Wednesday, November 22, 2017

Receive, Give Thanks, Give…

Thanksgiving is a holiday that is celebrated around the world, in places as diverse as Canada, the Caribbean, and Liberia. As a national holiday in the United States, it is celebrated annually on the fourth Thursday of November.

The historical origins of this holiday involve "giving thanks" to the Divine for a bountiful harvest and the blessings of the year that is ending. The holiday’s origins also include English traditions dating back to the Protestant Reformation that emerged as a reaction to the large number of religious holidays in the Catholic calendar.

In the United States, the Thanksgiving tradition dates back to 1621, to Plymouth in today’s state of Massachusetts, where members of the Wampanoag tribe helped 102 pilgrim colonists by giving them seeds and teaching them how to fish. Over time, this celebration has become one of our most anticipated and joyous holidays.

Historical evidence suggests that, in other present-day American places like Texas, Virginia, and Florida, similar ceremonies of "thanksgiving" were celebrated, some by Spanish explorers, even before that first Thanksgiving in Plymouth in 1621.

The common thread, of course, is gratitude – the emotion that is aroused when we recognize and appreciate in everything that is, in everything we have, and in everything that surrounds us, the goodness of life. Gratitude is the recognition and appreciation of all that is given by and received from a loving and transcendent presence that we call God, or from those who are dearest and closest to us, or from so many who anonymously contribute to the greater good.

For this reason, we can say that gratitude is an essential, original, and spontaneous emotion, corresponding to the grace and benevolence of God and of life; it is gratitude that encourages and gives us strength to continue living, trusting, loving, and sharing.

Gratitude is an emotion inherent in human nature that produces in us the joy of living, waiting, and sharing "without cost, what we have received without cost" (Mt 10:7-15).

THANKSGIVING DAY is, therefore, a deeply human celebration that gives us the opportunity – together with those most beloved to us – to acknowledge how much we have to be thankful for and how much we can give on a personal, family, social, and national level.

The historical achievements of this Nation, earned through the labor and perseverance of its inhabitants, have made the United States the most prosperous country on earth. Today, we enjoy a very good quality of life compared to many other countries. This opportunity for prosperity has made the United States a safe haven, a beacon of light or land of promise to which so many men and women came and continue to arrive in search of a better life and who, with their cultural wealth and labor, enhance the present and future of this Nation.
The greatness of this Nation depends on, and will always depend on, our common purpose to care for and give thanks for the inheritance that we received from those who preceded us on this soil; while we must work to create the legacy we will leave to future generations, hoping that those who are born here and those who come here will continue to find reasons to give thanks, to love, to share, and to wait... Our greatness today compels us to care for our values, nature, institutions, and the current social infrastructure so that future generations may also experience gratitude.

Recognizing that we have so much to give thanks for, we are compelled - at the same time - to give, to share, to serve, to be supportive so that those most in need in our society and in the world have the opportunity to give thanks. Thus, gratitude becomes a permanent celebration and, above all, an everyday, common, and national attitude.


Thursday, November 2, 2017

How to fix Obamacare

HEALTHCARE advocates for the poor let out a collective sigh of relief when attempts to repeal the Affordable Care Act (ACA) went down in flames. But the story is far from told. Legislators on both sides of the aisle agree that Obamacare, as the ACA is better known, needs significant re-engineering to become economically sustainable.

Criticism, particularly on the part of conservative legislators, is focused on the cost of the plan’s expanded Medicaid provisions. The critics have a point. The established administration of Medicaid-funded healthcare is inefficient. By some estimates, waste and corruption cost U.S. taxpayers close to $140 billion a year, some 12 percent of the program’s total budget.

Lawmakers eager for a solution need look no further than a revolutionary Medicaid reform program in New York State, designed by state Medicaid Director Jason Helgerson and championed by Gov. Andrew Cuomo, who secured $7 billion for the five-year initiative. It’s called the Delivery System Reform Incentive Payment (DSRIP) program. 

This jargon-laden moniker obscures a highly innovate formula for healthcare reform. Gone is the traditional fee-for-service Medicaid model that compensates the health care provider for tests, office visits, and procedures. In sharp contrast, DSRIP shifts to a value-based payment (VBP) model in which the doctor or healthcare system is paid according to the long(er) term health outcome for individual patients.

It makes sense! Health care providers are rewarded for keeping patients healthy. This means the provider—in keeping with the medical calling, it should be added—invests time and energy in comprehensive, holistic, preventive care – ensuring patients follow medical directives, take their medicines, keep their appointments. Suddenly, the patient is at the center of the equation.

