Analyze

Over half of the neighborhoods in Santa Ana (shown in pink on the map below), California are designated disadvantaged communities (DACs) by CalEnviroScreen, the leading tool for assessing environmental injustice in California. GREEN-MPNA, a community-based organization in Santa Ana, is working to change this through its DAC-X campaign: an action-oriented movement to reduce disadvantage through pollution reduction, health equity, economic justice, and inclusive governance. Aware of the risks of gentrification, the goal is to x-out disadvantage in a way that empowers rather than displaces current communities. The University of California EcoGovLab has worked closely with GREEN-MPNA on the design and development of the DAC-X campaign. The four pillars of the campaign were chosen, in part, because they align with the State of California’s own criteria for designating communities as disadvantaged. DAC-X’s design also draws together a diverse array of advocacy organizations, government agencies and schools working against issues that contribute to disadvantage, knitting together threads of work that often run in parallel. The long term goal is to increase these organizations’ collective capacity to address disadvantage – in a way that recognizes the intersectionalities and cross-scale interactions that produce it. One tactic we have used to advance the DAC-X campaign is the staging of Environmental Justice Stakeholder Meetings that bring relevant governmental agencies together in one room to speak and respond to Santa Ana residents.Thus far, these meetings have focused on pollution reduction and inclusive governance. Going forward, we will continue to grow our network of alliances in Santa Ana by organizing Environmental Justice Stakeholder Meetings to address other pillars of the DAC-X campaign, bringing for example, health equity advocates to the table, or educational institutions that could support workforce development. The DAC-X campaign itself – and this poster – also results from an alliance – between EcoGovLab (Browne, Adams, Fortun) and GREEN-MPNA (Flores, Gutierrez & Rea).

Browne, Aiden, James Adam, Jose Rea and Kim Fortun. 2023. "GREEN-MPNA's DAC-X Campaign for Environmental Justice: Designing for Alliance." In 4S Paraconference X EiJ: Building a Global Record, curated by Misria Shaik Ali, Kim Fortun, Phillip Baum and Prerna Srigyan. Annual Meeting of the Society of Social Studies of Science. Honolulu, Hawai'i, Nov 8-11.

The Emergency Medical Treatment and Labor Act is a law requiring that anyone coming into the emergency department will be stabilized and treated no matter what their insurance situation is. In terms of women's health, it is important to note that this means for active labors, medical treatment is necessary and required, no matter the health insurance of the patient. The purpose of this law to prevent certain patients from being turned away in an emergency situation or refused medical treatments if they are unable to pay, putting their health at risk.

EMTALA was enacted by Congress in 1986 and was part of the Consolidated Omnibus Budget Reconciliation Acts of 1985. Congress saw different cases around America where doctors were refusing medical care to patients who could not make a deposit at the time of their admittance to the ER. An example of this is a patient Eugene Barnes, who in 1985 suffered a stab wound and ultimately ended up dying because 6+ doctors refused to help him without payment or some form of compensation. This made national news and other cases began to come to light, such as at Baptist Hospital in Miami and many other areas. News outlets began to follow these cases and this caught attention of government officials. Shortly after, EMTALA was enacted.

http://www.pitt.edu/~kconover/ftp/emtala-draft.pdf

This policy applies to American law and patients who are in need of emergency medical treatment and is to be followed by all emergency departments and personnel alike. 

This was touched upon a little in a previous question. Many cases of patient dumping were popping up around America. Patients in need  of emergency medical care were being cast aside, ignored and delayed due to their inability to pay. In addition to the stab patient, Eugene Barnes that sparked this law, there were dozens of other cases where patients needed to be transferred to larger hospitals but the hospital refused to take patients without insurance, so the patients died. There were cases of people being asked right before surgery for a deposit, and being unable to pay were discharged with no surgery. There was also a very high rate of dead babies that were arising due to the fact that mothers in labor were being turned away because the patient was uninsured. It was then realized by the government that there were no legal duties for a hospital to treat people who are in emergency situations but cannot pay, only ethical and moral duties, which apparently weren't enough in some cases. This led to the birth of the EMTALA, requiring medical attention to all ED patients as well as transfers if needed to stabilize, including mothers in labor.

This policy greatly helped sculpt emergency medicine and public health. By giving the right to the patient to have emergency medical treatment required without proof of insurance or payment, astronomically influenced the amount of patients being turned away and their possibilty of developing worse illnesses or dying. In a paper I read, a young doctor in the late 70s and early 80s remembers watching a woman in labor give birth in the doorway of the hospital and proceed to borht her child in the parking lot after being turned away for not having insurance. By requiring hospitals and doctors to see that all ED patients get care, no patient was at risk of dying or complicating their baby's health and birth due to a lack of insurance, ultimately increasing public health efforts. Not all hospitals turned away their patients, but enough did to make it a public health concern and get Congress involved. EMTALA changed emergency medicine protocols but also public health expectations and actions.

http://www.hhnmag.com/articles/5010-the-law-that-changed-everything-and…

This policy was explicitly made for vulnerable populations who couldn't afford or for whatever reason did not have health insurance. The vulnerable parties that did not have health insurance were at risk of being turned away at hospitals during crucial times of need and emergency situations. This act completely absolved the worries and fears of this vulnerable population without health insurance by making it a law that these ED patients were to receive care and stabilization. This act was made for this specific vulnerable population, to prevent discrimination.