Vox Sentences - Colonialism in public health

Tuesday, December 19, 2023

Good afternoon,

Here’s the agenda today:

UP FIRST: Bureaucratic roadblocks amid a syphilis epidemic

CATCH UP: Texas ratchets up showdown with the Feds over immigration

—Dylan Scott, senior correspondent

Public health paternalism deepens a US syphilis outbreak

Tara Rose Weston for Vox

Syphilis cases have been exploding among Native Americans in South Dakota and yet public health agencies are withholding data sought by the tribal health leaders trying to mount a response.

Syphilis rates are up across the country, but they are highest in South Dakota. And in South Dakota, four out of the five people who contract syphilis are Native Americans. Meghan Curry O’Connell, who works for the Great Plains Tribal Leaders’ Health Board, is desperate to do something to slow the spread. But she doesn’t even always know who’s sick in the communities she serves, she told Vox’s Keren Landman.

Let’s break down the problem:

• Syphilis must be confirmed by a lab test administered at a hospital or a clinic.
• If the test comes back positive, the health care provider is supposed to notify state and federal health agencies — but they are not required to tell tribal public health workers.
• Because Native American tribes are legally sovereign nations, tribal epidemiologists can’t themselves access state or federal data on who has tested positive. They have to request that information from the state health department or the federal Indian Health Service.
• Those state and federal authorities are required by law to share data with tribal health officials. In practice, they often don’t. 

When Keren inquired of the state why not, the health department offered a weak argument that the Native American authorities were not equipped to handle sensitive information. (Tribal officials pointed out that the state and tribes have a long history of sharing information.)

“People don’t even realize how little we’re able to do if we don’t know ... who is sick,” O’Connell told Keren.

It is the worst of public health colonialism: Bureaucratic rigidity and paternalism are actively obstructing efforts to stop an outbreak that threatens both adults and infants.

This is the latest in a series of deeply reported articles Keren has written on the syphilis outbreak in South Dakota. I asked her what keeps her coming back to this storyline:

"There's nothing quite like a sexually transmitted disease to show how closely public health is linked with a society's culture. Diseases spread more readily when the activities that spread them are stigmatized — that's culture. And the policies that determine how effectively we respond are weaker when the people [they affect] are systematically marginalized — that's also culture, baby."

Read the rest of her deep dive here.

America’s border policy wars intensify

Michael Gonzalez/Getty Images

Texas Gov. Greg Abbott has signed a bill that makes it illegal to cross the US-Mexico border into his state, giving local authorities more leeway to make migrant arrests and setting up a showdown with the Biden administration.

Abbott has been hyping the threat of border crossings and instituting legally questionable immigration policies that allow the state to crack down because, in his words, the Feds will not. The new law would make it a misdemeanor to enter the state from any point except a legal port of entry. 

Abbott is portraying the act as “extreme.” At a bill signing on Monday, Abbott claimed illegal border crossings could drop by up to 75 percent as a result of the new policy.

The law is set to take effect in March. The Justice Department isn’t saying whether or not it will sue over the law. But given immigration policy is supposed to be set by the federal government, a confrontation of some sort seems unavoidable.

• This is the latest in a series of anti-immigration actions by Texas. Abbott had already authorized Operation Lone Star, allowing state law enforcement to patrol the borders and make arrests (on private land only, with the consent of the property owner). The state has spent billions on the campaign.
• Some of Abbott’s immigration policies have already been blocked by the courts. The state established a 1,000-foot floating barrier and placed razor wire along the Rio Grande River. Federal judges have ordered both should be removed.
• The new Texas law could end up at the US Supreme Court. Opponents say the law violates the Constitution, and legal experts believe any litigation could lead the high court to revisit a 2012 SCOTUS ruling that determined the federal government had the ultimate authority to set immigration policy.

• Icelandic volcano erupts. It’s not every day you see a sight like this. As of now, the eruption appears less dangerous to a nearby power plant and (evacuated) town than was initially feared. [NYT]
• Virtual doctor visits lead to surprise bills. When Sarah Kliff was writing about this issue a few years ago, the fear was you could end up at a hospital ER through no fault of your own and still face a huge balance. Now, patients are logging on for a video call with their doctor and then get charged hundreds of dollars for it. [NPR]
• Pope Francis has slowly made the Catholic Church more welcoming to LGBTQ people. His recent decision to permit priests to bless same-sex couples was the latest in a series of small steps to gradually relax the Church’s attitudes on gay rights, even if its official doctrines remain largely unchanged. [AP]

How mindfulness went mainstream

Jonathan Majors’s arrest and conviction, explained 

Why are Christmas movies all about kissing? A theory.

How to navigate a chronic illness

Today’s crossword

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