Courts that look like America: Will gains be lost under Trump?

Courts matter—look no further than President Trump’s “travel ban” executive orders, which have been stalled by federal district court judges in three different jurisdictions and by a three-judge federal appellate panel. And as the public considers the importance of the Supreme Court and legislators weigh Trump’s nominee to it, Neil Gorsuch, many journalists, including those with the New York Times and Washington Post, have sought to determine the possible ideological impact of Trump’s appointments to the lower federal courts.  Considering the 18 vacancies on U.S. Courts of Appeals, Washington Post’s analysis indicates that with the exception of the Second and Third Circuits “Trump’s nominations… will not do much to alter the ideological balance on individual courts.” A Ballotpedia analysis shows that federal judges likely to retire (or take senior status) over the next four years were nominated by a Republican president, “lessening the effect of the resulting vacancies on the ideological balance of individual courts.”

Few analyses, though, are focused on how Trump’s decisions will affect demographic diversity within the federal courts. At the end of Obama’s presidency, the U.S. had hit a milestone: only half its federal judges were white men (as the New York Times vividly displayed in February). Legal scholar Sherrilyn Ifill neatly summarizes why the inclusion of women and people of color in these roles matters:

The first, and I think widely accepted, view is that diversity on the bench promotes public confidence in the legitimacy of the courts. The second reason… is a bit more controversial but I think it is important to discuss it openly. That is the view that diversity on the courts enriches judicial decision-making, that the interplay of perspectives of judges from diverse backgrounds and experiences makes for better judicial decision-making, especially on our appellate courts.

Our nation’s federal courts make rulings on virtually every issue that is important to Americans: immigration, corporate malfeasance, medical malpractice, unsafe products, illegal working conditions, civil rights violations, and environmental pollution to name a few. And because the Supreme Court hears only about 100 of the more than 7,000 cases it is asked to review every year, decisions made by the twelve Circuit Courts of Appeals are the last word in thousands of cases—some 54,000 cases just last year.

It is impossible to know when and how a judge’s life experiences will contribute to deeper and more multifaceted understanding of the facts in these 54,000 cases, though it is not hard to imagine. Studies show, for instance, that when a three-judge panel ruling on sex discrimination cases includes even a single woman judge, the court is more likely to rule in favor of the plaintiff. This effect is present in cases on issues which female judges “possess information that their male colleagues perceive ‘as more credible and persuasive’ than their own knowledge.” Diversity among judges means making our federal courts look more like the country they sit in judgment of and it can enrich decision-making by bringing new life experiences to the bench.

Of course, the 50% mark is important, but it obscures differences by jurisdiction and type of court. For example, white men comprise 59% of sitting federal appeals court judges, but 80% of the Eighth Circuit Court of Appeals judges (the least diverse appeals court in the country). Of the currently sitting 232 federal appeals court judges, 26% are women (among them, President Trump’s sister Maryanne Trump Barry, a senior judge on the U.S. Court of Appeals for the Third Circuit).  It has been some 35 years since women could boast being nearly half of all law school graduates, but we are still struggling to maintain a quarter at the appeals court level. Further, just 10 of the 232 (4% of the total) are women of color, and of those, half sit on just one appeals court—the Ninth Circuit. Of that total 232, 10% (24 judges) are men of color. Five appeals courts have no women of color, and one has no men of color.

Much has been made of Senate Republicans’ refusal to advance the Obama-era nomination of Merrick Garland to the Supreme Court (and Democrats vow to filibuster Gorsuch’s nomination), but many appeals court nominees, even those supported by Republican senators, have languished on the Senate floor, too. Many would have advanced judicial diversity.  They included Rebecca Haywood, who would have become the first African-American woman on the Third Circuit, Jennifer Puhl, who would have become only the second woman ever to serve on the Eighth Circuit and the first woman to be an Article III judge in North Dakota, and Lucy Koh, who would have been the first Korean-American on any Circuit Court.

All this leaves the Trump administration with 18 openings. Two openings in the Eighth Circuit provide an opportunity to improve its “least diverse” standing. The Third and Fifth Circuits both have three openings and no current women of color.

