A Health Commissioner Who Knows What He's Talking About?

Cross posted at Daily Kos.

I know, it seems shocking. Look at the health statistics in the city of Baltimore - fifth highest overall mortality rate, second highest homicide rate, fourth highest infant mortality rate, third in low birth weight rankings... and the clincher: second highest AIDS and HIV rates, at a whopping 40.4% and 50.5%, respectively. Oh, and years of neglect and corruption in the City Health Department. How could the Baltimore City Health Commissioner be improving the situation?

Well, he is. Josh Sharfstein, M.D. is currently the Health Commissioner of Baltimore, and he has a pretty impossible job. He is tasked with improving the public health of a city that has such serious epidemics - the spread of HIV, heroin addiction, asthma among children, infant mortality...the list goes on. And he has to deal with Mayor Sheila Dixon and the Baltimore City Council - no easy feat.

But Sharfstein has proposed some interesting strategies for combating these problems. For tackling the spread of HIV and heroin addiction among Baltimoreans, he supports buprenorphine. Buprenorphine is an alternative to methadone, the controversial heroin substitute. Health professionals are divided on the benefits on buprenorphine. Some say it is over-prescribed and an inadequate substitute to counseling services. Others say it provides the benefits of methadone without being as highly addictive.

But the best part of bupenorphine is that regular doctors can describe it (after a number of hours of training). Methadone has to be distributed at special methadone clinics. No one wants methadone clinics in their communities, so it becomes more difficult to build them. Bupenorphine could help produce the safer consumption of heroin substitutes in Baltimore, and ultimately lead to a drop in the HIV rates among users.

Sharfstein has also committed to targeting other urban policy issues that affect public health. For example, high school dropout rates can turn into a public health nightmare - they can lead to increased rates of teen pregnancy and drug use, among other things. However, studies have shown that providing families with books will increase the likelihood that their kids will stay in school. So, the Commissioner came up with a plan for Baltimore City to give books to pediatricians, who would in turn give them to their patients so they would have something to read - simple, but effective.

Baltimore has also begun its "Safe Streets" program - a copy of Chicago's Ceasefire Program to lower gun violence in the city. There is no greater risk to public health than the murder rate, and it is not only the police commissioner who needs to get involved in such programs, the health commissioner must as well.

However, the greatest achievement Sharfstein has made is establishing a shift to community based health provision in Baltimore. For too long, the city has suffered a health budget that was too small to get anything done (thanks in large part to inadequate federal funding). However, community organizations can do more with less - they have more devoted staff, a knowledge of the local needs of their target area, and a relationship with the people that need access to services. All of these things allow community based organizations to provide primary care better than the City can. Thus, instead of wasting money on inadequate health services, the Health Commissioner has invested in community based primary care initiatives. However, the City still needs to do its part, and has maintained clinics and health centers that still fulfill a need.

Republicans constantly talk about the need to increase efficiency in our health care system - but they only know how to do that by cutting services. The services are still needed, we just need to change how we provide them. Supporting health care can take many forms, but two things is clear: government still needs to maintain a role in health care provision through funding local services, and we need more health commissioners like Josh Sharfstein in the country.

New Problems With HIV Risk

Cross posted at Daily Kos.

It is ludicrous to think that, almost 30 years after the AIDS epidemic swept through the country, the U.S. government could still let people at risk for HIV, and people who are newly infected with HIV, fall through the cracks. Unfortunately, this does seem to be the case.

An article in The New York Times calls attention to the new Centers for Disease Control and Prevention study on HIV risk among Americans. The study found that the groups that make up the majority of new HIV cases are gay or bisexual men and blacks. Infections among gay or bisexual white men occurred mostly in their 30s or 40s, whereas cases among gay or bisexual black men occurred mostly in their teens and 20s.

