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Raw milk health risks significantly outweigh any potential benefits − food scientists and nutritionists explain why

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theconversation.com – Juan Silva, Professor of Food Science, Nutrition and Promotion, Mississippi State University – 2024-06-19 07:45:26
Influencers extoll the benefits of drinking raw milk over pasteurized milk, but there isn't substantive evidence to support these claims.
AP Photo/Charlie Neibergall

Juan Silva, Mississippi State University; Joel Komakech, Mississippi State University, and Mandy Conrad, Mississippi State University

Despite an ongoing outbreak of bird flu in dairy cows, the popularity of raw milk has only risen. Advocates claim raw milk has superior health benefits over pasteurized milk. There is little evidence to support these claims, however, and the risk of serious illness is much greater.

Mississippi State University food scientists Juan Silva and Joel Komakech and nutritionist Mandy Conrad explain the difference between pasteurized and raw milk, addressing common misconceptions about the health risks and purported benefits of consuming unpasteurized milk. These questions are more important than ever, since cattle can shed viral material into their milk. Not only can pathogens end up in milk, but at least three farmworkers reportedly have contracted H5N1, the virus that causes avian influenza, in 2024. Farmworkers can get sick by handling infected animals or their byproducts, such as raw milk.

What is pasteurization? Does it destroy nutrients?

Pasteurization is a process that involves heating beverages and foods at high temperatures – over 145 degrees Fahrenheit (62.78 degrees Celsius) – to kill harmful microorganisms, such as bacteria, viruses and parasites. This reduces the total number of microorganisms in the product and also inactivates enzymes that could contribute to spoilage.

The taste, nutritional value and quality of pasteurized products aren't significantly affected by the process.

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While pasteurization can lead to some nutrient losses, the changes are generally minimal and outweighed by the benefits. Pasteurization typically causes minor denaturation of proteins and has little effect on fats and carbohydrates. While water-soluble vitamins such as vitamin C and some B vitamins, usually not abundant in milk except vitamin B2, can be partially degraded during pasteurization, fat-soluble vitamins (A, D, E and K, found in significant amounts in milk) are more heat stable and suffer minimal loss.

Thus, nutritional losses in milk due to pasteurization are generally small compared with the significant benefits of reducing foodborne illnesses and spoilage.

Is raw milk healthier than pasteurized milk?

Studies have compared the benefits of raw milk with pasteurized milk and have found little evidence that raw milk is superior to pasteurized milk. The perceived advantages of raw milk are outweighed by its health risks.

First, raw milk does not improve lactose intolerance.

Raw milk also does not have more vitamins than pasteurized milk. Milk is not a good source of vitamin C or other heat-sensitive vitamins, and pasteurization does little to reduce vitamin B2 or riboflavin, which is not as sensitive to heat. Moreover, Vitamin D is added to pasteurized milk to enhance your body's ability to absorb the calcium in milk.

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Raw milk health risks significantly outweigh any potential benefits − food scientists and nutritionists explain why
Pasteurized milk is fortified with vitamin D and other nutrients.
Burke/Triolo Productions/The Image Bank via Getty Images

Fortified milk replaces nutrients that may be lost in the pasteurization process. Vitamin D is added to milk to enhance uptake of the calcium found in the milk. No single food is perfect, so it is OK for milk to lack some nutrients, as these can be obtained from other foods.

Some people believe that probiotics – foods or supplements that contain live bacteria beneficial to health – are more prevalent in unpasteurized milk and products made from raw milk. However, raw milk is generally lacking in probiotics and has significantly more harmful bacteria. Probiotics are added to many dairy foods such as yogurt after pasteurization.

Furthermore, a 2011 review of the available research on the health benefits of raw milk found that many of these studies were conducted with poor methods, meaning their results should be interpreted with caution.

What are the health risks of consuming raw milk?

The health risks of consuming raw, unpasteurized milk come from the harmful microorganisms that may be present.

Raw milk has been associated with hundreds of foodborne disease outbreaks. Between 1998 and 2018, 202 outbreaks resulted in 2,645 illnesses and 228 hospitalizations. More recently, from 2022 to 2023, there were 18 outbreaks and recalls associated with raw milk. A number of outbreaks and recalls associated with pathogens in raw milk have already occurred in 2024. In all cases, pathogens in the raw milk that cause human diseases were directly responsible for these illnesses.

