Tag Archives: American inequalities

Inequity, Distance Learning, Disrupted Learning Communities & Social Eruptions

The lack of any master narrative about the virus was apparent. President Trump, grasping for authority as a true authoritarian playbook, argued the situation demands force, as his removed son-in-law, the dauphin Jared Kushner, spun 60,000 deaths from COVID-19 as a “great success story,” as if to challenge the nation’s personal narratives with a monolithic storyline of a disconnect from communities which were ravaged by hospitalizations. In claiming his father-in-law created a “pathway to safely open up this great country,” Kushner radiated overconfidence as he painted a future as rosy as the marble atrium of Trump Tower, even when the figures didn’t add up. It was akin to Trump’s 1993 proclamation, after huddling with bankruptcy lawyers to obtain new lines of credit, having had “the most successful year I’ve had in business!”–much reprised over the next decade.

The dauphin Jared not only used a spilt infinitive, but painted a split reality: claims Trump was doing “things right” with coronavirus testing plummeting to 30% percent, over twenty-five million unemployed and further furloughs coming, and one million infected by the coronavirus and 60,000 dead in a month, hardly fit narratives that suggest “great success.” As Vice President Pence followed identical talking points, in a few months, assuring folks “we slowed the spread, we flattened the curve, we saved lives,” we sensed a mismatch not only to any map in news media, but to the actuality on the ground, encouraging cognitive dissonance to a widespread crisis of public health by assuring Americans rather than “a much better place.” The sense that Donald Trump hadn’t been reading the President’s Daily Brief, or PDB, as early as January, of an infection that had spread to over a thousand people in China, before an outbreak of a novel coronavirus was reported to the World Health Organization on January 3, or before China sequenced a draft genome of the virus a month after the first outbreak, on January 11, calm was radiated through June.

The steep inequities on which that split reality was fractured was reinforced in how Trump recast protests against police violence as the work of terrorists–or socialists–and unrest that threatened a status quo. The mischaracterization of protests to mask their objection to racial profiling and the policing of a color line mirrored the masking of disproportionate damage in inner cities and among people of color in the first waves of the coronavirus infection, hospitalization and mortality rates, and the landscape of inequity that mirrored an uneven topography of health care in America, that had been more than apparent to many in the emergency rooms of hospitals where so few were white, before the CDC began tallying racial disparities, or citing “longstanding systemic health and social inequities [that] put some members of racial and ethnic minority groups at increased risk of getting COVID-19”–as the gaps in disproportionate mortality and hospitalization rates among all age groups broke down along racial lines, revealing, as any moment in social crisis, a systemic inequity long before data visualizations published on July 5, as if echoing how Frederick Douglas alerted many, as if they needed altering, in Independence Day celebration in 1852, questioned causes for celebration among enslaved not extended the franchise or right to participate in the promise of democracy the Constitution set forth–and the unfair three-fifths clause.

The disturbingly disproportionate rates of infection among minorities lacks attention–and their concentration over many contiguous counties–

New York Times, July 6 2020

–demands peeling back of layers, but the doubling and near tripling of CDC-reported rates of incidence coronavirus congregated around population hubs, including the greater Minneapolis area, in striking ways.

Perhaps it was no surprise school closures accentuated inequities–of dangers of a failure to connect to students, for reasons of economics or technology or priorities, a failure to meet nutritional needs long accepted as a mandate for the public school system, or the possibility of mental stability and socio-emotional learning, whose costs may be accentuated in increased depression, suicidal thoughts, and destructiveness? The damage caused by school closures has been more under the radar, and far less visible than the mortality rates from which the nation is reeling, but whose effects may be felt long down the road.

Most of the nation was unable to process where the nation was in relation to the epidemic’s spread, but the absence of congruency confirmed only a long-lasting narrative of social abandonment. There was indeed something like a national war of narratives continued in maps, as maps told different stories–and radically different histories–of a nation and its state of health, as the narrative of social abandonment and a public health crises was denied, massaged, and reorganized from the White House, as it attempted to manage the political narrative of the virus, and the increased social abandonment that was the result of decaying and undermined public health system was apparent–and, increasingly, the abandonment of the nation was somewhat emblematized in the closures of schools, and absence of funding not only for a public health response but for schools. Although kids were less likely to be a vector of transmission of SARS-CoV-2 than they would be in influenza, the persistence of modeling viruses as “the flu” led to a precocity of school closures, disrupting many family lives, and curtailing options of educational retention or progress, as few knew after a few months why the schools were shuttered–or what option other than shuttering schools were. Many have already scheduled reopening by mixed virtual and in-person operations, but suspension and evacuation seemed–akin to an actual war–the default reaction, perhaps in imitation of Chinese shuttering of state-run institutions in Wuhan–but quickly affected large numbers of students–so many that the metric and scale of mapping school closures quickly shifted from students to states from March 13 to 18.

