Urban Land Tenure Security as a Measure of Health

Posted on | May 30, 2023 | Comments Off on Urban Land Tenure Security as a Measure of Health

Mike Magee

 

“The title of our lands is free, clear, and absolute, and every proprietor of the land is a prince in his own domains, and lord paramount of the fee.”
Jesse Root, Chief Justice of the CT Supreme Court (1798)

When it came to social hierarchy and family position, land was the ultimate measure of success and influence in Great Britain. But by the time of the American Revolution, our Founders were already fast at work dismantling Primogeniture (“the right of succession belonging to the firstborn child, especially the feudal rule by which the whole real estate of an intestate passed to the eldest son.”) It had already largely disappeared in New England, and was gone in the southern colonies by 1800.

In its place, the colonists envisioned a “free and mobile market,” where land could be traded like money and other goods. To do so, the original land grants and “feudal tenures” were obliterated, and their legal documents swept clean by the new law of the land. The decisions on ownership were made locally, empirically and by “common wish” of those in power.

Property was meant to be traded, fast and furious, but most of all put to “productive use” in a young nation obsessed with rapid growth. As legal historian, Lawrence Friedman, suggested, “In land lay the hope of national wealth; for countless families, it was their chance to make some money. The land, once it was cleared of the native peoples (by hook or by crook), and properly surveyed, was traded with speed and fury. Speculation in raw lands was almost a kind of national lottery.”

Secure possession of land rapidly and dramatically segregated the “have’s” from the “have-not’s.” By the end of the century, industrialization and urbanization, fueled by Black flight from white southern segregationists and immigration from Europe and Asia, had escalated the growth of cities lacking required housing and infrastructures to support health and safety. The scientific revolution, a new Sanitary Movement, and the beginnings of government regulations together began to address infectious diseases and unsafe food and water.

More than a century later, urbanization (primarily as a source of jobs and access to power) has lost none of its appeal. Consider the fact that in 2012 there were about 7.0 billion global inhabitants with 49% rural and 51% urban. In 2023, we topped 8.0 billion, but 57% are now urban. By 2030, we’re projected to reach 9.0 billion with 2/3rds living in cities. The cities themselves are growing in number and size. There are now 512 cities worldwide, primarily on coastal plains, with populations over 1million.

Under ideal circumstances, this urban migration to concentrated land dwellings could serve our human population well – with jobs, clean air and water, transportation, housing and education, health care, safety and security. But without investment and planning, they can be a harbinger of poor health, and ultimately a death trap.

Recognizing this threat, urban geographers and public health professionals are increasingly collaborating in the creation of a common language and set of measures or determinants to gauge the success of governmental investment and action. One area of recent common focus is  “urban land tenure insecurity” as a contributor or determinant of poor health outcomes.

The researchers are attempting to put together a complex puzzle to answer the question, “Do variations in land tenure security and variations in health outcomes relate to each other?” What urban geographers have already established is that “livelihood, well-being and quality of life” are elevated by housing security in “formal settlements.” These sites have laws that ensure rights of dwellers as a hedge against homelessness, and a range of services that promote “employment, housing security, political participation, education, protection from environmental risks, and access to primary health care.”

In contrast, informal settlements place inhabitants at risk on multiple levels. First, by definition these sites lack the planning and infrastructure to support the populations who have congregated in this location. Second, the uncertainty of basic safety and security (literally “a roof over your head”), and the implied threat of forced displacement and instantaneous mobility, makes “setting” down roots much less likely. This undermines investing in community and support systems necessary for physical health. Finally the stress and disruption ever-present in these informal settlements ensures high burdens of mental health disease.

Land, then, does remain the “ultimate measure of success”  in modern times. But the success and influence engendered in secure housing and settlement has little to do with “overlords”, but much to do with access – to secure housing, healthy food, clean air and water, a job and transportation, recreation, and human relationships. And all of the above are enhanced by access to settled neighborhoods with access to health care.

“The Power To Part The Red Sea, While Failing To Scale The Ten Commandments.”

Posted on | May 23, 2023 | Comments Off on “The Power To Part The Red Sea, While Failing To Scale The Ten Commandments.”

