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Denise Thompson is Trying to Make Post-Disaster Rebuilding Better

Denise ThompsonDenise Thompson is an Assistant Professor in John Jay College’s Department of Public Management, and an expert on disaster management and risk reduction. Her new book, Disaster Risk Governance: Four Cases from Developing Countries, was published in July 2019 by Routledge. To learn more about where and how she does this work, you can read a profile of Dr. Thompson in this year’s Impact magazine.

 

Read on for an edited interview with Dr. Thompson about her work related to disaster planning and recovery, and how she approached writing a book on such a complex topic:

 

What factors are most important to consider when planning for storms or natural disasters, whether far in the future or imminent?

Maybe the best way to answer that is to look at the disaster cycle. Mitigation, planning preparedness, response, recovery, reconstruction, and then back to mitigation. Even though I put the phases into discrete components, the cycle is integrated, not discrete. And the steps must always be revised.

Mitigation is essentially putting structural and non-structural elements in place well ahead of a storm. That includes hardening infrastructure as well as putting systems in place to make sure we can respond.

The preparedness phase gets ready for imminent disaster, including by bringing together supplies, people and other resources to respond, and making sure supplies are prepositioned where they’re expected to be needed; organizing transportation and marking routes for evacuation; and more.

Recovery includes the immediate response post-disaster, where communities plan for building or rebuilding; get schools, offices, child care and other systems back up that are required for day-to-day functioning; and bring critical services back on line, like roads, food supplies, water, and the government.

Finally, reconstruction is a process of longer-term rebuilding. Ideally, this includes innovation to ensure communities are “building back better,” and is an extremely integrated, wide-spectrum process that moves toward hardened infrastructure and sustainable processes. This happens after an assessment is done of the damage, and must be integrated into planning.

One example is in the Bahamas. Because they are unable to rebuild exactly the same as before the storm hit, the government is thinking about putting some infrastructure underground, like communication towers, to create some protection from the next storm.

How do you factor in climate change when considering ongoing efforts to prepare for and recover from natural disasters?

Well, what is a disaster? We have to think about that. I was listening to a story on NPR, the bird population of the U.S. shrank by one billion birds – that’s climate change. And even epidemics. Certain bacteria and invasive species thrive in certain temperatures. So it’s a disruption, not only of the human ecosystem, but also of the animal ecosystem.

When we talk about disasters, we tend to talk about natural disasters, but it’s so much bigger. We’re not even talking about man-made disasters, like terrorism or cyberattacks, which could be catastrophic. Those are disasters, too, but man-made.

Miami Beach, FL, August 2019, during Hurricane Dorian
Miami Beach, FL, August 2019, during Hurricane Dorian (photo: Rosty McFly | Shutterstock.com)

Given the trends in natural disasters associated with climate change (e.g., hurricanes and tropical storms are more frequent, and more frequently of record intensity levels), are there places that are becoming unlivable, or that should be abandoned?

Yes, there are places that should be abandoned. A lot of these countries, their populations are concentrated along the coast, and there are vulnerabilities. Like schools that are flooded in every single storm of course should not have been built where they are.

Are issues of rebuilding and relocation tied in with race and class?

These issues are very tied to rebuilding in many places. You can also look at a place like Flint – race, class and vulnerability are interlinked. Or Newark. Usually, African Americans, Latinos and other minorities are more vulnerable to these disasters. And it’s harder for the poorest communities to recover – the same event has a more drastic impact. The rich have more resources.

In island states, the line is more blurred. The interiors are more rugged, which means most people tend to locate along the coastline, so it’s not as clear-cut an issue as in, say, Hurricane Katrina. But there’s an issue of moral hazard; even knowing that it’s dangerous, people build anyway, knowing that somebody will help them to rebuild. Like the government, or insurance money. So people tend not to bother to plan for disasters.

However, organizations have been exploring insurance, like livelihood protection, for poorer people. For example, the Caribbean Catastrophic Risk Insurance Facility (CCRIF) pools resources from many countries in the region, who pay into this fund. They are disbursed to governments directly, to help pay for rebuilding. Commercial facilities might be getting out of disaster insurance, but others are stepping into that void.

Is there an ideal balance between recovery efforts provided by home governments versus outside aid?

I don’t know if there’s an ideal balance. Governments operate at different levels – national, regional, local, community, household – so we usually say that the government closest to the people should be equipped to help them. But what we find is that often the governments closest to the people are themselves incapacitated by whatever event took place, and they’re not able to help. And if you go one level higher, they may be able to help in some ways but not others, and so on. In cases like those, outside help is needed; the quantity depends on the issue.

Is there a useful role for individual aid?

There’s a useful role, but it’s hard to manage spontaneous volunteers. They may put themselves in harm’s way. Typically we say, go through an entity to help. Most agencies right now want money, because they can best divert it to where it’s needed. That may be potable water, or a sanitary facility, or helping women or children get out of situations where they’re more vulnerable thanks to the disaster. It may be a number of things.

When you talk about disaster planning, mitigation, risk reduction, it’s a big, involved process, and very complex. It’s hard to get a handle on it, but agencies do it. Their effectiveness depends on resources. And no one place has the level of resources needed. That’s why governance systems are important, to bring all these things together – the resources, money, people, institutions, laws, and the formal and informal arrangements that must be made to keep people safe.

Cover of book, Disaster Risk Governance by Denise ThompsonThis is obviously a vastly complex topic that touches on every area you can imagine. How do you write a book about that? Is your book more broad, or is it more of a tool?

The idea for the book came when I was doing a lot of work in the Caribbean and seeing a lot of money being spent, with a minimal return on investment. When the next event came, we were still dealing with the same issues. Activities were happening piecemeal, done by aid agencies, governments, the UN. And preexisting factors, like colonialism, undermined institutions. These were antecedents to what we’re seeing now, but we never could put them together, because we’re always trying to put out fires.

Disaster management systems happen in context of the country, and I realized that countries with weaker governance systems also have weaker disaster management systems. Governance is an umbrella term, comprising all the institutions, systems, actors and processes that come together around disasters.

So what I wanted to do was come up with a number of variables we could use to pinpoint areas we could shore up to improve disaster risk reduction and outcomes. I looked at institutions as a key component in that, like legislation, insurance, security. I also talked about labor policy, networks, economic investment – all these things may not be part of disaster policy, but they support it.

Why did you pick those four specific countries – two in the Caribbean, two in Sub-Saharan Africa – to feature in your book? Did you find some similarities there?

When I came into academia in 2008, there wasn’t much literature on poor countries. And that is not specific to disaster management. The voice was missing. I thought, if I looked at the sub-Sahara and the Caribbean, I would be better able to come up with a governance framework that actually works for developing or poorer countries.

The similarities I picked up are mostly in the institutional and informal aspects. For instance, indigenous peoples from the Caribbean and from Africa were similar in that they had communities with their own laws and customs that may be opposed to planning around disasters. Also, these countries have a legacy of corruption – not all poor countries, some rich countries have higher rates of corruption – but still, government ineffectiveness, government inaccessibility to their populations, these things were comparable. Those cause inefficiencies and waste in the system, they cause people to take longer to recover from disasters. It’s complex and messy.

In the book you have to try to manage the multiple components; you can’t write on everything but you can pick out the salient things. I hope that’s what I was able to do.

Is it disheartening, to see inefficiencies and to see problems getting larger every year, problems that we’ve caused ourselves and failed to find effective solutions to thus far?

