On March 9, Cuomo announced a solution to one element of the supply problem in the wake of New York’s declared state of emergency: The state would start producing its own sanitizer, branded NYS Clean, to get around price gouging and supply issues. To start, 100,000 gallons a week will be distributed in government settings such as schools and prisons (more on that in a moment) as the state increases the speed of production. Cuomo even threatened to make the sanitizer available for commercial sale to counter price gougers, some of whom have already been fined for taking advantage of the public health emergency.

It’s the kind of bold statement designed to make a splash, but there’s little acknowledgement of who is responsible for making the product at speeds that allowed the state to ramp up production so quickly. The product is manufactured by Corcraft, which is the brand name for products produced by  the New York State prison system. “Employees” at Corcraft are incarcerated people making an average of $0.62 an hour.

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Corcraft and entities like it across the nation benefit from a literally captive workforce. 50,000 people are incarcerated in New York’s state prisons, and while not all of them work for Corcraft, many do, producing things like license plates, desks, textiles, janitorial supplies, and even eyeglasses. These products are in turn sold to government agencies, educational institutions, first responders, and select nonprofits by Corcraft as a “preferred source.” These entities have to “look to Corcraft first” as a supplier, even if they’re opposed to the use of incarcerated labor.

Across the nation, incarcerated workers generate billions in revenue for the prison system, making pennies on the dollar and in some cases nothing at all for their work. While some might consider it slavery, it’s entirely legal under the 13^th Amendment, which permits slavery or involuntary servitude “as punishment for a crime.” Nationwide, incarcerated people pave roads, maintain state parks, fight fires, grow crops, and manufacture scores of items.

Here’s a real bitter twist: According to Keri Blakinger and Beth Schwartzapfel at the Marshall Project, incarcerated people aren’t necessarily allowed to use hand sanitizer in jails and prisons. These workers are making a product they aren’t permitted to protect themselves with, even as conditions in jails and prisons can be extremely dirty, with even basic sanitation challenging. Sinks may be broken, sometimes no soap is provided so incarcerated people have to buy it from the commissary, and facilities are crowded.

This is already a dangerous combination for the spread of infectious diseases such as hepatitis a — which is spread through unwashed hands — and influenza. Many prisoners are also trying to manage chronic illnesses like diabetes and HIV, which can make them vulnerable to infection. The response to concerns about infectious disease may be to “quarantine” sick people in isolation, an unhealthy and dangerous approach to controlling infectious disease that comes with significant mental health effects.

As New York’s Department of Corrections implements COVID-19 policies such as screening visitors, it repeats public health recommendations for “all individuals within its facilities” —  wash frequently with soap and water for at least 20 seconds, use hand sanitizer when water is not available, keep your hands away from your face, and stay home when you are sick — all of which may be, to put it mildly, a challenge for incarcerated individuals.

Incarcerated people are commonly called upon to take personal safety risks for those who are not in jail or prison, as in the case of firefighters across the West who work alongside professionals in better gear, knowing that their training may not be transferrable to jobs on the outside thanks to their criminal records. Still, asking people to whip up 75 percent alcohol hand sanitizer for the health and safety of civilians while they’re struggling for scraps of soap in the midst of a public health emergency is truly a new low.

Access to tools to prevent the spread of disease and to protect people who are particularly susceptible to COVID-19 — such as those living in institutions like jails and prisons — is vital. There’s ample guidance from experts on highly effective ways to protect ourselves, but people in carceral settings can’t access the basic things required, such as sanitation supplies and tissues so they can cover their mouths and noses when they sneeze or cough.

If there’s an outbreak in a prison setting (something that may be inevitable in a confined, unhealthy, unsanitary environment), it will be because of the refusal to make changes to the rules in order to allow people to protect themselves.

When it comes to hazardous working conditions on American farms, many people think of pesticide exposure; as early as the 1960s, farmworkers were ringing alarm bells about it. But heat stress has actually surpassed pesticides — which cause cumulative harm over time — as the most immediate lethal danger in the fields, according to Dr. Marc Schenker, distinguished professor of public health sciences and medicine at University of California Davis. “We don’t see acute deaths from pesticide poisoning anymore,” says Schenker (though pesticides are still recognized as a significant danger with severe health risks for people exposed to them).

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An estimated 2.5 million farmworkers across the United States endure dangerously hot conditions on the job. As the heat climbs, workers can start to develop symptoms of heat stress including dizziness, nausea, fainting, vomiting, fatigue, poor coordination, and seizures. As their organs, especially their kidneys, start to break down, they can fall into a coma and die if not treated. Between 1992 and 2006, 68 farmworker deaths attributed to heat exposure were reported. Limited access to more current data makes it challenging to uncover the depth of the problem, though advocates claim deaths are likely underreported.

Outdoor temperatures aren’t the only issue. Personal protective equipment, ranging from suffocating Tyvek suits worn for pesticide application to thick trousers and heavy boots for working around thorny plants, can add to farmworkers’ misery.

“In workers, the major producer of body heat is metabolic workload,” explained Schenker. “If you’re working in outdoor conditions, you’re generating the majority of body heat from metabolism. The simple prevention is to reduce workload.” The piecework rate of payment for farmworkers, in which people are paid by the pound rather than by the hour, is a recipe for working as hard and as fast as possible. The system is great for employers, but bad for workers.

Access to drinking water, shade, and rest can help workers manage their body temperatures in high heat conditions. But just two states, California and Washington, have laws that require sufficient shade structures and drinkable water be nearby to meet the needs of the work crew. The Coalition of Immokalee Workers’ Fair Food Program, in which companies like McDonald’s and Trader Joe’s pay a premium for more ethically-sourced tomatoes, also requires access to shade, drinking water, rest breaks, and hygiene facilities as part of its code of conduct.  But even those requirements aren’t always enough.

In 2008, a 17-year-old pregnant farm worker died of heat-related illness because the drinking water was too far away, despite the fact that California’s heat protection law dated to 2005. Outcry led to enhanced safety regulations and better enforcement, but despite a dedicated heat violation hotline, improved data collection, and a push for better internal auditing to ensure complaints are investigated in a timely fashion, the problem persists.

Even if they have access to preventative care in the field, workers face another heat-related challenge when they go home: Farmworker housing may consist of crude shacks operated by farmers or contracting companies, or hot trailers with no air conditioning. Leydy Rengel of the United Farm Workers Foundation recalls the extreme heat of the Coachella Valley beating down on the trailer she shared with her parents, both farmworkers, as a child: “My parents would come home after 10-hour shifts, and didn’t have a place to cool down.” This can be dangerous, said Schenker: “Nighttime cooling is an important factor in preventing heat stress illness.”