Hind legs of cows standing in a stall
Pathogens from infected cattle can be found in their raw milk.
Tunvarat Pruksachat/Moment via Getty Images

Some illnesses from the pathogens in raw milk can have serious long-term effects, including paralysis, kidney failure and death.

Researchers found that areas where raw milk was legally sold in the U.S. from 1998 to 2018 had over three times more outbreaks than areas where selling raw milk was illegal. Areas where raw milk was allowed to be sold in retail stores had nearly four times more outbreaks than areas where sales were allowed only on farms.

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Is it safe to eat foods made from raw milk?

Many, if not all, dairy products made from unpasteurized milk are not safe to eat. A number of products can be made from raw milk, including soft cheeses, such as brie and Camembert; Mexican-style soft cheeses, such as queso fresco, panela, asadero and queso blanco; yogurt and puddings; and ice cream or frozen yogurt. Pathogens in raw milk can survive the processes involved in making these types of dairy products and thus be unsafe for consumption.

Only products that undergo a process to inhibit or kill harmful microorganisms may be safe enough to be made from unpasteurized milk. However, the potential for cross contamination of raw and cooked food as well as the survival of pathogens from inadequate processing is high when products are made with raw milk.

Can pasteurized milk still get you sick?

The few reported outbreaks associated with pasteurized milk can be traced to contamination after pasteurization. When handled properly, pasteurized milk is a very safe product.

The U.S. government requires farmers to destroy milk from herds infected with avian influenza. As of June 2024, 12 states have reported herds positive with H1N5, the virus that causes bird flu.

There is currently no evidence that consuming pasteurized milk from infected cows causes illness in people. Based on the evidence available, the Food and Drug Administration currently states that pasteurization is able to destroy or inactivate heat-sensitive viruses such as H5N1 in milk.

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Consuming raw milk, however, may pose a risk of disease transmission to people.

Can you gain immunity from H5N1 from drinking raw milk?

Some people believe that drinking raw milk can strengthen their immune system. However, there is no scientific evidence to support that drinking raw milk can improve immunity against disease.

Vaccines train your body to protect itself from future infections without actually getting sick from that infection. They do this by exposing your immune system to very small amounts of dead or significantly weakened pathogen.

Bird flu is spreading among dairy cows in the U.S.

Raw milk contains live H5N1 virus, meaning it could still infect you and make you sick. Rather than contributing to your immunity, raw milk exposes you to the virus at its full strength and can result in severe illness. Any protective antibodies that may be present in raw milk are likely degraded in stomach acid.

Moreover, people who contract bird flu from raw milk run the risk of transmitting it to other people or animals by giving the virus a chance to adapt and improve its ability to spread between people. This increases the risk of more widespread disease outbreaks.The Conversation

Juan Silva, Professor of Food Science, Nutrition and Health Promotion, Mississippi State University; Joel Komakech, Assisstant Professor of Food Science, Nutrition and Health Promotion, Mississippi State University, and Mandy Conrad, Assistant Clinical Professor in Nutrition and Dietetics, Mississippi State University

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The Conversation

Navigating mental health treatment options can be overwhelming – a clinical psychologist explains why it’s worth the effort

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theconversation.com – Bryan Cochran, Professor of Psychology and Director of Clinical Training, University of Montana – 2024-07-08 07:04:09
Many Americans are not getting the mental care they need.
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Bryan Cochran, University of Montana

The percentage of Americans seeking mental health treatment nearly doubled between 2004 and 2022, with almost a quarter of the population reporting that they saw a mental health care professional in 2022.

This surge in help-seeking has many potential explanations. The pandemic, along with other external stressors, led to unprecedented high rates of anxiety and depression across all age groups.

Yet the majority of Americans with a mental health condition are not receiving adequate treatment or any treatment at all.

People who are pondering getting help face a lot of decisions with little information about how to navigate the system available to them.

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As a licensed clinical psychologist and director of clinical training for a clinical psychology program at the University of Montana in Missoula, I spend a lot of time thinking about how to increase folks' access to treatment. I also field a lot of practical questions that people have about the process.

It's a difficult landscape to navigate, particularly when there is a nationwide shortage of mental health care providers.

Recognizing when to seek help

Mental health conditions – technically diagnoses or disorders – are defined by either feeling distress or experiencing impairment in one or more areas of your life.

