Tag: labor and employment

Only 5.7% of US doctors are Black, and experts warn the shortage harms public health | CNN

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CNN
 — 

When being truly honest with herself, Seun Adebagbo says, she can describe what drove her to go to medical school in a single word: self-preservation.

Adebagbo, who was born in Nigeria and grew up in Boston, said that as a child, she often saw tensions between certain aspects of Western medicine and beliefs within Nigerian culture. She yearned to have the expertise to bridge those worlds and help translate medical information while combating misinformation – for her loved ones and for herself.

“I wanted to go into medicine because I felt like, ‘Who better to mediate that tension than someone like me, who knows what it’s like to exist in both?’ ” said Adebagbo, 26, who graduated from Stanford University and is now a third-year medical school student in Massachusetts.

“The deeper I got into my medical education, the more I realized, if I’m in the system, I know how it works. I not only know the science, but I also know how the system works,” she said of how in many Black and brown communities, there can be limited access to care and resources within the medical system.

This has enabled Adebagbo to connect with patients of color in her rotations. She recognizes that their encounters with her are brief, she said, and so she tries to empower them to advocate for themselves in the health system.

“I know what to ask for on the patient side if I’m worried about something for myself. But then also, for my parents and my family,” Adebagbo said. “Because the way you have to move in the system as a Black person is very different, especially if you’re coming from a background where you don’t have family members that are doctors, you don’t know anyone in your periphery that went into medicine.”

Seun Adebagbo presenting her poster presentation as a first author at an international symposium and annual meeting of the American Academy of Facial Plastic and Reconstructive Surgery.

Only about 5.7% of physicians in the United States identify as Black or African American, according to the the latest data from the Association of American Medical Colleges. This statistic does not reflect the communities they serve, as an estimated 12% of the US population is Black or African American.

And while the proportion of Black physicians in the US has risen over the past 120 years, some research shows, it’s still extremely low.

One reason why the percentage of US doctors who are Black remains far below that of the US population that is Black can be traced to how Black people have been “historically excluded from medicine” and the “institutional and systemic racism in our society,” said Michael Dill, the Association of American Medical Colleges’ director of workforce studies.

“And it occurs over the course of what I think of as the trajectory to becoming a physician,” Dill said. At young ages, exposure to the sciences, science education resources, mentors and role models all make it more likely that a child could become a doctor – but such exposures and resources sometimes are disproportionately not as accessible in the Black community.

“We can improve our admissions to medical school, make them more holistic, try to remove bias from that, but that’s still not going to solve the problem,” Dill said.

“We need to look at which schools produce the most medical students and figure out how we improve the representation of Black students in those schools,” he said. “That requires going back to pre-college – high school, middle school, elementary school, kindergarten, pre-K – we need to do better in all of those places in order to elevate the overall trajectory to becoming a physician and make it more likely that we will get more Black doctors in the long run.”

Many US medical schools have a history of not admitting non-Whites. The first Black American to hold a medical degree, Dr. James McCune Smith, had to enroll at the University of Glasgow Medical School in Scotland.

Smith received his MD in 1837, returned to New York City and went on to become the first Black person to own and operate a pharmacy in the United States, and to be published in US medical journals.

A few decades later, in 1900, 1.3% of physicians were Black, compared with 11.6% of the US population, according to a study published in the Journal of General Internal Medicine in 2021.

Around that time, seven medical schools were established specifically for Black students between 1868 and 1904, according to Duke University’s Medical Center Library & Archives. But by 1923, only two of those schools remained: Howard University Medical School in Washington and Meharry Medical School in Nashville.

In 1940, only 2.8% of physicians were Black, but 9.7% of the US population was Black; by 2018, 5.4% of physicians were Black, but 12.8% of the population was Black.

“The more surprising thing to me was for Black men,” said Dr. Dan Ly, an author of the study in the Journal of General Internal Medicine and assistant professor of medicine at the University of California, Los Angeles.

Data on only Black men who were physicians over the years showed that they represented 1.3% of the physician workforce in 1900, “because all physicians were pretty much men in the past,” Ly said. Black men represented 2.7% of the physician workforce in 1940 and 2.6% in 2018.

“That’s 80 years of no improvement,” Ly said. “So the increase in the percent of physicians who were Black over the past 80 years has been the entrance of Black women in the physician workforce.”

Over more than four decades between 1978 and 2019, the proportion of medical school enrollees who identify as Black, Hispanic or members of other underrepresented groups has stayed “well below” the proportions that each group represented in the general US population, according to a 2021 report in The New England Journal of Medicine.

Diversity in some medical schools also was affected in states with bans on affirmative action programs, according to a study published last year in the Annals of Internal Medicine. That study included data on 21 public medical schools across eight states with affirmative action bans from 1985 to 2019: Arizona, California, Florida, Michigan, Nebraska, Oklahoma, Texas and Washington.

The study found that the percentage of enrolled students from underrepresented racial and ethnic groups was on average about 15% in the year before the bans were implemented but fell more than a third by five years after the bans.

Now, the United States is reckoning with medicine’s history of racism.

In 2008, the American Medical Association, the nation’s largest organization of physicians, issued an apology for its history of discriminatory policies toward Black doctors, including those that effectively restricted the association’s membership to Whites. In 2021, the US Centers for Disease Control and Prevention declared racism a “serious public health threat.”

One encouraging datapoint says that the number of Black or African American first-year medical school students increased 21% between the academic years of 2020 and 2021, according to the Association of American Medical Colleges, which Dill said shows promise for the future.

“Does the fact that it’s higher in medical school mean that eventually we will have a higher percentage of physicians who are Black? The answer is yes,” he said.

“We will see the change occur slowly over time,” he said. “So, that means the percentage of the youngest physicians that are Black will grow appreciably, but the percentage of all physicians who are Black will rise much more slowly, since new physicians are only a small percentage of the entire workforce.”

But some medical school students could leave their career track along the way. A paper published last year in JAMA Internal Medicine found that among a cohort of more than 33,000 students, those who identified as an underrepresented race or ethnicity in medicine – such as Black or Hispanic – were more likely to withdraw from or be forced out of school.

Among White students, 2.3% left medical school in the academic years of 2014-15 and 2015-16, compared with 5.2% of Hispanic students, 5.7% of Black students and 11% of American Indian, Alaska Native, Native Hawaiian and Pacific Islander students, the study found.

The researchers wrote in the study that “the findings highlight a need to retain students from marginalized groups in medical school.”

During her surgical rotation in medical school, Adebagbo said, she saw no Black surgeons at the hospital. While having more physicians and faculty of color in mentorship roles can help retain young Black medical school students like herself, she calls on non-Black doctors and faculty to create a positive, clinical learning environment, giving the same support and feedback to Black students as they may provide to non-Black students – which she argues will make a difference.

“Despite the discomfort that may arise on the giver of feedback’s side, it’s necessary for the growth and development of students. You’re hurting that student from becoming a better student on that rotation, not giving them that situational awareness that they need,” she said. “That’s what ends up happening with students of color. No one tells them, and it seems as if it’s a pattern, then by the end of the rotation, it becomes, ‘Well, you’ve made so many mistakes, so we should just dismiss you [for resident trainees] or we can’t give you honors or high pass [for medical students].’ “

Seun Adebagbo, right, with the site director (second from left) and two peers on her last day of her surgery rotation.

