The Grim Reality Behind the Pink Ribbon

With October behind us, so too is the frenzy around the pink ribbon—the symbol of our nationwide campaign against breast cancer. Despite month-long displays of solidarity, many awareness campaigns have turned a blind eye to perennial disparities in care. In a country where marginalized women are more likely to die from breast cancer, our efforts to curb the disease require constructive policies that work to dismantle inequities within our health systems—not pink-washed products.

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.

Gains from the war on breast cancer have by and large sidestepped women of color and low-income women.

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.




Why Poverty Isn’t a Halloween Costume

When a website documenting the attire of Walmart customers surfaced several years ago, its popularity grew quickly. As Walmart is known for its low prices, and a sizeable number of its customers have very little money, many photos on the site featured people in outdated, worn, and dirty clothing. Phone cameras made it easy to surreptitiously photograph a person walking among the aisles – to single them out and mock how they were dressed. And so, the “People of Walmart” website inevitably became a place where visitors could laugh at the expense of an impoverished person.

Their attire built upon a larger legacy of distorting the experiences of people living in poverty.

Some of the site’s fans have gone even further, just in time for Halloween. Recently in Acadia Parish, Louisiana, the principal of a local high school and her husband, a coach at the same school, attended a costume party dressed like a couple from the “People of Walmart” website. A photo of the pair made headlines because they were blatantly appropriating poverty. That is, they were dressing up as someone who is marginalized for the sake of entertainment. This practice often occurs during Halloween when revelers dress up in Native American, ninja, and geisha costumes without having any connection to these cultures, or through crude portrayals of Latino and African American celebrities. But therein lies the rub – when Halloween or the event ends, the appropriators can simply take their costumes off and go back to a life free of racism and hardship. The rest of us don’t have it so lucky.

In this case, the principal, Lee Ann Wall, wore tight, skimpy clothing with her hair in little braids. She had tucked what appeared to be the traditional “food stamp” coupons in her bra and placed a box at her feet filled with multi-racial dolls with a sign that read, “You wait on pay day, I be waiting for da first of da month!” implying a welfare check. Not to be outdone, her husband wore a shirt that read “Baby Daddy,” with pockets full of money and a gun, along with a red bandana for a belt.

Although the couple probably thought of their “People of Walmart” costumes as harmless fun, their attire built upon a larger legacy of distorting the experiences of people living in poverty. Indeed, throughout the last fifty years—and particularly during efforts to “reform” welfare—political leaders have painted people in poverty as lazy and entitled, most famously through the Reagan-era term “Welfare Queen.” Their logic is that if enough Americans believe that most people who need benefits will refuse to work and abuse the system, it will be easier to cut anti-poverty programs without incurring a backlash.

As a single parent putting myself through college, I know well that receiving government assistance requires fighting this stigma. In advocating for myself to receive assistance or even child support, I’ve heard people say I acted like I was entitled to these benefits. Or that I wasn’t thankful enough for them, or that I didn’t use them as they were intended. Or even that those benefits aren’t meant for me; that they are supposed to go to someone who’s “really” living in poverty.

Seeing people like Lee Ann Wall and her husband engage in noxious stereotyping while they are entrusted with helping children learn is especially devastating. I wonder, “Is that the way they see me and other parents whose children qualify for free lunches?” If my child went to their school, I’d be less likely to open up to them about my struggles as a parent, knowing that their vision of someone who receives government assistance is so negative and flippant. I’d worry about my own child experiencing discrimination.

Much like poverty is not a costume that we can slip on and off for the sake of entertainment, accepting government assistance is not something people boast about. It is the admission that you cannot provide for yourself and your family. It is asking for help from a system whose recipients are compared to thieves and serve as the punchline of jokes. And now, it seems that our struggles – instead of inspiring empathy – make for nothing more than a funny Halloween costume.




Public Defenders Key to Reducing Mass Incarceration

The well-known introduction to Law & Order—the longest running legal series in TV history—is indicative of the criminal justice narrative that dominates American thinking:

“In the criminal justice system, the people are represented by two separate, yet equally important, groups: the police, who investigate crime; and the district attorneys, who prosecute the offenders. These are their stories.”

Police and prosecutors are the good guys in white hats.  Those accused of crimes are threatening and already presumed to be “offenders.”  And defense lawyers—the men and women who protect the rights of the accused—are rendered irrelevant.  We see this narrative dominant not only in our culture, but in our policy and politics today.

Even last week, President Obama ignored the role of public defenders in a panel he convened on criminal justice reform, a long-neglected issue I applaud him for tackling.  The panel included a police chief and a federal prosecutor but no defense attorney, much less a public defender. Like every set of recommendations introduced since this conversation began, the discussion failed to include public defenders as part of a broader reform strategy.

