Racial and economic disproportionality

On February 2008 The Seattle Times published on their editorial page a guest piece on Equity and social justice. The election of Senator Barack Obama to the Presidency of the United States should increase the momentum to significantly erode racial and economic disproportionality. This will be particularly important as this nation’s racial make-up continues to undergo rapid change.

Is this of local concern? African Americans, Native Americans, Latinos and some Asian nationalities are aggregately worse off now than they were in 1970. Even updated census data would tell us the income inequality has seen rapid growth in our community. We need to be aware that the history of this country has taught us that communities with social unrest eventually see the erosion of their quality of life. Businesses relocate elsewhere and talented people find more suitable environments for work, play and to raise their children.

Bill Block who is leading the effort to end homelessness in King County sent me an email link to a New York Times article that discussed income in equality in five metropolitan areas, including King County. Researchers were from the University of Texas Inequality Project. The article reports ”According to Mr. Galbraith and Mr. Hale, much of the increase in income inequality in the late 1990’s resulted from large income changes in just a handful of locations around the country — precisely those areas that were heavily involved in the information technology boom.” The report shows that income inequality was the result of high technology investments in our area.

The 21st Century economy will be a technologically robust era. We are going to continue to invest in the expansion and enhancement of our tech industries. Does that mean we will also continue to be ravaged by poverty and race?

The point of the University of Texas research is not to discourage technological growth. It is to call our attention to its affect. But, we also know that out of the box solutions are being undertaken, explored, and researched in this community. We are the one community with all the tools and resources to reduce the impact of poverty. It will be done if we make considerably more strategic investments in early childhood education both locally and nationally. We also need to continue to rethink and retool our K-!2 schools. Most importantly, our efforts must focus on our poorest zip codes. In those zip codes lay the seeds that may fruitfully undermine our long-term quality of life.

Early Childhood investments are absolutely critical. There is cutting edge research being conducted at the UW Institute of Learning and Brain Sciences. They and other researchers would attest that before birth, an infant learns the “melody” of its mother’s voice. A newborn’s brain is only about one-quarter the size of an adult’s. It grows to about 80 percent of adult size by three years of age and 90 percent by age five. Some of the first circuits the brain builds are those that govern the emotions. The first two emotions are opposites: feeling calm and relaxed and feeling distress. Beginning around two months of age, these start to evolve into more complex feelings. During the first six years, its brain will set up the circuitry needed to understand and reproduce complex language. A six-month-old can recognize the vowel sounds that are the basic building blocks of speech.

Early Learning unquestionably makes a significant difference in the lifetime of an individual. Much of who we are is established between 0-5. Learning literally grows the brain. So, reading to and teaching children to read is an absolute must. But, the exposure to art, music, play, neighborhood, and outdoors activities are also powerful learning tools.

As a state and local priority we must reach every family with children between the ages of 0-5. If necessary, we should pair families in need of help with volunteers who can provide reading and artistic resources. We must do the same for children are under the care of unlicensed childcare providers. We must provide substantial funding for this effort with private and public sources.

In addition, the educational system must work for children in poverty. A Harvard retrained African American, Geoffrey Canada whose book “Whatever It Takes: Geoffrey Canada’s Quest to Change Harlem and America’ makes an incredibly strong case for reducing the impacts of poverty on the educational outcomes of children. It requires major system reform, parental training, and community accountability. We should attempt to uniformly replicate his efforts in the schools where we have significant participation in our free breakfast and lunch programs.

I have often heard, the poor shall be with us always. The context of the phrase denoted our indifference, thus our acceptance of poverty. Yet, we have come to believe we can change the world with technology. We have already changed our community by using the wealth generated by technology. Now is also the time to believe that we can eventually bring poverty in our community to its end.

Learn more

• Equity and Social Justice editorial
• Many Theories on Income Inequality, but One Answer Lies in Just a Few Places
• University of Texas Inequality Project
• Place Matters
• Why Does PLACE Matter?
• Neighborhood property values predict local obesity rates better than education or incomes
• Spatial factors and location are often missed, but critical, pieces of the puzzle in developing public and private policies that support working families.
• Harlem Children’s Zone
• PBS: Zero to Three Debate
• Zero to Three
• Bill and Melinda Gates Foundation Early Learning Initiative
• Eashington department of Early Learning
• Early learning: parents make a difference
• Talaris Institute
• Ready at Five Partnership
• Early Literacy and Brain Development Resources
• What We Know About How Children Learn
  
• Smarty Brains: High-IQ kids navigate notable neural shifts
• A Taste Of Success by Geoffrey Canada

Converge

The dictionary defines the word convergence as “To come together from different directions; meet.” This past week there were two disparate articles that raise both our hope and our concern about pandemic diseases. Each, standing alone, was not particularly significant. But, when read together they are disconcerting.

The first article was one of hope. This article, “Deep in the Rainforest Stalking the Next Pandemic” was written about Nathan Wolfe, a 38-year-old visiting professor of epidemiology at Stanford. Dr. Wolfe states, “Before, the best thing you could do was develop a vaccine, but now people are recognizing that’s not going to be enough.”

“If you find diseases before they’ve really emerged,” he continued, “you can control them early on, before you get a major epidemic.” The article continues, “With the goal of identifying more of these “little sources” — new disease-causing pathogens — and choking them off, Dr. Wolfe started the Global Viral Forecasting Initiative this year. If new disease strains could be culled before they had a chance to take hold in humans, he reasoned, health organizations would have to spend less money and energy on developing expensive vaccines and treatment drugs.”

The second article was a report from Lloyd’s of London. Their Emerging Risks Team issued a new report on the threat posed by a global pandemic.