Adebagbo says she had one site director, a White male physician, during her surgery rotation who genuinely cared, listened and wanted to see her grow as a person and physician.

“He has been the first site director who has legit listened to me, my experiences navigating third year as a Black woman and tried to understand and put it in perspective – a privilege I’m not afforded often,” Adebagbo said. “He made making mistakes, growing and learning from them a safe and non-traumatizing experience. Not everyone may understand the depths of what I’m saying, but those who do will understand why I was so grateful for that experience.”

But not all attending physicians are like her “mentor,” as she calls him.

For Dr. David Howard, one question haunted his thoughts in medical school.

During those strenuous days at Johns Hopkins University, when all-night study sessions and grueling examinations were the norm, his mind whispered: Where do I fit?

Howard, now a 43-year-old ob/gyn in New Jersey, reflects with pride – and candor – on the day in 2009 when he completed his doctoral degrees, becoming both an MD and a PhD.

At the time, “I felt like I didn’t fit,” Howard said. “I’m sure I’m not the only person who has thought those thoughts.”

Howard was one of very few men in the obstetrics and gynecology specialty, where most providers were women – and he is Black. He saw very few peers who looked like him and extremely few faculty in leadership positions who looked like him.

“When you’re going through a really difficult training program, it makes a big difference if there are people like you in the leadership positions,” he said, adding that this contributes to the disproportionate number of Black medical school students and residents who decide to leave the profession or are “not treated equally” when they may make a mistake.

Early on in his career, Howard shifted his thinking from “Where do I fit?” to “How do I fit?”

He even authored a paper in 2017, published in the American Journal of Obstetrics and Gynecology, about this self-reflection.

“Only slightly different semantically, the second question shifts focus away from the ‘where’ that implies an existing location. Instead, ‘how’ requires me to illustrate my relationship with existing labels and systems, rather than within them, allowing a multitude of answers to my question of ‘how do I fit?’ ” Howard wrote.

“Despite the challenges and realities of the medical field today, I fit wherever and however I can, actively shaping my space and resisting the assumptions that first prompted me to ask where I fit,” he said. “To finally answer my question: I don’t fit, but I am here anyway.”

The United States has made “some progress” with diversity in both clinical medicine and research – but diversity in medicine is still not at the point where it needs to be, said Dr. Dan Barouch, a professor at Harvard Medical School and director of the Center for Virology and Vaccine Research at Beth Israel Deaconess Medical Center in Boston, who has been an advocate for diversity and inclusion.

That point, essentially, would be where diversity in the physician workforce reflects the diversity in their patient population.

“It’s particularly important to have a diverse physician workforce to aptly serve the patients,” Barouch said. “We want to increase diversity in academia as well, but it’s particularly important for doctors, because having a diverse workforce is critical for the best patient encounters, and to build trust.”

Service to patients and patient trust are both among the cornerstones critical to the status of public health, according to researchers.

One example of broken trust between physicians and Black patients happened in the 1930s, when the US Public Health Service and the Tuskegee Institute launched an unethical study in which researchers let syphilis progress in Black men without treating them for the disease. The study ended in 1972.

Among Black men, “there were declines in health utilization, increases in medical mistrust and subsequent increases in mortality for about the 10- to 15-year period following the disclosure event,” when the true nature of the study was exposed in 1972, said Dr. Marcella Alsan, an infectious disease physician and professor of public policy at Harvard Kennedy School.

Yet research suggests that when Black physicians are treating Black patients, that trust can be rebuilt.

For instance, the impact is so significant that having Black physicians care for Black patients could shrink the difference in cardiovascular deaths among White versus Black patients by 19%, according to a paper written by Alsan while she was attending Stanford University, along with colleagues Dr. Owen Garrick and Grant Graziani. It was published in 2019 in the American Economic Review.

That research was conducted in the fall and winter of 2017 and 2018 in Oakland, California, where 637 Black men were randomly assigned to visit either a Black or a non-Black male doctor. The visits included discussions and evaluations of blood pressure, body mass index, cholesterol levels and diabetes, as well as flu vaccinations.

The researchers found that, when the patients and doctors had the opportunity to meet in person, the patients assigned to a Black doctor were more likely to demand preventive health care services, especially services that were invasive, such as flu shots or diabetes screenings that involve drawing blood.

“We saw a dramatic increase in their likelihood of getting preventive care when they engage with Black physicians,” said Garrick, who now serves as chief medical officer of CVS Health’s clinical trial services, working to raise awareness of how more diverse groups of patients are needed to participate in clinical research.

Initially, “it didn’t look like there was a strong preference for Black doctors versus non-Black doctors. It was only when people actually had a chance to communicate with their physicians, talk about ‘Why should I be getting these preventative care services?’ ” Alsan said.

The researchers analyzed their findings to estimate that if Black men were more likely to undergo preventive health measures when they see a Black doctor, having more Black doctors could significantly improve the health and life expectancy of Black Americans.

The nation’s shortage of Black physicians is concerning, experts warn, as it contributes to some of the disproportionate effects that infectious diseases, chronic diseases and other medical ailments have on communities of color. This in itself poses public health risks.

For example, in the United States, Black newborns die at three times the rate of White newborns, but a study published in 2020 in the Proceedings of the National Academy of Sciences found that Black infants are more likely to survive if they are being treated by a Black physician.

Black men and Black women are also about six to 14.5 times as likely to die of HIV than White men and White women, partly due to having less access to effective antiretroviral therapies. But Black people with HIV got such therapies significantly later when they saw White providers, compared with Black patients who saw Black providers and White patients who saw White providers in a study published in 2004 in the Journal of General Internal Medicine.

And when Black patients receive care from Black doctors, those visits tend to be longer and have higher ratings of patients feeling satisfied, according to a separate study of more than 200 adults seeing 31 physicians, published in 2003 in the journal Annals of Internal Medicine.

“There’s plenty of evidence, and other research has shown that the more the workforce in a health care setting really reflects the community it serves, the more open the patient population is to recommendations and instructions from their doctor,” said Dr. Mahshid Abir, an emergency physician and a senior physician policy researcher at the RAND Corp., a nonpartisan research institution.

But it can be rare to find health systems in which the diversity of the workforce reflects the diversity of the patients.

During her 15-year career as an emergency physician, Abir said, she has worked in many emergency departments across the United States – in the Northeast, South and Midwest – and in each place, the diversity of the health care workforce did not mirror the patient populations.

This lack of diversity in medicine is “not talked about enough,” Abir said.

“The research that’s been conducted has shown that it makes a difference in how well patients do, how healthy they are, how long they live,” she said. “Especially at this juncture in history in the United States, where social justice is in the forefront, this is one of the most actionable places where we can make a difference.”

