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Miami Herald
4 days ago
- General
- Miami Herald
Saving sinking homes
Saving sinking homes Stephanie Alexie awoke one morning to find her home surrounded by water too deep to wade through. "It looked like the ocean," she recalled. Neighboring houses appeared barely suspended on top of rippling blue pools-mirrors reflecting the clear sky. In the distance, the wooden boardwalk built over marshy tundra dropped off into a vast sea. Alexie and her children were stranded until neighbors came by with a boat to her corner of Nunapitchuk, a Yup'ik village of roughly 550 people. The land Alexie's home sits on never used to flood. But, in the last few years, seasonal transitions in the Yukon-Kuskokwim Delta-an area of western Alaska where the state's two longest rivers empty into the Bering Sea-have become more disruptive. Now, every spring, when the region undergoes a great thaw and chunks of ice break free from frozen rivers, Alexie finds herself sitting on an island. Alexie's home survived the May 2020 floods, which were the worst the village had experienced in years. But, floodwaters rose dangerously close to the building's foundation, rotting the insulation underneath its floors. Black mold-likely a result of moisture trapped in the home-bloomed across the kitchen ceiling. Alexie worried about where she and her family would go if the home became uninhabitable. It already felt like it was bursting at the seams: 26 people shared its four bedrooms. Mattresses with dozing children lined the living room floor. And toys and clothes spilled out of closet doors into the hallway. "There were too many things and no room," she described. Alaska is home to 40% of the country's federally recognized Tribes, nearly half of whose members are based within roughly 200 villages in rural Alaska. These Alaska Native communities are diverse in culture and geography, but share a common risk: Alaska is warming two to three times faster than the global average. A 2024 assessment by the Alaska Native Tribal Health Consortium found that 144 of these Tribes were facing some form of erosion, flooding, permafrost degradation, or a combination of all three. The Economic Hardship Reporting Project and The Nation have investigated how those environmental changes have contributed to a severe housing shortage in western Alaska. In Nunapitchuk, for example, water damage during the 2020 floods rendered several homes uninhabitable, forcing some displaced residents to move in with friends and family, increasing already-high rates of overcrowding in the village. Alexie thought about moving back to Bethel, a city of more than 6,000 and the largest in western Alaska, which also serves as the hub for the 56 villages in the Yukon-Kuskokwim Delta region. Although there is more available housing there, in Bethel, it would be more difficult to access the same traditional subsistence lifeways they practice in Nunapitchuk. In the absence of meaningful government assistance, residents have taken extreme acts of adaptation to stay on their ancestral lands, from dragging houses across the tundra to safer locations to moving into already crowded homes. As governmental neglect persists and climatic shocks worsen, Alaska Native communities worry it will be increasingly difficult to maintain safe shelter and keep their Tribes together. "We just have to live through it even though we don't get any help," Alexie said. The legacy of 'sick homes' Prior to prolonged contact with settlers and missionaries in the late 19th century, Indigenous peoples in western Alaska lived semi-nomadic lifestyles. Based on subsistence needs, Tribes might have moved from the coast in the spring, to riverside fish camps in the summer, to the tundra for black and whitefish trapping in the fall, and ice fishing in the winter. This mobility offered protection: People moved frequently to adapt to changes from flooding and erosion. Starting in the late 19th century, roaring waves of economic development brought an influx of settlers and boom-town investment. During the gold rushes in northwest Alaska, the federal government invested in schools as a tool of colonial control, in hopes that Native children "might find viable economic and social roles to play in western society," as described in a 1996 book recounting the history of education of Indigenous peoples in circumpolar regions. Settlers and the U.S. government positioned schools as crucial hubs for medical care and sanitation, with some also offering religious services, food, and clothing. These offerings, coupled with mandates for compulsory school attendance, pushed Alaska Native peoples to settle permanently around newly constructed schools. As a result, land that Tribes may not have found suitable for long-term habitation became the locations of many modern-day villages. In western Alaska, people settled along wetlands, marshy tundra, and rivers-where they frequently camped for ease of hunting and fishing. Decades later, these fragile waterside ecosystems have become bellwethers for the climate crisis. When temperatures warm in the spring, melting snowpack restores flowing river channels, plentiful lakes reemerge and trails become soggy. This "breakup season" ushers in a short subarctic summer, when the tundra transforms into muddy wetlands, reviving salmonberry shrubs and opening new opportunities for subsistence hunting and fishing. These days, snow melts earlier than ever before, and erratic temperature swings in the spring can unleash sudden deluges. Rapid breakup of ice hastens erosion along riverbanks. Although breakup season typically brings some flooding along riverbanks, more extreme floods, such as the ones affecting Nunapitchuk, are now more common. The warming climate warps life in western Alaska year-round, too. Freeze-up comes later in the fall, restricting traditional winter travel routes along frozen rivers and across sea ice, and consequently limiting access to fish, seals, whales, walrus, and other important subsistence resources. Fall storms are increasing in frequency and strength. In September 2022, Typhoon Merbok, born out of warmer-than-usual waters in the Pacific, pummeled western Alaska. Forty communities in the region were damaged, with losses to homes and fish camps, according to a government tally in the month of the storm. From 1953 to 2017, the number of federally declared disasters in the state increased dramatically, with the majority of these events caused by flooding or severe storms in the Yukon-Kuskokwim Delta region. And, as western Alaska has become wetter and warmer, once-frozen ground is sinking. Permafrost-the ice-rich soil that rests below the surface of roughly 85% of Alaskan land-is rapidly thawing. That phenomenon is projected to cost billions in infrastructure damage and is already increasing upkeep costs for homes that are losing their structural integrity as the ground below lurches. Worse, the effects of climate change-erosion, flooding, and permafrost thaw-don't always appear in isolation. They often amplify one another, leading to major land collapses, known by the Yup'ik term usteq. Natalia "Edna" Chase, a 60-year-old Yup'ik woman, moved into her Nunapitchuk home with her family when she was 2 years old. When it was built in the late 1960s, the house sat high off the ground on wood stilts-a structural feature intended to prevent the home's heat from thawing the permafrost below. As long as permafrost remains frozen, it can support homes and infrastructure. With rising temperatures, however, this frozen soil is degrading rapidly, transforming solid ground into muddy sinkholes and swallowing Chase's home. Each year, the home sinks 6 inches. When the marshy land engulfed the original flooring from her childhood home, Chase laid another floor on top. Soon, both were entirely underground. Chase's house, crookedly descending into the earth, is now supported by layers of plywood she built haphazardly on top of the sunken floors. Like Alexie, Chase was also affected by the 2020 Nunapitchuk floods. Water inundated her house, and she bailed out over 100 gallons. The flooding accelerated permafrost degradation underneath the building, according to Chase. Since then, conditions in her home have gotten exponentially worse. Her floors warp at steep angles. Whenever it rains or snow melts, the home floods. Last year, Chase tried digging a culvert under the building to drain floodwaters. A foot and a half underground, she hit permafrost, signifying what she already knew to be true-that the building was rotting from the ground up. "So if I want to build a house, it's not gonna be here," she said. As the ground shifts, the joints between her walls and floors split open. Every week, despite her chronic back pain, Chase moves all her appliances and furniture away from the walls to seal the cracks with a fresh layer of duct tape. But these are only stopgaps. Homes like Chase's were never equipped to survive in Alaska's extreme climates. Instead, developers constructed them hastily, and with little consultation with local residents, while riding the oil revenue booms of the 1970s. The discovery of oil in Alaska's North Slope in the 1960s set off fierce lobbying for the Trans-Alaska Pipeline project, which was the largest private-capital project in world history at the time. The resulting pipeline boom drastically altered life across the state, especially for Alaska Native communities. Oil companies sought control over vast swathes of land in order to begin oil drilling. They pushed for the passage of the Alaska Native Claims Settlement Act in 1971, which extinguished all Indigenous land claims across the state; in exchange, Alaska Natives received roughly $1 billion and 44 million acres of land. In a departure from the reservation system in the contiguous United States, the federal government conveyed these lands to newly established Alaska Native corporations. The Alaska Native Claims Settlement Act secured the future of the Trans-Alaska Pipeline, effectively creating a "pipeline right-of-way through the center of Alaska," according to Philip Wight, an assistant professor of History and Arctic and Northern Studies at the University of Alaska Fairbanks. It also inextricably linked Indigenous land sovereignty to oil development, and further consolidated Tribes in permanent villages by forcing them to lay claim to specific portions of land via Native corporations. The state of Alaska reinforced these permanent villages through investments in infrastructure. Massive amounts of oil revenue enabled the state to construct housing at an unprecedented rate; over half of Alaska's current housing stock was constructed during the 1970s and 1980s. Many homes in Indigenous villages-including Chase's home-originated in this industry-fueled housing boom. The speed and scale at which these homes were constructed had consequences. Much of this housing development ignored centuries of Indigenous wisdom on which structures are most resilient in climates of extreme cold. Developers modeled many homes after those typical in the temperate continental United States, erecting California ranch-style houses across the tundra. Decades later, these houses are deteriorating rapidly. "That has a lot to do with the current housing crisis, frankly, and it has a lot to do with the health issues we've seen with housing," said Ryan Tinsley, a Fairbanks-based construction expert. Tinsley has been advocating for more