The report, “Pandemic – Potential Insurance Impacts” focuses on the threat to the global business community and, in particular, the insurance markets of a global pandemic.

The report concludes that a pandemic is inevitable; explaining that with historic recurrence rates of 30-50 years it is prudent to assume that a pandemic will occur sometime in the future.

Trevor Maynard, Manager, Emerging Risks, at Lloyd’s and the report’s author says: “The significant message is that society should not optimize to one particular scenario as a worst case. Much has been said of the 1918 Spanish Flu epidemic, which is said to have killed up to 100 million people worldwide. While Avian Flu is seen as the most likely next pandemic, we have to ensure we are prepared for other types of pandemics that may require different responses and pose different challenges —some of which may well have higher rates of mortality than flu.”

Maynard goes on to say, “The threat of pandemic to the global economy cannot be underestimated.” He explains. “If you look at the example of a recent limited pandemic, such as SARS, the regional economic impact was severe and a repeat of the 1918 Spanish Flu outbreak, even without the current economic conditions, would be expected to reduce global GDP by between 1% and 10%.”

These two articles of warning and prevention are a reminder that pandemics remain a constant and extraordinary threat. The world population in 1918 during the Spanish flu pandemic was 1.8 billion people. Today, according to the Population Reference Bureau, in 2008 the world population is 6.7 billion: 1.2 billion people live in regions classified as more developed by the United Nations; 5.5 billion people reside in less developed regions. “We will likely see the 7 billion mark passed within four years,” said Carl Haub, PRB senior demographer and co-author of this year’s Data Sheet. “And by 2050, global population is projected to rise to 9.3 billion. Between now and mid-century, these diverging growth patterns will boost the population share living in today’s less developed countries from 82 percent to 86 percent.” Over half live in urban environments. Never in human history has the available supply of fuel for a pandemic illness been greater.

According to USA Today, the threat posed by infectious diseases is of growing and immediate concern to infectious disease experts. A soon-to-be released report by the non-profit Trust for America’s Health asserts, “infectious diseases from the developing world are anything but “a back-burner concern.”

The report, “Germs Go Global: Why Emerging Infectious Diseases Are a Threat to America,” cites National Intelligence Estimates that conclude outbreaks of new and resurgent infectious diseases, many of which “originate overseas,” kill more than 170,000 people in the USA each year.

The death toll would climb much higher in the event of a new global pandemic or bioterrorism attack. Infectious diseases, the report concludes, have become “a matter of national security.”

In his brilliant Pulitzer Prize winning book, Guns, Germs, and Steel, Jared Diamond “seeks the root answers to why European societies (and their American offspring) became the dominant powers on Earth in terms of wealth and power. He traces the proximate causes–the development of deadlier weapons technologies, immunity to germs, superior metal working, and writing systems–to the ultimate cause of the way food production varied in human societies and then looks at geographic variations and impediments that affected food production and the spread of technological innovation in all regions of the world.”

Dr. Irwin Sherman, a professor emeritus of biology at the University of California Riverside, in his book, Twelve Diseases That Changed Our World, also describes how bacteria, parasites, and viruses have swept through cities and devastated populations, felled great leaders and thinkers, and in their wake transformed politics, public health, and economies.

The US Center for Disease Control, The World Health Organization, and King County’s Department of Public Health have undertaken surveillance and preventive measures to protect the public from pandemic illnesses. Those investments must remain an international, national, and local priority. All of these agencies face the daunting challenge of developing measures to identify and prevent the spread from numerous germs that have the capacity to change human history. In an age of limited resources, the agencies must remain a key priority. We must commit to the robust funding of early warning systems. We must continue to remain vigilant about the microscopic life forms that with great swiftness and determination can change our world. If we don’t do these things, we are at peril.

A fool too late bewares when all the peril is past.
-Elizabeth I

Learn more…

• Lloyd’s Of London: Pandemic – Potential Insurance Impacts
• Deep in the Rainforest Stalking the Next Pandemic
• And now here is the virus forecast
• The American Association for the Advancement of Science
• Trust for America’s Health
• PBS: Guns, Germs, and Steel
• 12 diseases that Altered Human History
• UCLA Researchers Endorse Global Early Warning System to Prevent Future Pandemics
• Population Reference Bureau

Every gun that is made

“Every gun that is made, every warship launched, every rocket fired signifies, in the final sense, a theft from those who hunger and are not fed, those who are cold and are not clothed. This world in arms is not spending money alone. It is spending the sweat of its laborers, the genius of its scientists, the hopes of its children…This is not a way of life at all, in any true sense. Under the cloud of threatening war, it is humanity hanging from a cross of iron.”

-President Dwight Eisenhower

The public assumes that the US withdrawal from Iraq would reduce defense spending. The New York Times reported that the proposed US Defense Department 2009 budget “when adjusted for inflation, will have reached its highest level since World War II.” Although the Federal Government committed over $700 billion  to stabilize the financial markets, it will also spend $711 billion  on defense. Is it likely that we’ll see significant reductions in military spending? Probably not. The war in Iraq and Afghanistan has taken its toll on military equipment and it needs to be replaced. Those who serve in the military need better pay and health care. The development of new and advanced weapons systems will require significant investments. We will need to develop a full spectrum military. We will also see military spending continue to rapidly increase in most countries. The world is still too dangerous.

The next President of the United States will have to make either unpopular reductions in defense department spending or continue the explosive growth of the federal deficit. How will he fund Medicare which is expected to go broke in 2018? How will the federal government, which owes foreign investors over ten trillion dollars, reduce our indebtedness?

The President must also meet the demands of reducing poverty, disease, and hunger. He must recommit to making substantial investments to address our domestic needs. He must also maintain sustainable funding for our military needs. Will the next administration want the US to continue to be a military, financial, and cultural superpower? Do we want to? Can we afford it?