While the short-term implications of heat-related illnesses are well understood, not as much is known about what they mean for people in the long term. Schenker is researching this subject, with a particular interest in what happens if workers experience repeated incidents of acute kidney injury, a potential complication of heat stress. This is especially vital since climate change is making conditions for farmworkers even worse.

California’s most recent climate assessment warned that if greenhouse gas emissions continue at their current rate, the state’s average daily high temperature could be as much as 8.8 degrees Fahrenheit higher from 2070-2100 than it is today. Over that same period, the annual number of extreme heat days (over 103.9 degrees) could rise from four to twenty-four. The amount of land scorched in wildfires will increase 77 percent.

In California, the law protecting workers from the effects of high temperatures is clear, but enforcement has been erratic. The UFW Foundation was one of the entities that pushed the state to issue more clarity and direction to keep farms — and the contract companies that supply a large number of farmworkers — accountable. Schenker, who has spent years researching farmworkers, said “California really does lead the nation,” but what that can look like from farm to farm is highly variable.

During the recent high heat event, the UFW Foundation ran an awareness campaign encouraging people to report unsafe conditions and setting up tables at locations farmworkers frequent to educate them about their rights. Rangel said even with the promise of anonymity, workers were reluctant to report. “They’re rather just be quiet,” she said, especially when they’re undocumented. And when state officials may take days to respond, complaints don’t always lead to enforcement.

Outside California and Washington, the picture can be grim for farmworkers in high heat conditions. They have some protections under the Occupational Safety and Health Administration, but for farmworkers, especially undocumented people in isolated areas, knowledge of the law and the ability to ask for enforcement can be limited.

“Last year, there was a 24-year-old farmworker, an H2-A guest worker in Georgia, who had only been in the country for less than 10 days, and he suffered heat illness. Nobody paid attention, his employers were not informed of how to handle this. They thought he was just being lazy,” said Rangel. It wasn’t the first time an ill worker had died in similar circumstances.

As consumers grow more aware of concerns around farmworker health and safety — calling, for example, for restrictions on pesticide use and listening to farmworkers speak out about sexual abuse in the field — heat illness should be a more prominent topic of conversation. Just as hotter days and longer summers will affect the quality of crops, they’ll affect the quality of life for the people who cultivate and harvest them.

My doctor, recalling my poor insurance, asked, “Do you ever get to the other side of the state?” I looked at her quizzically. “Because there’s an imaging service over there that offers ultrasounds for …” She paused and searched her computer. “Let’s see … $137, maybe closer to $300 if they think you need both abdominal and transvaginal. But it’s like a two-hour drive.”

My eyes bulged out of my head. I was billed more than $1,000 for the last ultrasound I’d had at my local hospital years earlier.

“I’ll drive,” I said.

I was relieved that my doctor told me about the discounted service. If I’d had to pay $1,000 or more out of pocket then I would have put off the procedure, like so many Americans do (and that’s if I ever got it at all). I had no idea that health care service costs could vary so wildly.

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Not only do prices vary from place to place, but the amount a patient will pay for the same service within the same hospital can vary depending on whether a patient has health insurance and what health insurance plan a patient has. When I called my local hospital to compare their prices for the ultrasound, I was told that it would cost around $700 with my insurance. If I were uninsured, that price would go up to almost $1,200. Meanwhile, that $137 option was a two-hour drive away — I just had to know where to look.

People looking for a car are told to shop around, maybe get a used car, or borrow one from a friend. Too often that same ethos is pushed into the health care space, with patients told to look around for the best deal or negotiate prices with providers. But price shopping for health care services is not as straight-forward as price shopping for a vehicle, despite legislative attempts to solve the problem.

At the beginning of the year, a new rule went into effect that requires hospitals to post their list prices online. But, as Kaiser Health News points out, that kind of transparency won’t have much of an impact because patients can’t understand those prices. The lists are full of incomprehensible abbreviations, list services separately that would always be bundled together, and vary depending on a person’s specific health plan, so consumers cannot get the type of information they need for comparison shopping. Moreover, these are just the list prices charged by hospitals; they do not include the price of physicians’ services during the hospital stay.

Not everyone has a doctor like mine, who actively looked out for my financial interests. And many times, even when people do try to calculate costs ahead of time, the tools they’re given turn out to be wildly inaccurate. One person profiled by the Philadelphia Inquirer, who proactively used her insurer’s price estimator tool to calculate the out-of-pocket cost of a breast MRI, was shocked when she was billed more than twice what the tool had suggested would be the upper-end range of out-of-pocket costs for the procedure.

Plus, finding the cheapest care is just the first hurdle.

My ability to access more affordable diagnostic services depended on a lot of things aligning — I had to have flexibility in my schedule to drive to a discounted imaging service provider, and I needed a vehicle that could make the trip. When all of those things did happen, I still had to shuffle work deadlines, time the appointment so that the drive there and back didn’t conflict with my kids’ school drop-off, and arrange for after-school care for them.

That same flexibility simply isn’t possible for everyone. Nearly 1 in 5 workers experience unstable work hours, which makes it impossible to schedule time to head to a different health provider in order to take advantage of cheaper care. Also, around 9 percent of Americans don’t own a car, and in recent years the number of people obtaining driver’s licenses has been trending downward. In rural areas, the nearest health care provider could be hours away. Though I live in an urban area, the nearest discounted service provider was a two-hour drive.

In an emergency, no one has time to inquire about costs. And even in less urgent situations, there is often no way to accurately determine prices. While hospitals are now required to post their price lists online, health care isn’t Amazon, where items are easily searched for, compared, and where prices are fixed. And high-deductible insurance plans are increasing in number, including in employer-sponsored plans, as insurers attempt to cost-shift onto consumers. That means more people are going to be in the same place I was over time.

On my drive to the other side of the state, I considered how fortunate I was to be able to access discounted health services. But being a self-employed person with a vehicle should not provide me with more options than someone with a less flexible work schedule or who doesn’t have a car. No one should have to waste precious time searching aimlessly for the best deal for treatment, and no one should have to go without because they didn’t know it was more affordable elsewhere or because the more affordable location was not accessible.

Until the U.S. chooses to recognize health care as a human right, rather than a commodity or entitlement, the poorest Americans will continue to suffer.

The undisputed good news is that Americans chipped away at the old guard last night. After two years of constant stress about losing our health care, massive tax handouts to the wealthy, and open animosity towards anyone perceived as different, we finally gained some ground.

To celebrate, we’re taking a break from our usual doom and gloom and rounding up the results that we were excited to wake up to this morning.

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We finally have some good news about health care.

Congressional Democrats are in a better position to defend the Affordable Care Act, and are likely to work on stabilizing the ACA and addressing high drug prices in the new congress.

