Single-Payer Would Be a Good Start, but Real Health Equity Means Tackling Economic Disparities

We need to be clear that prioritizing health and well-being means prioritizing jobs, education and housing. (Photo: crazydiva / iStock / Getty Images Plus)We need to be clear that prioritizing health and well-being means prioritizing jobs, education and housing. (Photo: crazydiva / iStock / Getty Images Plus)

The horrifying specter of Trumpcare, the shortfalls of Obamacare and the continued rise in overall health care costs in the United States have provided an important opening for proponents to put single-payer back on the table. Attempts at creating a national health insurance scheme have come close but failed several times before in US history. However, while it is imperative to ensure that every American has equal access to quality care, single-payer is insufficient when it comes to ensuring our right to health and well-being.

Considering the organizing capacity, resources and political capital it would require to be successful in a single-payer campaign, we should be clear on what single-payer is and isn’t before we put all our eggs in that basket. Remember that the challenges single-payer faces are huge. Even if proponents are able to successfully manage the tax hike concerns that surround the issue, it seems highly unlikely in our current political context that a state could succeed in obtaining the multiple federal waivers necessary to implement a single-payer model. In California, where many assume single-payer legislation has the greatest chance of passing, the state constitution would also require voters to pass ballot measures on the state budget to lift the spending cap and reform legislation that mandates that around 40 percent of state tax revenue go to K-12 education.

So, what would single-payer do? Simply, it would provide all Americans access to comprehensive care regardless of income, pre-existing conditions or ability to pay — an extremely important achievement that would benefit many. However, insurance alone does not solve the serious, persistent and growing problems we have with health outcomes in this country.

Creating the conditions for health and well-being requires a lot more than insurance.

Many studies have shown that only about 20 percent of health outcomes are attributable to the care we receive. In reality, how long we live and how healthy we are during that time is largely determined by a combination of genetics, social and economic factors, and individual health behaviors. With “social determinants” like housing, employment and education accounting for a full 40 percent of health outcomes and the quality of the built environment we live in accounting for another 10 percent, it quickly becomes apparent that economic, social and geographic issues are health issues, and that creating the conditions for health and well-being requires a lot more than insurance.

While US health care costs have risen to over $3 trillion a year, representing almost a fifth of our economy, we consistently have some of the worst health outcomes among high-income countries. Americans have a shorter life expectancy, higher infant and maternal mortality rates, and higher incidences of many diseases. Moreover, we have significant and persistent disparities in those outcomes.

A recent Harvard study of 32 high- and middle-income countries found that the United States consistently reported the highest level of health and health care disparities across income levels. Lower-income Americans live shorter lives with higher incidences of heart disease, cancer, diabetes and mental illness, as well as dozens of other chronic conditions. One example starkly illustrates the type of disparities seen across the nation: the life expectancy in well-to-do Lyndhurst, Ohio, is a full 12 years longer than that of low-income Glenville, just 10 miles away.

Staggering health disparities are also observed between racial and ethnic groups in the United States. For example, African Americans are 77 percent more likely than non-Hispanic Caucasian Americans to develop diabetes, and people of color run two-to-four times the risk of reaching end-stage renal disease than whites.

Furthermore, these disparities cost us dearly as a nation. Not only are countless lives needlessly lost because of these inequities, but they come at a price of $300 billion a year in lost wages, health care costs and premature death, making a pretty good business case for addressing these harmful disparities.

Prioritizing health and well-being means prioritizing jobs, education and housing. It means meeting people’s daily needs and helping communities to flourish.

It seems, then, that we should be prioritizing health equity and the investment we need in our communities as we carry on this health care debate. Now more than ever, while we have this opening on such a critical issue, we need to be clear that prioritizing health and well-being means prioritizing jobs, education and housing. It means meeting people’s daily needs and helping communities to flourish.

Getting health care that works for everyone is really about having a say in how a fifth of our economy is spent. It’s about reversing the trend of disinvestment in our communities and ensuring the broad-based prosperity that allows us to lead healthy and happy lives.

Just imagine what would be possible if we were to redirect some of the massive resources that are currently funneled into a broken health care system to address the social determinants that go such a long way to defining health outcomes.

Increasingly, health systems themselves understand the connection between social determinants and health outcomes and are starting to take important steps to address those issues in the communities in which they operate. As such, some are experimenting with how to leverage their assets to benefit their local communities and, in turn, keep health care costs down. They are beginning with strategies like local hiring and procurement or providing on-site food pantries, just some of the many ways health systems’ resources can be invested “upstream” or closer to the root causes of health problems.