adaptable housing models in Alaska with his wife, Stacey Fritz, an anthropologist who formerly worked with the Cold Climate Housing Research Center. Older homes built in the 1970s and 1980s had thin, uninsulated walls that offered poor protection from subarctic cold temperatures. Weatherproofing processes attempted to fix these issues by adding insulation and sealing leaks, but failed to install proper ventilation. As a result, a 2018 statewide housing assessment estimated that more than half of Alaska's households lacked the ability to properly remove moisture and indoor pollutants from their homes. In such indoor environments, the health of the occupants suffer. "Many, many people we've interviewed have called [modern homes] sick homes," Fritz said. Alaska Native communities suffer from respiratory diseases at high rates; in the Yukon-Kuskokwim Delta region, children are hospitalized for RSV, or respiratory syncytial virus, at rates up to seven times that of the national average, according to a 2023 study published in the Pediatrics journal. And climate change is making indoor air conditions worse, as ambient temperatures and moisture levels increase, and wildfire events become more common. Chase's household has been living with long-term health consequences since their home sustained damage in the 2020 floods. Her 15-year-old son started using an inhaler, and her former partner, who was living with her at the time of the flooding, developed chronic obstructive pulmonary disease, or COPD, a lung condition that causes breathing difficulties. No matter what she does, she can't seem to prevent moisture from seeping in, sending mold-green, then black-up the walls of the house. "That stench on my clothes can never come out, that mildew smell," she said. 'We're not getting the help that we need' On an overcast March afternoon, Simon Lawrence drives on the Kuskokwim Ice Road. Parking just east of Kwethluk, a Yup'ik village about 30 miles inland from Nunapitchuk, Lawrence gestures out the window at an opening of the Kuskokuak Slough, a tributary of the Kuskokwim River. Just three decades ago, village children could safely hop over the narrow gap and play in its shallow waters during the summer, Lawrence recalls. Over time, erosion has deepened the channel, widening the gap between its banks and redirecting powerful currents toward the village. At age 55, Lawrence has spent almost half his life working in maintenance in Kwethluk's local education system. When he built his two-bedroom house in the early 2000s, he thought sitting it on the higher ground uptown would shield it from flooding. But now, the eroding river channel is inching westward toward a small stream connected to the heart of the village. When the two bodies of water inevitably meet, the resulting oxbow will likely unleash an outpouring of river water on Kwethluk's uptown. The floods could engulf several homes, including Lawrence's. This isn't the first time that changing river conditions have threatened housing. A few years prior, the advancing riverbank forced Kwethluk to apply for federal funding to tow four of its homes inland. The village needs to move four more buildings that are within 15 feet of the water, but are struggling to find funding. The equipment and personnel required for the relocations are costly. Even gathering the data to demonstrate climate-related threats, which is a requirement for many government funding requests, is an expensive task. The Alaska Native Tribal Health Consortium estimated in its 2024 report that this would cost $20 to $30 million for the 144 threatened villages across the state. When scarce federal resources are being spent on moving and repairing homes, local housing authorities are redirecting funds that normally go to new development. Maintaining safe homes in increasingly extreme and unpredictable environmental conditions is costly, but also increasingly necessary. "The reality of their climate is changing faster and more harsh[ly] than anybody expected 20 years ago," said Brian Wilson, the executive director of the Alaska Coalition on Housing and Homelessness. "The upkeep budget gets more and more expensive, which then also makes it so you can't build as many homes." And, even when housing authorities build new homes, volatile weather swings can interfere with construction that is already confined to a short season. Rural villages like Kwethluk are off of Alaska's road system. In warmer weather, people arrive by boat on the Kuskokwim River. And, when subzero temperatures hit, local crews plow a seasonal road averaging 200 miles over the thick river ice. Building materials are delivered to Kwethluk via river barges in the limited summer months. To get to the village, lumber and steel must travel through Seattle, Anchorage, and Bethel first. By the time they arrive, it's late summer's rainy season. And crews scramble to put the homes together before freezing temperatures set in. Global warming brings a wetter environment-and an increased incidence of precipitation events, such as freezing rain-that can disrupt these already-tight schedules. To alleviate these pressures, one of the former directors of Kwethluk's housing program wanted to build a facility in which homes could be fabricated. This manufactured housing system would enable prefabricated homes to be assembled year-round, regardless of weather conditions. "He had a good vision. If we had funding for that building, I would say go for it," said Chariton Epchook, Kwethluk's Tribal administrator. "Funding is what holds us back from the things we want to do." Epchook said the region's housing authority is already stretched thin. Access to funding is a particular challenge for Native communities living in rural Alaska, who are disproportionately low-income. Indigenous people in Alaska experience poverty rates nearly triple that of white Alaskans, census data shows. And poverty is the highest in rural, predominantly Native areas of the state: In one western Alaskan village of Alakanuk, nearly 40% of residents live below the poverty line. In many rural areas, people depend on subsistence harvesting-not just for survival, but to maintain culturally and spiritually important practices, too. Public funding is therefore crucial for maintaining infrastructure and services in villages. Many residents rely upon affordable housing units to remain in their village. Even for higher-income families that can afford market-rate rent or homeownership, the high cost of construction in remote villages disincentivizes private developers from investing in new homes. The majority of construction for affordable housing for Alaska Natives in villages today is funded through the Department of Housing and Urban Development's Native American Housing Assistance and Self-Determination Act programs, which were passed in 1996 to address housing gaps in Indigenous communities. Since the law went into effect, the program's funding has been used to build or acquire almost 41,500 affordable homes and restore an additional 105,000 affordable homes on Tribal lands and in Alaska Native communities. Funding levels, however, are subject to political whims and have remained largely stagnant. Until the 2024 fiscal year, inflation-adjusted dollars for the Native American Housing Assistance and Self-Determination Act's housing grant program remained below levels from fiscal year 2000. That means fewer houses have been built in the last two decades. That decline in available resources can be seen clearly in a coastal Inupiaq village north of Nunapitchuk. In Brevig Mission, a village outside of the hub community of Nome, the Native American Housing Assistance and Self-Determination Act funded 20 houses in the late 1990s, but in recent decades, it has barely covered the construction of five homes. The Bering Straits Regional Housing Authority, headquartered in Nome, serves Brevig Mission along with 17 other communities. The housing authority estimated in 2022 that Nome and its surrounding villages need about 400 new homes over the next 25 years. However, the housing authority only delivers about three new homes each year. Building one costs about $780,000, said Jolene D. Lyon, president and CEO of the housing authority in the Bering Strait region. Lyon and her staff also have to balance the logistical puzzle of constructing new homes with the upkeep of already existing ones. In Brevig Mission, for example, the severity of permafrost thaw has come as a surprise. Homes are sinking several feet. Water and sewer lines are pulling away from their hookups and creating mini glaciers. Windows are warping. "The 20-plus homes that we leveled last year need to be re-leveled again," Lyon said. "I cannot afford to do that every year…I don't have that kind of funding allocation." In other words, the climate crisis is exacerbating the funding squeeze for housing agencies. "Those changing terrestrial processes, whether it's permafrost degradation and thaw, whether it's erosion and flooding, that's all coinciding with a time where we have fewer resources than ever, at least at the state level, to put toward these kinds of projects," summarized Griffin Hagle-Forster, the executive director of the Association of Alaska Housing Authorities. And now, with frenetic federal funding freezes, even more projects-including several intended to proactively protect villages at risk for major climate hazards-are in jeopardy. Genevieve Rock coordinates mitigation efforts against climate impacts for the Tribal government in Shaktoolik, an Inupiaq village of around 200 on a narrow spit of land along Norton Sound, an inlet of the Bering Sea. The community was already considered one of the state's most threatened by climate change; that existential threat became even more urgent after Shaktoolik lost its protective berm in the 2022 typhoon. The community also has a prospective relocation site further inland with a potential water source and enough land to sustain a village. But in the near term, the village badly needs a safety access road and emergency shelter so that residents are not stranded when the next storm comes, Rock said. Much of Rock's time is spent applying for competitive federal grants from entities like the Environmental Protection Agency to attempt to meet those needs. "We're all competing against each other for federal funding, and that is just not our way," Rock said. "In our Native culture, we're a kind, caring, supportive, loving group of people that support each other. I have relatives over in Shishmaref, and that's miles and miles away, but now I have to compete against my relatives over there for federal funding to save all of our lives, and that's not right." There is no federal agency solely devoted to addressing the climate threats these communities are facing. As a result, solutions are emerging in a patchwork, and Rock said she often finds herself in a catch-22. Shaktoolik needs critical infrastructure, but federal agencies don't want to fund new construction in areas that may soon be underwater. Meanwhile, Federal Emergency Management Agency disaster funds are restricted to help with individual disasters, rather than the slow-moving disaster of climate change. "We're not getting the help that we need," Rock said. Co-published by Economic Hardship Reporting Project, The Margin, and The Nation. This story was produced by Economic Hardship Reporting Project and The Nation, and reviewed and distributed by Stacker. © Stacker Media, LLC.