Furthermore, the study showed that these groups are severely at risk for not getting the treatment they need:

In one of the most dismal statistics provided by the centers, researchers said that 80 percent of those found to be newly infected by the disease had not been reached by prevention efforts, which are often sponsored by federal, state and local health officials.

To say that this poses a public health risk barely skims the surface of the problem. People are who at risk for a disease as serious as AIDS should have access to the health care that they need, but sadly, this is not the case.

Those who do not have access to infection prevention services, or basic birth control or safe sex education programs, end up becoming at risk for AIDS.

(By the way, I think we can all think of a certain 17 year old from Alaska who might have benefited from some access to birth control and basic sex education programs...but that's neither here nor there).

These people often live in areas where these services are underfunded (especially when the federal government only promotes abstinence only education programs). And these people are hit again when they don't have access to the necessary treatment medications or programs.

This is a problem of people lacking, or having inadequate, insurance. This is also a problem of our health care services not targeting those who need them most. People need to wake up to these health disparities, as they create public health problems for the whole country. If they don't, things will only get worse.

Where Is Discussion of Access to Health Care?

Cross posted at Daily Kos.

Inadequate access to health care is a problem plaguing this nation's communities. In light of that fact, it was discouraging that no keynote speakers at the DNC or RNC managed to discuss this problem in a meaningful way in their speeches. Those at the DNC do get some credit for discussing the problem of inadequate health insurance coverage in the U.S., but that is only the tip of the iceberg. Where is the discussion of inadequate access to care, and the health disparities that follow from it, among our country's leaders?

Health Beat has started a series titled, "Americans Who Have Insurance — But Still No Access To Care." The first posting went up Tuesday, and discussed various problems plaguing the 56 million Americans that do not have regular access to health care. But it is important to note that this is not only a problem of people lacking health insurance - many of these 56 million Americans have insurance, but still do not have the access to care that they need.

The problem of inadequate access to care is even more evident in poor communities. The shortage of primary care physicians is most severe in those communities, and the effects are enormous. Health disparities in the U.S. still plague low-income areas, areas that are often populated largely by communities of color.

It is also important to note that this inadequate access to care is not only a problem for those seeking primary care. This week's Kaiser Health Disparities Report links to a study that shows minority single women and teenagers are less likely than others to receive proper prenatal care:

The task force report, based on data from 1990 to 2004, found that across all racial and ethnic groups, uninsured women had the lowest rate of trimester prenatal care at 73% and that women with private insurance had the highest rate at 96%. The overall average for prenatal care was 89%.

When these individuals do not have access to prenatal care, their children become subject to a host of potential health problems early in life, including ones as severe as infant mortality:

The task force recommended increased preconception health awareness, promotion of equity in birth outcomes and assurance of availability of early prenatal services for women living in areas with hospital closures or reductions in obstetrical services.

The Kaiser report also links to a study examining the causes of massive rates of obesity in Native American communities. The problems are most severe among youths:

Forty-three percent of boys and 39% of girls were considered overweight, according to the study.

Without access to health care, parents cannot teach their children about proper nutrition and dieting. Therefore, this cycle of bad health continues generation after generation.

We need our political leaders to talk about this issues if we want anything done. The conventions were a missed opportunity for both parties, but it wasn't the only one that will appear in this election cycle. Hopefully, next time we can expect more.

Series Two - Health Care: Introduction

The next series on this blog will focus on health care in the United States. It will cover a range of issues that are not focused on in the mainstream political arena, particularly the unequal access to health care, the inadequate quality of health care and the health disparities that exist in the U.S. I will look at how these issues are discussed (or not discussed) in politics in general and in the upcoming election.

When politicians do address health care, they mainly talk about lowering costs, improving efficiency in spending and getting more people covered. While the uninsured population is a huge concern in the U.S. and should be discussed, there are many other issues in our health care system that do not get the same kind of focus. These issues can be just as bad, or even worse, than lacking insurance.

