Article 25 of the Universal Declaration of Human Rights by the United Nations states that “ everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, in addition to the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.
The book, Mama Might be Better off Dead: The failure of health care in urban America (1993) by Laurie Kaye Abrahams, shows how this is still a dream to be realized in a modern, rich industrialized country like ours. One can see a breakdown in the social order in North Lawndale as observed by medical sociologists such as Susan Ross (1) and described by Abraham in her description of North Lawndale. It is a suburb in the east of Chicago, Illinois, composed mainly of poor black residents.
A suburb that lies a short distance away from downtown Chicago – the hub of power and wealth in the region. Of course, the wealth of Chicago had not reached North Lawndale and the Banes family. North Lawndale is described as a disadvantaged neighborhood with many of the chronic stressors that Latkin and Curry (2) discuss in their research. It is a community which looked like a war zone when President Johnson’s war on poverty did not seem to help. Abraham describes it as riddled with crime, drugs, broken down buildings, high unemployment and shattered lives, hopes, dreams and spirits.
She paints a vivid and accurate picture of the failure of the health care system in America, especially for the poor in our society that are still suffering from inequality in the twenty first century. She does this by giving us a representative snapshot of the millions affected using a poor black family in North Lawndale. Abraham describes how North Lawndale spanned an era from its founding in the 1800s to the good times of the 1910s through 1930s, a city, which was built by the Jewish immigrants. We see immigrants and their families thrive and prosper in the community of North Lawndale.
We then watch as the community went into 1960s and its population base shifted to mostly African Americans. Needless to say, it was a time of riots that devasted the community even as Martin L. King called the community his home. Then we were taken from the 1960s as we move closer to the present day. The view provided by the author reveals business moving out of the community. Abraham does an excellent job showing the decaying infrastructure and the subsequent fall of the once thriving community with its decreasing population. We finally arrive at the present day as we are introduced to the Banes family.
When we arrive at this present time, in our imagination we continue to hear the voices from the author’s descriptions of the community that has fallen into an abyss of despair and desperation. We hear, “ Man, I can’t find work! ,” “ What will I do to provide for my family? ” We hear others, “ How will I feed, house and have good health care for my children? ” We also hear, “ Hey man want to buy some crack? ” These voices are silenced momentarily by gunfire from a drug deal gone badly. Bang, bang, bang and a muffled scream. The sounds of sirens wailing through the streets; reality and present day is back.
The reality of present day North Lawndale is upon us; the reality of the Banes family, and its members such as Cora Jackson, Robert Banes and Tommy Markham emerges before our eyes. The author brings us to focus on how a family is affected by the socioeconomic environment living in a poor area. We see what many Americans experience and endure from poorer communities in our wealthy nation. This is achieved through the eyes of the Banes family. The author shows us a glowing disparity especially in health care – health care that should be available for all but is frequently substandard especially for the poor.
The problem, of course, is not North Lawndale’s alone. The situation there is but a small microcosm of a health care system that is flawed with many gaps. This is a national problem that comes from a hodgepodge of federal, state and local policies. The author points out actions taken in the private sector that further exacerbate the problem. Abraham relays to the reader the mechanisms of the various flawed systems that confront a particular family and the profound effects on their lives.
She follows the family over approximately one year and shows us not just numbers and statistics but the effects of poor health care access on a real American family. She thereby links the health policy debate that became a symbol of American discontent with the existing state of affairs and a need to change the same – a need for change that was highlighted by debate that was largely initiated by Harris Wolford in 1991 during his campaign for U. S. Senate from Pennsylvania. Laurie Abraham, who is a journalist by profession, is currently the editor of Elle magazine.
She worked with Mirabella magazine until May, 2000. She has also written for prestigious publications such as The New York Times, The New Republic, Health, and The Village Voice. She has won many awards for her work. The author was certainly not new to the field of health care journalism when she wrote the book, Mama might be better off dead: the failure healthcare in urban America. She had published articles such as, “ The daily grind of kidney failure wears down the low income family,” and “ States, infant mortality program falling off the ‘ 9 by 90,’ goal. ”
Abraham has consistently shown an in depth knowledge with clear and factual writing that brings her stories down to a personal level. She did this again in her book, Mama might be better off dead: The failure health care in urban America. She introduces us to the central but unfortunate cast of characters with all their warts and blemishes in a life’s drama that is being played out right before us. The main characters include (Cora) Mrs. Jackson, the poor transplanted southern grandmother, who was sixty nine when the author’s interviews and observations started.