Yahoo
23-05-2025
- General
- Yahoo
Hawaiian taro takes root in Oregon
In the Kumulipo, the Hawaiian creation story, the goddess Ho'ohōkūkalani gives birth to a stillborn son, who is buried in the fertile soil. In her grief, she waters the soil with her tears, and a sprout emerges, becoming the first kalo plant. This plant nourishes her second-born son, Hāloa, the first Native Hawaiian. For Native Hawaiians, kalo, also known as taro—a tropical plant prized for its starchy, nutritious, rootlike corm as well as its leaves—is not just a traditional food source but an ancestor, symbolizing a lasting and reciprocal connection to land. As a staple crop, kalo has sustained Pacific Islander cultures for generations. Now kalo has sprouted thousands of miles from its ancestral home in the Portland, Oregon, metropolitan area, where a growing Native Hawaiian population resides. The land for the garden—or māla, in Hawaiian—started with just 6 square feet but has expanded exponentially, with multiple locations. What these gardens produce is more than just food and a bond with Indigenous culture; it is a thriving community, the Economic Hardship Reporting Project and Civil Eats report. "We give a safe space for our Hawaiian families," said Leialoha Ka'ula, one of the garden project's founders, describing its greater purpose. "It [is] also food sovereignty, that relationship to ʻāina, or land. It's a place of healing." Ka'ula, like many Native Hawaiians and Pacific Islanders (NHPI), left the islands due to the high cost of living there, combined with low wages and lack of jobs and housing. It's part of a pattern that followed the illegal overthrow of the Hawaiian Kingdom in 1893 and declaration of statehood by the U.S. in 1959. Then as now, emigration is fueled by unaffordable living costs, low-wage jobs, and a housing crisis driven by tourism, luxury development, and an influx of mainlanders. In 2020, the U.S. Census reported that, for the first time, more Native Hawaiians live in the continental U.S. than they do in Hawaiʻi, with Oregon having nearly 40,000 NHPI residents. Many in the diaspora long for stronger ties to their home and cultural identity. According to Kaʻula and others, the relationship with kalo is binding, and without it, Native Hawaiians lose vital connections to their culture and mana, a Hawaiian term for spiritual and healing power. But growing kalo is not as easy as just planting it in the ground. Cultivation took years of effort and help from multiple hands. Born on Oʻahu and raised on Hawaiʻi Island, Kaʻula was steeped in Hawaiian culture through her family. Her grandmother introduced her to the Hawaiian language when she was little. Wanting to continue those studies, she attended a Hawaiian immersion charter school, where she also learned cultural practices like hula, chanting, and the traditional farming methods of her ancestors, including how to grow kalo. Kaʻula came to the Pacific Northwest in the early 2000s to study psychology at Washington State University and eventually settled in Beaverton, Oregon. From her first days in Washington, Kaʻula dreamed of growing kalo there, but accessing land was a challenge. Meanwhile, she started a hula academy in Beaverton to help carry on the traditions of her elders. She also helped found Ka ʻAha Lāhui O ʻOlekona Hawaiian Civic Club (KALO HCC), one of several such clubs across Hawaiʻi and the continental U.S. promoting Native Hawaiian culture, advocacy, and community welfare after the dissolution of the Hawaiian Kingdom. Kaʻula envisioned growing kalo through the Civic Club as a part of a new youth program, but it wasn't until she met Donna Ching, an elder at the hula academy, that plans began to take shape. Ching, also Native Hawaiian, served on the board of the Oregon Food Bank (OFB), which has gardens where immigrant communities can grow culturally important foods. Ching helped secure a modest plot for the youth program in the Eastside Learning Garden, in Portland—and the kalo project was born. The next step was to ensure a blessing for the māla. KALO HCC invited Portland-area Indigenous community organizations like the Portland All Nations Canoe Family and Confluence Project to request permission to grow native Hawaiian plants on local land. The ceremony and the planting took place in August of 2021. After chanting and prayers, NHPI youth from the club tossed in handfuls of rich, black soil and planted dozens of baby kalo, already sporting several tender, heart-shaped leaves. The elders in the community watered the bed. Especially for those who had left the island many decades earlier, it was monumental to see kalo being planted in Oregon. In the first season, KALO HCC harvested 25 pounds of kalo leaves, called lau, which are used for food, medicinal purposes, and ceremonies. For her role in procuring the land, Ching was given the first harvest to make lau lau—a traditional Hawaiian dish of fatty pork or butterfish along with vegetables, all wrapped in kalo leaves and steamed. The kalo leaf softens in the process, adding an earthy flavor. The leaves are also an ingredient in other dishes like squid lūʻau. The roots, technically called corms, were left to keep growing beneath the soil; they are used to make poi, a nutritious mash that has been a dietary staple for centuries. "I haven't made lau lau since I left home, because [lau is] really hard to find here," Ching said. "When you think about how more of us now live on the big continent than in Hawaiʻi, if we move and we don't take some of that 'ike—that knowledge—with us, or find a way to grow [it], we're going to lose it." Due to the garden's success, Oregon Food Bank allotted an additional 75-square-foot space to plant the following year. KALO HCC harvested 500 pounds of leaves, most of which were distributed to community members for free. They were also able to hire one paid staff member to help take care of the māla, thanks to a partnership with Pacific Climate Warriors, an international youth-led grassroots network led by Pacific Islanders to address climate change. Now the garden produces other crops, too, including carrots, mānoa lettuce (a variety developed in Hawaiʻi), bok choy, and kale, all of which are eventually given to community members. The garden holds weekly work parties, and some 160 volunteers from diverse backgrounds help out over the course of the year, raking mulch, weeding, fertilizing, and harvesting. One volunteer drives monthly from her home in Olympia, Washington, nearly two hours away. "It's worth every mile," said Nicole Lee Kamakahiolani Ellison, who also serves on the board of KALO HCC. Ellison left the islands when she was 8 and grew up in Las Vegas. She is a project manager with IREACH at Washington State University, a research institute that promotes health and healthcare equity within Indigenous and rural populations. Ellison got involved with the garden a year ago while working on a project with Ka'ula about Native heart health. She said she didn't believe kalo could be grown in Oregon's climate. "You go down [to the garden] and you're not in Portland anymore," Ellison said. "It's like you're somehow transported back home on some weird magic carpet ride." She added that a bonus of volunteering is connecting with the kūpuna (elders) who also volunteer, as well as hearing the sound of pidgin, Hawai'i Creole. On the islands, kalo, a canoe crop—one of the plants carried to Hawai'i by the first Polynesian voyagers—is grown in both dryland (or upland) and wetland environments, the legacy of sophisticated traditional irrigation systems that ran from the mountains to the sea in land divisions called ahupua'a. (Those traditional systems for kalo, once central to Hawaiʻi's agriculture, were displaced by private land ownership, the sugar industry, and the overthrow of the Hawaiian kingdom.) Wetland taro is routinely flooded; dryland kalo doesn't require that, but needs regular rain and humidity. Optimal temperatures for kalo are in the 70 F to 90 F range. Planting in the Portland dryland garden typically starts in the spring, with the kalo leaves and corm maturing in about nine months. The garden uses primarily an Asian strain of kalo, but also includes descendants of cuttings from Oʻahu, Mauʻi, and Hawai'i Island. The kalo in the Oregon dryland garden is adapting well to its new location and growing strong. Kaʻula said the club members have learned they can grow garlic to keep the soil warm, which accelerates the kalo's growth in the spring. They also leave the kalo corm, the starchy root of the plant, in the ground during the winter, where it multiplies. One root can quickly turn into 10, she said. For now, the group is electing not to harvest the corms so that they continue to grow. This winter, they put a dome over the kalo plants to see if they would last through the freeze—which they did. Now the KALO HCC can have kalo year-round, just like in Hawaii. The success of the māla comes at a time when it may be needed most. Recent data shows that nearly 60 percent of the NHPI in Oregon lives below the poverty line. The food bank has taken hits from the recent federal funding cuts, losing 30 truckloads of food due to the Department of Agriculture's food-delivery cancellations across the U.S., and said they have already seen a 31 percent increase in visits to their locations compared with the previous year. "Our [cultural] diets are healthy, but food is expensive, and when it's expensive, many move away from that diet to something more affordable—and a lot of that affordable food is not healthy for us," Ching said. In October 2023, KALO HCC published an academic paper about their Portland kalo project, describing how establishing the māla in the continental U.S. connected people to the land, improved their mental health, and created a sense of place for Native Hawaiian community members. The paper also suggests that the garden, through cultural foods and practices, might improve health outcomes overall. "Culture is health, is what we're trying to argue," Kaʻula said. "Sometimes people say that traditional healthcare aligns with the Western models, but we're trying to say no, we want indigenous healthcare. Can we get the FDA to approve poi as medical support? Can we get the FDA to approve kalo as a supplement, and how can we ensure better access to all of that?" KALO HCC is currently conducting another study, this time through clinical trials, in hopes of finding the connection between traditional foods, physical health, and emotional well-being. For this study, they are working with Oregon Food Bank and Oregon's Pacific University to collect and analyze data. Native Hawaiians and other Pacific Islanders living in the U.S. have some of the highest rates of heart disease, hypertension, asthma, cancer, obesity, and diabetes in comparison with all other ethnicities. Research ties these poor health outcomes to colonization and historic inequities, multigenerational trauma, and discrimination, as well as poverty, lack of housing, education, and environment. "[From] what we see in other Native communities, their views of food and how it relates to health is huge," said Sheri Daniels, the CEO of Papa Ola Lōkahi, a Native Hawaiian health organization that advocates for the well-being of Native Hawaiians through policy, research, and community initiatives. Daniels said that providing data can be challenging, but offering resources and opportunities for people to improve self-esteem and strengthen cultural identity are always possible, and can yield insights, too. "The cool thing about kalo is that you get to build community, you get to meet and see others who might be in the same [emotional] space as you, trying to establish that bond of what it means to be Hawaiian," she added. As of this March, new kalo plants had already started sprouting through the soil. They will triple in size in a month, providing more nourishment to the local community in the upcoming year. KALO HCC has also created additional māla at Pacific University, where 25 percent of the student body is Native Hawaiian, and at schools in Tacoma, Washington, and within the Beaverton School District. "Everything that our lāhui (community), our aliʻi (royalty), and our kūpuna (elders) did was never about one person," Kaʻula said. "It was about, how does it trickle down? How does it create a unified community?" Co-published by Economic Hardship Reporting Project and Civil Eats. This story was produced by Economic Hardship Reporting Project and Civil Eats, and reviewed and distributed by Stacker.