This devaluing of defense counsel is completely contradictory to our democratic ideals.  Our system recognizes counsel for the accused as essential if we are to achieve equal justice.  The Supreme Court said as much in Gideon v. Wainwright when it ruled that poor people accused of crimes must be provided counsel.  The Court recognized that without lawyers there can be no justice, for it is through counsel that all other rights are protected.

That decision was made in 1963, and we understood from experience that we could not always count on the judicial system to protect society’s most vulnerable members.  Poor people, and especially African Americans, had too often been treated abhorrently, and Gideon demanded that—through the right to counsel—there would be greater protections against such treatment in the realm of criminal justice.

Indeed, our nation came to understand the defense lawyer as heroic.  We rooted for lawyers like Atticus Finch in To Kill a Mockingbird, published in 1960 and awarded an Oscar for the film adaptation the year of the Gideon decision. We understood the criminal justice arena as a civil rights battleground, and the defense lawyer as critical to challenging a system that is inclined to trample the rights of the poor if left unchecked.

But as a “tough on crime” mindset took hold of the public psyche over the past four decades, we forgot the importance of our constitutional obligation to protect the vulnerable.  Instead we have created a community of “others”—almost exclusively poor and non-white—which needs to be monitored, controlled, and isolated from the rest of us.  In our rush to punish, the right to counsel gets short shrift as we fail to provide adequate resources so that defense lawyers can serve all of their clients effectively.

As a “tough on crime” mindset took hold of the public psyche, we forgot our constitutional obligation to protect the vulnerable.

Indeed, we have cheered law enforcement while demonizing the populations that are locked up and the advocates who speak for them.  In doing so we have fueled our generation’s greatest civil rights crisis—mass incarceration.   Of the 2.2 million people locked up in America, almost all are poor, and disproportionately of color.

And who represents the people who are being locked up? Public defenders, who serve roughly 80 percent of all of the accused. As a result of our under-investment in these vital public servants, many poor people are forced to rely on lawyers who may juggle 800 cases annually, or are so overwhelmed that they can only spend several minutes on any particular client. John Oliver brought national attention to this problem earlier this year. He highlighted how, for example, some New Orleans public defenders were limited to seven minutes per case, and their office was so under-resourced it had to resort to Kickstarter to raise needed funds.

If we want lasting criminal justice reform and a real end to mass incarceration, we must reverse this practice of ignoring the need for a strongly supported system of public defenders.

We can change laws designed to govern how police, prosecutors, and judges do their jobs, but if we do not adequately support public defenders so that they can point out when the rules are broken, violations will go undetected.

We can devise alternatives to incarceration, but if lawyers do not have the time and resources to unearth mental health issues, substance abuse problems, and other important life circumstances, judges will not have the information they need to ensure just outcomes.

The current national conversation offers us our best shot at comprehensive criminal justice reform since Gideon v. Wainwright.  If we truly care about justice and liberty for every American accused of a crime—regardless of income—then we need to stop treating this conversation as though it were an episode of Law & Order.

Public defenders—and how we as a nation support and invest in them—must be at the center of the reform debate.



Criminal Justice Reform Will Fall Short If We Fail to Invest in Civil Legal Aid

In recent weeks, both the House and the Senate have introduced bipartisan legislation that would begin to overhaul our nation’s broken criminal justice system. These bills are nothing short of historic. But unless policymakers also invest in civil legal aid to support formerly incarcerated people who are re-entering their communities, efforts to dismantle mass incarceration are doomed to fail.

For most returning citizens, release from a correctional facility doesn’t mark the end of their punishment. Individuals are commonly sent back into a community with only a few dollars, a bus ticket, and a few days’ worth of any needed medications. Many have no housing to return to—and living with relatives could put their families at risk of eviction due to draconian “one strike and you’re out” public housing policies. Finding a job is unlikely to happen overnight—or even within the first year of release—because of the great challenge of securing employment if one has a criminal record. And in many states, people convicted of felony drug offenses too often go hungry as they are barred for life from accessing the meager assistance that income and nutrition aid programs provide.

For most returning citizens, release from a correctional facility doesn’t mark the end of their punishment

To make matters worse, many returning citizens face debts in the tens of thousands of dollars due to child support arrears. In many states, these payments accumulate while individuals are behind bars, even though they have little or no way to earn income. And in a growing nationwide trend, states and localities are closing budget shortfalls through tactics such as charging inmates “pay-to-stay” fees for incarceration, collection fees, and even fees for entering a payment plan to pay off their debts. With funding for public defenders falling drastically short, some courts are even charging public defender fees for exercising one’s constitutional right to counsel.