The series will also look at the U.S.'s health care system in the context of the other countries' health care systems. There are other countries that our leaders could learn a lot from (good and bad) when seeking to improve the U.S.'s health care system.

Also, many of these postings will be cross posted on two other blogs - the Daily Kos and Scoop08. Please look at those if you get a chance.

Upper West Side, Manhattan

I thought it would be appropriate to end this series of the blog by discussing graffiti in my neighborhood. Before doing this blog, I hadn't noticed any graffiti on the Upper West Side. Once I started looking for it, I saw it was everywhere.

Some of the graffiti is part of construction sites. Some of it is on buildings, either nice brownstones or commercial sites. Regardless of what building it is on, that building is extremely expensive. Someone is either paying high rent, has massive lease or mortgage, or is sitting on millions of dollars of property. Whether or not graffiti is on it has nothing to do with how it is priced.

This series on graffiti was meant to show a number of things - graffiti might be a symptom of crime, or it might be a symptom of a large artistic presence in an area. It might be a bad influence on a neighborhood, causing property values to go down, or it could be completely irrelevant in how the homes are valued.

Sometimes graffiti matters in an urban area, and sometimes it doesn't. But the presence of graffiti in such different kinds of neighborhoods shows that one cannot judge it before looking at what it means to the area. It is impossible to generalize the effect of graffiti - good or bad.

North Philadelphia, Philadelphia

The past few posts have been about graffiti in neighborhoods that are doing relatively well. Many of them used to be impoverished or dangerous, but now they are safe neighborhoods with a lot to offer, including graffiti.

However, graffiti is still actively present in neighborhoods that are not doing well. North Philadelphia is one of these neighborhoods. It's been described as a war zone. Gangs are active in the area, which is one of the main reasons it is covered in graffiti. As the Amtrak train runs through the area on its way to stopping in Downtown Philadelphia, there are mile long strips that are overwhelmed by tags.

It's hard to tell if the graffiti in North Philadelphia has any influence over the area. People riding through on the train can tell it is not a nice place, but not just from the graffiti - from the shootings, from the abandoned houses, from the decrepit roads. On the other hand, the graffiti might not be there if the gangs were not overwhelming the area.

Graffiti in North Philadelphia is an example of how many people still think of graffiti - as a symptom of the failure of a city. It's hard to tell if graffiti has had any role in making North Philadelphia what it is today. But ultimately, when people look at North Philadelphia, what they see is graffiti - and what they see is not good.

Alphabet City, Manhattan

Anyone who has seen the play "Rent" knows about what Alphabet City used to be like. The neighborhood was chock full of homeless people who lived in abandoned houses in the area (and became known as "squatters"). Drug addicts and prostitutes overwhelmed the area...it wasn't exactly family friendly.

But Alphabet City survived. It became trendy because artists moved in, like so many neighborhoods in New York have. But some physical aspects from its past remain - many of the same houses are there (the ones that the squatters lived in) but they've been renovated. The streets and parks look the same, minus the addicts. Essentially, the neighborhood is completely recognizable.

And, of course, the graffiti is still there. However, it is not really at all controversial, at least not in the same way it is in other neighborhoods. People don't question whether it will cause crime, or decrease property value in Alphabet City. Much of the graffiti itself is done by actual Alphabet City residents (like the mural posted in this blog).


The New York Times reported that a famous graffiti artist, Angel Ortiz (aka LA II), recently restored a Keith Haring mural in the Lower East Side (just south of Alphabet City). People felt that Ortiz's tagging was a perfect addition to the mural. Haring clearly appreciated Ortiz's work, since he left one of Ortiz's tags untouched when he was painting the mural.

Graffiti does not always have to be controversial. Sometimes, everyone agrees on what it does for a neighborhood. In this case, everyone agrees its effect seems to be quite positive.

