Safety Net

Out of the shadows and out of poverty: Reducing poverty through immigration reform

The Census Bureau recently released new data on poverty in the United States. While the coverage that followed provided an overview of the new numbers, and in the case of TalkPoverty examined policy choices that would dramatically reduce poverty, there is one important issue that received little attention: the potential for immigration reform to create a pathway out of poverty, by enabling undocumented immigrants to work legally and maximize their earnings.

Today, there are an estimated 11.3 million undocumented immigrants living in the US. Under current immigration law, these individuals are barred from working legally and, as a result, regularly self-select into jobs that minimize their risk of detection and deportation. Most undocumented workers ultimately find themselves in low-wage jobs where they are susceptible to exploitation and unable to exert their labor rights. In fact, researchers have found that undocumented workers are nearly three times more likely to experience wage theft than legal workers. It’s a simple fact: our broken immigration system is forcing families to live under precarious financial conditions.

Our broken immigration system is forcing families to live under precarious financial conditions.

Thankfully, there are smart and much needed policy changes on the horizon.

As Republican House Speaker John Boehner refuses to hold a vote on immigration reform, President Obama is expected to take administrative action.  While the President’s action would be limited and temporary, it would greatly improve the financial security of undocumented immigrants.

Through executive action, the president can focus enforcement resources on high-priority targets, such as criminals and those who threaten national security, while permitting a specific group of people to apply for a temporary work permit and a reprieve from deportation. This process is known as deferred action and would likely be extended to undocumented immigrants who have been in the U.S. for a significant number of years and have family ties here. But what does this immigration fix have to do with poverty?


The acquisition of temporary work permits would allow undocumented workers to apply for jobs that best match their skills, thereby maximizing their earning potential. Equally important, the ability to work legally decreases the likelihood that these workers will be victims of labor abuses, ranging from wage theft to unsafe working conditions.

A recent report by the Center for American Progress estimated that greater labor market mobility and stronger workplace protections would increase the average undocumented immigrant’s earnings by 8.5 percent, or an additional $1,872 each year.  This increase in income is equivalent to 37 percent of average food expenditures—or 27 percent of average transportation costs—for families earning between $30,000 and $39,999 annually (which is the average income bracket for families with an undocumented immigrant).

It’s clear that the fiscal benefits of deferred action would pull some immigrant families out of poverty, keep others from slipping into it, and strengthen the financial security of all of these families.

But it’s not just the families of undocumented immigrants who would benefit from deferred action, all Americans would be better off. As undocumented immigrants receive temporary work permits, they will transition from the informal to formal economy and begin paying taxes legally. In fact, allowing undocumented immigrants who have been in the U.S. for at least 10 years to apply for work permits would increase payroll tax revenues by an estimated $33 billion over five years—that means more resources for vital programs like Social Security that benefit everyone.

Only congressional action will completely fix our broken immigration system. And it’s only through permanent reform that the US will fully realize the fiscal benefits of bringing undocumented immigrants out of the shadows. But until Congress takes up immigration reform, executive action would begin the process of fixing our system.

As Americans wait for President Obama to announce which executive actions on immigration he will take, they should remember that a step toward fixing our immigration system is a step toward greater financial security for everyone.



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Safety Net

In Our Backyard Interview: Understanding Poverty and Inequality in D.C.

This interview with the D.C. Fiscal Policy Institute (DCFPI) kicks off a series of interviews with D.C. service providers, advocates, and low-income people for TalkPoverty’s In Our Backyard project. DCFPI does critical work educating policymakers and the public about the policies we need to reduce poverty in the nation’s capital.

In Our Backyard aims to highlight efforts to dramatically reduce poverty and inequality in our city. If you are interested in writing for the project, please email us at

TalkPoverty: What were the reasons and the need for the creation of the D.C. Fiscal Policy Institute [DCFPI]?

Ed Lazere: We were created in part because the city passed a pretty steep and regressive tax cut on the idea that we needed to cut our top income tax rate because otherwise people would flee the city which is not really supported by the research at all. There wasn’t a DCFPI to respond to that argument.