In addition to trapping returning citizens in poverty, these financial debts can be a path to re-incarceration for those who are unable to pay. These and other obstacles to successful reentry are a big reason why more than two-thirds of formerly incarcerated individuals are rearrested within three years of release, many for crimes of survival. For example, M.H.—homeless, pregnant, and hungry—was rearrested for stealing two plums and three candy bars while on probation for another low-level retail theft offense.

So, what does all of this have to do with civil legal aid? Even though civil legal aid attorneys do not represent defendants in criminal proceedings, they play a critical role in dismantling a system that fuels a vicious cycle of re-incarceration by continuing to punish people long after they have served their time.

For example, civil legal aid attorneys help formerly incarcerated individuals secure affordable child support orders and fight other unjust fines and fees, so that they are able to avoid modern-day debtor’s prison. They help people obtain the necessary documentation to replace lost identification—which is key to getting reestablished in society. Civil legal aid attorneys also assist in getting driver’s licenses restored, which can be crucial to getting and keeping a job.

When employers illegally exclude jobseekers with criminal records, civil legal aid can help individuals challenge hiring discrimination. And many civil legal aid attorneys also help people clear their criminal records which improves their chances of finding employment.

Unfortunately, funding for civil legal aid has long fallen far short of what is needed to meet demand. As a result, for every client served by legal aid, a second person in need of services is turned away. Overall, less than 20 percent of low-income Americans’ civil legal needs are being met—a phenomenon known as the “justice gap.”

While sentencing and prison reforms are key aspects of building a fair and equitable criminal justice system, these reforms are not enough. Reversing the nation’s decades-long trend of mass incarceration will also require removing unnecessary barriers to employment, housing, education, and more. This means we must ensure access to the critical re-entry services that civil legal aid provides.

Earlier this year, the Senate Judiciary Committee passed an appropriations bill that—while far from sufficient to meet demand—would boost legal services funding for FY 2016 by $10 million. Meanwhile, House appropriators have called for slashing legal services funding by $75 million—a staggering 20 percent below the current funding levels. While Congress has passed a stopgap measure to keep the government funded until mid-December, as it continues to debate the budget it should ensure that any proposal includes adequate funding for civil legal aid.  Additionally, Congress should take swift action to reauthorize and boost funding for the bipartisan Second Chance Act. This legislation allows the Department of Justice to award federal grants to government agencies and nonprofit organizations—including civil legal aid programs—that provide services to support re-entry.

If the criminal justice reform legislation introduced this fall is enacted, many currently incarcerated individuals will have an opportunity to petition for reduced sentences or early release. Civil legal aid lawyers will be important partners in helping these individuals transition back into our communities and get back on their feet. Neglecting the back end of mass incarceration—including by failing to adequately invest in civil legal aid—is a recipe for ensuring that most people will end up behind bars again, and that many of the gains we see from criminal justice reform will be short-lived.


First Person

Mississippi’s Women Are Some of the Poorest in the Country. But We’re Getting Organized

This post first appeared at

When I think of it, I get chill bumps.

I never thought I’d see the day when so many women — of all backgrounds, but mostly women of color — would come together to make Mississippi a better place for ourselves, a better place for our children and a better place for our future.

But that’s what we’re doing right now with the Mississippi Women’s Economic Security Initiative (MWESI) — a movement to push an agenda that was developed the old-fashioned way: by talking to people about the obstacles they face and then addressing the issues they are concerned with. Nine town halls have been held across the state over the past year to give women a chance to speak up about their lives and learn from one another. And what we learned was this: The top priorities for women who are struggling — or who have struggled — in our state, are childcare, education, jobs and wages, health care, and domestic violence and child support.

As the initiative moves forward, the MWESI Leadership Team will draft bills that reflect the most crucial needs women raised in the Town Talks; and they will encourage women and supporters to call and write and e-mail our state legislators. They will need us to come to the state capitol next year when the 2016 legislative session starts, and we must turn out by the hundreds — by the thousands — to get lawmakers to vote on issues that matter to us.

I hear that MWESI team members are planning to go back to the places where they hosted Town Talks to hold civic workshops to teach us how bills become laws — so that we will understand why it is so important for us to push our legislators. I hear they are also planning to work with their partners to hold legal clinics to help us learn how to better navigate the system, and we have to come out to those workshops by the hundreds. These are the important next steps we must make toward making Mississippi women secure.

