California Health Report | HealthyCal - Part 2
 

California Health Report

  

A dangerous complication: Domestic violence in pregnancy

Published: May 14, 2013 | No Comments

Photo: Flickr/Bies

Affordable Care Act provisions help but aren’t enough, advocates say

By Hannah Guzik
California Health Report

When Margot Newman* went into labor, her boyfriend broke her cell phone and hogtied her to the toilet in their cramped bathroom. If she left, or screamed, he said he’d kill her.

As her contractions grew stronger, she pleaded for him to let her go to the hospital. Finally, he allowed her to go to her sister’s house nearby, and she took Newman to the Ojai Valley Community Hospital.

“I prayed and prayed and prayed that I could get through the day,” Newman said. “We finally got to the hospital and my blood pressure was really high, and I had really high contractions, because he had put me in to labor.”

Her son, Landon, was born after 30 hours of labor and a number of medical interventions, due to Newman’s high blood pressure and other complications, likely stemming from the abuse she’d experienced in the days before, her doctor said.

Her doctor didn’t know about the severity of abuse beforehand, but had provisions of the Affordable Care Act been in place, he might have. Under the new federal law, health care providers are required to offer domestic-violence screening and counseling to all women, and health insurance companies are required pay for those services.

“An estimated 25 percent of women in the United States report being targets of intimate partner violence during their lifetimes,” reads a fact sheet on the coverage from the federal Department of Health and Human Services. “Screening is effective in the early detection and effectiveness of interventions to increase the safety of abused women.”

Health care providers statewide have been working to implement the new requirements since they took effect in August 2012. Meanwhile, activists and those who work with domestic violence victims say the provisions are a good start, but still not enough to solve the problem.

“I just think this is a really big problem and I think we have to improve the OBGYN comfort level with intervening and improve the skills set to intervene,” said Priya Batra, a women’s health psychologist who helps lead a domestic violence taskforce in Sacramento. “The most helpful intervention is saying, ‘This is not OK, you do not have live this way, there is hope out there for you.”

If they didn’t do so already, most health care providers have added a domestic-violence screening aspect to their “well-woman exams,” or annual checkups. But, depending on the provider, the screening could range from simply asking women experiencing abuse to check a box on an intake form to the physician taking several minutes to ask each patient a series of questions.

“I encourage clinicians to ask, ‘How are things at home?’ something that’s a conversation,” said Brigid McCaw, an internal medicine doctor and the medical lead of Kaiser Permanente’s Family Violence Prevention Program in Northern California.

“I will often follow it up with, ‘Do you ever feel physically or emotional threatened or hurt by your partner or spouse?’” To help them comply with the new law, some doctors, nurses and therapists are also receiving special training on how to help women experiencing domestic violence, something McCaw believes should be standard, she said.

“This is so common, unfortunately — one out of four women will experience intimate-partner violence in their lifetime — and you can’t tell just by looking on an age or social or economic status or education or religion or sexual preference,” she said. “So screening every woman when they come in for a well-woman visit or other conditions or concerns is absolutely warranted. There’s no way to know unless you ask.”

There’s also a lack of emergency shelters and transitional housing for victims, whose ability to escape the abuse often hinges on having another place to live, Batra said.

According to the 2012 National Census of Domestic Violence Services, a survey taken by all domestic violence agencies statewide on Sept. 12, the agencies served 5,258 victims in California that day. On that same day, the groups were unable to meet 1,170 requests from victims for help. About 68 percent of those requests were for housing — both emergency and transitional.

Domestic violence often escalates during stressful life events, such as pregnancies, particularly if they’re unplanned or occur in tangent with economic difficulties, according to the California Partnership to End Domestic Violence.

Women who have been pregnant within the last five years experience 12 percent higher rates of intimate partner violence, according to the 2005 California Women’s Health Survey cited by the nonprofit.

Of those experiencing physical intimate partner violence, 75 percent of the victims in the survey had children under the age of 18 at home.

Domestic violence and abuse — whether emotional or physical — can take a toll on both a pregnant woman and her developing fetus, McCaw said.

“We’re just beginning to understand in the last 10 to 15 years how important the maternal experience is for how babies do,” she said. “The fear and stress related to intimate partner violence, even if there aren’t direct injuries, certainly has an impact on the developing baby and those risk can stay with the baby over time.”

Pregnant women living with abuse face higher chances of pre-term delivery, as well as pregnancy complications, such as high blood pressure. They also have higher incidences of depression, post-traumatic stress disorder and anxiety disorders, McCaw said.

A pregnancy can make it more difficult for a woman to leave an abusive relationship, particularly if she’s reliant on her partner for health insurance, money or housing, said Krista Kotz, program director for Kaiser’s Northern California Family Violence Prevention Program.

“In general, things that would make a woman more financially vulnerable make it more difficult for her to leave,” she said.

Ventura mother Dena Lopez* experienced severe abuse when pregnant with all three of her children, giving birth twice with black eyes, bruises and broken ribs, she said. Finally, after giving birth to a stillborn baby who she “felt sure was brain damaged because of the beatings,” she left her husband.