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FDA proposes new levels for lead in baby food, but critics say more action is needed | CNN

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CNN
 — 

The allowable levels of lead in certain baby and toddler foods should be set at 20 parts per billion or less, according to new draft guidance issued Tuesday by the US Food and Drug Administration.

“For babies and young children who eat the foods covered in today’s draft guidance, the FDA estimates that these action levels could result in as much as a 24-27% reduction in exposure to lead from these foods,” said FDA Commissioner Dr. Robert Califf in a statement.

The

Baby foods covered by the new proposal – which is seeking public comment – include processed baby foods sold in boxes, jars, pouches and tubs for babies and young children younger than 2 years old, the agency said.

While any action on the part of the FDA is welcome, the suggested levels of lead are not low enough to move the needle, said Jane Houlihan, the national director of science and health for Healthy Babies Bright Futures, a coalition of advocates committed to reducing babies’ exposures to neurotoxic chemicals.

“Nearly all baby foods on the market already comply with what they have proposed,” said Houlihan, who authored a 2019 report that found dangerous levels of lead and other heavy metals in 95% of manufactured baby food.

That report triggered a 2021 congressional investigation, which found leading baby food manufacturers knowingly sold products with high levels of toxic metals.

“The FDA hasn’t done enough with these proposed lead limits to protect babies and young children from lead’s harmful effects. There is no known safe level of lead exposure, and children are particularly vulnerable,” Houlihan said.

The director of food policy for Consumers Reports, Brian Ronholm, also expressed concerns. In 2018, Consumer Reports analyzed 50 baby foods and found “concerning” levels of lead and other heavy metals. In fact, “15 of them would pose a risk to a child who ate one serving or less per day,” according to Consumer Reports.

“The FDA should be encouraging industry to work harder to reduce hazardous lead and other heavy metals in baby food given how vulnerable young children are to toxic exposure,” Ronholm said in a statement.

Exposure to toxic heavy metals can be harmful to the developing brain of infants and children. “It’s been linked with problems with learning, cognition, and behavior,” according to the American Academy of Pediatrics.

Lead, arsenic, cadmium and mercury are in the World Health Organization’s top 10 chemicals of concern for infants and children.

As natural elements, they are in the soil in which crops are grown and thus can’t be avoided. Some crop fields and regions, however, contain more toxic levels than others, partly due to the overuse of metal-containing pesticides and ongoing industrial pollution.

The new FDA guidance suggests manufactured baby food custards, fruits, food mixtures — including grain and meat-based blends — puddings, vegetables, yogurts, and single-ingredient meats and vegetables contain no more than 10 parts per billion of lead.

The exception to that limit is for single-ingredient root vegetables, such as carrots and sweet potatoes, which should contain no more than 20 parts per billion, according to the new guidance.

Dry cereals marketed to babies and toddlers should also not contain more than 20 parts per billion of lead, the new FDA guidance said.

However, the FDA didn’t propose any lead limit for cereal puffs and teething biscuits, Houlihan said, even though the products account for “7 of the 10 highest lead levels we’ve found in over 1,000 baby food tests we have assessed.”

The limit set for root vegetables will be helpful, Houlihan added. Because they grow underground, root vegetables can easily absorb heavy metals. For example, sweet potatoes often exceed the 20 parts per billion limit the FDA has proposed, she said.

Prior to this announcement, the FDA had only set limits for heavy metals in one baby food — infant rice cereal, Houlihan said. In 2021, the agency set a limit of 100 parts per billion for arsenic, which has been linked to adverse pregnancy outcomes and neurodevelopmental toxicity.

There is much more that can be done, according to Scott Faber, senior vice president of government affairs for the Environmental Working Group, a nonprofit environmental health organization.

“We can change where we farm and how we farm to reduce toxic metals absorbed by plants,” Faber said. “We also urge baby food manufacturers to conduct continuous testing of heavy metals in all their products and make all testing results publicly available.”

Companies can require suppliers and growers to test the soil and the foods they produce, and choose to purchase from those with the lowest levels of heavy metals, Houlihan added.

“Growers can use soil additives, different growing methods and crop varieties known to reduce lead in their products,” she said.

What can parents do to lessen their child’s exposure to toxic metals? Unfortunately, buying organic or making baby food at home isn’t going to solve the problem, as the produce purchased at the grocery store can also contain high levels of contaminants, experts say.

A 2022 report by Healthy Babies, Bright Futures found lead in 80% of homemade purees or store-bought family foods. Arsenic was found in 72% of family food either purchased or prepared at home.

The best way to lessen your child’s exposure to heavy metals, experts say, is to vary the foods eaten on a daily basis and choose mostly from foods which are likely to have the least contamination. Healthy Babies, Bright Futures created a chart of less to most contaminated foods based on their testing.

Fresh bananas, with heavy metal levels of 1.8 parts per billion, were the least contaminated of foods tested for the report. After bananas, the least contaminated foods were grits, manufactured baby food meats, butternut squash, lamb, apples, pork, eggs, oranges and watermelon, in that order.

Other foods with lower levels of contamination included green beans, peas, cucumbers and soft or pureed home-cooked meats, the report found.

The most heavily contaminated foods eaten by babies were all rice-based, the report said. Rice cakes, rice puffs, crisped rice cereals and brown rice with no cooking water removed were heavily contaminated with inorganic arsenic, the more toxic form of arsenic.

After rice-based foods, the analysis found the highest levels of heavy metals in raisins, non-rice teething crackers, granola bars with raisins and oat-ring cereals. But those were not the only foods of concern: Dried fruit, grape juice, arrowroot teething crackers and sunflower seed butter all contained high amounts of at least one toxic metal, according to the report.

While buying organic cannot reduce the levels of heavy metals in infant food, it can help avoid other toxins such as herbicides and pesticides, Dr. Leonardo Trasande, director of environmental pediatrics at NYU Langone Health told CNN previously.

“There are other benefits to eating organic food, including a reduction in synthetic pesticides that are known to be as bad for babies, if not even more problematic,” Trasande said.

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ER on the field: An inside look at how NFL medical teams prepare for a game day emergency | CNN

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CNN
 — 

When Buffalo Bills safety Damar Hamlin dropped to the ground from a cardiac arrest earlier this month, help was by his side in under 10 seconds to administer CPR.

It wasn’t coincidence or luck. Rather, it’s the result of careful planning and practice – the execution of detailed choreography performed by the medical personnel present at every National Football League game.

Saving Hamlin’s life was the ultimate test.

“What we want is that the players are getting the same care here that they would if they were in a hospital or health care facility and that’s what the system has been set up to do,” NFL Chief Medical Officer Dr. Allen Sills told CNN Chief Medical Correspondent Dr. Sanjay Gupta on Saturday.

About 30 medical personnel are at every game, including orthopedic and trauma specialists, athletic trainers, paramedics and dentists. Sills gave CNN a rare behind-the-scenes look at the league’s medical personnel during Saturday’s playoff game between the Jacksonville Jaguars and the Los Angeles Chargers. The goal, Sills said, is to deliver hospital-quality care on the gridiron.