At the end of its five-year run, in 2020, DSRIP is on target to reduce unnecessary hospitalizations by 25 percent, which will represent a savings to New York State taxpayers of $12 billion. Reducing avoidable emergency room visits and hospital stays is precisely the fruit of comprehensive, holistic care. Today, it is all too common for Medicaid patients to fall through the cracks and wind up in the ER at great cost to the system not to mention the patient. Let us not forget that we are talking about real people, human beings whose illness and suffering carries its own, often-overlooked cost.

At this writing, the DSRIP program—after 30 months of laying the foundation of a complex infrastructure of clinical care models and performance measuring tools—has entered the second half of its five-year mandate. Since April 1, all 25 so-called Performing Provider Systems (PPSs) are being measured by the state according to performance targets and clinical outcomes. Encouragingly, in the first two years of the program, PPSs earned 95.78% ($2.53 billion of a possible $2.64 billion) of all funds.

It is important to note that NYS Medicaid Director Helgerson’s vision goes beyond the strictly medical and behavioral health factors that determine the well-being of a Medicaid recipient. His goal for healthcare transformation is to also address the social determinants of health. He asserts that successful, long-term reform of the Medicaid system means that, as he put it, the “healthcare sector must embrace a broader role in the communities in which we serve.” 

Research has amply shown that non-medical factors have a significant impact on a person’s health. For the bulk of vulnerable and poor Medicaid recipients living in urban settings, social or environmental conditions have a huge effect on physical and mental health: poor living conditions, pollution, crime, unemployment, lack of access to healthy foods. The list goes on.

The U.S. lags significantly on this front—even though it is very clear that neglecting social determinants of health is costing the country billions of dollars a year. In Helgerson’s vision, the primary care physician, the neighborhood doctor of old, is at the center of a coalition of service providers with expertise to address the gamut of a patient’s needs, medical and otherwise.

One notable stumbling block is the relative shortage of primary care physicians, particularly in lower-income areas. Across the board, less than 30 percent of U.S. physicians provide primary care, compared to well beyond or close to 50 percent in Canada, France, and Germany. Millions of Americans lack access to a primary care doctor, the very person who could play a central, comprehensive role in their health and well-being.

On this score, Advocate Community Providers (ACP) stands out as the only physician-led PPS in New York State. ACP’s vast network of 3,500 providers includes 1,400 Primary Care Physicians and 1,700 specialists who practice in the Bronx, Brooklyn, Manhattan, and Queens. What’s more, many live and work in the same neighborhoods as their patients—patients with whom, in many cases, they share the same ethnic background. Cultural competence is strongly emphasized by the DSRIP protocol and strongly embraced by ACP.

These neighborhood doctors know their patients intimately and understand the social and environmental factors that impact the household. They are committed to the comprehensive well-being of their patients, their families, and the communities at large. This rehabilitation of the role of the family doctor is driven and encouraged by the Value-Based Payment model, as it promotes a holistic approach to healthcare reform.

Such could be the next chapter for America’s healthcare reform, with individual states or the federal government adopting a Value-Based Payment formula to improve the quality of Medicaid care, even as it reduces waste and fraud. Making the considerable investment in a nationwide DSRIP program has the potential of truly enormous savings down the road—savings that in turn could keep Obamacare premiums for non-Medicaid insureds in check. Such radical reform should be able to garner bipartisan support.

Finally, to dream even bigger, why couldn’t the for-profit insurance companies who are part of the Affordable Care Act work with their providers and also introduce—not to say enforce—a Pay-for-Performance formula? Monies spent in the best possible way and savings achieved will benefit all parties—patients, first and foremost, but also providers, insurance companies, and the government. For the business-minded party in charge of the Administration and Congress, truly smart reform of Obamacare at all levels should be a no-brainer.

Wednesday, November 1, 2017

Comprehensive, holistic care will keep Medicaid patients healthier

It is the story of summer 2017 and a nation’s differences are laid bare as Congress struggles to formulate an acceptable law to replace the Affordable Care Act. Are the proposed replacements “mean,” or do they not go far enough? How do leaders reconcile the practical drive to slash the nation’s public health care budget with the repugnant (and politically unattractive) prospect of leaving at least 22 million fewer Americans without health insurance coverage?

How do legislators come to terms with proposed Medicaid cuts that would jeopardize health care for more than 70 million people—among them children, the elderly, people with disabilities and pregnant women—by 2026?

There is no doubt that health care expenditures in the United States need to be curbed; compared with other industrialized nations, we spend the most per capita but deliver inferior care. Medicaid as we know it has been prone to waste and fraud. However, simply cutting the health care budget will only worsen the situation for those at the lower rungs of society. These are the men, women and children our government is dutybound to provide for, and to do it well.