That was more than 30 years ago, and she’s now a grandmother and teacher at an adult education program in Ventura County. Lopez also volunteered at a local shelter for domestic violence victims.

“I talk to the women who are in the same state of mind that I was in, and I try to tell them, ‘You don’t try to stay together for the kids. In the end, the decision to leave, it’s a life or death choice,’” she said. “The biggest thing is just knowing you’ve got some outside support and that’s the one big reason that you stay or return.”

Newman, who was also beaten multiple times while pregnant, left her son’s father a few days after he was born, with $3 in her bank account. She wasn’t sure how they’d survive, but she found work as a waitress, got an apartment in Ojai and obtained full custody of her son.

Landon is now two and doesn’t remember his father.

“I didn’t want Landon to grow up thinking that it’s OK to treat women that way,” Newman said. “He’s such a sweet and loving boy. What happened before almost seems like a dream.”

* Names have been changed to protect the safety of victims of abuse.

 

How will Brown balance oil, environmental interests?

Published: May 13, 2013 | 1 Comment

By Daniel Weintraub

California’s economy has been powered for decades by technology, trade and tourism — businesses and jobs mostly near the coast from San Diego to Los Angeles and around the San Francisco Bay Area. The state’s great inland valleys, while serving as a breadbasket for the world, have not been a land of high-paying employment or tax-producing industry.

A glance at the most recent unemployment numbers reflects this reality. While the state’s overall jobless rate is still high by historic standards, it has fallen to 6.3 percent in Orange County, 6.0 percent in San Francisco and 5.7 percent in San Mateo County. In the Central Valley, by contrast, unemployment remains in double digits from Kern County (13.6) all the way to San Joaquin (14.1).

Could Big Oil change all that?

A revolution in the oil industry that’s been taking place in Pennsylvania, Ohio and North Dakota is poised to sweep through California’s oil patch, with the potential to produce hundreds of thousands of jobs and billions in tax revenue for the state.

But there’s a big catch. That same revolution also brings the chance of environmental degradation, threatening the water supply and abetting a carbon-based economy that many were hoping would soon become a thing of the past. That might not be a problem in the rust belt or the job-starved upper Midwest, but environmental protection is one of California’s passions. It is also one of its attractions.

At issue is the future of what is known as the Monterey Shale, a geologic formation that stretches beneath the Central Valley from Bakersfield to Modesto. Parts of this region have been a source of oil for generations. Despite recent declines, California still ranks fourth among the states in crude oil production, behind Texas, Alaska and a surging North Dakota, and most of that oil comes from the southern Central Valley and the surrounding hills.

Geologists say the Monterey Shale dwarfs the oil fields now under development. It holds an estimated 15 billion barrels of oil, or two thirds of the shale-oil reserves in the United States, according to the US Energy Information Administration. If fully developed, the oil field could create as many as 2.8 million jobs and, on an annual basis, $24 billion in extra tax revenue, according to an industry-funded study by University of Southern California economists.

Those numbers might be inflated. But even a fraction of that benefit could transform California’s economy. To put things in perspective, consider that California today still has 140,000 fewer jobs than it did before the recession in 2007, and before that, it took the state more than 20 years to create 2.8 million jobs – from all sources.

The oil in the Monterey Shale, however, can only be retrieved using the technique known as hydraulic fracturing, or fracking. This involves injecting massive amounts of water and, possibly, chemicals into the ground thousands of feet below the surface to break the rocks and free the oil locked within them.

The oil industry has used fracking in California for generations, without incident, according to industry trade associations. But operations in other parts of the country have been blamed by residents and environmentalists for contaminating the water table with toxic chemicals. No one wants that to happen here.

And even if every local environmental risk could be resolved, fracking raises another question for California. The state has been a leader in the fight to limit greenhouse gases, which are blamed for warming the earth and come primarily from the burning of carbon-based fuels. Does California now want to be in a position of enabling the retrieval of vast amounts of oil that will postpone the day at which we might have to confront our carbon dependency?

Gov. Jerry Brown, who all his life has straddled the line between environmentalists and the business world, seems eager to see fracking move forward in California, if he can be assured that it will be done safely. From building a bullet train to transforming the state’s water system and overhauling the way we finance education, Brown is using his second round as governor to build a record that might one day rival his famous father’s. Ushering in a new economic boom that puts the state’s budget on firm footing at last would help cement that legacy.

But Democrats in the Legislature, alarmed at what they say has been lax oversight from Brown’s administration, are trying to put a stop to new fracking operations. Legislation moving through the state Assembly would place a moratorium on the practice and order state regulators to study it and then allow fracking again only if it poses no risk “to the public health and welfare, environment or economy of the state.” The moratorium could last until 2019.

Would Brown sign such a measure if it reached his desk? Probably not. The bill’s intent implies that the governor does not already have the state’s best interests at heart, and it infringes on his powers as chief executive. If Brown wants more studies of fracking, or wants a pause in the practice, he can make that happen without orders from the Legislature.

