citizens, and is a necessary part of treating immigrants like full and equal members of our community.

*    The aftermath of the ICE raids in Postville, Houston, and most recently Rhode Island, is still being felt in communities across America.  However, a Washington Post article describes how it is not only workers and their families feeling this strife - now, it is employers as well:

The crackdown's relatively high costs and limited results are also fueling criticism. In an economy with more than 6 million companies and 8 million unauthorized workers, the corporate enforcement effort is still dwarfed by the high-profile raids that have sentenced thousands of illegal immigrants to prison time and deportation.

*    A story in the MetroWest Daily News calls attention to a local organization in Massachusetts, the MetroWest Immigrant Worker Center, that is defending the rights of immigrant workers in the U.S.  Immigrant workers are routinely subject to labor law violations, including the denial of compensation and overtime, as well as unnecessary injuries on job sites.  In addition, the article points out that all immigrants, including undocumented ones, have worker rights:

Contrary to what many people think, illegal workers have rights. Although in the country illegally, those who work are entitled to be paid for their labor and overtime. If they are injured on the job, they are eligible for workers' compensation coverage, said [Diego] Low, [director of the MetroWest Immigrant Worker Center] who has been advocating for immigrant workers' rights for the last 25 years.

*    A DMI Blog posting points to an extremely upsetting Associated Press report of a beating in a Pennsylvania town that left a 25 year old Mexican immigrant named Luis Ramirez dead.  

Hate crime or not, the killing has exposed long-simmering tensions in Shenandoah, a blue-collar town of 5,000 about 80 miles northwest of Philadelphia that has a growing number of Hispanic residents drawn by jobs in factories and farm fields.

Last month the Appeals Court of Massachusetts issued two decisions regarding prisoner access to health care, both of which have vast implications for prisoner rights.  Through their rulings, the court affirmed two critical American values: redemption, the belief that humans are evolving beings who warrant the chance for rehabilitation when they falter, and healthcare as a human right.  The cases,  Sullivan v. Correctional Medical Servs. et al. No. 07-P-964 72, 2008 WL 2552982 (Mass. App. Jun. 27, 2008) and Kilburn v. Dept. of Corrections et al., No. 07-P-987, 2008 WL 2566382 (Mass. App. Jun. 30, 2008) concerned claims of negligence due to poor dental care provided to prisoners by private health care contractors hired by the state.  Part of the case for the prisoners' claims rested on an appeal to third-party beneficiary rights.  Third parties in contracts have the right to sue if they can prove that they are the intended beneficiaries of the contract and are reliant on the contract.  Through their rulings, Massachusetts courts suggest that prisoners have standing as third party beneficiaries and can thus sue private health care providers despite their exclusion from the contract between the state and these private contractors.

In Kilburn v. Dept. of Corrections the Court ruled that the state cannot simultaneously deny responsibility for those healthcare duties delegated to its contractors and claim that those contracts were not meant to benefit the prisoners.  The fact that the state would make this argument to begin with is reflective of the larger shortcomings of the prison-industrial complex.  By contracting out the care of prisoners to private entities, the state claims that it is not liable for inadequate care provided by these groups.  The Appeals Court of Massachusetts took a stand for the right of prisoners to proper healthcare, and more generally to fair treatment, by stressing the state's responsibility in prisoner care.  It went further to argue that inmates' lack of standing to sue as a third party beneficiary of the contract does not make the state immune from liability or free from responsibility.  Simply because prisoners do not have the means to raise claims does not absolve the state of its duties.

While the decisions do not explicitly grant prisoners third-party beneficiary rights, they mark an important
step in this direction.  They document the receptiveness of the court third-party claims in government contracts on the part of prisoners.  Moreover the rulings affirm that the state cannot divorce itself from its responsibility to prisoners. Practicing redemption means providing the conditions that allow people to develop, to rebuild, and to take full responsibility for their lives after misfortune or mistakes.  Through its decisions, the court asserted the state's own responsibility in providing these conditions for prisoners. This particular case concerns dental care, but it opens the door for an invigorated conversation about the fundamental human rights of those people behind bars, and the responsibility of the state in caring for those prisoners such that they may one day reenter society and have the opportunity to achieve their own, full potentials.

A piece in the Sunday New York Times reports that conservative think tanks like the American Enterprise Institute and the Heritage Foundation are engaged in hot internal discussions about self-transformation.  With support for a conservative president and a conservative Republican party at all-time lows, the Times reports, "policy cooks have returned to the kitchen to whip up a menu of new solutions for conservatives disaffected with the party."  Some, like A.E.I. fellow and Bush alum David Frum, are even taking a fresh look at conservative heresies, like the idea that it's in all of our interest to offer people in prison education, mentoring, and support for their children.

Those of us in the progressive ideas sector could also benefit from some self reflection.  Few if any transformative progressive ideas emerged from the crowded, marathon primary season, and few are on display in the current debate.  And that's especially true when it comes to the concerns of the voters who are bringing the most progressive energy to the race: new African-American, Latino, and young voters.  Those voters are struggling with broken systems of education, health care, credit, immigration, housing, and criminal justice, among others.  And they are ready for a reinvented, positive role for the public structures that expand opportunity.

Progressive think tanks and advocacy groups have to step up to that challenge.  For decades, we've been seeking incremental change and, more often, fighting off harmful proposals.  As the Bill Clinton years proved, that dynamic won't magically change just because a more left-leaning Administration or Congress is in office.  It will be up to us, and to the new generation of organizers, activists, bloggers, and thinkers, to bring the big ideas and to push them forward in a form and language that resonates with everyday Americans.