As a superpower nation, we are clearly being reminded of the moral requirement to look beyond our military needs.

• Each year, more than 8 million people around the world die because they are too poor to stay alive.
• Over 1 billion people—1 in 6 people around the world—live in extreme poverty, defined as living on less than $1 a day.
• More than 800 million go hungry each day.
• Over 100 million primary school-age children cannot go to school.

Based on definitions established by the World Bank, nearly 3 billion people-half of the world’s population-are considered poor. In his recent address at the United Nations Food and Agriculture Organization, Pope Benedict XVI blamed food shortages on “feverish speculation” that drives up prices, along with “corruption in public life or growing investments in weapons and sophisticated military technologies to the detriment of people’s primary needs.”

“Of all the enemies to public liberty war is, perhaps, the most to be dreaded because it comprises and develops the germ of every other. War is the parent of armies; from these proceed debts and taxes … known instruments for bringing the many under the domination of the few. No nation could preserve its freedom in the midst of continual warfare.”

-James Madison, Political Observations, 1795

Learn more

• Global Poverty by NetAid
• Data on Poverty and Inequalityby the World Bank
• Barron’s : “Defense Stocks Can Benefit Even Under Obama”
• Pope: Military spending creates food shortages
• Proposed Military Spending Is Highest Since WWII
• Goodbye to Defense’s Gilded Age?
• Analysis: U.S. defense spending problem
• Defense Spending Rises Above Financial Turmoil
• U.S. Deficit to Reach Record $490 Billion in 2009
• World Military Spending by Global Issues
• Crisis could crimp defense spending, now at World War II levels
• Medicare Will Go Broke By 2018, Trustees Report
• World Wide military Expenditures by Global Security
• Defense Spending and Military Budgets by Borgen Project
• Defense Spending by The Center for Arms Control and Non-Proliferation

The spider to the fly

The US Treasury and Federal Reserve are giving over a trillion dollars to financial institutions. They also intend to invest and assume partial ownership in them as well. Yet, the only thing being promised the American taxpayer is easier credit. Is that a good thing?

Everyone, including my son, who happens to be a junior in college and unemployed, is being inundated by offers for credit cards. Most of my household mail consists of mailers from numerous financial institutions offering me credit cards. They promise low interest rates yet the fine print says that if you make one late payment, they can charge you a usurious 25-30 percent. Credit cards have become so easy to get, but so expensive to manage. The allure of credit cards is appropriately captured by this stanza from the poem Spider to the Fly by Mary Howitt, Will you walk into my parlour?” said the Spider to the Fly, ‘Tis the prettiest little parlour that ever you did spy.

Should we be concerned? In the New York Times article Some Debt Trends Are Good. This Isn’t One of Them, they reported AMERICAN credit card debt is growing at the fastest rate in years, a fact that may signal coming trouble for the banks that issue them. This week the Federal Reserve reported that the amount of revolving consumer credit that is outstanding hit $937.5 billion in November, when seasonally adjusted, up 7.4 percent from a year earlier.” Market Watch in their news piece, Another shoe to drop, says Credit-card debt is on the brink of imploding and will be the next storm to hit the fragile finance industry, an investment research firm predicted this week. The Washington DC think tank, Center for American Progress, believes so. In their report, House of Card, they state, As borrowing in the mortgage market slows, credit card borrowing is accelerating-a dangerous trend because borrowers still face weak income growth. That means the credit card market could eventually run into the same problems that now afflict the subprime mortgage market.

The Center for Responsible Lending, a nonprofit, nonpartisan research and policy organization dedicated to protecting homeownership and family wealth, in its report Pushing the Limit states, During the past few years, the United States has experienced an unprecedented boom in household debt. Although most household debt is in the form of mortgages and home equity lines, credit card debt deserves particular attention. The reason: credit card debt tends to carry high interest rates, large fees and a number of hidden costs, all of which weigh disproportionately on lower income families. They are also concerned about the mortgage refinancing of credit card date. In their report, Risking Homes to Pay Off Credit Cards, The fear of overwhelming credit card debt is driving many Americans to hand their equity back to mortgage lenders in the form of “cash-out”

What are the solutions? The Council on American Progress succinctly summarizes a variety of solutions: implement a credit card safety rating system that can give consumers better information about their credit cards and thus help them make better decisions; and Congress should mandate a higher level of fairness in credit card terms by adopting the Credit Cardholders’ Bill of Rights Act that also bans several of the most abusive credit card practices.

USA Today reports in its article a proposal would limit increases in credit card fees, and rates. The Federal Reserve, the Office of Thrift Supervision, and the National Credit Union Administration are recommending a proposal that would:

• Bar issuers from raising interest rates on existing debt, except under certain conditions, such as when a promotional rate expires or when a borrower pays 30 days or more late.
• Prohibit issuers from calculating one month of finance charges based on two months’ worth of activity, a punitive practice called double-cycle billing.
• Require card issuers to apply monthly payments that exceed the required minimum at least partly to higher-rate card debt. Borrowers often face varying interest rates on credit card debt, for cash advances, balances transferred and purchases.
• Bar financial institutions from charging checking-account customers a fee for paying an overdraft – unless the customer has had the chance to opt out of this payment.
• Bar financial institutions from charging checking-account customers a fee for paying an overdraft – unless the customer has had the chance to opt out of this payment.

“Do not accustom yourself to consider debt only as an inconvenience; you will find it a calamity.”