In making its picks to fill these vacancies, the Trump Administration—if it acts according to custom–will be constrained by the Senate, specifically by the views of senators on the Judiciary Committee and the home-state senators where circuit seats are situated.  Specific circuit seats are historically tied to a state within that circuit, and the Senators from those states (most importantly, but not exclusively, those aligned with the President’s party) recommend candidates to the White House for consideration. So, a Senator’s vetting process is crucial for determining the diversity of candidates who will move forward. In Texas, where the Fifth Circuit openings originate, Senators Cruz and Cornyn will use a Federal Judicial Evaluation Committee (with members they have appointed) to vet the six candidates rumored to be under consideration (all of them men).

According to Brookings, “Senate Judiciary Committee leadership says it will continue not processing judicial nominations unless both home-state senators of either party return favorable ‘blue slips’ approving a nominee. Home-state Democratic senators may hard bargain with the administration about nominees, as did Republican senators during the Obama administration, creating more and longer nominee-less vacancies.”  If continued, this “blue slip” process will give Democratic senators some power over appointments, since 12 of the 18 vacancies are in states with at least one current Democratic senator. Two of these 12 vacancies are on the “least diverse” Eighth Circuit, where Minnesota’s two Democratic senators (who both sit on the Judiciary Committee) will have some power to change that statistic.

While the two candidates making the final cut for Trump’s Supreme Court nomination were conventional, conservative white men, arguably bringing little in the way of different life or professional experiences to the Supreme Court, it is not yet clear how the White House will process lower court appointments and who will be influential.  At the Cabinet level, public and legislator pressure was at least partially responsible for the withdrawal of Secretary of Labor nominee Puzder and push-back regarding a Latino-free cabinet may have influenced the choice of successor Alex Acosta. If the public and legislators demand diversity, that pressure could help determine the composition and collective wisdom of our lower federal courts.

Debra Fitzpatrick, Center on Women, Gender and Public Policy, Humphrey School of Public Affairs and Carol Chomsky, Professor of Law, University of Minnesota

— Photo by justwhack

Implications of ACA Repeal and Replace for the Health Insurance Coverage Gap

In 2014, the Affordable Care Act (ACA) expanded Medicaid and established health insurance exchanges for people to purchase private health insurance with subsidies. This led to significant gains in health insurance.  Between 2013 and 2015, the rate of health insurance among non-elderly Americans increased 5.8 percentage points, and an estimated 17.6 million more non-elderly Americans had health insurance.

Gains in health insurance were particularly strong for groups that have had historically high rates of uninsurance, such as people who identify as Hispanic or Latino. If the ACA is repealed and replaced by a Republican health care reform bill, it is widely expected that these coverage gains will erode or be lost entirely. Previous posts to the Gender Policy Report have focused on the impact of the Affordable Care Act (ACA) and its possible repeal on fertility among Latinas, on women’s health care and coverage, and on women and LGBTQ individuals. In this post, we examine gains in health coverage by race/ethnicity with an eye to the potential loss in coverage if the most recent Republican plan[1] to repeal and replace the ACA were implemented. This post draws on SHADAC’s analysis of the National Health Interview Survey and is limited to non-elderly adults (aged 0–64).Hispanics/Latinos, Asian Americans, and African Americans have had the largest gains in coverage since ACA implementation

The populations of Americans identifying as Hispanic/Latino, Asian American, or African American experienced the largest increases in insurance coverage in the period after implementation of the Affordable Care Act in 2013. Rates of coverage had been stable before 2013.

The population of Americans identifying as Hispanic or Latino had the lowest rates of insurance coverage before the ACA and the largest gains in coverage after ACA implementation. After remaining stable from 2011 to 2013, rates of insurance coverage among Hispanics/Latinos increased by 9.3 percentage points, meaning 6.3 million more non-elderly Hispanics/Latinos had insurance coverage in 2015 than in 2013. Asian Americans and African Americans also gained health coverage under the ACA with increases in rates of insurance coverage of 7.2 and 6.6 percentage points, respectively.

The gap in coverage rates between populations of color and whites narrowed historically under the ACA

As shown in Figure 1, all groups experienced increases in rates of coverage. This increase in coverage resulted in a historic narrowing of the gap in coverage between whites and populations of color between 2013 and 2015, with all represented racial/ethnic groups experiencing a reduction in the coverage gap (Figure 2).

The gap between Hispanics/Latinos and whites narrowed the most—4.8 percentage points between 2013 and 2015—though the rate of coverage among Hispanics/Latinos is still lower than among other racial/ethnic groups (Figure 3).