On a state level, voters were clearly motivated by concerns about health care. They also approved Medicaid expansion in three states: Idaho, Nebraska, and Utah. This extends Medicaid coverage to 340,000 low-income people.

The victories for Medicaid don’t stop there. In Maine, where the governor and voters have been engaged in a protracted battle over Medicaid expansion, Governor-elect Janet Mills says she’ll implement Medicaid expansion “immediately” upon taking office. Tony Evers in Wisconsin and Laura Kelly in Kansas could also drive expansion in their states, where leadership has historically resisted it. Sadly, all isn’t rosy: Montana voters rejected a ballot measure that would have extended Medicaid funding via a tobacco tax, ending coverage for nearly 100,000 residents.

A number of pro-choice candidates performed well last night. But two states, West Virginia and Alabama, amended their constitutions to specifically rule out the right to abortion. It’s a symbolic amendment for as long as Roe v. Wade stands, but the new balance on the Supreme Court could place it in jeopardy.

Florida is giving the vote to 1.4 million residents.

Florida’s Amendment 4 restored voting rights to people with felony records. Until last night, it had been one of only three states (now two) that denied people convicted of felonies the right to vote after they served their sentences. That disenfranchised more than 9 percent of the state’s population overall, and 21 percent of African Americans.

It’s difficult to estimate how big of an impact this could have moving forward, but it’s certainly possible that this influx of new voters will sway future elections. And, most importantly, it will allow more than a million people to vote on the policies that affect their lives.

One other bright spot last night was in Colorado: The state passed an amendment barring the use of slavery as punishment for a crime. Other ballot measures were, to put it nicely, kind of a bummer. Six states passed a version of Marsy’s law, which establishes a victims’ bill of rights that has the potential to violate the rights of people accused of crimes and makes it harder for people who are incarcerated to access parole boards and early release. In addition, North Dakota and Ohio both rejected measures that would lessen sentences for drug crimes.

Conservative states are raising their minimum wage.

Voters in Missouri and Arkansas approved increases in the minimum wage, which will together provide a raise to nearly 1 million workers. Missouri’s ballot initiative, which won with more than 62 percent of the vote, will hike its wage to $12 per hour by 2023. Arkansas’, approved by nearly 70 percent of voters, will increase the minimum wage to $11 per hour by 2021. Missouri’s initiative also reverses a minimum wage decrease that the state legislature imposed on St. Louis, which had raised its own minimum wage to $10 in 2017.

This continues a trend of minimum wage action on the state and local level. Though the federal minimum wage of $7.25 per hour has not been increased since 2007, four states approved wage hikes in 2014, and four more did the same in 2016, while cities including Baltimore, Seattle, and Washington, D.C. have increased their own minimums.

Still, 21 states adhere to the federal minimum wage, the purchasing power of which peaked in the 1960s. We would certainly like to see more movement here, since wages have been stagnant across the country for the last several decades – particularly for low-income workers and black and Hispanic families.

Massachusetts will uphold rights for transgender Americans.

In 2016, Massachusetts passed a bill to prohibit discrimination based on gender identity in public places, but the law’s opponents managed to get it placed on the ballot this year. Voters upheld the law, which provides protections that don’t exist on a national level, by nearly 70 percent. In most states, it is still legal to discriminate against someone in housing, business, employment, and public accommodations because of their sexual orientation or gender identity.

Because we’re celebrating, we’ll gloss over how irritated the entire TalkPoverty staff is that it’s possible to put these rights on the ballot. Instead, we’ll look at this as a blow to the specious arguments that opponents to trans rights have been making against trans Americans.

San Francisco is taxing corporations to help people experiencing homelessness.

It was generally a bad night for tax policy on the state and local level, due to several states, including North Carolina, Florida, and Arizona, approving anti-tax ballot measures, and the defeat of an effort to raise corporate taxes and implement a progressive income tax in Colorado in order to spend more money on public schools.

However, San Francisco approved an increase in its corporate tax — which will be levied on about 300 of its biggest businesses — in order to raise money to combat the city’s homelessness epidemic. At least 50 percent of the funding will be dedicated to direct housing in a city where some 7,500 people are experiencing homelessness.

The successful campaign in San Francisco was mirrored in two other Bay Area cities and counters a similar effort in Seattle, where the city council passed and then repealed a “head tax” due to opposition from Amazon and other big corporations.

I sat down with Rebecca Cokley, a senior fellow for disability policy at the Center for American Progress, to discuss this.

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Rebecca Vallas: So I’ve had conversations with a lot of folks who say “Why does it matter? People can use all kinds of language but isn’t this just about people being a little too PC?”

Rebecca Cokley: I’m going to read a quote from Leslie Templeton from the Women’s March Disability Caucus. She just posted a series of snapshots of news clips talking about the mental status of Trump. She said, “When you read stuff like this, having said issue yourself, it makes you feel small. It makes you feel inferior, it makes you feel weak. Not only do I feel like my rights are being attacked by Trump, I feel who I am is being attacked by the American people.”

These are people’s lives. The accusation of someone’s unfitness to serve in any sort of role—whether as a parent, a colleague, a boss, an educator—is impacted by the slightest accusation, especially around mental health. It’s not about someone being PC or not, it’s really about a lack of understanding of the impact of labeling someone without irrefutable proof.

RV: So there’s a connection being made between his negative behaviors and his unpopular policies that people are explaining by this labeling. You’re saying that by extension people who themselves have mental health disabilities, mental illness, intellectual disabilities, and so forth are being implicated in these negative behaviors.

RC: Definitely. I also think one of the challenges with all these armchair diagnostics is that the people that are doing it aren’t even clear on what a mental health disability is. We sit there and see articles titled like, “Can someone with the attention of a kitten on crack make a decision?”, “Trump has social autism,” “Trump has a dangerous disability.” People still like to think about the other, the unknown, the shadow in the corner of the room, the thing we don’t talk about, versus acknowledging that it’s your son seeking therapy, it’s your best friend who is grieving the loss of their mother, it’s your boss who is now taking anti-anxiety meds. It’s much easier to castigate those folks than to say, “No, these are real people, and in some cases even me.”

RV: There’s a particular significance of this conversation having to do with the presidency or really with any elected office. It’s basically gospel that people with mental illness or mental health disabilities are unfit to serve. If someone has ever sought treatment—whether for depression or for substance misuse—even just that can stop someone from being taken seriously as a potential candidate. So in reinforcing this kind of narrative around what mental illness is and tacking it onto Trump’s face, there is a much deeper consequence that a lot of people aren’t thinking about that has to do with maintaining the status quo or even taking us backwards in terms of representation by people with disabilities in elected office.