– Samuel Johnson

Related information

• The Spider and the Fly poem by Mary Howitt
  http://tiny.cc/yo4HU
• Some Debt Trends Are Good. This Isn’t One of Them
  http://tiny.cc/jSuTA
• Another shoe to drop
  http://tiny.cc/g6uKK
• House of Card
  http://tiny.cc/B8zyu
• Problems with Plastic: Credit Card Debt Hits Record High
  http://tiny.cc/QiGPz
• The Center for Responsible Lending
  http://tiny.cc/B4Ww7
• Pushing the Limit: Credit Card Debt Burdens American Families
  http://tiny.cc/IIaVA
• Risking Homes to Pay Off Credit Cards
  http://tiny.cc/Gmo5S
• Proposal would limit increases in credit card fees, rates
  http://tiny.cc/lOrWL

The earth is not flat

In this age of global warming, many have directed our attention to the use of cap and trade tools to reduce carbon emissions. According to the U.S. Environmental Protection Agency:

Cap and Trade is a market-based policy tool for protecting human health and the environment. A cap and trade program first sets an aggressive cap, or maximum limit, on emissions. Sources covered by the program then receive authorizations to emit in the form of emissions allowances, with the total amount of allowances limited by the cap. Each source can design its own compliance strategy to meet the overall reduction requirement, including sale or purchase of allowances, installation of pollution controls, implementation of efficiency measures, among other options. Individual control requirements are not specified under a cap and trade program, but each emissions source must surrender allowances equal to its actual emissions in order to comply. Sources must also completely and accurately measure and report all emissions in a timely manner to guarantee that the overall cap is achieved.

Denis Hayes, one of the world’s foremost environmentalists, would seem to be an unequivocal supporter of cap and trade schemes to reduce global warming. Many others from across the political spectrum support them. Yet, in a thoughtful, provocative, and visionary article he effectively challenges our belief in the cap and trade system. He is reminiscent of those who said the earth is neither the center of the universe nor flat. He insightfully argues:

The backbone of any comprehensive policy to limit greenhouse gas emissions must cap carbon at the places — coal mines, oil fields, pipelines, ports — where it enters the economy. Instead, at the behest of corporate behemoths and their green enablers, our political leaders are focusing most of their attention on smokestacks, and when that is obviously impossible (e.g. with gasoline or propane) on refiners or distributors. They want to cap CO2 where it enters the atmosphere — an approach that is guaranteed to fail because there are far too many point sources.

Regarding Europe’s cap and trade schemes he states, “Europe has already attempted a cap-and-trade program, and it belly-flopped.” According to Denis, their failure taught us:

• The most important part of cap-and-trade is the “cap.” Any successful law must place an impermeable lid on the amount of carbon that enters the atmosphere. To whatever extent additional trees or windmills are used to “offset” additional carbon-based fuels, the exercise is self-defeating.
• In contrast to regulating a sea of smokestacks, the best course is to require carbon permits at the 2,000 sources where carbon enters the economy. It would be simple, straightforward, and impossible to “game.” It is vastly more effective than trying to police carbon dioxide wherever carbon is burned. In setting the number of carbon permits issued — and thus determining how much coal, oil, and gas can enter the economy — the government would be setting an absolute, easily-enforced cap on emissions.
• All carbon permits should be auctioned — not given away. In Europe, permits were given away to large carbon users to ease their transition to the new regime. Major polluters made cheap improvements, lowered their emissions, and sold their unneeded permits. This gave windfalls to the worst polluters, penalized companies that had already invested in efficient new factories and renewable energy, and helped guarantee that Europe would miss its Kyoto targets.
• Auctioning 100 percent of all carbon permits is fair and transparent; it eliminates backroom special-interest pleadings. By reducing the number of permits auctioned each year, the government can guarantee that its emissions targets are met.

Recently, we’ve witnessed historic volatility on Wall Street and world markets as worries of a worldwide recession begin to overtake us. Yet, there remains one bullish market. In a Washington Post article entitled, There’s a Gold Mine In Environmental Guilt, it reported, This is strange territory. The Dow is down. Wall Street needs a bailout. But in the Washington area and across the country, there is still a bull market in environmental guilt. But, are we likely to witness an historic collapse of the market that was established to save the planet?

The New York Times in a counterpoint response to the Post article, A Bull Market on Offsets, but What Are They Really Worth? states, “Writing last year at the online journal Nature Reports Climate Change, a Web site of Nature Publishing Group, an assembly of five scientists and climate experts called the fuzzy notion of additionality the ‘most vexing’ challenge facing the offsets trade — particularly in voluntary markets like those in the United States.”

The blog’s closing paragraph states:

Developing market-wide standards for drawing lines, as well as creating mechanisms for government oversight, the authors of The Nature article say, is a first step. As it is, a wide array of competing industry standards are being developed, the experts lament, which might well undermine the whole enterprise: “Although the consequences are difficult to predict,” the authors write, “the confusion produced by a host of independent ’standards’ operating in a regulatory vacuum has the potential to discredit market-based environmental policies.

The European Community, the United States, and those nations that have committed to reduce human impacts on the climate must heed the words of Denis Hayes and the authors of Nature Reports Climate Change. If we ignore them, we will fail to save the planet.

Learn more

• Climate Solutions:Charting a Bold Course, Denis Hayes Opinion
• There’s a Gold Mine In Environmental Guilt
• A Bull Market on Offsets, but What Are They Really Worth?
• Nature reports Climate Change
• European Commission on Climate Change
• Pew Center Global Climate Change Report on Europe Union and Global Climate Change
• Diamond and Kashyap on the Recent Financial Upheavals
• Eco Business Carbon Offset Survey
• Carbon Offset Survey
• Carbon Tax or Cap & Trade: Does It Matter Which One?
• EU vote weighs carbon-trading riches
• EU has difficulties fighting climate changes

Overdrawn

Hardly noticed, and buried deep in the hundred pages of bailout legislation, is a provision that would raise the statutory ceiling on the national debt to an eye-popping $11.315 trillion dollars. In part, it includes the $700 billion bailout money, the $85 billion the U.S. government is lending to save the insurance company AIG, and the $200 billion it put up for mortgage giants Fannie Mae and Freddie Mac.