Jackie Banes, the dutiful daughter, wife, mother and caregiver. Robert Banes, the ailing husband, father and son-in-law. Tommy Markham, the father and son, who becomes a household member at the end. And, the beautiful children – Latrice, the older child who loved her mother dearly; the son, DeMarest, a grown up 4 year old; and Brianna, the sweet baby of the family. Among these family members Abraham gives us eye opening descriptions of the different struggles and arduous maneuverings through Medicare, Medicaid and other insurers of those with severe health problems.
She does this in a methodical and convincing manner. She describes how care received is often too slow to come, episodic, inappropriate and filled with gaps – health care that failed to be there for those in the family with severe medical problems, especially Cora, Robert and Tommy. The description of Cora who has high blood pressure and diabetes is sure to sadden the reader. The diabetes with its complications that results in the amputation of her right foot, followed by her right leg and then the left leg takes her into a state of depression as she can no longer do what she had done when she had been healthier.
The reader can sense that Cora would not have suffered if preventive health care was accessible to her. However, Cora is just an example of how events can affect health as researched by Alan McFarlane (3). Abraham describes Robert Banes, the husband, father and son-in-law as a worker, drug user, and somewhat responsible father. She tells us how Robert had worked at low wage jobs and could not get consistent health care coverage until his kidneys failed, and how his focal glomerulosclerosis was not controlled due to inadequate health care coverage and lack of primary care.
The end result was that his kidney failed sooner than it should have if he had had better care. Robert’s experience with medical care can best be described by William Wilson (4) and his writings on social conditions for poor blacks. Apparently, blacks are disproportionately disadvantaged in terms of health care, too. Jackie Banes is a devoted, intelligent, tremendously resourceful wife, mother, sister, and daughter. Her ingenuity helps the family multiple times traverse the vast expanses of Medicaid, Medicare and other health care insurers as she tries her utmost to get the best possible care for her family members.
At times she was even unaware of what health care was available to her family because of a lack of knowledge and insurers who withheld information from her and other underprivileged persons. She lacked medical coverage when she was pregnant with her daughter, Latrice. In fact, she did not receive prenatal care for 6 months before she gave birth. Tommy Markham is a father, son, uncle and brother- in-law, who was only 48 when he had a stroke due to high blood pressure that was not treated properly over the years. A stroke, which could have been prevented!
Tommy is the philosopher who says, “ You could be damn near dying, and the first thing they ask is, ‘ Do you have health insurance? ’” The supporting characters comprised of the Banes children: Latrice, DeMarest and Brianna. Latrice is her mother’s confidant who could have been stricken by measles during an epidemic that rolled through Chicago and North Lawndale in 1989. She had not received a vaccination to prevent it, a vaccination other children also could not receive in her area because of inadequacies in immunizations. In Latrice’s case, she won the odds, as she was lucky and the measles passed her by.
Many children died, however, as measles roamed North Lawndale, Chicago and many of its suburbs. Demarest is the 4 year old helper; at four he plays the role of a child who is much older. Finally we get to Briana, the sweet one year old baby of the family. The author brings the reader right into present day lives of the Banes’ and gives the reader invaluable insight of how the health care system in our country has been inadequate especially for poor families. Abraham points out many specific instances out of which one stands out.
Cora developed severe depression but the Illinois Medicaid does not pay for mental health care and Medicare pays only 50%. The family was not able to afford mental health care on its own. All the same, the author states that her book was not intended to be an indictment of our health care system. It was merely intended to show the inequities and the quality of health care that exist for the lower classes and less fortunate. I believe it actually does both. The author gives us a despairing look along with a realistic and sorrowful description of the family and their crusades to stay alive in spite of many hurdles.
The main character, Jackie, does most of the work and is the care giver for her family. While the title is, Mama might be better off dead: The failure of health care in urban America, the real title might read, “ Many of the Banes’ might be better off dead” or “ Many poor Americans might be better off dead. ” As we read the book we are overwhelmingly drawn to Jackie. We see that the only thing holding the family together through the trials and tribulations was the bulwark of the family, Jackie. She was constantly juggling things to make ends meet and trying to keep a normal life.
Undoubtedly, she was the leader of the family, who had to deal with her mother’s developing health problems, as well as her brother’s. In addition, she had to deal with her husband’s heath issues, his drug use and his brushes with the law. While she tries to get health care for her children, she also tries to be a loving and involved mother. She enjoys quality time with her children when she is not dealing with the myriad of crises in the family many of which revolve around health care issues. With all that is going on, she tries to instill the importance of education in her children.