Yes, but at the same time, we’re working more closely with communities, and households and individuals, and I think that’s where it has to happen. So while governments create the policies, the infrastructure and the systems, the ecosystem is bigger, with subsystems within it. If you work at the micro level, you can shore up the entire system.

In the Caribbean and in Africa, there are regional agencies that are the real workhorses and innovators – the East African Commission, the African Union, Caribbean Disaster and Emergency Management System, CARICOM. CCRIF, for example, is one of the first in the world to push for countries to pool their resources. Other regions, like Southeast Asia, are doing a similar thing. All of these groups come together to actually build and pilot things.

Gerald Markowitz shines light on corporate bad behavior

Distinguished Professor of History Gerald Markowitz and long-time writing partner David Rosner, a Professor of Sociomedical Sciences at Columbia University, have been researching industrial pollution and contaminants since the early 1970s. Their first jointly-authored book, Deadly Dust: Silicosis and the Politics of Occupational Disease in Twentieth-Century America, explored historical evidence of the lung disease silicosis, which is a hardening of the lungs due to inhaling dust found in sand or rock. Thanks to Deadly Dust, Markowitz and Rosner came to the attention of lawyers bringing workplace safety suits on behalf of construction workers suffering from silicosis, launching a long career of research and expert testimony on occupational disease and toxic substances. In the early 2010s, the duo began an investigation into asbestos and asbestos-related disease.

Their work turned up hundreds of articles on the dangers of asbestos, now a watchword for poisons that can lurk in our homes, dating from 1898 to the present. Markowitz and Rosner also referred to corporate records and documents made public through court discovery; a more recent project called ToxicDocs is an open-source, online database of more than 15 million pages of documents related to silica, lead, vinyl chloride, and asbestos that were previously not easily accessible.

In June, Markowitz’s expertise was featured prominently in the American Journal of Public Health, in an article detailing a representative episode in the history of the struggle between industry and regulators. In “Nondetected: The Politics of Measurement of Asbestos in Talc, 1971-1976,” Markowitz and his co-authors describe the years-long interval between the talc industry’s acknowledgement that asbestos is toxic and their taking action to protect consumers, and the subsequent conflict between the Conflict, Toiletry, and Fragrance Association (CTFA) and the U.S. Food and Drug Administration (FDA) over regulating appropriate methods for detecting asbestos contamination in consumer talc products and setting safety standards.

The focus of the article, said Professor Markowitz, “was that the cosmetic industry, I think very consciously, used this concept of nondetected, which we as consumers think of as ‘no asbestos in the talc,’ but nondetected could mean enough asbestos in the talc to cause disease. And that’s what the industry understood, but consumers did not.”

The CTFA’s 1970s victory in lowering detection standards and advocating for self-regulation is still bearing fruit; recent lawsuits against talcum powder manufacturers allege the household product causes cancer due to asbestos contamination. As recently as 2018, courts awarded plaintiffs record damages of close to $4.7 billion in a case against manufacturers, capturing public attention.

We sat down with Professor Markowitz to talk about his work researching industrial poisons and about corporate responsibility to the consumer in today’s world. Read on to hear from Professor Gerald Markowitz in his own words.

 

Why do you believe that talc product manufacturers continued to accept a lower standard for asbestos eradication despite known health dangers, not to mention the risks of litigation?

When they developed this idea, in the 1970s, their basic argument was that there should be as little federal regulation as possible. [The CTFA] was able to lobby the federal FDA that the technologies that the FDA was proposing were not able to be completely accurate, would give too many false positives, would take a long time to do, and would be costly. So they proposed their own method. And they’re able to eventually convince the FDA that it should not be federal but industry regulation.

But what they admit privately is that their method, which is not as demanding as the FDA’s proposed method, was not necessarily accurate and was not necessarily consistent. So to a certain extent, they were really able to forestall regulation by claiming that they could do as good a job [of detecting asbestos in talc products], even though they themselves admitted that they could not do as good a job. And by the very nature of their method, they were going to uncover much less asbestos than the FDA’s method was capable of uncovering.

Do you think there’s something special about the current moment that made this article of particular relevance?

Authors David Rosner and Gerald Markowitz holding a copy of their latest book, Lead Wars
David Rosner and Gerald Markowitz

I think it was the variety of ways that deregulation has had an impact on the health and welfare of people in the United States and other parts of the world. To the extent that these articles could help to call attention to that happening, they are important. The advantage of history is that we are able to really see the process unfold in a kind of detail that we don’t necessarily have in observing regulatory of anti-regulatory actions taking place at the moment we’re living in. That level of detail I think is instructive in terms of being able to understand how similar things could be happening today.

Would you like to see this history galvanize some kind of action?

The most important thing that can happen is that people really have to take politics seriously. The United States has a long history of mass movements really demanding and achieving fundamental reforms. Just going back to the 1960s, the demand for civil rights, the efforts of people to get voting rights for African Americans, that didn’t happen simply because Congress decided to pass a law; people were demanding it in mass actions. These are really instructive in terms of what can happen today, and even what is happening today.

Pieces accompanying your article in the AJPH, such as the one by former Assistant Secretary of Labor for the Occupational Safety and Health Administration David Michaels, suggest that corporate influence is getting stronger, to the detriment of consumer and public health. The current administration has loosened or degraded regulatory standards for a variety of products — should we expect more legal battles down the line?

Yes, absolutely. Since the 1970s there has been a very sustained effort by many businesses to oppose regulation, and you get the classic statement by Ronald Reagan, when he said that ‘government isn’t the solution, government is the problem.’ I think the legacy of that, of the push for deregulation as a means of stimulating the economy and freeing business to innovate and all of those kinds of ideas, I think the legacy of that is going to be a variety of problems, not only in consumer products but in environmental damage. It’s going to be for workers, for consumers, for people living in communities where toxic substances are going to be released, we’re going to be suffering those consequences, and the unfortunate thing is that it’s only going to be remedied in retrospect.

And to add one other element, we know that the burden, especially of environmental pollution, toxic waste, global warming, is going to affect poor communities and communities of color to a much great extent than richer communities. At a college emphasizing social justice, this becomes an even more vital issue.

Are there other consumer products known to include dangerous adulterants that are similarly being ‘underregulated?’

BPA [bisphenol A, a chemical used to make certain plastics since the 1960s] is one example; a lot of household cleaners and flame retardants are another one. We’ve discovered that flame retardants are extremely dangerous to people, and that people have them in their bodies. Formaldehyde is another one; there was a scandal about formaldehyde in temporary housing given to people after Katrina, that was unsafe.

There are lots of things we have clues about, but the real scandal is that chemicals are being produced and we’re using them in very large quantities, that have never been tested. And in the United States we have this philosophy, innocent until proven guilty. It’s the same philosophy with chemicals — they are innocent until proven guilty. The Europeans have a system, chemicals can’t be introduced until they’re proven safe. It’s a basic difference in philosophy that companies need to prove that something is safe before they can experiment on us and ensure it doesn’t cause cancer. But in the United States they say that if it does cause cancer, we’ll take it off the market, but that’s very difficult to prove and you’ve done the damage already.

You note in your article that talc researchers were disappointed when their work became known to the industry, but that ‘nothing was done until the results became public.’ Do you think it remains true in cases of corporate wrongdoing that nothing is done until the public finds out all the information?

In the 1970s, there was this wonderful act passed called the Freedom of Information Act (FOIA). The fundamental principle behind that was that if you shine the light of publicity and information and people have that, then they have the ability to act in their own interests. One contribution that historians can make is, using the older historical records, we can cast a light on activities and attitudes and actions that permit people to see what is going on and demand change.

