COVID-19 amplified America’s devastating health gap. Can we bridge it?
The COVID-19 pandemic is making health disparities in the United States crystal clear. It is a clarion call for health care systems to double their efforts in vulnerable communities.
19 November, 2020
Credit: Joe Raedle/Getty Images
- The COVID-19 pandemic has exacerbated America's health disparities, widening the divide between the haves and have nots.
- Studies show disparities in wealth, race, and online access have disproportionately harmed underserved U.S. communities during the pandemic.
- To begin curing this social aliment, health systems like Northwell Health are establishing relationships of trust in these communities so that the post-COVID world looks different than the pre-COVID one.
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<p>In the last 100 years, we've made incredible advances in health care, advances that would be viewed as miraculous to any previous generation. To pick one example, the<a href="https://ourworldindata.org/life-expectancy" target="_blank"> U.S. life expectancy</a> in 1950 was 68.2 years. We've since added 10 years to that average. Social programs have helped the young and elderly, two of the most health-vulnerable populations, receive unprecedented levels of care and attention. And telemedicine has decoupled many Americans' health support and monitoring from brick-and-mortar hospitals, expanding access to care.</p><p>Yet, despite these advances and despite handily<a href="https://www.brookings.edu/research/a-dozen-facts-about-the-economics-of-the-u-s-health-care-system/" target="_blank"> outspending other OECD nations on health care</a>, the United States preserves vast health disparities. As James Madara, CEO and executive vice president of the American Medical Association,<a href="https://www.ama-assn.org/about/leadership/america-s-health-care-crisis-much-deeper-covid-19" target="_blank" rel="noopener noreferrer"> </a>wrote on the organization's site: "The U.S. health system that exists today is a hodgepodge of ideas, programs, and regulations that is both extraordinarily expensive and highly inefficient. And despite its size and technological advancements, our health system is beset by tremendous gaps and inequities that favor some groups while unfairly disadvantaging others."</p><p>Our current predicament has its origins in tectonic sociohistorical forces that have shifted and fractured the health care landscape. For those at the peaks, access to superior care, education, resources, and social networks serve to protect their health. For those in the canyons, the ground continues to weather away with each past and ongoing crisis—consider, for example, the disproportionate fallout from<a href="https://diabetes.diabetesjournals.org/content/60/11/2667" target="_blank" rel="noopener noreferrer"> </a><a href="https://www.salon.com/2013/09/29/ronald_reagans_shameful_legacy_violence_the_homeless_mental_illness/" target="_blank" rel="noopener noreferrer">the dissolution of the Mental Health Systems Act</a>.</p><p>Then came COVID-19.</p>
COVID-19 deepens U.S. health disparities
<p>Communities on the pernicious side of America's health disparities have their unique histories, environments, and social structures. They are spread across the United States, but they all have one thing in common.</p><p>"There is one common divide in American communities, and that is poverty," said <a href="https://www.northwell.edu/about/leadership/debbie-salas-lopez" target="_blank">Debbie Salas-Lopez, MD, MPH</a>, senior vice president of community and population health at Northwell Health. "That is the undercurrent that manifests poor health, poor health outcomes, or poor health prognoses for future wellbeing."</p><p>Social determinants have far-reaching effects on health, and poor communities have unfavorable social determinants. To pick one of many examples, <a href="https://www.npr.org/2020/09/27/913612554/a-crisis-within-a-crisis-food-insecurity-and-covid-19" target="_blank" rel="noopener noreferrer">food insecurity</a> reduces access to quality food, leading to poor health and communal endemics of chronic medical conditions. The U.S. Centers for Disease Control and Prevention has identified some of these conditions, such as obesity and Type 2 diabetes, as increasing the risk of developing a severe case of coronavirus.</p><p>The pandemic didn't create poverty or food insecurity, but it exacerbated both, and the results have been catastrophic. A study published this summer in the <em><a href="https://link.springer.com/article/10.1007/s11606-020-05971-3" target="_blank">Journal of General Internal Medicine</a></em> suggested that "social factors such as income inequality may explain why some parts of the USA are hit harder by the COVID-19 pandemic than others."</p><p>That's not to say better-off families in the U.S. weren't harmed. A <a href="https://voxeu.org/article/poverty-inequality-and-covid-19-us" target="_blank" rel="noopener noreferrer">paper from the Centre for Economic Policy Research</a> noted that families in counties with a higher median income experienced adjustment costs associated with the pandemic—for example, lowering income-earning interactions to align with social distancing policies. However, the paper found that the costs of social distancing were much greater for poorer families, who cannot easily alter their living circumstances, which often include more individuals living in one home and a reliance on mass transit to reach work and grocery stores. They are also disproportionately represented in essential jobs, such as retail, transportation, and health care, where maintaining physical distance can be all but impossible.</p><p>The paper also cited a positive correlation between higher income inequality and higher rates of coronavirus infection. "Our interpretation is that poorer people are less able to protect themselves, which leads them to different choices—they face a steeper trade-off between their health and their economic welfare in the context of the threats posed by COVID-19," the authors wrote.