Hispanics/Latinos, Asian Americans, and African Americans gained coverage through programs cut most significantly under ACA repeal and replacement

The ACA’s largest impacts on health coverage came through its expansion of Medicaid coverage to low-income childless adults in 35 states and the creation of tax credits to help low- and middle-income families purchase individual-market coverage. These programs contributed substantially to the narrowing of the gap in health coverage between populations of color and whites.

The recent Republican plan to repeal and replace the ACA makes dramatic cuts to the Medicaid program and its expansion and substantially reduces the size of tax credits to help families and individuals purchase individual-market coverage. If implemented, these changes would likely have a disproportionate impact on individuals who gained health coverage through these new programs or currently rely on the pre-ACA Medicaid program that the Republican bill cuts, many of whom are people of color.

Since 2013, non-elderly Latinos and Asian Americans experienced gains in Medicaid coverage of 4.1 and 3.8 percentage points, respectively. These gains in Medicaid coverage are most likely the result of the ACA’s Medicaid expansion, though some may also come from new enrollment in traditional Medicaid programs (i.e. the “welcome mat” effect). Groups like Latinos and Asian Americans that made larger gains under Medicaid expansion are potentially more vulnerable to losing coverage if that program were to be rolled back as it is in the recent Republican bill (Figure 4).

The recent Republican health reform bill repeals the ACA’s income-based tax credits and replaces them with flat, age-based tax credits. This change would make individual-market health insurance far less affordable for low- and middle-income individuals and families, many of whom are people of color. Non-elderly Asian Americans, Latinos, and African Americans would be more vulnerable to losing coverage under the recent Republican plan, since these groups experienced larger gains in individual-market coverage than whites or individuals identifying with multiple races or with some other race (Figure 5).

Further, while non-elderly Latinos, African Americans, and the population of individuals identifying with multiple or some other racial group experienced significant gains in employer-sponsored health coverage (ESI), they are less likely than whites to have ESI, one of the sources of coverage least affected by the Republican plan to repeal and replace the ACA.

A repeal of the Affordable Care Act would likely widen the gap in rates of coverage between populations of color and whites

The longstanding gap in rates of health coverage between whites and populations of color narrowed substantially since implementation of the ACA (Figure 2). Programs like Medicaid expansion, the health insurance exchanges, and tax credits for purchasing coverage contributed significantly to the narrowing of that gap. If these programs were repealed, defunded, or otherwise rolled back—as they are under the recent Republican plan—individuals who benfited from these coverage expansions would likely lose their coverage, again widening the gap in health coverage rates between whites and populations of color.

– Robert Hest, Graduate Research Assistant, State Health Access Data Assistance Center (SHADAC); Masters of Public Policy Student, Humphrey School of Public Affairs

— Photo by WBUR

[1] All references to the Republican plan to replace the Affordable Care Act refer to the House Bill known as the American Health Care Act as it existed when it was pulled from consideration on the House floor March 24, 2017 after failing to garner the necessary support to pass.


Offshoring: Who is Harmed?

The Trump administration has made opposition to trade and offshoring a hallmark of its economic and social policies. Its “America First” strategy, which President Trump introduced in his inaugural address, paints globalization in especially stark and violent terms: “The wealth of our middle class has been ripped from their homes and then redistributed across the entire world… We must protect our borders from the ravages of other countries making our products, stealing our companies, and destroying our jobs. Protection will lead to great prosperity and strength.” The focus on the destruction of jobs has been central to Trump’s campaign and his early presidency, and appears to be a very targeted message: we are going to save the jobs of white, working class men.

Recent research shows that men are especially aggrieved by offshoring, and my own research shows that white men in particular attach a strong political salience to offshoring regardless of their own economic conditions, but is offshoring really just an issue for men?

When President Trump talks about other countries making our products, stealing our companies, and destroying our jobs, he is referring to the phenomenon of offshoring. Offshoring, sometimes called ‘outsourcing’, refers to the economic phenomenon of jobs being moved overseas. Yet of course this does not literally refer to jobs actually being shipped abroad, as the rhetoric suggests, but instead a natural response to the pressures of global trade. Countries focus their economic energies on producing products they can make relatively cheaply, and import the rest. As a result, the US tends to import many products that use a lot of labor to produce, since labor is less expensive abroad. As we import those products instead of making them here, there is a decrease in jobs here and an increase in jobs abroad.