We see ourselves as using a combination of research and putting the numbers out there for the advocacy community, hopefully communicated in a strategic way, and then partnering with other organizations to try to shape the city’s budget to be more focused on the needs of low-income residents; and to do research that highlights the challenges that low-income residents face, like affordable housing or poverty, and to address working conditions, like the minimum wage or paid sick leave.

TalkPoverty: Can you describe poverty in the nation’s capital for people who know nothing about it?

Jenny Reed: The poverty rate in D.C. is a little over 18%. There were about 109,000 residents living below the poverty line in 2012. Our poverty rate has continued to be high even during strong periods of economic growth in the city. We have about 1 in 4 kids living in poverty, but in the eastern and southern parts [of the city], child poverty rates are much higher. In some neighborhoods it’s 50%.

Lazere: The poverty rate consists almost entirely of people of color… African American and Latino. Income inequality is quite dramatic in the District. If you divide the population, ranking them top to bottom, the bottom earners were even with most large U.S. cities, but at the top, the average income is the highest in the country. As a result the gap between the top and the bottom is one of the highest in the country. If you’re living in a community with substantial inequality, a lot of things may be more expensive, like housing, because it’s all one market. The high-income people are shopping in the same market as you are. They’re going out to restaurants or theater and you don’t. There’s a psychological effect of being at the bottom of a rung of a very unequal society.

Reed: We have found that a large share of people in families in poverty work. For a lot of people the problem is getting access to full time year-round work, and full time year-round work that actually pays a decent wage. D.C. recently increased its minimum wage.  It will be $11.50 by 2016. The first phase of the increase went into effect July 1 up to $9.50.  We think that will help…. We did a simulation that showed if you could get everyone into a $15 an-hour job and access to full time year-round work you could move about 80% of the people [out of] poverty in D.C.

Lazere: The minimum wage was passed the same day as something almost as equally monumental [that] got almost no attention, which was an expansion of our paid sick leave requirement. D.C. is fairly unique among jurisdictions in requiring every employer to provide some amount of paid leave for illness or domestic violence. [That] legislation passed in 2008, but you weren’t eligible until you’d been on the job for almost year. For most low-wage workers, they’re in an industry where the turnover is often 100% within a year, so it was likely that many, many people never got to the point where they started accruing [leave].

The bill that passed last fall made sure all workers were covered. They start accruing leave from the first day on the job, and there are no exclusions for tipped restaurant workers as there had been before. That was big. It’s pretty dramatic and people we know, particularly single parents who have the highest poverty rate, often face challenges if a child is sick. Do I stay home with them and risk losing my job because I don’t have paid sick leave? Now for at least some number of people they won’t have to make that difficult choice.

TalkPoverty: What is the unemployment rate in D.C.?

Lazere: For people with [just a high school degree], it’s about 20 percent. We’re talking about an unemployment rate that’s twice what the national unemployment [rate] peaked at during the great recession—in the middle of a city where construction cranes are everywhere, people are building ugly popup housing, [and] restaurants are opening left and right.

TalkPoverty: So what do you make of that? One guy who wrote for us in Maryland lost 6 people in two years to gun violence, this young guy. He found a job in community development and he takes people to job fairs and describes the devastation of 50 people going and getting nothing. He said just what you said: we see all of these shovel-ready projects starting and none of the jobs going to low-income people who are ready to work. What do you make of that?

Reed: Workforce development is probably one of the most important things we can do, but it’s really hard to do well. There are a couple ways the city really needs to do a better job. One is the Workforce Investment Council which they’ve recently beefed up. [It’s comprised of] business leaders, developers, labor, and government officials that are all supposed to get together and say, “This is where D.C. should be investing its workforce development dollars.” They have an executive director, but they really are just getting started.