Yahoo
06-05-2025
- Health
- Yahoo
Higher ed's dubious deal with prison health care
Higher ed's dubious deal with prison health care By January 2018, Tremayne Durham had been in New Jersey State Prison in Trenton for nearly a decade. Being locked up corrodes a person's health, and Durham was no exception. He was diagnosed with lumbar stenosis—a narrowing of the spinal canal—and received steroid injections. His doctor prescribed him a walking cane in November 2019. When COVID hit in March 2020, Durham was quarantined but allegedly told he couldn't bring his cane. Soon after, he says he told a nurse he was suffering horrible back pain, needed his cane, and wanted to see a doctor. When a nurse dismissed his appeal, Durham lobbied a prison guard, who said he complained too much. Over the next 10 days, Durham repeatedly asked for what he needed. Finally, he experienced what he called "severe shooting pain" while showering. Without his cane, a shower chair, or handrails, he says he fell to the floor. Officials took him in a wheelchair to the prison clinic, where he was treated for several days, Economic Hardship Reporting Project and The Chronicle of Higher Education report. In March 2021, Durham filed suit against the prison guards and nurses. The latter group is overseen by a company called University Correctional Health Care (UCHC), which provides health care for all New Jersey prisons. A District Court initially dismissed the complaint. But upon appeal, in September 2023, a judge writing on behalf of a three-person panel ruled that the lawsuit could proceed. According to the ruling, Durham sufficiently argued that prison officials showed "deliberate indifference" to his health and that he had a diagnosed disability. "It is not hard to imagine how dangerous a shower could be for someone suffering from back pain and an inability to walk or stand on their own," the judge wrote. Durham's case was sent back to the lower court. Durham was not alone. UCHC and its staff have been named in numerous lawsuits, with adult and juvenile inmates and detainees alleging neglect, abuse, and maltreatment. In 2016, the former medical director at Northern State Prison in Newark, New Jersey, was fired and had his medical license suspended for five years after he failed to do even basic testing for an inmate suffering from fainting, disorientation, and muscle weakness. The inmate died shortly after. In 2019, a detainee at a facility for sex offenders in Central New Jersey was allegedly ignored by medical personnel after prison guards assaulted him and left him for dead. (One guard was indicted for official misconduct, and a lawsuit filed by the detainee's family is pending.) In 2023, the family of an inmate who allegedly died because the effects of his post-brain-surgery steroids were not monitored filed a suit that likewise remains pending. UCHC is a nonprofit operated by Rutgers University. Instead of providing care directly or through a private provider, New Jersey grants UCHC responsibility for providing medical, mental-health, and dental care to roughly 20,500 adults and juveniles in New Jersey's jails and juvenile facilities and on parole. According to the current contract, which began in 2019 and has been extended every year through the end of 2024, the state paid UCHC almost $170 million annually for its services. The organization, which now has about 1,100 staff and faculty members, was formed in 2005. It is headed by a psychologist, Frank A. Ghinassi, but other top administrators come from backgrounds in private health care delivery, such as the chief operating officer, J. Chad Knight, formerly the CEO of a network of Atlanta physicians. Universities form health care organizations for prisons Rutgers is among several universities that have formed separate organizations to provide health care to inmates and detainees. Commonly called "academic-correctional health partnerships," the modern form of these arrangements originated in the 1990s in Texas. But they have since expanded to New Jersey, Georgia, and Connecticut, among other states. Most programs are small, but in some cases, like at Rutgers, universities have taken over health care delivery for the correctional departments of entire states, replacing the work normally done by government agencies. Indeed, after government agencies, academic medical centers are now the most common source of health care for incarcerated people in the country, surpassing private providers. Contracts between these organizations and state and federal correctional agencies can be worth hundreds of millions of dollars and affect tens of thousands of inmates. Advocates for academic-correctional health partnerships say they offer prisoners the expertise of scholars and university-affiliated doctors, provide training opportunities to medical students, and save money. "UCHC has made performance improvement a key ingredient of its health care service-delivery model," Ghinassi said when accepting the 2019 award for "Program of the Year" from the National Commission on Correctional Health Care, a trade association. Arthur Brewer, UCHC's medical director, told a Rutgers alumni magazine that the organization is a model, improving outcomes and decreasing hospitalization and mortality. "A great deal of oversight ensures that no one's care is overlooked," the magazine reported. A spokesperson for Rutgers told The Chronicle in an email that UCHC "serves New Jersey by ensuring individuals in the correctional system receive the medical care they deserve." Is that true? There is little evidence that academic-correctional health partnerships improve health outcomes for inmates and detainees, let alone that they grant prisoners the care they deserve. In some cases, the programs have been canceled after proving to be as bad as or worse than the systems they replaced. "There is not a lot of measurement of quality that goes on in these systems," says Warren Ferguson, professor emeritus at the University of Massachusetts Chan Medical School. Asked if academic institutions are better at delivering health care to inmates than other providers, Ferguson says, "The answer is, nobody knows." And this despite the huge sums that are injected into these programs. Marc Stern, a professor at the University of Washington School of Public Health, says that while the schools promise they provide top-notch services for inmates, there isn't much support for these statements: "No one's ever really studied it." In 1976, the Supreme Court ruled that inmates in U.S. prisons were entitled to adequate health care, the absence of which would count as "cruel and unusual punishment," prohibited by the Constitution. In the following two decades, the prison population exploded, ballooning health care costs for municipalities, states, and the federal government. In 1993, the Texas Legislature took a novel approach by establishing the Correctional Managed Health Care Committee (CMHCC), a partnership between the state's department of criminal justice and its public medical schools and hospitals that provides health care to inmates. The University of Texas Medical Branch (UTMB) manages care for nearly 80 percent of the state's roughly 150,000 inmates, with Texas Tech University handling the rest. The UTMB-Texas Department of Criminal Justice Hospital is an eight-story building within the constellation of buildings on the UTMB campus in Galveston, Texas. It is, according to its website, "the first and only hospital specializing in offender care on the campus of a major medical center and teaching institution," with 172 inpatient beds, an operating and recovery room, and a multiservice ambulatory-care center, all secured by locked gates. Although many Texas prisons have their own infirmaries, inmates from across the state are routinely sent to the prison hospital for surgeries and other complex services. Through CMHCC, the state paid UTMB around $630 million for its services in fiscal year 2024 and $646 million in 2025. For decades, UTMB officials have touted Texas' system as a model for other states. "Significant improvements in the provision of medical and psychiatric care to Texas' prison population have occurred during the nine years that the managed-care program has been operational," two UTMB officials reported in a 2004 issue of the Journal of the American Medical Association. In particular, they wrote, vacancy rates for medical staff declined, compliance levels with performance standards increased, and, most importantly, there were decreases in patients' rates of diabetes, cholesterol, hypertension, and AIDS. More recently, the school bragged that it has plans "to be the recognized world leader in the delivery of correctional health care services." Some programs have been canceled after proving to be as bad as or worse than the systems they replaced Critics find these purported advances unimpressive. "If you start with a dysfunctional health care system, almost any intervention, especially a thoughtful one, is going to result in improvements," says Stern, who formerly worked as the assistant secretary for health care in Washington's corrections department. Small improvements in just a few areas, starting from a very low level, do not justify the claims made by UTMB, he says. The advances they cited could have occurred by chance, even without UTMB's involvement, simply because conditions couldn't get much worse. Nor are Texas prisons improving over time; the mortality rates in 2017, 2018, and 2019 were higher than in any year prior, going back to 2001. In 2018, a Houston Chronicle report found that UTMB and the state corrections department were giving toothless prisoners pureed food instead of dentures. "There's this misunderstanding that dentures are the only way to be able to process food," Owen Murray, UTMB's vice president of offender services, told the Houston Chronicle. In fact, he insisted, "our ability to provide that mechanically blended diet is actually a better solution than the mastication and chewing process." "Generally speaking, someone with no teeth should be offered dentures," Jay Shulman, a Texas A&M adjunct dentistry professor who has testified in lawsuits over prison dental issues, said at the time. "The community standard for dental care has not been applied to prisons." Following the newspaper's report, prisoners were provided with dentures. Lawmakers have repeatedly criticized UTMB's use of public funds. In 2011, a state audit of UTMB's correctional health care found that the school was paying its doctors higher-than-standard reimbursement rates, double- and even triple-charging for some expenses, and charging the state for prohibited expenditures. (UTMB disputed some of these charges and claimed the program operated at a loss.) A 2020 state audit noted some improvement in these areas, but the same problems were still evident. For instance, "from Sept. 1, 2017, through Feb. 29, 2020, UTMB charged the program $18.2 million for UTMB employees' salaries and benefits" without appropriate documentation. The school continued using the program to pay for staff members' employee-referral bonuses and even conference-registration fees. Partly because of budgetary pressures, UTMB helped pioneer telemedicine, allowing health professionals to treat inmates remotely instead of requiring cumbersome in-person visits. Texas prisons recorded 40,000 telemedicine visits in 2010–2011 and 140,000 in 2019, saving the state between $200 and $1,000 on each. Indeed, the Texas system is now the largest telehealth network in the world. In 2010, the former head of UTMB Correctional Managed Care argued that "just about every routine exam" could be performed remotely. Interviews with UTMB inmates and their advocates suggest that telemedicine can have significant drawbacks. "Telehealth is really ineffective for what these people deal with," says Brittany Robertson, founder of Texas Prison Reform, a nonprofit that works to end solitary confinement in the state. While virtual appointments might be appropriate for bug bites or sinus infections, they are dangerously ill-suited to detecting when patients have cancer or diabetes, she says. "They swear by it, and it probably is cost-effective," then-State Sen. John Whitmire, currently the mayor of Houston, said in 2019. "But I ain't so damn sure. It's not the way I'd want my family treated." UTMB expressed pride in its unique ability to meet the challenges of COVID; officials attributed their success in part to their telemedicine program. Murray, the UTMB executive, told a reporter during the pandemic: "We've done a very good job managing those patients' care within the prison system. … We really have done a very good job with our testing and access to testing and ability to—within these prisons—quarantine and restrict movement, quarantine patients who are certainly positive for the virus but also quarantine those that have come in contact." In fact, during COVID, Texas prisons saw a 74% mortality increase, with 253 additional deaths over the previous year's total. A report from the University of Texas at Austin found that from April to August 2020, Texas had more inmates and staff who died from COVID than any other state. This might seem commensurate with its high prison population, but even proportionately, Texas prisons had some of the highest death rates in the country. In May 2020, Murray said that "the mitigation-effort steps the department has taken has been exceedingly helpful." That very month, 46 people died of COVID in Texas prisons. The Albert C. Wagner Youth Correctional Facility was a detention center in South Jersey that held 600 people until it closed in 2019. Nikeelan Semmon served four years in the U.S. Navy and two years in the Army Reserves before becoming a prison guard there. In 2016, at age 36, he was a senior corrections officer, married with a young son, and a member of Jesus My Light Holy Temple. On July 1 of that year, Semmon had chest pains and difficulty breathing. He went to the nurse's station for assistance. The nurse on duty, overseen by UCHC, told Semmon that his symptoms weren't severe enough to keep him from working, according to a lawsuit his family filed. A few hours later, he returned to the nurse's station. This time, a prison guard took him seriously and called an emergency code. According to the lawsuit, the guards who arrived to help said the nurse in charge failed to call 911 immediately, declined