HealthyCal.org

By Dorie Seavey and Eileen Boris

California home care workers and consumers won a major victory when an agreement was reached to limit proposed cuts to service hours in the In-Home Supportive Services program for fiscal year 2014. Yet home care workers in California – and across the nation – still await another critical decision that will affect their paychecks and their dignity: whether a federal labor law will continue to exclude home care workers from minimum wage and overtime protections.

In December 2011, the Obama administration announced a proposal to revise a decades-old rule that denies basic wage and hour protections to our nation’s fastest-growing workforce: home care aides. Among the nation’s most poorly paid workers, home care aides are a lifeline for millions of Americans who need assistance to remain living in their homes and communities. Yet, for decades, these workers have lived in the shadows, their crucial role in supporting America’s families—and maintaining the health and well-being of elders and people with disabilities—denied.

The proposed rule, which is now under final review, would extend federal minimum wage and overtime protections to nearly a half million California home care workers—and nearly 2 million workers across the country.

California’s In-Home Supportive Services (IHSS) program is the nation’s largest publicly funded home care program. It serves more than 400,000 elders and people with disabilities (called “consumers”). Some state officials and IHSS consumers have not been supportive of the change in federal law because, they believe, California’s Medicaid program cannot absorb the additional cost of paying time and a half for overtime. Consequently, they argue, the new regulation will cause a reduction in services and force people with disabilities into institutional care.

In a recent analysis of IHSS authorized service hours, however, PHI found there is no evidence to support these claims. In fact, we believe that the proposed change supports consumers’ needs by making home care a more “legitimate” and respected occupation, one that can attract sufficient workers to meet the growing needs of aging and disabled Californians.

Our findings show that 90 percent of IHSS workers use less than 160 hours of support services per month. That means, for the vast majority of IHSS consumers, overtime hours are not required.

Individuals with very high-hour support needs (280-283 hours per month) comprise only 2.5 percent of all IHSS consumers. For these individuals—if they rely on only one home care aide —the annual cost of services, including time and a half for overtime, would be $50,022 annually. Nursing home care for the same individual would cost $63,875, nearly 25 percent more.

So even under the most extreme assumption—that one worker is providing nearly 70 hours of service per week—it would still be less expensive to serve this individual at home. Moreover, under the Supreme Court’s Olmstead decision, the state has an obligation to serve individuals with disabilities in the most integrated setting of their choice.

In reality, IHSS is likely to adapt by asking consumers who have high-hour needs to schedule multiple workers. Consumers, along with family members who work as IHSS paid assistants, might find such a solution disruptive at first. But it can lead to real benefits. Consumers would have the added insurance of a trusted backup attendant when their primary attendant is unable to work. In addition, the many IHSS workers who work part time but would prefer more hours could receive additional work through sharing high-hour cases.

Notably, 15 states already provide, under state law, minimum wage and overtime protections for home care aides. On average, these states have the exact same rates of institutionalization for people with functional limitations as states that do not offer such protections. Nevada, a state that offers these labor protections, has the nation’s lowest rate of institutionalization.

California’s home care workers earn a median hourly wage is $10.33. One third have no health coverage, and half rely on public benefits to support their families. Is it fair to continue to ask these workers—predominantly women of color— to sacrifice their wages to keep costs down for consumers? Home care workers provide valuable services—and the need is growing dramatically. Without basic labor protections, it will be increasingly difficult to attract workers to this vital occupation.

Providing all home care workers with minimum wage and overtime protections under the Fair Labor Standards Act (FLSA) would help make home care a respected occupation–-and ensure the stable, skilled home care workforce necessary to support growing numbers of Californians who, despite functional limitations, wish to live in their own homes and communities.

Dorie Seavey, Ph.D., is Policy Research Director for PHI, a national nonprofit committed to improving the quality of long-term services and supports by improving the quality of jobs for direct-care workers.

Eileen Boris, Ph.D., is Hull Professor and Chair of the Department of Feminist Studies, University of California Santa Barbara. She is the author, with Jennifer Klein, of Caring for America: Home Health Workers in the Shadow of the Welfare State (Oxford University Press, 2012).

By Dr. Nadine Burke Harris and Esta Soler

Picture yourself walking through a forest. Now, imagine that you’ve come face to face with a large bear. Instantly, your emergency response system kicks into gear, flooding your body with stress hormones. Your pupils dilate, your heart starts beating fast, and your skin becomes cold and clammy. The executive, cognitive portion of your brain shuts off so you can focus only on two options—-fight or flight.