However, truly addressing social determinants necessitates a coordinated, national effort and it requires that we keep our eye on the ball. What we need is good jobs, strong communities, safe and stable housing, access to education and a healthy environment.

If structured well, a single-payer system would certainly be a step in the right direction. By properly deploying global budgets and moving away from a fee-for-service model, a single-payer system could reinforce an ethos of “value over volume” in the health care sector, a strategy which is already leading to some important advances in Medicare and Medicaid delivery. The Center for Medicare and Medicaid Innovation (CMMI), created by the Affordable Care Act, has been supporting and developing these kinds of alternative payment systems that aim to lower costs while improving care. This work is contributing to the growing evidence base for the effectiveness of value-based payments while experiments with Accountable Care Organizations and bundled payments are seeing providers taking on increased financial risk, prompting them to seek out new ways to help patients stay healthy. Projects that provide robust primary and preventative care services have also been sought out by CMMI as a way to bring down lifetime health care costs while allowing patients to live healthier lives by intervening earlier on in the progression of a disease or identifying risk factors before serious health problems occur.

Yet we must remember that countries with single-payer systems can still struggle with significant health equity issues. For example, while Canadians generally enjoy relatively good health compared to much of the rest of the world, a 2016 report from the Canadian Institute for Health Indicators found persistent or even increased income-related inequalities in the majority of health and well-being indicators tracked over the last decade. Immigrants, refugees and Indigenous populations also experience barriers to access in the health system, which add to the inequities in outcomes. Even the United Kingdom, which tends to score very well on health equity studies, has had health inequalities high on the agenda for years, recognizing the concerted effort needed to tackle this complex problem.

Since the issue of single-payer is on the table now, it is incumbent upon us to explore how to make a single-payer system maximally effective and to think beyond insurance to what else our communities need in order to thrive. If we take advantage of this opening on health care to envision what it would really take to transform our health care system into a system of health, we could be leaders in the drive toward health equity worldwide. Let us live up to that challenge — many of our lives depend on it.

Halifax’s first ever exhibition of artwork by Caribbean born and descended NS artists happens Monday

click to enlarge "Maudrie" by Justin Augustine, oil, 2000 - SUBMITTED

  • submitted
  • “Maudrie” by Justin Augustine, oil, 2000

Caribbean Diaspora Cultural Festival
Monday, August 7, noon-9pm
Halifax Commons, Caribbean Diaspora Festival Tent

Halifax’s first ever exhibition of art by Caribbean born and descended Nova Scotian artists, Kaiso, is on view for one day only this Monday, as part of the Caribbean Diaspora Cultural Festival.

“This new exhibition shows the diversity of Caribbean culture in Nova Scotia and brings attention to the contributions that Caribbean born peoples have made to the province in the visual arts,” says curator and Black Artists Network of Nova Scotia organizing founder David Woods, in a press release.

Paintings by Woods will be on display as well as work from Justin Augustine, Angel Gannon, Michelle Flemming, Laurel Francis, Habiba El-Sayed, Kaas Ghanie and selections from Black Artists Network members Heather Cromwell and Alex Thuku.

Expect paintings, quilts, installations, photography and ceramic sculpture reflecting “Caribbean images” as well as exploring “social issues and local African Nova Scotian history.” The Caribbean Diaspora Cultural Festival also features dancing, singing, drumming, a domino tournament and more.

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Jim Vance Gets Place in African American Museum

National Museum of African American History and Culture founding Director Lonnie Bunch explains why Jim Vance earned a spot in the museum. News4’s Barbara Harrison talked to Bunch.

‘Rumble’ Celebrates Rock ‘N’ Roll’s Native American Roots

Rock musician and Native American music pioneer Stevie Salas performing in Germany in 2010. Salas served as executive producer on Rumble, which he was also featured in. Thomas von der Heiden/Courtesy of the artist hide caption

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Thomas von der Heiden/Courtesy of the artist

Rock musician and Native American music pioneer Stevie Salas performing in Germany in 2010. Salas served as executive producer on Rumble, which he was also featured in.

Thomas von der Heiden/Courtesy of the artist

In 1958, the guitar riff known as “Rumble” shocked audiences. Its use of distortion and bass made it sound dangerous and transgressive to audiences at the time — and its influence is still heard today. Behind that song was a Native American musician named Link Wray, who went on to inspire legions of rock ‘n’ roll greats. He’s featured in a new documentary called Rumble: The Indians Who Rocked The World, which aims to finally give Native American musicians their due.