When Hamlin collapsed on January 2, speed was of the essence. Studies find that for every minute someone who experiences cardiac arrest and doesn’t receive CPR, their chances of survival decrease 7 to 10%.

Hamlin’s heart was restarted on the field. The 24-year-old spent more than a week in the hospital in Cincinnati, then transferred to a hospital in Buffalo before he was released home last week.

Sills said that being on the field was likely a factor for Hamlin: Survival is more likely for someone who experiences cardiac arrest in the hospital. One study found that 10 to 12% those who have cardiac arrest outside of the hospital survive to discharge, but that survival rate more than doubled for those who experienced cardiac arrest in the hospital.

“I think he was being resuscitated as he would have been in an emergency room at that moment,” Sills said.

Hear audio of medical personnel treating Damar Hamlin after he collapsed

The NFL requires all teams to have an emergency action plan, or EAP, for all player facilities, including practice fields.

The plans are filed by the teams every year and are approved by the League as well as the NFL Players Association, the players’ union, Sills said. They run drills on the plan, so when an event like Hamlin’s cardiac arrest occurs, the medical team’s choreography is close to automatic.

“The EAP was followed to a letter that night,” Sills said. “In that moment everyone knew what they needed to do, how they needed to do it and had the equipment to do it and felt comfortable.”

These plans include details about where ambulances are located, the quickest route to the hospital, where medical equipment is stored, and even what radio and hand signals will be used in case of a medical event.

While the teams are all connected by radio, the sound from the game and the crowd can be overwhelming.

“It gets loud and so having those nonverbal signs is a way for us to communicate,” explained Dr. Kevin Kaplan, Jacksonville Jaguars’ head physician. For example, using two hands as if driving a steering wheel indicates needing the medical cart, while crossing arms to make an “X” is an all-call for medical personnel.

The home team sends the plan to the visiting team a week before the game. Then, an hour before kickoff, medical teams from both teams gather to review and confirm the details in what’s known as a “60-minute meeting.”

Medical teams from the Los Angeles Chargers and Jacksonville Jaguars gathered for the 60-minute meeting ahead of kickoff on Saturday.

It’s like the NFL’s version of what happens in a hospital: Before doctors perform a procedure, the medical team gathers for a “timeout” to review who is responsible for what.

Before the football game, they identify the team physicians, athletic trainers and key trauma personnel, including an airway specialist who can place a breathing tube in moments, if needed.

In the excitement of game day, there needs to be a simple, clear way to identify who can help in case of an emergency. At any NFL game, you’ll see it: a red hat.

Dr. Justin Deaton, NFL airway management physician, wears a red hat on the sideline of the Jacksonville Jaguars-Los Angeles Chargers game on Saturday.

“That signifies me as the emergency physician, the airway physician, so that even the other team knows when I come out what my role is,” Dr. Justin Deaton told Gupta. “Once I come out onto the field, I kind of take over, I identify if the patient is either unconscious or has an airway obstruction.”

At every game, Deaton stands along the 30 yard line, just like his counterparts at other games.

“We standardize the location so that everybody knows where our airway physician is going to be located,” said Sills.

If the player isn’t breathing, it’s up to Deaton to identify who will administer CPR. If the player’s breathing is blocked and he can’t breathe on his own, Deaton may have to intubate the player on the field. In order to do so, he carries a videoscope to look down someone’s throat and an ultrasound machine.

In the event Deaton can’t get the patient to breathe through their mouth, he’s prepared to essentially do surgery on the field.

“If someone has an obstruction or significant trauma to the face and we can’t secure an airway by the mouth, we’re able to make an incision and insert that way,” he told Gupta. “I really have all the resources available here that I would have in an emergency room.”

The challenge is that they’re surrounded by chaos – not the more controlled environment of the emergency department or operation room.

“When you have a larger-than-average-sized person that’s laying flat on the ground and not able to be elevated to a certain level with extra equipment, plus cameras and other people around, those are really the confounders and things that make it more difficult to manage,” Deaton said.

In football, it’s not just about executing in the moment – it’s about anticipating. The same is true for medical personnel.

The NFL includes certified athletic trainers on its medical team to serve as spotters. They’re positioned throughout the stadium, including a booth that oversees the entire stadium, to watch the game in real time and again in replay – sometimes over and over – to immediately catch any injuries or assess those that might have been overlooked. They have around 30 different angles of the field at their fingertips.

“We watch every play probably minimally four times and then we’ll go back and watch it again,” said Sue Stanley-Green, one of the athletic trainer spotters assigned to Saturday’s game. “We just want to make sure we don’t miss anything.”

Spotters around the field at every game have different views of plays -- and potential injuries.

The spotters who sit in a stadium booth above the field are able to communicate directly with the medical team on the sidelines and direct them to concerning plays and possible injuries. They also have a unique line of communication to the referees, and the ability to stop the game for a medical timeout.

Sills acknowledges that there is always room for improvement and need to evolve.

In September, Miami Dolphins quarterback Tua Tagovailoa experienced an apparent head injury while playing against the Bills. He stumbled after being hit, but was allowed to return to the game. The incident put new scrutiny of the NFL and its policies.

Afterward, the league changed its concussion policy. Now, Sills says, “if we see something that looks like ataxia on video, (players) are done.”

Sills said he believes the NFL’s network of practices is working to keep players safe, and the league is currently reviewing the moments around Hamlin’s cardiac arrest. One aspect of emergencies that Sills wants to see more work on is privacy.

In the moments after Hamlin fell, his teammates formed “kind of a shield,” Sills said, which limited the view of Hamlin.

“I think there’s some things there that we may look at,” Sill said. “Obviously any of us would want some privacy in a moment like that.”

But when facing a test like saving a life on the field, “everything went really as well as you could have asked to have gone in the moment,” Sills said. “It’s always about the right people, the right plan and the right equipment.”

Bob Costas Damar Hamlin split for video

Bob Costas: Hamlin collapsing is not an indictment of NFL safety

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Lovie Smith said the NFL had ‘a problem’ about Black coaches. A year later he was fired and the league is being criticized yet again about its lack of diversity | CNN

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CNN
 — 

When Lovie Smith was hired by the Houston Texans in February 2022 as the team’s new head coach, he said the NFL had “a problem” with hiring Black coaches and diversity.

“I realize the amount of Black head coaches there are in the National Football League,” Smith told reporters just under a year ago.

“There’s Mike Tomlin and I think there’s me, I don’t know of many more. So there’s a problem, and it’s obvious for us. And after there’s a problem, what are you going to do about it?”

Smith was fired Monday at the end of his one and only season at the helm of the Texans, finishing with a record of 3-13-1.

Smith is the second Black coach in two years to be relieved of his duties by the Texans, which fired David Culley at the end of the 2021 season.

Smith’s time in charge wasn’t full of wins and high points – though his parting gift to the organization was a last-minute Hail Mary victory over the Indianapolis Colts, which saw them relinquish the No. 1 pick in the 2023 NFL draft to the Chicago Bears. But his Texans team showed togetherness and competence, traits often desired by outfits undergoing a rebuild.

Houston general manager Nick Caserio said Smith’s firing was the best decision for the team right now.