Your body’s emergency response system could save your life—-if a bear in the forest really is confronting you. But, what happens if that big bear is waiting for you when you get home every day? Or follows you as you walk down the street to the local store? Or threatens you in the schoolyard? In the face of such extreme and repeated danger, your emergency response can go from saving your life to damaging your health and well-being.

Around the country, this scenario is similar to the reality faced by millions of children who experience violence and trauma at home, in their schools, and in their communities. According to a report by the U.S. Attorney General’s Defending Childhood task force, our children are experiencing and witnessing violence on an alarming scale. The numbers are staggering. Approximately two out of every three children in the U.S. are exposed to violence.

The good news is that we now know a great deal about how to change the odds for children exposed to violence and trauma. But, to protect children across our country, we need to galvanize a broad, national movement to call for the solutions we know can work. In the absence of such an effort, many of our children will experience lifelong consequences from exposure to violence and the toxic stress it causes. With their brains and bodies still being formed, children are uniquely vulnerable to the impact of toxic stress on their physical, mental, and emotional health.

A major study by the Center for Disease Control found that childhood exposure to abuse and other traumatic stressors, termed Adverse Childhood Experiences (ACEs), led to a multitude of social and health problems. For example, adults who had been exposed to four or more categories of Adverse Childhood Experiences were more than twice as likely to develop chronic lung disease and more than four times as likely to develop depression. Subsequent research has shown that children with four or more categories of ACEs are 32 times more likely to have learning or behavioral problems in school than those who had none.

Violence can happen in any community and can take on many forms, from sexual and physical abuse to violence in homes or neighborhoods, including violence against friends, family members, trusted adults, or bystanders. Some children—-as many as one in ten-—may experience multiple layers of violence at the same time. These children in particular are at high risk of never developing the basic capacities they need to function normally and lead productive and successful lives as adults.

When the futures of millions of children are jeopardized, we all suffer. Our health care, social services, law enforcement, education, and other public systems bear the brunt of our failure to prevent this epidemic; and the costs are astronomical. A 2012 study by the CDC found that total lifetime estimated financial costs associated with just one year of confirmed cases of child maltreatment (physical abuse, sexual abuse, psychological abuse, or neglect) is approximately $124 billion.

If we don’t intervene, it’s clear that we all pay the price when children are not successful in school, enter the juvenile justice system, or grow up to become perpetrators of violence themselves. Less recognized is the price we pay for the healthcare of millions of Americans whose heart disease, chronic lung disease, obesity or depression may have been prevented with early and effective care.

We have learned a great deal about how to prevent violence, and how to help children exposed to violence and trauma heal and thrive. The next step is to launch a state and national agenda to make homes, schools, and communities safer, more supportive, and healthier places for all of our children. We must not allow violence to deny any child the right to grow up safe and secure. Here’s what we can do:

- Start early by identifying kids who are exposed to violence through routine screenings, and establish prevention programs within the health care system, schools, and youth organizations to protect children from future violence.

- Focus our efforts on early childhood and early adolescence, critical stages when it comes to preventing violence. We can intervene then with those who already have experienced extensive and multiple traumas when there is the greatest opportunity for healing and positive development.

- Change public policies to support prevention and healing for children and families, using key policy shifts such as health care reform and laws designed to prevent violence against women and to help children who are victims of violence and abuse.

- Don’t spend money on things that don’t work—-such as punitive juvenile justice facilities—-and re-invest in programs that can help children heal and thrive. Instead of supporting zero-tolerance policies that drive troubled kids out of schools and away from safety, let’s keep kids in school and connected to safe and stable adults.

- Make violence a public issue, and educate all Americans about this problem and the role each of us can play to ensure that our children are safe.

Too often, the youngest victims go unseen and unheard. It is up to all of us—-from teachers to clergy, to coaches, to doctors, to parents—-to take the steps needed to effectively protect and heal children exposed to violence, giving them the web of support they need to grow up healthy, happy, and secure.

Dr. Nadine Burke Harris is the founding physician and former medical director of the CPMC Bayview Child Health Center, and CEO of the Center for Youth Wellness. Esta Soler is president of Futures Without Violence. They originally wrote this piece for the Rosenberg Foundation’s Justice in California publication.