March 13, 2020/EdWeek

–to entire states where schools were shuttered due to COVID-19–as panic spread of a lack of any coordinated government response on federal levels–

Leslie Maxwell (Chronicle of Higher Education) & Karin Fischer (Education Week)/ (EdWeek). March 18, 2020

–and gained increasing national uniformity, without any clear model for continuing instruction, creating dynamic learning situations, or assisting the many families who depended in many under the board, improvised, or silent ways on public education. Even as debate was focussed on the children of “critical workers” or the “essential workforce,” and emergency responders, the shutting down of the entire education industry and those who depended on public schools, as well as private ones, left the nation limping as we approached summer.

The national war of narratives continued in maps, as maps told different stories–and radically different histories–of a nation and its state of health, extending to the labelling of the anti-policing protests to domestic terrorism, in ways that seemed set to expend force on a domestic theater, but not for education or health care. Yet while the infection was in need of curtailing, children are only able to account for 2% of COVID-19 cases, and seem to transmit the disease far less than others–and are rarely hospitalized, as they are far younger; the continuation of schools in Australia and New Zealand suggest that children rarely pass on the infection to other kids or teachers, and the mechanics of transmission was perhaps poorly understood as the reaction to earlier fears of pandemics–from the age of SARS or H1N1, or H1N5, were rolled out, without attending to how SARS-CoV-2 was contracted or had spread. Most importantly, perhaps, keeping schools open was a basis for monitoring kids, and focussing their attention, as well as engaging their minds, in ways that the schools were struggling, in part as government had done little to encourage.

A need for orientation was the increasingly pressing story of COVID-19, which point-based maps perhaps poorly showed. For the sense of an absence of leadership was more apparent for some time: intense social distancing practices adopted as an efficient top-down if radical means to curtail transmission of the novel coronavirus in China, where sevenfold decreasing of social contacts successfully contained the coronavirus, had been rarely adopted in the United States. Distancing was a public health strategy successfully adopted in Italy, where Chinese experts had arrived, but stubborn refusal to adopt World Health Organization protocols or potential foreign help mapped onto a home-brewed failure to enact social distancing in the highly mobile population that had enabled infections to spread beyond the actual CDC tally in the United States; we moved through months with no sense of when testing would occur, or become widely available in areas of need: as health services are viewed as a good regulated by markets and providers, there was not even a clear sense of testing protocols or practices, as states were left to fend for their own private contractors, often residing out of state, and no clear abilities of a turnaround in tests or test kits were provided.

The lack of a national health care system, eroded in the previous thirty years, was betrayed in the lack of any ground game. President Trump revealed the hope of testing to the nation as if game show prizes in a Reality TV show, rather than a public health disaster–addressing the nation from a lectern with a detachment from governance of the situation on the ground, as if seeking to foment dissensus. The practices of testing widely that was suggested met disinterest from the President, lest “when you do more testing, you find more cases, and then they report our cases are through the roof,” as if it was disadvantageous–suggesting a lack of interest in creating consensus that has yet to be understood, revealing a strikingly limited attention span to anything but registers of perception, even in public health.

While we are before a new disease, which we do not grasp in its pathways of infection fully, or its vectors of transmission, and mitigating factors, and lack the vaccine we will probably need to contain, we may feel, as historian of science Lorraine Daston put it, in “ground zero of empiricism,” and all in the seventeenth century, vulnerable to a disease far less dangerous or deadly than Yersina pestis, without adequate explanatory categories or diagnostic tools. But the disorientation of facing the disease disrupted the nation, and the current news that Gilead Sciences hope to charge hospitals $3,120 per patient with insurance to be treated with six vials of the drug suggests that Trump encouraged the inequity of any treatment or response to COVID-19,– triggering fears of a spate of unaffordable drugs in a pandemic will be driven by a profit motive in Trump’s America.