If you seek out mental health treatment, a diagnosis is often required for you to receive services. You should seek out professional advice as a first step. Clinicians make diagnostic determinations based on the Diagnostic and Statistical Manual of Mental Disorders, currently in a revised, fifth edition.

Finding adequate mental health care amid a nationwide shortage of mental health professionals is tricky, but not impossible.

Getting a diagnosis

Mental health practitioners include, but are not limited to, psychologists, social workers, counselors, psychiatric nurse practitioners and psychiatrists. Many people start with a referral to one of these providers through their primary care provider.

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There are clear differences between these professions in terms of training and scope of practice, but all require licensure. The best way to check if a practitioner's license is valid or if they have had misconduct actions is to do a search for your jurisdiction, the profession (such as psychiatrist), plus “license lookup” or “license verification” to be directed to your state's official licensure site.

The training of mental health professionals is vastly different within this broad category. Psychiatrists, psychiatric social workers and some psychologists (in states that allow it) are trained in prescribing medications for mental health conditions. Counselors and social workers typically hold a master's degree that is focused on understanding humans' well-being, methods of psychotherapy and providing treatment. Psychologists typically hold a doctorate degree and have additional, specialized training in psychological assessment, research and supervision.

The right specialist for you might be determined by your specific needs, such as an assessment or medication, but pragmatic issues are often key factors.

Paying for therapy

If you are one of the 92.1% of Americans who are fortunate to have health insurance, by law you should receive coverage for therapy that is comparable to what you would receive for medical or surgical procedures. However, mental health care is still difficult to access in many parts of the U.S.

Exact coverage may depend on your deductible, whether the therapist is in- or out-of-network, and the therapist's rates. Ethical guidelines for all of these professions dictate that a therapist should let you know about their rates, expected course of treatment and your rights as a client as soon as possible in the therapy process. Not all therapists accept Medicare or Medicaid, unfortunately; these plans often reimburse providers at lower rates than private insurance companies.

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Often the number of sessions that are covered by insurance is determined by your diagnosis. Your therapist should always be able to tell you the diagnosis that you have and what they have submitted to your insurance company. It's important to know that many mental health care providers are limited in the types of insurance that they take, if they do so at all. Check with your health care plan to see your exact coverage for mental health services, including more complex situations such as inpatient hospitalization or long-term treatment.

Many communities have excellent school-based health centers for youth and certified community behavioral health centers for all ages. These useful resources often provide “one-stop shopping” for health care and can sometimes provide therapy services on a sliding fee scale.

The first community health centers in the U.S. launched nearly 60 years ago and still provide crucial medical services, including mental health care.

What to expect in a session

The exact type of therapy you receive depends on several factors: your diagnosis, your therapist's specialized training, your goals for treatment and your preferences.

Research indicates that certain treatments are particularly effective for some specific diagnoses. Pay attention to what treatment specialty your therapist provides: Some offer specific approaches such as cognitive behavioral therapy, psychodynamic psychotherapy or dialectical behavior therapy.

Regardless of the specific type of therapy you receive, you can expect to be asked a lot of questions about your thoughts, behaviors and feelings. Information about your past challenges and successes can help to clarify the goals for treatment. Knowing when you started feeling distressed, how it's affecting your life and what you would like to be different are all important in helping your therapist to formulate a treatment plan.

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Some of the things that you talk about in therapy are likely to be painful or difficult, and it's not uncommon for you to sometimes feel worse in therapy than you felt before. This is because a lot of people have pushed away emotionally challenging aspects of their lives before coming to therapy. Coming to terms with these experiences by sharing them with your therapist is most often beneficial.

Using medication alongside conventional therapy

Medication and psychotherapy are often used in combination with one another. If the person prescribing your medication and your therapist are two different people, you'll be asked to sign a release of information for each of them so that they can coordinate your treatment.

For example, you may meet with a psychiatrist just a few times each year, but a weekly therapy session may give your therapist insight into how you are responding to medication on a more timely basis.

Certain conditions may particularly benefit from the combination of therapy and medications. For instance, major depression, obsessive-compulsive disorder (OCD) and panic disorder often have better outcomes with combined treatment. Sometimes the steps that people need to take in order for therapy to be effective, such as gradually confronting feared situations for those with OCD, are more approachable for people who are also taking effective medication.