additional medical help, and needed to be told to get the proper equipment. The guards performed CPR on Semmon and paramedics rushed him to a nearby hospital. But it was too late—he died of a heart attack. Hundreds of prison guards lined a New Jersey street as Semmon's body was taken to and from a memorial service. Nearly one year later, Semmon's widow and son attended a candlelight vigil for him held at the Capitol Mall in Washington, D.C. His name was added to the National Law Enforcement Officers Memorial wall for those who died in the line of duty. Lawyers working on behalf of Semmon's family alleged that if he had received timely and appropriate medical treatment and had been transferred to a hospital earlier, he would not have died. In 2021, UCHC paid his family $1.5 million in a settlement. Overall health of individuals in New Jersey prisons remains poor Like UTMB executives, UCHC officials have long portrayed New Jersey as a model for how it handles the health of inmates. "In a civilized society, prisoners should get adequate care; it's the right thing to do," Jeffrey L. Dickert, then-UCHC's chief operating officer, said in 2016. (He has since retired.) In a 2014 paper in the Journal of Correctional Health Care, five experts at UCHC and Rutgers concluded that the state's prison system, as well as its patients, benefited from the partnership. "UCHC is currently providing a level of mental-health and medical services to inmates in the prison system that is achieving better outcomes than what is typically found in the community," they wrote. As proof, they cited evidence that inmates in New Jersey prisons had lower hypertension rates than Medicare and Medicaid patients and that a higher percentage of inmates received diabetic care in New Jersey than in Michigan. In addition, about 80 percent fewer inmates had been transferred to the state's forensic psychiatric hospital since UCHC took over mental health for the prisons, without an increase in suicides. "Most [inmates] return to society after three to five years," said Donald Reeves, UCHC's director of psychiatry. "It's our goal to return them in better shape than when they arrived." The overall health of individuals in New Jersey prisons remains poor, however, even accounting for any progress introduced by UCHC. Data compiled by the state and obtained through public-records requests show that the average age of death of individuals in state prisons (except a facility that holds sex offenders following their sentence completion) has ranged between 52.2 and 60.7 since 2009. This is well below the state's average life expectancy of 77.7 years in 2020. Similarly, a 2024 report in The Guardian found that men in New Jersey's prisons died, on average, more than 12 years earlier than the overall population, often after receiving little care while they were ill. Black men died an average of 14 years earlier than all men in the overall population and seven years earlier than Black men in the overall population. Some prisoners died of treatable cancers, while others died from treatable symptoms of chronic diseases. "The numbers suggest that neither age distribution nor socioeconomic background and race completely explain why men in New Jersey prisons are dying so young, leaving the finger pointing at standards of health care in state prisons," according to the report. In 2016, Brewer, UCHC's medical director, said inmates have easier access to health care than the public. But during COVID, New Jersey prisons were some of the deadliest places to be incarcerated in the United States. A study from the University of California at Los Angeles found that 47 more deaths occurred in the state's prison system in 2020 than in 2019, a staggering 142 percent mortality increase—even though the prison population decreased that year, as inmates deemed to be low-risk offenders or especially vulnerable were released. This was far worse than the overall national increase of 62 percent. A facility in Central Jersey that detains sex offenders indefinitely after their criminal convictions, and where UCHC oversees health care, had the single highest COVID mortality rate of any institution in the United States. Under the terms of the state contract, UCHC must provide the Department of Corrections with a range of monthly and annual reports measuring things like the mental health of inmates, litigation, grievances filed, incident reviews, compensation and benefit plans, and much else. But the corrections department told The Chronicle that it possessed only a few reports from just three months in the spring of 2024. A UCHC spokesperson referred The Chronicle back to the DOC. In addition, under the contract terms, the DOC is required to compile reports assessing UCHC's performance. It couldn't find those reports, either. UCHC insists that it delivers high-quality care to inmates—and that doing so is cost-effective. The program "makes economic sense for New Jersey," Dickert said in 2016. "Inmates can sue if health care is withheld, and this litigation is costly. Those who are denied care may require hospitalization. This costs taxpayers even more money." But an audit of the state prison's medical contracts found that, between the summer of 2013 and the summer of 2015, UCHC charged medical providers $905,300 in claims for inmate hospitalization expenses that it never incurred, was reimbursed for employee salaries at improperly high rates, and had staff members inaccurately logging the hours they worked. The audit, which noted that many other UCHC procedures were adequate, was conducted by the state legislature and obtained through a public-records request. More generally, health care costs for inmates in the state have continued to skyrocket. Indeed, they have been the driving cost of the continued increase in New Jersey's prison budget, which has risen steadily—it saw a 12 percent increase over 2023 alone—even though the inmate population is down 30 percent since 2020 and the state has shuttered four prisons. A 2023 report from the state Department of Corrections Ombudsman found that the second-most common complaint inmates had, after concerns about their property, was related to health care. According to the report, "A significant number of incarcerated people and their families contacted the Ombudsperson Office about pending requests to be seen by health care providers, accessing follow-up information about test results and labs, wait times for specialist appointments, and medication refills." Trainees commented on the shockingly advanced pathology of the inmate patients. Meanwhile, Ghinassi, UCHC's president and CEO (who also heads Rutgers's mental-health care system), drew a salary of $792,467 in 2023; Arthur Brewer, the medical director, earned $361,683. Conversely, as of June 2024, the Department of Corrections refused to spend the $2.6 million that state lawmakers allocated more than a year ago to give inmates their first wage increases in more than 20 years. Some inmates make $1 per day at their prison jobs, and the highest wage is less than $8 per day. Until the policy was suspended in 2020, the state required that inmates pay for any medical care they incurred while locked up. Inmates are still charged a fee if they take prescribed medicines. Nearly all UTMB's medical students and residents complete a rotation in the prison hospital. Academic-correctional health partnerships frequently tout the experience that idealistic young people obtain in working with a deeply vulnerable population as a major benefit of the initiative. "The physician-assistant students who train at [the prison hospital] often comment that it has been their best rotation, because they are able to learn so much from just one patient," according to UTMB Health, the school's newsletter. A doctor explained in the newsletter that inmates have rare conditions, offering unique learning opportunities for students. But some students approached Jason Glenn, an assistant professor who was then at UTMB and who studies incarceration and health care (now at the University of Kansas), to say their experiences had made them uncomfortable. Over three months, beginning in December 2014, Glenn and his colleagues conducted focus groups with UTMB medical trainees. The results, first published in 2020 in the journal Health & Justice, were dismaying. Instead of expressing a unique empathy, the medical trainees mimicked a widespread suspicion that administrators and senior staff members taught them: Inmates were usually feigning illness. This suspicion remained even after inmates were properly treated, proving they had needed care. Even as trainees were conditioned to think inmates were quick to feign illness, each of Glenn's focus groups still commented on the shockingly advanced pathology of the inmate patients. "There are a lot of interesting diseases and things you don't get to see in a developed country," one trainee explained. Advanced cancers were particularly common, as was the risk of tuberculosis. Alarmingly, respondents said they were given more responsibility to treat and help operate on patients than they would have been if the patients weren't prisoners. "When I was in surgery … I was first assist on at least half the cases that I scrubbed into," one student confided. UTMB students routinely indulged their curiosity by searching for their patients' criminal histories, often easily available online. There were no institutional guidelines around such behavior. Invariably, some trainees let their negative moral judgments of the patients influence their work. "If I know what they did and it's something that I felt strongly about," one student admitted, "I may not even do it on purpose, but I may not do the hardest that I can. I may not do my best." The elusive search for best practices Glenn and his colleagues put together a list of all the universities that partner in one way or another with prisons. Alongside the direct providers like UCHC and UTMB are more common, smaller collaborations that exist across the country, from New Mexico to Washington and from Florida to New York. Individual faculty members sometimes volunteer or work at jails and prisons. In other cases, initiatives primarily train students and residents as part of a course in underserved populations, as part of a community-residence rotation, or as part of a fellowship, while other trainings are devoted entirely to correctional health. For instance, George Washington University's School of Medicine and Health Sciences offers an elective course titled "Introduction to Correctional Medicine," in which students work in local jails for four weeks. They also have a volunteer program for students to help deliver health education to detainees. George Washington offers some of the country's first academic programs in correctional-health administration: an online graduate certificate and a master's degree. Glenn's team reached out to each program to inquire about their standards. Although they had been around for decades, Glenn wanted to know if there were common procedures or best practices. "What we found is they're all just kind of winging it," he said. In compiling the list of academic-health partnerships, Glenn found that nearly 35 initiatives of varying sizes existed at one time or another—but that some had been canceled. Soon after UTMB's program was established, the University of Connecticut partnered with the state's Department of Corrections to establish Correctional Managed Health Care (CMHC), which provided all medical, mental-health, pharmacy, and dental care for inmates. The arrangement continued for more than two decades. In 2017, the contract was worth $82.7 million. In its annual report that year, CMHC pledged to become "a national leader in correctional health care." Alas, 2017 would be the last year CMHC existed. State auditors had long noted that the CMHC's negligence in keeping adequate records led to major failures. For instance, three prisoners with foot troubles—a loss of sensation, amputated toes, a worn-out prosthetic foot—were reportedly denied care. But it was impossible to determine if they received proper care because officials didn't keep proper records. The state paid $1.3 million to an inmate after he claimed CMHC staff delayed identifying and properly treating his skin cancer by more than a year. "They don't treat us like human beings," the man said. Finally, in 2018, Connecticut ended the partnership and returned responsibility for health care to the corrections department after a consultant's report found CMHC's system provided "untimely" health care and lawsuits kept piling up. In the second decade of CMHC's work with the state, the attorney general fielded more than 1,000 complaints and lawsuits from inmates about the shoddy health care and medical conditions in its jails. The University of Connecticut denied providing substandard care. But when the state contract ended, so did CMHC. The University of Connecticut was not alone in failing to realize its ambitions to be a leader in correctional health care. In 2016, the sheriff's office in Fulton County, Georgia, awarded a nearly $20-million contract for prison health care to a Tennessee-based private company called Correct Care, which subcontracted with Morehouse College's medical school. But beginning in August 2017, five inmates died within a 75-day period in the jail, The Atlanta Journal-Constitution reported. First, three people recovering from opioid addiction killed themselves in short succession. Authorities said medical-intake officials should have been prepared for the inmates to have psychiatric struggles and potentially be a danger to themselves. Soon after, a woman who was in jail for violating probation on a drug conviction complained of pain and trouble breathing. She was later found lying on the floor, naked, unresponsive to a nurse's question—but the nurse walked out and said there were no medical concerns beyond mental-health problems. Within minutes, the woman was dead. Finally, days later, a diabetic man with exceptionally high glucose levels died after Morehouse officials failed to give him his prescribed insulin. As a result of the spate of deaths, Fulton County declined to renew the contract. "Morehouse is not qualified to do any of this," Fulton's chief jailer said, according to the Journal-Constitution. Some universities have found novel ways to cash in on prison health care. In 1998, the University