Popular understanding of offshoring tends to focus on its effects in manufacturing. Offshoring primarily hurts those whose work involves routine and repetitive tasks. [i]  While many occupations fit this description – support roles that can be conducted over the phone or internet rather than in person, especially — the conversation about offshoring most often focuses on jobs in manufacturing. These workers suffer in the form of job losses and lowered wages.

It is difficult to say exactly how many jobs in manufacturing have been lost to offshoring, largely because the same characteristics that make a job vulnerable to offshoring also make it easy to replace with robots.

Yet data from the Bureau of Labor Statistics does show us that there are fewer manufacturing jobs in the US now than there were in 2007, although the big drop in manufacturing jobs happened in 2010, and the number has been steadily growing since (Figure 1 below).

Another thing the data make clear is that manufacturing is a male-dominated field (Figure 2, below). On average, almost three-quarters of manufacturing jobs in the US are held by men. Logically, this would suggest that any job losses that do occur primarily hurt men, and research suggests that white men in particular tend to be affected by offshoring. Researchers have found that white men in areas most exposed to the labor market disruptions caused by trade are especially likely to die by suicide and my own recent research with Andrew Kerner (U. of Michigan) and Brian Richter (U. of Texas) shows that white men feel especially and uniquely aggrieved by offshoring, even when we account for their own economic situation.

Yet what is interesting about the plots of the BLS data is that when manufacturing jobs decreased, the proportion of those jobs held by men actually slightly increased. While this could absolutely be statistical noise, it does suggest that, while more men were hurt by job losses in manufacturing, women may be the long-term casualties. As Figure 2 shows, this small increase in the proportion of manufacturing jobs held by men looks somewhat differently when we look at total jobs: while more men lost jobs when manufacturing employment dipped, they have also accounted for a larger share of the new job creation.

The increase in women working in manufacturing is almost imperceptible on this plot, when viewed on the same scale as men, while employment among men is steadily increasing.

While these plots do not control for other possible explanatory factors and cannot explain why this is happening, they do suggest that job losses in manufacturing – whether due to offshoring or to automation, another likely culprit for the loss of highly routinized jobs – may have disproportionately hurt women. As new jobs have been created in manufacturing, the field may be becoming more male-dominated.

It is also possible – maybe even probable – that the male-domination of manufacturing is why it is such a great talking point for Trump. While it is difficult to disentangle whether his strong support among white working-class men is a cause or an effect of his messaging, that support base is strong and Trump shows signs of continuing to speak to them and address their concerns. While he has made a great spectacle of visiting and “saving” jobs at a Carrier plant in Indiana, or “stopping” automobile factories from investing in Mexico, there have been recent closures and job losses that have gone entirely unmentioned. Retail establishments such as Macy’s, Wet Seal, and Sears have all announced massive closures in recent months, with Macy’s alone shedding 10,000 jobs. Despite this accounting for more job losses than either Carrier or the automobile companies, there has been no mention of “saving” these jobs. And that may well be because the service sector is female-dominated, and the administration does not think women’s work is worth saving.

— Jane Lawrence Sumner is an Assistant Professor of Political Science at the University of Minnesota

— Photo by WolfVision



[i] Owen, Erica. Exposure to Offshoring and the Politics of Trade Liberalization: Debate and votes on Free Trade Agreements in the U.S. House of Representatives, 2001-2006. International Studies Quarterly. Forthcoming.

Owen, Erica & Johnston, Noel P. Occupation and the Political Economy of Trade: Job Routineness, Offshorability and Protectionist Sentiment. International Organization. Forthcoming.


Rehabilitation in Prison?

Educational Programs for Women Prisoners in 2014

The expansion in imprisonment rates in the U.S. since the 1970s is well known. Less well-reported, however, has been the way this expansion affected women. Although a small share of the prison population (7 percent), women’s imprisonment rates grew faster during the prison boom and have seen a slower decline since 2010. By 2015,  over 110,000 women were in prison nationwide—of which, nearly 50% were women of color.[1] Women have unique pathways into and out of prison: women behind bars are more likely to be parents, to have histories of drug use and family trauma, and to be raped while in prison.