Absent a moratorium, Brown will remain in the driver’s seat. It will be fascinating to watch him balance so many competing interests on a decision that, one way or the other, could have a profound effect on California’s future.

Daniel Weintraub has covered California public policy for 25 years. He is editor of the California Health Report at www.healthycal.org

 

The Search for Meaning in Late-Life Entrepreneurship

Published: May 12, 2013 | No Comments

By Matt Perry
California Health Report

Mark Anderson had a lengthy resume as a successful project manager at the terminus of the Alaska Pipeline.

When he eventually relocated to California, he hired on with a major electrical contractor. Supervising the removal of hazardous materials, he accomplished in four months a clean-up job the company had struggled for years to complete.

His reward?

Anderson was fired, replaced by a subordinate earning half his salary.

After the initial shock, Anderson pulled up his entrepreneurial bootstraps and did what any savvy, young entrepreneur would do. He opened his own business – Geographica, an eclectic collection of international treasures – last December in a back alley two miles from the state Capitol.

“You get to be your own boss,” Anderson, who turns 60 in August, says with a smile. “I really enjoy the people who come through here.”

He is not alone. Older adults facing age discrimination or squeezed out by employers looking to cut costs are finding entrepreneurship a surprisingly realistic option in a rugged new economy.

For more than a decade, Pat Guerra has collaborated with the Global Social Benefit Incubator at Santa Clara University, helping hundreds of entrepreneurs start businesses targeting clean water, off-the-grid energy solutions, subsistence farming and similar ventures.

In January with a university colleague, Guerra launched the Encore Venture Accelerator Program, customized for older entrepreneurs.

“The program is specifically tailored to the needs of people over 50 in launching a venture,” he says of his first class of 10 students. “It greatly increases the probability of success.”

A whopping 25 million Americans between 44-70 hope to start their own businesses in the coming 5-10 years, according to a 2011 MetLife Foundation study. Half want to start what they consider a socially responsible enterprise.

Paul Tasner has already done just that. Tasner was a senior executive for Method cleaning supplies when he was downsized after the 2008 economic slump.

Two years ago at age 66, Tasner joined forces with his business partner – a recently laid-off architect – to start San Rafael-based PulpWorks, which designs and manufactures sustainable packaging for consumer products.

The two received intensive assistance from neighboring Venture Greenhouse, an incubator for green businesses. Venture Greenhouse helped them set priorities, create a business model, and find customers.

“We got so much great advice,” says Tasner. “And they really held our feet to the fire.”

Nancy Burkart worked at her family arts and crafts business for decades despite her frustration at its lack of toxin-free supplies. After a divorce, Burkart started Earth Safe Finishes online with her daughter in 2007.

“There’s no retirement now,” says Burkart. “You do what you need to do.”

Yet while pursuing lifelong dreams and serving a larger purpose are great motivators, they don’t always pay the bills.

“It’s all about financial literacy and risk management,” says Elizabeth Isele, co-founder of Senior Entrepreneurship Works, a Washington, DC-based non-profit started last year and has assisted 400 adults age 50 and over.

Isele says these entrepreneurs are part of an important economic shift in the United States. The title of her October Washington summit in the nation’s capital says it all: “New Engines for a New Economy.” (A Bay Area summit at Google headquarters in Mountain View is scheduled for July.)

In San Francisco, Encore.org (formerly Civic Ventures) helps job-seekers find encore careers and also encourages “encore entrepreneurs.”

Jim Emerman, Encore.org’s executive vice president, says along with green businesses, older entrepreneurs often target two areas: youth development and health improvement.

One San Francisco clinical therapist recognized how few children inside the foster care system received proper mental health care. Launched in 1994 as the Children’s Psychotherapy Project, the initiative pairs volunteer therapists one-on-one with foster youth. Now called A Home Within, the non-profit has 50 chapters in 22 states, winning Encore.org’s 2008 Purpose Prize for social entrepreneurship.

Isele says her organization targets unlikely entrepreneurs: low-income seniors.

“Sometimes they are greater risk-takers than the higher income makers because they know what’s at risk,” she says. “They’re investing in an idea, and they know they have to believe in it. And they are incredibly responsible.”

Isele ponts to Ireland – with its mandatory retirement age and stressed pension funds – as a model for older adults with its Senior Enterprise initiative.

“It is the program that is held up as the model program by the EU,” she says. “The EU commission is very interested in senior entrepreneurship.”

The key to success, says Emerman, is experience.

Older adult entrepreneurs target “all kinds of special needs that lend themselves to the kind of advice that someone with a lifetime of experience can bring to bear,” he says.

Lenders should take into account this very real “social capital,” says Isele.

“That should be considered equally with a credit report.”

Matt Perry wrote this article as part of the MetLife Foundation Journalists in Aging Fellows program, a collaboration of New America Media and the Gerontological Society of America.

 

What does Obamacare mean for young people?

Published: May 8, 2013 | 1 Comment

Photo: m00by/Flickr

By Callie Shanafelt
California Health Report

Most young people feel like they have years of good health in the bank. They are, as a group, so unlikely to buy insurance that insurance companies dubbed them the young invincibles and in some cases gave up on trying to enroll them in health care plans.