Haight-Ashbury, San Francisco

An article in the San Francisco Observer from February 2005 shows that the "war against graffiti" in San Francisco has been waging for a number of years. District 5 contains the neighborhood of Haight-Ashbury, one of the most famous and most visited areas in San Francisco. Some residents of Haight-Ashbury have taken it upon themselves to force the city to fight the spread of graffiti in their neighborhoods:

Daniel Homsey, District 5 Liaison in the Mayor's Office of Neighborhood Services, is on a crusade to put a stop to what he calls a graffiti problem that’s out of control in District 5.
“As a city employee and a native San Franciscan, I'm truly frustrated with the graffiti. It is unbelievable what is going on. The City is spending millions of dollars on cleaning up graffiti—not on parks, kids’ after school programs, meth clinic slots,” said Homsey...
There are extensive laws on the books to penalize graffiti crimes in San Francisco.
If the graffiti damage to the property is less than $400, it’s a criminal misdemeanor. For a misdemeanor, the maximum penalty is six months in jail. First-time offenders are entitled to go to pretrial diversion and be sentenced to community service in the SFPD’s graffiti abatement program. Repeat offenders can be placed on probation for up to three years, be monitored, and have to do graffiti abatement.

However, a friend of mine recently visited Haight-Ashbury and took these pictures of the graffiti she saw in a restaurant she was dining in. This is what she said:

"The graffiti would have probably been regarded as ugly and a little disturbing anywhere else, but it just totally blended in with the quirkiness of the surroundings and added to the "charm" of the restaurant - so much that I took multiple pictures."

So, while residents of Haight-Ashbury might be fighting to get the graffiti out of their neighborhood, at least some visitors are appreciating it. In addition, the graffiti certainly hasn't led to a drop in the value of housing in the neighborhood - the median price of a home in Haight-Ashbury is $1,096,337 (compared to the median price in San Francisco, which is $656,700).

Moreover, it is impossible to ignore the counterculture history of Haight-Ashbury. The beatnik poets of the 50s, the antiwar activists of the 60s, and hippies and artists from many generations have flocked to the area for decades. Because of this history, the neighborhood still embodies that counterculture sentiment (despite the fact that many of the hippies and beatniks are long gone). People move to Haight-Ashbury because of what it represents - it is a cool place to live because of its rich history. Whether it is covered in graffiti or not, whether the residents hate the graffiti or not, people have embraced the anti-conformity past of Haight-Ashbury. Perhaps graffiti is simply the latest installment in this long counterculture tradition.

The Berlin Wall, East Berlin

The Berlin Wall was a physical and metaphorical symbol of political division in Germany from 1961 - 1990. It was built with the sole purpose of keeping two groups of people from interacting with one another. It signified the power of the East German regime (a regime that sought to suppress any opposition within its government and among its people). It said to the world, "you are not welcome, and you are not to interfere." It was, to say the least, political.


When The Berlin Wall came down, everything changed - the German people, the German government, the whole world. Politics between Western and Eastern Europe, between the United States and the Soviet Union, was completely redefined.


However, not all of the wall was dismantled. Large chunks of it remain along the former border of West and East Berlin - the most famous points are at Checkpoint Charlie and the Spree River. Berliners didn't want the wall completely destroyed because the people wanted a reminder of their past (a sentiment that was shared all over the world).

Graffiti played a significant role in the history of the Berlin Wall. When Berlin was divided, graffiti was sprawled across the wall on its West side - whether or not it was the intention of the people spraying their aerosol cans, it was a symbol of protest against the East German government. People could not graffiti on the East side of the wall because of the laws against freedom of expression (the only kinds of art that were acceptable in East Berlin were the kinds that were deemed "appropriate" (aka pro-regime) by the East German government).


Now, the section of the wall along the Spree River is called the East Side Gallery. After the wall came down, artists from all over the world came to paint murals on the wall's East side. Graffiti artists are still active on the wall - many of the original murals have been tagged and covered with graffiti. A lot of people were very unhappy about this (there is a group committed to restoring the artwork on the wall - here is a link to their website).

