8.4: Tobacco Nation

Tobacco Nation

Unhealthy lifestyles, dangerous working conditions, risky cultural behaviors, and bad luck all increase the likelihood of individuals becoming dependent on the government for support. By mapping these individuals as groups, we can see very uneven patterns of disability across the US, which strongly suggests that both cultural practices and economic conditions are important causal variables in the creation of a disability crisis in the United States. Employment in mining and factory work seems one predictor of worker disability, which makes sense because those jobs are often physically demanding and sometimes dangerous. A lack of economic diversity in many of these same locations means that few other job opportunities are available for those with only a physical disability. This means, that even if you were injured while working in one job, in some parts of the country, you could find another job where your physical condition didn’t matter. In some parts of the US, because the types of jobs are limited to hard physical labor, an inability to lift heavy objects (for example) would keep you from finding almost any job.

The geographic pattern evident in the map of disability welfare differs wildly from media stereotypes about persons receiving government welfare. Mapping disability coverage offers a counterbalance to a common, misguided stereotype of the urban welfare queen, the politically charged symbol of those who abuse government assistance, generally assigned to women of color. The map of disability payment hotspots shows that in reality, welfare payments go to communities that are overwhelmingly rural, and predominantly white. While it is difficult to estimate the percent of fraudulent disability claims, the intense clustering visible on the map invites further research into why some counties have so many disabled people. It is statistically unlikely that nearly one-third of any region’s total population could be physically disabled by workplace injuries, even though the demographic profiles of poor, rural counties skew toward the elderly and ill-prepared to survive with a disability. To account for this reality, geographers age-adjust data to help account for the fact that older people are more likely to suffer a workplace injury from which they cannot recover. People without a high school diploma may also be declared disabled by an injury that would not qualify as an injury for a person with a college degree. It is reasonable to assume serious injuries normally occur in a somewhat random pattern around the US, therefore should be a somewhat random pattern to the disability map as well. Instead, there is a definite clustering pattern to disability claims in the US, which suggests fraud -which is very difficult to prove. Closely associated with the disability epidemic in the United States is burgeoning opioid drug addiction. Many of the same regions of the US where physical disabilities are very common also suffer from widespread opioid addiction. This crisis is explored more fully in the chapter on crime and punishment.

Autism:

One of the disabilities recognized by the US government is Autism, which is, in reality, a group of related conditions characterized by a range of cognitive and behavioral impairment levels, more properly known as Autism Spectrum Disorders (ASDs). ASDs are among the fastest-growing health concerns worldwide. The cause or causes of ASDs is the subject of exceptionally intense debate and millions of hours of research. Nobody yet knows for sure what causes ASD.

Figure : Map: Autism Cluster in wealthy, northwestern Los Angeles County. Source: UC Davis Health System

Figure : Infographic - In recent years, measles, a disease that was once declared eliminated in 2000 has re-established itself. Most people who get measles were not vaccinated, so exposure from outside sources spreads rapidly. Source: CDC

Generally, researchers think that genetics is the primary factor in ASD, but determining causality has proven to be very complex. Partly this is because the symptoms themselves are hard to identify, but it’s also because of the geography of autism. Medical geographers and spatial epidemiologists are heavily involved in autism research because autism clusters are reasonably easy to identify on a map. In greater Los Angeles, for example, unusually high rates of autism appear in Torrance, Beverly Hills, Van Nuys, Calabasas, Laguna Beach, and Mission Viejo. Of course Los Angeles has a well-earned reputation for air pollution, leading some to believe that exposure to airborne toxins is a causal variable. Indeed, there is some evidence to suggest that environmental exposures to various pollutants may function as triggers for the condition, but definitive answers have proven elusive. What is clear is the effect of neighborhood on the diagnosis of ASD. Most of the autism clusters in greater Los Angeles are in wealthy neighborhoods; so geographers suspect that the disorder’s dramatic rise in upscale areas is likely a product of improving diagnostic capabilities among medical professionals serving the upper-middle class, rather than evidence of a real increase in ASD. In poorer areas, where environmental conditions are generally far worse, parents, families and school officials appear to misdiagnose ASD or overlook symptoms that are commonly noticed in wealthier communities. Ethnicity and economics may also affect the likelihood that parents will acknowledge or accept a diagnosis of ASD for their child. The uneven spatial pattern of diagnoses makes the task of identifying the root causes harder because the known pool of persons with diagnosed with ASD is an unrepresentative sample of the true ASD population.