Mike Magee

A few weeks ago New York Times columnist Tom Friedman wrote, “We Are Opening The Lid On Two Giant Pandoras Boxes.” He was referring to 1) artificial Intelligence (AI) which most agree has the potential to go horribly wrong unless carefully regulated, and 2) global warming leading to water mediated flooding, drought, and vast human and planetary destruction.

Friedman argues that we must accept the risk of pursuing one (rapid fire progress in AI) to potentially uncover a solution to the other. But positioning science as savior quite misses the point that it is human behavior (a combination of greed and willful ignorance), rather than lack of scientific acumen, that has placed our planet and her inhabitants at risk.

The short and long term effects of fossil fuels and carbonization of our environment were well understood before Al Gore took “An Inconvenient Truth” on the road in 2006. So were the confounding factors including population growth, urbanization, and surface water degradation. 

When I first published “Healthy Waters,” the global population was 6.5 billion with 49% urban, mostly situated on coastal plains. It is now 8 billion with 57% urban and slated to reach 8.5 billion by 2030 with 63% urban. 552 cities around the globe now contain populations exceeding 1 million citizens.

Under ideal circumstances, this urban migration could serve our human populations with jobs, clean air and water, transportation, housing and education, health care, safety and security. Without investment however, this could be a death trap. 

Clean, safe water is fundamental to maintaining the health and productivity of these city dwellers. Investment in water infrastructure, according to the OCED, delivers a 3 to 1 return on investment. So the money should be easy to find. But it’s not. And it’s not for a lack of science or technology. It is an issue of priorities. For example, American citizens manage to find 16 billion a year to spend on bottled water, almost always no better, and occasionally worse, than common tap water.

Robin Wall Kimmerer, in her novel “Braiding Sweetgrass,” writes:  “Among our Potawatomi people, women are the Keepers of Water. We carry the sacred water to ceremonies and act on its behalf. ‘Women have a natural bond with water, because we are both life bearers,’ my sister said. ‘We carry our babies in internal ponds and they come forth into the world on a wave of water. It is our responsibility to safeguard the water for all our relations.’”

When it comes to planetary health, that is the kind of respect, common sense, and imagination we need to yield quicker and better results than AI. Planetary health requires well ordered priorities and shifts in human behavior like the recent trend away from huge, dangerous and disruptive hydroelectric energy projects like the Three Gorges Dam in China. Humans now rely on hydroelectric projects for 16% of the world’s energy. That’s good in that it is renewable and lowers carbon emissions. But its’ effect on the environment, displacing humans and animals with dam construction, and playing a role in catastrophic disasters when dams fail, have drawn criticism.

In response, a simple solution called “pumped storage” is rapidly supplanting huge dam projects. The system is simple – two reservoirs, one high and one low. When energy use is low, water is pumped into the upper reservoir. When demand is high, water is allowed to flow into the lower reservoir through turbines that generate needed energy. Places like China, which has been all in on hydropower, has switched 80% of its’ future projects to “pumped storage” because it is fast, safe and effective, and can “provide a flexible backup for wind and solar.” The key insight is that the reservoir system acts as a battery, storing potential energy ready to go, on demand, without adding the additional cost of storage.

Knee-jerk over reliance on scientific inventiveness lets us all off the hook. Before we give a green light to the next batch of dot-come gazillionaires, we’d be smart to ask two questions: What makes sense? and What’s best for the health of our planet and her human inhabitants?

In fairness to Tom Friedman, he warns about putting all our eggs in the scientific basket without tightening regulations that support “scaled sustainable values.” Yet his final words do little to encourage confidence based on past human history and performance. As he puts it, “God save us if we acquire godlike powers to part the Red Sea but fail to scale the Ten Commandments.”

“We Call Upon The Rivers That Rim The Earth . . .”

Posted on | May 17, 2023 | 2 Comments

Mike Magee

Most futurists will agree that the true challenge is not so much predicting what will happen, but when it will happen. For example, twenty years ago I predicted that many challenges related to integrated water resource management (population growth, urbanization, global warming, disaster preparedness, water safety and purity, ground water contamination, relative water requirements of human dietary choices, aging infrastructure, the pricing of water and more) made it a compelling human health issue that would engage health professionals.