 

Gerald Markowitz is a Distinguished Professor of History in the Interdisciplinary Studies Department at John Jay College and the Graduate Center of CUNY. His research focuses on the history of public health in the 20th century, environmental health, and occupational safety and health. He has authored a number of books, most recently Lead Wars: The Politics of Science and the Fate of America’s Children, also in cooperation with David Rosner.

Research Productivity 2018: A Thread

In June 2019, OAR shared a few of our 2018 most productive scholars with our Twitter followers. Check out the whole thread below, and don’t forget to follow @JohnJayResearch and the researchers mentioned below to get more information in real time!

Last year we recorded more than 700 journal articles and book chapters published by @JohnJayCollege faculty members! While we finish adding up this year’s #JJCResearch productivity, we want to introduce you to some of our most productive #JJCFaculty scholars

First up is @ktwolff11, who also won the 2019 Scholarly Excellence Award and the Donal EJ MacNamara Award for significant scholarly contributions to #criminaljustice! His most recently published article examines patterns of recidivism after a sex offense, find it here: (bit.ly/2XaqWmw)

Next is @kevinnadal, @JohnJayCollege professor of psychology and the author/editor of two books in 2018! His research explores the impacts of microaggressions on the mental health of marginalized groups including people of color, women, LGBTQ individuals, & more. #JJCResearch

Today’s ft. #JJCFaculty scholar is @ElizabethJeglic, who published 2 books, 9 peer-reviewed articles, 6 book chapters, and 7 online articles and blogs last year!! Her research focuses on sexual violence prevention — her latest article is in journal ‘Sexual Abuse’ #JJCResearch

Next up is @JohnJayCollege criminal justice prof @PizaEric. Not only is he often featured by the media as an expert on policing matters, but he published 13 journal articles in 2018 on the data behind risk-based policing, CCTV, and more! #JJCResearch

Do you know @JohnJayCollege poli sci prof Samantha Majic? An OAR #BookTalk alum (), last year she published new book “Youth Who Trade Sex in the U.S.” and has been speaking and writing about the harms of & issues surrounding sex trafficking. #JJCResearch

You can watch her 2014 book talk here: (bit.ly/2KAdH8P)

Last year, @DrMazzula, who is the founder of the @LatinaRAS as well as a @JohnJayCollege prof, kept busy writing and presenting about two key issues: microaggressions, and gender/minority representation in academia. #thisiswhataprofessorlookslike #JJCResearch

And don’t forget Philip Yanos, who in 2018 not only published his book ‘Written Off,’ but also a monthly column in @PsychToday by the same name. His articles, on stigma attached to mental illness, were cited more than 700 times last year!
#JJCResearch

Find his blog here: (bit.ly/2IQ2w9J)

 

 

 

 

 

 

 

 

 

And last but not least, @JohnJayCollege is home to some great podcasts. Check out @indoorvoicespod, @TWOH_VL, @NewBooksPoliSci, @QualityPolicing, @JohnJayTLC on Teaching and Learning, and @lavueltablog. So much to learn about!

#JJCResearch

Social Inclusion Leads to Violence Reduction in Ecuador – Dr. David Brotherton

David Brotherton headshotSince 2007, the Ecuadorian approach to crime control has emphasized policies of social inclusion and innovations in criminal justice and police reform. One notable part of Ecuador’s holistic approach to public security was the decision to legalize a number of street gangs in 2007. The government claimed this decision contributed to the reduction of homicide rates from 15.35 per 100,000 in 2011 to close to 5 per 100,000 in 2017. Professor of Sociology David Brotherton was commissioned by the Inter-American Development Bank to spend six months evaluating these claims through a qualitative research project focusing on the impact on violence reduction had by street gangs involved in processes of social inclusion. The results were published in 2018, arguing that social inclusion policies helped to transform gang members’ social capital into a vehicle for behavioral change. In December 2018, Dr. Brotherton was awarded a grant by the Harry Frank Guggenheim Foundation to continue the work.

 

What did you learn during the initial phase of your research?

We learned a lot. These are very large groups, with over 1,000 members spread across Ecuador, and they managed to create a new kind of culture within their organizations that was pro-social, pro-community, with a strong element of conflict resolution and mediation, cultures where they were working as partners with the government and non-state actors like universities on progressive agendas. They were partners in pro-social activities, everything from creating new youth cultures to voting, job training, and strengthening local communities, all of which you don’t associate with street gangs. And in their ranks are the most marginalized youth of their country, so they can reach kids that are so marginal that other organizations don’t reach them, even indigenous kids from the Amazon, and it is so important to bring them in and work with them. This is all across Ecuador.

When we asked the members what had changed, they said they don’t get into the same level of conflict. Where there might have been a previous period where they were at war with one another, they were able to end it with the government playing a role.

Sometimes these interventions don’t last very long, once the money runs out, but here you had a government that constantly maintained a presence and lived up to its promises, so the trust level became really high.

The end result is not necessarily unique, we’ve seen this in other places like with the Latin Kings in New York and various places in Spain, but the outcome across ten years was quite remarkable. Homicide rates are so indicative of a country’s ability to resolve tension, so when you see the inarguable statistics of homicides going down every year for ten years — it’s related to different factors, they also reformed the police department, but when you see that kind of result it’s pretty impressive.

 

What key aspects of the inclusion policy allowed gangs to successfully transition from criminal to purely social organizations?

The government recognizes that they won’t change overnight, because the economic situation doesn’t allow that, but you make it such that whatever [gangs] are involved in doesn’t hurt the community, and there are other pathways they can move into and you are creating real opportunities. So what does that look like? It looks like being recruited into programs at the university to give you skills, diploma programs. And these kids become a kind of role model for their mates.

In addition to that, [all of the gangs] were incorporated as non-profit organizations, which allows them to get government grants to do things like community building. You’re not just rhetorically arguing for a new culture, you’re making a new culture and making it happen. Those joining the organization come in with a different set of expectations, and it has a tremendous ripple effect. They created a strata of professional workers.

Also, the police are told not to pick them up, or intervene in their meetings. And the kids don’t fear any kind of stigma, they’re not constantly being harassed. With the communitarian police force, they worked with the heads of the police. It’s a totally unique phenomenon, and flies directly in the face of what we’re pushing in the U.S., which is zero tolerance.

 

Where else might this social inclusion approach be effective in curbing violence?

I mean, it could be effective in the U.S. Social inclusion is the complete opposite of the repressive policy that nearly always leads to what we call deviant amplification. You need to stop the stigmatization and have meaningful relationships with street groups, with intermediaries from the government. In the U.S., the police are so strong that this is all very difficult.

To make this work anywhere, politically you need to make a decision about where to invest resources. [In Ecuador,] they didn’t invest in the military, they didn’t invest in massive tax breaks for corporations, in fact they did the opposite. They boosted money for culture and art. If you stick with these political decisions, they will pay dividends over time.

 

What is the next step in completing this research?

I have a full-time field researcher, Rafael Gude, who has been working in Ecuador since April, focusing on the relationship between the Catholic University of Quito and the Latin Kings and Queens. I’m going down myself July 3-15 to do field work both with the Latin Kings and Queens and to attend a big national meeting in Cuenca, then I travel to Las Esmeraldas, on the Pacific coast of Ecuador, where we will interview members of the third major street organization in Ecuador, called Masters of the Street. We want to understand the changes in that group and the roles of social and political empowerment in the reduction in violence.