Some young adults, inevitably, will be proven wrong in their optimistic evaluations of their health.

“We’re not invincible—no one’s invincible,” said California organizer Tamika Butler. It’s not that people of her generation don’t want insurance, Butler said, it’s that they can’t afford it.

Butler works for the Young Invincibles, an organization created in 2009 by two millennials who wanted to reclaim the term and advocate for health coverage for their generation.

Many advocates and experts wonder if the Affordable Care Act will actually make care more affordable for young people – or if the young will simply end up paying the price of lowering costs for everyone else. The “age-rating” provision of the ACA prevents insurers from charging an older client more than three times the amount they charge a younger client. In most states, the rate stands at 5 to 1. To make up for charging older people less, insurers are expected to start charging younger people more once the provision goes into effect in 2014.

Right now, young people are generally benefiting from protective changes ushered in by Obama care.

Possibly the most popular provision of Obamacare was the expansion of dependent coverage so that young people can stay on their parents insurance until age 26. Even those who want to repeal the legislation want to keep that provision intact. As one of the first provisions enacted, it’s also one of the first indicators to be evaluated.

The data suggests the change was a success in increasing the number of Americans with insurance. “The total enrollment exceeded original expectations,” said Harvard assistant professor and senior advisor to the Department of Health and Human Services Benjamin Sommers.

More than 3 million young people gained insurance between September 2010 and December 2011 because of the change, Sommers found. In his analysis, youth of all socioeconomic and racial backgrounds benefited from the provision.

“It’s hard to see whether it narrowed disparities,” Sommers said. “But we’ve really seen broad benefits in coverage.”

Those who it helped the most were single, male and out of school.

“The biggest gains tended to be in kinds of people who had fewer options,” Sommers said.

In the past, married young adults have had more health-care possibilities through a spouse, so the legislation helped to provide single young adults with another option through their parents. Women were also more likely to be insured, so Sommers said that the provision helped men catch up. Before the change, many insurers allowed young people to stay on their parent’s insurance while in college, so the provision also provided a new option for those no longer in school.

Sommers also found that young adults with poor health were most likely to get coverage in the first few months of the provision.

Because of the provision, 23-year-old Kurt Henlin was able to stay on his parents insurance after he graduated from Temple University last May. His mother has insurance through her job as an administrator at Bronx Community College.

Henlin majored in communications and wants to become a talent agent in Hollywood. He moved to Los Angeles in August to follow his dream. He is now temping at a talent agency.

“Most entertainment industry jobs do not offer insurance,” Henlin said.

He’s glad he has three more years to get on his feet before he has to worry about providing his own health plan.

“They agreed to pay until I’m a fully functioning adult,” Henlin said.

Next year, Henlin could also possibly qualify for a subsidy toward an individual plan through the state exchange, or for coverage through Medi-Cal once more of the Affordable Care Act provisions go into effect.

That’s when some experts worry the honeymoon between young people and Obamacare will end. In the past few months, insurers and opponents of the legislation have said that young adults should fear “rate shock,” because premiums will go up once the new provisions take effect.

While testifying before a House Energy and Commerce Committee subcommittee on March 15, Christopher Carlson, an analyst for a management consulting firm, said that premiums overall are not likely to increase, but he encouraged legislators to look closer at the Affordable Care Act’s effect on certain groups, including the young.

“Understanding these issues requires analyses that go beyond consideration of broadly stated averages, which can mask the effects on important subpopulations,” Carlson said.

“Our study indicates that the impact of the age rating compression will increase the average premium for policyholders between ages 21 and 29 by 29 percent,” Carlson said.

He went on to note that huge increases only affect to individuals who aren’t eligible for any premium subsidies through the exchange.

Carlson estimates that 1.4 million of the 11.2 million currently uninsured young people will not qualify for subsidies.

Other experts challenge the assertion that there will be huge rate hikes. An Urban Institute study, for instance, found that taking into account the premium subsidies and Medi-Cal expansion, rate increases will be minimal.

And many will qualify for help from the government. More than one million uninsured young people will qualify for Medi-Cal and 1.5 million will qualify for a subsidy, notes Jen Mishory, Deputy Director of the Young Invincibles. She also pointed out that the Affordable Care Act outlines a catastrophic plan for people under age 30, which satisfies the individual mandate if young people don’t want to pay the higher premiums.

Carlson recommends a few ways to slow projected increases. One possible solution would be to phase in the age band over a period of years. His other suggestion is to legislate the affordability of the catastrophic plan.

But Mishory said the benefits of finally having coverage are worth the price.

“We looked at it as generational compromise,” Mishory said.

 

How dirty (or clean) is your zip code?

Published: May 5, 2013 | 1 Comment

By Daniel Weintraub

Tucked between two traffic-choked freeways, the southeast corner of Santa Ana is among the least healthy places to live in California. The neighborhood’s air is dirtied with diesel emissions and other pollutants. Nearby businesses release an unusually large amount of chemicals. The community has more hazardous waste clean-up sites than almost anyplace in the state. And its groundwater is threatened by contaminants leaking from underground storage tanks.