</p><p>"There are so many pandemics that this pandemic has exacerbated," Dr. Salas-Lopez noted.</p><p>One example is the health-wealth gap. The mental stressors of maintaining a low socioeconomic status, especially in the face of extreme affluence, can have a physically degrading impact on health. <a href="https://www.scientificamerican.com/index.cfm/_api/render/file/?method=inline&fileID=123ECD96-EF81-46F6-983D2AE9A45FA354" target="_blank" rel="noopener noreferrer">Writing on this gap</a>, Robert Sapolsky, professor of biology and neurology at Stanford University, notes that socioeconomic stressors can increase blood pressure, reduce insulin response, increase chronic inflammation, and impair the prefrontal cortex and other brain functions through anxiety, depression, and cognitive load. </p><p>"Thus, from the macro level of entire body systems to the micro level of individual chromosomes, poverty finds a way to produce wear and tear," Sapolsky writes. "It is outrageous that if children are born into the wrong family, they will be predisposed toward poor health by the time they start to learn the alphabet."</p>Research on the economic and mental health fallout of COVID-19 is showing two things: That unemployment is hitting <a href="https://www.pewsocialtrends.org/2020/09/24/economic-fallout-from-covid-19-continues-to-hit-lower-income-americans-the-hardest/" target="_blank" rel="noopener noreferrer">low-income and young Americans</a> most during the pandemic, potentially widening the health-wealth gap further; and that the pandemic not only exacerbates mental health stressors, but is doing so at clinically relevant levels. As <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7413844/" target="_blank" rel="noopener noreferrer">the authors of one review</a> wrote, the pandemic's effects on mental health is itself an international public health priority.<blockquote>We need to find ways to unify this country because we're all human beings. We're all created equal, and we believe that health is one of those important rights.</blockquote>
Working to close the health gap
<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDc5MDk1MS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYxNTYyMzQzMn0.KSFpXH7yHYrfVPtfgcxZqAHHYzCnC2bFxwSrJqBbH4I/img.jpg?width=980" id="b40e2" class="rm-shortcode" data-rm-shortcode-id="1b9035370ab7b02a0dc00758e494412b" data-rm-shortcode-name="rebelmouse-image" />Northwell Health coronavirus testing center at Greater Springfield Community Church.
Credit: Northwell Health
<p>Novel coronavirus may spread and infect indiscriminately, but pre-existing conditions, environmental stressors, and a lack of access to care and resources increase the risk of infection. These social determinants make the pandemic more dangerous, and erode communities' and families' abilities to heal from health crises that pre-date the pandemic.</p><p>How do we eliminate these divides? Dr. Salas-Lopez says the first step is recognition. "We have to open our eyes to see the suffering around us," she said. "Northwell has not shied away from that."</p><p>"We are steadfast in improving health outcomes for our vulnerable and underrepresented communities that have suffered because of the prevalence of chronic disease, a problem that led to the disproportionately higher death rate among African-Americans and Latinos during the COVID-19 pandemic," said Michael Dowling, Northwell's president and CEO. "We are committed to using every tool at our disposal—as a provider of health care, employer, purchaser and investor—to combat disparities and ensure the <a href="https://www.northwell.edu/education-and-resources/community-engagement/center-for-equity-of-care" target="_blank" rel="noopener noreferrer">equity of care</a> that everyone deserves." </p><p>With the need recognized, Dr. Salas-Lopez calls for health care systems to travel upstream and be proactive in those hard-hit communities. This requires health care systems to play a strong role, but not a unilateral one. They must build <a href="https://www.northwell.edu/news/insights/faith-based-leaders-are-the-key-to-improving-community-health" target="_blank" rel="noopener noreferrer">partnerships with leaders in those communities</a> and utilize those to ensure relationships last beyond the current crisis. </p><p>"We must meet with community leaders and talk to them to get their perspective on what they believe the community needs are and should be for the future. Together, we can co-create a plan to measurably improve [community] health and also to be ready for whatever comes next," she said.</p><p>Northwell has built relationships with local faith-based and community organizations in underserved communities of color. Those partnerships enabled Northwell to test more than 65,000 people across the metro New York region. The health system also offered education on coronavirus and precautions to curb its spread.</p><p>These initiatives began the process of building trust—trust that Northwell has counted on to return to these communities to administer flu vaccines to prepare for what experts fear may be a difficult flu season.</p><p>While Northwell has begun building bridges across the divides of the New York area, much will still need to be done to cure U.S. health care overall. There is hope that the COVID pandemic will awaken us to the deep disparities in the US.</p><p>"COVID has changed our world. We have to seize this opportunity, this pandemic, this crisis to do better," Dr. Salas-Lopez said. "Provide better care. Provide better health. Be better partners. Be better community citizens. And treat each other with respect and dignity.</p><p>"We need to find ways to unify this country because we're all human beings. We're all created equal, and we believe that health is one of those important rights."</p>
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Experts fear Thanksgiving COVID spikes—Can you have your turkey and stay healthy too ?