Las Esmeraldas had the highest rate of violence, with a really high homicide rate of around 70 per 100,000, which is now down to 20, and it’s on the border with Colombia so this is the biggest drug trafficking area and also very poor. This is a completely different socio-economic context, and mainly black Ecuadorians, so we want to see how the whole issue of race works itself out as they’re trying the same policy.

Also, things have changed; although the same party is in power, it’s not the same government. We thought they were going to completely reverse the policy, but a number of media organizations got into this report, and I gave this big talk in Medellín last year, and it’s become a real media story about this success. So this government has maintained the same policy, and embraced it as much or more than the last government.

Right now, we are also looking to do work in the prisons where the inmate population has increased substantially in recent years and many of the incarcerated have joined the groups.

 

Why is it important to continue this research?

The importance of this work is that it demonstrates a viable alternative to “zero tolerance” and other repressive policies that led to the highest homicide rates in the world — for example, in Central America’s Northern Triangle. The topic has been covered by the BBC and is out in English, Spanish and Portuguese, with multiple other Latin American nations now taking notice, including the president of Mexico.

 

How does your research dovetail with the HFG Foundation’s mission?

The research meshed with their general focus; they’ve always supported innovative anti-violence or violence prevention studies. For them to come on board, it’s a big deal.

 

You can learn more about the first stage of this research via the report on the Inter-American Development Bank’s website, or by listening to him talk about his research on the BBC program The Inquiry (starts at 13:43) or on the Peter Collins Show podcast.

 

Dr. David Brotherton is a Professor of Sociology at John Jay College and the CUNY Graduate center. He is the author of a number of books on gangs and immigration, most recently co-authoring Immigration Policy in the Age of Punishment: Detention, Deportation, and Border Control. He is a founding member of the Social Anatomy of a Deportation Regime research working group based at the Center on Social Change and Transgressive Studies at John Jay.

 

John Jay Featured Grant – Reducing Prison Overcrowding: Jeff Mellow + Deborah Koetzle

John Jay faculty and staff came together for a reception on May 14th to honor 76 of their own who received major and external grants and awards in 2018. The funded projects are a testament to the hard work John Jay’s community devotes to research and to honorees’ dedication to studies and creative work that strengthen the scholarly fabric of the institution. The awards funded projects of all types, from those with potential therapeutic implications to those that could change international policy, and more.

Among the honorees were Dr. Jeff Mellow and Dr. Deborah Koetzle. Their grant, from the U.S. Department of State’s Bureau of International Narcotics and Law Enforcement Affairs, took them to El Salvador to work on alleviating the severely overcrowded conditions in many Salvadoran prisons.

Both Dr. Mellow and Dr. Koetzle have been working to apply evidence-based, empirically-verified practices to corrections for many years, so when the opportunity came to apply their knowledge gained from research in the United States to an international setting, they knew they had to take it. The project took place in cooperation with El Salvador’s National Criminological Council and Director of the General Office of Penal Centers.

Prison overcrowding

El Salvador’s rate of incarceration is among the highest in the world — second only to the United States, with more than 600 out of every 100,000 persons incarcerated. Although the overcrowding rate is slowly coming down thanks to the construction of new prison facilities, the researchers described unhealthy conditions in some prisons. Some facilities were at 800 or 900 percent capacity, with bunks overfilled with bodies, increased risk of infectious disease, and insufficient room for programming or recreation.

Dr. Koetzle described the severely overcrowded prisons as “strangely quiet” and very still, as inmates have little room for movement. “No one should have to live in those types of conditions,” said Koetzle. “But the other side of that is really seeing the government and the system putting forward meaningful, genuine efforts to address it.”

Releasing the bottleneck

The counterpart to overcrowded higher security institutions are the granjas, or minimum security prisons, to which incarcerated individuals can transition as part of their rehabilitative journey toward release. Their gradual reintegration and movement through the system requires a protracted process of repeated assessments. “Inmates have to both finish a minimum of a third of their sentence, and also engage in very extensive programming to move from closed prisons to open prisons,” said Mellow. “But the problem is there’s a bottleneck, and only about 6% of the inmates, out of 40,000, are in the open prisons.”

As part of the government’s effort to ameliorate prison conditions and move people through the system more quickly, the researchers were engaged to hire, train and manage criminological teams — composed of one lawyer, one educator, one psychologist and one social worker — that helped to build capacity to assess inmate progress toward rehabilitation while drafting more than 2,000 proposals to improve the process based on empirical data collected throughout.

“Our goal was to improve the correctional system and policies, to maintain our relationships down there, and help [the government] to introduce additional evidence-based practice and risk assessments that we think can really help them open up bottlenecks and be more efficient and effective in identifying low-risk individuals to move them through the rehabilitative phases,” said Mellow.

They brought to the process many collective years of experience in working to introduce standardized, evidence-based practice to the U.S. correctional system. Both professors also brought back lessons learned from their time in El Salvador that could translate to better practice in the United States, emphasizing the ways Salvadorans involved in the justice system are still encouraged to feel a part of their community on the outside. “They have families much more engaged, and they are really trying to provide for employment opportunities,” remarked Koetzle. “I think on those two fronts in particular, we could learn.”

Mellow also outlined elements of the rehabilitation program, broadly called “Yo Cambio,” that he felt were exceptional, including “conjugal visits, which we rarely do in the United States, and focus on vocational education. They also have a Fair Day where inmates will go out to sell all the wares they’ve made inside the prison, and the national Olympic game day. You can see that they are really trying to show that inmates are part of the community. They’re people.”

The life of a PI

Working on a large international grant was both a challenge and a source of immense satisfaction. “You’re wearing 100 different hats,” said Mellow, who was Primary Investigator on the grant. “Everything from drafting subcontracts to thinking about lunch for the trainings, to dealing with messages every day, getting everybody paid, and dealing with the funder. Plus doing the actual work, and writing the quarterly and final reports and analyzing the evaluation. If you think about it, you’re managing 40-something people.”

It was “not typical to have so many staff in institutions for this length of time,” added Koetzle, the project’s Senior Advisor. “[And] engaging in international work stretches you a little bit differently.” They took seven trips to El Salvador during the two-plus years of their grant work, and talked about the greater investment of resources, time and flexibility needed to pull off a successful overseas project.

But the challenges created by managing a large grant from so far away were paired with a huge pay-off. Both Mellow and Koetzle agreed this was one of the most rewarding projects they’d ever undertaken, and talked about the valuable insights they had learned from working in a different context and system. They also had only positive things to say about their team of local staff, both about their capabilities and their constant enthusiasm and dedication.

“That’s something that really stood out — the number of times they thanked us for giving them the opportunity to help their country,” said Koetzle.

Jeff Mellow, Lidia Vásquez, and Deborah Koetzle in El Salvador

 

Next steps

Now that the grant has ended, as of February 2019, Dr. Mellow and Dr. Koetzle, along with co-PI and Senior International Officer in John Jay’s Office of International Studies and Programs Mayra Nieves and their program coordinator, PhD candidate and Salvadoran native Lidia Vásquez, are looking ahead. They are working on publishing their results with a Salvadoran university, in Spanish, and would like to see some of their recommendations translated to national policy. Their greatest hope, though, is to find continuing funding to keep doing the work to which they’ve dedicated so much time over the last two years, and perhaps even extend its scope to other nations in Central and South America with similar overcrowding and assessment challenges in their own criminal justice systems.