However, people do not focus on the fact that much of the original murals in the East Side Gallery were graffiti murals - some of them were made (at least in part) with aerosol cans. In these cases, graffiti art is a political symbol in the same way it was when West Berlin protesters used it. Graffiti has continued to be part of urban life in Berlin, in positive and negative ways, but its past and present significance makes one thing clear: it is both a tool and a symptom of politics.

Long Island City, Queens

Long Island City, specifically the building known as "5 Pointz," is the graffiti artist's Mecca.

Graffiti artists from all over the world come to Queens to temporarily leave their mark on the corner of Jackson Avenue and Davis Street. Meres One, the self-proclaimed "CEO" of 5 Pointz, has a website - 5ptz.com - where he displays the artwork that is currently on the building. Every few weeks the murals change and new artists have an opportunity to come in and show their love for the aerosol can. However, before anyone can start working on 5 Pointz, Meres One needs to see a sample of their work and ok it.

The other thing to mention about 5 Pointz is that it is completely legal. The landlord of the building granted Meres One permission to graffiti there (so no one is trespassing or committing acts of vandalism when they graffiti). In addition, all artists must have a permit in order to do anything to any part of the graffiti walls. Violators, Meres One assures us, will be prosecuted.

5 Pointz has managed to integrate the counter-culture aspect of graffiti art with the laws of New York City. Not only that, 5 Pointz has been embraced by the community in Long Island City. This is partly because 5 Pointz is located across the street from P.S. 1, the contemporary art wing of the Museum of Modern Art (MoMa). The people who live in and visit the area are art lovers (they wouldn't be there if they weren't).

Long Island City was not a desirable place to live for many years - despite its close proximity to Manhattan, the train tracks run outdoors through the area, so the neighborhood can be very noisy even late at night. While there are some nice brownstones and row houses in the area, a lot of it is old, decrepit industrial space. As we saw in Williamsburg, artists often end up saving a neighborhood like this. 5 Pointz, and graffiti culture in general, fits nicely with their efforts.

Inglewood, Los Angeles

Last week, the state of California passed a law that forces everyone convicted of graffiti vandalism to remove the graffiti themselves, and (in some cases) keep the surface clean for up to a year.

The Los Angeles Times reported on the story on Thursday. The author of the law, Assemblyman Mike Davis (D-Los Angeles) said:

"By having to clear up the mess, they would realize how much effort and cost is involved in tidying up after them."

However, others feared that gang retaliation would be a significant problem and lead to taggers having to risk their lives in the process of cleaning off the walls:

"The cause for a lot of violence involves graffiti and either crossing it out or removing it," said Khalid Shah, director of Stop the Violence, a gang intervention program.
He said Homeboy Industries closed a program that put gang members to work removing graffiti after two young people were shot to death while cleaning walls.

The debate over the potential benefit and harm of this legislation (which Governor Schwarzenegger signed into law last Wednesday) makes one thing clear: graffiti is an urban policy issue. Politicians and gang members are both players in urban politics, and the judgments each group makes about graffiti goes beyond aesthetics.

Politicians might say they want to remove graffiti because it is an eyesore, but their criticism of it goes beyond what it looks like. Assemblyman Davis is a classic example of this: he has devoted a large part of his career in the state government to fighting crime in his district (see Smart Voter for more information). Crime prevention in Los Angeles has a lot to do with minimizing the influence of gangs in certain areas. Tagging lets it be known that a gang has a presence in a neighborhood - it is a physical sign of intimidation.

Likewise, gang members don't sprawl their tag in an area because they have a desire to express themselves artistically - they tag to mark territory, to show their strength. When their graffiti is taken down, it is an insult to their authority.

In the context of crime prevention, how people address graffiti in urban politics is dependent on how both of these groups feel. In some neighborhoods, the community can judge graffiti and decide for itself what its artistic value is. However, in other neighborhoods, the leaders (whether they are politicians or gang members) make the decisions.