Experts plead with Americans to keep gatherings limited this Thanksgiving, while families devise new ways to celebrate the holidays.
19 November, 2020
Credit: Lightfield Studios/Adobe Stock
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<p>Like any holiday, Thanksgiving has always had challenges mixed in with the fun. There are maddening travel logistics, crafting a dinner to meet everyone's dietary needs, avoiding your uncle's ceaseless <a href="https://bigthink.com/videos/talking-politics" target="_self">politic-baiting conversation starters</a>, and, of course, finding someone who can muscle through <a href="https://bigthink.com/tag/turkey" target="_self">the post-dinner slumber</a> to tackle the dishes. But this year, families must face an unprecedented challenge: managing family expectations and safety during the pandemic.</p><p>After 2020's contentious news cycle and a <a href="https://www.scientificamerican.com/article/a-running-list-of-record-breaking-natural-disasters-in-2020/" target="_blank">record-breaking number of disasters</a>, Americans want a dollop of normality to go along with their pumpkin pie. Unfortunately, this desire has grown in tandem with <a href="https://coronavirus.jhu.edu/" target="_blank" rel="noopener noreferrer">COVID-19 cases</a>. As of this writing, the United States is climbing its third pandemic peak and has endured more than 11 million cases and nearly 250,000 deaths (more than any other country). According to Johns Hopkins data, last week saw the U.S.'s highest seven-day average at 78,738 cases per day.</p><p>"We're at a point where the epidemic is accelerating across the country. We're right at the beginning of the steep part of the epidemic curve," Dr. Scott Gottlieb, former U.S. Food and Drug Administration commissioner, <a href="https://www.cnbc.com/2020/10/31/us-reports-record-99321-new-covid-cases-as-scientists-warn-of-difficult-winter-.html" target="_blank" rel="noopener noreferrer">said on CNBC</a>. He added, "You'll see cases start to accelerate in the coming weeks. December's probably going to be the toughest month."</p>
The experts agree
<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDc5MDgyNi9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYxMjU4MTI4OX0.3o3ULs3WhMned31DMmr-mvZdiFYvqo6NxcaxSAh9sjQ/img.jpg?width=980" id="3894b" class="rm-shortcode" data-rm-shortcode-id="105be1aaba5ecf60fd69fa89486833f7" data-rm-shortcode-name="rebelmouse-image" />A graph showing confirmed coronavirus cases from Jan. 3 to Nov. 18, 2020. The third, current peak is the largest so far.
<p>Dr. Gottlieb is just one of many experts who worry that Thanksgiving trips and gatherings will bolster the growth of COVID cases in America. Dr. James Phillips, chief of disaster medicine at George Washington University Hospital, <a href="https://www.cnn.com/2020/11/14/health/us-coronavirus-saturday/index.html" target="_blank">told CNN</a> that he expects cases to spike after Thanksgiving, further stressing the health care system and prompting harsher restrictions. If Americans do not learn from Thanksgiving, he forecasts another spike at Christmas.</p><p>Dr. Iahn Gonsenhauser, chief quality and patient safety officer at The Ohio State University Wexner Medical Center, concurs. As he <a href="https://www.livescience.com/thanksgiving-gathering-safely-coronavirus.html" target="_blank">told Live Science</a><u>:</u> "Most experts would agree that we're expecting to see a spike after Thanksgiving and that's a spike on top of already very discouraging and very scary numbers. By far the safest choice that anybody can make this Thanksgiving holiday and likely stretching into the other winter holidays that are coming up is to host your celebration virtually."</p><p>While many Americans may recognize Dr. Gonsenhauser's advice as sage, it's equally unwelcomed. <a href="https://www.axios.com/us-surgeon-general-pandemic-fatigue-record-covid-929e5cd3-d42a-4bab-b541-5e3d79abe242.html" target="_blank" rel="noopener noreferrer">Pandemic fatigue</a> is depleting the nation's willpower and <a href="https://www.psychologytoday.com/us/blog/license-shine/202009/six-tips-reduce-covid-decision-fatigue" target="_blank" rel="noopener noreferrer">clouding its judgment</a>. Add to that a longing to see family and friends—many of which we may have been separated from for close to a year—and it's easy to see why so many Americans are heading home for the holidays.</p><p>According to a TripAdvisor survey, <a href="https://www.cbsnews.com/news/thanksgiving-holiday-travel-covid-19-surge/" target="_blank" rel="noopener noreferrer">56 percent of Americans plan to travel</a> this Thanksgiving—less than previous years but a substantial amount nonetheless. Airlines are adding more flights to meet the demand, and <a href="https://www.vox.com/21525068/covid-19-airplane-risk-coronavirus-pandemic-airports" target="_blank" rel="noopener noreferrer">more people in airports</a> will increase the likelihood of transmission. Many other Americans will travel by car, popularly seen as the safer option but one that still increases one's risk of exposure at restaurants, gas stations, and public restrooms.