“We are hoping for the project to come back, “said Mellow. “That is our goal.”

 

Dr. Jeff Mellow is a Professor in John Jay College’s Criminal Justice Department, Director of the Criminal Justice MA Program, and a member of the doctoral faculty at the CUNY Grad Center. His research focuses on correctional policy and practice, program evaluation, reentry, and critical incident analysis in corrections.

 

 

Dr. Deborah Koetzle is an Associate Professor in the Department of Public Management at John Jay College and the Executive Officer of the Doctoral Program in Criminal Justice. Her research interests center around effective interventions for offenders, problem-solving courts, risk/need assessment, and cross-cultural comparisons of prison-based treatments.

 

Maria J. D’Agostino — Negotiating Bias in the Workplace

If gender inequity is baked into today’s workplace, what can John Jay students and other Master in Public Administration (MPA) candidates do to fix the problem? Dr. Maria D’Agostino, with co-authors Helisse Levine (LIU-Brooklyn) and Meghna Sabharwal (UT-Dallas), published an article in the Journal of Public Affairs Education in March that represents the first step toward answering that question.

Dr. D’Agostino, an Associate Professor in the Department of Public Management, has focused her recent research on women in public administration. Not only are women — along with other persons whose gender presentation isn’t traditionally male — underrepresented in leadership and management roles but, according to the theory of Second Generation Gender Bias, the workplace isn’t even built to accommodate the needs of anyone but men.

Longstanding cultural beliefs and biases, formed over many decades, put up invisible barriers to women’s advancement, and workplace structures and practices can inadvertently favor men. One such practice is negotiation, which figures prominently in 21st century workplaces. When negotiating for starting salaries and other benefits, studies show that men see better negotiation outcomes than women, and that these differences are more due to stereotyping and structural bias than to behavioral differences. Negotiated Order theory, which has also heavily influenced D’Agostino’s work, suggests that the results of biased negotiations build up over time, meaning that when women or people of marginalized genders start out behind, they usually stay behind.

D’Agostino believes that MPA programs are a great place to take on these challenges. “A lot of experimentation goes on in the public sector,” she said, giving examples of vital pieces of legislation that have trickled down from government policy to private sector workplaces, including Title IX, Paid Family Leave, and New York City’s 2017 law barring employers from asking about applicants’ salary history.

According to D’Agostino, MPA graduates are often perfectly placed to address inequality. “[Graduates] work in city, state, and federal government, they work in nonprofits, and in the private sector. The essence of public administration is serving the public and the common good, and they are the face of that; they are the decision-makers in terms of creating policy that becomes city, state, and federal law, which can even spread to the private sector. They are both creating and implementing policy, so they have a big impact on the future.”

It is therefore a concern for D’Agostino and her colleagues that more MPA programs aren’t tackling issues of workplace inequality head on. In her study, researchers surveyed MPA administrators to find out how many programs around the country offer courses in negotiation, let alone courses that incorporate elements of gender bias into coursework. They found that “none of the programs offered a standalone course on gendered negotiation, and those that offered courses on negotiation generally only focused on transactional portions,” said D’Agostino.

Her suggestion? Incorporate second generation gender bias into curricula as a core competency for all MPA programs. Raising awareness among students in the field could lead to big changes inside workplaces, but also in the ivory tower. “Academics could do more research, which could inform practice, which would affect training, which would impact the field in terms of gender equity.”

These are big dreams for sweeping change in MPA programs and in offices across the U.S. For now, D’Agostino and her colleagues are developing a conceptual framework for talking about the issue. Her next step is to interview both men and women in various positions in seven states, to try to understand the implications of second generation gender bias as they play out in real workplaces and to hear about real workers’ experience with bias.

You can find the full article, “Gender in negotiation: Preparing public administrators for the 21st century workplace,” online at the Journal for Public Affairs Education’s website.

 

headshot of Maria D'AgostinoMaria D’Agostino is an Associate Professor in John Jay College’s Department of Public Management. She is also the co-founder of Women in the Public Sector at John Jay, a program which educates, engages, and fosters a consortium of students, faculty, public service practitioners, and community members interested in women in public service. It promotes gender equality and provides opportunities to address gender issues in public service.

Dr. D’Agostino is the co-recipient, with WPS co-founder Dr. Nicole Elias, of the 2018-19 Inaugural Presidential Student-Faculty Research Collaboration Award from John Jay’s Office of Student Research and Creativity, for the examination of gender equity in municipalities. Her recent research has focused on women in public administration, including a 2018 co-edited book, Governing in a Global World: Women in Public Service.

Dr. Phillip Atiba Goff – Data Science for Justice

Phil Goff speaks at TED2019
Phillip Atiba Goff speaks at TED2019: Bigger Than Us. April 15 – 19, 2019, Vancouver, BC, Canada. Photo: Ryan Lash / TED

On April 16, 2019, John Jay College’s Franklin A. Thomas Professor in Policing Equity Dr. Phillip Atiba Goff spoke at Session 4 of TED2019 in Vancouver. The program featured eight speakers representing eight projects that are receiving funding from The Audacious Project in 2019. Dr. Goff spoke on behalf of his independent non-profit organization, the Center for Policing Equity (CPE), which was one of this year’s Audacious Projects.

CPE focuses on addressing racism in the United States. According to Dr. Goff, “When we change the definition of racism from attitudes to behaviors, we transform that problem from impossible to solvable.” CPE’s project, COMPSTAT for Justice, is a database leveraging data collected from police departments and cities on police behavior in an effort to identify problem areas where specific police behaviors can change.

With the support of The Audacious Project, CPE wants to extend the results it’s already seen with partners adopting COMPSTAT for Justice, by delivering the project to police departments serving 100 million people across the United States over the next five years.

To hear Dr. Goff’s TED Talk, visit the @TEDTalks Twitter page, where the link to the livestream is still up. You can read more about Session 4 of TED2019 on the TEDBlog.

Nathan Lents is sticking to the science

As an evolutionary biologist, and author of such books as Not So Different: Finding Human Nature in Animals and Human Errors: A Panorama of Our Glitches, From Pointless Bones to Broken Genes, Nathan H. Lents has joined the ranks of scientists whose work is under attack by proponents of intelligent design.

There is no coherent theory about intelligent design; according to Lents, the one commonality is that supporters “don’t buy modern evolutionary theory, or some part of modern evolutionary theory. They hold a whole variety of incompatible positions.” The views of intelligent design supporters range from believing the planet was created less than 10,000 years ago, to finding a role for God in gradual or ongoing acts of creation and evolution, to those who think God “set up” for life to evolve as it has in something Lents calls “the Perfect Pool Shot.”

Lents’s most recent book, Human Errors, came out in 2018 to great excitement from the science and reading communities. When it was published, he thought that intelligent design supporters “would just roll their eyes. I didn’t offer it as a serious critique [of intelligent design], so I didn’t think they would respond in a serious way but they absolutely did; they went on the attack.” Lents said it took him months to learn about the different types of creationists and how to respond to and refute their attacks effectively, promoting scientific thought without getting dragged into the mud.

This month, Lents and two co-authors can be found standing up for modern evolutionary theory in Science, a journal that has been at the center of important scientific discovery and thought since its founding in 1880, reviewing Darwin Devolves, a new book by biochemist Michael Behe. He is among the best-known figures in the intelligent design movement; Lents characterizes Behe as a serious man who views his own work as serious science.