Trump is fond of using military metaphors of describing the coronavirus as a war, but was reluctant to ensure statistical datasets central to how military mapping tools provided a new sense of regarding the legibility of a map as a public repository of meaning, in earlier disease maps, to articulate arguments about the public good: growing levels of the public tabulation of mortalities linked to specific causes of death and their locations in a city provided a manner to present maps as a way to confront an epidemic such as cholera on a massive scale. Its paths of infection were the subject of the famous medical map by Dr. John Snow’s map, that south to present data to doctors as a way to embody the disease in clear cognitive terms, and rebut the theory of infection by effluvia as “Asiatic cholera” was transmitted in London, from “pollution” that was inherent in water,–here also shown in bars in relation to pumps–

unlike the images of miasmatic infection spreading into low-lying areas from the River Thames to congested areas overcrowded with London poor–

Richard Grangier, Detail of Miasmic Effluvia from Thames against Spread of Cholera in London (1850)

–if we were not worried by miasma transmitted among the crowding of the urban poor from effluvia emanating from river Thames, spread by endemic absence of cleanliness among urban poor and laboring classes, we were hardly able to process the spread of COVID-19, rules of its containment.

From the first bubble maps of COVID-19 infections in New York City, to the maps of “hot-spots” by mid-April, we watched waves of mortality, mostly focussed in cities like New York, but spreading into the Tri-States area, and then blooming in Miami and New Orleans, we watched “hot-spots” grow, often without orientation to the vectors of transmission.

As early as February 15, before Trump made any announcement save a denying entry of ships carrying COVID patients in the US territory of Guam, as the Philippines, Taiwan, Jamaica, and the Grand Cayman Islands–outbreaks of infections had blossomed in several cities in the United States, infections had spread across much of the nation, and we could barely trace the mutations of the pathogen already present by March 15 all fifty states.

We possess limited statistics, alas, to track the pandemic whose airborne transmission is not easily mapped by analogy to flu, and whose mutations seem of different levels of danger–and interact with different morbidities, wiping out many older populations as seen in northern Italy–over a quarter being elderly in Lombardy, which has the highest elderly dependency ratio among developed countries–and even more in the populations of the institutionalized in prisons, old age homes, hospitals, and internment camps. The amazingly detailed county-based counts of cases and testing that are daily tabulated for the country provide alternative views of looking at risk, but we perhaps payed less attention to the routes of transmission, and had little evidence from which to work, with limited testing being performed, and few testing facilities able to process the complex tests of swabbed samples, despite the readiness of our nation to on-site on-demand service.

Testing v. COVID Cases, April, 2020
Web App Tracking COVID-19 Cases in America as of April/Chris Barker, UC Davis

Despite the adequacy of our point-based mapping skills, we may be distracted by the flies of dots of mortality and infection rates, in large part as fear of providing too many tests might fan the flames of insecurity, it seems, as widespread testing might promote in the general public and in our financial markets. As a result, we have created the most dangerously deceptive scenario in which the United States seems to be committed to projecting confidence, even if it is the global epicenter of the spread of the highly contagious pandemic.

We need a far finer-grained map of the country, whose layers called attention to the dangers of places where social distancing is not easy to maintain–like ocean liners, Wuhan markets, urban areas more crowded, and with less access to open space. It increasingly seems that the uneven geography to which the choropleths we have inherited from old models of data visualization are spectacularly blind from levels of class, uneven health care, exposure to pollution or overcrowded living conditions, that they, indeed, seem to naturalize in their appeal to a miasmatic notion of disease transmission or effluvia–common to many of the first statitistical data visualizations of cholera, like the London maps developed by Richard Grainger, and Dr. John Snow in the 1850s.

Detail of Intensity of Distribution of Cholera in London by 1850 by Richard Grainger

We had much harder time embodying COVID-19, as its infection was so diffuse, and the pathogen so contagious, but pathways of contagion multiplied in a linked nation where intense pathways of travel blurring space to conceal the huge stratification of society by divisions of wealth.

The uneven geography of the nation should not be bleached from our own choropleths in an attempt to explain or communicate the topography of infection that is increasingly apparent. It was clear that Trump was little interested in testing or counts, from prohibiting ships with passengers were infected with coronavirus to dock, to insisting the count of fifteen infections would soon decline–rather than grow from twenty-one to the thousands and beyond two million.