I am so thankful to have so many women standing with me as we embark on this journey to make our new agenda a reality in the state where you might least expect it: We have the highest women’s poverty rate in the nation at 23.1 percent; almost 1 in 3 of our children live in poverty, and nearly 65 percent of families in poverty are headed by single mothers. I consider all of the women who have come forward to work on this effort to be my sisters, and that makes me feel safe as we confront the great challenges that lie ahead for us.

I’ve come quite a long way in my own journey — a journey which has led me to become a part of this movement. I haven’t always been a woman who could stand confidently with other women. There was a time in my life when I felt small and unimportant. By the age of 18, I was pretty much a walking billboard for many of the negative stereotypes that are often attached to African-American women. I was a college student — so I was uninsured, unemployed, technically uneducated — and I was pregnant. And while having a child was a life shock to me, for many other naysayers it was exactly what was expected, because my own mom was only 19 years old when she had me. To many policymakers and too many other people, I was just another poor black child, born to another poor black child, bearing another poor black child. I was of absolutely no consequence.

The labels that were attached to me — baby mama, poor decision maker, uneducated, unworthy — I let those labels hold me down. And I held my head down for a long time. I took Medicaid to cover my child’s prenatal care and her delivery, and WIC so I could provide some essentials to her. And I went out and I found a job. My mom and my neighbor — they handled a lot of the child care my daughter needed because the wages I earned weren’t enough to cover the cost. That’s true for too many women in Mississippi and around the country today too. In fact, a mother earning the minimum wage ($15,080 per year) with two children would spend more than half of her income on child care in our state.

Eventually, I returned to school. But a year after my daughter was born, my Medicaid ended. So I was an uninsured mom, unable to access a lot of the routine health care that I needed in order to be a healthy mother to my child. As a student, I worked nights and weekends. And I struggled. A lot. I worried about my child care. I worried about my child. I worried about my bills. I worried about my own health care. But, eventually, I learned to stand tall again and to hold my head up for my own good and the good of my child. I graduated from college and I now have two degrees in social work.

But I quickly became aware that while education lessened my burden, it didn’t completely alleviate my struggle. For more than 10 years I worked two jobs trying to make ends meet. In our state, 26 percent of black women with college degrees still struggle to make ends meet. This statistic should come as no surprise, since the women of Mississippi make up half of the state’s workforce but hold 72 percent of the minimum wage jobs. And when women do look for opportunities through job training, too often they are steered towards low-wage jobs rather than family-supporting careers.

I know from experience how it feels to be college educated and still struggling. When my employers needed me on nights or weekends, many times I had to take my daughter with me. And I’m grateful for those employers and clients who allowed me to bring my little girl into the room with me, and let her sit in the corner and color or listen to music or put her head down, because they knew that I was struggling and just trying to make it for my child.

Now, as a social worker, I meet women all the time who ask me, “What do I need to do so that I can have safe, affordable, reliable child care for my children?” “How do I find health-care providers who have mom-friendly hours and allow me to come in after hours?” “What do I need to do for my own health-care services — not just for family planning but also my regular health-care needs?” And I have seen too many women, in tears, with their hands trembling, ask me “What do I need to do to make sure that I feel safe from domestic violence or sexual assault?”

To be honest, I didn’t always have the right answers for my clients. I didn’t always know what to tell them.

But I’ve learned that these questions are not unique to me or to my clients, and there are answers. When I came to the Initiative’s town hall in Jackson, there were 35 women and many of them stood up and asked these same questions and more. And I had chill bumps — because now I could go back to my clients, my friends, my family and my community, and say that we are working and fighting on these issues in order to make Mississippi women secure.

I can tell them that there are literally thousands of women who are working to make sure that we all have access to health care — 90,000 more women would be covered through Medicaid expansion alone. I can say that we are working for family-sustaining wages so that we don’t need government assistance; paid sick and family leave; and funding and technical assistance so that women can pursue non-traditional occupations. I can let folks know that we’re trying to close that wage gap so that we are paid the same money for the same jobs as our male counterparts, instead of 71 cents on the dollar. And I can tell people we’re fighting to make sure that women are protected in the event of sexual assault or domestic violence — 50 percent of sexual assault victims lose their jobs or are forced to quit. We are doing all of this and more — fighting for the economic, physical and emotional security of women in Mississippi, because you can’t separate any of those three things or substitute one for another.

I wish I could tell women it’s going to be easy, but we know it won’t be. There are going to be times when someone may be the only woman in a room, standing up for this agenda, but we won’t waiver. There are going to be times when people will try to divide us or make us feel small, but we will stand firm and hold our sisters tall. There are going to be times when we’re afraid, or just plain tired, but we can’t give up. And we can’t worry too much about how this ends, or where we are right now as we get started. We just need the courage to take a stand, and to fight for the women of Mississippi.