It will even affect the iconic National Debt Clock in New York that now sits above the entrance of an Internal Revenue Service office in midtown Manhattan. It will need to be reprogrammed to handle the extra digit!

Why do I care? Why should you? Well, I have three children and promised their life would be better than my own. We should not hand my kids or yours a debt payment that is the greatest in the history of the world. With each year, government spending rises and the budget deficit gets bigger. As Steve Chapman, a columnist and editorial writer for the Chicago Tribune writes “As the Baby Boom generation retires, the gap will grow. Given current trends, federal outlays stand to double between now and 2050, while revenues remain roughly stable.”

He continues to write, “By then, two programs — Medicare and Medicaid — will cost as much as the entire federal budget does today. Which means that, essentially, we’ll be financing two federal governments. If you dislike carrying a defensive end on your back, wait till his twin climbs aboard.”

Wikipedia concisely states, “The Government Accountability Office (GAO), Office of Management and Budget (OMB) and the U.S. Treasury Department have warned that debt levels will increase dramatically relative to historical levels, due primarily to mandatory expenditures for programs such as Medicare, Medicaid, Social Security and interest. Mandatory expenditures are projected to exceed federal tax revenues sometime between 2030 and 2040 if reforms are not undertaken. Further, benefits under entitlement programs will exceed government income by more than $40 trillion over the next 75 years. The severity of the measures necessary to address this challenge increases the longer such changes are delayed. These organizations have stated that the government’s current fiscal path is “unsustainable”.”

In Congressional testimony, Peter Orszag, Director of the Congressional Budget Office said that “substantial increases in revenues,” perhaps even in tax increases, will be necessary in the short term to cover the initial infusion of hundreds of billions in borrowed dollars into the private sector, especially given the already record budget deficits and federal debt levels the government is currently running.”

He also said “that the combination of high budget deficits and record expenditures on bailouts — including the proposal now before Congress — has significantly hampered the government’s ability to respond further to any economic crises.”

On his blog site Orszag states, “How Would Rising Budget Deficits Affect the Economy? Sustained and rising budget deficits would affect the economy by absorbing funds from the nation’s pool of savings and reducing investment in the domestic capital stock and in foreign assets. As capital investment dwindled, the growth of workers’ productivity and of real (inflation-adjusted) wages would gradually slow and begin to stagnate. As capital became scarce relative to labor, real interest rates would rise. In the near term, foreign investors would probably increase their financing of investment in the United States, but such borrowing would involve costs over time, as foreign investors would claim larger and larger shares of the nation’s output and fewer resources would be available for domestic consumption.”

He continued to state, ”According to CBO’s simulations using that model, the rising federal budget deficits under this scenario would cause real gross national product (GNP) per person to stop growing and then to begin to contract in the late 2040s. By 2060, real GNP per person would be about 17 percent below its peak in the late 2040s and would be declining at a rapid pace. Beyond 2060, projected deficits would become so large and unsustainable that the model cannot calculate their effects. Despite the substantial economic costs generated by deficits under this model, such estimates greatly understate the potential loss to economic growth because the effects of rapidly growing debt would probably be much more disorderly and could occur well before the time frame indicated in the scenario.”

The growth of the federal debt is the emergency we face. It is unsustainable and unfairly burdens future generations. We’ve seen the enemy; it is our appetite for spending.

Learn more

• United States Public Debt
• Concord Coalition
• CBO Director’s Blog
• The Bureau of Public Debt
• Paulson Plan May Push U.S. Debt to Post-WWII Levels
• The National Debt, Pt. II: Why the National Debt Matters
• Making the Wall Street Bailout Understandable
• US has boosted debt before

Save a life

Infections – we all get them, and astoundingly, many people will die from them. But, you’d never think that we’d get them in the hospital while being treated for another illness. Or see the needless loss of life of a newborn baby because of an infection in a nursery.

Some individuals will become infected in an ambulatory care facility. These infections are called health-care-associated infections (HAIs), also referred to as hospital acquired infections.

HAIs are a serious and pervasive issue afflicting our health care system. According to the Centers for Disease Control and Prevention (CDC), HAIs are estimated to be one of the top 10 causes of death in the US, totaling 100,000 per year. That means more patients die of HAIs than from HIV/AIDS (60,000 per year) and automobile accidents (40,000 per year). Specifically, central-line infections occur in 250,000 people a year in the US, and are fatal between 5% and 28% percent of the time.

HAIs are very costly, should be mostly preventable, and everyone – patients, employers, hospitals and even state and federal government (Medicare) – bears the burden of these costs. It is reported that HAIs add as much as $20 billion in additional costs to the health care industry. In 2005, the average payment for a hospitalization in Pennsylvania was over six times higher for patients who contracted a hospital-acquired infection than for patients who did not acquire infections, according to a report by the Pennsylvania Health Care Cost Containment Council. Moreover, a 2007 study of 1.69 million patients who were discharged from 77 hospitals found that the additional cost of treating a patient with an HAI averaged $8,832. This is alarming when data show that Medicare, alone, the federal health insurance program for persons over 65, paid for over one-third of all hospital costs in 2005, according to the American Hospital Association.

Ironically, the Federal Office for Human Research Protections shut down a Michigan HAI project, even as it proved itself to be effective. I think it is time for Congressional action.