“On behalf of the entire organization, I would like to thank Lovie Smith for everything he has contributed to our team over the last two seasons as a coach and a leader,” Caserio said in a statement.

“I’m constantly evaluating our football operation and believe this is the best decision for us at this time. It is my responsibility to build a comprehensive and competitive program that can sustain success over a long period of time. We aren’t there right now, however, with the support of the McNair family and the resources available to us, I’m confident in the direction of our football program moving forward.”

But the firing of the 64-year-old coach, the Texans organization as a whole, and the measures implemented by the league to promote diversity have been heavily criticized by former players and TV pundits.

“The Houston Texans have fired Lovie Smith after 1 year. Using 2 Black Head Coaches to tank and then firing them after 1 year shouldn’t sit right with anyone,” former NFL quarterback Robert Griffin III tweeted Sunday, when news of Smith’s firing broke.

On ESPN, Stephen A. Smith and NFL Hall of Famer Michael Irvin also condemned the decision. Smith called the Texans organization an “atrocity.”

“They are an embarrassment. And as far as I’m concerned, if you’re an African American, and you aspire to be a head coach in the National Football League, there are 31 teams you should hope for. You should hope beyond God that the Houston Texans never call you,” Smith said.

Irvin said Black coaches are being used as “scapegoats” by the Texans.

“It’s a mess in Houston and they bring these guys in and they use them as scapegoats. And this is what African American coaches have been yelling about for a while and it’s blatant, right in our face,” he said.

When CNN contacted the Texans for comment, the team highlighted the moment at Monday’s news conference when Caserio was asked why any Black coach would consider working for the team, and his response was that individual candidates would have to make their own choices.

Smith on the sidelines during a game against the Indianapolis Colts.

“In the end it’s not about race. It’s about finding quality coaches,” the general manager said. “There’s a lot of quality coaches. David (Culley) is a quality coach. Lovie (Smith) is a quality coach.

“In the end, each coach has their own beliefs. Each coach has their own philosophy. Each coach has their comfort level about what we’re doing. That’s all I can do is just be honest and forthright, which I’ve done from the day that I took this job, and I’m going to continue to do that and try to find a coach that we feel makes the most sense for this organization. That’s the simplest way I can answer it, and that’s my commitment.

“That’s what I’m hired to do, and that’s what I’m in the position to do. At some point, if somebody feels that that’s not the right decision for this organization, then I have to respect that, and I have to accept it.”

CNN has reached out to Lovie Smith for comment.

At the beginning of the 2022 season, NFL.com reported Smith was one one of just six minority head coaches in the NFL, a low number in a league where nearly 70% of the players are Black.

Since Art Shell was hired by the Los Angeles Raiders in 1989 as the first Black head coach in modern history, there have been 191 people hired as head coaches, but just 24 have been Black.

However, the NFL has taken steps to increase diversity in the coaching ranks.

Notably, in 2003, the NFL introduced the Rooney Rule to improve hiring practices in a bid to “increase the number of minorities hired in head coach, general manager, and executive positions.”

But the Rooney Rule hasn’t been an unqualified success.

In 2003, the Detroit Lions were fined $200,000 for not interviewing any minority coaches before hiring Steve Mariucci as their new head coach.

In response to criticism, the NFL announced it was setting up a diversity advisory committee of outside experts to review its hiring practices last March. Teams would also be required to hire minority coaches as offensive assistants.

Despite changes to the rule being implemented in recent years to strengthen it, a 2022 lawsuit alleges that some teams have implemented “sham” interviews to fulfill the league’s diversity requirements.

Last February, former Miami Dolphins head coach Brian Flores filed a federal civil lawsuit against the NFL, the New York Giants, the Denver Broncos and the Miami Dolphins organizations alleging racial discrimination.

Flores looks on during his time as the head coach of the Miami Dolphins during a game against the New York Jets.

Flores, who is Black, said in his lawsuit that the Giants interviewed him for their vacant head coaching job under disingenuous circumstances.

Two months after submitting the initial lawsuit, Flores added the Texans to it, alleging the organization declined to hire him this offseason as head coach “due to his decision to file this action and speak publicly about systemic discrimination in the NFL.”

In response to the lawsuit, the Texans said their “search for our head coach was very thorough and inclusive.”

The NFL called Flores’ allegations meritless.

“The NFL and our clubs are deeply committed to ensuring equitable employment practices and continue to make progress in providing equitable opportunities throughout our organizations,” the league said in response to the lawsuit.

“Diversity is core to everything we do, and there are few issues on which our clubs and our internal leadership team spend more time. We will defend against these claims, which are without merit.”

But 12 months after firing their last Black head coach, the Texans have fired another one.

“How do you hire two African Americans, leave them one year and then get rid them?” questioned NFL Hall of Famer Irvin.

“You know the mess that Houston is,” Irvin added. “We get the worst jobs and we don’t get the opportunity to fix the worst jobs, just like this.

“I don’t know any great White coach that would take the (Texans) job unless you give them some guarantees. ‘You’re going to have to guarantee me four years to turn this place around.’ But the African American coaches can’t come in with that power because Lovie wouldn’t have got another job.

“This was his last chance to get back into the NFL and you have to take what’s on the table to try to change that.”

Irvin speaks on media row ahead of Super Bowl LVI on February 10, 2022 in Los Angeles.

The Texans are now searching for a new head coach under general manager Caserio. The new appointment will be Caserio’s third coach in the role: It is almost unprecedented for a general manager to get the opportunity to hire a third head coach with the same team.

Texans chairman and CEO Cal McNair said he would take on a more active role in the hiring process. The next head coach will be the organization’s fourth in three years.

According to the NFL, the Texans have requested to speak to five candidates already about filling Smith’s position, a list that includes two Black coaches.

After Smith was hired in March 2021, McNair said: “I’ve never seen a more thorough, inclusive, and in-depth process than what Nick (Caserio) just went through with our coaching search.”

At that introductory news conference, Smith spoke candidly about how to bring greater diversity to the NFL coaching ranks.

“People in positions of authority throughout – head coaches, general managers – you’ve got to be deliberate about trying to get more Black athletes in some of the quality control positions just throughout your program. If you get that, they can move up, that’s one way to get more.”

Smith continued: “It’s not just an interview, if you’re interviewing a Black guy. It’s about having a whole lot of guys to choose from that look like me. And it’s just not about talk. You look at my staff, that’s what I believe in. And letting those guys show you who they are. That’s how we can increase it, then it’s left up to people to choose. We all have an opportunity to choose, and that’s how I think we’ll get it done.”



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The year in sport: A fond farewell for some, a glimpse of the future for others | CNN

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CNN
 — 

An athlete, former jockey AP McCoy said earlier this year, is the only person who dies twice, such is the pain of walking away from the intoxicating, all-consuming nature of professional sport.

McCoy retired from his long, decorated racing career in 2015, and since then has had to learn, in his own words, how to “start again and have another life.”

Based on the past 12 months, there are some notable sports stars who might have been listening extra closely to McCoy’s experience of retirement – or indeed to anyone else who has spoken candidly about the difficulty of ending a successful sporting career.