Although it is clear closures of school can delay epidemic spread, reducing “peak incidence” up to 60%, the benefits of eliminating the contact network of populations was sacrificed long after the national emergency was declared, as undetected infections were many times greater than confirmed cases. But the closure of all schools in twenty-three states by the second weekend of April curtailed the school year, upending grading policies, assignments, and exams, that upended any interactive learning experiences as all activities migrated online into virtual form, as the nation hunkered down without retooling graduation or educational guidelines but suspending instructional hours, educational resources or support for the remainder of the year.

School Closures (Recommended in Shaded Areas and State-Mandated) and No Policy, April 2020

Especially terrifying in this second, and perhaps as profound, landscape of a lack of national policy, is the lack of any coherent attention to the students who suffer from an absence of schooling or networks of socialization. Both seem discounted in the advocacy of private educational corporations that has been promoted from the Presidency of George H.W. Bush, and his early Education Secretary, Margaret Spelling, which promoted the code words of “school choice” and “standards and accountability” as good business practices of redefining the role of government in the pragmatics of education that have created the current state of play in public schools and have cascaded across time: for in fashioning himself as an “Education President,” despite the skepticism of educators, encouraging corporate- sponsored teaching modules and reading tests to restructure public education, the mandate of No Child Left Behind, animates the ubiquity of Zoom, teleconferencing, and remote learning, as a Ghost in the Machine of distance learning that has eroded expectations for interacting creatively.

Indeed, the effects of the Bush Presidency have extended far beyond his term in office, as they were rooted in a compromise among party elites to open the door to private investment in education, that were the roots of a virtual landscape of the online education that seems arrived from Silicon Valley, promoted by the talking points of online remote education and the architecture of removed instruction, an infrastructure of disconnection that is echoed by evangelists of wireless interconnection by Bluetooth, whose very vision of an interlinked landscape almost designed to exclude many.

While bluetooth is not foregrounded in remote learning, the very notion of a remote interface is embedded in the technology: and the hierarchy of communication in a disembodied experience of remote learning is in a sense paradigmatically structured in the hierarchical remove of Bluetooth remotes. For while the problem of replicating a hierarchical relation of learning and instruction in remote learning tools risks a remove that minimized actual interface, the Bluetooth devices promote a smooth remote operation of frictionless efficacy and passive interconnection absence in the best classrooms. It is almost haunting that Bluetooth still promotes with tone-deaf blindness a master/slave architecture as better enabling communication to an array of “slaves” from one device in a piconet, over a scatternet. The disconnects accentuated across remote education ays that would dishonor the name of the Scandinavian King Harald “Bluetooth” Gormsson, ruler of Denmark and Norway, son of King Gorm the Old and of Thyra Dannebod, whose tenth-century monarchy united warring factions in Scandinavia to a harmonious land of concord, a much of the same land and islands that developed a model functional health care system in the Age of COVID-19. Bluetooth technologies sought to inaugurate a concord of the interlinked, but by a concord of objects in interlinked space, more than health-care, the unity the Viking King Harald Bluetooth created among Danes, Scania and Viking was preserved in the historic Curmsun Disk, rediscovered in the wake of World War II, a map of Scandinavian unity in its cross with four dots bound by an octagonal ridge, offering a precedent from cross-border unity, dating c. 960-1125 AD, during King Harald’s rule.

If the ability for remote diagnoses is invaluable in confronting COVID-19, Yet on a level of educational inequities–and this is the essential subject of this wide-ranging post–the record is far more mixed, and the stare of the tenth century ruler might well shame us in its simplicity.

For DeVos has systematically undertaken, in the cover of a lack of formulation of health policies, a not hidden sustained and concerted efforts to promote distance learning solutions as schools shuttered during the pandemic. By actively seeking out and developing contacts with school officials, state governors, and school district leaders, she seems to have exploited national vulnerabilities while offering no road map to how public school policy might develop in the face of multiple stresses that the pandemic has unexpectedly introduced, abdicating any role on providing guidance for reopening.

As decisions fell to often divisive district boards who are asked to struggle to formulate plans with uncertain funding and state support, leaving many schools open to later accusations of a filature of management, the lack of a national policy worked to the advantage of education businesses; De Vos’ greater attention to preparing to foot the bill for the future development of charter, private, and parochial schools to pick up the pieces where public schools “failed” seems to have been conducted behind the backs of public school principals and teachers: it stands to be senselessly and insensitively disruptive to networks of support public schools provide.