Can we reduce HAIs? The leading hospitals in the nation successfully tackling them are Allegheny General Hospital in Pittsburgh, Johns Hopkins in Baltimore, and a consortium of hospitals in Michigan. Allegheny, under Dr. Jerome Granato’s leadership the past five years, and with support from Dr. Peter Perreiah of the Pittsburgh Regional Health Initiative, reduced central-line HAIs by 90% in two years, and sustained a 15 month period in their ICU with no infections.

In this state, the Puget Sound Health Alliance (Alliance), a regional consortium of employers, providers, health plans, unions, and patients aimed at improving the quality of health care in Puget Sound, has made HAIs a priority (www.pugetsoundhealthalliance.org). An Alliance workgroup recommends “highlighting the incidence of hospital acquired infections to lower their occurrence and resulting costs to the system.” The Alliance is currently working with the State Department of Health to make the data more transparent and more consumer-friendly, and will include HAI outcomes data in future reports of its own Community Checkup Report (www.wacommunitycheckup.org). The Alliance is also researching how it can help accelerate current HAI efforts in the Puget Sound region using the proven interventions from Pittsburgh and Johns Hopkins.

Mirroring national efforts, the Washington State Hospital Association (WSHA) and Washington State have been engaged in patient safety efforts. Washington was the first state to get all its hospitals participating in Institute for Healthcare Improvement’s 100,000 Lives Campaign. WSHA is actively engaged in national efforts in addition to its own effort, which includes providing technical assistance to hospitals and disseminating posters and brochures to promote hand washing and staff training. Washington State, in 2007, passed SB1106 to mandate public reporting of certain HAIs beginning in January 2009. A phased-in approach, in July 2008, all hospitals were required to start collecting and reporting all central line-associated infections in ICUs. (When this data will be available to the public has not yet been determined.)

We know what works, as evidenced by efforts in Pittsburgh, Baltimore, and Michigan, and now it’s our turn to implement these best practices here and work with the federal government to break down barriers to efforts that will save patients’ lives. It is imperative that we publicly report the incidence of health care associated infections by facility in King County and the State of Washington, in order to shed light on the problem and save lives.

Related information

• Health-Care-Associated Infections in Hospitals Report, General Accounting Office (GAO)
• Consumers Union’s website
• The Checklist, Gawande, Atul.  The New Yorker.
• Dispelling the Myths: The True Cost of Healthcare-Associated Infections: Pennsylvania Health Care Cost Containment Council
• CDC Library

Fragile, handle with care

Renata Alder, a New York Times film critic and award-winning novelist, made a concise observation of society’s need to respond to the needs of the mentally ill. She said, “Nothing defines the quality of life in a community more clearly than people who regard themselves, or whom the consensus chooses to regard, as mentally unwell.”

The tragic shootings in Skagit County that claimed six lives once again reminds us of the fragility of our state’s Mental Health system. It’s not the first time we’ve received this kind of reminder. Eleven years ago, the stabbing death of a retired Seattle firefighter by a mentally ill man who had been released from jail prompted changes in the law. But all too often it takes a tragic crime before we discuss the needs of the mentally ill.

The Heritage Foundation reports, “An estimated 5.6 million Americans suffer from severe mental illness. It strikes without regard to age, gender, race, education, socioeconomic status, culture, or ideology. In many cases it brings suffering not only to the individual but also to family and friends. Depression, which causes many of the 30,000 suicides in America each year, especially targets the elderly…” They also conclude that the “economic costs of mental illness are staggering. America spends over $69 billion yearly on direct treatment costs.”

So what are the major challenges facing the State of Washington’s Mental Health system? A state-commissioned study of residential and hospital bed capacity and need that was completed several years ago found an additional 680 residential and inpatient beds are needed statewide. But no action was taken on that study. Instead, state and local hospital beds have continued to be closed, and even more closures are planned next year.

The 1999 Legislature initiated the “Community Integration Assistance Program” to improve the process of identifying mentally ill offenders released from the Department of Corrections. These individuals, who pose a threat to public safety, were to be provided with treatment and services for up to five years. The funding provided by the state for each person served is $700 per month for Medicaid-eligible participants and $900 per month for those not on Medicaid. The reimbursement rate has not increased since the program began in 2000 despite an enormous increase in housing and other costs. In many cases, especially in King County, the cost of housing alone exceeds the reimbursement received from the state that is meant to cover all costs

Housing is absolutely critical for people with mental illness if the mentally ill are to benefit from treatment and move toward independence, employment, and recovery. It is integral for them to have the best opportunity, yet housing is hard to find for anyone with low income, and even harder for those who have a serious mental illness. The homeless, mentally ill, are much more likely to commit crimes and end up in jail. It is imperative that the housing dollars authorized by the recently adopted sales tax for mentally ill services should not be diverted for other uses.

We need training for our police about how to work with people with mental illness, and more resources for police to refer people to programs that help avert crises and violent acts; to divert people from jail and into treatment.

Legislation on gun ownership for people who have been involuntarily committed needs to better align between the state and county – currently there are different standards – with state legislation allowing ownership if you have been committed for 14 days or less and federal legislation not allowing ownership if you have been committed for any length of time.

There is insufficient state funding to provide services for people who are mentally ill, but not covered by Medicaid, either because they are too disorganized to get through the process, or because their illness is new (such as the first break psychosis of young people), or because of their immigration status. When people can’t get the treatment they so desperately need, they are much more of a risk to themselves and others.

Involuntary commitment is an extremely controversial issue. Most people with mental illness are not dangerous and their civil rights must be protected. Yet many people believe that it should be easier to commit people who have mental illness. As a result, commitment laws have been amended numerous times since 1998, all with the intent of making it easier to commit people who might be a danger.