“Michael Behe believes in common descent, the true age of the earth, that all living things have evolved, he believes in all of that. But the only thing that he takes issue with is the source of all this diversity in life, that then gets acted on by natural selection. He thinks that God or a supernatural force of some kind has to provide this new influx of genetic information somehow, periodically, and then evolution can play out for a while. Either it was preloaded in the ‘perfect pool shot’ or there are ‘continuing miracles of life.'”

While creationism and trying to explain science with a creationist mindset have always been with us, in the late 1990s Behe introduced a concept called “irreducible complexity,” and this notion has really taken over those who are trying to marry science and creationism. Irreducible complexity is the idea that evolution must be false because natural selection acts by propagating mutations that create advantage for the organism; however, some structures are so complex that they never could have evolved, because their individual pieces must work together to convey advantage. Behe holds that evolution could not have produced all of the interrelated structures in a complex system like, for example, the eye, because the innumerable steps and parts it takes to make up the eye (and therefore to create vision) aren’t advantageous on their own, and therefore could not have evolved without the hand of an intelligent designer.

Lents doesn’t agree with that theory. “What we do know is that these structures don’t evolve as fully-formed units. When the eye was evolving, it wasn’t like a fully-formed retina — boom — just appeared, and then a full-formed lens, that’s not how it works. The whole thing becomes gradually more complex, and then, of course, many, many steps later it looks like if you remove any one part the whole thing doesn’t work, but that’s because it’s evolving as a unit, not stepwise. It’s not like building a car. The good thing is that, if you look at the eye, we can find intermediates, not in the fossil record but in living things right now, that have an earlier version of the eye.”

In this review, Lents sticks to the science. They point to sections or examples in Darwin Devolves that fail to take into account evidence produced by testing modern evolutionary theory. Although Lents and both of his co-authors have been subject to attacks on their work by supporters of creationism, he says he’s learned his lesson about responding to attacks that are ultimately unserious or political in nature.

“I’ve come to realize, Lents says, “that in these exchanges, my real audience is not the intelligent design community. I’m writing for millions of silent readers who come into this debate innocently and earnestly when they see their children start to learn about evolution in middle school and they want to see what’s out there, they want to read for themselves. So that’s who I’m writing for, the people who are just genuinely trying to find answers about what the science really says, what evidence do we really have, that kind of stuff. So I’m not really speaking to the intelligent design community anymore, I’m just speaking to the general public, trying to correct the record on science.”

In fact, that really sums up Lents’s approach to writing more generally. He wrote his second book for the general public, “first of all to entertain, but also to help them understand how these little quirks that we have in our bodies have come to be, and how to live with them, and survive and thrive.” It’s very important to Lents to advance the idea of a scientific mindset, which he says intelligent design proponents don’t have.

“Science, at its best, comes at the evidence and tries to come up with an explanation that best fits that evidence. And even when that explanation starts to become what we call accepted science, it is still tested. But intelligent design supporters, including Michael Behe, their starting point is that they have a truth that they already believe is true, and then they try to mold an explanation for the science around that preconceived notion. So it’s backwards. And that’s why they end up with egg on their face so often, because they’ll come up with an explanation that fits the limited data that we have at one point in time, and then we just get more data and a fuller understanding and they have to keep revising their explanation. And that’s just not a good way to come up with the truth.”

Lents plans to continue writing fact-based science texts with the general public in mind, even if he does invite further criticisms from the intelligent design community or other conservative elements. He says he’s currently laying the foundation for his next book, “which is about human sexuality in the evolutionary context. If you see a pattern in my work, it’s that I’m getting more and more controversial with each book.” Lents wants to look at human sexuality as it’s connected to the greater natural world, and the ways that social constructs have shaped our expressions of sexuality. His argument? “A label-free approach to sexuality is much more in line with our natural biology. The only thing labels do is create restrictions.”

 

Dr. Nathan H. Lents is a Professor of Biology at John Jay College, as well as the Director of John Jay’s Honors College. Apart from being the author of the two books mentioned above, Dr. Lents blogs at The Human Evolution Blog and on Psychology Today. For more, read his bio.

To read his review with co-authors Joshua Swamidass and Richard Lenski in Science, visit the website.

 

 

John Jay Scholars on the News – Vaccines and the Flu

flu virus illustration

It’s winter, which we sometimes call “flu season.” In fact, “you can catch influenza at any time during the year if exposed to the virus, and its severity is the same regardless of when you get sick,” says Edgardo Sanabria-Valentín. We don’t fully know the answer to why influenza is more common during the colder months. According to Nathan Lents, “The virus is viable for a longer time in cold air, and spreads more readily in dry air. Another reason that may contribute is that winter air dries our mucus membranes, which makes them less effective at preventing viral entry. We also tend to spend more time indoors with closed windows and recirculated air.”

 

A somber anniversary

Mike Wallace

The 2018 flu season was also the 100th anniversary of the infamous global influenza pandemic, a year when more

than 500 million people around the world are estimated to have died from flu. Of that number, 675,000 fatalities came from the United States, with roughly 20,000 from New York City alone. According to Mike Wallace, in his 2018 book Greater Gotham, more Gothamites died of disease in the city than died during World War I; the ongoing war effort actually impaired New York’s efforts to fight the flu, by concentrating soldiers in training camps where disease could spread and by taking much-needed medical personnel away from home to establish medical camps near the battlefields in Europe.

Despite the high numbers of fatalities at home, New York of 1918 had a lower death rate than other major cities (4.7 deaths per 1,000 residents, as compared to Boston’s rate of 6.5 and Philadelphia’s of 7.3). This was attributed by Health Commissioner Royal Copeland to New York’s long history of public health work, and particularly the alleviation of unhealthy conditions around the city at the turn of the 20th century.

Vaccines and you

Dr. Nathan Lents
Nathan Lents

Today, scientific and public health efforts have brought some protection from a repeat of 1918 in the form of vaccines. In the case of the flu, explains Dr. Lents, “Each year’s vaccine is targeted toward the three to four strains that appear to be spreading the most rapidly. The injected vaccine contains killed viruses [from those strains], while the nasal spray contains live but weakened viruses. In both cases, the large dose of viral particles elicits a strong immune reaction from our bodies, including the production of antibodies that can stick around for years or even decades. The second time we are exposed to the same virus, it only takes a day or two to mount the same level of immune response. This ‘priming’ gives the immune system enough of a head start that it usually prevents the infection from ever taking hold.”

Because the influenza virus is so good at mutating from year to year, “no vaccine is 100% perfect, and getting the flu shot will never protect you against 100% of all flu strains,” says Dr. Sanabria-Valentín. But the vaccine will “significantly decrease the risk of getting sick, and will decrease the severity and length of infection, and decrease the chance that you get other people sick” if you do contract the virus.

Vaccinating also helps to protect those around you in other ways, namely by contributing to “herd immunity.” “Some people cannot be vaccinated because they are too young, too old, immune-compromised, or battling other kinds of infections,” says Dr. Lents. When the percentage of people in a population are effectively immunized, it helps to prevent the spread of disease to those who were unable to receive the vaccine. But when the percentage of vaccinated people falls because individuals who otherwise could be immunized choose not to be, it puts vulnerable populations at risk.