Research has long established that having one mental health diagnosis increases the risk of having another one; for example, people who have attention-deficit/hyperactivity disorder, or ADHD, are frequently also diagnosed with other conditions such as anxiety, depression and substance use disorder. Situations where people have more than one diagnosis may also be best treated through a combination of psychotherapy and pharmacotherapy.

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Finding the right fit

Several research studies have indicated that the quality of the therapy relationship based on the client's feeling of connectedness is an important factor in treatment outcome.

If you don't feel that there's a great match between what you need and what your therapist is offering, you should keep looking for a better fit.The Conversation

Bryan Cochran, Professor of Psychology and Director of Clinical Training, University of Montana

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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The Conversation

Detroit’s legacy of housing inequity has caused long-term health impacts − these policies can help mitigate that harm

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theconversation.com – Roshanak Mehdipanah, Associate Professor in Public , University of Michigan – 2024-07-03 07:37:04
More than half of Detroiters rent Detroit's aging housing stock.
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Roshanak Mehdipanah, University of Michigan; Kate Brantley, University of Michigan, and Melika Belhaj, University of Michigan

Detroiters who face rising rents, poor living conditions and systemic barriers to affordable and safe housing are at greater risk of poor health, our research finds.

We study the connection between housing inequities and health, with the goal of informing local, state and national policy. Our focus is on how interdisciplinary research on housing relates to equity in health, race, income and aging.

Housing instability can take many forms, including living in overcrowded or inadequate conditions, having to make frequent moves or spending the bulk of household income on a place to live. These stressors can lead to an increased risk of eviction, homelessness, poor mental health and even physical illness.

Half of Detroit's residents are renters who earn a median household income of $26,704, nearly $13,000 lower than Michigan's median, according to American Community Survey data.

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We also found that 60% of renters in Detroit are cost-burdened, meaning they spend more than 30% of their income on housing-related costs, including rent and utilities.

A legacy of discriminatory housing practices

These issues didn't develop overnight. Detroit's current racial housing inequities are influenced by the legacy of redlining. Redlining refers to the federally sponsored practice of banks and insurers refusing or limiting loans, mortgages and insurance within Black neighborhoods.

The effects were long term. As recently as 2019, formerly redlined areas had almost 30% lower homeownership rates and a $60,000 difference in median household income compared with mostly white areas that were provided with better opportunities beginning nearly a century ago.

Beyond the financial effects, research also shows that the practice of redlining in Detroit is associated with self-reported poor health, heart disease and poor vision among current residents of these areas.

Tax foreclosure leads to poor health outcomes

Discriminatory housing practices continue today, often taking the form of foreclosures and evictions.

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In the past two decades, Detroit has experienced one of the highest tax foreclosure rates in the country.

At the height of the foreclosure crisis in 2015, approximately 6,408 owner-occupied homes were repossessed by the county, displacing those Detroiters and putting them at a higher risk of poor mental health.

This has led to more sales at auction to investors and speculators, who tend to evict more tenants than other types of landlords and to allow their properties to fall into disrepair.

Eviction, poor housing quality and health

Detroit saw about 30,000 eviction filings annually before the COVID-19 pandemic.

After a few years of respite due to pandemic-era housing policies, evictions have climbed back toward prepandemic levels. In 2023, more than 20,000 Detroiters had evictions filed against them.

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Research connects eviction to a range of poor physical and mental health outcomes.

Even the Detroiters not at risk of eviction often pay increasing rental costs for poor-quality housing despite attempts by the city to implement a rental ordinance requiring landlords to register and obtain a certification of compliance with Detroit's rental ordinance.

Research shows that 9 in 10 pandemic-era eviction filings involved properties not in compliance with local health and safety codes, including those that regulate lead hazards. At the same time, much of the housing stock continues to decline as it ages and compliance efforts are not well enforced.

Some who are evicted have nowhere to go. In January 2023, 1,691 Detroiters were experiencing homelessness, increasing their risk of mental health challenges, disease and even death.

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Policies that have worked

There is some good . Tax foreclosures in Detroit have decreased significantly from the height of the tax foreclosure crisis.