Another rock legend featured in the film is Stevie Salas, who has played with Justin Timberlake, Rod Stewart, George Clinton, Mick Jagger and others. He also helped curate an exhibition about Native Americans in rock ‘n’ roll at the Smithsonian’s National Museum of the American Indian, and served as Rumble‘s executive producer.

For Salas, the project of spotlighting Native American musicians is personal: He’s Apache, and when he was starting out in rock, he saw little visibility for other Native American musicians.

“[Music] really started as hobby when I got out of high school in San Diego,” he says. “I moved to L.A., and I was discovered by George Clinton and started to work with him and Bootsy Collins and Was (Not Was). Then I got this huge gig with Rod Stewart — that’s when, all of a sudden, I was playing arenas and Madison Square Garden and all these places. I just started looking around and wondering — to me, I looked like everybody else. But then I realized I didn’t, and I just started to wonder: Were there any other people out there doing what I was doing that were like me? And at first, it really seemed like there weren’t, but as I started to talk to people and gig, I realized there were a bunch.”

In a conversation with NPR’s Lulu Garcia-Navarro, Salas explains what it was like to research rock ‘n’ roll’s Native American heritage. Hear their conversation at the audio link, and read on for highlights.

Interview Highlights

On Jimi Hendrix’s Native American identity

Jimi Hendrix is one of the musicians whose Native American heritage is discussed in the documentary Rumble: The Indians Who Rocked the World. Evening Standard/Getty Images hide caption

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Evening Standard/Getty Images

Jimi Hendrix is one of the musicians whose Native American heritage is discussed in the documentary Rumble: The Indians Who Rocked the World.

Evening Standard/Getty Images

When I started at the Smithsonian with Tim [Johnson], to do the exhibit on this, Janie Hendrix — Jimi’s sister — she goes, “Jimi has to be in this. Because my grandmother was Cherokee. It was super important to him.” But then when we went to make the film later on with Rezolution Pictures, PBS — who was one of our distributors with Independent Lens — was like, “Come on. You guys expect me to believe this? Jimi Hendrix?” And I secretly arranged for Janie Hendrix to call my cellphone while we were having this discussion. She called me, and I go [to PBS], “Well, you know what? Why don’t you ask Jimi’s sister, personally?” And she just let him have it. And then PBS did the deal with us — and that’s how we got the film going, in a lot of ways.

On the shared history between African-American music and Native American music

I always assumed the Delta blues was a black art form, because that’s what I was always taught. But as a kid, I was always taught that Columbus discovered America too. What we realized was happening was: When you watch Rumble, and you see the development of North America, music was just a by-product of what was going on with the repressed people. So you had the slaves and you had the Native Americans — all were outcasts.

On balancing anger and optimism in the film

I found really hard with my producer-partners, and the directors who I worked with, because there’s a lot of anger there. In the corner of the room, you have this big blob of nothingness called racism that you just want to reach for and use. And it’s so easy to use, and it’s so satisfying to use, because you’re so angry. But I said, “No. We’re making a film about heroes. We’re making a film about people who did incredible things, against incredible odds, and it should inspire people.” I didn’t want to say, “We got screwed again! You stole our land, you stole our music.” I didn’t want that. Neither did a lot of my Native American friends who are working towards really feeling great and doing greater things in life. We didn’t want to go backwards. We wanted to go forwards with this, and I’m really proud that we were able to do that.

You can hear songs from the artists featured in Rumble in the Spotify playlist below, created by Studio 360.

Web editor Marissa Lorusso contributed to this story.

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Mentoring Black youth part of province’s action plan

When Mariama Barrie was starting her career, she received guidance and advice from a mentor at Toronto’s Nia Centre for the Arts.

And once she started her own event planning business, she began sharing her expertise with youth in the community as part of a program that was recently chosen for expansion under the Ontario government’s $47 million Ontario Black Youth Action Plan.

The plan, a provincial first, will fund agencies that support youth, aiming to help more than 10,000 Black children across the province in their communities.

Michael Coteau, minister of children and youth services, recently announced that $9 million of the funding will be spent on mentorship programs in Greater Toronto, Hamilton, Ottawa and Windsor, over the next four years — programs that include everything from arts activities to academic help to boosting job skills.

Coteau, who is also responsible for the province’s anti-racism initiatives, said the mentoring programs are “a great example of an on-the-ground solution to help improve the futures of Black children, youth and their families.”

The province’s action plan was created in response to statistics that show Black youth are overrepresented in the care of children’s aid, are more likely to drop out of high school and face high unemployment rates.

Dwayne Dixon, executive director of the Nia Centre near Oakwood Ave. and Vaughan Rd., said “very early in my artistic journey, when I was coming up, there were very limited opportunities — financial or otherwise — for young Black artists to make the arts a viable career choice,” and he’s confident “experiences like mine will be the exception and not the rule.”