If the glyph on everyone’s computer is not without alphabetical content, but a brands ancient runes, the signature of two initials of Harald’s Oath of Scandinavian unity, committing to the equanimity of his faithful rule–

–that the corporation Eriksson, who pioneered the technology of linking devices by wireless, adopted to advertise its service, in a brand emulating a pledge to link devices in harmony and concord absent from the uneven topography of access to education or medical services today. It may be time to ask for true leadership, or speculate what would Harald “Bluetooth” Gormsson say before increased inequities of distance learning.

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Filed under COVID-19, education policies, epidemiology, mapping school closures, remote learning

Mapping the Expanse of our Health Care Debacle

Has racism reared its ugly head in the debate over healthcare?  Dr. Atul Gawande likened attempts of conservatives to reject health care exchanges as “advice that no responsible parent would ever give to a child.”  For it seems a deeply obstructionist tactic that recalls in so many senses the resistance to integrating schools after Brown v. Board of Education under the misnomer “freedom of choice.”  Gawande noted with real disbelief that courts had to intervene to prevent such retroactive obstructions, much as the Voting Rights Act had been designed to allow courts to intervene in obstructions of the right to vote in similar regions.  While Gawande was not alone in finding that the mantra “defund Obamacare” tsponsored by “almost exclusively white members”  elected to represent “bright red districts” to be fueled by racist hatred or be a cover for deeply racist fears, or be a cover for the sense that poorer parts of the society should not be covered by the wealthier, or by the middle class–and a deep dissatisfaction of the apparent redistribution of wealth that this created, as if this constituted an unwanted interference of the government in individual choice.

Not only do we live in a landscape of quite jarring disproportions of health-care and access to health providers, but of deeply disturbing shifts in life expectancies, that undoubtedly are influenced by a truly terrifyingly inequality in access to health care–which may offer the sort of data visualization from which to begin debate on health care.

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Inequalities in Life Expectancy among US Counties, 1980 to 2010/Dwyer-Lindgren, Bertozzi-Villa, Stubbs, et al./FiveThirtyEight

Filtered by a color ramp that less sharply conveys sharp ruptures, the inequities between in life expectancy among individual counties suggests some quite sharp differences that are apparent in the landscape whose populations we may have decided that we’re less interested in working to ensure of up to a decade:

YEars diff Life Exp.pngFiveThirtyEight

The sharper and perhaps more surprising decline of women’s life expectancy during the decade between 1997 and 2007–the first time of such widespread setbacks in longevity in recent memory–betrays a shockingly similar concentration throughout Oklahoma and Kentucky and West Virginia, as well as Nevada, that mirrors the discontinuity in life expectancy nation-wide to the above snapshot, in ways that might suggest a health crisis, and may well mirror the doubling of those classified as obese between 1980 and 2010–and something as simple as widespread dietary change, as well as habits like smoking, contributing to high blood pressure and obesity in an almost national epidemic.  The dismay with which Dr. Christopher Murray, direction of the Institute for Health Metrics and Evaluation at the University of Washington, noted in 2011 that “there are just lots of places where things are getting worse” seems echoed in the infographics above and below, where the sharp discrepancies of an unexpected decline in health and life expectancy mirrors the increasing inequality and economic divide in America, in ways that seem to distinguish the United States, according to the chair of a 2011 National Academies panel on life expectancies, unlike other countries, that effectively pegs health care to income levels.  The decline of life expectancies in Appalachia and the Deep South is not, perhaps, surprising, but speaks to a bizarre division of the nation, especially as many welathier coastal areas in California and the Northeast, as well as Florida, have seen a rise in life expectancy of both women and men.

Life expectandy for women 1987-2007.png

The absence of similar geographic disparities in life expectancy on a very local if not granular level is absent from Great Britain, Canada and Japan, but suggests the growing demographics of inequity that threaten to be only reinforced by the absence of a comprehensive plan for national health care.  It is a terrifying truth that the majority of poor uninsured reside in 114 of 3,000 counties in the nation, of which 52–just under half–have actually adopted or imposed increasing obstacles to access to adequate national health care for their residents as an unwanted federal intervention.