I was wrong. And yet, twenty years later, at the end of this week, I am delivering an updated address on the issue to an overflow crowd at the the Presidents College at the University of Hartford. Apparently water, and the 25 facts all health professionals should know about water, have finally made it to the mainstream.

Witness for example, this week’s headline in the Washington Post, “States near historic deal to protect Colorado River.” It announced a long sought after potential bargain by California, Arizona and Nevada, which form the river’s Lower Basin, to take actions to save the Colorado River and preserve its value as a source of drinking water for 40 million, hydropower for tens of millions, and recreation most notably on the ever-shrinking Lake Mead and Lake Powell. The deal to conserve 13% (3 million acre feet) of each state’s river allocation over the next three years carries a federal contribution to the states of over $1 billion dollars.

By the way, an acre foot is the amount of water it would take to cover an acre of land with 1 foot of water – about 360,000 gallons.

Coming to a deal has meant engaging the Upper Basin states of Colorado, New Mexico, Utah and Wyoming which use far less of this valuable resource than their Lower Basin counterparts. The 1,450 miles of the river move through the seven states as they meander from the Rocky Mountains to Mexico, traversing dependent farms and cities. Also, the discussions for the first time have allowed 30 Native American tribes in the basin to have a voice at the table.

Interior Secretary Tea Harland, the first native American to hold the post, took the bull by the horn in an event at the Hoover Dam that made it clear that time was running out with Lake Powell and Lake Mead at 1/4 of their normal levels, and close to forcing closure of the hydroelectric dam production of electricity. As Colorado’s water commissioner bluntly stated to her counterparts, “Are we going to make a choice to do better? If we don’t want the secretary to manage us, can we show we can manage ourselves?”

The deadline for a firm deal is May 30th. If deadlocked, I would recommend beginning the next mediation session with this ancient Chinook blessing: 

We call upon the earth, our planet home, with its beautiful depths and soaring heights, its vitality and abundance of life, and together we ask her to

Teach us, and show us the Way.

We call upon the mountains, the Cascades and the Olympics, the high green valleys and meadows filled with wild flowers, the snows that never melt, the summits of intense silence, and we ask that they

Teach us, and show us the Way.

We call upon the waters that rim the earth, horizon to horizon, that flow in our rivers and streams, that fall upon our gardens and fields and we ask that they

Teach us, and show us the Way.

We call upon the land which grows our food, the nurturing soil, the fertile fields, the abundant gardens and orchards, and we ask that they

Teach us, and show us the Way.

We call upon the forests, the great trees reaching strongly to the sky with earth in their roots and the heavens in their branches, the fir and the pine and the cedar, and we ask them to

Teach us, and show us the Way.

We call upon the creatures of the fields and forests and the seas, our brothers and sisters the wolves and deer, the eagle and dove, the great whales and the dolphin, the beautiful Orca and salmon who share our Northwest home, and we ask them to

Teach us, and show us the Way.

We call upon all those who have lived on this earth, our ancestors and our friends, who dreamed the best for future generations, and upon whose lives our lives are build, and with thanksgiving, we call upon them to

Teach us, and show us the Way.

And lastly, we call upon all that we hold most sacred, the presence and power of the Great Spirit of love and truth which flows through all the Universe … to be with us to

Teach us, and show us the Way.

Connect The Dots: Britain’s Coronation and Health Disparities in America.

Posted on | May 12, 2023 | 2 Comments

Mike Magee

And so the week of the long-awaited coronation of a new British Monarch has come to an end. Of course the debate over this practice will continue as long as the practice lasts. The question was posed in wide range of blaring headliners like, “Is the British Monarchy a Worthy Institution or Outdated Relic?” 

As Charles III assumed the throne, one analyst summed it up this way, “The British monarchy is UK society’s most exquisite display of romanticism – at once representing the grandness of the past and the promise of the future. However, it is both expensive to uphold and may be trapping the British in a past they no longer connect with (just ask Harry). Do you think the British monarchy should be preserved, or, in the absence of Queen Elizabeth, is it time for a change?”