We partly attributed this to the pandemic-era moratorium on tax foreclosures initiated by the Wayne County Treasurer's Office, which ended in 2023. The county also oversees the Michigan Homeowner Assistance Fund and programs such as Pay As You Stay and the Detroit Tax Relief Fund, which have helped clear tax debt for homeowners.

Programs such as Detroit's Homeowners Property Exemption program have exempted some low-income homeowners from paying property taxes in an effort to prevent tax delinquency.

However, our research shows that despite efforts to raise awareness about these programs, few qualifying households access them. This places them at risk for foreclosure and possible displacement.

New policy directions

Detroiters' resilience and persistent advocacy have led to significant wins for housing justice, helping to translate community concerns into city policy.

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In 2022, residents successfully organized for the right to counsel for qualifying low-income Detroiters facing eviction.

The city could also follow the lead of other U.S. cities such as Philadelphia by exploring eviction diversion and mediation models to reduce eviction filings.

More targeted efforts are also needed to invest in Black homeownership to ensure stability and encourage long-term residence.The Conversation

Roshanak Mehdipanah, Associate Professor in Public Health, University of Michigan; Kate Brantley, Research Area Specialist, University of Michigan, and Melika Belhaj, Research Associate, University of Michigan

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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ICE detainees suffer preventable deaths − Q&A with a medical researcher about systemic failures

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theconversation.com – Cara R. Muñoz Buchanan, Physician and Clinical Fellow in Policy and Social Emergency Medicine, Harvard Kennedy School – 2024-06-28 07:37:35
The ICE Health Service Corps suffers from outdated systems and a lack of translation services, despite a federal mandate to provide them.
ICE Health Service Corps

Cara R. Muñoz Buchanan, Harvard Kennedy School

The 2024 Homeland Security appropriations bill increased funding for U.S. Immigration and Customs Enforcement operations to handle an anticipated daily detainee population of 41,500, up from an average of 34,000 in recent years.

Yet recent studies have exposed cracks that call into question the agency's ability to medically care for the detainees it is entrusted with, including inhumane conditions, high suicide rates, structural problems such as the use of prisons to hold detainees, delayed or interrupted medical care and overcrowded conditions. Research also shows that the pandemic years further exacerbated these inequalities.

One recent report by a trio of nonprofit advocacy groups blames preventable deaths of people detained by ICE on inadequate investigations and flawed systems at the agency. The report, Deadly Failures, released on June 25, 2024, by the American Civil Liberties Union, American Oversight, and Physicians for Human Rights, documents inadequacies in diagnosis, treatment and emergency response. It points to suicides that might have been prevented with appropriate mental health care and properly managed medication. And it details underlying issues – understaffing and a lack of interpretation and translation services.

asked Cara Buchanan, an emergency physician and clinical fellow in health policy and social emergency medicine at the Harvard Kennedy School, whose research the report cites, about research in this area by her team and others, ICE's track record on detainee medical care and what needs to be done to improve medical care for people in ICE custody.

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What have you and your colleagues found in studying medical care for detainees in U.S. Immigration and Customs Enforcement custody?

Our research shows that preventable deaths of people in ICE detention are often preceded by lapses in a standardized, consistent and competent approach to medical triage, including identification and escalation of the need for emergency care.

What has other recent research uncovered in this area?

Research across many disciplines, including medicine, law, policy, criminal justice, health economics, human rights and public health, correlate structural design features of immigration detention facilities to adverse health outcomes for detainees. This includes the use of solitary confinement, which is linked to an increased risk of self-harm for detainees in ICE custody.

The COVID-19 pandemic highlighted significant health disparities in immigration detention facilities. Many facilities failed to provide adequate basic, preventive and emergency medical care.

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Studies also demonstrate a persistent lack of transparent information about conditions in ICE facilities that continues to prompt ongoing calls for increased oversight and accountability to address the systemic sources of poor health outcomes.

The ultimate failure of the immigration detention system to protect the health and safety of detainees is the outcome of preventable death. Publicly available ICE detainee death reports provide basic details about timelines preceding death. However, independent investigations and analyses into the circumstances surrounding these deaths have demonstrated pervasive and systemic negligence.

Billions of dollars of congressional appropriations continue to pour into the expansion of ICE detention facilities, and private prisons contracted to provide services for immigrants in detention report profit margins in the billions of dollars.

How did your work fit with the recently released report?

Deadly Failures expounds on our prior research with a depth and breadth of context.