of Massachusetts Chan Medical School began providing mental-health services to the state Department of Corrections. "Movement into correctional health care makes fiscal sense for medical schools," two UMass staff members explained in a 2002 paper in Psychiatric Services, co-written with a corrections staff member. "The medical school benefits by building its revenue base." Making good on this promise, UMass has pioneered a different model—it operates a consulting division, now called ForHealth Consulting, with more than 400 contracts and 1,100 employees in more than 25 states. Since 1999, ForHealth has been working with the Bureau of Prisons (BOP), and one of its projects, since 2012, is acting as a third-party administrator managing comprehensive medical services for about 5,500 inmates at a federal prison in Butner, North Carolina. In September 2023, an NPR investigation found that 1 in 4 inmates who die in the country's 120-plus federal prisons do so at Butner. Because the prison has a hospital and the largest cancer-treatment facility in the country, terminally ill inmates are routinely routed there. But the high mortality rate might not be only a matter of size. A 2022 Justice Department audit of UMass's contracts with Butner and prisons in Massachusetts and New York—totaling more than $300 million—found that the BOP personnel there "did not have a reliable, consistent process in place to evaluate timeliness or quality of inmate health care." In addition, the BOP kept shoddy records at UMass prisons, bought equipment without open competitions, and went beyond its authority in approving invoices. "We believe it is difficult for the BOP to determine whether inmates are receiving care within the required community standard," the report added. As a for-profit company, ForHealth isn't required to disclose its clients or financial records, despite being closely associated with a public university. In an email, a spokesperson told The Chronicle: "Our history, background, and milestones as part of UMass Chan Medical School are available via our website. Our clients and partners include health care and human-service organizations in states across the country and our annual revenue contributes to UMass Chan's mission." A few years ago, Glenn and several other academic health experts nationwide decided they had seen enough. They were particularly disturbed by reports of shackling incarcerated women while they gave birth. No laws mandate such a thing, but prisons and jails have significant leeway to tell medical personnel that it's done for safety reasons, usually with little pushback. Similarly, prisons and jails often prohibit academic medical centers from contacting the family members of inmates facing important medical situations. Glenn and others started drafting a Patients' Bill of Rights that outlines to prisoners the minimum care they are entitled to receive and explains to academic medical centers the laws in different states and their obligations to the inmates under their care. "All the ethical obligations that medical providers have to patients do not cease just because those patients are under the jurisdiction of any given state's department of corrections," Glenn says. The bill is meant to be an open-source resource that details academic institutions' authority when dealing with correctional institutions—an authority they don't always understand. Glenn presented a paper on the bill at the 2023 conference of the Academic Consortium on Criminal Justice Health in Raleigh, North Carolina, and the document is currently being finalized. Some of the experts interviewed for this story caution that, even though the model is unproven or flawed, academic-correctional health partnerships have the potential to improve the woeful state of American prison health care. "Many academic health-science centers consider their role as not just providing high-quality care for people who have means, but to also ensure that there is health equity in providing health care and quality health care to all populations who are at risk. And that's inclusive of people who are incarcerated or people who are involved in the legal system," says Ferguson, of UMass's Chan Medical School. He says that while universities generate revenue from partnering with prisons, the programs are also costly and require a lot of infrastructure development. Newton Kendig, a clinical professor of medicine at George Washington University, says that academic centers can offer benefits, providing incarcerated patients access to telehealth subspecialty care services that are not otherwise available in many rural settings. At this point, however, scant research supports the notion that these programs can significantly improve upon state-run correctional agencies. The experiences of the systems in Texas, New Jersey, and Connecticut do not bolster claims by universities that they are able to provide high-quality care to inmates. Indeed, they raise questions about whether universities can change the status quo at all—or whether they merely become complicit in a negligent system. As Dickert, UCHC's former chief operating officer, has said, "We're guests in the DOC's house, and we conduct ourselves accordingly." Co-published by Economic Hardship Reporting Project and The Chronicle of Higher Education. This story was produced by Economic Hardship Reporting Project and The Chronicle of Higher Education and reviewed and distributed by Stacker.
Yahoo
06-03-2025
- Business
- Yahoo
America welcomed this refugee who fled the Taliban; now he's a founding CEO opening doors for job seekers facing adversity
In the fall of 2021, Cyrus Jaffery walked into a McDonald's in West Point, Nebraska and offered the cashier a job. For months, while bringing his energetic kids in for their monthly order of chicken nuggets and fries, he had observed how cheerful and attentive Rosa Barragan was with her customers, no matter their background. Jaffery was a serial entrepreneur looking to grow his businesses; he knew a good hire when he saw one. Shortly after, Barragan, then 24, became an account manager on the customer experience team, working across the eight independent insurance agencies Jaffery runs under the Omaha-based CJ Insurance Group. Even today, Jaffery's job offer across that fast food counter feels "unreal," said Barragan. "I was very surprised. I'm at McDonald's. I smell like grease. Why me?" At the time, the recent college graduate had been working 16-hour days—eight hours at McDonald's for about $11 an hour and eight hours doing family support social work for $15 an hour. She lived with her parents and felt stuck. Jaffery's job offer allowed her to move out, move to Omaha, and work regular eight-hour days, earning more than twice the pay at a salaried job with benefits and flexibility. Jaffery, who employs 90 people and expects his roster to grow to 200 or more by the end of 2024, has made a habit of hiring people with nontraditional backgrounds—servers, artists, chefs with no industry experience, parents with employment gaps, or people who've been fired multiple times, Economic Hardship Reporting Project and Fast Company explain. Jaffery doesn't care about pedigree. "We hire for character," he said. "It's easy to teach someone how to do insurance; it's hard to teach them how to be a good human being." To Jaffery, a résumé only says so much. He's willing to take a chance on people outside the norm. He's willing, because not long ago, someone took that very chance on him. Jaffery was born in Kabul, Afghanistan, in 1988. A few years later, amid the country's civil war, the Taliban bombed his family's house, forcing him to flee to neighboring Pakistan with his mother and siblings. (Jaffery's father stayed behind to run the family gas station and, later, assist the U.S. military.) In 2002, the family was resettled in the U.S. as refugees and eventually made their home in Omaha, Nebraska. Arriving in the U.S. just months after the attacks of 9-11, "was not the best for people from Afghanistan," Jaffery said. With his heavy accent and foreign style, Jaffery became a target for bullies at his mostly white high school. There was "a lot of racism," he said. "It was tough." He and his brothers relied on each other, trading tips on how to navigate teen social life in America. Eventually, he joined the school's soccer team, where he excelled and built a community. "I finally felt like a normal kid," he said. But life at home was hard. His mom made a modest living cleaning houses; often their food stamps ran out before the end of the month. After soccer practice, Jaffery would head to one job at a call center, followed by an evening shift at McDonald's. On weekends, he cleaned homes with his mom. He craved a stable, white-collar career. After graduating from Nebraska Wesleyan University, he turned to insurance. He knew he was outgoing and would make a good salesman. The field seemed secure; "everyone legally needs insurance," he said. And agents earn predictable revenue off their cut of monthly insurance payments. But after an internship with a national insurance company and interviews with different agencies, he couldn't land a full-time position. When Wells Fargo offered him a job as a personal banker, he moved on. A few years later, Jaffery's future wife, Michelle Rivera, brought him home to meet her parents, Cynthia and Tom. Jaffery was awestruck by the spacious house overlooking a golf course. "I want this life," he remembers thinking. As it turns out, Tom Rivera was an insurance agent. When Tom Rivera saw Jaffery's eyes wander around his house, he thought, "I know that look." Rivera himself was one of eight siblings whose parents had fled Mexican poverty in the 1950s. He'd grown up spending his summers clearing weeds, hoeing beans, and thinning sugar beets across Nebraska farmlands alongside his parents and siblings. Rivera understood that Jaffery had the same work ethic, ambition, and sense of family. "What I saw in him was the same thing I saw in myself; if you just gave me a chance, I could prove myself," Rivera said. Inspired by the wealth and security Rivera built from his career, Jaffery took another stab at breaking into the insurance industry. But it led to another string of rejections. Rivera eventually recommended Jaffery for a job at his company. As a friend—and later father-in-law—Rivera mentored Jaffery through early career challenges. Jaffery took these lessons to heart and quickly became a high-performing agent. He was soon exceeding monthly goals, outpacing other top performers and winning awards. Jaffery began to consider taking a risk. If he went independent, he could sell products from a range of insurance companies, have more control over who his agency hired, and earn more. But if he left, he'd lose his clients with his current employer and be forced to start over. He turned to Rivera, who explained how Jaffery could leave his current company without burning bridges. He helped him think through planning for the company's future, potential downsides, and balancing the responsibilities of a CEO with the responsibilities he had to his family. "You reach for the moon," Rivera remembered saying. "But you don't want to pull away from your family." Jaffery went independent in 2019 and has seen his business grow at rapid speed, spawning a tech platform that helps independent agents more efficiently gather quotes from multiple carriers, along with multiple independent agencies that partner with real estate and banking. He attributes much of his company's success to his open-minded hiring strategy. Whether he's hiring nontraditional candidates or those referred to the company, he doesn't rule out folks with atypical résumés. The majority of his hires do not have college degrees, and many come from the service industry, where he believes folks develop the people skills needed for his industry. So much of the decision comes down to how well the candidate can hang with Jaffery and the team. "If they are a good fit, and I like their story, personality, and work ethic, we give them a chance," he said. Even when he's reviewing a formal application, he's looking for the Rosa Barragans of the world. People who are used to "talking to people all day, pleasing them, solving problems," he said. These are the skills necessary to attract, sign, and maintain relationships with insurance clients. When a late-career woman reached out to him after being let go from the industry multiple times, Jaffery met with her. He listened to her story. He learned that previous companies didn't offer room for advancement, and they micromanaged her work. She had the skills his company was seeking; she just needed space to thrive, which he happily offered. "She's been with us for almost three years now," Jaffery said. "She's one of our best employees and she's knocking it out of the park." Jaffery understands that there's often a divide between people's potential and the opportunities they're given. Sometimes you can create your own opportunities—like Rivera's parents bringing his family to America. Other times, you might benefit from larger forces—like the United States providing refugee status to a family escaping the Taliban. But sometimes, your ambition and resilience only get you so far. If you're Rosa Barragan, you might need a Tom Rivera or a Cyrus Jaffery to open doors that were previously closed. Jaffery is trying to open these doors for as many people as possible. CJ Insurance Group runs donation drives for Afghan evacuees who fled the Taliban two summers ago. But he worries their door might soon be closing. Without a Congressional pathway to permanent residency, most of these evacuees could be deported back to Afghanistan. "I see myself every day in the people that are moving here from Afghanistan," Jaffery said. If the U.S. just gave them a chance and let them stay, he said, "they're going to become me." Whether it's Americans welcoming newcomers or employers looking for their next hire, Jaffery believes there is so much untapped potential before us. "We just need to give people the opportunity to shine." Co-published with Fast Company. This article is the third in a series about gatekeepers in the professional world taking a chance on those with non-traditional backgrounds. Read the full series here. This story was produced by the Economic Hardship Reporting Project and Fast Company, and reviewed and distributed by Stacker.