Almost all agree, the Queen impressed with her longevity, consistency, and commitment to the role. This week’s reporting was laced with kind remembrances of her, like the story told by Royal Protection Officer, Richard Griffin, about the time he and the Queen were strolling the grounds of Balmoral Castle in Scotland, when they encountered two American hikers who did not recognize her. She stopped to greet them, which was her custom, and one of the hikers volunteered where he was from, and then inquired of the Queen where she lived. 

In Griffin’s words, “She said, ‘Well I live in London, but I’ve got a holiday home just on the other side of the hills. And he said, ‘How often have you been coming up here?’ She replied that she had walked these hills for over 80 years, from the time she was a little girl. The American replied, ‘Well, have you ever met the Queen?’ Without missing a beat, she replied, ‘Well I haven’t, but Dick here meets her regularly.’ Turning to Griffin, the tourist boldly asked, ‘Oh, you’ve met the Queen? What’s she like?’ Griffin’s response, ‘Oh, she can be very cantankerous at times, but she’s got a lovely sense of humor.’” The tourist then took out his camera, gave it to the Queen, threw his arm around Griffin, and asked the Queen to shoot a selfie of the two, and she happily obliged. Not to offend, he then asked the elderly lady for a picture with her as well, and Griffin took the shot, and left it to the tourist to later discover who she really was.

Of course, the centuries which preceded Queen Elizabeth’s arrival were not nearly as light-hearted, and at the core of the differences that drew their ancient relatives to war with each other was the very ground these two tread that day. It was the land and the landed gentry that anchored their dispute.

As legal historian, Lawrence Friedman, wrote this about Britain, “The lord of the manor was a little sovereign in his domain. Only people with land or land rights really mattered: the gentry, the nobles, the upper clergy. Land was the source of their wealth, and the source and seat of their power…The social system of the kingdom turned on the rights in land… Clearly American traditions were quite different. There was no landed gentry. The land was widely held. But in America too, land was the basic form of wealth…After 1787, the vast stock of public land was at once a problem and an opportunity…Once land was surveyed, the idea was to dispose of it…The land was a commodity, an asset. The land was not on the whole, to be treated as a capital asset of the government…the goal was to privatize it, as soon as humanly possible…(compared to England) It no longer carried its ‘premodern role as the foundation for social hierarchy and family position.’” Primogeniture, the British lines of inheritance of land, was dead.

Possession of land for white males gave access to voting rights in those early years in America. And over the next two centuries, women, native Americans and African Americans, were denied access to land and home ownership, laying the grounds for wide disparities  that persist to this day. As one recent study documented, “A study in Boston found that for 25- to 44-year-olds, the mortality rate was 9 times higher for men who are homeless and 10 times higher for women who are homeless compared to the general population of Massachusetts — and the mortality rate for 45- to 65-year-olds was 5 times higher for people who are homeless. The health effects of homelessness can begin early in life, as pregnant women who are homeless are more likely to deliver preterm and low birthweight babies.”

The problems with American health care didn’t come out of nowhere. But as with Queen Elizabeth’s accidental tourist above, the naivete’ of leaders who believe in the possibility of “American exceptionalism” in the absense of universal health services and an enlightened social safety net, is strikingly laughable.

Prediction: ERA Beats Republicans In A Third Round Knockout!

Posted on | May 3, 2023 | 2 Comments

Mike Magee

Believe it or not, The Equal Rights Amendment (ERA) was first introduced 100 years ago in 1923. But it was only adopted by Congress by a 2/3 majority vote 49 years later in 1972. That was simply step 1 in the world’s most complex and difficult national constitutional amendment process.

Step 2, approval by 3/4 of the states, seemed off to a running start with 28 of the required 38 states signing up that first year. But 1972 was also the year that Phyllis Schafly, an outspoken supporter of patriarchy and stay-at-home motherhood, began echoing her anti-ERA message on Chicago News Radio WBBM. The following year, she went national with a CBS Morning News contract, followed by a gig with CNN from 1980 to 1983.

