links for 2007-04-23
A Letter on Paul Wolfowitz

Falling Indicators of Human Development in Mississippi

Governor Haley Barbour manages to achieve a thing that many corrupt dictators have not: to lower the Human Development Index of the people he governs:

In Turnabout, Infant Deaths Climb in South - New York Times: Eric Eckholm: [I]n recent years the [infant] death rate has risen in Mississippi and several other states. The setbacks have raised questions about the impact of cuts in welfare and Medicaid and of poor access to doctors.... “I don’t think the rise is a fluke, and it’s a disturbing trend, not only in Mississippi but throughout the Southeast,” said Dr. Christina Glick, a neonatologist in Jackson, Miss., and past president of the National Perinatal Association.

To the shock of Mississippi officials, who in 2004 had seen the infant mortality rate — defined as deaths by the age of 1 year per thousand live births — fall to 9.7, the rate jumped sharply in 2005, to 11.4. The national average in 2003, the last year for which data have been compiled, was 6.9. Smaller rises also occurred in 2005 in Alabama, North Carolina and Tennessee. Louisiana and South Carolina saw rises in 2004 and have not yet reported on 2005.... Most striking, here and throughout the country, is the large racial disparity. In Mississippi, infant deaths among blacks rose to 17 per thousand births in 2005 from 14.2 per thousand in 2004, while those among whites rose to 6.6 per thousand from 6.1. (The national average in 2003 was 5.7 for whites and 14.0 for blacks.) The overall jump in Mississippi meant that 65 more babies died in 2005 than in the previous year, for a total of 481....

Dr. William Langston, an obstetrician at the Mississippi Department of Health, said in a telephone interview that officials could not yet explain the sudden increase and were investigating. Dr. Langston said the state was working to extend prenatal care and was experimenting with new outreach programs. But, he added, “programs take money, and Mississippi is the poorest state in the nation.” Doctors who treat poor women say they are not surprised by the reversal.

“I think the rise is real, and it’s going to get worse,” said Dr. Bouldin Marley, an obstetrician at a private clinic in Clarksdale since 1979. “The mothers in general, black or white, are not as healthy.”... “I don’t think there’s a lack of providers or facilities,” he said. “Some women just don’t have the get up and go.”

But social workers say that the motivation of poor women is not so simply described, and it can be affected by cuts in social programs and a dearth of transportation as well as low self esteem. “If you didn’t have a car and had to go 60 miles to see a doctor, would you go very often?” said Ramona Beardain, director of Delta Health Partners. The group runs a federally financed program, Healthy Start, that sends social workers and nurses to counsel pregnant teenagers and new mothers in seven counties of the Delta. “If they’re in school they miss the day; if they’re working they don’t get paid,” Ms. Beardain said.

Poverty has climbed in Mississippi in recent years, and things are tougher in other ways for poor women, with cuts in cash welfare and changes in the medical safety net. In 2004, Gov. Haley Barbour came to office promising not to raise taxes and to cut Medicaid. Face-to-face meetings were required for annual re-enrollment in Medicaid and CHIP, the children’s health insurance program; locations and hours for enrollment changed, and documentation requirements became more stringent. As a result, the number of non-elderly people, mainly children, covered by the Medicaid and CHIP programs declined by 54,000 in the 2005 and 2006 fiscal years. According to the Mississippi Health Advocacy Program in Jackson, some eligible pregnant women were deterred by the new procedures from enrolling.

One former Medicaid official, Maria Morris, who resigned last year as head of an office that informed the public about eligibility, said that under the Barbour administration, her program was severely curtailed. “The philosophy was to reduce the rolls and our activities were contrary to that policy,” she said.

Mississippi’s Medicaid director, Dr. Robert L. Robinson, said in a written response that suggesting any correlation between the decline in Medicaid enrollment and infant mortality was “pure conjecture.” Dr. Robinson said that the new procedures eliminated unqualified recipients. With 95 enrollment sites available, he said, no one should have had difficulty signing up...

I must say that I am surprised that you can--if you are a Republican appointee of Haley Barbour's--get your words into Erik Eckholm's New York Times article while refusing to talk to Erik Eckholm. If there is a point to mainstream journalism at all--rather than dueling press releases--it is that reporters get to ask questions. I have a call into Erik. I hope to have further insights into his thinking soon. Had I been him, I would have told Barbour and Robinson that inclusion of their words in the story depended on their making themselves available for questioning.

And, of course, Erik Eckholm doesn't have control over the data or the statistics.. He doesn't seem to know that there are 2.8 million people in Mississippi. He doesn't seem to know that about 15% of the non-elderly population--make that 350,000--were on Medicaid. Cut Medicaid enrollments by 50,000, by 1/7. 42,000 babies born in Mississippi each year. For the share who die to jump from 0.97% to 1.14%... That's a less than 1/3000 chance. That's worth saying.

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