By Robert K. Ross and Linda P.B. Katehi

Preventive measures and an active, healthy lifestyle are without question the best way to maintain good health and keep down health care costs for everyone, and the California Endowment and UC Davis want to spread that message far and wide.

The Endowment’s Health Happens Here campaign promotes the idea that people live longer, healthier lives when communities have access to healthy and affordable choices where they live, work, play and learn.

UC Davis is following the Health Happens Here model to help its students achieve healthy, vibrant lifestyles in an integrative wellness campaign that can be replicated at college campuses everywhere.

In support of this goal, UC Davis students will hold the first ever “5K Stride for Aggie Pride” on campus Sunday, April 7. In addition to raising money for scholarships and emergency funds for students in need, the event will formally launch the partnership between the Health Happens Here campaign and the UC Davis Division of Student Affairs.

We all know that staying healthy requires more than doctors and dieting. Every moment of our day, our surroundings and the decisions we make affect how well, and how long, we live.

A healthy life is directly connected to the streets in the neighborhoods we live in, the classrooms where our students spend half their waking day and our ongoing access to preventive health care.

The days of approaching health care as something we use only when we get sick must end. We all have a responsibility to promote healthy lifestyles and choices that keep us out of the doctor’s office and hospitals in the first place. It’s the best way to reach our full potential and to control runaway health care spending.

At UC Davis, the Division of Student Affairs has been following the Endowment’s Health Happens Here campaign to promote total wellness among its 34,000 graduate and undergraduate students.

The idea behind the UC Davis effort for school-based wellness is to provide what students need to live healthy lives so the right choice for them also becomes the easy choice.

From UC Davis’ dining services that are focused on sound and affordable nutrition to nurture the mind and body, to educational programs in affordable cooking and diet, the university is providing students with desirable and safe environments in which to develop both their enthusiasm and skills for preparing healthy meals. UC Davis students also have an opportunity to promote the health benefits of organic produce, running a 5-acre organic garden that is part of the university’s Student Farm Market Garden. The garden provides organic produce year-round to the dining services and to a seasonally operated campus farmer’s market.

Just as the Endowment promotes the availability of affordable and safe options for physical activities in neighborhoods throughout California, the campus at UC Davis offers students an abundance of opportunities for healthy exercise and exertion.

The university and the city of Davis have one of the most comprehensive networks of greenbelts and bike paths that enable and encourage students to move safely on and off-campus. With more registered bicycles than motor vehicles, Davis is a model of self-locomotion that provides physical and mental well-being as the same time it contributes to a cleaner and healthier environment.

UC Davis also offers a variety of recreational and athletic programming that promotes the idea that a good mind-body balance is critical to the success of any individual. We know that people who work hard are more successful when they’re active. There are few places where we see that reality played out on a daily basis more than a bustling and vibrant college campus.

Another important piece of the puzzle at UC Davis is the effort already underway to develop a strategic plan to guide transition to a tobacco-free campus by 2014. Eliminating smoking is essential to good health, and everything we do to help college students avoid tobacco will pay dividends for them – and for society – now and in the future.

Social, cultural and emotional health are also taken into consideration. The campus opened a new Student Community Center last year that helps promote social and emotional wellness through a variety of student services and programs that honor diversity, offer students of all backgrounds and interests places to gather, interact and to raise political and cultural awareness throughout the student population.

There is no doubt that everyone’s quality of health care can be better, more affordable and accessible if we focus more on preventing illnesses and disease rather than simply treating a patient when he or she is already very sick.

The California Endowment’s Health Happens Here is promoting that message throughout California. We are happy to report that UC Davis has embraced it and is working hard to integrate its principles fully on campus. That will help make for a healthier university, healthier students and a healthier California.

Robert K. Ross, M.D., is president and chief executive officer for The California Endowment, a health foundation established in 1996 to address the health needs of Californians. Linda P.B. Katehi is chancellor of the University of California, Davis.

Note: The California Endowment is a financial sponsor of HealthyCal.org.

By Lloyd Levine

Want to improve your health? Drive an electric vehicle. Ok, so maybe that is overstating it a bit. Beyond improving your psychic well being, an electric car will have a negligible impact on your individual health. However, if everyone were to start driving Plug-In Electric Vehicles (PEVs), the cumulative impact on public health would be dramatic.

Plug-in electric vehicles, which are powered by an electric motor and a large battery, are substantially the same as cars powered by internal combustion engines. Their frames, bodies, and interiors are made out of the same materials and generate the same amount of toxics. The difference between the gas and electric engine is what gives PEVs the big edge in public health.