Corny, but effective and dogged in pursuit culture war issues, she was a gifted publicist who leveraged the role of “housewife” for all it was worth. One of her gambits was to deliver homemade bread, jam and apple pies to state legislators with the message ”Preserve us from a congressional jam; Vote against the ERA sham” and “I am for Mom and apple pie.”   

The irony that she had been largely “not at home” as an active conservative political warrior since signing on as a young researcher at the American Enterprise Institute in 1946, and (by now) had waged a battle for three decades to preserve “traditional American values” as a lawyer, editor, and national speaker apparently never registered with her wildly enthusiastic fanhood. 

That idolation didn’t fully translate to a younger generation. In 2008, eight years before her death at 92, her alma mater, Washington University in St. Louis, awarded her a honorary degree at the graduation ceremony. As she rose to receive the award, 1/3 of the graduating class rose and turned their backs on her, and three faculty members walked off the stage.

Two decades later, long after many had thought the ERA was dead and buried, three states added their “yes” votes to what could become the 26th Amendment – Nevada (2017), Illinois (2018), and Virginia (2020). What changed of course was the stacking of the Supreme Court with conservative, theocratic justices, and the subsequent attack on Roe v. Wade followed by the Dobbs decision and (predictably) the Red state assault on women’s autonomy and freedom.

So, with step 1 and step 2 now secured, has the Equal Rights Amendment, preventing motherhood and pregnancy discrimination, gender discrimination and violence, pay inequity, and intrusions on women’s freedom to control their own health decisions and reproductive life, arrived just in time? Well, not exactly. It seems that when the ERA gained its 2/3 Congressional vote in 1972, Congress wrote in a deadline for 3/4 of the states to achieve passage. That deadline was seven years (1979). It subsequently extended that three years to 1982. Also during the intervening years, a few states have attempted to rescind their approval. Is that allowed?

Article V, Section 4.2.1 speaks to the issue of deadlines. The congress.gov site states: “One prominent question is whether Congress may place a deadline on the states’ ratification of a proposed amendment, either in the text of the proposed amendment or the accompanying joint resolution. The text of Article V does not specifically address the issue. In Dillon v. Gloss, the Supreme Court held that the Constitution implictly authorizes Congress to “fix a definite period” for ratification of an amendment…Limited historical practice suggests that if Congress does not specify a deadline for ratification, the amendment remains pending before the states until the requisite number of states have ratified it. In 1992, the Twenty-Seventh Amendment, which addressed the effective date of congressional pay raises, became part of the Constitution more than 202 years after it was proposed.”

Article V. Section 4.2.2 addresses the effect of state legislatures “changing their mind” and rescinding prior action. The congress.gov site states: “The Supreme Court indicated that whether a state could ratify an amendment after rejecting it—or rescind an amendment already ratified—were political questions for Congress to resolve.  As support for this theory, the Court cited Congress’s 1868 adoption of a concurrent resolution declaring that the Fourteenth Amendment had been ratified. Congress adopted this resolution despite the fact that three states had previously rejected the amendment before later ratifying it, and two states attempted to rescind their prior ratifications.”

In short, Congress appears to have the power, if it chooses, to eliminate the deadline for state ratification and therefore add the three additional required states, and deny the request of states who “on second thought” would like to change their “yes” vote on the ERA Amendment to a “no.”

On January 24,2023, a bipartisan resolution to set aside the time limit for ratification was put to the vote. It was defeated 51 to 47. But recent state victories in Kansas, Kentucky, Michigan and Vermont on abortion rights in the 2022 Midterms suggest that this is only round 1. 

Round 2 is already underway, as Red state legislatures fail to listen to warnings from Republican party leaders and push everything from forced birth on raped teenagers to government approved D&C’s for bereaved mothers suffering miscarriages to reversal of women’s pharmaceuticals long ago approved as safe and effective by the FDA.

As Republican Governor of New Hampshire, Chris Sununu, warned, “Any conversation about banning abortion or limiting it nationwide is an electoral disaster for the Republicans…The Republican Party has an inability to move off this issue in a way that doesn’t scare the heck out the average voter, the independent voter, the younger generation of voters. These guys keep pushing themselves deeper and deeper into an ultra-right base that really does not define the bulk of the Republican Party.”