Last year, the state Mental Health Division brought in national consultants to lead a task force of mental health professionals, law enforcement, consumers, advocates, prosecuting and defense attorneys, and state officials to review the involuntary commitment law. The conclusion of the task force is that changing laws is not the answer; what is needed are more accessible, consumer-focused, comprehensive services.

Even if the state were to respond to all of the issues listed above, there is no way to ensure that nothing like what happened 11 years ago in King County, or last week in Skagit County, will ever happen again. What we can and should do is provide services and safe housing for persons with mental illness that will minimize the risks for them and for society, while also giving them the resources needed to help them in the recovery process.

The Heritage Foundation report concludes, “Current mental health policy tends to support the status quo system regardless of the effectiveness of services.” This must not continue. America has the compassion, resources, and available treatments to care effectively for its citizens who suffer from severe mental illness.”

Learn more:

• King County’s Mental Illness and Drug Dependency (MIDD) Action Plan
• More about Renata Alder
  • Wikipedia
  • Salon
  • New York Times
  • Answers
• Sick minds of shooters a bigger problem than guns, Seattle Post Intelligencer
• State pays in blood for flawed mental health system, Seattle Post Intelligencer
• Suspect’s mom describes him as being ‘desperately mentally ill’, MSNBC
• Campaign for Mental Health Reform
• President’s new Freedom Commission on Mental Health, Mantal Health
• Families and the Crisis in U.S. Health Care, Child Parenting
• Principled Mental Health System Reform, Heritage
• Mental health reform: What it would really take, CNN
• Reform how we treat mental illness, Seattle Post Intelligencer

Do you have any skin in the game?

In King County our budget process has always been placed above political ambition and the parochial self-interest of different branches. It is my fervent hope that that tradition will continue as we grapple with the most difficult budget the County has ever faced. Unfortunately, that isn’t the tempo of recent public discussions.

Who stands to lose if we continue down the battle path, you the taxpayer, voter, and resident of King County? So the question for you: do you have any skin in this budgetary game?

With all of the recent posturing, press releases, press conferences and rumor mongering, one of the most critical services the County provides has received very little discussion. In this day and age of confrontational politics and news, it could become the unfortunate victim.

So, let me digress a bit. Remember these points. The human body is an ecosystem, flourishing and nurturing hundreds of millions upon billions of bacteria and microbes; the history of disease should worry us; human beings are not a stationary species; and, when we kiss, hold or shake hands, share our food, or engage in sex, we are simply mixing up a new batch of microbial material!

History is replete with the impacts of infectious diseases. Insects, birds, rats, plants, and humans have transmitted these diseases. They have reshaped history and retired entire cultures. Germs reshaped the history of the lands we now call the United States. Disease nearly eradicated the Native American population of North America. It is estimated that two thirds of the Native American population died of illnesses introduced by Europeans. Do we face these same threats today? According to all of the experts, the threat is growing at an ever-increasing rate. These organisms are mutating and evolving with remarkable speed with increasing resistance to medical treatment: they are genetically shrewd and wish to survive. SARS, avian influenza, hantavirus and extensively drug resistant tuberculosis are just a few recent examples of newly identified infectious agents that have caused serious human illness. Our food production and distribution system makes it easier than ever for contaminated products to reach large numbers of persons spread over wide geographic areas. So far this year the US has seen more measles cases than any time since 1996, primarily do to infected persons from other countries traveling to the US and setting off a series of outbreaks. How does all of this happen?

Wikipedia provided this description of the skin: ”The skin supports its own ecosystems of microorganisms, including yeasts and bacteria, which cannot be removed by any amount of cleaning. Estimates place the number of individual bacteria on the surface of one square inch (6.5 square cm) of human skin at 50 million though this figure varies greatly over the average 20 feet2 (1.9 m²) of human skin. Oily surfaces, such as the face, may contain over 500 million bacteria per square inch (6.5 cm²).” That is just the skin!

But, it isn’t just our skin that houses bacteria and microbes. Dr. Trudy M. Wassenaar, in “Bacteria more than Pathogens” says, “We house millions of bacteria on our skin and in our nose, mouth, and gut:

• Up to 500 species can be found as normal oral flora
• There can easily be 25 species living in a single mouth
• A milliliter of saliva can contain as many as 40 million (4 x 107) bacterial cells
• 108 bacterial cells present in the cecum (the initial part of the colon) per milliliter of content is normal and many of these species are different from those found in the mouth
• We are born sterile (free of bacteria) but within hours we are colonized by our little friends, not to be left alone again.”

NPR reports, “The human body contains 20 times more microbes than it does cells. In fact, a visitor from outer space might think the human race is just one big chain of microbe hotels.” Inside and out, we are just one big carrier of other life forms!

But, why should King County government care about your body or mine?

Typically, we live in a natural, harmonious balance with the multitude of organism we naturally carry within our bodies and even more potential pathogens living in innumerable natural reservoirs in the environment, including animals, water and soil (I.e., influenza and avian influenza viruses, Legionnaire’s disease, leptospirosis, E. coli, salmonella and other food-borne diseases). We’re literally surrounded by infectious agents.

But, all too often, that natural balance is upset, leaving us vulnerable to disease. Germs constantly learn new tricks – development of drug resistance and new virulence traits allow them to cause disease more effectively in human populations. In addition, new infectious agents emerge when we upset the balance between man and nature, encroaching on new habitats (SARS).

As Mary Wilson from the Harvard School of Public Health and the Harvard Medical School in her seminal paper “ Travel and the Emergence of Infectious Diseases” states, “Today’s massive movement of humans and materials sets the stage for mixing diverse genetic pools at rates and in combinations previously unknown. Concomitant changes in the climate, technology, land uses, human behavior, and demographics converge to favor the emergence of infectious diseases caused by a broad range of organisms in humans, as well as in plants and animals.” Simply put, the introduction of an infectious disease can happen any day, and at anytime. It is not a matter of if, but when. They will arrive with someone, likely a visitor, relative, friend, or a neighbor.