Then there’s the workforce intermediary which DCFPI and D.C. Appleseed and Employment Justice Center advocated for. It’s sort of a matchmaker. They’re supposed to be the liaison between say the developer for the convention center hotel that was recently built and the Department of Employment Services to say, “I’ve got all of these people who have these skills. You need these people with these skills. Let’s put them together.” But I don’t think that the Workforce Intermediary has really been able do anything. They’re still kind of figuring themselves out.

Lazere: You hear from a lot of D.C. residents: “I got training for a job and then there wasn’t a job at the end.” They get understandably discouraged and not very optimistic about participating in other training after that.

TalkPoverty: You hear a lot of that with TANF training programs too…

Lazere: It’s a similar thing. They used to go through the same ropes of, “Let’s get your resume ready, let’s help you get some business clothes and teach you how to do an interview.” And a lot of people didn’t show up because they were like, “I’ve done this already. What I really need is just for you to connect me to a decent paying job.”

The District made an effort to revamp its “one size fits all” TANF employment program, largely because we highlighted the problems.  The current program is not perfect but still is far more customized than the old program.  DCFPI is in the midst of assessing how well the new TANF employment program is working.

Reed: I think that there’s concern about some of the major D.C. programs like our transitional employment program or our one-stop centers [that] haven’t really shown great outcomes. They might be giving people something to do, but it’s not connecting them to a job and that’s a big problem.

Lazere: I just learned recently that while the city monitors for the federal programs whether someone got a job and how long they kept it and ways they got it, they don’t really do that for the locally funded programs. How can you have and modify and shape an effective program if you’re not looking at how well you’re doing?

TalkPoverty: How do you think the city can balance having people come into areas that were previously less developed with providing affordable housing for low-income people?

Reed:  Where I think D.C. could do a better job is being more proactive about preservation. We absolutely need to build more affordable housing, but we also need to make sure we’re holding on to what we have. We’re not helping people stay in the neighborhoods as they develop around them. We could be more proactive about tying affordable housing preservation strategies to major economic development projects. Just like you do [an] environmental analysis, or traffic analysis, you could do an affordable housing analysis and say, “What’s at risk here? Is there project-based Section 8 housing that we think owners might want to opt-out of? Are there low-income buildings with tenants that we think the owner might try to sell? Can the district purchase it? Can the tenants purchase it? What can we do to keep the neighborhood affordable?”

You won’t be able to keep every unit, but it’s actually a lot cheaper for the city to preserve units or build new affordable housing prior to development then to try and do it after development has started.

Lazere: The way that governments do their budgets it tends to be fairly incremental. We spent $100 million [on affordable housing] this year, so we’ll spend $102 million next year and then $103 million. That’s just not really going to work. With prices rising so fast, we’re losing ground every year. Once you’ve lost a neighborhood, you’ve lost this tremendous opportunity to preserve affordable housing for a long period of time.

We spend about $2 billion as a city on education, [and] we spend $500 million on our police department… So why is it that in a city where the number one challenge for residents is affordable housing, we spend three times on public safety when crime is going down than what we spend on housing? And the number of homeless families jumped 23% or 25% this year.

TalkPoverty: 25% THIS YEAR? When the economy’s supposed to be getting better…that goes to your recovery report. Recovery for who?

Reed: That was a huge issue this past winter. There was a really significant rise in the number of homeless families and the D.C. shelter system was incredibly overwhelmed. We put families in recreation centers for one night only and they had to reapply for shelter every day. If it wasn’t below 32 [degrees] it was tough luck. You had to be out. A pro-bono law firm brought a class action against the city. They’ve won two injunctions against the district.

TalkPoverty: Against that policy?

Reed: Both of the judges ruled in favor of the plaintiff, finding that the recreation centers violated the law. By law families are supposed to be placed in rooms or apartment-style shelters and what they did was set up partitions like what you see when you’re giving blood. It was really horrible the way they set them up. Families couldn’t get in until after 9 and they had to leave by 7 in the morning. They couldn’t use the showers even though the showers were there. There was no food. The lights were kept on all night, there was no privacy. The judges found not only was it a violation of the law but it was causing irreparable harm to the children.