Given all of these challenges, it is surprising that there is one area where women prisoners are less disadvantaged than men: educational status.

Paralleling trends in the general population, female prisoners are (slightly) more likely to have completed high school diploma and (much more rarely) college. Still, the vast majority of prisoners have few educational credentials. As of 2004, over 60 percent of state inmates reported that they had not made it past 11th grade.

Below, I analyze data from a new survey of prisoners collected in 2014 by the U.S. Department of Education’s National Center for Education Statistics’ Program for the International Assessment of Adult Competencies (PIAAC). These data give us an updated, and richer, portrait of prisoners’ educational history and current desires for services. Below, I show that women have gender-specific reasons for being pushed out of school before prison, and, once incarcerated, women are less likely to complete educational credentials behind bars.

Both women (and men) desire far more educational and vocational training than they are currently receiving.

In addition, almost no prisoners are participating in the advanced education programs (i.e. Bachelor’s degree) that have the biggest effects on reducing recidivism. Together, the results suggest that states could be doing much more to equip prisoners to succeed post-release, including expanding evidence-based educational programs and providing funding mechanisms like Pell grants to make college affordable for prisoners.

Let’s start with prisoners’ in-prison participation in formal academic education programs.[2] As shown in Figure 1, the PIAAC data show that the most common response was that prisoners had not been able to take any formal academic program since admission. This was particularly true for women—47 percent of women (compared to 41 percent of men) had not advanced academically during their current period of incarceration.[3] Among those that had completed education, the most common programs were high school or GED programs (with men finishing these programs at a higher rate than women).

The emphasis on remedial education and G.E.D. classes behind bars might explain women’s lower participation rates, as they are more likely to enter prison with such credentials. Alternatively, this might reflect more limited programming options in women’s facilities.

The number of inmates participating in higher education was vanishingly small. Under 10 percent of prisoners in men’s and women’s prisons had completed a certificate from a college or trade school. Even smaller percentages—roughly 3 percent—had completed an Associate’s degree or higher credential. These tiny numbers are dispiriting given research shows that higher education is particularly useful for finding work and staying out of prison post-release. In addition, such programming makes prison environments more humane, benefiting both inmates and prison staff.


As shown in Figure 2, these low participation rates are not due to a lack of desire—63 percent of both men and women behind bars reported that they would like to participate in a formal degree or certificate program. Yet less than half of that—21 percent of men and 28 percent of women—were currently enrolled in such activities at the time of the survey. Oddly, these results suggest the opposite gender trend as compared to the earlier results, with more women currently “studying for any kind of formal degree or certificate” but fewer reporting completion of academic credentials since admission. This might reflect women reporting participation in the kinds of soft-skills programs (which can come with a “certificate”) described below or gender differences in length of program engagement and/or completion rates.

In addition, the PIAAC data allows us to study why prisoners stopped their schooling prior to incarceration—in other words, why are prisoners’ educational trajectories so truncated? As displayed in Figure 3, the most common response for both men and women was that they wanted to work. Men were significantly more likely to report ending school because they were locked up (20 v. 12 percent) or expelled (9 vs. 5 percent), suggesting that men are much more likely to stop education due to criminalization. Women, in contrast, were more likely to be pulled out of education due to family and care-taking responsibilities, including illness or death of loved ones (11 percent) and pregnancy or other health issues (15 percent). These results echo the concerns of other scholars about the gendered barriers disadvantaged young people face in completing their education and the increasing criminalization of young people of color in schools.

Finally, academic programs do not represent the full range of education programs in prison. Most commonly, inmates participate in “soft-skills” training to prepare them for re-entry, including life-skills, job readiness, and vocational training. As shown in Figure 4, just under half of men and women behind bars have participated in reentry and vocational training programs since admission. In addition, classes specifically focused on parenting are especially common among women—25 percent of women (vs. 15 percent of men) reported participating in child-rearing classes since admission. However, these programs have a poor track record of improving outcomes for returning citizens.