Vaccinations:

The most controversial topic surrounding ASD has been the popular, but scientifically unproven, belief that vaccinations cause ASDs. These unfounded fears keep many parents from vaccinating children against common, and sometimes deadly, diseases. As a result, a handful of diseases thought extinct have re-established themselves in the US.

Measles is a classic example. In the year 2000, the CDC declared measles “eliminated” from the US because no Americans had the disease. In the 1960s, millions were infected with measles and hundreds died every year. Today, Americans not vaccinated against measles remain at risk when traveling internationally, or when exposed to international visitors, or immigrants from affected regions. A significant outbreak of measles occurred in Southern California during early 2015, after a tourist with measles visited Disneyland in Anaheim and it spread among unvaccinated children in the region. In 2019, the worst outbreak in many years sent hundreds to hospitals across the country. The worst outbreak was probably in New York City’s Orthodox Jewish community, where exposure to people from Israel is high and vaccination rates are relatively low.

Figure California Counties - Pertussis infection rates vary considerably across California in 2014. Areas with large immigrant populations and large anti-vaccine populations show high infection rates. Source: CDC downloadable data

Pertussis, better known as “whooping cough” is another disease that has re-emerged in recent years thanks to vaccination paranoia. In recent years, the number of pertussis cases in the US has risen to levels not seen since the 1940s. By mapping pertussis rates by California’s county shows an interesting pattern. Higher rates of pertussis are evident in parts of California with many Latin American migrants. Latinos had by far the highest rate of whooping cough at 174 cases per 100,000 in 2014. This high rate is likely caused by poor access to affordable, quality medical care for pregnant women and infants. Language barriers between patients and health care providers may exacerbate the problem. Extended families who live together in crowded housing, especially if adults recently arrived from Latin America without updated vaccinations, can put at risk the health of infants and small children living within the household.

The map of pertussis in California also shows outbreaks in some of the wealthiest, best-served counties. Many wealthier families purposefully opt-out of vaccination programs, thereby fueling the pertussis epidemic in otherwise wealthy, healthy and medically well-served communities. In parts of upscale Sonoma County, where pertussis rates were exceptionally high in 2014, several schools had vaccination rates well below the rates considered safe. In some schools, more than half of the children were not vaccinated. Their parents had signed “personal belief exemptions”, which excused children from being vaccinated based on religious or moral grounds. Still they sent their children to school not immunized against common contagious diseases. Though pertussis is unlikely to kill healthy children in upscale neighborhoods, it is nevertheless highly contagious and spreads into other neighborhoods, or even countries, where infants from poor families are at serious risk from the disease. California eliminated most exemptions for children attending public school in 2015.

Children who are not immunized against disease take advantage of what is called, herd immunity, a condition that characterizes groups of people in which around 90% of the group have developed immunity, generally through vaccinations, to an infectious disease. The group immunity critically lowers the chances of infection for those without vaccinations and/or immunity. This behavior is sometimes used as an example of the free-rider problem, that occurs when individuals take advantage of a community resource without contributing to the maintenance of the shared resource. The free-rider problem echoes the “tragedy of the commons” scenario, discussed in the Political Geography chapter. Those people with compromised immune systems who cannot be vaccinated must rely on herd immunity to keep from getting sick, making it imperative that those with otherwise healthy immune systems get vaccinated for the good of others.