A few miles away, along the Newport Coast, it’s a different story. Traffic is relatively light, and the air is clean. There are no industrial chemicals to speak of, little hazardous waste exposure and no clean-up sites. The community is one of the healthiest places to live in California.

This tale of two zip codes – 92707 in Santa Ana and 92657 in Newport Beach – emerges from a new online mapping tool that allows Californians to see a detailed environmental report card for the places where they live, work or play.

Promoted as the first of its kind in the nation, the database scores about 1,800 zip codes around the state and then ranks them against each other on 11 different measures of environmental quality, individually and as a group. (The tool uses “census” zip codes, which are very similar to but not always identical to postal zip codes.)

But it doesn’t stop there. Importantly, the tool also combines the environmental results with several demographic measures that reflect a population’s vulnerability – age, poverty, asthma rates, among others — producing a “pollution burden score” that shows which neighborhoods are most at risk for health problems caused by the environment.

The tool, produced by the state Office of Environmental Health Hazard Assessment, is a potentially crucial link in solving the puzzle of how health and place are connected, and why people who live a short distance apart have such wildly different health outcomes.

As currently designed, the scorecard doesn’t do that. The few health measures it uses, such as asthma rates and the number of low-birthweight babies, were included to help measure a population’s vulnerability. Someday, its creators say, they may link their measures of environmental conditions to other sources that assess the health of a population.

In a very crude experiment to see the potential for this kind of analysis, I plugged those two Orange County zip codes into another online tool produced by MeasureofAmerica.org, which compares life expectancy, education and income by community. The results: if you live in that Newport Beach zip code that California’s environmental scorecard ranks as one of the cleaner places in the state, your life expectancy at birth is 88 years. If you’re born into that other neighborhood three or four miles away in Santa Ana, you can expect to live ten years less, or about 78 years.

That’s a huge disparity, and one that can be seen up and down the state. A correlation between environmental conditions and life expectancy is not the same as cause and effect. It would take a rigorous study to get to really flesh out those connections. But where would you rather live?

The state’s tool is still a work in progress, as its name – CalEnviroScreen 1.0 – suggests. Besides lacking a link to health statistics, its ranking system is based on percentiles, not absolute numbers, like a college professor who grades her students on a curve. That means that even if every zip code in the state became nearly pristine but there were still tiny differences among them, the scorecard would still rank them from best to worst, obscuring any assessment of whether they were all healthy places or not.

The tool is also far more difficult to use than it should be in this age of mobile apps and interactive web sites.

To get the most out of the information, the user has to toggle among three different sources — a mapping tool, a sortable spread sheet that contains the raw data, and a thick report that explains what you are looking at. The definitions of the categories assessed are often too cryptic for the average person to understand, and the first version of the tool published last month didn’t even say whether a “low” score or a “high” score in the ranking system was more desirable (it turns out that low scores are better).

But these bugs will likely be worked out in later versions.

“We’re open to suggestions on how to improve the data and make the scores more reliable, and how to make it more accessible to the general public,” said Sam Delson, a spokesman for the office. “We’re a scientific office, and generally our materials are read and responded to by stakeholders, other scientists, and this is something we realize is drawing a lot of public attention.”

Indeed, the web site drew close to 100,000 visitors in its first two days online, and it will likely remain popular. While Delson said it was not intended to be used to guide local land-use decisions, the information it conveys will no doubt be helpful to neighborhoods looking to fight the next hazardous waste dump or high-polluting factory in their midst.

Information is power, and all of the information in the CalEnviroScreen was already available to public, but only to those who knew it was there, knew how to find it and knew how to make it usable.
The new web tools let just about anybody with access to a computer find out how their neighborhood compares to the community down the road and to towns across the state. And then do something about it.

Daniel Weintraub has been covering California public policy for 25 years. He is editor of the California Health Report at www.healthycal.org

 

Tribal courts aim to heal

Published: May 3, 2013 | 1 Comment

Non-Natives in the tribal court system can expect a version of justice that differs from most American courts. The Yurok tribe practices restorative justice, which intends to repair the community and victim after a crime is committed. Instead of sentencing someone to a few days in jail, for instance, they may sentence them to give up fishing rights or donate fish they catch to the community. Photo: Linda Tanner/Flickr.

By Callie Shanafelt
California Health Report

Advocates for Native American survivors of intimate violence cheered when they won the right to prosecute non-Indian assailants in tribal court. That change came with a provision in the Violence Against Women Act earlier this year. On at least one slice of California sovereign tribal land, the change also means defendants will have to engage with a very different criminal justice system – one that is based on restorative justice.

“What you’re trying to do is resolve a problem,” Yurok Tribal Judge Abby Abinanti explained of their tribal court’s guiding principle. “There must be a consequence for a bad act. You work through the consequence, and if they’re amenable to it, make it up to the victim.”