Such discrepancies are not new, and are readily visible in the US Census, a precious record of national discrepancies and continuities that is now increasingly important to determine the allocation of public resources.  But they were strikingly similar in 2012, in ways deserving to send a shock through the nation because of the inequities it exposed:

Life.jpgKelly Johnston, University of Virginia Library  Scholars’ Lab (2011)

 

The historical decline in life expectancies particularly among rural America–a region that even when adjusted for race shows a huge historical divide that demands drilling down very deeply, as it cannot be reduced to a single cause.

 

LifeExpectancyMapsThe New York Times

 

Given the extent of these painful discrepancies, it is telling that almost half of the counties with uninsured populations lie in states that have not accepted the expansion of health care under the Affordable Care Act:  from Texas to South Carolina, state legislatures have created obstacles to its adoption or implementation, rejecting funds needed to expand Medicaid programs–as have twenty-five states–or even to sponsor health exchanges in their states to make programs available as options for health insurance through the Affordable Care Act.  Both such runarounds do disservice to their populations, as are the attempts of other states to limit the possibilities of access to health-care “navigators” who assist people with enrolling at local health-care centers:  states have independently set up obstacles mandating criminal background checks, fees, exams, or additional course work to sabotage folks from selecting health insurance, and in so doing perversely perpetuate the gaping pockets of inequalities in the current status quo which a map divided by the percentage of populations receiving Supplemental Nutrition Assistance Programs (SNAP)–one important indexed of the uninsured–reveals.

SNAP map

The divides within the southern states of America, where a consistently large proportion of the numbers of uninsured reside, suggests something link a deep valley deeply entrenched within the national landscape but rarely appreciated or explicitly mapped.  When Sabrina Tavernise and Robet Gebeloff examined the results by mapping the refusal to accept an expansion of insurance or even Medicaid against census numbers of poor and uninsured in The New York Times; the coincidence between lack of insurance with refusals of government funds for health care was so frightening that it merited a follow-up editorial on the injustice of blocking health reform–asking how we can accept placing at risk the most vulnerable in our society, including uninsured single mothers, children living below the poverty line, and uninsured low-wage earners, according to data also coming from the Kaiser Foundation.

The interactive four-color map used estimates provided by the 2011 Census Bureau‘s  American Community Survey to reveal how the twenty-six states refusing federal funds (through Medicaid or assistance to buy policies) are also distinguished by terrifyingly high levels of poor or uninsured:

% Uninsured in States Saying No

legend- Poor and Uninsured Americans

As the Times noted, this includes all the Deep South save Arkansas.  The twenty-six states, whose governors or legislatures have intentionally hampered the implementation of the Affordable Care Act, have seceded from federal health care reform, by taking advantage of the Supreme Court’s decision that the expansion of health reform was optional, and not able to be federally mandated.

It scarily mirrors the states whose populations of uninsured exceed 8% of their total populations, or where suffering from poverty and inadequate heath care is most intense:

8% poor and uninsured

legend- Poor and Uninsured Americans

To be sure, much of the arguments against the ACA are rooted in the fear that the act will be a nail in the coffin of the United States as we know it and lead to an insurmountable increase of national debt:  but the paranoiac fear that its perpetration is so short-sighted that it is intended to prevent a return to smaller government has deeper roots.

The depth of local opposition to the ACA follows a deeply disturbing map of national disparities.  Indeed, the refusal to implement the law reflects disturbing ties to the sort of census data on large numbers of African American populations, if one compares the distribution of this refusal to the one-to-one mapping of our population provided in the “Racial Dot Map” designed by the statistical demographer Dustin Cable, who used data of racial populations across national census blocks as measured in the 2010 Census to provide a “snapshot” of the national population.  The map assigns each inhabitant a single dot, colored by a collapsed category of racial self-identification.  Mapping the same data on racial classification alone, using a more simplified classification of racial identity than the census itself, reveals an eery echo of deep segregation among those regions rebuffing the plan for national health care:
SouthWest Dot Map with Names

The disturbing nature of this coincidence, while not measuring to poverty or to low wage earnings, reveal a scary image of the very regions that are ready to spurn federal assistance for the uninsured members of their populations.