True reform—a goal apparently lost in the partisan bickering—would be to get smarter about exactly how health care dollars are spent, so that costs can decrease even as the quality of care improves.

A revolutionary experiment underway in a handful of states is aiming to do just that. California, Kansas, Massachusetts, New Jersey, New York, Oregon and Texas have authorized versions of the Delivery System Reform Incentive Payment program. At its heart is the value-based payment formula, which stipulates that health care providers are compensated based on their patients’ longer-term health outcomes rather than the volume of services provided (that is, transactions such as office visits and tests).

The D.S.R.I.P. model—executed in New York State by 25 performing provider systems (also known as P.P.S.’s)—incentivizes health care providers to keep a close eye on their patients’ progress, monitor adherence to medical directives, assess mental health factors and empower patients to self-manage chronic conditions. The objective is to prevent 25 percent of unnecessary hospitalizations, which, at the end of the program’s five-year mandate, is projected to save New York taxpayers $12 billion.
Imagine such a strategy implemented in all 50 states; the Affordable Care Act’s drive to cut Medicaid spending could be achieved even as the quality of care improves. This is truly the best of both worlds, satisfying both patient advocates and budget hawks.

The visionary behind D.S.R.I.P. is Jason Helgerson, the Medicaid director of New York’s Department of Health, who passionately argues that we must take into account the social determinants of health as well as a patient’s medical condition. On this score, the United States lags behind other developed nations that recognize the significance of these factors in providing health care to the poorest citizens.

Social determinants include patients’ housing situations as well as their economic, employment and educational status. In many cases, they are also affected by the criminal justice system. These nonclinical issues directly impact physical as well as mental health, and they should be taken into consideration as part comprehensive health care designed to produce lasting results.

Case in point: A recent briefing for P.P.S.’s by the New York State Department of Health on housing issues reported that indigent households often choose to pay rent over buying food; this is a practical decision but one with serious health implications, particularly for young children. Rent and housing instability is shown to put mothers at a 200 percent higher risk of depression. There is also the impact of mold, lead paint and pest infestations. As a recent study by New York University’s Furman Center showed, an increase in “poverty concentration—the extent to which poor New Yorkers are living in neighborhoods with other poor New Yorkers” compounds the impact of a troubled housing situation as a social determinant of health.

In the vision of Helgerson—who likens the D.S.R.I.P. model to a start-up driven by venture capital—the neighborhood-based primary care physician becomes a true community leader who engages local leaders and activists in the areas of housing, employment and education to form community action teams. Their mandate is to make comprehensive resources—both medical and nonmedical—readily available to the poorest Medicaid patients in order to ensure their long-term flourishing.

Comprehensive, holistic care is the solution to keeping Medicaid patients healthier, taking control of chronic illnesses and avoiding expensive emergency room visits and hospitalizations. Such comprehensive care is commensurate with respect for the human dignity of each and every human being. Our nation’s political leaders should commission research into the social determinants of health and refocus their attention on health care reform that provides states with incentives to being truly smart and innovative in how public health care funding is spent. Billions of dollars can be saved while millions of lives are lastingly improved.

Tuesday, October 31, 2017

Health of Latinos in New York City gets mixed scorecard

THE NEW YORK CITY Department of Health and Mental Hygiene just issued its first-ever report on the state of mental and physical health of the city’s Latino population. Some 2.4 million strong—and representing more than 20 countries of origin—Latinos account for almost one-third of the city’s population. Puerto Ricans account for 30 percent of the Latino population, with Dominicans and Mexicans forming the next two largest contingents. 

The report notes that a disproportionate number of Latino New Yorkers live in poverty — more than half compared to one-third of non-Latinos. Far fewer Latinos earn a high school diploma or go to college. More than 50 percent of Latinos in New York spend more than 30 percent of their monthly income on rent, leaving insufficient funds for food—particularly healthy foods, like fruits and vegetables—clothing, and health care.

As a result, many thousands of Latinos live in conditions and confront circumstances that are impediments to good health and access to quality healthcare.

One of the report’s most surprising findings is that Latinos as a whole have a lower premature mortality rate than non-Latinos. Specifically, when it comes to the leading causes of death—heart disease, cancer, and the flu—Latinos have lower death rates than New York City’s non-Latinos. The study also reveals that Latinos are less likely than non-Latinos to smoke and are more likely to have a mammogram and flu shot. This is where the good news ends.