A gas-powered car generates all manner of toxic pollutants and particulate matter. Exposure to those substances increases the risk of developing cancer and lung disease. Tail pipe emissions are by far the biggest source of their pollution. While carbon dioxide is the most commonly known, tailpipe emissions also contain:

• Nitrogen oxides, which impair visibility, cause lung damage, worsen emphysema and bronchitis, and exacerbate heart disease;
• Hydrocarbons, which react with NOx and sunlight to form air pollution commonly known as smog;
• Sulfur dioxide, which is a key component of “acid rain”, and also aggravates existing heart and lung diseases;
• Particulate matter, which can get deep into the lungs and adhere to lung tissue. PM10 aggravates asthma, causes respiratory illness, and can be a cause of cancer;
• Benzene, which, over the long-term can suppress the immune system, cause excessive bleeding, and damage bone marrow. Benzene is also linked to leukemia and other blood cancers;
• Ozone, which is a byproduct directly created from tailpipe emissions. Ozone causes respiratory illness and distress, and makes people more sensitive to allergens, which in turn triggers asthma attacks.

With nearly 30 million cars on the road in California alone, the combined effect of all these chemicals is a significant health hazard. It is such a health hazard that federal, state, and local government agencies are expending significant time, money and energy to find ways to reduce and mitigate the pollution.

Pure PEVs (as opposed to plug-in hybrids) have no combustion and no tailpipe, therefore no emissions. Further, while tailpipe emissions are the biggest source of vehicle emissions, they are not the only source.

Evaporation of gasoline from the engine of cars occurs in more than just a trivial amount. Since PEVs have no gas there is no evaporation.

Other negative health impacts of gas-powered vehicles are reduced in PEVs or don’t occur at all. Prolonged exposure to motor oil has multiple, negative health effects, and oil that is not properly disposed of can leach into and poison drinking water. Because PEVs have no pistons to lubricate, they don’t need or use any oil at all.

Brakes are also a significant and surprising source of particulate matter. When brakes are employed, the force necessary to stop a car creates toxic particulate matter from the pads. The particulate matter gets into the air and into the water system and can cause respiratory illness and cancer.

The regenerative braking technology employed by PEVs to increase battery range significantly reduces brake wear. The energy return system slows the car significantly the moment the driver takes the foot off the gas. PEVs can go from 35 mph to 3 mph in half a city block without pressing the brake pedal.

The shift to PEVs will result in an increase in the need for electricity. That has caused some people to wonder if emissions from the increase in electricity generation offset the benefits from the reduction in tailpipe emissions. However, a shift from gas-powered to electric-powered vehicles would result in only a modest increase in generation, but a dramatic reduction in tailpipe emissions. The tailpipe emissions of cars account for approximately 50% of all air pollution, and 80% of air pollution in urban areas. The increase in electricity generation, meanwhile, may not result in any increase in emissions, depending on the source of the power.

In 2011 approximately 30% of California’s in-state generation came from sources of electricity that have no emissions, and 53% came from natural gas. Those percentages will increase as California meets its 33% renewable energy mandate and replaces existing in-state nuclear and imported coal power. According to the United States Environmental Protection Agency, a natural gas-fired power plant produces virtually no sulfur dioxide or particulate matter, and minimal amounts of carbon monoxide and nitrogen oxides. Solar, wind, geothermal, and hydroelectric generate no emissions.

And here’s an important point that does not get enough attention: it takes the equivalent of 6 kilowatt hours of electricity just to refine one gallon of gas. An average plug-in electric vehicle can drive 16-20 miles on that same 6 kWh of electricity. In other words, it would be more efficient – and better for the air — to send the electricity straight to the car rather than routing it through the oil refinery to make gas.

No matter how it is viewed, the start-to-finish process of creating and delivering electricity, and driving a car powered by it is much healthier (or far less harmful) than the start-to-finish process of creating and delivering gasoline, and driving a car powered by it.

The net effect of thousands of electric cars replacing gas powered cars will be a dramatic reduction of harmful emissions at every step in the process. The reduced tailpipe emissions alone give PEVs a huge health advantage over gas-powered cars. When you add in the elimination of oil, gasoline evaporation, and the reduction in brake pad pollution, as well as the emissions generated in the transportation and refining of petroleum, converting our transportation system to PEVs will dramatically improve public health.