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The report provides clear policy recommendations for major stakeholders – the Department of Homeland Security, the Department of Justice, Congress and local and state governments.

These recommendations range from feasible to ambitious in detailing actions that would eliminate preventable death for those in ICE custody. Proposed interventions include prompt disposition of detainees who have medical and mental health vulnerabilities, limiting the physical and fiscal expansion of detention facilities, investing in community-based services, banning solitary confinement, passing legislation to ensure accountability to standards of care in facility contracts and establishing mechanisms for regular public data reporting. The report also calls for ICE to dismantle the mass immigration detention system at large.

I was particularly heartened to read the second line of the Deadly Failures executive summary, which highlights the most striking finding of our research – the troubling trend of ICE releasing people from custody immediately prior to their deaths.

Why does this happen?

ICE regulations specify that when a detained noncitizen dies in custody, the agency will conduct timely notification, review and publication of the death. But the regulatory language about people who die immediately after release from ICE custody is vague and doesn't include a reporting timeline or proposed mechanism of accountability for such deaths.

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When we investigated the total number of deaths in ICE custody from fiscal years 2021 to 2023, our research team cross-referenced published ICE death reports with releases issued by investigative journalists and immigration advocacy groups. Our review of public records and available legal documents confirmed four deaths that were not accounted for in the 11 death reports ICE published from those years.

Through this investigation we found a pattern of detainees who, while hospitalized, were released from ICE custody after being deemed critically ill, with death clinically imminent. When we reviewed these detainees' medical records we found deaths that could have been prevented. In one such case, a detainee contracted COVID-19 while in custody and suffered a series of complications, including multiple hospitalizations for recurrent infections. Concerns raised by the facility medical director about the patient's persistently critical condition went unaddressed, and after ultimately suffering a stroke the patient was placed on life support. ICE released the unconscious patient from custody just prior to his death. This technical release from custody allowed ICE to avoid mandatory public reporting of this case and its details.

Officially, ICE has said that it is continuing to evaluate its enforcement of health standards and is looking for ways to improve medical care delivery.

Our research team's key recommendation, also highlighted by the authors of Deadly Failures, is that all deaths of individuals that occur within 30 days of release from ICE custody be included in mandatory public reporting of ICE statistics and death reports. This is a critical measure of transparency and accountability.

ICE detainees suffer preventable deaths − Q&A with a medical researcher about systemic failures
The Port Isabel ICE detention center in Los Fresnos, Texas.
Veronica Gabriela Cardenas-Pool/Getty Images

What should Immigration and Customs Enforcement be doing to prevent unnecessary deaths on its watch?

Time in ICE custody is related to preventable death. People detained in ICE facilities should be released as quickly as possible so their medical needs can be transitioned to more consistent and long-term care.

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Triage should also be standardized. Detainees who show signs and symptoms of serious medical conditions should be rapidly assessed and quickly transferred to local emergency rooms for further evaluation and treatment. Rigorous oversight and accountability should be established for all workers at ICE facilities and for clinical outcomes of detained patients.

Are you still seeking answers to questions you have about detainees? If so, what are you looking for?

ICE's collection, recording and sharing of high-quality data regarding the capacity of ICE facilities, the scope of health services available and metrics of health outcomes for people detained in ICE custody is markedly limited. The dearth of data leaves a barrage of unanswered questions regarding the conditions that contribute to poor health outcomes. In my view, ICE detention facilities should be held to standards of transparency and accountability to federal and public reporting, as are other large systems of medical care.

Is there anything that has surprised you in what you've found over the past few years?

The instances of deficient professional language services, including interpretation and translation, for people detained in ICE custody is surprising. It is at odds with a federal mandate that stipulates a patient's right to receive health information in their preferred language at no cost. This right is exercised daily in U.S. hospitals and clinics across the country for the nondetained with in-person interpreters or readily accessible technology.

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Woman in white coat examines man in orange jumpsuit
An ICE Health Service Corps photo shows a detainee in an orange jumpsuit receiving care.
ICE Health Service Corps

Ultimately, it is disheartening but not surprising that extensive research continues to demonstrate a diminished standard of care experienced by people detained in ICE custody.The Conversation

Cara R. Muñoz Buchanan, Physician and Clinical Fellow in Health Policy and Social Emergency Medicine, Harvard Kennedy School

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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