April 28, 2006

Don't Just Remember. Act!

During the month of April, the world commemorated the victims of some of humanity's most heinous offenses. April 6 was Remembrance Day in Rwanda and just this week, April 25 marked Yom Hashoah, or Holocaust Remembrance Day. These remembrance days provide the opportunity to reflect on the tragedies of the past and mourn the millions of innocent human beings murdered in the last century.

Unfortunately, remembering is not enough. Even as we recall the horrific crimes of genocide that marred the twentieth century, the seeds for a future remembrance day are being cultivated. The current situation in the Darfur region of Sudan has already been labeled by President Bush and others as "genocide," making it the first genocide of this new century. However, the inaction of the world community that marked previous responses -- and is so condemned each remembrance day -- is sadly being repeated.

The campaign by the government-backed Arab militias, known as janjaweed, to wipe out villages and populations of African tribes in Darfur -- tribes, it should be noted that, like their attackers, are overwhelmingly Muslim -- is now over two years old. Hundreds of villages have been destroyed. Hundreds of thousands of villagers have been forced to flee into unprotected refugee camps in neighboring Chad, camps the janjaweed have begun to terrorize as well. The estimated number of dead ranges from 100,000 to 400,000 from attacks, starvation, and disease.

Action in response to what has consistently been characterized as the world's greatest humanitarian crisis has been cautious and ineffective. Foreign governments took the word of the Sudanese government that the militias would be reined in, echoing Munich. An African Union peacekeeping force, sent with two few soldiers and too limited a mandate, made little difference, echoing Rwanda. The lessons that ought to be reinforced by the multiple remembrance days are being ignored.

To be fair, the United States government has probably done more to confront this genocide than any previous genocide -- a bar that was pathetically easy to surpass -- but every incremental step has been hard fought by a dedicated group of individual activists, lawmakers, and human rights organizations. A small victory came this week when a US-sponsored sanctions directive was issued by the United Nations Security Council to be imposed on four Sudanese military officers. On Sunday, this month of remembrance will conclude with a (hopefully) giant march in Washington, DC, to urge further and more useful action.

But progress is slow and every delay costs thousands of innocent lives. These are lives that the world will somberly commemorate in the future with some version of a Darfur Remembrance Day. The inability to confront an unfolding genocide even as we commemorate genocides of the past proves that remembrance is only one step. The other step toward truly making genocide prevention a global priority is action. And it is up to both citizens and governments to act.

While governments have the diplomatic, economic, and even military tools to make a greater impact, there is much that can be done on an individual level, beginning with lobbying the government to take a more proactive approach in Darfur. In addition, one could donate to organizations providing direct aid to victims and anti-genocide advocacy, or one could become educated about the situation and inform friends, or one could write letters to local editors asking for more consistent media coverage, and one could invite others to take these steps as well. These actions may not make headlines, but they are the small actions that ignite the engine of change.

As April concludes and some of the genocide remembrance days are behind us for another twelve months, it is time to take the second step toward genocide prevention. It is time to act to stop the genocide in Darfur. Now.

To take action today, join the Million Voices for Darfur being represented at this weekend's march. Check http://www.savedarfur.org/home or http://www.genocideintervention.net/ for updated information and more ideas for action.

April 21, 2006

Abstinence from Reality

Imagine you have in your hands the capability of immunizing every American woman from HPV, a sexually-transmitted disease, several strains of which are the primary cause of cervical cancer. Science has shown that by eliminating these strains of HPV, a vaccine could significantly decrease instances of cervical cancer and other illnesses resulting from HPV. What would you do?

I hope you would find a way to get that vaccine to as many women as possible -- in the US and globally -- to help decrease, even eliminate, the possibility of contracting HPV and cervical cancer.

Unfortunately, this compassionate route may not be what the people actually charged with making such decisions settle upon. Later this year, the FDA is expected to approve an HPV vaccine. However, the committee that makes recommendations regarding immunizations may not recommend the HPV vaccine for widespread use. The Bush Administration is cool to any policy -- scientific or otherwise -- that could be construed to implicitly condone premarital sex. As Senator Tom Coburn puts it, "Premarital sex is dangerous, even deadly. Let's not encourage it by vaccinating ten-year-olds so they think they're safe." How's that for a pro-life stance?