Round 3 could deliver a knock out to Republicans in 2024, and leave the ERA standing tall in the middle of the ring declaring “I am the greatest of all Amendments!”

The GOP Has Become the Party of Theocrats, and Samuel Alito Is their High Priest.

Posted on | April 23, 2023 | 1 Comment

Mike Magee 

In the realm of historical fiction, Justice Alito and his GOP supporters have proven themselves masterful.  The 7 to 2 decision (with Alito and Thomas in opposition) to leave the FDA alone for now with jurisdiction over the safety and efficacy of Mifepristone, does little to reassure that these Theocrats are men of their word.

Justice Alito’s reliability should be viewed through the lens of the testimony provided by Justices Kavanaugh, Barrett, and Gorsuch, under oath, on the topic during their confirmation hearings. Alito and Clarence Thomas and these co-signers on his leaked Dobbs draft assured us that the dismantling of Roe v. Wade would be self-limiting since  “none of the other decisions cited by Roe and Casey  “involve the critical moral question posed by abortion.”

But the history and performance of these five Justices, their original and current supporters, their documented religious orthodoxy, and the web of conservative schools and think tanks  that nurtured their well-entrenched biases, all suggest a conspiracy that could threaten our democracy.

Elizabeth Fresse PhD, research associate at Auburn Seminary, sounded the alarm a year ago with this warning, “Morality has thus become the reigning justification for the state to infringe upon the liberty of female Americans and to subjugate their reproductive labor to its power. An interrogation of this morality, however, reveals that it is underpinned by a theology that both erases and assumes the subjugation of female gestational labor in procreation to patriarchy. We must shatter this male-dominant moral logic and foreground female personhood and agency in order for every American to be equally free.”

Dr. Linda Rosenstock, Dean Emeritus and Professor of Health Policy and Management at UCLA’s Fielding School of Public Health, has laid it out clearly that the loss of women’s autonomy over birth decisions, most especially unintended pregnancy, would be catastrophic.

“The broader the access to proven family planning methods, the lower the unintended pregnancy rate and the lower the abortion rate. We can’t underestimate the role of educating and empowering women – and men – about these issues.”

These are not simply the opinions or insights of a single health expert. They are backed up by the following facts:

1. Since 1981, abortion rates in U.S. women, age 15 to 44, have declined by nearly two thirds from 29.3 per 1000 to 11.4 per 1000.

2. Approximately half of all pregnancies in the U.S. are unintended.  Of those unintended, approximately 40% of the women chose to terminate the pregnancy by abortion – either procedural or chemically induced.

3.  The decline in the number of abortions has coincided with increased access to long-acting reversible contraception, including IUD’s and contraceptive implants. These options are now safe, increasingly covered by insurers, and more accessible to at-risk populations. Contraceptive reversible implants are now chosen by 16%, IUDs by 21%, and operative tubal ligation by 28%.

4. The increasing inclusion of sex education in middle school and high school curricula (DeSantis antics aside) has been accompanied by a decline in high school sexual activity by 17% between 2009 and 2019.

5. There were 629,898 abortions recorded by the CDC in 2019. For every 1000 live births that year, there were 195 other women who chose to terminate their pregnancies. More than half of the 1st trimester abortions are now chemically induced through Plan B-type pills.

The GOP, bolstered by minority-rule Right to Life advocates, bred and nurtured by ultra-conservative Catholics and Evangelical Christians, have (by their actions) revealed that a broader agenda than simply eliminating abortions is at work here. That broader agenda includes patriarchal control over women’s sexuality and enhancing congregant birth rates in America.

State GOP “dignitaries” want to play doctor and manage miscarriages one the one hand, while limiting contraception to promote handmaiden status on young women on the other. Using one crazy judge in Texas , they seek to dismantle the FDA and PhRMA science. Book sanctions, pedophilia fantasia, insistence that failed “abstinence-only” sex education works, highly organized assaults on women’s services provided by Planned Parenthood? In a climate like this, is it reasonable to assume that Justice Alito is trustworthy?