Nia not only runs programs like the one Barrie volunteered for, called the “Follow Your Instinct” internship, but also a larger program that helps budding artists job shadow professionals, take on apprenticeships and find internships.

Barrie said her connection to the Nia centre “goes way back,” after she graduated from the University of Guelph-Humber, the then-executive director helped her learn to develop her career. She said she didn’t just receive help, but also honest evaluations of her work, “critiquing it when I needed feedback,” she said.

“It was very valuable to me … it helped me develop into the professional that I am today, the entrepreneur I am today. I see the difference it makes in young people, especially in our communities.”

She later went on to found her own company, Premium Events, and also began working with four youths at Nia — the youngest about 17 — on a daily basis for eight weeks. “The group was small,” she said, and the help “very specific to their needs.”

In Peel, Marlon Pompey said he at first mentored a different groups of youth for Big Brothers/Big Sisters of Peel, but a year ago began one-on-one, feeling he could have a bigger impact that way.

His “little,” who is 12, lives in his old neighbourhood, said Pompey.

“I came from that neighbourhood, I made something of myself … I got a scholarship,” said Pompey, who played basketball at university. “ … I wanted to give back.”

The two go carting, play paintball, golf and have plans to go mountain biking, added Pompey, who works in Peel Region.

“He’s a really good kid.”

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Jay-Z releases all African American cast version of F.R.I.E.N.D.S. for ‘Moonlight’ music video

Screengrab from the clip of Jay-Z ‘Moonlight’ music video, shared by director Alan Yang via his Twitter handle.

LONDON: ‘F.R.I.E.N.D.S.’ is BACK! But, in a music video and without the original cast.

According to The Independent, Jay-Z has released his very own version of beloved sitcom F.R.I.E.N.D.S. featuring an all African-American cast.

The brand new video for ‘4:44’ track ‘Moonlight,’ which was exclusively unveiled on Tidal, also references the Best Picture error which rocked this year’s Academy Awards when ‘La La Land’ was incorrectly named as the evening’s biggest winner in place of the song’s namesake, Barry Jenkins drama ‘Moonlight’.

The ‘F.R.I.E.N.D.S.’ re-imagining was directed by Alan Yang – co-creator and star of Netflix series ‘Master of None’ – and it features Jerrod Carmichael, ‘Get Out’ star Lil Rel Howery and Issa Rae (U.S. series Insecure) in the roles of Ross, Joey and Rachel.

Making up the rest of the collection is Emmy-nominated Atlanta star Lakeith Stanfield as Chandler, Tessa Thompson (Westworld, Thor Ragnarok) as Monica and Tiffany Haddish, who can currently be seen in new film ‘Girls Trip,’ playing Phoebe.

Yang also shared a 15-second clip from the music video on his Twitter handle.

Sunday Book Review: Poetry: Claudia Rankine on the Legacy of Gwendolyn Brooks


Gwendolyn Brooks in her home in Chicago. Credit Associated Press

New Poems Honoring Gwendolyn Brooks
Edited by Peter Kahn, Ravi Shankar and Patricia Smith
278 pp. The University of Arkansas Press. Paper, $29.95.

Work Celebrating the Writing of Gwendolyn Brooks
Edited by Quraysh Ali Lansana and Sandra Jackson-Opoku
Illustrated. 416 pp. Curbside Splendor Publishing. Paper, $24.95.

Gwendolyn Elizabeth Brooks was born in Topeka, Kan., at 1 p.m. on Thursday, June 7, 1917.

But her family moved to Chicago shortly after her birth, and she was a Chicagoan until her death, in 2000. The author of more than 20 volumes of poetry, Brooks holds the distinction of being the first African-American to win a Pulitzer Prize (in 1950, for her second book of poems, “Annie Allen”), and she received numerous accolades, including the National Medal of Arts and an American Academy of Arts and Letters Award. In honor of the centennial year of her birth, two anthologies have arrived: “Revise the Psalm,” edited by Quraysh Ali Lansana and Sandra Jackson-Opoku; and “The Golden Shovel Anthology,” edited by Peter Kahn, Ravi Shankar and Patricia Smith.

In their shared mission, these books complement each other without too much overlap. The novelist Richard Wright, in a reader’s report for Harper & Brothers in the early 1940s, declared Brooks essential: “America needs a voice like hers.” Confirming Wright’s claim are the hundreds of artists represented in these two new anthologies, poets who have used her work as a prompt or a point of engagement.