RC: Definitely. When we’re talking about people with disabilities writ large we’re talking about 54 to 58 million people. If you’re zooming in specifically on people with mental health disabilities or mental illness, we’re talking about 10 million people in this country. And I think as we’re talking about Trump, it really is much easier to point at “mental fitness” than to actively talk about behaviors. That’s uncomfortable, because it forces us to be specific: What are the behaviors that we’ve seen? What are the behaviors that are evident in this person’s history that we should be pointing at to say “we screwed up here.” We dropped the ball, we elected somebody who was unfit to become president of the United States.

Besides, we have a history in this country of electing people with disabilities. Right now we can look at Sen. Tammy Duckworth (D-IL) and Rep. Jim Langevin (D-RI) as people with physical disabilities that are currently serving in government.

RV: Your examples point out that people would not be looking at Trump and saying “man, his disability makes him unfit to serve” if it were a physical disability—that’s something that people at their core would understand would be deeply offensive. But if it’s a mental illness, all of a sudden that seems to be equivalent to unfitness to serve.

That brings us to something you often talk about, what you refer to as “a hierarchy of disability.” And what this means in the policy context, for example, is that it has been a lot easier to get health coverage if you’re a person who has a physical illness or a physical disability than it is to get mental health coverage. But that conversation is rare when it’s about social perceptions and stigma. I think what we’re seeing here is this massive gap between the trust that a lot of people in this country have for the potential leadership or decision-making by people without disabilities or people with physical disabilities, compared with people who have mental health disabilities or mental illness or intellectual disabilities and so forth. Am I right to characterize it that way?

RC: I think you’re definitely right. I’ll even use myself as an example, being a little person. I walk in the room and you can tell that I’m a little person. Nobody is going to object to me asking for a stool or jumping on the chair to push the chair down. But for a long time I wasn’t as out about having obsessive compulsive disorder and it wasn’t something I frequently talked about until I was in my 20s. I was actually challenged by a friend and mentor of mine, Andy Imparato, who is very outspoken about having a mental health disability. When Andy and I were on a four-hour car ride from Washington, D.C. to Newport News for the Virginia Youth Leadership Forum, there were two topics of conversation: One, why haven’t I proposed to my then-boyfriend, now husband and two, why don’t I talk about having OCD?

We had a conversation about why I was hesitant to talk about it, and why I had put myself out as an advocate, as a spokesperson, as somebody working in the disability space, but I was not coming to the table with my whole self there. And so I tried it that night. I addressed the fact that I walk in the room as a little person and that’s a privilege. And I often don’t think we talk about disability as privilege. There is a privilege to my existence as a person with a physical disability. There’s a privilege to the fact that unlike 80% of disabled people, I grew up in a family just like me.

And then I addressed the fact that I also have Obsessive Compulsive Disorder and I used to wash my hands like 200 times a day. The number of young women who came up to me afterward was amazing. It was about 50 young women that pulled me aside that all wanted to talk about mental health disabilities. The fact that I had a job, the fact that I was in a relationship, the fact that I was being paid to go around the country and talk to other young people with disabilities, and the fact that I was working on a presidential campaign at the time were huge.

So I think a lot of times when we have internally stigmatized our own mental health disabilities and then we face a public that criminalizes mental health, without any criminal behaviors associated with it. We do it for no more reason other than to say that you don’t like somebody, for no more reason than to say that somebody is evil or you don’t agree with their decisions. It invalidates a part of their humanity, and makes it that much harder for folks to come out.

RV: I want to get to the solutions part—how we do better. You talked about the importance of precision in language. What’s your advice to those folks who are out there wanting to be good allies on this?

RC: I think checking in on your friends that have mental health disabilities and saying, “Hey, how is it going? Do you need anything? How are you feeling in this time?” And doing some real deep listening as to what people are encountering, because it’s hard right now. I think also connecting to organizations that work with folks with mental health disabilities, whether it be groups like Dan Fisher’s Psych Survivors Network or certain chapters of the National Alliance on Mental Illness that are doing some really good things. Engage to see what needs to be said, what is the right language to use, and ask your friends. So much of our language gets caught up on the fear of saying the wrong thing versus taking five seconds and asking your friends what’s the right thing to say.

I also think, as long as we continue to hold mental health at arms length as “the other,” we can’t have the conversation that we really need to be having. That leads to the criminalization of mental health and the knee-jerk reaction of saying, “Oh, that person can’t do that job because they’re nuts.”

RV: I want to read a tweet by Julia Bascom, Executive Director of the Autistic Self Advocacy Network. She says, “We can conclude that the president is unfit to serve without armchair diagnosis or violations of medical ethics. We can resist racism, totalitarianism, and a nuclear threat without ableism. We don’t need this, we can do better, progressives have a moral obligation to do better.” Powerful words. But it feels to me that that piece of call-to-action language doesn’t quite go as far as some people are wanting to go, especially given the conversations about invoking the 25th Amendment. So I would love to hear any suggestions you have about how people can handle these kinds of hard and honest conversations when folks are looking for guidance about how they can actually engage in this conversation but in a way that is not ableist.

RC: I think going back to the last line of Julia’s tweet, progressives have a moral obligation to do better. We are the party that came up with mental health parity in health care, thanks to former Senator Paul Wellstone. We are the party that is pushing for the U.N. Convention on the Rights of Persons with Disabilities. We are the party that is pushing to end sub-minimum wage programs for people with disabilities. We are the party that is pushing to increase access to mental health services on college campuses and programs for young people with mental health disabilities. Why are we then at the same time being so quick to use disability diagnosis as a weapon? Because we don’t like the president and we think the president is acting like a jackass. If President Obama wasn’t afraid to say Kanye was a jackass, why can’t we say that President Trump is being a jackass?

This interview was conducted for Off-Kilter and aired as part of a complete episode on January 6. It was edited for length and clarity.

The study revealed that, among black women, there are 10.1 cervical cancer deaths per every 100,000 individuals—versus just 4.7 per 100,000 white women. Previously, these figures were believed to be 5.7 and 3.2, respectively.

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It’s hardly a secret that socioeconomic status and racial discrimination greatly impact patients’ health outcomes in the United States. Low-income patients with diabetes are 10 times more likely to undergo limb amputation than affluent ones, black women are 41% more likely than white women to die from breast cancer, and even though African Americans are more likely to have elevated blood pressure than white Americans, they are 10% less likely to be screened for high cholesterol. The list goes on.

But what makes the recalculated cervical cancer death rates stand out is that the disease is preventable as long as it is detected early and treated appropriately. The low fatality rates among white women by and large reflect that fact. Black women, however, die from cervical cancer at rates comparable to those in sub-Saharan Africa.