Williamsburg, Brooklyn

Think of an area with bad housing stock that was home to a massive oil spill, has poorly paved sidewalks and "views" of abandoned smoke stacks...does that sound like some place you'd want to live?

No? Then you're not a hipster.

I am talking about Williamsburg - one of the trendiest areas in Brooklyn, New York. In true New York fashion, the artists first came in the 1970s when the rents were close to nothing. Then, the hipsters followed. They brought with them a love of the bohemian lifestyle...and overpriced coffee. Now, Williamsburg has both - McCarren Pool (which is about to be redone, good or bad news depending who you ask) and Oslo Coffee are good examples of each.


Guess what else the area has? Graffiti! Loads of it! And I know I said I wasn't going to be making any artistic judgments, but most of it really isn't that pretty. But you know what? Neither is the rest of Williamsburg, so it fits quite well.

This part of Brooklyn goes completely against the common perception of what an ideal place to live is. But there is a large community of people (some of whom live in Manhattan) that flock to Williamsburg for the concerts, the food and the nightlife. So many people want to live there that it is no longer affordable for the artists who moved there in the first place ("so goes the neighborhood...")

Moreover, the graffiti in the area fits with its atmosphere - if all of it was removed, Williamsburg would almost look too clean. Some areas of a city are not meant to be polished...many people like a little bit of grit, a place that is rough around the edges. Graffiti is part of making that happen.

SoHo, Manhattan

SoHo has changed drastically over the last 30 years - it used to be full of empty warehouse space. Then, the artists came into parts of the neighborhood and rented the warehouses as work spaces. After that, the entire area was on the upswing and practically became trendy overnight. Now, buildings in SoHo are home to famous designers' stores and wealthy New Yorkers (the area has some of the highest rents in the city). And yet, people rarely discuss how much graffiti is in the area.

Upon first glance, these images hardly look like graffiti - they fit with the trendy atmosphere of the neighborhood.

However, these other images look like classic graffiti tags (like the ones that were scrubbed off subway cars day after day in the 1990s when the NYPD was practicing "broken windows" policing strategy). And yet, here they are - in SoHo, one of the most expensive neighborhoods in Manhattan.



What is even more interesting is how people who shop and work in the area have embraced the graffiti culture. Not only are there no signs of anyone scrubbing it off, there are people all over the street selling t-shirts and hats with graffiti art sprayed on them. These shirts below sell for $20 each!


Graffiti in this area is not only accepted as part of the character of SoHo. It helps bring tourism and more shoppers to the area, and allows these street entrepreneurs to make a lot of profit. Could this, perhaps, be replicated in other areas?

Series One - Graffiti Art: Introduction

The first series for this blog is on graffiti art. I've become interested in graffiti as an issue in urban politics. There are a number of local politicians, particularly in New York, who have devoted their political careers to combating what they refer to as graffiti vandalism in the city. They see graffiti as a symptom of urban decay, and something that needs to be destroyed before an area or a neighborhood can thrive.

On the other side of the fence are people who actually make graffiti art. They have different names - some call them taggers, some call them artists. But I'm not interested in any artistic distinction between the two groups of people - I'm focusing on why a certain piece of graffiti is called art, and why another piece of graffiti is called a symptom of urban decay. I also want to try looking at the difference between taggers and artists in terms of how they are portrayed, either by politicians, the media, or people who live in the neighborhood. I also want to see if the difference between types of graffiti has more to do with where (geographically) the graffiti is. For example, if something is displayed in SoHo, is it automatically seen as something that is artistic? Or at least something that is more artistic than a tag on the subway?

I don't know the answers to these questions, so I'd like to try to use the blog to figure it out. Again, I'm not trying to look at graffiti through an artistic lens (I'm not nearly talented enough to do that) - I'm trying to examine how graffiti is viewed in an urban politics context. At the very least, I think it will be a fun project.

Pam