“The Golden Shovel Anthology” structures itself around the form developed by the prodigious poet Terrance Hayes, whose own poem “The Golden Shovel” opens the book. A Golden Shovel poem sneaks an existing poem into the end words of each line. That way, the new poem always remains in conversation with its precursor. In his introduction, Shankar writes that the anthology is “an inherently collaborative effort, a dialogue, a response,” and the same description works for Hayes’s form, which unites all of the poems here. Read their end words, and you’ll find a Brooks poem. In the foreword, Hayes says he came up with the idea when he was helping his 5-year-old son memorize Brooks’s “We Real Cool,” which starts with a sort of subtitle or epigraph: “The Pool Players. / Seven at the Golden Shovel.” The words of Brooks’s poem moved into Hayes’s head space and became a lyric to push against or engage:

When I am so small Da’s sock covers my arm, we
cruise at twilight until we find the place the real

men lean, bloodshot and translucent with cool.
His smile is a gold-plated incantation as we

drift by women on bar stools, with nothing left
in them but approachlessness. This is a school

I do not know yet. But the cue sticks mean we
are rubbed by light, smooth as wood, the lurk

of smoke thinned to song. We won’t be out late.
Standing in the middle of the street last night we

watched the moonlit lawns and a neighbor strike
his son in the face. A shadow knocked straight

Da promised to leave me everything: the shovel we
used to bury the dog, the words he loved to sing

his rusted pistol, his squeaky Bible, his sin.
The boy’s sneakers were light on the road. We

watched him run to us looking wounded and thin.
He’d been caught lying or drinking his father’s gin.

He’d been defending his ma, trying to be a man. We
stood in the road, and my father talked about jazz,

how sometimes a tune is born of outrage. By June
the boy would be locked upstate. That night we

got down on our knees in my room. If I should die
before I wake. Da said to me, it will be too soon.

Nestled into the last word of each line is Brooks’s canonical poem: “We real cool. We/ Left school. …” Throughout this anthology, more than 60 other well-known Brooks poems can be read the same way, with lines from “The Mother” and “The Bean Eaters” tripping down the right-hand side of the page. The anthology ends with “Non-Brooks Golden Shovels” and “Variations and Expansions on the Form.” The cross-section of poets with varying poetics and styles gathered here is only one of the many admirable achievements of this volume.


“Revise the Psalm” brings a more expansive response to Brooks. The editors have included poetry, prose, photographs and paintings created in recognition of both Brooks and her work. Essays speak back to individual poems like “The Mother,” or reflect on Brooks’s impact or on personal encounters with her. We get a keen sense of the poet and her fierce commitment to community engagement. For example, Adrian Matejka writes about attending a reading where Brooks spent more time reading poems by elementary school children than reading her own work.

The portraits represent Brooks at different points in her 83 years. Most notable is the author’s photo by Roy Lewis, for her 1969 book “Riot,” with Brooks wearing the Afro that signified her break with her mainstream publisher as she joined the voices of the Black Arts Movement. Lansana and Jackson-Opoku, the editors of “Revise the Psalm,” use the phrase “‘Gwendolynian’ influences,” describing their anthology as “a project of literary and artistic revision, the process of ‘talking back’ to works that inspire, teach, challenge and engage.” Not surprisingly, given this endeavor, the book includes some Golden Shovel poems.

More often than not, however, the poems in “Revise the Psalm” are more loosely inspired by Brooks’s subjects. Consider “Daystar,” by Rita Dove. (She is one of a handful of poets who appear in both volumes.) Though written for Dove’s Pulitzer Prize-winning book “Thomas and Beulah,” “Daystar” takes on a subject that was of central importance to Brooks — the quotidian outer life and the rich inner life of African-American mothers:

She wanted a little room for thinking:
ut she saw diapers steaming on the line,
a doll slumped behind the door.
So she lugged a chair behind the garage
to sit out the children’s naps.

Sometimes there were things to watch:
the pinched armor of a vanished cricket,
a floating maple leaf. Other days
she stared until she was assured
when she closed her eyes
she’d see only her vivid own blood.

She had an hour, at best, before Liza appeared
pouting from the top of the stairs.
And just what was mother doing
out back with the field mice? Why,
building a palace. Later
that night when Thomas rolled over and
lurched into her, she would open her eyes
and think of the place that was hers
for an hour — where
she was nothing,
pure nothing, in the middle of the day.

Whether one considers the breadth of writing inspired by Gwendolyn Brooks or drops down into the possibilities of the Golden Shovel form, Richard Wright was not wrong about her importance: She has served her readers across a century.

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