Of course, cervical cancer is also "dangerous, even deadly." In the US, 5,000 women die each year of cervical cancer. The number who die of the disease globally is nearly a quarter-million. Senator Coburn would have us ignore a tool that could decrease these numbers for fear that protecting women in this way may encourage more promiscuous behavior. Even if decreasing/eliminating the risk of HPV and cervical cancer had been shown to increase promiscuity, and it has not, are the 5,000 lives that could be saved so expendable as to be sacrificed in the name of a moral principle -- sexual abstinence before marriage -- many Americans do not even ascribe to?

By promoting abstinence as the only legitimate way to prevent STDs or unwanted pregnancy, the Bush administration has transformed health decisions that ought to be based on science into political decisions based on morality. According to researchers in various branches of the government, government scientists are being kept on a very tight political leash that inhibits the free and open inquiries required to make valuable scientific advances. This merger of science and politics has allowed the Administration to pursue its social goals -- like abstinence programs -- by using selective science. Of course, this is all perfectly consistent with the Administration's complete aversion on many topics to dissenting voices and evidence.

What about a hypothetical HIV vaccine? Certainly, a vaccine against the most deadly STD would be distributed immediately and en masse. Don't be so sure. Reginald Finger, former medical advisor to the conservative group Focus on the Family, says, "With any vaccine for HIV, disinhibition (the removal of risk or fear) would certainly be a factor and it is something we will have to pay attention to with a great deal of care." Before dismissing Finger's opinions as that of an out-of-touch ideologue, know that he sits on the very committee charged with making immunization recommendations. His stance should not be surprising as the logic is consistent -- an HIV vaccine would decrease the risks of premarital sex and thus, could lead to greater promiscuity.

There can be no question that abstinence is the most effective method of preventing STDs and unwanted pregnancies. Teaching abstinence is useful and healthy. However, there can also be no question that the majority of Americans do not practice abstinence before marriage. In fact, many Americans see premarital sex as normal and sensible, not immoral. Denying those who choose to engage in premarital sex -- an activity that, by the way, is perfectly legal -- tools that can improve their health or save their life, whether it be the HPV vaccine or education on contraception, is not a policy at all. It is the imposition of one group's morals on the health of all Americans in deliberate disregard of reality.

I invite those making the HPV vaccine recommendations to open their eyes and look beyond the political goals their bosses hope to accomplish. If they cannot, I invite them to look in the eyes of the families of any American who contracts an illness the vaccine could have prevented and explain themselves. Maybe then they would see reality.

April 14, 2006

Updates and Notes

Thanks to two sedars and a knee injury, time was limited this week for a column. Instead, here are some updates on recent topics......

Genocide in Sudan: This week, rebel forces attacked the capital city of Chad, signaling the potential expansion of the Darfur conflict into a wider Chad-Sudan war. The Chad rebels launched their attack from Darfur and the Chad government contends they were supported by the Sudanese government. Meanwhile, the janjaweed militias who have been committing genocide of African tribes in Darfur, expanded their attacks into refugee camps across the Sudanese border into Chad. The escalation of violence and the expansion of the conflict show that the current African Union peacekeeping force is inadequate.

The African Union is set to cede control of the Darfur mission to United Nations peacekeepers later this year. However, earlier this month, the Sudanese government blocked a high-ranking UN official, Jan Egeland, from visiting Darfur as scheduled. "We are having an endless nightmare of administrative obstacles to our work in Darfur," Egeland said. As bureaucracies grind, the suffering continues.

Here in the US, the House passed the Darfur Peace and Accountability Act this week calling for a Presidential enjoy to the region and sanctions against the Sudanese government. The Senate passed a similar bill and the two houses will now meet in committee and attempt to work out a joint bill to send to the President to sign. This is a positive, if late and continuously slow, development.

Darfur advocacy groups are planning a significant march in Washington, D.C., at the end of the month. They hope to gather a million petition signatures prior to the march - click here to add your name.

Health Care in Massachusetts: The rosy political alliance between a conservative governor and a liberal legislature became a bit less rosy when Governor Mitt Romney line-item-vetoed several provisions of the much heralded Massachusetts health care plan. Romney vetoed a fee employers would have to pay if they did not provide health care to their workers, gaining the ire of Massachusetts House speaker, Sal DiMasi.

