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Health and Human Rights in South Los Angeles

While the LA Times was writing about gang violence in South LA, more than 700 people gathered on June 5th for the first South Los Angeles Health and Human Rights Conference to consider the institutional violence visited on the people who live there. At the California Science Center, health care professionals, community organizers and advocates adopted a new conceptual framework to bring about transformation based on the principles of social medicine and the Universal Declaration of Human Rights.


Dozens of speakers and convenors, from Jim Mangia of St. John Well Child and Family Center to Lark Galloway-Gilliam of Community Health Councils, drove the point home: Human rights are not just inalienable, they are indivisible, interdependent and interrelated which means the fulfillment of one right often depends on the fulfillment of others. Perhaps health care professionals were the first to appreciate how this applies to South Los Angeles, because nowhere is this interconnectedness more apparent than through the framework of social medicine.

Since the 19th century, social medicine has taught that to have healthy individuals, you need healthy communities. The government’s responsibility for safety and security goes far beyond the prevention of violent crime, though of course that matters. You also need at the very least safe housing, clean water, clean air, education, adequate nutrition, access to employment, and a voice in governmental decisions that affect you—all factors that are included in the Universal Declaration of Human Rights and significantly lacking in the lives of the people of South LA.

The Declaration, spearheaded by Eleanor Roosevelt, was adopted and proclaimed by the General Assembly of the United Nations in 1948. Though the US has not (yet) specifically ratified the provisions or enshrined some of its words right into the Constitution as some other countries have done, we as a nation became committed at that time to disseminating the Declaration and teaching it in schools and making it apply not only to Egypt and Afghanistan and Zimbabwe but here at home. For example:

Article 25

Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.

Everyone. But there is one pediatrician for every 9,090 children in South LA compared to a pediatrician for every 526 kids in West LA. Access to specialists in South LA is even worse. Five emergency rooms have closed since 2000, leaving only one full-scale ER/trauma center, and this in a nearly 100-square-mile area with more than one million residents.

Frank Donaghue, CEO of Physicians for Human Rights, who spoke during the morning plenary session and has worked all over the world pronounced himself “appalled” that about as many people are covered by health insurance in South LA as in Rwanda.

For individuals, this disparity in health care access means, for example, that by the time a patient named Jimmy reached Kaiser Permanente physician Dr. Tumani Leatherwood, he’d had diabetes for many years, going without care and without the education that could have taught him how to manage his condition. He already needed dialysis. A man who could have been a productive citizen and loving father died two years later, age 42, blind, with both his hands and feet amputated, “a trunk barking out orders to his children.”

Article 23

Everyone who works has the right to just and favourable remuneration ensuring for himself and his family an existence worthy of human dignity, and supplemented, if necessary, by other means of social protection.

If you don’t have a stable and sufficient income, how can you possibly lead a healthy life? At least 75% of South LA residents who are employed work in low-wage jobs that offer no health insurance and little stability in terms of continuing employment. Since the large manufacturing plants closed in the district after World War II, there’s been an ongoing tension between job access and job quality. Community partnerships have worked hard to place residents in thousands of union jobs with career ladders, and hope to see more jobs created through green retro-fitting programs, but so far, it’s a drop in the bucket.

Given the overall lack of investment from the outside, South LA’s business and industrial base consists mostly of shoe-string and Mom-and-Pop operations which are unable to obtain credit, unable to professionalize or expand or pay decent wages. Many workers rely on the underground and informal economy and work at dangerous jobs that don’t pay enough to live on and offer no benefits. Many residents must work two or three jobs to support their children—meaning they are not home to give those children the care they need. Approximately 90,000 residents are both out of work and out of school, their lack of employment an obvious risk to public safety.

In addition to the effects of racial and ethnic discrimination, poverty itself is self-perpetuating as it creates multiple barriers to employment that are interrelated and cannot be removed by the individual alone: disability due to untreated conditions, toxic environmental factors, stress (including PTSD), substance abuse; inadequate education (including limited English skills, limited literacy); homelessness; negative score on credit checks; lack of access to child care or affordable transportation; prison record, and more.