One of the factors behind the disparity is that black patients face inferior access to quality detection services and follow-up care (the root cause of which is, of course, racial discrimination). Another recent study of patients with advanced-stage cervical cancer found that a majority received substandard care, and that those patients were more likely to be black and low-income.

As Dr. Otis W. Brawley, the Chief Medical Officer for the American Cancer Society, said in response to the Johns Hopkins study, “When we look at the difference between black and white, and rich and poor, we find the same disparity. The quality of assessment and follow-up treatment can be the difference. The question becomes: How do we get adequate preventive care to all people?”

But unlike the medical community, whose goal is to expand care, Congressional Republicans’ relentless attacks on the Affordable Care Act and Planned Parenthood will dramatically reduce it—and worsen the racial disparities that have killed so many black women.

The Affordable Care Act mandated coverage of cervical cancer detection services—along with all preventive care—at no cost to the patient. But the Republican-controlled Congress and White House have already taken steps to dismantle the ACA, and the fate of preventive care is uncertain as a result. (Conversations between House and Senate Republicans reveal that there is no consensus around how best to replace the healthcare law.) If racial disparities in cervical cancer death rates boil down to unequal access to quality detection services and subsequent treatment, then patients who struggle to afford care are bound to be worse off under repeal.

The proposal to roll back the Medicaid expansion, backed by many Congressional Republicans, threatens to strip coverage—and thereby the ability to obtain detection services and treatment—from the patients who arguably need it the most. Some 11 million low-income individuals will lose access to Medicaid under this proposal, and black women are more likely to be affected. Moreover, the proposal to turn Medicaid into a block grant will cut between 14 million and 20 million patients from the health insurance program.

Furthermore, Congressional Republicans continue to target Planned Parenthood, a core provider of reproductive and sexual health services—cervical cancer detection included. If they defund Planned Parenthood, the health care provider will be stripped of more than one-third of its budget. Low-income women and women of color, who are disproportionately represented among its patients, will likely suffer worse medical outcomes as a result. And if Congressional Republicans follow through with plans to slash Title X—the nation’s only federal source of funds for reproductive health clinics—patients will find cervical cancer detection services (and other vital healthcare) even further out of reach.

Racial disparities in medical outcomes are completely avoidable—particularly when the disease in question is as preventable as cervical cancer. While the medical community rallies to address these differences in mortality rates, efforts to rectify them will only be stymied by Congressional Republicans. But the cost, in this case, is people’s lives.

In 2011, the Texas state legislature barred Planned Parenthood from its Medicaid program and excluded from state health plans any clinic affiliated with an abortion provider. This policy decision has had damaging consequences for some of the most vulnerable women in the state. A recent report found that in counties where Texas defunded Planned Parenthood affiliates, there was a dip in usage of long-acting reversible contraceptives (LARCs) and injectable contraceptives—the most effective forms of contraception available. During this time period, there was also an increase in births to mothers covered by Medicaid. Given that this surge in births occurred in the very counties where women faced new barriers to accessing contraceptives, it is highly probable that many of them were unplanned.

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These troubling outcomes are also likely attributable to the Texas omnibus abortion law—known as the Targeted Regulation of Abortion Provider (TRAP) law—which went into effect the same year that Planned Parenthood was excluded from state health plans. TRAP includes a number of provisions that make it more burdensome for women to obtain abortions. Among the provisions are bans on abortions that occur after 20 weeks, restrictions on medication abortions, and a requirement that physicians have admitting privileges at a hospital within 30 miles of where they perform abortions. A challenge to the law is currently before the Supreme Court.

Together, these restrictive policies have threatened not only women’s reproductive health and autonomy but also their economic security. Women without coverage are more likely to forgo care in order to prioritize other basic needs like food, rent, and childcare. And some low-income patients in states with restrictive abortion laws now face prices that are triple the cost of what women in states with access and availability pay for care. The scarcity of these services also means that many women have to travel hundreds of miles to obtain annual wellness visits, cancer screenings, and maternal care. Many of these women will lose wages to travel time and, adding insult to injury, will incur the additional expenses of transportation, food, and childcare.

Perhaps most horrific of all, we know that women who have lost access to services are now attempting to self-abort in the absence of accessible and affordable abortion care. The true irony is that by enacting harmful policies targeting abortion—a safe and legal medical procedure—policymakers have jeopardized the ability for low-income women in particular to make timely and informed decisions about reproduction.

And yet, the abortion war continues to rear its ugly head. In 2015 alone, 17 states passed more than 50 abortion restrictions. Eleven states slashed funding to Planned Parenthood or any clinic that provides abortion care among its health services. As states continue to introduce this kind of harmful legislation under false pretenses, one truth remains the same: the legal right to abortion and other reproductive health services means nothing without the ability to affordably and reasonably access it.

While the Supreme Court weighs the merits of Texas’s TRAP law, and the women of Ohio brace for an uncertain future, these states should be a cautionary tale not only for 2016, but for years to come.

Although we have seen a dramatic decrease in the number of teen pregnancies, the United States still experiences higher rates of teen pregnancy and sexually transmitted infections (including HIV) than other Western countries. Despite this fact, current conservative proposals would cut funding for TPPI by nearly 90 percent. This critical program, which represents one of the two major federal funding streams for comprehensive sex education, works to reduce the number of unplanned teen pregnancies through increasing access to medically-accurate and age-appropriate evidence-based programs, contraception, and reproductive health care services. But instead of backing this successful model, Congress would increase funding for Abstinence Only Until Marriage programs (AOUM) by $10 million, despite the fact that states with abstinence-only education have the highest teen birth rates.

Many AOUM programs (also known by the misleading term “Sexual Risk Avoidance” programs) advance deeply problematic gender expectations and generally ignore the needs of LGBTQ youth or stigmatize homosexuality. They also often provide medically inaccurate information, undermining students’ ability to make safe and informed choices.

This misguided effort by conservatives to gut TPPI fails to address the immediate causes of teen pregnancy. The U.S. has high rates of unplanned pregnancy and STIs relative to other nations likely because we have lower rates of contraceptive use. By contrast, comprehensive sex education, which TPPI helps to provide, increases contraception usage and particularly benefits teens, who are disproportionately likely to experience unplanned pregnancies.

Unlike abstinence-only programs, TPPI also works to address racial disparities in access to comprehensive sex education by specifically focusing on the African American and Hispanic communities. These communities are less likely to receive comprehensive sex education—if any at all—and face higher rates of poverty. Economic deprivation is known to make it more difficult for teens of color to access contraception and other sexual health services. The result is that Hispanic and black youth have the highest teen pregnancy rates—more than double that of white youth—and are disproportionately likely to contract STIs.