The journey of a thousand miles begins with a single step. The conversion of an entire fleet begins with the purchase of a single car. Drive electric today; it’s good for your health….and mine.

Lloyd Levine is a former member of the state Assembly and a volunteer with Sac EV, a local club that promotes the development and use of electric vehicles. He can be reached at lloyd@filamentstrategies.com

By Anne Pearson

Here in California, when it comes to protecting people from secondhand smoke, we’ve reached what some are calling the final frontier – laws restricting smoking in apartments, condos, and other multi-unit housing.

But as more and more California cities and counties move forward with smoke-free housing laws, another major public health concern often gets lost in the shuffle: how to make sure these new laws don’t put low-income residents at risk of losing their homes.

California paved the way for smoke-free bars and restaurants almost 20 years ago, and local lawmakers here began passing smoke-free housing laws in 2007. That year the city of Belmont made international headlines when it enacted a strong, first-of-its-kind ordinance – which the San Francisco Chronicle deemed “the most sweeping anti-smoking law in the world” – banning smoking not only in most public places but also in all multi-unit housing in the city.

Today, at least 28 cities and counties in California – including Baldwin Park, Compton, Union City, and Richmond – have laws on the books that prohibit smoking in at least a certain percentage of units in housing complexes.

There’s no question that these laws are an important strategy for protecting people, especially low-income residents, from the hazards of secondhand smoke. The California Air Resources Board has joined the U.S. Surgeon General in officially declaring that there is no risk-free level of exposure to secondhand smoke. Among nonsmoking adults, secondhand smoke causes about 50,000 deaths a year from heart disease and lung cancer, and among children it exacerbates asthma and causes lower respiratory tract infections such as pneumonia and bronchitis. Low-income families bear the greatest burden of these health consequences.

Secondhand smoke can seep under doorways and through wall cracks, and the Surgeon General has determined that eliminating smoking is the only way to fully protect nonsmokers. Separating smokers from nonsmokers, cleaning the air, and ventilating buildings don’t prevent exposure.

Half of all renters in California say that secondhand smoke gets into their apartment from somewhere else, according to the American Lung Association in California. Of those, 37 percent say it bothers them “a lot” or “so much I’m thinking of moving.”

Still, as momentum grows for local laws banning smoking in multi-unit housing, some are concerned about the health impact on tenants who smoke – especially tenants in subsidized housing, whose limited income leaves them few choices if they are forced to relocate. Eviction can split up families, lead to job losses, and give rise to depression. A history of eviction also makes it more difficult to secure decent and affordable housing.

Smoke-free housing laws should protect tenants not only from secondhand smoke but also from housing insecurity. How can cities and counties be sure smoke-free housing policies take into consideration the potential health consequences for low-income residents who smoke?

A few key recommendations:

• Get tenants’ rights groups involved. Soliciting input from housing advocates early gives residents buy-in and increases the likelihood of compliance. It also minimizes the chances that concerns will emerge late in the game and derail the policymaking process.
• Incorporate a phase-in period. “Grandfathering” existing tenants who smoke will undercut the effectiveness of a new smoke-free housing policy. But an extended phase-in period of up to one year can give tenants who smoke time to adjust. During a phase-in period, landlords should offer tenants who are bothered by secondhand smoke the option of moving to another unit in the complex, if possible – and tenants with disabilities that are exacerbated by exposure to secondhand smoke should be reasonably accommodated.
• Be fair. Smoke-free policies shouldn’t provide a fast track to eviction. Tenants ought to be given sufficient opportunities to comply with new restrictions, and penalties should safeguard tenants’ rights and account for the difficulty of quitting the habit. Eviction should be a remedy of last resort.
• Provide access to support. Quitting smoking can be a challenging task, as just about anyone who’s attempted can attest. To make it easier for tenants struggling to comply with a smoke-free housing policy, public housing agencies and housing providers should offer referrals to programs like the California Smokers’ Helpline (www.californiasmokershelpline.org), which offers free one-on-one counseling, self-help materials, and other services to help tenants quit or better manage their smoking.

Smoke-free housing policies are a powerful way to protect people from the hazards of secondhand smoke. But as cities and counties continue to move forward with these laws, it’s important to keep in mind the health consequences for people who will face challenges complying. Smoke-free housing policies should be strong, but they should also be humane.

Anne Pearson is vice president of programs at ChangeLab Solutions, a nonprofit policy research and training center based in Oakland, which offers more resources for developing smoke-free housing laws in California.