What organizations are there to protect us? The United Nation’s World Health Organization, the US Center for Disease Control, and most importantly, our King County Department of Public Health are responsible for our health safety. The Department of Public Health is our key local first responder, our community’s immune system. It is that department that has the primary responsibility to prevent, detect, treat, and control the widespread introduction of diseases.

Our local Public Health Agency quietly protects us from infectious diseases every single day. They insure that our food and water are safe to consume. If the local and national health and economic security of the general population were our highest priority, public health would also be our highest priority. It is there that the greatest number of lives can be saved and protected. It is that department who we will all turn to when the infection eventually lands as SeaTac; or arrives at our ports; or drives here on I-90 or I-5. If the Department of Public Health fails, we all lose.

Balancing a budget is a challenge. Public Health must be a priority. One can make a compelling case for the preservation of social safety nets, public safety, and justice. We will need a balanced approach. This is not a time for the cynical and expected game of political one-upmanship. Nor should we tolerate the voices that play to our fears, suspicions, distrust, and our base interest. We are a better community when the voices we hear speak to our optimism, even in the most trying times. Maybe we’ll be pleasantly surprised. Maybe, there is a glimmer of a chance that the common good will be united with common sense. Maybe.

Learn more

• CDC: Traveler’s Health
• Foreign Affairs Magazine: Preparing for the Next Pandemic
• Viruses, Plagues, and History
• How Columbus sickened the New World: Why were Native Americans so vulnerable to the diseases European settlers brought with them?
• When Germs Travel
• When bugs outwit drugs
• Diseases Decimate Native American Populations
• Threat of infection: Microbes of high pathogenic potential – strategies for detection, control and eradication
• Preparing for the Next Pandemic
• Antimicrobial resistance
• Infection Control Today Magazine
• Microbial Threats to Health: The Threat of Pandemic Influenza
• The Global Threat of Emerging Infectious Diseases
• Can We Detect ‘The Coming Plague’

Down the road

We may be entering an era where our major infrastructure will be owned by private entities with public partner. Matt Rosenberg, a senior fellow at the transportation think tank Cascadia Center for Regional Development, eloquently spoke to this in his article, “A state agency eyes public-private transportation” which appeared in the on-line publication Crosscut. The article suggests that the Washington State Investment Board may be interested in financing various highway improvements in the State of Washington through a public private partnership. The Investment Board, like other large organizations with significant pension and other cash accounts, has found that government’s transportation infrastructure provides a good return on investment.

For many reasons, it is quite likely that there is more than a little interest in this outcome. Washington, like other states across this country face multi-billion dollar investments in highway maintenance and expansion projects. In addition, Congress is not interested in another gas tax increase (last time it was raised was 1983). At this year’s Democratic National Convention, I participated in a Rockefeller Foundation funded session entitled “The 2008 Rocky Mountain Roundtable Transportation & Infrastructure Roundtable.” There was an interesting exchange between Pennsylvania Governor Ed Rendell and Rep. Rosa DeLauro (D) Connecticut. Despite the insistence of both Gov. Rendell and former Speaker of the House Richard Gephardt that a gas tax might be necessary, Rep. DeLauro made it clear that the House of Representatives had little appetite for a gas tax increase. Where does that leave us? Clearly, it is unlikely that we’ll see the Federal government pouring billions into any s tate’s roadway system.

What does this mean? Quite frankly, the Central Puget Sound, like every major metropolitan area of the country, will begin to see system wide variable tolling – not taxes – to finance congestion relief and unclog our roadways. This was suggested in a 2007 study of the region by Jack Oplia from Booz Allen Hamilton on behalf of King County. It is also the position of the United States Department of Transportation. In addition, the Puget Sound Regional Council (PSRC) is also looking at system tolling alternatives in their Transportation 2040 update. One alternative involves just limited access roadways; the other: limited access roadways and arterials. Both alternatives show huge congestion relief and revenue generating potential.

Why will we see private/public partnerships? In order to build you must sell bonds against tolling revenue. To get a good rate from the bond market and a lower toll, government usually pledges its full faith and credit. As states and municipalities reach their capacity to bond, they may seek a large private partner to help cover risk. This is where the private market has aggressively stepped into the transportation arena. Investment banking giants, Morgan Stanley, Goldman Sachs and JP Morgan were all represented by senior partners at the Rocky Mountain Roundtable in Denver touting the capacity of the private sector to invest in our public infrastructure assets. It is has done successfully in the United States and abroad

The future will unquestionably bring system-wide variable tolling. It will ease congestion, reduce harmful emissions, and finance and rebuild our transportation infrastructure. Before these tolled facilities will be owned and operated by the private sector is something we will need to watch closely. We owe the public as much.

Learn more

• A state agency eyes public-private transportation funding, Crosscut
• Washington State Investment Board Eyes Infrastructure Projects
• National Strategy to Reduce Congestion
• Overview of Highway Trust Fund Estimates
• Congressional budget Office: Transportation and Infrastructure
• U.S. highway trust fund veers toward crisis, Los Angeles Times
• U.S. highway system badly in need of repair, MSNBC
• Puget Sound Regional Council Transportation 2040
• Variable tolling is knocking at the door
• Value Pricing Pilot Program
• Urban Partnerships
• Lake Washington Urban Partnership
• USDOT’s Urban Partnership Agreement (PDF)
• U.S. DOT unveils Bush Administration’s new approach for transportation