Conquering vaccine hesitancy

Edgardo Sanabria-Valentín

“Controversies about vaccinations have been out there since we adopted this preventative measure almost 100 years ago,” says Dr. Sanabria-Valentín. “There are a lot of myths about vaccinations which are peddled by conspiracy theorists trying to sell you something or by people who might have good intentions but got swindled by ill-intentioned people trying to make a fast buck. One of the most popular ones is that vaccines can cause autism in children. This claim was first made in a study that was demonstrated (by many groups) to be fraudulent; no direct relationship between receiving vaccinations and autism has been found. There is overwhelming consensus among scientists and physicians that vaccines are safe and effective even though, like most medical treatments, in very rare cases they can cause side effects and in even rarer instances can cause serious unintended health problems. There is overwhelming evidence that vaccination has helped not just individuals, but humankind.” Although diseases like smallpox, polio and the measles were all but eliminated by vaccine technology, skepticism about immunization–which many attribute to the rise of social media–has caused some long-gone diseases to stage a comeback.

Dr. Lents stated that “in 2017, 80,000 people died of influenza, the highest number in 40 years. If more healthy people had been vaccinated, that number could have been much less. Each person that decides not to vaccinate adds a little bit of risk to the entire population.” This dynamic played out in October 2018, when measles–which was declared eliminated in the US in 2000–broke out in Williamsburg, Brooklyn. The New York City Department of Health confirmed 42 cases in Williamsburg and Bensonhurst as of mid-December, and is currently barring un-immunized students from attending local schools. And according to The Guardian, Europe is also experiencing a surge in vaccine hesitancy and a corresponding growth in the numbers of new measles cases; Europe will see more than 60,000 new cases this year and 72 deaths, the highest number this century.

headshot Evelyn Aranda Jaque
Evelyn Aranda Jaque

It is generally agreed that fears about vaccine side-effects are overblown, and contradicted by scientific consensus. “Vaccines are constantly monitored and modified as circumstances dictate. The FDA does not approve a vaccine unless initial trials indicate the benefits clearly outweigh the risks. In response to vaccine safety concerns today, healthcare providers have to give vaccine information sheets to recipients clearly describing the risks and benefits of the vaccine. And finally, vaccines are subject to particularly high safety standards because, unlike other health treatments, they are given as preventive measures to protect healthy people,” explains Dr. Evelyn Aranda Jaque. “Although vaccination is not 100% effective, studies on flu vaccination programs have shown that people who get vaccinated are less likely to be seriously ill or die in comparison with those who do not vaccinate. We must consider that the widespread use of vaccines for life-threatening diseases in the United States has led to a dramatic decrease in their incidence.”

 

Evelyn Aranda Jaque is a substitute Associate Professor at John Jay College, where she teaches classes including Immunology and Microbiology. She received her Ph.D. from the Physiology Department at Pontificia Universidad Católica de Chile. Dr. Aranda Jaque’s research since her doctorate days has largely focused on the role of angiogenesis (the formation of new blood vessels) in tumor progression.

Nathan Lents is a Professor of Biology and Director of the Honors Program and Macaulay Honors College at John Jay College. He holds a Ph.D. in human physiology and postdoctoral training in computational biology from NYU. In addition to his laboratory research, Dr. Lents writes popular science articles, blog and books. His most recent book is Human Errors: A Panorama of Our Glitches from Pointless Bones to Broken Genes.

Edgardo Sanabria-Valentín is the Associate Program Director of John Jay College’s Program for Research Initiatives in Science and Math (PRISM) as well as the college’s Pre-Health Careers Advisor. He holds a Ph.D. from NYU-School of Medicine, and spent three years working in the biotechnology industry. Dr. Sanabria-Valentín is the recipient of the ESCMID Young Scientist Award (2007), a Leadership-Alliance Schering Plough Graduate Fellowship (2006), and the NBHS-Frank G. Brooks Award for Excellence in Student Research (2001).

Mike Wallace is a Distinguished Professor of History at John Jay College and author of Greater Gotham: A History of New York City from 1898 to 1919. Dr. Wallace is also the co-author of Pulitzer Prize-winning Gotham: A History of New York City to 1898 and the founder of the Gotham Center for New York City History at the CUNY Graduate School. He received his undergraduate and graduate degrees from Columbia University.

John Jay Scholars on the News – The Opioid Epidemic

The terms “opioid crisis” or “opioid epidemic” have come to be used as political buzzwords, but what does it really mean to say that America is in the grip of an “opioid epidemic”? According to the Centers for Disease Control, more than 72,000 people in the United States died as the result of an overdose in 2017, and approximately 30,000 of these were from the use of fentanyl and other synthetic opioids — that comes to around 100 per day! Fentanyl, a powerful opioid designed to treat severe and chronic pain, is roughly 100 times stronger than morphine, and is currently being used to adulterate other abused substances, making these overdoses likely to increase.

From the perspectives of policy, policing, and public health, this rash of deaths is worthy of further consideration. John Jay College scholars from across disciplines and research areas tell us what they think has contributed to the trend of deaths from opioid abuse and what approaches may be best suited to tackling the problem.

What is different about the pattern of drug abuse we are seeing today that has caused it to be referred to as the “opioid epidemic”?

Jeff Coots (Director, From Punishment to Public Health Initiative): One main reason for concern around opioids today is that they are simply more deadly than the other drugs we consume. However, the rates of overall illicit drug use are actually quite steady — especially when we remove cannabis consumption from the conversation. The latest results from the National Survey on Drug Use and Health show steady illicit drug consumption from 2002-2013 at about 4%, with those aged 18-25 using a bit more than twice the rate of other age groups. We do see a slight increase in heroin consumption as prescription opioids become less available, but this doesn’t impact the overall rates of illicit consumption.

Heidi Hoefinger (Visiting Scholar, Anthropology): The situation is considered an “opioid epidemic” due to the size of the problem now, and its potential for growth. But this issue is also getting more attention than past drug “epidemics” because it’s a white, middle-class problem, particularly here in New York, with Staten Island and Long Island having some of the highest rates of use and overdose. There has definitely been a “softer” approach to this epidemic as opposed to the “crack epidemic” of the 1980s, which saw much more aggressive law and order efforts resulting in mass incarceration. Many poor people of color are still sitting in prison because of that heavy-handed approach. It’s definitely a good thing that opioid addiction is currently being viewed as more of a public health issue, but it’s extremely problematic that Black and Latinx folks continue to suffer the consequences of racist applications of drug policy.

Can you point to a few of the key factors that you believe are to blame for the current public health crisis?

Jeff: The origins of the current crisis began with the marketing of OxyContin as a non-addictive painkiller in the 1990s followed by the introduction of “pain” as the fifth vital sign in 2001. This led to higher rates of opioid prescription drug use and related overdose fatalities in the early 2000s. The second “wave” of opioid-related deaths are attributed to increased heroin consumption starting in about 2010, following a crackdown on prescription opioid distribution — consumers simply switched to the cheaper and more available opioid. The third wave is attributed to the increased presence of synthetic opioids like fentanyl in the market, starting in about 2013. These synthetics can be much more potent and make it difficult for users to control their dosage, leading to more overdoses.

Marta Concheiro-Guisan (Assistant Professor, Forensic Toxicology): Other socioeconomic factors like unemployment and economically-depressed areas should also be considered in trying to understand the whole problem and the populations most affected by it.

Heidi: The biggest drivers are probably Big Pharma and corporate greed because pharmaceutical companies were deceptive about the true effects of opioids, claiming they were non-habit inducing. They also offered incentives to doctors for prescribing, which led doctors to over-prescribe opioids instead of safer alternatives. Insurance companies typically cover opioids as opposed to alternative therapies, so they’ve played a role in this as well. It’s encouraging to see that NYC (among other cities) is suing some major pharmaceutical companies for their role in the epidemic, but there still needs to be more accountability on the part of Big Pharma.