The ability to try non-Natives in tribal courts, which was hotly contested, came with the reauthorization of the Violence Against Women Act earlier this year. Many Native women suffer from intimate violence. Nationally, Native American women experience higher levels of physical violence, rape and stalking than any other racial group. More than one in three Native American women will be raped in their lifetime, according to the Department of Justice. The majority of perpetrators are not Native American.

(Related: New VAWA provides unprecedented protection for Native American women)

Few perpetrators were brought to justice for a number of complex reasons. In states where native tribes did not share jurisdiction with the state, for instance, non-Native people could and did commit violent crimes against Native American women – and no one on tribal land had the authority to prosecute them. They had to rely on federal officials to find a prosecute criminals, a difficult proposition, especially where tribal lands are geographically isolated. Native American women may also live on a reservation with non-Native men who haven’t been subject to tribal authorities, including the tribal police.

Tribal courts haven’t had the right to prosecute non-Native people since 1978 when the Supreme Court ruled that tribes do not have jurisdiction over non-Indians. House Republicans like Senator Chuck Grassley were reluctant to give the right back.

“[U]nder the laws of our land, you got to have a jury that is a reflection of society as a whole, and on an Indian reservation, it’s going to be made up of Indians, right? So the non-Indian doesn’t get a fair trial,” Grassley explained at a town hall meeting in his home state of Iowa in February.

The conflict over tribal jurisdiction was unfortunate and misplaced, Abinanti said. “Clearly they don’t have a sense that we’re functional,” Abinanti said. “I’m not out to mistreat any defendant.”

Abinanti is a retired state court judicial officer and is familiar with both the state and the Native court systems. They are, she notes, systems with different philosophies about retribution and rehabilitation within tribal courts.

But the Yurok tribe focuses on restorative justice. They resolve needs of the victim, the offender and the community, rather than addressing harm to the state as done in most courts in the U.S. The Yurok’s goal is to repair the actual harm that has been done and find healing to end the bad behavior for the benefit of the community.
By providing support to the perpetrator, Abinanti also hopes to end their bad behavior.

“By the time it gets to somebody like me, it’s not the first time it’s happened,” Abinanti said.

This approach is aligned with traditional Native American perspectives about justice. Historically, the Yurok Tribe had a justice and dispute resolution system that included mediation or payment as part of the resolution process. A village leader or group of leaders would listen to the complaint, dispute, or problem and arrive at a settlement amenable to the wronged party and the community.

“One of the most important components of this traditional response was the conversation and negotiation that would occur about the incident, in which tribal leadership would mediate between the two parties,” reads a document of the Northern California Tribal Court Coalition Domestic Violence Court.

Working with Judge Abinanti is very different than working with state judges in Del Norte County, said Yurok Social Services domestic violence advocate Porscha Cobbs.

“With tribal court, there are ways to show accountability in a restorative way,” Cobbs said.

Instead of sentencing someone to a few days in jail, they may sentence them to give up fishing rights or donate fish they catch to the community. This would be a much more significant consequence than a night in jail for a Yurok man, Cobbs said. Many living on reservations in this rugged stretch of the far North of the state depend on fishing from the Kalamath River for subsistence.

Victims who went through the restorative justice process felt less fear of their perpetrator, an increased sense of security and a greater ability to resume normal daily life, according to one study.

Restorative justice models have been used around the world in many indigenous communities. One of the most notable recent examples was the Truth and Reconciliation Commission in South Africa. In order to heal from the injustices during Apartheid, the commission offered amnesty to perpetrators who agreed to tell the whole truth of their wrongs.

This community accountability may mean tribes can succeed with a variety of methods for healing and criminal justice. Though tribes are diverse in their approaches to criminal justice, several in the North are joining with the Yurok to better respond to domestic violence.

Stephanie Dolan directs the Northern California Tribal Court Coalition of five tribes. Dolan is setting up a domestic violence court for all the tribes in the coalition. Three of the tribes have the largest Native populations in the state.

Dolan partnered with the Center for Court Innovation in 2011 to conduct a survey about domestic violence among the tribes in her coalition. Their results differed somewhat from national statistics, showing that most participants thought that perpetrators of violence against women on reservations are equally of Native and non-Native backgrounds.

Members of the five tribes contend with high unemployment rates and high rates of women and children living below the federal poverty level and higher than average rates of substance abuse and mental health problems. These issues are risk factors for domestic violence and sexual assault.

Judge Abinanti says the new VAWA provision is helpful, but may be beside the point. “Who’s doing it is not my concern,” Abinanti said. “The issue is the behavior is not ok.”

 

New VAWA provides unprecedented protection for Native American women

Published: May 2, 2013 | 1 Comment

Juana Majel-Dixon addresses VAWA rally attendees. Photo: National Congress of American Indians/Flickr

By Callie Shanafelt
California Health Report

Native American women are physically abused, raped and stalked more than women of any other racial group in the nation. A new provision in the Violence Against Women Act, passed in February, allows Native American courts to prosecute non-Native offenders for the first time since the 1970s. While most expect the provision to help address violence against Native women, it also poses challenges for California’s tribal courts, which work with far fewer resources than county courts.