Lazere: There’s a new national model that started largely with the Recovery Act of getting people out of shelter quickly through rapid rehousing because shelter is not a good place for anybody to live.

I think the issue with rapid rehousing in D.C. is with housing so expensive, most families who become homeless are very young and have very limited job experience. When you [try to] put them into an apartment that’s $1,000 a month even that’s hard to find right? Then to tell them a year from now you’re on your own [because rent is no longer covered after one year]—on a… job that pays $10.00 an hour.  A lot of families are very nervous about going into rapid rehousing because when they’re in shelter it may be crappy but at least they get to stay.

Lazere: Part of the solution is to get someone out of shelter quickly. You hope that rapid rehousing will give them the stability they need to get their life back together. But there still needs to be something at the end [when the rent subsidy runs out] for that significant number of people who may have a job that may be more stable, but still not enough to [pay for] their home on their own.

Reed: Maybe we should give people longer than a year to get settled and get to the point where they can afford the rent. We should make sure people aren’t paying too much of their income towards rent. Program rules allow maybe 45% [of a person’s income toward rent], which is way too high. I understand maybe 30% isn’t achievable, but 35% maybe max. More than that and we’re getting into a likelihood that they’re going to end up back in shelter.

There’s a lot on the homeless services front that we could be doing. We kind of backed away from our permanent supportive housing investments for the chronically homeless. It combines long-term affordable housing with intensive services. Chronically homeless are folks with severe mental health or chronic health issues and they really need intensive supports to maintain their housing.  It’s shown to save a ton of money because there’s less reliance on costly emergency services.

D.C. was progressing pretty well and just kind of stopped investing in the program. In the upcoming budget, we will start making fairly good investments again. For example, the mayor put in money so we’ll end chronic homelessness among veterans in 2015 which is part of a federal campaign as well. We can end chronic homelessness in D.C. There’s about 2,300 families and individuals. It’s not an unachievable number. There’s a plan. We just need to fully invest in it to get it done.


Two Perspectives on My Brother’s Keeper

Can My Brother’s Keeper Fulfill Its Promise Without Keeping Sisters Too?

My Brother’s Keeper: Toward a More Inclusive Nation

Lisalyn R. Jacobs: Can My Brother’s Keeper Fulfill Its Promise Without Keeping Sisters Too?

The President’s announcement of the My Brother’s Keeper (MBK) initiative did not surprise me.  I advocate on behalf of a women’s rights organization; I worked through several sessions of Congress with the offices of then-Senator Barack Obama and Representative Danny Davis on their fatherhood bill.

I was, however, frustrated by the announcement and I remain so.

The initiative contemplates a public-private partnership with the federal government primarily using the power of the bully pulpit – though Administration officials have also taken part in community outreach and listening sessions, and spent a considerable amount of time and effort to gather, synthesize, evaluate and submit a first report to the President.  But MBK looks past struggling girls and at-risk young women while urging that time and resources be spent on at-risk boys and young men.

Let me be clear:  I think that programming that supports children and young men and women in at-risk communities is vital, and desperately needed.  I salute the President for acknowledging the need for a focus on the needs of youth in communities that are—as we have seen in Ferguson this summer—under siege.

What troubles me, however, are two things:  The suggestion that the problems being faced by boys and young men of color are so unique – or so much worse than those that girls and young women face – that they need their own initiative; and the related but in some ways more dangerous idea that the violence that young men face is more deserving of focused attention.

In a recent editorial, the Washington Post summarized the “men of color are at greatest risk” argument this way:  “That minority men are at disproportionate risk throughout their lives has largely been seen as unavoidable.”

What this observation fails to acknowledge is that the minority males that are the focus of MBK live in places where crime rates are high, homicides are commonplace, and schools are oftentimes failing, and consequently, that these are problems for everyone in the community:  struggling families and their boys and girls, alike.