Indeed, a focus on the Deep South in Cable’s map, here presented with place-names to render it more legible, reminds us of the relatively clear boundaries in many of these regions among areas which are populated by “whites” or by “Blacks” and “Hispanics”, and a focus on the Deep South reveals the striking nature of the lack of integration in counties that single-mindedly stubbornly refused to expand health care.
Dot Map in the South

There are, to be sure, serious criticisms that can be leveled against the categories retained by the census or instantiated within Cable’s map.  But the  esthetically appealing rendering of census data in the Racial Dot Map reveals some deep divides in our nation’s fabric which may well lie at the heart of the refusal of accepting a mandate for health insurance, even though the refusal is regularly framed as an issue of states’ rights or resistance to federally imposed exchanges of health care.

Indeed, even when stripped of place-names, the distributions that the demographer Cable extracted from the data in 2010 Census blocks creates something of a graphic counter-prompt to the assertion of states’ rights that justifies for such recalcitrant and obstructionist refusing to expand health care:

SouthWest Racial Dot

Although the Racial Dot Map is not an exact tool, and randomly redistributes an average of individual color points within census blocks, we might compare the gross level of integration, which only generalize racial characteristics of a population, to urban areas on the Eastern seaboard:

Eastern Seabord and MD Dot Map

While gross data, and hardly refined as an image of how we live, the contrast with the clearly segregated boundaries of isolated cities suggest a topography of not only racial, but social distancing, and one in which one might imagine anger directed toward the devotion of federal monies to those in need.

Of course, the story is not all bad–even if the crafty recalcitrance of these twenty-six states threatens to erode its ability to reach the most needy among us.  For the profiles of counties within states that have accepted the expansion of course contain uninsured who can be expected to benefit greatly from it–most notably in Arkansas, the one state in the Deep South to accept the ACA–and New Mexico, as well as the more rural areas of California’s central valley, rural Virginia, and the Northwest.

% poor and uninsured in state accepting expansion
legend- Poor and Uninsured Americans

The government shutdown from the start of the fiscal year has prevented many Americans from enrolling for health care online, as was long expected to be possible.  Many will, as a result, rely on filling out paper long forms when seeking to enroll in the program most suitable to them.  But the government shutdown may be a smokescreen meant to cover the obstructionism that the expansion of healthcare, as well as a tactic to delay its final implementation–both since the attention to shutdown has absorbed the 24 hour news cycle, and detracts attention from obstacles to the ACA’s effective implementation.  The shutdown seems to appeal not only as a stunt, but as a final line of resistance to providing universal health care, for a contingent convinced that it will be actually impossible to repeal “Obamacare” once it is enacted and goes into effect.

The mean-spirited nature of this obstructionism is revealed once one examines who will be hurt by a refusal to put the ACA into full effect.  Indeed, a  state-by-state examination of the distribution of non-elderly uninsured across the nation offers a somewhat terrifying profile of troughs of national inequities with which we have yet to contend.  Take, for example, the deep pockets of an absence of insurance among populations in South Carolina:

South Carolina

Or, even more scarily, perhaps, the deep trough in much of central Florida and the panhandle:

FLorida

While the entire state suggests a massive picture of uninsured, the central region is dominated by huge numbers of uninsured, which the governor stubbornly refuses federal insurance:

Central Florida

An even more grave disparity of access to health care is revealed in Alabama as a belt across its more rural areas:

Alabama's Belt

The divisions in Arkansas are almost a belt around Little Rock:

Arkansas

Or a dismaying divide within the rural areas of Georgia, where Atlanta seems something like an island of access to insurance only in its best neighborhoods, but swamp-like regions of uninsured spread out at its northwest and southeastern edges:

Georgia

And, in a particularly terrifyingly unethical mosaic, the disparities between rural and urban Texas appear particularly strikingly stark, and reveal a deeply historical artifact of income disparities and economic livelihoods across the state:

Texas

One could continue almost ad infinitum, covering the ground of the United States as if it were a map coextensive with the nation, but one doesn’t have to struggle much to grasp the depth of disparities and the dangerousness of perpetuating such deep divides in access to adequate health care.

When one speaks of two nations in America, divides between red states and blue states mask the depth of divisions between the uninsured and insured, and reveal the increasing difficulty of the blindness of one population to the other.  Discounting populations whose lack of adequate health insurance is, in essence, naturalized as part of the status quo may provide the clearest illustration of the persistence of racism in America.

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Filed under data visualization, Deep South, national health plan, public health, Voting Rights Act