Nationally, non-Native men commit 86 percent of crimes against Native women, according to the Department of Justice. Preying on women living on Native lands in Minnesota, for instance, is common during hunting season, a disturbing parallel pointed out by Native American novelist Louise Erdrich in a recent New York Times commentary. The offenders were secure, Erdrich suggested, in the knowledge that tribal police couldn’t arrest them.

“To protect Native women, tribal authorities must be able to apprehend, charge and try rapists — regardless of race,” she wrote a few months after winning the American Book Award for The Round House, a novel set in the aftermath of a rape on tribal land.

The new provision in the Violence Against Women Act (VAWA) came after a decade of such activism.

Juana Majel-Dixon of the Pauma Band of Luiseño Indians in Southern California was a part of the fight for the provision from the beginning. She is Vice President of the National Congress of American Indians and has a traditional appointment to the Pauma legislative council.

Ten years ago, a delegation of American Indian women went to the national task force that administers the money for VAWA programs. They asked for two percent of VAWA funds to help Native Americans.

(Related: Tribal Courts Aim to Heal)

At that time, rates of sexual assault and domestic abuse were just beginning to be tracked by race.

“This is starting to look pretty scary out there, how many Native women were being harmed,” Majel-Dixon remembers saying. The board ended up allocating 10 percent of funds to Native American women.

The extent of the problem became clear to them as they were advocating for victims of abuse, Majel-Dixon said.

The money allowed them to set up services specifically for Native American women and to collect data about the issue. “We ourselves realized there were no protections in Indian country,” Majel-Dixon said.

So they started to push for the provision to allow for the prosecution of non-Native defendants.

Yurok tribal member Elsie Losey says the provision would have helped her escape her abusive marriage. She grew up in Eureka watching her parents’ violent fights.

“I had this pattern of looking after the bad boy, the one that was going to push me around,” Losey said. “I thought it was a sign of love.”

A series of bad boyfriends eventually led to an abusive relationship with a non-Native construction worker with whom she had three children. Her partner isolated her from her family, tribe and the outside world. The first time he brutally beat her was when she left the house to visit a friend while he was at work.

“I wouldn’t leave cause I thought I loved him and I thought he loved me,” Losey said. “The first beating I will never forget. I could take the mental abuse but the physical—oh, my god!” Sometimes, Losey said, her husband would hit her with 2x4s from his job site.

Losey is not alone. A survey intended to help develop a domestic violence court was recently conducted among five northern tribes in California—including the Yurok. Almost half of the women responding reported that a partner had abused them. Slightly more than 70 percent of respondents said that they thought the perpetrators of domestic violence were equally Native American and non-Native. Many also said they felt more comfortable addressing these crimes with tribal police and in tribal courts.

But tribal courts, which are small and short on funding in California, may find it difficult to meet the requirements to prosecute non-Native defendants. None have their own jails. California is also one of a few states where Native and non-Native authorities have equal jurisdiction on tribal land, so the federal government doesn’t provide as much funding to tribal courts here.

There are only 22 tribal courts in the state, serving 40 of the 107 federally recognized tribes in the state. Many of the courts are also fairly new. The rest of the tribes rely on local authorities.

The new VAWA provision may be most helpful in states where tribal justice systems are more robust, like Minnesota, but until recently had no jurisdiction over non-Native people.

The members of the five Northern California tribes expressed more concern with the lack of cultural competency among non-Native authorities and service providers. The five tribes are currently developing a unified approach to domestic violence so the courts can better serve their members.

Forty-three percent of respondents felt that law enforcement—city and county law enforcement in particular—did not treat members of the community fairly in reports or investigations of domestic violence.

“I went to court once, and it went to pre-trial, and the judge told me if there was another domestic violence incident that brought me to court, they were going to send CPS to get my kids, and they would take me and my husband to jail,” said one victim of domestic violence participating in a focus group that was part of the survey. “And now I feel that I can’t turn to anybody if I have an issue. Or if we have a verbal altercation, I feel that I have to stay there and endure it. And stay and stay and stay because I can’t turn to anybody else. And that’s what makes it rough.”

Losey said that when she called the police about the beatings, her husband would be very calm and tell them that he would never hit her. With the police in the house, Losey finally felt protected, and would let her anger about the abuse show. So the police accepted her husband’s version of events.

She didn’t know where else to turn. “I thought I wouldn’t be able to make it without him, I ran my family support so low in the ground,” Losey said. “So I stayed.” She remained in her abusive relationship for seven years.

Dealing with Native authorities would have made her feel like she was understood, Losey said. “I would have felt way more comfortable; I think it would have went a lot more smoother for me.”

 

Chula Vista students slim down

Published: April 30, 2013 | No Comments

Fruits and vegetables replace cupcakes at Myrtle Finney Elementary, one of 44 schools in the Chula Vista Elementary School District.

By Marty Graham
California Health Report

When the Chula Vista Elementary School District south of San Diego surveyed the physical condition of the 25,000 students enrolled in 2010, the results were worrisome. About 40 percent of the kids were at an unhealthy weight – with the highest rates among fifth and sixth graders.