</p><p>In response, governors have instated a patchwork of restrictions. They've closed nonessential indoor businesses, limited restaurants to pick-up orders, and made face masks a requirement when out and about. <a href="https://www.govtech.com/em/safety/As-Thanksgiving-Holiday-Looms-Hospitals-Gear-up-for-COVID-Surge-.html" target="_blank" rel="noopener noreferrer">Hospitals have also geared up</a> for an influx of new patients while facing their own holiday challenges. Many are already caring for large swaths of COVID patients while the winter weather is making physical-distancing tactics, such as outdoor tents, more difficult to manage. </p><p>"We don't really want to see mamaw at Thanksgiving and bury her by Christmas," Dr. Mark Horne, president of the Mississippi State Medical Association, <a href="https://apnews.com/article/travel-family-gatherings-coronavirus-pandemic-thanksgiving-holidays-3c759ab924a0d9de27803527ddf36c1c" target="_blank" rel="noopener noreferrer">told the Associated Press</a>. "It's going to happen. You're going to say 'Hi' at Thanksgiving, 'It was so great to see you,' and you're going to either be visiting by FaceTime in the ICU or planning a small funeral before Christmas."</p>To grandmother's house we go?
<p>Even while governors and experts pleaded with families to limit Thanksgiving gatherings to individual households, there has been no uniform, country-wide restrictions put in place. As such, every family must perform a risk calculation to decide how to spend Thanksgiving.</p><p>"[G]iven the fluid and dynamic nature of what's going on right now in the spread and the uptick of infections, I think people should be very careful and prudent about social gatherings, particularly when members of the family might be at a risk because of their age or their underlying condition," Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Disease, said on <a href="https://www.cbsnews.com/news/fauci-thanksgiving-covid-different/" target="_blank">CBS Evening News</a>. </p><p>He added, "When you're talking about relatives that are getting on a plane, being exposed in an airport, being exposed in a plane, then walk in the door and say 'Happy Thanksgiving' — that you have to be careful about."</p><p>To help families make their decisions, <a href="https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/holidays/thanksgiving.html" target="_blank" rel="noopener noreferrer">the Centers for Disease Control and Prevention (CDC) has released Thanksgiving considerations</a> to supplement safety alongside local rules and regulations. The agency lists several factors to consider in any risk calculation. These include local levels of COVID-19, potential travel exposure, the number of people attending, the health risks of those attendees, and the duration of the gathering as well as its location.</p><p>If people from outside the household will attend, the CDC recommends the following actions to increase safety and limit viral transmission:</p><ul><li>Ensure everyone wears a mask when not eating or drinking;</li><li>Keep people who do not live together at least 6 feet apart;</li><li>Have people bring their own food, drinks, utensils, etc. No potluck-style dinners;</li><li>Host the gathering outdoors or increase indoor ventilation;</li><li>Keep music levels down to prevent shouting or speaking too loudly;</li><li>Encourage good handwashing; </li><li>Clean and disinfect commonly touched surfaces often.</li></ul><p>You can find more information on the <a href="https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/holidays.html" target="_blank" rel="noopener noreferrer">CDC's Holidays website</a>. It's also worth noting that <a href="https://medical.mit.edu/covid-19-updates/2020/07/how-long-symptom-onset-person-contagious#:~:text=The%20CDC%20identifies%20a%20%E2%80%9Cclose,who%20has%20been%20positively%20diagnosed" target="_blank" rel="noopener noreferrer">a negative result on a COVID-19 test</a> is no guarantee of safety. People can harbor the virus, become infectious to others, show no symptoms, and still render a false positive several days after their initial infection.</p>Staying home for the holidays
<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="caf5ae9303d7359a42a37cfc200d83b1"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/yDuHtJCj_Og?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span><p>For families staying physically distanced, there remains the question of how to celebrate Thanksgiving this year. 2020's standard answer has been the Skype or Zoom call. Certainly an option, but one that should be spiced up for the holiday meal.</p><p>You can, for example, integrate your preferred telecommunication app can into shared experiences. Family members can work meal prep together or teach each other their signature dishes. Activities like crafts, decorating, and thankfulness trees can be coordinated by the kids and shared with the family simultaneously. You can cook up the same meal, light the same scented candles, and listen to the same music to create a common sensual environment.