The facts clearly show that it is counterproductive for Congress to slash funding for evidenced-based programs while pouring more resources into programs that we know are ineffective. Moreover, it is inequitable, as cutting TPPI funds would specifically harm the students who already face limited access to comprehensive sex education and reproductive health care services.

But while the correlations between poverty, race, and teen pregnancy are undeniable, we have to avoid treating teen pregnancy prevention as a silver-bullet solution to ending poverty. A 30-year study from the University of Pennsylvania that followed 300 teen mothers from Baltimore found that teen childbirth was not the major cause of their economic difficulties. This finding has been supported by Melissa Kearney and Phillip Levine who also note that, “teen birth itself does not appear to have much direct economic consequence.” Rather, women who grow up in poverty are likely to live in poverty their entire lives regardless of whether or not they have a baby as a teen or wait until they are older.

But regardless of its effectiveness as an anti-poverty measure, the work of TPPI to reduce the prevalence of STIs and unplanned pregnancy is valuable. The program promotes equality among teenagers and increases students’ agency. Moreover, TPPI is ushering in an important paradigm shift by funding comprehensive sex education aimed at empowering young people to parent when they decide they are ready; this contrasts with the dangerous notion of using contraceptives to reduce the number of poor children, an idea popular among some moderate and conservative politicians that brings to mind a dark history of forced sterilizations and state control over the bodies of low-income women.

Instead of gutting effective programs, our elected leaders should adopt a broad strategy to ensure young people can reach their full potential. While programs like TPPI that fund comprehensive sex education are a central part of this work, the government must also invest in jobs and adopt strong anti-poverty policies in order to bring about more opportunities for social mobility.

The clock is ticking for Congress to act. We need politicians that will fight for the sexual health and empowerment of teenagers, not contest the very existence of the institution they serve.

Certainly, if you ask people what they think about making high-quality, affordable early childhood care and enrichment opportunities available for everyone—not mandating them, but simply making them available—few, if any, would say they are opposed. This consensus is in part due to mounting research in neuroscience, public health, economics and social science that supports a simple conclusion: investing in early childhood benefits the development, wellbeing, and long-term health of children. We also know how to create, scale and support these social and educational programs—Head Start, for example—and make them accessible.

Nevertheless, not all children have an opportunity to experience high-quality early childcare, for the simple reason that we have chosen not to support universal access. So why aren’t we committed to ensuring these opportunities?

Our political discussions about early childhood tend to center on parents’ choices and responsibilities—on the need for parents to make good decisions for their young children. But wouldn’t a tighter safety net of opportunities and support make good decisions easier, and make parents less likely to stumble in their efforts?

Instead of casting aspersions on parents, we need a new conversation—one that places children and what is optimal for them at the center.

That’s what The Raising of America—a new, five-part documentary series—is trying to do. I’m proud to be a part of the film, which probes how conditions faced by young children and their families form the foundation for future success—both in school and in life.

In exploring the prolific data about the positive effects of quality early care on health, The Raising of America brings to light the consequences of our failure to provide adequate support for parents raising young children.

Our Experiences Shape Our Biology

In recent years, as the film shows, we’ve seen a gradual shift in the way we understand health. Medical professionals are now examining health outcomes through a more holistic lens. What we’ve learned is that health is profoundly influenced by socioeconomic factors seemingly outside of the healthcare system.

Study after study has shown that our experiences—positive as well as negative—influence the ways our biological systems develop and operate. We also know that children who live in high-stress homes and environments with a lot of concentrated disadvantage are most likely to have adverse childhood experiences, or ACEs. A higher prevalence of ACEs can affect children’s emotional regulation, which in turn can impair optimal learning. A child who has difficulty regulating his or her emotions is not likely to be able to stay in the classroom and learn. And a child who drops out of school is less likely to succeed in life.

We’ve come to understand that where you live matters to your health. In a neighborhood that suffers from chronic poverty—with a lower ratio of caregivers to kids, low employment, unsafe housing, community violence and physical decay—the odds are stacked against optimal health and development.

Yet with all of this knowledge, we still haven’t bridged the gap between data and practice by offering universal early care and enrichment opportunities.

The Choice We’ve Made

It strikes me that as a society we have accepted the notion that the challenges parents face are all “just part of raising a child”—that it’s not imperative for all children to have access to the high-quality early care that they need to succeed.

I would love to give working parents a sense that they are not alone in their experience—that there are countless others like them who want to be great parents but are struggling to give their children what they need. This sense of community in itself can be powerful and galvanize positive action.

What if together we called for the consideration of health and wellbeing in all of our public policy choices? Adopting this new framework might help us understand that policies that support safe neighborhoods promote not only crime reduction, but also physical and mental health and educational success.

Families cannot meet the demands of both our economy and raising children alone. It’s my hope that the larger conversation we’re launching—through ongoing research and with The Raising of America—will prompt a closer look at how we can develop an opportunity agenda for our nation’s children, and steer a course that puts the needs of children front and center.

I hope this is the moment when society looks at the status of young children and declares that it does not have to be this way, that we can change the experience of childhood. Let’s get started.

One such product hit the shelves last year when oil behemoth Baker Hughes—which specializes in hydraulic fracturing, or “fracking”—joined forces with breast cancer foundation Susan G. Komen to produce pink drill bits. Fracking, a procedure by which oil is extracted from the ground, is highly toxic. More than a quarter of the chemicals used are known carcinogens, and some are linked to breast cancer. On top of that, fracking is more likely to occur in impoverished areas, where medical care—let alone care for breast cancer—is already difficult to come by.

A few years prior, Susan G. Komen teamed up with an unlikely ally: Kentucky Fried Chicken. The fast-food chain packaged its signature dish in pink and pledged a donation to its partner for each “Bucket for the Cure” sold. The campaign stirred a fair deal of controversy—and rightly so, as fried meats are associated with breast cancer. In addition, the campaign marketed its product—with all of its adverse health implications—primarily to the poor in a dubious effort to access hard-to-reach populations. The fast-food chain is found largely in low-income neighborhoods, where healthier food options are often out of reach for most residents.

To be sure, not all campaigns against breast cancer have raised so many eyebrows. Some 67 percent of women at high-risk ages have received mammograms within the past two years, a statistic that, while far from perfect, attests to the success of many awareness campaigns. Billions of dollars are poured into breast cancer research annually, which is surely another part of the reason that breast cancer patients now enjoy a five-year survival rate of close to 90 percent, up from about 75 percent in 1980.

But a closer examination of the numbers reveals a much more grim reality. Gains from the war on breast cancer have by and large sidestepped women of color and low-income women, and instead have accrued largely to more privileged patients. Prior to 1980, such shameful disparities did not exist. Black women and white women faced nearly identical mortality rates of about 33 deaths per 100,000. But today, black women are most likely to die from the disease. Researchers say that biological differences do not account for differences in survival.