While the reception of the health care bill remains overwhelmingly positive, there are many questions about its applicability on a larger scale. The Boston Globe concludes in this article that the plan is unlikely to work as a national model.

Immigration: I have been asked by several readers for thoughts on the current immigration debate. I don't feel qualified to discuss the particulars of the bills being discussed, but I have been moved by the passion and organization of the recent rallies. I believe that in several decades, when Hispanics have political power proportional to their numbers, we will look at this moment as a key turning point. I found this article by Juan Williams in the Washington Post particularly thoughtful on the subject.

Just Weird: I read this week that McDonald's is experimenting with using call centers to take drive thru orders at some restaurants. The customer will pull up and be connected to a person at a call center perhaps thousands of miles away (though at this point, still in the US -- phew) through the internet. The call center will take the order, which will appear on screens in the kitchen at the physical restaurant. The system is said to improve efficiency, accuracy, and customer service. It will also result in decreased labor costs, code for fewer workers. I found this development somewhat strange and disconcerting, particularly since one of the first phrases I spoke as a working person was: "Welcome to Corky's. Can I take your order?"

April 07, 2006

A Remedy from Massachusetts

If I feel a pain in my backside, I go to the doctor and have it checked out. If it's something serious, I get it fixed, and if it's not, I stop worrying about it. I do not let the problem linger. I'm able to take preventative measures, catching potential emergencies in their early stages before they develop into more serious and expensive conditions.

I am able to do this because I have health insurance. Forty-five million Americans cannot do this because they do not.

In this land of plenty, it is an outrage that so many citizens are not covered for the medical costs to keep them healthy. Not having health insurance is both bad for one's health -- the death rate for people without health insurance is 25% higher than for people with insurance -- and bad for one's pocketbook -- the leading cause of personal bankruptcy is unpaid medical bills.

No American should be left to face this situation, yet finding a way to deliver more health coverage to Americans has rarely been a successful political endeavor -- just ask Hillary Clinton. Conservatives want to allow health care consumers more autonomy to select only the coverage they need, while liberals want the government to provide a safety net of insurance to everyone. The two visions of the problem are diametrically opposed and neither side has been willing to work with the other to solve the problem.

Until now. In Massachusetts, a conservative governor and a liberal legislature came together to develop -- believe it or not -- a reasonable compromise. Facing a loss of federal government aid if the number of uninsured citizens was not reduced, Massachusetts put together a program designed to cover 95% of the state's residents within three years. The plan confronts three distinct categories of uninsured -- the very poor, the working poor, and the not poor at all -- with three distinct solutions.

For the very poor, those living below the federal poverty level, the state will provide essentially free coverage, following a liberal model of state-provided coverage. For the working poor with incomes above the poverty level but too meager to afford health coverage, the state will pay part of their premiums on a sliding scale based on income. This is a liberal solution -- the state pays -- with a conservative slant -- only as much as you need. And for the not poor at all, a surprisingly large group of mostly young male professionals of good health who have chosen to live without health care even though they could afford it, the state will force them to pay a penalty of up to half the cost of private health insurance if they still choose to go without insurance. This is a conservative solution -- adjust incentives to adjust behavior, allowing for personal autonomy -- with a liberal slant -- get more people covered.

On the national scene, a similar compromise is less likely. Congressional Republicans, especially House members from safe seats, are intent on expanding a program of health-savings accounts -- tax-free accounts individuals can use to pay for health care -- as the solution to the problems of health insurance. Unfortunately, HSAs are of little use to those who simply cannot afford health insurance. Over 70% of uninsured Americans have family incomes under $50,000. HSAs offer these citizens nothing more than the current unaffordable system.

The Massachusetts plan remains untested and some on both sides are not sure it can be successful. I'm not one qualified to evaluate it one way or the other. But the plan is already a triumph in two senses. First, it shows that Republicans and Democrats can work together and compromise toward a common goal. And second, it shows that a common goal of the two parties is an increase in the number of Americans with affordable health insurance.

Sensible policy crafted for the benefit of the people? As hard as it may be to believe, such things can happen. At least in Massachusetts. In Washington, partisanship and stubbornness remain pains in all of our backsides -- conditions we must treat quickly. Say, in November.