Together, these findings suggest that men and women face many similarities in the dearth of supportive in-prison programming, a high level of forced disengagement from schooling early in life, and a desire for meaningful educational programs inside of prison. Not surprisingly, the starkest differences emerge in response to gendered care-taking responsibilities, with women more likely to quit school for family reasons and to be engaged in parenting classes behind bars. These issues will take substantial policy change to address, but we can start by reducing the incarceration rate and spending more on those who remain behind bars. In particular, prisons should offer the kinds of supportive services that improve prison environments and help prepare prisoners to return to their families and communities. The re-opening of Pell grants for prisoners at the end of President Obama’s second term in office was a promising step in the right direction. As groups (including those on the right) continue to campaign for President Trump to continue the momentum on criminal justice reform, education programs should be a core tenant of proposals to both reduce imprisonment rates and make conditions in prisons more humane.

 — Michelle S. Phelps, Departments of Sociology and Law, University of Minnesota


Thank you to Ryan Larson for producing the graphics accompanying this post.

Photo by Matthias Müller


[1] Descriptions of “women’s” or “men’s” experiences are based on the gender designation of inmates’ facility. Transgender prisoners may be placed in gender-affirming or gender-contradictory facilities, depending on states’ policies.

[2] For details on the PIAAC question wording and how I create the outcome categories displayed in the figures, refer to the footnotes at The Society Pages.

[3] This difference is statistically significant at the 10% threshold. The PIAAC has less than 300 respondents from women’s prisons so differences must be substantively large to achieve statistical significance. Differences reflected in the text are statistically significant at the .10 cut-point unless otherwise noted.


Beyond the Wall

Since November there’s been an upsurge in local, national and international marches where protestors carry signs that read: “Build Bridges, Not Walls.” They are responding, of course, to the Trump Administration’s long-promised Border Wall.

And they are reiterating something scholars already know: even where there are border walls, creative community building, so often spear-headed by women, easily blurs boundaries.

The U.S.-Mexico border we know today was formed out of two moments, the 1848 signing of the Treaty of Guadalupe Hidalgo between the U.S. and Mexico (which designated the Rio Grande river as the official border separating Texas and from its southern neighbors) and the Gadsen Purchase, which, in 1853, established the rest of the dividing line. Not only a geographic boundary, the border became associated with a set of practices of inclusion and exclusion affecting those on both its sides.

Still, Mexicans were not immediately or irrevocably “othered” by the U.S. government.

Mexican workers provided necessary labor for U.S. manufacturers, both within the U.S. (where they worked as conquered labor, migrant labor, and as “guest workers”) and in Mexico (in maquiladora assembly plants). It took a 1970s-era recession to spur a stronger stance against Mexican immigration to the U.S., with the Immigration and Naturalization Service (now known as Homeland Security) specifically citing such migrants as national security threats. Explaining economic problems as a consequence of unauthorized migration and employing the language of “invasion,” even then CIA director William Colby would claim that population growth south of the border would mean “120 million Mexicans” by the end of the century and a Border Patrol without “enough bullets to stop them.”

Similar fears are employed today, as the administration looks for ways to slash budgets so as to fund President Trump’s wall. Of course, there is already a border wall that crosses 653 miles of the 2,000-mile stretch separating Mexico and the U.S. Economists peg its cost at $7 billion, and estimate that Trump’s proposal will cost another $25 billion (excluding labor costs). No one is truly able to account for how this wall will be handled on privately owned land or in Texas, where the Rio Grande flows, but these details are cast aside. Natural obstructions haven’t stopped the Border Patrol before, after all—in the stretch of border between San Diego and Tijuana, for instance, the Surf Fence project granted $4.3 million on behalf of the Patrol to erect a barrier stretching 300 feet into the Pacific Ocean.

Goods and capital are freely allowed to cross; the border is designed to obstruct, control, and regulate the movement of people, of labor.

In heated rhetoric, U.S. citizens are told that border security is about violence, crime, economics, and the drug war. Women and children are victims (though not blameless ones) and border dwellers are simply collateral caught in sometimes-literal crossfire. Where statistics show a doubling in migrant deaths in the last 20 years, government spokespeople and media report on the “unintended consequences” of border militarization. From a human rights perspective, the wall and its construction have already violated international norms, including the rights of indigenous peoples, the right to private property, and the right to non-discrimination. This is all, it would seem, the collective cost of U.S. safety.

The reality is that 82 million people call the borderlands home. They survive, even flourish. And women are central agents, not victims, in this setting.

In my ongoing research just across the U.S. border in Maclovio Rojas, I have met women, like Hortensia Hernandez, who assume leadership roles to fight for community well-being and lead their neighbors in building their own schools, sports fields, and public services in an area where neither the U.S. nor Mexican government seems willing to help.