The survey prompted the district to act. The schools overhauled their menus, banned birthday cupcakes, integrated movement into recess and the classroom, and focused on educating students about better nutrition in the neighborhoods where obesity rates were highest.

By the time the survey was repeated this year, the programs put in place had had an impact, according to Sharon Hillidge, resource teacher for wellness. Body mass indexes were down 3 percent and fitness levels had improved.

“We were hoping for maintenance, we thought it would be five to 10 years before we saw improvement,” Hillidge said. “We were so pleased to see improvement – we have made an impression either on the students or the parents.”

The school district learned a lot devising the new program – garnering headlines with a “No Cupcakes” policy and startling everyone involved by finding they could draw obesity on a map. And, Hillidge said, they discovered that a lot of their stereotypes fell away and that new ideas for food-based activities like fundraising and parties came forward.

But they also found that everyone, the students, parents and teachers really engaged in the new approach to emphasizing the health of the students and that the small steps can yield big results.

“The biggest change was the sixth graders, who were in fourth grade when we did the survey,” Hillidge said. “They went down
five percent – and the two schools with the biggest losses were the most unhealthy – they improved by 10 percent.”

Chula Vista is a city with a clear east-west divide. The east side is mostly newer, planned development with more parks, higher family incomes and less access to fast food. The west side, old Chula Vista, includes more commercial development, including strip malls and a high concentration of fast food restaurants.

“We used the Center for Disease Control (and Prevention) maps for adult obesity as a base and then did overlays of where the fast food restaurants and parks are,” Hillidge explained. “It was a shock to see that where you live has such a profound impact on your health.”

Five schools in west Chula Vista had more than 30 percent obesity rates – the five closest to fast food outlet concentrations. Two years later, only two of the original five are still at that level, she said.

When the results for the 2010 survey came in, the school district mobilized to look at the food and activity environments, Hillidge said.

“Our concentration had been on scholastic testing, on keeping the kids at their desks learning,” she explained. “We realized we really need to be concerned about long-term health issues. We all worked in our silos so we didn’t have a connection with the Health and Human Services programs.”

The schools worked with the county’s department of Health and Human Services, which had launched a 10-year Child Obesity Initiative in 2006 in response to the alarming national increase in obesity and unhealthy weights – mirrored in the county population.

County Supervisor Greg Cox, who represents Chula Vista, has been active in promoting the county’s goals and tracking progress since the school district gathered its baseline data.

“The Chula Vista Elementary School District has done incredible work lowering childhood obesity rates among their students and creating a healthy, safe and thriving school district,” Cox said last week. “This district is a role model for school health and wellness, both locally and nationally.”

Jeffrey Thiel, the school district’s executive director for operations and instruction, said that it’s too soon to overthink the data.

“We see the data as a baseline and we are figuring out how to take this momentum and go forward,” he said. “I don’t think any of us can pinpoint a single cause for the improvement but we know that awareness has increased – what our students talk about at lunch has completely changed.

“We are giving them healthier choices and we are educating them on why it matters – we even hear from the parents, and that is very powerful,” Thiel added. “We had a lot of buy-in and less pushback, but we have plenty more to learn and plenty more to do.”

The first step in improving students’ health was the complete revision of the district’s wellness policy. A committee led by the district’s superintendent looked at nutrition and the food environment, physical activity levels and physical education and began communicating with families about their concerns and plans.

“Some of the changes seem so small – we no longer have flavored milk – it turned out not to be the big issue we thought it might be,” Hillidge said. “We changed to non-food birthday parties – that was the most controversial decision for parents and students.”

For teachers, the policy changes affected little things like not carrying cups with Starbucks logos, and big things, including all the fundraising for classrooms that involves selling food that usually isn’t very healthy.

“That takes away from our classrooms,” Hillidge said. “We still haven’t found a good answer there.”

Teachers worried that planned steps to get the kids more active inside the school would turn the classrooms into chaos, Hillidge said.

“We found we can integrate math and science with physical activity, and we had to show teachers it was doable without turning things into chaos,” she said. “Our teachers really care about the health of their students and we’re finding that as their health improves so does their ability to learn.”

And the schools revised recess to make it active by setting up activity stations – from playing basketball to walking around the track with friends, rather than just socializing or waiting for recess to end. The kids can still socialize – they just have to move while they’re doing it, Hillidge said.

Some of the survey findings were surprising and remain a surprise, Hillidge said. For example, boys were much more obese than girls.

“At the elementary school age, they’re the ones who are much more engaged in video technology, games and apps, than girls,” Hillidge said. “It would be interesting to see middle school results, when the kids are getting their own cell phones, and more girls are engaged with the technologies, but at this age, the cultural stereotype that boys are more active is not happening.”

Educating the kids about healthy eating and living has become a mission at the schools – down to choosing wellness as the topic for the schools’ speech contest.

“It gave kids a chance to work on their story-telling and to educate each other,” Hillidge said. “Information is power, especially when you give it to kids.”

 
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