She puts insects in jars so the children can identify them. She corrects her daughter to use isn’t instead of ain’t, as Latrice picks up slang language in the neighborhood. Reading the book I was truly amazed at the compassion, dedication and pride that Jackie took in her family; as well as how well she and the family survive on how little they have. I appreciate the difficulty that Jackie faced in making the many decisions she had to make – ‘ Can we take mom to the doctor? What about physical therapy? Have we cut down our spending so mom can be eligible for care? If the spending is cut down she can get transportation to take her mom to the clinic (7).
She does not have the money to pay for the transportation on her own. Hence, her constant juggling of the various health care issues for the family – which happen to be major health care issues – along with raising her children and holding a poor and somewhat dysfunctional family together is sure to amaze many readers. She is the glue, and the family is functioning only because of her. Jackie handled her responsibilities with grace and dignity. I could not have done anywhere near the great job she did.
The love and caring she had for her family in such extreme times of stress is moving. If there was such a thing for this she deserves a medal of honor – a medal for a family member who excels under duress and over a long period of time, for Jackie truly deserves to be honored. The author allows us an insightful look into the thoughts and feelings that Jackie and other family members had. Jackie, at times, would feel sad for her mom as she knew her mom was getting depressed. After her mom had surgery that amputated her leg she gets mad at her mom because her mom had told the hospital orderly that it took two to lift her.
She feels that her mom should go to a nursing home. But, if she had put her mom in a nursing home she would feel sorry also. Either way she would not feel any better. If her mom had had adequate heath care she probably would not have had to even think about having her in a nursing home. It would have been incredible to know this and have to make a decision one way or another. After all, her mom needed the care of a nursing home and Jackie knew it might be better. But, it was her mom, even if she had to lift her in and out and make all the arrangements for her daily life and health care.
How many millions of times is this scenario played out across our country with the current state of health care for the poor and disadvantaged? I can only imagine the kinds of emotional struggles that Jackie as well as millions of Americans must go through in dealing with family issues related to health care – issues that could have had a better outcome or resolved completely with better health care access for all. At this point in time, it is as though Jackie and millions of others cannot win with whatever decision they come up with.
Abraham does a great job describing the family and its plight, while helping us understand the suffering that forty seven million Americans – including millions of children – without health care insurance are presently undergoing. Abraham’s book also made me reflect on my own family’s experiences with health care related issues and how the community had an effect on the same. I thought of the times at various ages I had accessed health care, from when I was a child to an adult. I had great access to immunizations starting when I was a child, something which Jackie’s children did not have.
I feel fortunate that my community was very involved with such things as immunizations. I remember going as a class in grade school to a room in the local library to get immunized for polio. There was no such thing for the Banes children. As a child, I never had any problems getting to a doctor. When I was about 7 I had a growth on my leg which kept getting bigger and bigger. The care of the doctor was great. He even came to the house to look at my leg. A house call is unheard of today. The growth got larger, so the physician decided it had to be removed. I was hospitalized and had the operation to remove the growth.
It all went smoothly, and the after care was excellent to boot. We never had any problems like the Banes’ did. Michael J. Fox’s book, Lucky Man, discusses the same issue of socioeconomic differentials in health care access. In his case, a celebrity has been able to successfully struggle against Parkinson’s disease unlike countless poor people who simply cannot. As a teen any health problems I experienced were dealt with very quickly and were covered by insurance. I remember that my sister fell down some stairs and fractured her skull. She was hospitalized for some time before being sent home.
She had to stay in bed for months but her care was great. I do not recall any major problems with treatment or cost. She eventually recovered completely. It would have been hard if my family had been in the Banes’ family position. Things might have turned out completely different. My family never had to wait months to see a doctor like Latrice, Briana and her brother did. I grew up in a community that did not have problems with health care access. As I look back, I know I took many things for granted. I never gave a second thought to the fact of socioeconomic differentials in health care access.
It was hard for Jackie to get even simple things like immunizations for her children – even during a measles epidemic. It really makes me think of how fortunate I was and still am to have something the Banes’ and millions of Americans and their families do not seem to have, that is, access to good health care, primary care and good community infrastructure. The bruises, scrapes and other illnesses in my family were generally taken care of quickly and promptly. As an adult, too, I have had pretty good coverage for myself and family. It was important to me.
Even as a college student, in the military or in civilian life, I generally had good medical care and coverage. There was one exception, however: I had a case of Lyme disease and was not satisfied with the care I obtained from my health care provider. I had to reach out to another health care provider. This was quite costly. Abraham’s book made me think about it. The book also made me realize how my family and I have by and large experienced a pretty good standard of health care. I cannot imagine where my family would be today if we had been in a situation similar to the Banes’.