Yahoo
04-03-2025
- Health
- Yahoo
What's driving the permanent crisis of drug addiction?
To express the ambient feeling that "things are getting worse," there exists, of course, a meme. It plots iterations of a chart, and on its x-axis floats the disembodied, smiling face of President Ronald Reagan. After his inauguration, watch the data veer up and off into oblivion: from health care spending, executive pay, and the size of the federal government, to the privatization of public services, social isolation, and economic inequality. The bottom line: Only half of babies born in 1980—today's forty-four-year-olds—will make as much money as their parents did. Surprisingly, publicists for the Sackler family—the owners of Purdue, which manufactures OxyContin, and, as the purported architects of the "opioid epidemic," the epitome of contemporary capitalist villainy—presented a Reaganesque chart in a 2021 PR offensive called "Judge For Yourselves." The project aimed to "correct falsehoods" and push back against a tidal wave of press that presented OxyContin as the epidemic's singular culprit, Economic Hardship Reporting Project and The Baffler explain. Purdue, to be sure, did not literally present a chart with a smiling Reagan, but they might as well have. This chart was designed by two infectious disease modelers, Hawre Jalal and Donald S. Burke, who made a grim discovery while examining the leading causes of death in America. They plotted drug-overdose deaths from 1979 to 2016, and what they found was utterly baffling: deaths consistently rose 7% each year, doubling every eight to ten years, for more than four decades. Nothing else—not gun deaths, not suicide, not AIDS, not car crashes—adheres to an exponential curve for this long. Since 1999, more than one million people have died from overdoses. But in the United States, people don't tend to think of this decades-long emergency as a continually accelerating death toll; it gets framed as a series of discrete, though sometimes overlapping, epidemics, implying a predictable arc that spikes, plateaus, and eventually falls. First, as The New York Times warned on the front page in 1971, there was a "G.I. heroin addiction epidemic" in Vietnam. The drug's use was also on the rise in places like New York, where, in the following year, at least 95% of those admitted to drug addiction treatment reported using it. The crack cocaine epidemic arrived in the next decade, followed by a rise in the use of methamphetamines, which the late Senator Dianne Feinstein would call the "drug epidemic of the nineties." But these were soon displaced in the popular imagination by OxyContin, which hit the market in 1996 and set off successive waves of what came to be known as the opioid epidemic, something we're still struggling through. The past forty-five years of drug use in America does not match this relatively tidy narrative—in reality, there's a beginning and middle, with no end on the horizon. But in a strange way, this exponential curve told a story the Sackler family could get behind, one that made them look less culpable: How could Purdue be responsible for the opioid epidemic if overdose deaths were rising for more than a decade before OxyContin was even brought to market? "We were contacted by [Purdue] lawyers," Burke told me. "It was my sense that they would like us to testify that it wasn't their fault." They declined the offer. Still, Purdue was right about something. Drug mortality in America neither begins nor ends with the company's actions. What pharmaceutical manufacturers, drug distributors, insurance companies, doctors, and pharmacies—the entire profit-mad medical system—collectively accomplished was to accelerate a train that was already speeding off the rails. With corporate power unchallenged and regulators asleep at the wheel, drug markets, like so many other consumer markets, have become more deadly, more dangerous, and, despite decades of aggressive and costly drug enforcement, more ubiquitous. Jalal and Burke's finding also presented a paradox. How could four decades of seemingly distinct epidemics—from heroin and cocaine to meth and fentanyl—aggregate into one giant wave of death? How is this wave still gaining power, and when will it crash? When we zoom out, we have what looks less like a collection of epidemics involving a series of novel, addictive drugs, and something more like a chronic social crisis exacerbated by market conditions. Underlying sociological and economic drivers must be at work. "We can come up with explanations that are specific to some era," Peter Reuter, a veteran drug policy researcher, told me. For instance, consider how, in the 1970s, cocaine manufacturing and trafficking networks in Latin America advanced alongside growing demand for the drug in America. "But then, it's very hard to find something that goes on for forty-five years now." David Herzberg, a historian of the pharmaceutical industry and author of "White Market Drugs: Big Pharma and the Hidden History of Addiction in America," has an idea. He proposes that drug markets are behaving the way other consumer markets have since the neoliberal turn, when "free enterprise" was unleashed to work its unholy magic. "The rise in overdoses tracks a time period in which corporations that organize human labor and human activity were increasingly given carte blanche," Herzberg told me. "While OxyContin is an example of a corporation taking advantage of this," he said, "Purdue didn't create the conditions that enabled it to do what it did." Hence, the irony of the Sackler family's lawyers holding up a chart where time begins in 1979. Across this period, illicit market innovations have mirrored many of the same ones seen in legal markets: sophisticated supply chains, efficiencies in manufacturing, technological advances in communications and transportation, and mass production leading to lower prices. Meanwhile, the social dislocation and alienation of consumer society has left millions of Americans unmoored, adrift, or otherwise floundering. Contrary to popular rhetoric, drug addiction is not the cause of poverty but one of its chief consequences. Studying the dynamics of crack houses in New York and open-air drug markets in Kensington, Philadelphia, the ethnographer Philippe Bourgois found a pattern of lives scarred by a combination of state neglect and violence: abusive childhoods, crumbling schools, abandoned neighborhoods, all aided by government-incentivized white flight. The historian Nancy Campbell, author of "OD: Naloxone and the Politics of Overdose," uses the phrase "unlivable lives" when talking about the increasing immiseration of Americans. "Drugs are powerful ways people use to mitigate their circumstances," Campbell told me. Opioids work as a salve for pain both physical and psychic. It's no surprise that overdose deaths repeatedly occur in the deepest cracks and faults in American society. The rise in deaths, for instance, has been steepest in Black and Indigenous communities, which bear the brunt of concentrated poverty, cycles of state violence, and intergenerational inequality. This decades-long rise in drug mortality has yet to have any substantive influence on the United States' sclerotic drug policy; the current crisis remains widely viewed as a discrete epidemic, disconnected from the history that precedes it. Rather than ask what lies at the root of persistent substance use, this myopic framework—peddled by the Centers for Disease Control and Prevention, parroted by politicians and industry leaders—focuses on individual drugs as causative vectors, while locking addiction in the realm of individual neurobiology. The public is led to believe that the usual responses to epidemics will somehow work for drug addiction: isolate, quarantine, and treat the sick. This almost always means criminalization, incarceration, and compulsory treatment—or else bizarre interventions like the Department of Defense's quixotic search for a fentanyl "vaccine." The endless declaration of one drug epidemic after another also perpetuates a blinkered state of emergency, necessitating the spectacle of a disaster response to yet another drug "outbreak." This not only forecloses the possibility of a response that's actually effective, it precludes a deeper understanding of the role of drugs in American life. What Jalal and Burke's exponential curve lays bare is the accumulation of our long, slow, and violent history. When a problem is big, bad, and mysterious enough, Americans tend to reach for the metaphor of the epidemic. Mass shootings and gun violence are an epidemic. Suicide is an epidemic. There's an epidemic of loneliness. Between guns, drugs, and despair, not to mention the actual viruses and diseases out there, America is awash in epidemics. Susan Sontag famously argued in "Illness as Metaphor," "Any disease that is treated as a mystery and acutely enough feared will be felt to be morally, if not literally, contagious." Though neuroscience has shed some light on the inner workings of addiction in the brain, the metaphorical baggage persists: drugs "hijack" the brain, creating a "disease of free will" that saps the host of human agency. The loss of control over one's desire feels bound to the insistence that those who succumb to addiction are morally weak and spiritually sick. Anxiety over drugs has dominated public discourse for as long as Americans have used them—to the extent that the New York City health commissioner labeled substance use "emphatically an American disease" back in 1919. But we lose something by relying on this kind of language. There is no need to find a rationale for why a virus leaps from person to person; it's what they are programmed to do. So, what is the rationale for drugs and addiction? When it comes to opioids, they have a much longer history in the United States than is commonly assumed. "To see the opioid crisis as new and unprecedented in this way required a radical act of forgetting," Herzberg writes in "White Market Drugs." Herzberg had noticed that the news media continually rediscovers the fact of opioid use by white people, women, and affluent suburban and rural users. This was most stark during the early wave of overdoses attributed to pharmaceutical opioids, when news outlets ran with the story that opioid addiction had suddenly found "a new face." In a 2015 segment by "60 Minutes" on "Heroin in the Heartland," the surge in opioid use was described as "an inner-city problem" that spiraled outward and into the "biggest drug epidemic today." But this was not the first national struggle with opioids. The earliest recorded "opioid epidemic" in the United States dates back to the nineteenth century, when rapid industrialization led to an explosion of consumer goods. "Among these commodities and consumer goods were derivatives of the opium poppy and the coca plant," Herzberg writes, noting that opioid use tripled from 1870 to the mid-1890s. "Drug consumers, like consumers of other goods, faced a bewildering variety of new and often dangerous products." The market was flooded with tonics and elixirs containing stimulants like cocaine and opioids like heroin that promised to cure everyday illnesses and ailments. The proliferation of drugs in a rapidly industrializing America soon led to the first attempts to regulate and curb their use. But drugs are never just about drugs, as Benjamin Fong writes in "Quick Fixes: Drugs in America from Prohibition to the 21st Century Binge": "When people aim to control or regulate drugs, they are actually aiming to control or regulate other things about society." The earliest crackdowns were tied to racial panics. The United States' first known drug law (pertaining to a substance other than alcohol) banned opium dens in San Francisco in 1875. It was enacted less out of concern over the effects of the drug than unfounded fears that young white women and men were getting "stoned in fetid [Chinese] dens," as the law scholar George Fisher summarized it. In "The American Disease", a sweeping analysis of the foundation of American drug policy published in 1973, the historian and psychiatrist David F. Musto closely tracked the regulation of cocaine, which began in 1914 and stemmed largely from a Southern white population fearmongering over a rebellion among "cocainized blacks," who were purportedly imbued with superhuman strength by the stimulant. The cycle of drug laws targeting racial minorities continued into the 1930s with the federal prohibition of marijuana. This time, the federal government and temperance advocates produced and distributed propaganda about how Mexicans, high on pot, were driven to senseless murder. By 1937, a year after the film "Reefer Madness" terrified American parents of the drug's destructive properties, marijuana was federally prohibited. Despite these efforts, drug use continued. As did fearmongering