For instance, schools compound the problem by disproportionately sanctioning youth of color, from preschool age and up. Black girls are suspended at rates higher than girls of any other race and most racial groupings of boys as well. The fact that the suspension rate for African American boys is 20 percent – versus a 12 percent rate for black girls – should send a message that the education system needs to do better by all youth of color; not that young men should be the chief focus of the Administration’s first major initiative to examine the enduring and entrenched problems experienced by youth of color in at-risk communities.

Additionally, whether you look at educational attainment or economic prospects, black and Hispanic men and women are doing worse both in absolute terms and relative to their white counterparts.

There is no going forward, unless we all go forward together – boys and girls, young men and young women, are our collective future.

Nevertheless, I’ve encountered too many people who have fallen prey to the notion that MBK and similar programs that exclude or marginalize at-risk girls are the solution. Two problems stem from this view:  1) providing more opportunities in at-risk communities will not change the preconceptions and bias that felled Jordan Davis, Renisha McBride, and most recently Mike Brown; 2) focusing on young men exclusively (or primarily) overlooks the fact that young women are similarly situated and that the unique challenges they face might very well be ignored by this type of “trickle down” programming.  To paraphrase a post-Ferguson tweet I saw recently, “you can’t [save just] half the community.”

People point to the salience of the verdict in the Trayvon Martin murder case, and now, the killing of Mike Brown to explain the narrow focus of MBK on young men.  The concern in these cases grows, at least partially, out of this country’s ugly past, which is strewn with black and brown bodies that were lynched or otherwise dispatched for reasons trivial to non-existent, and never with the sanction of a court.  So, it’s crucial to recall that black women were lynched, too, with the earliest records dating back to the late 19th century.  And it’s equally important to recognize that women of color, including trans women, continue to be brutalized and murdered, whether by law enforcement or private citizens (see here, here, and here).  Moreover, we cannot hope to begin the work of dismantling the systems that permit this kind of institutionalized oppression to continue unless we acknowledge that Asian, Arab, Latino, and Native communities are at-risk as well.

As we observe the 20th anniversary of the Violence Against Women Act this month, it’s important to point out that the type of violence that women of color experience is simultaneously similar to and distinct from the kind of violence most often experienced by men.  Young women in many of the above-mentioned communities also struggle with staggering levels of domestic violence and sexual assault (see also here).   This violence is particularly difficult to identify and respond to because of underreporting, which is connected to the pervasive levels of police mistrust in of color, Native, immigrant, and LGBT communities.  And, as we’ve been reminded recently, the failure to report can also be a result of crimes of sexual violence being perpetrated by the police.

There is a deep reservoir of expertise within the Administration when it comes to providing culturally appropriate services in communities that are rightfully dubious of law enforcement, and supports for children who have witnessed violence.  These are among the approaches that MBK should assess and replicate in the months ahead.  As the Administration contemplates the way forward for MBK, it is also vital that the program includes a focus on the ways in which violence and other obstacles – including poverty, maternal morbidity, reproductive justice, underemployment, limited access to apprenticeships and job training – manifest in the lives of girls and young women of color.  Until both MBK and its well-financed external counterpart, the Boys and Men of Color Initiative, widen their focus to include girls and young women of color, at-risk communities will have neither the tools nor the resources necessary to ensure that they can move forward and flourish.   Make no mistake:  there is no going forward, unless we all go forward together – boys and girls, young men and young women, are our collective future.

The fact is that the challenges at-risk boys and girls face are community challenges.  Until we are all safe and prospering, none of us will be.

Lisalyn R. Jacobs is V.P. of Government Relations at Legal Momentum.  She leads the organization’s federal advocacy on violence against women, poverty, and economic issues.  A single mother, she lives in the suburbs of Washington, D.C. with her 6 year-old son. On Twitter:  @LRockL


Sam Fulwood III: My Brother’s Keeper: Toward a More Inclusive Nation

Not long after President Obama announced his “My Brother’s Keeper” initiative, an ambitious effort to rally public and private support for boys and men of color, a group of concerned activists mounted a high-visibility campaign to alter – some might say, to undermine – the White House plan.  Surprisingly, this rear-guard action came, not from the ranks of right-wing conservatives, but from the President’s skeptical, left-most flank.