Other recently granted rights under these privacy precedents include:

• The right to interracial marriage (Loving v. Virginia),
• The right to obtain contraceptives (Griswold v. Connecticut)
• The right to engage in private, consensual sexual acts (Lawrence v. Texas)
• The right to same-sex marriage (Obergefell v. Hodges).

Paraphrasing the proverb from a book called The Court and Character of King James by Anthony Weldon, 1651,: “Fool me once, shame on you. Fool me twice, shame on me.”

The GOP Wants To Manage Your Miscarriage – You Good With That?

Posted on | April 17, 2023 | 5 Comments

Mike Magee

Twenty years ago, I headed up a social science think-tank focused on defining the role of the patient-physician relationship in well-functioning democracies. In six countries (including the U.S., UK, South Africa, Germany, Japan, and Canada), our studies revealed a rapidly evolving relationship – one moving toward mutual decision making and team approaches to care.

Perhaps more significant was the revelation that the relationship was advancing the cause of democracy in three ways. First, it promoted trust and confidence across entire populations without prejudice. Second, it processed individual’s fear and worry which, if allowed to build and expand, could have a destabilizing effect on self-governance. And third, it encouraged forward facing optimism while reinforcing bonds between individuals, families and communities committed to joint problem solving.

In short, the patient-physician relationship showed the strength and willingness to individualize and confront complex, deeply personal, and intensely human dilemmas in real time and privately on a 24/7 basis. These very traits were the reason why the Supreme Court in 1973, in Roe v. Wade, entrusted the patient-physician relationship to navigate the wide range of issues involved in women’s autonomy over birth decisions.

Consider for example that 1 in 5 of the roughly 5 million U.S. pregnancies in 2020 ended in miscarriages. 80% of these were in the first trimester, with the remaining 20% almost exclusively in the second trimester.

Health professional management of a miscarriage is an exceedingly complex affair. It requires rapid, same-day, evaluation to assess the mother’s condition, the stage of development and viability (if any) of the fetus, the need for medical or surgical treatment to minimize blood loss or prevent infection, and the short and long term management of grief, depression, and (at times) feelings of guilt for the mother and family members.

Now consider that the cases above are being grouped together by Republican state governors with another  930,000 women in 2020, who for a wide range of reasons, took a different path and chose to terminate their pregnancies. That’s roughly 14 women for every 1,000 women age 15-44 in our nation, with Southern states having 4 times the number of abortions as northeastern states. 54% used the 2-pill regimen for medical abortion, and 46% underwent a surgical procedure. In either case, health professional management was once again time dependent, complex, and required both medical and psychological team support to achieve satisfactory outcomes.

The size and nature of managing the societal challenge of maternal-fetal health is exactly the reason why the Supreme Court in 1973, in Roe v. Wade, entrusted the patient-physician relationship to navigate with women patients the wide range of issues involved in women’s autonomy over birth decisions. The ruling left decision making largely in the hands of women and their doctors during the first two trimesters, and allowed a significant role for government in the third trimester.

At the time, most agreed that this reasoned compromise was both wise and sound, and leaders accepted that “perfect should never be the enemy of the good.” For example, in 1971, America’s leading conservative religious organization, the Southern Baptist Convention, went on record as encouraging its members “to work for legislation that would allow the possibility of abortion under such conditions as rape, incest, clear evidence of severe fetal deformity, and carefully ascertained evidence of the likelihood of damage to the emotional, mental, and physical health of the mother.”

Two years later, both the Southern Baptist Convention and the Christian Medical Society chose not to actively oppose Roe v. Wade, and reaffirmed that position in 1974 and 1976. The Southern Baptist Convention’s views on abortion were part of its long-standing support for the separation of church and state, and Baptist medical communities largely opposed the idea of churches and their pastors wading into delicate health care issues.

Yet thanks to the Dobbs decision by a Court stacked with ultra-conservative Justices, here we go again with male state politicians playing doctor to the detriment of women’s freedom, autonomy, and health.  It’s 2023, and the GOP wants to manage your miscarriage. Are you good with that?

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