Sad to say, some 22 percent of Latinos do not have health insurance, compared with 9 percent of non-Latinos and 13 percent of all New York City residents. Compared with their fellow New Yorkers, Latinos are more prone to suffer from chronic conditions such as obesity and diabetes.

Nearly one-third of Latinos are obese, compared to 20 percent of the rest of the city’s population, while 17 percent of Latinos struggle with diabetes—and many end up dying from the disease—as compared to just 10 percent of non-Latinos. As measured by Latinos’ reports of mice and cockroaches in the home—which, the report says, are “known asthma triggers”—more than 50 percent of Latinos are at risk of asthma compared to 31 percent of non-Latinos.

Illustrating cultural differences across the Latino communities, the study shows that Puerto Ricans are more likely to have negative health-related outcomes. Puerto Ricans are outliers in terms of smoking ¬ – 25 percent report smoking vs 12 percent for Latinos overall and 15 percent for non-Latinos – and are more likely to consume one or more sugary drinks per day, which is a key contributor to obesity. The prevalence of asthma among Puerto Ricans is nearly three times that among non-Latinos in New York City.

The study also found that Latino immigrants who have lived in the U.S. for more than 10 years are more likely to suffer from “adverse outcomes” in health when compared to Latinos who have immigrated more recently. What’s more, U.S.-born Latinos are more likely than Latinos born abroad to consume one or more sugary drinks per day. This finding too calls for further investigation to explain this striking and curious discrepancy.

Given the report’s findings, it is obvious that healthcare providers responsible for serving the Latino community of New York City must take into account a host of environmental, cultural, social, as well as mental and emotional factors, in addition to strictly medical considerations. It is clear that the bulk of Latinos are eligible for the provisions of Medicaid. Yet, that system as it has been functioning traditionally has been falling short.

A unique experiment underway in New York State is offering hope. Launched in 2015 with a five-year mandate, the Delivery System Reform Incentive Payment (DSRIP) program is moving Medicaid-provided medical care away from a fee-for-service model and toward a Value-Based Payment (VBP) system. The DSRIP objective is to save New York State tax payers billions annually through a reduction by 25 percent of unnecessary hospitalizations.

That goal can be reached by keeping patients healthier in the long-run—and patients are kept healthier thanks to a closer relationship with, in particular, their primary care provider, a bond that is developed, nurtured, and encouraged by the VBP system. That system incentivizes doctors—aided by their staff and Community Health Workers—to keep closer track of their patients, to get to know them better, to take an interest in their family life, their living conditions, their job status, their economic condition; in short, to become familiar with the totality of their circumstances.

The new research indicates that fewer Latinos (76 percent) report access to a primary care provider than non-Latinos (87 percent), with only 57 percent of Latinos of Mexican decent reporting such access.

Cultural competence is a key requirement for the 25 so-called Performing Provider Systems (PPSs) in New York State operating under the DSRIP mandate. Among them, Advocate Community Providers (ACP), operating in New York City—and serving in particular Latino, African American and Asian communities—is the only physician-led network, in contrast with the other PPSs that are hospital system-based corporations. A majority of ACP doctors work in the very neighborhoods where their patients live; and they often share the same cultural background and speak the same language. Those factors make possible the establishment of an authentic, intimate patient-doctor relationship.

Through DSRIP, these neighborhood physicians are transforming their practices to deliver better quality, more efficient, more comprehensive care – which is essential to closing gaps in access to care in underserved communities. The vision is that primary care providers—a new, contemporary iteration of the old-fashioned family doctor who is easily accessible to all people in the neighborhood—have a chance to delve deeper into the lives of the people care for. They can discover, for example, what kind of cultural factors distinguish Puerto Ricans from other Latinos, cultural predispositions that make for certain behavioral patterns that can adversely affect people’s health. These predispositions, or cultural nuances—can be addressed, probed, even corrected, just as behavioral or cultural traits among recent Latino immigrants that are beneficial for health can be examined and held up as a model for other Latinos.

It is to be hoped that the Report — “Health of Latinos in New York City”—will encourage city and state officials to examine still more closely all the determinants—social, medical, and cultural—that affect the health of New York City Latinos and, in future, the factors that impact the state of health of other minority and population groups in the city.

Genuinely close attention paid to the health and wellbeing of people – rather than patients who by definition are ill in some way or another – is the hallmark of truly smart healthcare. The future of healthcare reform will be smart in the sense of data-driven intelligence fueled by carefully kept, comprehensive individual Electronic Health Records—as well as smart in the purely human sense, in the form of both a common-sense and more studied understanding of what make individuals behave the way they do, what circumstance they must cope with, and how their health benefits or suffers as a result.