The African American Policy Forum, which describes itself as “an innovative think tank connecting academics, activists, and policy-makers to dismantle structural inequality and engage new ideas and perspectives to transform public discourse and policy,” assumed leadership in the effort to compel the White House to include women and girls in the “My Brother’s Keeper” Initiative.  The group collected signatures of more than 1,000 women of color demanding gender equality in the President’s program and rallied 200 black men to publish an open letter in a major newspaper.

While their argument packs the emotional wallop of seemingly protecting the interest of girls and women, the logic is faulty and the public shaming tactic is divisively misguided. Arguments that President Obama’s initiative to support boys and men of color is somehow disrespecting or ignoring the plight of black girls and women strikes a hollow and discordant note. Worse yet, it comes from within the ranks of those who profess to share the President’s ultimate objective of creating a fairer society and more opportunity for all.

To be clear, those critical of the “My Brother’s Keeper” effort are focused on tactics and resources, not the end goal. Like politicians, social activists must marshal money and media attention to drive public support to its cause. In and of itself, that’s neither a good, nor bad thing; it’s the way of the public policy world.

But public policy is just that, serving the greater good of the entire society. If the policy is well-crafted and executed, the larger society will benefit.  The acid test of a targeted effort, such as “My Brother’s Keeper” would be whether all – not just boys and men of color – prosper. True, women and girls of color, too, have challenges deserving focused attention. So do communities of immigrants and people with disabilities and folks in the LGBT communities.

But in a universe of short attention spans and limited (to nonexistent) resources, can we target all at once? Where does the President (or any socially conscious group) draw a line when seeking to reach the greatest public policy end?  Or, stated another way, is support for one cause, by definition an affront to another?  It doesn’t have to be.

Indeed, such fallacious zero-sum thinking is at the heart of the opposition to the “My Brother’s Keeper” Initiative. “My Brother’s Keeper” draws one set of targeted efforts to protect boys and men of color, but there’s nothing about it that excludes anyone – including women and girls.  Quite the contrary, if the President’s initiative is successful, the totality of America will benefit.

When we transform structures to work for marginalized groups, it can often benefit all groups, and it certainly doesn’t harm any of them

Valerie Jarrett, the Senior Advisor to the President, argues that line of reasoning in defending the White House and pointing out its efforts to assist girls and women. “I think the flaw in logic is not understanding that this is not either/or, this is both/and,” Jarrett said in a recent appearance television interview to defend the initiative.

The same logic undergirded a recent White House Summit on Working Families, where the President made it clear his focus is on improving the life opportunities for all Americans, including women and girls.

And here is a critical point:  All too often, these issues are thought of as women’s issues, which I guess means you can kind of scoot them aside a little bit.  At a time when women are nearly half of our workforce, among our most skilled workers, are the primary breadwinners in more families than ever before, anything that makes life harder for women makes life harder for families and makes life harder for children.  When women succeed, America succeeds, so there’s no such thing as a women’s issue. . . .This is a family issue and an American issue — these are commonsense issues.

john a. powell, director of the Haas Institute for a Fair and Inclusive Society at the University of California at Berkeley, and Maya Rockeymore, chief executive of the Center for Global Policy Solutions, are convincing in their support of “My Brother’s Keeper’s” targeted approach.   In an essay for The Chronicle of Philanthropy, they draw an analogy to public debates over to the Americans with Disabilities Act, which became law in 1990 and outlawed discrimination based on disability and provided protections for the disabled. It was a targeted law that proved to be beneficial to a much larger, public body. They write:

We can understand this idea if we think of individuals who are in a wheelchair trying to reach an upper floor. An escalator will not support those individuals in the same way as it would those who are able-bodied. It is not the disabled group that needs fixing but the structure. The goal is to convey everyone to the upper floor, and it is universal. But the strategy to achieve this goal must be targeted toward the disabled individuals to address their circumstances, which differ from those of other groups. We call this strategy “targeted universalism.”