My grandmother had diabetes which was controlled pretty well. She never had multiple amputations like Cora Jackson did. She got good quality care in our community. Indeed, Abraham made the story very compelling with heartrending but vivid descriptions. It made me think of the dynamics of the community and social structure on health care. It also makes one ask, ‘ How can we, as a wealthy, industrialized nation, allow such inequalities? ’ Reform is greatly needed – a reform, which not only includes health care but focuses on the entire community. Good health care is dependant on a good structure in the community.
As we look at health care reform and improving health care access we must contemplate the links of health care with education, work, the environment and the socio-cultural sector. Hence, I believe there should be a partnership between, public, private, volunteer sectors and the patients themselves (5). The author suggests such things as financial aid to inner cities, better primary care clinics for the poor, health provider training, and better health care coverage for mental health, in addition to improved public health services and coordinated management and delivery structures.
I believe we also have to address the adverse affects of income differences and health between higher and lower income inequalities. We have to stop the problematic access to health care. We should have it as a top priority. While health care access in third world countries is a major problem it should not be here in an industrialized country with great wealth and resources. The United States, as an advanced industrialized country, has one of the lowest rates of health care access in the world of the advanced countries.
Perhaps, therefore, the first thing we have to change is the governmental stance on health care. We have to step up and stop the inequity trend in health care in such communities as North Lawndale. For this, we must look at the whole infrastructure of a community. What good is health care if we do not get to the roots of the problem? We need good preventative care for the whole nation. We have to stop the inequities in health care that are creating more Mrs. Jacksons and Robert Banes’ and a system that works only when health conditions turn into chronic illnesses and the costs skyrocket.
A lot of the problems may, indeed, be prevented with good quality care that is provided to every child and adult of America, poor or rich. It is not just about money but it is also about human suffering. Much of the Banes family’s sufferings could have been prevented had they had good preventative care. When we go into an underserved community like North Lawndale, it is important to initially set up a selective primary health care system. Once we have the selective primary care system running efficiently and effectively, we should expand it into a comprehensive primary health care system that is carried out through a long term process.
The long term comprehensive primary care system may require significant changes in social, economic, and political structures and with community perceptions, with a horizontal and vertical approach (6). The system is truly broke and needs to be fixed on an urgent basis. Abraham writes that her book was not an indictment of the healthcare system but that she just wanted to show the disparities in the system. I believe it is, however, an indictment – an indictment against our nation, a wealthy industrialized nation that cannot take care of its own.
We lag behind other industrialized countries, which have better care for their poor and underprivileged. The author at the end of the book briefly provides general recommendations for health care reform. She writes that we need a new strategy to stop the endless pursuit of curing at the expense of caring. The book made me look at my life and how the health care system has impacted it as well as how it has impacted others at different socioeconomic levels, particularly the poor. Is this justice and democracy to have such glowing inequities in health care? I think not.
What more can we do to provide a better life for the less fortunate, in terms of healthcare, education and standard of living in their communities? How shall we lessen their suffering? Abraham calls for a new kind of thinking – a paradigm shift – one that puts more stress on preventative care rather than waiting until one’s health condition has turned into chronic illness. How shall we end the strain that Jackie experienced in Mama Might be better of Dead? What shall I, what can we, as a community, city, state, or nation do in order to create a better standard of living for those less fortunate.
The top of the list is a better standard of health care and primary care. Knowing thus, I can state with confidence that Abraham’s book and this course have enlightened me. The impact on health of socioeconomic disparities has, indeed, opened my eyes. It has given me an appreciation of what I have had as well as what can be done for the others on the lower end of the socioeconomic ladder. It especially makes me think of the children around us that would definitely need a better tomorrow. Children like Jackie, Lattice, Briana and DeMarest.
After all, the future of our nation depends on the health of these children. Of a certainty, we have to take on the issue of better healthcare for the poor as individuals, communities, cities, states and as a country. It is our obligation if we are to remain a great people and country. To meet this obligation, we would have to support policies that ensure good health care access for all. Despite the fact that I do not intend to either praise or demean any political leader, I believe that a health care plan like the American Health Choices Plan of Hillary Clinton should work wonders for our nation.
This Plan is expected to allow all Americans to enjoy health care benefits that are similar to the ones enjoyed by the Congress in our day. I believe all the people of my nation deserve to be treated as V. I. P’s. In our upcoming presidential election, therefore, we, as a nation, should seek leaders that promise to end the socioeconomic inequalities in our nation once and for all. By struggling for the right health care policies in our system of democracy, I would certainly play my part to help the Banes’ and millions of others like them.