</p><p>You can also find telecommunication apps designed to be used alongside specific activities. <a href="https://discord.com/" target="_blank">Discord</a> is a favorite among gamers for video games. Even if battle royales aren't your family's speed, it works perfectly well for <a href="https://bigthink.com/personal-growth/board-games-for-kids" target="_self">board games</a>, and your family's favorite likely has a digital version available. Similarly, <a href="https://www.netflixparty.com/" target="_blank" rel="noopener noreferrer">Netflix's Teleparty</a> provides an online space to watch and chat about movies together. If Black Friday was your family's bonding tradition, try scouring for the savings together online and share a cocktail afterward to toast a successful shop. There is also the platform <a href="https://gather.town/" target="_blank">Gather</a>, which allows for proximity video chatting in a customizable 2D world.</p><p>If your family wishes to disconnect from the binary realm, try beginning a new holiday tradition this Thanksgiving. You can write holiday letters to distant family members. We're talking physical letters, which <a href="https://www.karger.com/Article/Abstract/343131" target="_blank" rel="noopener noreferrer">preliminary research suggests</a> has the salubrious bonus of reducing stress and anxiety for the writer. You can create holiday care packages for friends. And this year especially, the holiday card and photobook traditions will be more appreciated than ever. If you're in a time crunch, emails or texts are also nice.</p><p>For most families, Thanksgiving in 2020 will be unlike any other and will be, for better or worse, one to remember. Thankfully, there are ways to stay safe and healthy—and help others do so, too—while still connecting with loved ones in a meaningful way.</p>
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How Benjamin Franklin tried—and failed—to form a union
It was a concept borrowed from the Iroquois, and one that America never quite mastered.
13 November, 2020
- Most people know the basics of American history and may even be able to name all 13 colonies, but where exactly did the idea to form a union come from?
- Political writer and essayist Richard Kreitner explains how Benjamin Franklin learned the concept from the Iroquois Confederation. When he tried to introduce it to the colonists, however, they "thought it was essentially equivalent to tyranny."
- The idea eventually caught on, but not without land disputes and issues of representation, which explains why the US House of Representatives has 435 voting seats while the Senate has just two seats per state, equal for all states regardless of population size—it was a compromise. Kreitner argues that this imbalance may one day rupture the US political system.
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Last five American presidents seen as illegitimate in dangerous trend
Recent American presidents have all faced a crisis of legitimacy in a trend that threatens the health of our democracy.
10 November, 2020
Credit: MANNY CENETA/AFP via Getty Images
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<p>The election of 2020 concluded the way Donald Trump's ascent to power began – with claims over legitimacy. In fact, the last five American presidents have been labeled "illegitimate" by their opponents, demonstrating a growing and dangerous trend that threatens bedrock principles of our democracy.</p><p>Bill Clinton's 1992 victory came as a result of a three-way race between him, George H.W. Bush, and the third-party candidate, Ross Perot. Garnering 43 percent of the popular vote, Clinton's support in the country seemed low, especially in light of the fact that Republicans blamed Ross Perot for siphoning off votes that their candidate could have received. As a result, Republican leaders at the time like Bob Dole <a href="https://www.latimes.com/archives/la-xpm-1992-11-08-op-186-story.html" target="_blank">proclaimed</a> that Clinton did not have a mandate to enact his legislative agenda, hinting at his lack of true legitimacy. </p><p>This kind of sentiment led to opposition to what was perceived as Clinton's liberal agenda—allowing gay people in the military, raising taxes, and attempting to fix the healthcare system. The Republican opposition coalesced in the <a href="https://www.theatlantic.com/magazine/archive/2018/11/newt-gingrich-says-youre-welcome/570832/" target="_blank">Gingrich Revolution of 1994</a> and culminated in the impeachment hearings of Clinton's second term.</p>
<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDc2Njc4Ny9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY1MTk2NjY4Nn0.BFQdBr44Btm5LNeFeKKB0qdqbUv3qAGJcPpcDds4Gss/img.jpg?width=980" id="c8159" class="rm-shortcode" data-rm-shortcode-id="e069bae126d2aae6c7a7215b0bf87d06" data-rm-shortcode-name="rebelmouse-image" alt="Bill Clinton, Ross Perot, and George H. W. Bush" />
U.S. presidential candidates Bill Clinton (L), Ross Perot (C) and President George Bush (R) shake hands with the panelists at the conclusion of their final debate on 19 October 1992.