What are the implications for American society should this systemic issue continue unabated?

Jeff: I think we are having a really important debate in the country right now about how our collective response to drug use differs along racial lines. Drug Policy Alliance and Columbia University co-hosted a conference in 2016 to highlight how the white opioid user who may have started on prescription drugs and then switched to heroin is considered a victim of circumstance and provided overdose treatment, rehabilitation and a call for compassionate public health responses. Meanwhile, black and brown heroin addicts who may not have had health insurance and access to prescription drugs tend to get jail cells, court-mandated treatment and moralizing “just say no” campaigns grounded in personal responsibility. Obviously, the the shift towards funding treatment and reducing criminal justice involvement is welcome, but the carnage reaped in the previous regime of zero tolerance and deterrence must be acknowledged and reconciled at the local and national levels.

Heidi: It has been compared to HIV in some arenas, in that it’s affecting a marginalized and stigmatized population (e.g., drug users) but it’s not getting the same attention and funding it deserves. The numbers of overdoses and deaths will likely continue to rise as long as the stigma exists, and as long as pharmaceutical companies continue to operate unchecked, as long as doctors continue over-prescribing, as long as insurance companies don’t see the value in covering alternative treatments, and as long as harm reduction remains undervalued and underfunded.

Marta: The biggest impact on American society is, of course, the tragedy of the families affected by this unprecedented health issue, and the loss of so many young people’s lives. The Centers for Disease Control and Prevention estimates that the total “economic burden” of current opioid misuse alone in the United States is $78.5 billion per year, including the costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement.

The Opioid Crisis Response Act of 2018 was recently signed into law. It authorizes new funding and grants to address the crisis, advances initiatives to raise awareness and to get more first responders to carry naloxone, and drives increased coordination among federal agencies to stop drugs like fentanyl at the border, among other measures. Do you think this bill takes the right approach to dealing with the crisis? Does it go far enough?

Heidi: Many of these are welcome changes, and are actually similar to Obama’s opioid plan from 2016, but the problem is that this plan doesn’t allocate much more funding — which is needed. If this is a serious public health problem, it should receive funding and attention similar to that provided for HIV/AIDS or Ebola, as well as a similarly concerted, multi-organizational response. But addiction is still a very stigmatized condition, and not taken as seriously as it should be. People with addictions are still often blamed for their own demise, and not viewed in the same light as people with other chronic illnesses.

Marta: From my point of view, one critical element in addressing this crisis is the treatment of addiction as a health issue rather than as a stigma, and a drastic improvement of current services and their accessibility. Another important aspect is education for the general population and among professionals such as medical doctors. More funds are also necessary for the forensic sciences to develop a clearer picture of the current crisis, to know all the opioids that are involved, to monitor future crises, and to research addiction.

Jeff: We need to invest heavily in reducing demand and mitigating the risks associated with consumption, rather than focus on interrupting supply. Efforts to control access to drugs have failed for over a century. In reducing demand, we need to do a better job of addressing pain and trauma, take a hard look at our overreliance on pharmaceuticals and reduce the number of people who become addicted in the first place. In working with those already experiencing opioid dependence, we need to provide competent and evidence-based care including Medication Assisted Treatment (MAT), which is the gold standard for treating those with opioid disorders. In terms of mitigating risks, increased naloxone access is crucial, but increased use of other Harm Reduction strategies is needed as well.

What do you believe is the best way to address this epidemic?

Marta: This epidemic has to be addressed with a multidisciplinary approach, as indicated by the National Institute on Drug Abuse (NIDA) and other governmental agencies. Promoting the use of naloxone, the improvement in the accessibility of medical assistance and addiction treatments, the expansion of prevention programs in schools and for the general public, and increasing funds for the forensic sciences and addiction research are among what I consider the priority areas.

Jeff: The best way to reduce the impact of opioid overdose fatalities is to focus on saving the lives of those who choose to consume opioids. This strategy, more commonly known as Harm Reduction, focuses on reducing the negative side effects associated with illicit drug use, rather than punishing and/or moralizing at those who engage in use. These strategies include needle exchange programs, peer-based education, MAT programs, and safe consumption facilities, all of which treat those who consume illicit drugs as human beings worthy of compassion and competent medical care for their medical issues. As I noted earlier, our previous strategy of interrupting supply and punishing consumption — i.e., the War on Drugs — has not reduced the rates at which our citizens consume illicit drugs. It has, however, made that consumption more dangerous and more damaging for those communities with higher rates of use and criminal justice presence.

Heidi: Societal attitudes towards drug users and people with addictions need to change. For this to happen, people need to understand that drug use has always been a part of human history, drug users are not inherently bad people, and people will continue to want to alter their consciousness or treat pain through drug use. People also need to understand the racialized history of drug policy in this country, and that laws against drug use (which are unevenly applied across race and class) were implemented for racial, class and economic reasons (and because of who was using the drugs), not necessarily because of the harmful effects of the drugs. When people are exposed to this history, and these realities, then perhaps stigma against drug use will change, and people affected by the current epidemic will get the proper help that they need.

In addition, we need more funding for harm reduction and evidence-based drug education programs in middle schools, high schools, college and universities. Not the “Just Say No” type, because those don’t work. But the kind where students can ask open, honest questions and get factual, evidence-based, non-biased, non-moralistic responses so they can know the potential effects and risks and make more informed decisions. And there also needs to be more support for medication-assisted treatment programs (like methadone and buprenorphine), as well as harm reduction programs like DanceSafeNYC that provides factual, evidence-based drug education and drug checking kits at music festivals and events. These types of initiatives take harm reduction beyond syringe exchange programs and make them more accessible to a diverse range of young people, which ultimately saves lives, and may start to turn the tide of this epidemic.

 

Marta Concheiro-Guisan, Ph.D., is Assistant Professor of Forensic Toxicology at John Jay College. She has experience in the development and validation of new analytical methods and toxicological analysis of different types of specimens–including plasma, blood, urine, oral fluid, hair, sweat and other tissues. She has participated in Drugs and Driving Research Projects, including the ROSITA (Road Site Testing Assessment) and DRUID (Driving Under the Influence of Drugs) European Projects, to study alternative matrices to detect drug impairment, and in clinical protocols involving different types of drugs of abuse and drug exposure during pregnancy. Dr. Concheiro-Guisan has more than 40 publications in peer-reviewed journals.

 

Jeff Coots, JD, MPH, serves as the Director of the From Punishment to Public Health (P2PH) initiative based at John Jay College. Prior to joining P2PH, Mr. Coots completed a joint Juris Doctor/Masters of Public Health degree program at Northeastern University School of Law and Tufts University School of Medicine, where he focused his studies on the social justice and health impacts of mass incarceration. While in Boston, he served as an Albert Schweitzer Fellow and delivered dialogue-based “Health Reentry” workshops to introduce strategies for working in collaboration with a primary care provider to prevent new infections and mitigate the effects of chronic disease.

 

Heidi Hoefinger, Ph.D., is a Visiting Scholar in John Jay College’s anthropology department, where she teaches a course on gender and sexuality within the social and cultural contexts that exist in an increasingly integrated but unequal global world. She also works on a large European Research Council (ERC) project led by Kingston University in London, in which she is the New York-based ethnographer looking at anti-trafficking efforts in New York City, and their effect on sex work/ers and migration policy. Among her areas of interdisciplinary research interest are gender and sexuality, globalism and transnationalism, and drug use.

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