A 2015 study found that black women were between 40 and 70 percent more likely to have a late diagnosis, when they are already in the advanced stages of breast cancer. Hispanic women were 30 to 40 percent more likely to be diagnosed in advanced stages. Late detection, of course, so often translates to higher costs of care and lower survival rates.

Race even impacts the quality of treatment that breast cancer patients receive. The same 2015 study concluded that black women were between 30 and 60 percent more likely than white women to undergo inappropriate treatment for the disease, and Hispanic women were 20 to 40 percent more likely.

Research cannot fully explain these disparities, but poverty is a clear factor, facilitated by woeful public policies and institutionalized racism. Women in low-wage jobs without paid sick leave—disproportionately women of color—are less likely to receive the preventive care necessary to detect breast cancer in its early stages. As a result, these women are more likely to die from the disease. One study found that, while 63 percent of women with paid sick leave had received a mammogram within the past year, only 52 percent of women without paid sick leave had gotten one. And it makes sense. The 40 million workers who toil without paid sick leave risk reductions in precious income or even the job itself for time away. Preventive care cannot be a luxury only afforded to those in comfortable jobs.

While breast cancer has no cure just yet, solutions to health disparities like these do exist. Paid sick leave is among them. Clinics funded through Title X—the federal grant program that is constantly under threat—offer mammograms to low-income women and serve as a lifeline for those otherwise on the margins of care. Medicaid, too, has proven an invaluable source to those in poverty, but 19 states have refused to expand the insurance program under the Affordable Care Act. This policy choice has dire consequences. It is in some of these states—like Alabama, Kansas, and Oklahoma—where women are most likely to die from breast cancer.

When black patients die from breast cancer three years before white patients, and low-income women face impossible choices between the care they need to survive and their livelihoods, we need to embrace policies—not pink drill bits—to curb our unjust health disparities.

Throughout its history, Medicare has been effective at reducing poverty for older people and people with disabilities, and at increasing access to health care. In the program’s very first year, more than 19 million people over age 65 enrolled; access to care increased by one-third; poverty among older and disabled Americans decreased by nearly two-thirds; and personal economic security increased for older people and their families.

As Congresswoman Rosa DeLauro said, “Medicare is a bedrock part of the American social insurance system.” It has provided peace of mind for millions of Americans, who know they will have reliable health care coverage in retirement. The program covers people most in need of care—people who often wouldn’t be covered by private insurers or couldn’t afford such insurance. It also strengthens families by limiting the financial burden of health care costs for their older and disabled relatives.

Many people are unaware that Medicare has also helped change our society. For example, its creation was a huge boost for civil rights. Any hospital wishing to collect Medicare funds had to desegregate to qualify for payments. As a result, thousands of hospitals fully desegregated in only four months.

Medicare has seen many positive changes.  It added hospice coverage in 1982 and now almost half of beneficiaries who die use this important benefit. In 2008, Medicare coverage of mental health services changed, so that these services were reimbursed at the same rates as other Medicare-covered services delivered in the same care settings. As a result, hospital care for mental health services no longer costs more than hospital care for a physical health problem.

In 2010, the Affordable Care Act added a decade of economic security to the Medicare Trust Fund, increased free preventive services, and increased parity between traditional Medicare and private Medicare plans.

A recent “improvement” came about as a result of work by the Center for Medicare Advocacy – where I serve as the Executive Director – and by our partners at Vermont Legal Aid. When Medicare beneficiaries have a chronic condition, such as Alzheimer’s or Multiple Sclerosis, they often need skilled care in order to maintain their condition or slow deterioration. Medicare regularly denied such coverage because the beneficiaries weren’t “improving.” This harmful practice impeded access to necessary care and placed an unfair burden on families who were forced to pay for these services. As a result of a 2012 settlement with the Centers for Medicare & Medicaid Services, coverage for skilled care can no longer be denied simply because an individual isn’t improving. Coverage is available for skilled care to maintain an individual’s condition.

Despite Medicare’s success, it faces threats like never before. From privatization to coverage denials, to political pressure that would limit coverage and increase costs for beneficiaries in the future. However the Center for Medicare Advocacy is advocating for a number of common sense solutions that would better protect beneficiaries and help improve Medicare’s financial security, without cutting benefits or coverage. These include:

• Paying Medicare Advantage at the same rates as traditional Medicare. Private plans should not be paid more than traditional Medicare. This would save more than $132 billion dollars over 10 years;
• Adding a prescription drug benefit to traditional Medicare;
• Requiring Medicare to obtain the best prices for prescription drugs — — which would save more than $141 billion over 10 years;
• Fixing the broken Medicare appeals system by eliminating one of the first levels of review. The vast majority of reviews at the initial and second levels are “rubber stamp” denials which simply add bureaucracy and waste money. This would save around $100 million per year in operating costs.

Medicare works well for the American people and it has for 50 years. Let’s ensure that it stays strong and continues to open doors to health insurance and health care for our nation’s most vulnerable people and their families.

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.

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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.

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.

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.

It’s time to renew our nation’s deep commitment to ending poverty. This commitment shouldn’t be made out of mere sympathy but in the interest of our nation as a whole. But getting out of poverty starts with a healthy body and healthy mind. Let’s all agree that an adequate, nutritious diet is something each and every one of us needs—and deserves. This shouldn’t be a stretch for most of us to see and understand.

More and more we are realizing how our diets impact our physical and mental health. Lack of access to adequate, nutritious food prevents students from thriving academically and workers from performing at peak levels at their job. Healthy food is an important engine to propel students and workers out of poverty. This is not to oversimplify the problem, or to suggest that this is all that needs to be done, but it is a very important starting point. Access to real food is foundational to climbing out of poverty.

As someone who has played a lot of sports in my life, and even coached a little, I know that when it comes to athletics and improving and developing talent it all starts with fundamentals. This means recognizing how interconnected the issue of poverty is to many other issues like health, education, being safe, feeling cared about, and good, healthy food. A student cannot learn if he is full of sugar and processed food—or distracted by hunger pains. An adult can’t stay healthy if he or she needs to eat the cheapest, most accessible and most processed food for years at a time. The most basic thing we can do to lay the foundation for good health, and academic, social and financial success, is to eat—as Michael Pollen has put it—real food. We are what we eat, period.

When it comes to health and wellness, and solving the gut-wrenching issues of poverty and hunger, we need to get back to the fundamentals. We need to grow more of our food in or near our cities, which can drive investment into our poor neighborhoods. We need ‘edible classroom’ programs which can get more healthy food to our kids, teach our students about where food comes from and the knowledge of how to grow it. We need a garden in every school yard, a kitchen in every school where students can learn to prepare the food they grow, and a salad bar in every cafeteria. And we need to protect and strengthen investments in our bedrock federal nutrition programs such as the Supplemental Nutrition Assistance Program and Child Nutrition programs.