And in Tijuana, a majority-female workforce toils long hours for low wages in the factories of multinational corporations.

Women there have created cross-border alliances with activists in the U.S. to try to improve their working conditions. Their American counterparts show their support by, for example, protesting in front of the homes of factory owners who live in the U.S. Such transfronteriz@ organizing transforms “us versus them” divisions into a movement recognizing that we are all workers with entwined destinies.

The borderlands include both U.S. and Mexican territory, U.S. and Mexican citizens and nations of Indigenous peoples. They represent a site of resistance, conviviality, agency, and creative community building. This is a space in which transformative politics not only can but already does take place.

The health of both countries’ economies, so reliant on the cross-border construction and sale of goods, and the health and viability of borderlands communities will be immeasurably impacted whether the Trump Administration’s wall comes to fruition.

Politicians, corporate leaders, and borderlands residents must come together—like so many autos built with U.S. parts in Mexican factories—to fashion not only steel walls but also humane policies if the people and economies of both countries are to flourish.

Michelle Téllez, Assistant Professor of Mexican American Studies at the University of Arizona.

Safety Implications of Regulatory Rollback at the FDA

Prescription drugs in recent years have experienced breathtaking price hikes and occasionally have proven dangerous after they have gone on the market. What is happening with these issues since the Trump administration took office? For one, President Trump announced recently his intention to roll back FDA regulations as much as 75%.  Scott Gottlieb has just been named Trump’s choice to lead the FDA, and he as well as the other two candidates, Jim O’Neill and Joseph Gulfo, called for streamlining regulatory procedures. Jim O’Neill even called for drugs to be tested only for safety.

Once marketed, individuals can take new drugs “at their own risk” and thereby prove – or disprove – their effectiveness.

All adults as they age are more likely to take not just more drugs but drugs for both acute and chronic conditions. These individuals, with few exceptions, take prescription medicines because they need them to stay alive, to manage conditions adequately enough to be functional, or to dull chronic or acute pain. Taking drugs for them is not a choice—they have no option but to “take the risk.” Under O’Neill’s plan, prescription medications intended for life-threatening conditions could end up killing these people if they turn out to be ineffective, an outcome that is all too likely given that an average nine out of ten new drug candidates prove unsuccessful.

Furthermore, the need to take such unsafe risks is not spread evenly across the population.

Lower income individuals, although they do not take more prescription drugs than higher income individuals, suffer from higher rates of chronic and life-threatening diseases. They, then, would be impacted the hardest.

Though data on gender is not plentiful, one 2014 study found that out of a sample of approximately 30 million individuals, women overall are more likely to use prescription drugs than are men, with 67.5% of women utilizing prescription drugs versus 58.9% of men. In the 18-44 age group the difference was even greater, with 64.1% of women versus 48.6% of men utilizing at least one prescription drug. Women also overall took a higher number of prescription drugs, 5 on average versus 3.7 for men.

These statistics evidence the fact that, though everyone who takes prescription drugs is at risk of regulatory rollbacks – and in the space of a lifetime, this includes most people – women are at more risk given the higher number of prescription drugs they consume.

Frighteningly, despite being prescribed more drugs, women are less frequently given the clinically recommended medications for particular . For example, they are less likely than men to be given the recommended medications for cardiovascular disease or diabetes. Women with histories of coronary artery disease receive cholesterol-lowering drugs at significantly lower rates than men with the same history – 59% vs. 71.5%. Down the road, this could mean that women are at higher risk of inadequately-managed coronary artery disease, while men receiving the latest cholesterol-lowering drug or beta blocker will be at higher risk of adverse reactions from inadequately tested new pharmaceuticals.

One potential reason for Trump to trim regulations is to speed the approval of drugs, something that on the surface seems like a good idea. The faster a new drug can be approved, the faster it can get to market and to the people who need it. And indeed, it takes a long time to get a new drug approved for market: an average of eight to twelve years.

Yet, the current approval process emerged for a reason: it was implemented and revised in response to preventable tragedies arising from unsafe drugs.