Among them is Roger Federer, who called time on his trophy-laden tennis career at the Laver Cup in September after years spent trying to recover from two knee surgeries.

In the letter announcing his retirement, Federer, like McCoy, alluded to the heightened emotions of being a professional athlete and how they make saying goodbye so hard.

“I have laughed and cried, felt joy and pain, and most of all I have felt incredibly alive,” Federer wrote. “To the game of tennis,” he signed off the letter, “I love you and will never leave you.”

Those final words were reassuring for fans who have admired Federer’s career for so many years, but also spoke to another issue: namely, of how hard it can be to walk away entirely from professional sport after retirement.

It remains to be seen exactly how Federer will remain involved in tennis moving forward, and the same can be said of Serena Williams, who announced she would “evolve away from tennis” ahead of this year’s US Open – but refused to say she was retiring.

On several occasions over the past three months, the 23-time grand slam champion has even teased fans about a potential return to tennis.

At the 2022 US Open, Serena Williams lost to Australian Ajla Tomlijanovic in the third round.

While Federer and Williams have stepped away from their careers as two of the greatest athletes of all time, other sports stars can’t seem to decide when, or how, to walk away.

Heavyweight boxing champion Tyson Fury has yo-yoed in and out of retirement this year, saying in October that he’s finding it “really hard to let this thing go.”

And earlier this year, Tom Brady announced he would be retiring from the NFL, leaving the sport as a seven-time Super Bowl champion and arguably the greatest quarterback of all time. the 45-year-old then reversed that decision and is still breaking records with the Tampa Bay Buccaneers during his 23rd season in the NFL.

However in September, Brady and Gisele Bündchen announced they were to divorce after 13 years of marriage.

“I think there is a lot of professionals in life that go through things that they deal with at work and they deal with at home,” the Bucs quarterback said on his weekly podcast a few days the couple’s divorce announcement.

“Obviously, the good news is it’s a very amicable situation, and I’m really focused on two things: taking care of my family, and certainly my children, and secondly doing the best job I can to win football games. That’s what professionals do.”

Tom Brady flip-flopped on retiring.

Brady has redefined what most believed to be the average shelf-life of an athlete, and he’s not the only person refusing to let the light dim on his career.

LeBron James is about to turn 38 but is still setting records in the NBA – in February passing Kareem Abdul-Jabbar for the most combined regular season and postseason points in NBA history.

Federer’s rivals Rafael Nadal, 36, and Novak Djokovic, 35, meanwhile, have added to their grand slam tallies this year – the Mallorcan at the Australian Open and French Open, where he became the oldest men’s singles champion, and the Serbian at Wimbledon. Djokovic’s Wimbledon triumph moved him to within one grand slam title of Nadal’s men’s record of 22.

Having been deported from Australia over his vaccination status at the start of the year, Djokovic is set to compete at the Australian Open at the start of 2023 – a tournament he has won on nine previous occasions and is favorite to win again next year off the back of his recent ATP Finals victory.

For Nadal, his future in the sport rests on the amount of strain his injury-ravaged body can continue to withstand.

In golf, Tiger Woods faces similar questions. The 15-time major champion completed a stunning return from serious leg injuries suffered in a car crash at this year’s Masters, scoring a remarkable one-under 71 at Augusta National before making the cut the following day.

Then there’s sprinter Shelly-Ann Fraser-Pryce, who turns 36 later this month but has shown no signs of slowing down. The Jamaican produced a string of consistently fast performances this year, running under 10.7 seconds for the 100 meters a record seven times and claiming her fifth world championship title over the distance in July.

Shelly-Ann Fraser-Pryce celebrates winning the women's 100m final at the World Athletics Championships in Eugene, Oregon, in July.

And it’s not just athletes who have defied the call of retirement this year. In November, 73-year-old Dusty Baker became the oldest ever manager to win the World Series when he guided the Houston Astros to a 4-2 victory against the Philadelphia Phillies.

Many of the athletes who stole the headlines in 2022 have been doing so for years.

No one is sure where an aging Cristiano Ronaldo will play his club football in January after ending his second spell at Manchester United in ignominious fashion, but the 37-year-old still appears to be set on extending his playing career after Portugal’s quarterfinal exit from the World Cup.

His rival Lionel Messi, meanwhile, ended the year on a sensational high, guiding Argentina to a third World Cup trophy. The 35-year-old Messi scored twice in an absorbing final against France and finally got his hands on the World Cup at the fifth time of asking, further staking his claim as the game’s greatest ever player.

That hasn’t been the only recent instance of an established superstar winning silverware. In last season’s NBA Finals, Steph Curry guided the Golden State Warriors to a fourth championship title in eight seasons – in the process picking up his first Finals MVP award as the Warriors beat the Boston Celtics.

In baseball, meanwhile, Aaron Judge enjoyed a season for the ages. The 30-year-old outfielder, who has reportedly just signed a nine-year, $360 million deal with the New York Yankees, hit 62 home runs last season, breaking Roger Maris’ single-season American League (AL) home run record from 1961.

On Wednesday, the Yankees named Judge, the reigning AL MVP, as the 16th captain in the franchise’s history.

Judge (left) hit a record-breaking 62 home runs last season.

But even as familiar faces have continued to shine, the past year has also seen future stars emerge.

The 19-year-old Carlos Alcaraz ends the year as the youngest No. 1 in the history of the men’s tennis having triumphed at the US Open, and in the women’s game, Iga Swiatek, who rose to No. 1 in the world following Ashleigh Barty’s decision to retire after winning the Australian Open, looks set to dominate for years to come.

This year, the 21-year-old Swiatek won her second grand slam title at the French Open – which came in the middle of a 37-match winning streak – and her third at the US Open.

In Formula One, Max Verstappen has cemented his position as the best driver in the sport, comfortably defending his world title with four races to spare, while Erling Haaland, regarded as one of the best strikers in European football, has been scoring goals at a record-breaking rate during his first season at Manchester City.

There was no stopping Max Verstappen this year.

At the Winter Olympics in Beijing, then-18-year-old freestyle skier Eileen Gu stole the headlines, winning two gold medals and a silver for the host nation; she also became the first freestyle skier to earn three medals at a single Olympics.

Another teenager, figure skater Kamila Valieva, had a memorable Games for different reasons. The 16-year-old tested positive for trimetazidine, a heart medication, in December 2021, but the result didn’t come to light until Valieva was already in Beijing and had won gold in the figure skating team event.

In that competition, she became the first woman to land a quadruple jump – which involves four spins in the air – at the Winter Olympics.

The outcome from the positive test remains unresolved, and in November, the World Anti-Doping Agency referred Valieva’s case to the Court of Arbitration for Sport after deeming the Russian Anti-Doping Agency had made no progress.

Eileen Gu performs a trick during the women's freestyle freeski halfpipe final at the Beijing Winter Olympics in February.

Russia’s invasion of Ukraine has cast a shadow over much of this year’s sporting calendar.

