President Barack Obama's visit to the Standing Rock Sioux Tribe in North Dakota Friday will let him get a first-hand look at the challenges facing Native Americans. And there are many.
The Census Bureau says 27 percent of Native Americans are poor. Helen Oliff of National Relief Charities says on the reservations her organization serves, the poverty rate is actually higher, which exacerbates another problem: many Native Americans have little access to fresh, healthy food.
“You have a lot of convenience stores on the reservations," Oliff explains. "Many people are 30 to 60 miles away from the nearest regular grocery store.”
That leads many people to eat the pre-packed foods the convenience stores sell.
Unemployment is also problematic, partly because it's hard to reach jobs from remote reservations.
“When our reservation area was created, back in the day, it really put us in a box, literally," says Scott Davis, a Lakota Sioux and head of the North Dakota Indian Affairs Commission.
Davis says the Obama administration has given tribes more autonomy, and President Obama has included the Choctaw Nation in his Promise Zone program, which helps impoverished communities access federal resources.
When Friday the 13th rolls around, we often hear reports that the date is unlucky for the economy. Superstitious employees, we're told, call out sick from work, frightened flyers cancel plane tickets and more than a few of us won't leave the house to go shopping. So, is it true?
Dan Ilves, senior vice president of leisure at Travel Store, is inclined to call it bunk.
"I've never heard of a client or had a client tell me they will absolutely not fly on Friday the 13th," Ilves said.
Lisa Hale, who directs the Kansas City Center for Anxiety Treatment, says that while 25 percent of the population cops to being superstitious, only about 1 percent identify as "very superstitious." Those folks might avoid the workplace on Friday the 13th, but, Hale points out, superstitious people help pump money into the economy, too. Someone, after all, is buying all those lucky rabbit foot keychains.
Almost all the seafood Americans eat -- 90 percent, to be exact -- is imported. A new study from the Fisheries Centre at the University of British Columbia found that as much of a third of wild-caught, imported seafood is caught illegally or without proper documentation.
The United States has one of the largest seafood markets in the world with these illegal imports potentially adding up to $2 billion dollars; a huge bite out of the pockets of American fishermen.
To understand why illegal catches are such a big deal just ask a fishermen.
“Well, it’s a lot harder because of the damage done to the stock,” says Willy Hatch, who runs a charter and commercial fishing boat in Falmouth, Mass. Hatch fishes for tuna and says a combination of fewer fish to catch, and cheap, illegal tuna imported from countries like Thailand and the Philippines drives the price down for fishermen like him.
“America is an expensive country to live in and operate and we’re held to the highest levels of conservation and we have to compete against other countries where they’re pretty much allowed to go hog wild,” he says.
“It's hugely more expensive,” says Logan Kock, vice president of strategic purchasing & responsible sourcing for Santa Monica Seafood, a distributor. He says limits on fishermen are important but the restrictions can cut into their profits. Kock points to one local fishery in particular.
"They had to design nets where the top edge is down about 30 feet -- that's to allow marine mammals and turtles to go above it. It has to have pingers on it, in case at night marine mammals come by, they'll be able to sense the presence of a net. Those guys can't fish within three miles because that's where young threshers are growing -- it's a nursery. They can't fish offshore at other times of the year because that's when other fish are breeding. They can't fish in the non-marine protected areas. There's an abundance of restrictions that are on them, that not only restrict the areas where they can fish but it also drives the cost of their fishing practices way up."
Kock notes illegal imports squeeze fishermen the most -- those working under the table drop prices to unload their catches, so law-abiding fishermen are often forced to drop their prices to compete. But he says the practice creates ripples.
“There’s the collateral fix because that fisherman has a boat, the boat needs ice, the boat needs fuel, the boat needs repairs. And so it's a community thing.”
Megahn Brosnan, manager of the Pew Charitable Trusts’ Ending Illegal Fishing project, says this is neither a problem for the United States to fix on its own, nor one that other countries should tackle independently.
“This is a global problem -- it really is," she says.
Brosnan notes that almost a third of all fish populations in the world have been overfished. She says the supply chain needs more oversight, all fishing vessels should receive unique identification numbers, and ports should have more inspectors. Otherwise, resources will continue to be depleted:
“If at a certain point, if you take too many mom and dad fish, then there’s just not going to be enough to go around.”
Brosnan says that with big oceans where even aircraft carriers look tiny, trying to stop illegal fishing needs to be an international effort.
In healthcare these days, data is king. The primary care offices in Camden, N.J., have access to some of the most sophisticated patient data in the country.
They can track many of their sickest and most expensive patients across the city’s healthcare system, which gives them a better handle on the kind of primary care that will keep them out of the hospital.
But the efforts of the Urban Health Institute – one primary care office in the city – show why for all of data’s promise there are real world limits.
Every morning, a team of nurses, social workers, and healthcare coordinators reviews the patient data that pours in from the city’s three hospitals. If one of their patients has been admitted, they’ll go to that patient’s bedside to set up a primary care appointment.
To do listJessica Kourkounis
Studies show hospital readmissions drop if a patient gets primary care follow-up within seven days of discharge. One of the biggest tests for the healthcare system is how well doctors and hospitals find ways to respond to the lives the data reveals.
UHI’s Amy Kaplan says while the data leads right where she needs do go, she doesn’t know who she’ll find in that room.
“A majority of the encounters [with patients] are not simply: you go in, the phone number is correct, you make the appointment, you leave.”
Often, she says, “it takes digging around, and that takes time.”
Many patients are what are called “poor historians": folks who aren’t sure which medications they are taking, the name of their doctor, or even their home address. Other patients don’t have phones or are only able to occasionally borrow a neighbor’s phone.
Marcia Johnson (left) and her team of nurses and health workers at the Urban Health InstituteJessica Kourkounis
One morning a few weeks ago, the team discussed the case of a patient with a leg wound that required a refrigerated antibiotic. The problem: he’s homeless, so he has no refrigerator.
The solution was to send a homecare nurse to meet him on a street corner a few times a week.
The nurses in the meeting agreed that solution only delayed the inevitable: the guy back in the hospital.
Social worker Marcia Johnson, who oversees the UHI team, knows no amount of data or well-meaning efforts from her staff gets this patient a stable life so he can recover.
“We sit and have these conversations and just kind of think through it,” says Johnson. “Healthcare doesn’t know how to solve some of these problems.”
And while the efforts to help the nearly homeless patient are wholly inadequate to solve all of his problems, it’s a start. It used to be the case that these kinds of patients would just disappear after leaving the hospital.
Thanks to the data they’ve gone from invisible to visible.
This ongoing series on healthcare and data is produced in partnership with Healthy States.