Does this mean that we should only focus on the individuals in the wheelchair? No.

But neither does it mean that we treat all groups attempting to get to the upper floor the same. A targeted universalism approach is concerned about the mobility of all groups while recognizing that some groups will require targeted strategies to get there.

Should we remain concerned about groups that are still not being targeted or well served, such as women and girls of color? The simple answer is yes.

Notice that if we build an elevator, it benefits not only the wheelchair-bound group but also everybody else. When we transform structures to work for marginalized groups, it can often benefit all groups, and it certainly doesn’t harm any of them, including those with unlimited mobility.

Unfortunately, rational reasoning falls hard on the ears of advocates who imagine an overflowing gravy train of administration focus on men and boys of color and their exclusion from the philanthropic largess. They’re wrong. And worse, in their crabs-in-a-barrel attacks, they do harm to an initiative that offers promise to help move us toward a fairer, more inclusive nation.

Sam Fulwood III is a Senior Fellow at the Center for American Progress and Director of the CAP Leadership Institute. His work with the Center’s Progress 2050 project examines the impact of policies on the nation when there will be no clear racial or ethnic majority by the year 2050.



Safety Net

The Surprising Opponent to a Solution for Our Oral Health Crisis

One in three people in the U.S. can’t get dental care when and where they need it. The fact is, finding a dentist is tough, especially for those who rely on public health insurance. There’s a dental provider shortage in America leaving nearly 49 million people without access to quality care.  Instead of getting the treatment they need, people live in pain, miss school or work, and develop life-threatening infections.

Maybe you’ve heard about the tragic death of 12-year-old Deamonte Driver.  His mom couldn’t find a dentist who would accept Medicaid and she couldn’t afford the $80 extraction for his infected tooth. Sadly, Deamonte’s dental-related death is not an isolated incident. In fact, the American Dental Association (ADA) reports that over an eight-year period, 66 people died after being hospitalized for a dental infection.

The good news is we already know how to dramatically improve access to dental care: allow mid-level dental providers—similar to physician assistants and nurse practitioners—to perform routine care. It’s a safe, cost-effective and productive solution to the crisis.  However, progress is being blocked by an organization that you might least suspect would stand in the way—the ADA.

Mid-level dental providers have been utilized by more than 50 countries for almost a century and are now practicing in Alaska, Minnesota and Maine. In all, more than 20 states are currently considering allowing these health professionals to provide routine and preventive care like cleanings, fillings and some extractions.

While studies show conclusively that mid-level dental providers deliver safe, quality care, these workers also boost the economy. They allow dentists to grow their practices and increase revenues while treating more patients. The model creates new, good jobs that offer a career ladder for current dental employees. Finally, by improving the health care options available to employees and their families, implementing mid-level dental  helps communities attract new businesses.

While the ADA’s own journal acknowledged “a variety of studies indicate that appropriately trained mid-level providers are capable of providing high quality service,” the organization remains opposed.  The ADA continually cites “safety” as its primary concern, claiming that these dental professionals are not properly trained to perform “surgical” procedures. However, the organization has never been able to point to a single study that supports that view. In contrast, there have been thousands of studies on the quality of care provided by dental mid-levels, and none has ever shown it to be unsafe. The ADA’s voice of opposition is an increasingly lonely one, as the list of supporters of reform is growing—from the American Academy of Pediatrics to AARP.

Change is never easy. When dental hygienists were introduced in the early part of the last century, organized dentistry opposed them.  Likewise, the medical community initially pushed back against physician assistants and nurse practitioners. Now, however, dentists and doctors can’t imagine functioning without these skilled team members, and our health care is far better because of it.

It’s just a matter of time before mid-level dental providers make their way to all 50 states.  Millions of Americans living in pain will then have something to smile about.