Athletes and teams from Russia and Belarus were banned from competitions across various sports, including qualification games for this year’s World Cup and participation at Wimbledon.

The decision from Wimbledon was perhaps the strongest stance taken by a sports organization, resulting in the ATP and WTA Tours removing ranking points from this year’s tournament.

At the start of the war, many Ukrainian athletes – like skeleton racer Vladyslav Heraskevych and MMA fighter Yaroslav Amosov – opted to put their careers on hold and support the country’s military efforts.

Boxer Oleksandr Usyk has also spoken passionately about serving his country, and in the ring has extended his undefeated record, beating Anthony Joshua in August to retain his WBA (Super), IBF, WBO, and IBO heavyweight titles.

Oleksandr Usyk lands a punch on Anthony Joshua during their

Throughout 2022, sport and geopolitics have been closely entwined. This month, WNBA star Brittney Griner returned home to the US having been detained in Russia for nearly 10 months on drug smuggling charges.

Despite her testimony that she had inadvertently packed the cannabis oil that was found in her luggage, Griner was sentenced to nine years in prison in early August and was moved to a penal colony in the Mordovia republic in mid-November after losing her appeal.

The 32-year-old’s arrest in Russia sparked diplomatic drama between the US and the Kremlin which played out alongside Russia’s war in Ukraine.

She was released in a prisoner swap that involved Russian arms dealer Viktor Bout. The exchange, however, did not include another American that the State Department has declared wrongfully detained, Paul Whelan.

Brittney Griner is seen getting off a plane in an undated photo posted to her Instagram.

Perhaps no sport has been as gripped by internal politics this year as much as golf, which was rocked by the launch of the Saudi-backed LIV Golf series in June.

LIV Golf has been criticized by some of the game’s leading players – including Woods and Rory McIlroy – while others – major champions Phil Mickelson and Dustin Johnson – have abandoned the PGA Tour in favor of the lucrative, breakaway series.

It has left the sport divided. Earlier this year, LIV Golf joined an antitrust lawsuit alongside some of its players, alleging that the PGA Tour threatened to place lifetime bans on players who participate in the LIV Golf series.

The suit also alleges that the PGA Tour has threatened sponsors, vendors, and agents to coerce players into abandoning opportunities to play in LIV Golf events.

The PGA Tour filed a countersuit in late September, claiming “tortious interference with the Tour’s contracts with its members.”

The LIV Golf series is backed by Saudi Arabia’s Public Investment Fund (PIF) – a sovereign wealth fund chaired by Mohammed bin Salman, the crown prince of Saudi Arabia and the man who a US intelligence report named as responsible for approving the operation that led to the 2018 murder of journalist Jamal Khashoggi. Bin Salman has denied involvement in Khashoggi’s murder.

LIV Golf’s launch is part of Saudi Arabia’s wider ambition to host and invest in global sports events. This year, it staged the rematch between Usyk and Joshua and even won a bid to host the 2029 Asian Winter Games.

But unquestionably, the most prominent sporting event held in the Gulf region this year has been the World Cup in Qatar.

The four-week-long tournament came to a thrilling conclusion on Sunday as Argentina lifted the trophy, bringing down the curtain on what FIFA president Gianni Infantino argued was the greatest World Cup of all time.

There were upsets, high-scoring games, and brilliant goals throughout – right up to Sunday’s showpiece when Messi reigned supreme and Kylian Mbappé scored a stunning hat-trick in a losing cause.

The match between Argentina and France at Qatar 2022 is being viewed as the greatest ever World Cup final.

It was the first time a country in the Middle East had hosted the World Cup, and Qatar, which has a population of just three million people, invested billions of dollars in building seven new stadiums, as well as new hotels and expansions to the country’s airport, rail networks and highways.

The tournament was also fraught with controversy, particularly when it came to allegations surrounding the country’s poor human rights record and treatment of migrant workers.

Since 2010, many migrant workers in Qatar have faced delayed or unpaid wages, forced labor, long hours in hot weather, employer intimidation, and an inability to leave their jobs because of the country’s sponsorship system, human rights organizations have found.

In the face of such criticism, Qatar has maintained it is an open, tolerant country and has seen the World Cup as a vehicle to accelerate labor reforms.

Elsewhere in international football, England won the Women’s European Championships for the first time in front of a record crowd on home soil, while Senegal claimed the Africa Cup of Nations (AFCON) title in February, also for the first time.

Outside international competitions, Real Madrid won its 14th European crown by defeating Liverpool in the Champions League final – a game that was marred by security issues.

Real Madrid defeated Liverpool in this year's Champions League final in Paris.

The match itself was delayed by more than 35 minutes after Liverpool fans struggled to enter the Stade de France and tear gas was used by French police towards supporters held in tightly packed areas.

Paris police chief Didier Lallement admitted in June that the chaos was “obviously a failure” and said he takes “full responsibility for police management” of the event.

Tragically, football has witnessed multiple serious stadium disasters this year. In October, more than 130 people were killed in a stampede in the Indonesian city of Malang – one of the world’s deadliest stadium disasters of all time.

Indonesia’s President Joko Widodo later said the country would demolish and rebuild the stadium, vowing to “thoroughly transform” the sport in the football-mad nation.

Players and officials from Arema Football Club gather to pray on the pitch for victims of the stampede at Kanjuruhan stadium in Malang.

A stadium crush in the Cameroonian capital of Yaoundé during this year’s AFCON also saw at least eight people killed and 38 injured during the game between Cameroon and Comoros.

Looking ahead to 2023, Australia and New Zealand is scheduled to host the Women’s World Cup in July and August.

The US Women’s National Team (USWNT) could become the first team to win the tournament three times in a row.

This year, the United States Soccer Federation (USSF), the USWNT’s Players Association (USWNTPA) and the United States National Soccer Team Players Association (USNSTPA) forged a landmark equal pay deal – the first federation in the world to equalize prize money awarded to the teams for participating in World Cups.

Next year will be the first time the USWNT has played a major tournament under such a deal.

Among the other major sporting events being held next year are the World Athletics Championshps in Budapest, Hungary, and the Rugby World Cup in France.

In the NFL, Super Bowl LVII in Glendale, Arizona is only weeks away, while the NBA Playoffs begin two months later in April.

With the men’s World Cup over, club football resumes in Europe and tennis’ first grand slam of the year, the Australian Open, begins on January 16.

For sports fans, that will hopefully serve as tonic to stave off the January blues.



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‘Living in despair and hopelessness’: A lack of affordable housing can put people’s health at risk | CNN

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KHN
 — 

When Louana Joseph’s son had a seizure because of an upper respiratory infection in July, she abandoned the apartment her family had called home for nearly three years.

She suspected the gray and brown splotches spreading through the apartment were mold and had caused her son’s illness. Mold can trigger and exacerbate lung diseases such as asthma and has been linked to upper respiratory tract conditions.

But leaving the two-bedroom Atlanta apartment meant giving up a home that rented for less than $1,000 a month, a price that is increasingly hard to find even in the nation’s poorest neighborhoods.

“I am looking everywhere,” said Joseph, who is 33. “Right now, I can’t afford it.”