While holding tight to our values, we'll need to reexamine some core assumptions.  And, perhaps most importantly, we'll have to really listen to the hopes, dreams and concerns of our nation's diverse communities--not just through polls and focus groups, but through tough and honest conversations and the interactive power of Web 2.0.  Now is the time to ask ourselves some tough questions, and to change what we do in response.

*    The New York Times is reporting that a recent study of the American health care system, conducted by the Commonwealth Fund, has found that while the U.S. has the most expensive health system in the world, the quality it delivers is grossly inferior to other industrialized nations' health care.  The report highlighted the fact that many of the improvements made in the U.S. health care system over the years, such as decreasing the number of preventable deaths, dwarfed in comparison to the greater achievements other countries made:

Other countries worked hard to improve, according to the Commonwealth Fund researchers. Britain, for example, focused on steps like improving the performance of individual hospitals that had been the least successful in treating heart disease. The success is related to "really making a government priority to get top-quality care," [Karen] Davis, [president of the Commonwealth Fund] said.

The report also emphasized the inefficiencies in the U.S. health care system and the role they play in diminishing quality:

The administrative costs of the medical insurance system consume much more of the current health care dollar, about 7.5 percent, than in other countries...
Bringing those administrative costs down to the level of 5 percent or so as in Germany and Switzerland, where private insurers play a significant role, would save an estimated $50 billion a year in the United States, Ms. Davis said.

*    An article in Friday's Washington Post discusses the potential that community health providers have to save states millions of dollars in health care costs by shifting some of their health programs' emphasis to preventing illness.  A recent Trust for America's Health report found that nonprofit community programs could have an enormous role in developing health initiatives such as anti-smoking laws, healthy eating and physical activity programs.  However, despite the fact that many of these programs target at risk groups in impoverished areas, they face a serious lack of funding:

The researchers found that many such programs lack funding, a chronic problem for many preventive health initiatives.

"People think preventive health care pays off 20 or 30 years from now, but this shows you get the money back almost immediately, and then the savings grow bigger and bigger," [Senator Tom] Harkin [D-Iowa] said.

To learn more about the importance of community health programs, please see the previous posting on The State of Opportunity titled Local Progress in Tackling Health Disparities.

*    An opinion piece in yesterday's Chicago Tribune calls attention to the health disparities among women with HIV.  Black women have higher rates of HIV, despite the fact that studies have shown that they do not engage in "risky sex" any more than white women do:

A black woman in a poor neighborhood, for example, who engages in the lowest levels of risky behavior is dramatically more likely to acquire a sexually transmitted disease than higher-risk women in communities with low rates of infection, according to public health experts...
In short, who you are, and where you live and, consequently, the sexual partners you choose, matters when it comes to HIV prevention.

*    "The Shame of Postville, Iowa," an editorial in Sunday's New York Times, calls attention to an essay written by Erik Camayd-Freixas.  Mr. Camayd-Freixas is a professor and court interpreter who witnessed the aftermath of last month's ICE raid on the Postville community.  He was disgusted when he saw the injustice in the legal system that the workers were subjected to; instead of being deported immediately, over 260 workers were charged with serious identity fraud crimes and sentenced to 6 months in prison:

What is worse, Dr. Camayd-Freixas wrote, is that the system was clearly rigged for the wholesale imposition of mass guilt. He said the court-appointed lawyers had little time in the raids' hectic aftermath to meet with the workers, many of whom ended up waiving their rights and seemed not to understand the complicated charges against them.

The editorial also added:

No one is denying that the workers were on the wrong side of the law. But there is a profound difference between stealing people's identities to rob them of money and property, and using false papers to merely get a job. It is a distinction that the Bush administration, goaded by immigration extremists, has willfully ignored. Deporting unauthorized workers is one thing; sending desperate breadwinners to prison, and their families deeper into poverty, is another.

*    Following the allegations of Guantanamo Bay-like treatment at ICE facilities, the Seattle Times has an article detailing numerous stories of abuse at an ICE facility in Tacoma, Washington.  The stories are part of a 65-page Seattle University Law School report titled "Voices From Detention".  Detainees claim that they are routinely subjected to physical and verbal abuse, strip searches and manipulation:

The report's authors said conditions are consistent with those at detention centers across the country. They are calling on Congress to pass laws that protect the rights of detainees...

Detainees in the study say they were pressured to sign documents or asked to sign paperwork they didn't understand, a practice their attorneys say often leads to their unwitting deportation...

The report said one woman, after an attorney's visit, was strip-searched and told to open her legs while a female guard peeped into her private parts.

To learn more about detainee treatment at ICE facilities, see this posting on The State of Opportunity.

*    Even after weeks of people discussing the horrific effects of the Postville and Houston raids, ICE has done it again - according to The Providence Journal, ICE agents arrested dozens of maintenance workers in a raid of Rhode Island court houses on Tuesday:

The raid led to a noisy demonstration by at least 100 people outside the Immigration and Customs Enforcement office at 200 Dyer St. last night. Police officers arrived as the crowd grew; at one point the police pushed a line of demonstrators across the parking lot.

For a full summary of the stories on the Rhode Island ICE raid, go to the Citizen Orange Pro-Migrant Sanctuary Sphere posting.

*    The New York Times is also reporting that many immigrants in New York City, most of them Latino, face being disenfranchised in the November election because the federal government is taking so long to fully process their citizenship applications:

At stake are the applications of at least 55,000 people in the New York City area who have been waiting at least six months -- and as long as four years -- for their documents to be processed, the lawyers said.