Safety Net

Two Battles, One War: The Struggle to End HIV/AIDS and Poverty

Despite the fact that biomedical research continues to march towards a cure, HIV continues to spread. Why? Why are there new infections when we can prevent transmission of the virus? Why do people living with HIV in the United States continue to die when we have the treatments that will enable them to lead long, happy lives?

We frequently talk about stigma and a lack of access to healthcare as primary obstacles to ending this epidemic, and commit ourselves to addressing these issues. But one thing we don’t talk about enough is poverty. When it comes to contracting HIV, living in poverty is one of the greatest risk factors of all.

It’s no coincidence that African Americans—only 13 percent of the US population—constitute 46 percent of the people who are newly diagnosed with HIV, and also suffer a poverty rate 11.5 percentage points higher than the nation as a whole.

It’s no coincidence that men who have sex with men account for 65 percent of new HIV infections, and that LGBT men and women are more likely to live in poverty than their heterosexual peers.

It’s no coincidence that injection drug users are more likely to share needles if they are living below the poverty line.

And it’s no coincidence that counties with high HIV rates also have poverty rates nearly 7 percentage points higher than the rest of the country.

Our fight against HIV is inextricably tied to the fight against poverty. Earlier this year, Jim Yong Kim, President of the World Bank Group, said, “Just as money alone is insufficient to end poverty, science is powerless to defeat AIDS unless we tackle the underlying social and structural factors.”

The barriers that prevent us from ending HIV/AIDS are no longer scientific, they are societal. According to the Center for Disease Control and Prevention (CDC), “Poverty can limit access to health care, HIV testing, and medications that can lower levels of HIV in the blood and help prevent transmission. In addition, those who cannot afford the basics in life may end up in circumstances that increase their HIV risk.”

Imagine not knowing your status, and being unable to take a day off work to get tested for fear of losing your job. Imagine having to choose between groceries and the gas required to drive yourself to the HIV clinic, or going without heat so that you can afford to stay on your medication.  Worst of all, imagine your financial situation is such that risky behavior like transactional sex feels like the only way you can survive.

Poverty is a disease that affects not only individuals but entire communities. Poorer communities lack the resources to adequately treat and fight the virus. Therefore, regardless of your personal income, living in impoverished areas dramatically increases your vulnerability to HIV.

In 2010 the CDC found that 2.1 percent of heterosexual residents in low-income urban areas are infected with HIV. These are epidemic levels—far higher than the national average of 0.45 percent. Further, the residents in these areas who were living below the poverty line were twice as likely to be infected with HIV as those living above the poverty line.  Regardless of race, as incomes fall, the likelihood of being infected with HIV skyrockets, leading the CDC to conclude that “poverty is the single most important demographic associated with HIV infection among inner-city heterosexuals.”

Fortunately, there are organizations that are beginning to make gains in the fight against this trend.

Just as poverty and HIV are inextricably linked, so too must our efforts be to end them.

Medical AIDS Outreach of Alabama (MAO) works in the rural areas of the Black Belt Region of southern Alabama—where rates of HIV infection are alarmingly high—to provide treatment and combat stigma for hundreds of people, 75 percent of whom live in poverty. When transportation from rural areas to urban clinics is too expensive and prevents people from receiving treatment, MAO uses telemedicine to check in with patients and to ensure that they are adhering to their treatment regimen.  The Elton John AIDS Foundation supports the MAO community health workers who connect patients in rural areas with the care they need, which is their fundamental right.

The Fortune Society in New York City works with formerly incarcerated individuals to provide housing, job training, and, for those living with HIV, connection to medical treatment. By taking a holistic view of each of their clients, The Fortune Society combats poverty and HIV one person at a time, with the knowledge that one dramatically affects the other.  The Elton John AIDS Foundation is a proud funder of this work as well.

Whether fighting AIDS abroad or here at home, the words of Jim Yong Kim ring true: “To end both AIDS and poverty, we need sustained political will, social activism, and an unwavering commitment to equity and social justice.”

Just as poverty and HIV are inextricably linked, so too must our efforts be to end them.