Credit: J. DAVID AKE/AFP via Getty Images
<p>The 2000 election brought issues of legitimacy to the contest between Clinton's successor George W. Bush and Al Gore. Bush received fewer votes in the national count and won as a result of a Supreme Court decision after a wait of several weeks. The infamous Bush v. Gore decision stopped a recount of Florida votes, giving the state to Bush by just a few hundred votes. A later analysis revealed that a full statewide recount could have netted Gore the victory. As such, a perception of illegitimacy followed Bush (at least until 9/11).</p><p>Who was calling for Bush's impeachment at the time for getting the U.S. involved in the Iraq War under false pretenses (lack of WMDs)? None other than Donald Trump, <a href="https://www.washingtonpost.com/news/the-fix/wp/2016/02/13/in-2008-donald-trump-said-george-w-bush-shouldve-been-impeached/" target="_blank">who revealed</a> how he thought Clinton's impeachment was a total overreach compared to the fact that Bush got off scot-free for pulling America into a war it didn't need to fight.</p>
<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDc2Njc5Mi9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY2NjExNjQyN30.a4RM1ogPHgY6W2beG2YpF5wiGpR2pR8h2e_zP3oMfcU/img.jpg?width=980" id="b933e" class="rm-shortcode" data-rm-shortcode-id="97eac9928e7a188cc85ad84f4c2d228e" data-rm-shortcode-name="rebelmouse-image" alt="Al Gore supporters" />
Supporters of Democratic presidential candidate and vice president Al Gore march to the Florida State Capitol to rally against the Florida legislature. 2000.
Credit: TIM SLOAN/AFP via Getty Images
<p>Trump, of course, is also the one who for years <a href="https://www.cnn.com/2016/09/09/politics/donald-trump-birther/index.html" target="_blank" rel="noopener noreferrer">questioned</a> the right of the next president, Barack Obama, to have such a position. Trump was the most high-profile "birther," pushing the unfounded conspiracy that Obama wasn't a real American and was, in fact, born in Kenya. </p><p>Who else spread such theories? It's worth noting that Hillary Clinton supporters were <a href="https://www.theatlantic.com/ideas/archive/2020/05/birtherism-and-trump/610978/" target="_blank" rel="noopener noreferrer">known to circulate </a>chain emails with similar Kenya-oriented claims about Obama's origins.</p>
<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDc2Njc1Ni9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYxMTM2NzYzMX0.g1qwA5BXlH7La5l6hp09s1Ev-EF_QV3R14F73OmTRk4/img.jpg?width=980" id="72426" class="rm-shortcode" data-rm-shortcode-id="ea9649e84e63355e9a3d91164d58a44e" data-rm-shortcode-name="rebelmouse-image" alt="Donald Trump and Barack Obama" />Donald Trump Is Sworn In As 45th President Of The United States
Credit: Scott Applewhite - Pool/Getty Images
<p>In his turn at the helm, Donald Trump's 2016 victory over Hillary Clinton was plagued strongly by the notion that he received help from foreign powers and didn't win fair and square. The Mueller investigation into his potential collusion with Russia found much support for this notion but didn't go as far as to charge the President. Still, harkening to the <a href="https://www.nbcnews.com/news/us-news/sen-mccain-russia-s-election-meddling-unprecedented-attack-n700981" target="_blank">clear-cut conclusions</a> of various investigative and spy agencies, Democrats generally saw a major asterisk around Trump's election, with Hillary Clinton and Rep. John Lewis flat-out <a href="https://www.nbcnews.com/meet-the-press/john-lewis-trump-won-t-be-legitimate-president-n706676" target="_blank">calling him</a> an "illegitimate" president.<br></p><p>The nearly two decades of political behavior that saw an escalation of legitimacy attacks against the country's most powerful elected leader bring us to 2020, with another crisis in the making, courtesy of Trump. With no evidence to back it up, the President has been claiming that the election has been stolen from him in favor of Joe Biden. While his arguments haven't found much support among the courts, Trump continues to make the claim, both to continue the fight and to weaken his opponent even if Biden does end up with the Presidency.</p>
<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDc2Njc2OS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYxMTIwNzUzNn0._eLNXNU7IvUaNhbpufjvDmOp4ZiXfAnCI_ZalxzDoq8/img.jpg?width=980" id="3d21e" class="rm-shortcode" data-rm-shortcode-id="03506fe8a97e3135bd20e6520f3812b9" data-rm-shortcode-name="rebelmouse-image" alt="Donald Trump and Joe Biden" />
This combination of pictures from October 22, 2020 shows US President Donald Trump and now President-elect Joe Biden during the final presidential debate.