around them to achieve political ends. In 1969, President Richard Nixon undertook an enforcement scheme called Operation Intercept, in which he sent two thousand customs agents to execute a zero-tolerance inspection policy for every vehicle entering the United States from Mexico, ostensibly to disrupt the flow of illicit drugs. But checking every vehicle was impossible back then, just as it is now. Nevertheless, for three weeks, traffic ground to a halt—until Mexico ultimately relented and agreed to sign an agreement against drug trafficking called Operation Cooperation. It's unclear what effect, if any, either operation had on the drug supply. While the former failed to yield any major drug seizures, there are some reports, written mostly by hippies, of a "marijuana famine." Some speculate that new smuggling channels opened up in response, with rising hashish imports from Vietnam and North Africa. Still, Nixon aide G. Gordon Liddy concluded that Operation Intercept was a success, writing in his memoir that it "was an exercise in international extortion, pure, simple, and effective, designed to bend Mexico to our will." The other victory was rhetorical. Operation Intercept reframed drug use as what scholar Daniel Weimer called a "foreign danger": something that was being done to us rather than something we were doing to ourselves. Two years later, Nixon codified this framing when he launched the war on drugs, which instrumentalized the false connection between race and drug use to ramp up police enforcement and incarceration. Another Nixon aide (and Watergate co-conspirator), John Ehrlichman, admitted as much in 1994, when he told the writer Dan Baum that by "getting the public to associate the hippies with marijuana and blacks with heroin, and then criminalizing both heavily, we could disrupt those communities. We could arrest their leaders, raid their homes, break up their meetings, and vilify them night after night on the evening news. Did we know we were lying about the drugs? Of course we did." Drug policy is driven as much by a compulsion to revile and vilify drugs as it is to keep people from using them. The ulterior motives behind the history of drug regulation and enforcement raises the question of what is ideologically and politically embedded in the popular "drug epidemic" framework, which licenses punitive measures against those drawn to drug use. In the 2010s, the market shift to illicitly manufactured fentanyl reinvigorated drug war rhetoric. The idea that we're living through something singular gave the government ammunition to double down on existing tactics. The thinking goes: because fentanyl is so lethal, we must go harder on enforcement than ever before. Across the country, states are adopting harsher laws to combat the supposed crisis: thirty of them now have drug homicide laws on the books, allowing prosecutors to charge those who use and share drugs together with murder. The idea that we're living through exceptional times isn't exactly wrong. The mathematics and physics of fentanyl are unprecedented. The total amount of the synthetic opioids consumed in the United States each year is estimated to be in the single-digit metric tons. By comparison, Americans annually consume an estimated 145 tons of cocaine and 47 tons of heroin. That means all the fentanyl consumed by Americans in just one year can fit inside a single twenty-foot cargo container. Some fifty million shipping containers arrive in America by land, air, and sea every year. Because fentanyl is so potent—with doses measured in micrograms—very small amounts can supply vast numbers of customers. Counterfeit fentanyl pills contain about two milligrams of fentanyl. There are 28,350 milligrams in an ounce, which means one dose amounts to one ten-thousandth of a single ounce. Authorities could barely keep up with cocaine and heroin. To say fentanyl detection is like finding a needle in a haystack is to vastly underestimate the scale of the problem before us. To add another layer to this already impossible scenario, fentanyl is unlike cocaine and heroin in that it is synthetic, odorless, and tasteless, making shipments even more difficult to detect. And the supply has no real upper limit: production is only tied to the amount of precursor chemicals available, which seem pretty much limitless. Any nation with a pharmaceutical or chemical manufacturing industry can theoretically produce the necessary precursors and ship them to suppliers around the world. If one country cracks down on precursor chemicals, another can fill the void. At this time, India and China manufacture much of America's generic drug supply. The global market's rapid acceleration underscores the folly and futility of relying on the same enforcement tactics on the supply side, and the same medical and health interventions on the demand side. The U.S. policy response has never been this nakedly outmatched and unsuited for the task at hand. Still, authorities boast of massive investments to curb the fentanyl crisis. They champion handshake deals with foreign leaders to staunch the flow of the drug into the country. They publicize record-breaking fentanyl seizures, only to turn around and report record-breaking overdose figures. For example, the state of California's 2023 "Master Plan" for tackling drugs includes more than $1 billion, from overdose prevention efforts to interdiction and enforcement. The California National Guard seized 62,224 pounds of fentanyl that year, a 1,066 percent increase from 2021. And yet overdose deaths continue to climb across the state, increasing by 121 percent between 2019 and 2021. Conventional enforcement and seizure methods have done little to contain the spread. A father in Oklahoma, who lost his son to the drug, says, "If the goal is supply interdiction, search every vehicle," referring to the thousands of cars and trucks that cross the U.S.-Mexico border every day. "Do 112,000 deaths warrant the interruption to commerce and commuters?" he asked. "What about 600,000? Or 1,000,000?" The question points to a crucial and oft neglected tension: the symbiotic relationship between legal and illegal markets. It's one reason why U.S. drug policy cannot actually disrupt the fentanyl market. To attempt to do so would hobble commercial trade between Mexico and the United States. The vast majority of fentanyl seizures occur at legal ports of entry and interior vehicle checkpoints. U.S. citizens, not migrants, are also much more likely to traffic drugs across the border. Typically left out of the debate around the crisis at the border is that federal law is expressly designed this way: for U.S. citizens to receive consumer goods manufactured in Mexico. For the first time in two decades, imports from Mexico are outpacing imports from China. The flow of illicit drugs follows the flow of consumer products. Hidden in avocados, cheap cars, home appliances, and LCD screens that our economy depends on is the very same stuff that's killing tens of thousands of people each year. In 2022, the disease modelers Jalal and Burke projected that half a million Americans would die of drug overdoses between 2021 and 2025. So far, the data supports this estimate. "Dismayingly predictable," as they put it. Unless something drastically changes, the curve will keep rising. Drug mortality alarmed officials in 2010 when thirty-eight thousand people died in a single year. Drug deaths were declared a "national health emergency" in 2017, when the annual death toll topped seventy thousand. In 2022, overdose deaths nearly reached 110,000. The fear is that we'll learn to live with these figures as just another grim and inevitable feature of American life. File drug overdoses away under "intractable problem," somewhere between gun violence and the climate crisis. Something obviously needs to change, but American drug policy feels stuck, mired in disproven and outdated modes of thinking. Briefly, it seemed there was real movement toward treating addiction as a public health issue, but the sheer lethality of fentanyl, in part, snapped policy back to the mode of coercive criminalization, derailing newer, progressive reform efforts to roll back racist drug enforcement through decriminalization, with an emphasis on expanding public health, harm reduction, and treatment. The tide of reaction against these nascent efforts has been swift and effective. San Francisco voters passed a measure to drug test welfare recipients. Oregon has ended its decriminalization experiment. With social approaches in retreat, the idea of full-on legalization feels increasingly out of touch with today's reality. But is complete legalization even desirable? Every time the left brings up the idea, two substances come to mind: alcohol and tobacco. These two perfectly legal, regulated products are immensely hazardous to individual health and society at large. Tobacco kills nearly 500,000 people every year; that's more than alcohol and every other drug combined. Drinking, meanwhile, kills nearly 500 Americans a day: more than every illicit substance, including fentanyl, combined. During the pandemic lockdowns, people drank more, and they drank more alone. The trend did not reverse once we returned to "normal." Contrary to all the buzz around nonalcoholic bars, millennials, and Gen X are binge drinking at historic levels. The same set of social, psychological, and economic factors at work in illicit drug use, magnified by the market's invisible hand, are also apply to alcohol: people are more alone and more stressed, with access to a cheap, heavily marketed product that, thanks to on-demand home delivery, is easier than ever to access. Advertisers spent nearly $1.7 billion marketing alcohol in 2022 alone. How, then, is the legalization and regulation of drugs going to help us? Benjamin Fong, in "Quick Fixes," summarizes the debacle: "A more rational society would undoubtedly minimize the impacts of black markets by regulating all psychoactive drugs (and, perhaps, controlling their sale through state monopolies or public trust systems), but legalization in this society likely means bringing highly potent substances into the purview of profit extraction." Black markets flood the country with mass-produced and highly lethal substances, but legal, "regulated" markets do the same. Both are turning record profits. Consumers are at the wrong end either way. It's hard to not feel deep pessimism about where things go from here. Cringey, commercialized marijuana; the glut of ketamine infusion clinics; venture capital closing in on psychedelics; Adderall and Xanax prescriptions being handed out by telemedicine companies over Zoom. It's precisely more of what got us here: a bewildering array of addictive products unleashed onto anxious, isolated consumers who are groping in the dark for relief from physical and psychic pain, coping with unlivable lives. Fortunately, it's almost impossible to fatally overdose on many of these substances, but death shouldn't be the only way to measure the consequences of the great American drug binge. The current rhetorical, legal, and medical framework is simply no match for the deep malaise driving the problem. Root causes are downplayed, millions are left untreated, and thousands of preventable deaths are unprevented. We need a stronger, more expansive paradigm for understanding the exponentially increasing number of overdose deaths. A new language of substance use and drug policy that encompasses, and is responsive to, market dynamics and the social dysfunction to which they give rise. A consumer-protection model that does not criminalize the suffering, but also addresses the anxiety and dread that leads to compulsive, chaotic, and risky substance use. There must be something beyond, on the one hand, prohibition by brute force, and on the other, free-for-all drug markets ruled by profit. How can we create a world where people don't need to use drugs to cope, or when they do use them, whether for relief, enhancement, or plain old fun, the penalty isn't addiction, prison, or death? Purdue lawyers thought the Jalal and Burke chart could absolve the Sackler family. Instead, it indicts its rapacious behavior along with the entire economic, political, and social system that's come of age in the decades since 1979 as well. We're not, in fact, living through an opioid epidemic that started in 1999, or even a fentanyl epidemic that started in 2014; something else, something fundamental, is deeply wrong. Responding to each and every successive wave of drug use as an acute, discrete crisis has failed for the past forty-five years. And it will continue to fail so long as we continue responding to the wrong problem. Co-published by Economic Hardship Reporting Project and The Baffler This story was produced by Economic Hardship Reporting Project and The Baffler, and reviewed and distributed by Stacker.