Mark Ridley-Thomas, recently elected to the county board of supervisors, told the meeting “Don’t be bashful. Don’t be ashamed,” in pressing for rights. “This is a partisan crisis,” he asserted, “not a budget crisis.”

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Indeed, it’s easy to identify spending decisions based purely on ideology—the right wing ideology that government itself is bad, that the poor (particularly poor people of color) are responsible for their own suffering and should therefore be chastised while the barriers preventing their access to a better life must be remain intact under the pretense that these barriers don’t exist. This ideology exalts the admirable ideal of individual responsibility but mocks the notion of civic and community responsibility. Many middle and upper-income Americans by now must understand what South LA residents have long known: systemic and institutional factors can undermine even your best, most determined individual efforts.

California, without blinking, continues to spend millions to carry out the death penalty and to refuse parole to prisoners who’ve served behind bars for decades and pose no threat to society. We have ample money to lock kids up but not to fund the education and training that would keep them out of jail and give them—and the state of California--a better future.

In South LA, families double up and triple up in unhealthy overcrowded slum housing. Even so, there’s not enough of even this inadequate housing to go around. South LA has more than twice as many homeless residents as downtown’s Skid Row where services are concentrated. And 91% of South LA’s homeless are unsheltered. The area’s homeless population includes families, veterans, the ill and disabled, substance abusers, and people with Masters degrees. It includes people who’ve always worked until losing their jobs to the economy and their homes to foreclosure.

Experiences with addressing homelessness around the country and documented in Los Angeles by the United Way proves that putting people in subsidized apartments of their own supported with a range of social services not only stabilizes them so they can contribute again to society but actually costs less in tax dollars than putting these same people in shelters. As for leaving people on the street, not only is it inhumane, it’s also the least cost-effective because of the expense incurred every time the police book a homeless person, with every trip by ambulance, every visit to the emergency room, every stay in a mental or general hospital--costs that balloon out-of-control, spending taxpayer dollars while doing nothing toward solving the problem.

The only reason to treat the homeless as we do is not because it’s cost-effective: it’s a way to express society’s contempt.

Article 23 guarantees “social protection,” but rightwing ideology says we mustn’t “give” people anything.

Nicole Perez of the Legal Aid Foundation points out the maximum welfare grant available to a single person—who can’t be undocumented or have a felony conviction—is $221/month. Is it any wonder there are more homeless people in Los Angeles County than in any state of the union?

Already inadequate grants to families are being reduced. The governor’s budget will cut off help to 250,000 children, while Medi-Cal, the state’s medical assistance program, as of July 1 will no longer pay for dental care or optometry. Even people who are covered often lack access to care, as reimbursement rates are already so low, doctors refuse Medi-Cal patients. The governor also wishes to end payment for dialysis as well as breast cancer treatment for women over 65—a triage system which would mean the state has simply decided that some people’s lives need to end. His proposal to eliminate mental health care will create more homelessness, individual pain, community distress.

It’s ironic that a day after the conference, Governor Schwarzenegger gave the commencement address at Charles Drew University of Medicine and Science. The governor praised the graduates for their commitment to practicing medicine in the inner cities. At the very same time he seeks to cut the funds that would keep urban clinics open and provide Medi-Cal coverage to the people of South LA.

diane lefer

In one break-out session, Malcolm Carson of the Legal Aid Foundation of Los Angeles quoted the other Malcolm – Malcolm X – who suggested looking at the racial situation in the US not as a civil rights issue but as a human rights issue. Perhaps we need to flip that script, and incorporate human rights into our legally enforceable civil rights.

The people of South LA have waited and waited and waited for equity and their rights. Enough is enough. When it comes to money, in this, the wealthiest state in the weathiest country, when human rights become the priority, there is enough.

Diane Lefer