Credit: JIM WATSON and Brendan Smialowski / AFP via Getty Images
<p>Where does this leave us, with each subsequent election creating a deep polarization and disappointing half the country to the point where they simply don't believe the other side and feel cheated? Nowhere good. Professor of Journalism Andrés Martinez described the situation aptly in 2017, in a way that resonates even louder today when we face a continuation of this sad trend:</p><p style="margin-left: 20px;"><span style="background-color: initial;">"</span><span style="background-color: initial;">It's desirable, and quintessentially American, to strenuously oppose policies and ideas we disagree with," wrote Martinez in <a href="https://www.washingtonpost.com/posteverything/wp/2017/01/20/americans-have-seen-the-last-four-presidents-as-illegitimate-heres-why/" target="_blank">Washington Post.</a> "But the haste of recent years to delegitimize opponents, and to call them un-American, is itself un-American. It leaves us with a bankrupt, even <em>illegitimate</em>, politics, devoid of shared narratives, aspirations, values and, increasingly, facts."</span></p><p>Martinez's prescience that facts will fall soundly at the expense of political ambitions is exactly where we find ourselves. The once-collegial chambers of government rife with unbreakable gridlock and loud accusations of misdeeds by opponents that your side doesn't even need to prove any more. A country where half the people feel the leader is illegitimate yet again but with much more anxiety and anger than ever before. A country tearing itself apart. </p>
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Oregon decriminalizes drugs: Here are 3 metrics other states will track
It's "the biggest blow to the war on drugs to date," said Kassandra Frederique, executive director of the Drug Policy Alliance.
06 November, 2020
Credit: pxfuel.com
- Oregon voted to decriminalize possession of small amounts of all drugs, including heroin, cocaine and methamphetamine.
- The state also legalized the therapeutic use and sale of psilocybin mushrooms.
- As the laws go into effect, other U.S. states will be watching to see how the experiment plays out, influencing future votes across the country.
<p>Amid the uncertainty of the unfolding U.S. 2020 presidential election, Americans decided one thing on November 3 with refreshing clarity and unity: It's time to move away from the war on drugs.</p><p>In the nine states where ballots featured legalization or decriminalization measures, all passed. That includes recreational and medicinal marijuana in South Dakota, medical marijuana in Mississippi, and recreational marijuana in Arizona, Montana and New Jersey.</p><p>But Oregon passed the most sweeping and historic reforms, voting to partially decriminalize all drugs—even heroin, cocaine and methamphetamine. Oregon's measure 109 also legalized the therapeutic sale and use of psilocybin mushrooms, which, as a <a href="https://bigthink.com/mind-brain/psychedelics-depression" target="_self">new era of psychedelic research continues to show</a>, have proven remarkably effective at treating conditions like depression, anxiety and post-traumatic stress disorder. </p><p>Of course, drug decriminalization isn't legalization. Oregonians caught in possession of small amounts of hard drugs will be fined $100, whereas they would've been fined up to $6,250 and sentenced up to a year in jail under the previous law. The initiative, called the Addiction Treatment and Recovery Act, also allows people caught with drugs to avoid paying the fine if they undergo a health assessment at an addiction recovery center.</p><p style="margin-left: 20px;">"Today's victory is a landmark declaration that the time has come to stop criminalizing people for drug use," <a href="https://apnews.com/article/oregon-first-decriminalizing-hard-drugs-01edca37c776c9ea8bfd4afdd7a7a33e" target="_blank">said</a> Kassandra Frederique, executive director of the Drug Policy Alliance, which was behind the measure. "Measure 110 is arguably the biggest blow to the war on drugs to date."</p>
<div id="49425" class="rm-shortcode" data-rm-shortcode-id="c5811192ec0f155d42d5c9410cb009f1"><blockquote class="twitter-tweet twitter-custom-tweet" data-twitter-tweet-id="1323839290246389760" data-partner="rebelmouse"><div style="margin:1em 0">Oregon made history tonight by becoming the first state to decriminalize drug possession! Our c4 @DrugPolicyAct led… https://t.co/s9pNxUn4HI</div> — Drug Policy Alliance (@Drug Policy Alliance)<a href="https://twitter.com/DrugPolicyOrg/statuses/1323839290246389760">1604462857.0</a></blockquote></div><p>The new laws aim to reframe drug use as a public health issue.</p><p style="margin-left: 20px;">"People suffering from addiction are more effectively treated with health care services than with criminal punishments," Oregon's initiative says. "A health care approach includes a health assessment to figure out the needs of people who are suffering from addiction, and it includes connecting them to the services they need."</p><p>Marijuana and hard drugs remain illegal on the federal level. But as Americans generally continue to shift toward favoring drug reforms, citizens and policymakers will be watching Oregon to see how the experiment plays out, and the outcomes will likely influence voters in other states. Here are a few things to keep an eye on.</p>
Arrest and incarceration rates