The original Pure Food and Drug Act of 1906 was strengthened in 1938 when an anti-infective elixir called Dr. Massengill’s Elixir Sulfanilamida killed 107 individuals. Public fear resulting from these deaths led Congress to pass a bill that strengthened labeling of food, drugs, and cosmetics, and also gave the FDA greater power to seize products. The thalidomide tragedy, when hundreds of babies were born with no or underformed limbs to women who had taken thalidomide during pregnancy, prompted Congress to pass the 1962 Kefauver-Harris Amendments. These Amendments, among other things, enabled the FDA to prevent new drugs going to market, and created the three-phased, randomized controlled clinical trial structure required today for thoroughly testing a drug’s safety, dosing, and efficacy. With the AIDS epidemic, the FDA created a fast-tracking mechanism to get drugs approved more quickly in urgent circumstances. This concession came only after intense and consistent campaigning by early AIDS activists tired of seeing hundreds die while new pharmaceuticals were showing the promise in early-phase testing of keeping them alive.

Though certainly not infallible, the FDA’s current set of regulations and procedures for drug and new device approval are there for good reason: there is little doubt they succeed much of the time in shielding the public from the worst consequences of what can happen when drugs, vaccines, or devices are not properly vetted.

Indeed, in a report released last year, the FDA noted twenty-two drugs that had shown promise in early-stage testing (which tests for safety) but had failed late-stage, Phase III testing (which tests for efficacy while continuing to test for safety). Seven of these twenty-two failed to prove either safety or efficacy in Phase III trials.

Returning to the question of time to approval, expedited approvals themselves, once the exception at the FDA, are now becoming more the norm. A recent article from The New England Journal of Medicine shows that in 2013 more than 60% of new drugs were fast-tracked through the approval process. In addition to the AIDS drug-related fast tracking program, the FDA now has four more programs enabling pharmaceutical companies to receive expedited approval for drugs, for example, for rare diseases, breakthrough therapies, and even for antibiotics. Yet as the authors of the NEJM article note, this is not necessarily a good trend. Expedited review is typically intended for patients with urgent conditions who have no other options, and as such, the FDA requires less evidence of safety or efficacy for these therapies.  For that reason, though, the expedited review is often time-limited and approval granted contingent upon a promise of further testing even while making the expedited drug available in humanitarian cases. Nevertheless, given the FDA’s wide latitude in defining what qualifies for expedited approval, pharmaceutical companies are increasingly fast-tracking drugs because it means earlier time to market, not because it means saving more lives.

There is also little doubt that in recent years the FDA has come under fire for long delays in drug approval that are not related to testing, but rather to how long it takes new drug, vaccine, or device applications to wind their way through the approval process.

One of these problems is due to the vicissitudes of funding that the FDA, like all federal agencies, experiences with changes in administration. As noted by one commentator, there are about one thousand vacant seats at the FDA right now, which inevitably has to cause delays.

Despite this barrier, the FDA set a goal to approve standard new drugs within ten months, and expedited drugs within six.  For 2016, they met that ten-month average goal, and almost met the priority approval goal. In contrast, in 1993 average times to approval were twenty-seven and twenty months, respectively. Now, however, Trump has issued a hiring freeze, which is likely to undermine this progress.

Rolling back regulations at the FDA would not accomplish the efficiency that Trump wants. On the contrary, slashing the budget would ensure that seats remain empty and that more become empty, resulting in fewer experts to make the approvals still necessary even with regulatory reductions, and consequently, longer approval times. Fewer regulations would put individuals at vastly higher risk when consuming new pharmaceutical drugs and vaccines or utilizing new devices. These risks could be relatively minor, but they could also be catastrophic.

To add such significant safety risk to prescription medications inadequately tested before marketing is inhumane; it treats individuals as guinea pigs while the risk of injury is unevenly spread by income and by gender.

No one needing prescription drugs would be spared the unconscionable risk entailed in allowing new drugs, vaccines, and devices to be marketed with little testing, and equally little knowledge about whether they are safe or effective. The one optimistic note here is that several pharmaceutical companies themselves have pushed back on Trump’s recommendation. They note the uncertainty this would lend to the FDA and its approval system, and cite as well the safety issues that would inevitably result. If the pharmaceutical industry doesn’t even want rolled back regulations, why should Trump?

Susan Craddock, Acting Director, Center for Bioethics; Professor, Gender, Women and Sexuality Studies and the Institute for Global Studies, University of Minnesota

— Photo by Meghana Kulkarni