Since then, Joseph, her 3-year-old son, and infant daughter have teetered on the edge of homelessness. They have shuffled between sleeping in an extended-stay motel and staying with relatives, unsure when they might find a permanent place to live.

A nationwide affordable housing crisis has wreaked havoc on the lives of low-income families, like Joseph’s, who are close to the brink. Their struggle to stay a step ahead of homelessness is often invisible.

Rents soared during the pandemic, exacerbating an already-severe shortage of available housing in most U.S. cities. The result will be growing numbers of people stuck in substandard housing, often with environmental hazards that put them at higher risk for asthma, lead poisoning, and other medical conditions, according to academic researchers and advocates for people with low incomes. These residents’ stress levels are heightened by the difficulties they face paying rent.

“People are living in despair and hopelessness,” said Ma’ta Crawford, a member of the Human Relations Commission in Greenville County, South Carolina, who works with families living in extended-stay motels.

Housing instability — such as having trouble paying rent, living in crowded conditions, or moving frequently — can have negative consequences on health, according to the federal Office of Disease Prevention and Health Promotion.

In addition to potentially facing environmental risks, people who struggle with housing insecurity put off doctor visits, can’t afford food, and have trouble managing chronic conditions.

Losing a home can also trigger a mental health crisis. The suicide rate doubled from 2005 to 2010, when foreclosures, including those on rental properties, were historically high, according to a 2014 analysis, published in the American Journal of Public Health, that looked at 16 states.

Rents jumped 18% nationally from the first three months of 2021 to early 2022. And there is no county in the country where a minimum-wage worker could afford a two-bedroom rental home, according to an August report from the National Low Income Housing Coalition. Nationwide, only 36 affordable housing units are available for every 100 people in need, forcing many families to cobble together temporary shelter.

“It’s a vicious cycle,” Crawford said. “Every motel here has a school bus stop.”

In the Southeast, evictions are more common than anywhere else in the nation, says an analysis published this year in the Proceedings of the National Academy of Sciences.

Georgia has 19 evictions for every 100 renter households, according to data from the Eviction Lab at Princeton University. There are 23 evictions for every 100 renter households in South Carolina, and Virginia has 15 evictions per 100 renter households. The national rate is about eight evictions per 100.

Despite President Joe Biden’s promises to address the affordable housing shortage, researchers and activists say inflation — and Democratic deal-making — is only worsening the health threat.

Last year, the Biden administration included billions of dollars in the “Build Back Better” bill to increase the number of Housing Choice vouchers — a difficult-to-get benefit that helps people with low incomes pay rent. Under the voucher program, also known as Section 8, recipients put 30% of their income toward rent, and the federal government pays the remainder. Currently only 1 in 4 people who qualify receive the vouchers because of limited funding.

But lawmakers stripped out the provision that raised the number of vouchers, a compromise to pass the bill that became known as the Inflation Reduction Act.

About 2.3 million households rely on the program to help pay rent. Joseph applied years ago but has yet to receive any benefits.

The day before her son was born in September 2019, Joseph moved into an apartment complex in southwestern Atlanta, one of the poorest sections of the city. A year later, she upgraded to a two-bedroom unit in the same complex that cost $861 a month, far less than the typical apartment in metro Atlanta.

Recently, Joseph returned to the two-bedroom apartment to show KHN its condition. What appeared to be mold surfaced after a pipe burst and the air conditioning broke, but the complex owners did little to fix the situation, Joseph said.

The gray and brown splotches were on her mattress, sofa, and other plastic-wrapped belongings. They covered boxes of diapers stacked on dressers, an Elmo doll lying facedown, a child’s sneaker, and pink onesies.

After a pipe burst and the air conditioning broke in Louana Joseph's apartment, gray and black splotches covered a ventilation grille.

A property manager at Seven Courts Apartments, where Joseph lived, declined to comment when reached by phone. The management company did not respond to repeated requests for comment.

A few months after leaving the apartment, Joseph and her two children moved in with her sister in Orlando, Florida, with their remaining possessions — a car and some clothes.

A lack of affordable housing can force families with low incomes, like Joseph’s, to endure health risks such as mold, vermin, and water leaks, said Alex Schwartz, a housing expert at the New School in New York City. And the trauma of evictions, foreclosures, and homelessness can undermine physical and mental well-being, Schwartz said.

For five years, Nancy Painter lived in an apartment in Greenville, South Carolina, that had mold and cracks in the walls, ceiling, and floor. Sometimes, Painter said, she carried a can of bug killer in both hands to fend off roaches.

An autoimmune disease makes her extremely susceptible to colds and other respiratory illnesses, and arthritis causes her crippling pain. But she stayed in the apartment until last year because the rent was $325 a month. Painter moved out only after the landlord made plans to renovate the unit and raise the rent.

Painter, 64, now lives on about $1,100 in Social Security disability benefits. Her poor health left her unable to keep working in a fast-food job. She pays more than 70% of her income for a room in a house she shares with other adults who can’t find affordable housing.

Such renters should put no more than 30% of their income toward housing so they have enough left over for other basic needs, according to federal government formulas. “My options are so slim,” Painter said. “All I want is a small place where I can have a garden.”

In August, Louana Joseph's son, M.J., developed an upper respiratory infection that his mother suspects was caused by mold that was spreading in their apartment.

The problems are especially acute among Black people and other groups that have been denied good jobs, mortgages, and opportunities long beyond the Jim Crow era, said Dr. Steven Woolf, a professor of population health and health equity at Virginia Commonwealth University. Life expectancy can vary by 15 to 20 years between different neighborhoods in the same city, he said.

Federal lawmakers routinely fail to prioritize the nearly 50-year-old housing voucher program, said Kirk McClure, a professor emeritus of urban planning at the University of Kansas. The U.S. offers less help with housing than do other rich countries, like the United Kingdom and Australia, where voucher programs allow everyone who meets income requirements to get help, McClure said.

“In the wealthiest society in the world, we could give every poor person a voucher,” McClure said. “This doesn’t require anything magical.”

Officials from the U.S. Department of Housing and Urban Development, which oversees the voucher program, did not respond when asked whether the administration planned to push for more housing vouchers.

Joseph’s prospects of finding another home remain dim as rents skyrocket.

The fair-market rent — which is determined annually by the federal government based on a rental home’s size, type, and location — for a two-bedroom home in the U.S. reached $1,194 a month, on average, in 2019, according to a 2020 report from the National Low Income Housing Coalition. A family of four living on poverty-level income could afford $644 a month, the report said. In the city of Atlanta, the median rent for apartments of all sizes is $2,200, up nearly 30% since January 2021, according to the real estate website Zillow.

A lack of child care has kept Joseph from pursuing full-time jobs. But she can’t qualify for one state child care assistance program since she doesn’t have full-time employment, and another state program she sought out won’t have openings until next year.

She sued the Seven Courts Apartments’ owner in small claims court in June for $5,219 to compensate her for the ruined belongings and rent she has already paid. A settlement could allow her to move into a new home.

“I am stuck because I have nowhere else to go,” Joseph said.

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