<p>Reduced arrest and incarceration rates for drug possession are likely to be the most obvious changes. The Oregon Criminal Justice Commission <a href="https://www.opb.org/pdf/IP44%20-%20REI%20Statement%20Supplement_1602708982790.pdf" target="_blank">estimates</a> that the new laws will reduce convictions for drug possession by about 90 percent, from 4,057 convictions in 2019, to a projected 378 in 2021.<br></p><p>The commission's report also estimates that drug convictions among Black and Indigenous Oregonians may drop by 94 percent, and that racial disparities in drug arrests could drop by the same amount.</p><p>If more Oregonians stay out of the criminal justice system, it could help more people find employment, housing, addiction services and student loans, all of which can be harder to access with a drug conviction on your record. </p><p>It's also conceivable that the new initiative will reduce contentious interactions between Oregonians and law enforcement, which, potentially, could lead to lower arrest rates for other infractions, and create fewer opportunities for police interactions to turn violent.</p><p>Alternatively, if the initiative frees up time and resources for Oregon law enforcement, the state could see arrests rise for other types of crimes. That may include arresting more dealers and traffickers, considering the new laws only apply to users carrying small amounts. If police focus on the suppliers, it will likely change the dynamics of Oregon's illegal drug trade.</p>Drug use rates
<p>How will removing the threat of jail and steep fines change drug use and overdose rates? It's hard to say for sure, but Portugal's 2001 decision to decriminalize drugs provides some clues. In the years following decriminalization, the nation's drug overdose deaths and <a href="https://www.scientificamerican.com/article/portugal-drug-decriminalization/" target="_blank">HIV infection rates dropped significantly</a>, while <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=1464837" target="_blank">drug usage either stayed constant or decreased</a>.<br></p><p>That drug use remained constant or decreased may be because Portugal only decriminalized drugs, meaning drugs weren't legally available for purchase at something like a marijuana dispensary. But it's also worth noting that Portugal invested money in addiction treatment services, as Oregon <a href="https://ballotpedia.org/Oregon_Measure_110,_Drug_Decriminalization_and_Addiction_Treatment_Initiative_(2020)#How_is_the_drug_addiction_treatment_and_recovery_program_funded.3F" target="_blank">plans to do with tax revenues from marijuana sales and savings on correctional services</a>.</p><p style="margin-left: 20px;">"Most accounts of the Portugal experiment have focused on decriminalization, but decriminalization was part of a broader effort intended to encourage treatment," <a href="https://www.cambridge.org/core/journals/law-and-social-inquiry/article/uses-and-abuses-of-drug-decriminalization-in-portugal/1F68DA5A8F0369F3FBA6B2B04E454BBE" target="_blank" rel="noopener noreferrer">Hannah Laqueur</a>, an assistant professor in the Department of Emergency Medicine at the University of California, Davis, <a href="https://www.nytimes.com/2020/10/05/upshot/portugal-drug-legalization-treatment.html" target="_blank" rel="noopener noreferrer">told</a> <em>The New York Times</em>.</p><p>Oregon will be a particularly interesting case study for decriminalization's effects on drug usage, considering the state ranks among the worst for <a href="https://www.wweek.com/news/state/2019/10/02/nobody-can-beat-oregon-for-drug-use-and-abuse/" target="_blank" rel="noopener noreferrer">rates of addiction, use, and overdose</a>.</p>Treatment rates
<p>Although Oregon plans to expand investments in treatment programs for drug users, some are worried the new initiative will discourage people from seeking help.<br></p><p>John Kitzhaber, a former E.R. physician in Oregon, called for Oregonions to reject the measure, writing on his <a href="https://blog.johnkitzhaber.com/vote-no-on-measure-110/" target="_blank">blog</a>:</p><p style="margin-left: 20px;">"Measure 110 would eliminate this invaluable tool by reducing the possession of highly addictive drugs like heroin, cocaine, methamphetamine and oxycodone to a "violation," which means the court will no longer have the ability to offer people the choice to pursue treatment. It also means that a teenager caught in possession of heroin or meth will only receive a ticket, which in many counties means that parents won't be informed of their child's drug use."</p><p>Still, even if Oregon's measure reduces the number of people who get treatment, that wouldn't necessarily be an indictment of decriminalization writ large, but rather the specific way the state is allocating funds. Kitzhaber concluded his post with a sentiment shared by both drug reform advocates and some of the measure's opponents: "Incarcerating people who suffer from addiction should not be tolerated."</p><span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="1f7bc5a3d5d9b078bad4b151ae3da84f"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/VIpqZmdBgvw?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span>Drug prevention advice for parents Watch the newest video from Big Think: https://bigth.ink/NewVideo Join Big Think Edge for exclusive videos: https://bigth....
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