Our current policies make healthy food inaccessible for millions of Americans, while subsidizing and making pervasive fake foods that give us diabetes, heart disease and high blood pressure—which lead to higher healthcare costs down the line.  An ounce of prevention is worth a pound of cure—yet policymakers continue to make penny-wise and pound-foolish decisions.  Every dollar wasted on the current approach is money that can’t go to investments that bring more justice to our broken economic system.

There are leaders that are already making connections between the food we eat, our health and well-being, and the poverty we see all around us. Laurie David’s new movie, Fed Up, includes commentary from Katie Couric, First Lady Michelle Obama, and former President Bill Clinton. Dr. Mark Hyman, a thought leader in the area of food and nutrition, says the country cannot afford the cost of bad food, and the bad health that follows. In one of his recent blog posts, he said that because of bad food, “….our kids are sicker, leading to an achievement gap that limits our capacity to compete in the global marketplace, and 70 percent of our kids are too fat or unfit to fight, threatening our national security. These are not small problems.”

Pilar Gerasimo, a writer and editor, says that health is the “gateway” to power. Without optimal health and vitality, she says, everything else that we want to do gets harder. The bottom line is this: integrating healthy eating and wellness into our social safety net will energize our current programs, strengthen the mental and physical well-being of those who need them, and inspire more Americans to support a new approach that will better position families in poverty to work their way up the ladder to the American Dream.

“The ability of women to participate equally in the economic and social life of the Nation has been facilitated by their ability to control their reproductive lives.”

-Justice Sandra Day O’Connor, Planned Parenthood v. Casey

In the Burwell vs. Hobby Lobby Stores, Inc. decision on Monday, conservative Supreme Court justices ruled that only some women are entitled to control over their health. This decision represents the latest chapter in an ongoing conservative effort to weaken the reproductive rights of some of the most vulnerable women in the country.

Since no female justice joined the opinion, five men determined that Hobby Lobby and other “closely-held” corporations cannot be compelled to provide insurance coverage for contraception for their employees if they disagree on religious grounds. The owners of Hobby Lobby objected to covering two forms of emergency contraception and two types of intrauterine devices (IUDs) because they feel that using them results in abortion. Although this decision was predicated on objections to four types of birth control, the Supreme Court decision likely affects all twenty contraception methods covered by Affordable Care Act (ACA) regulations. This decision could potentially affect millions of women since “closely-held” corporations employ over 52% of American workers.

The majority bowed to ideology at the expense of science and common sense. There is no medical evidence that emergency contraception, IUDs, or any other form of contraception covered by ACA regulations, cause abortion. In contrast, contraception is designed to prevent unwanted pregnancies that do sometimes lead to an abortion. In an ironic twist, Hobby Lobby objected to providing insurance coverage for IUDs, which are twenty times more effective at preventing unwanted pregnancy than contraception methods lucky enough to receive the Hobby Lobby stamp of approval.

The Hobby Lobby decision furthers the separation of women into distinct economic classes—those who can afford the contraception they want and those who cannot. It undermines the right of millions of women to access vital preventative care regardless of their ability to pay. As Justice Ginsburg noted in her dissent, the cost of obtaining an IUD without insurance is practically equal to the monthly salary of a low-wage worker. Emergency contraception is also expensive—a single dose can cost more than $60. Hobby Lobby places low-income women who cannot pay out of pocket at the mercy of their employers.

The ruling is also intensely harmful to the one in three women who are currently experiencing or will experience domestic violence. An astonishing 99% of survivors report that abusers restrict access to economic resources in some way. Even though some survivors may appear wealthy, they are in fact low-income due to this economic abuse. When employers refuse to cover contraception, the vast majority of survivors cannot afford it. Making matters worse, conservatives also support huge cuts in funding for the Title X clinics that survivors and other low-income women might be able to turn to for access to low-cost contraception in the event that their employer opts out of coverage. Between the actions of a conservative court and Congress, survivors and low-income women simply can’t win.

By decreasing women’s access to contraception, Hobby Lobby empowers abusers. Forcing survivors to have unwanted pregnancies is a common tactic used by abusers to make survivors more dependent on the relationship. The mechanism? Interfering with or failing to use contraception. Twenty-five percent of adolescent survivors report that abusive partners tried to force them to become pregnant by interfering with contraception. Abusers may destroy or hide oral contraceptives; purposely rip holes in condoms or remove them during sex; fail to withdraw as a method of birth control; or forcibly remove other forms of contraception such as patches, vaginal rings, or IUDs.

The American College of Obstetricians and Gynecologists recommends several strategies to combat this kind of reproductive coercion. They encourage health care providers to package oral contraceptives in ways that an abuser may not detect, such as in an unmarked envelope. They also promote the practice of inserting IUDs that have the strings removed so that abusers cannot detect their presence. An IUD needs to be inserted every twelve years, as opposed to a shot that needs to be administered every three months, or an oral contraceptive that must be taken daily. As a result, IUDs are arguably the best way to provide unobtrusive, effective contraception to survivors.  Thanks to five male Supreme Court Justices, however, IUDs likely just became much harder to access, and the lives of many low-income women and survivors became much harder too.

Thank you, Mr. Supreme Court.

A local crisis center referred me to the Blue Valley Community Action Partnership for assistance with food and housing. After listening to my situation, the staff treated me with dignity as they provided my family with nutritious food from the food pantry, clothing, household goods, and new backpacks full of school supplies for my children. My family was enrolled in the Homeless Prevention and Rapid Re-housing Program, which enabled me to find a safe home by providing temporary financial assistance for rent and utilities.

I enrolled in the Supplemental Nutrition Assistance Program, or SNAP, so I could buy groceries. And Medicaid provided us with vaccinations, medical and dental care, prescriptions, and counseling services, which allowed my kids to enroll in a new school.

The security of having a home, food, and medical care was a tremendous weight off my shoulders, allowing me to focus on finding employment in our small rural community. In August, two months after initially receiving help, I obtained a part-time job at a retail store. A few weeks later, I became a full-time employee as a case coordinator for the Homelessness Prevention and Rapid Re-housing Program when it became available at the Blue Valley Community Action Partnership, the same program that originally helped me.

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I have now been employed there for more than three years and gained the job skills needed to advance to my current position as a research and development officer.

It has been a struggle to become financially independent; at times I needed to work two jobs and had to rely on income tax credits to make ends meet, but I am fortunate to no longer need assistance for my family’s basic needs.