Thanks to its visionary leadership and in collaboration with New York State Department of Health officials, ACP has begun laying the groundwork to continue to support this network of independent physicians even after the DSRIP program ends in March 2020 through a for-profit entity, called, appropriately enough, Somos, Spanish for “we are,” or rather: “we stand, as in ”we stand with the poor.”

For the sake of the common good, the unique, transformative, indeed revolutionary DSRIP formula—that turns doctors into community leaders—simply must find a way to continue in a sustainable, commercially viable way.

Click here to download a PDF of the report.

Monday, October 30, 2017

In Chile, the world’s first mobile shelter for the homeless makes its debut

A HIGH-RANKING Vatican official, known to be a conservative in doctrinal matters, recently confided to a visitor that—even as Pope Francis continues to come under fire for a perceived lack of clarity when it comes to Church teaching—what really is winning him over is the Pope’s steadfast love of the poor, his insistence that a Christian’s first duty is to love his or her neighbor who is suffering.

This duty to love the poor—the mentally or physically disabled, the outcast, the stranger, the homeless, the person at the margin of society—was the theme of Pope Francis’s first Apostolic Exhortation, Evangelii Gaudium, the “Joy of the Gospel.”

“Works of love directed to one's neighbor,” the Pontiff wrote, “are the most perfect external manifestation of the interior grace of the Spirit… [and] there is an inseparable bond between our faith and the poor. May we never abandon them.”

More and more, local Churches around the world are taking their cue from this papacy’s deeply pastoral emphasis, developing more programs that allow those who have much to share their bounty with those who are deprived.

On that front, Archbishop Fernando Chomali of Concepción, Chile has launched a unique initiative: a mobile shelter—called Alberguemóvil La Misericordia, the “Mercy Mobile Shelter.” The archdiocese raised money from local businesses, automotive designers,
 and trade unions to outfit a passenger bus with four beds, a couple of showers, and other amenities. The mobile shelter pulls up every evening at the city’s Independence square and opens its doors for the homeless.

Volunteers make sure the visitors are taken care of and graciously received into an atmosphere that treats them in accordance with their human dignity, offering them kindness and respect. “More than providing a service,” said Archbishop Chomali, “we deliver dignity.” He insists that the unique mobile shelter is not merely a “favor” to the city’s homeless, but that it represents “a labor of justice.”

He continued: “They say that we are a developed country, but there are people on the street,” and it is a Christian’s duty to make up for the gap that separates rich and poor. That perspective echoes Pope Francis’ insistence that, ultimately, the Church is called to help “eliminate the structural causes of poverty and to promote the integral development of the poor.”
That major effort, says the Pope, goes hand-in-hand with “small daily acts of solidarity in meeting the real needs which we encounter.” The Mercy Mobile Shelter does its part and does so remarkably effectively. One of the mobile shelter volunteers, Natalia del Pino, a university student, said that the shelter team welcomes the homeless “with simple warmth,” adding that “it’s not hard to enter.” Undoubtedly, the Mercy Mobile Shelter will be a particularly strong draw on cold nights.

Luz Clarita, who takes advantage of the shelter’s hospitality, reports: “Here, they tell us stories. And they listen to us.” Ana, another visitor, stresses: “we feel very fortunate and give thanks to the Archbishop.” A local news show reported that the Mercy Mobile Shelter “connects a great number of people who are ready to help” with homeless men and women, who are “seeking just a few hours of comfort, a hot shower and some sleep.”

The concept of a mobile homeless shelter may well catch on in major cities across Chile and beyond its borders. One can even imagine such an approach in major urban centers in the United States. The Mercy Mobile Shelter also has great symbolic value in impressing upon passers-by to do something personally to relieve the plight of the poor.

Again, as the Pope has written, “almost without being aware of it, we end up being incapable of feeling compassion at the outcry of the poor, weeping for other people's pain, and feeling a need to help them, as though all this were someone else's responsibility and not our own.”

The Pope makes the case that, as the poor “know the sufferings of Christ … [we] need to let ourselves be evangelized by them.” In Concepción, Chile, the Mercy Mobile Shelter is a modest flagship for the fundamental thrust of this papacy.

Archbishop Chomali’s groundbreaking initiative makes manifest the message of the Church’s first World Day of the Poor, scheduled for Nov. 19, 2017, with Pope Francis proclaiming: “We are called, then, to draw near to the poor, to encounter them, to meet their gaze, to embrace them and to let them feel the warmth of love that breaks through their solitude. Their outstretched hand is also an invitation to step out of our certainties and comforts, and to acknowledge the value of poverty in itself.”

The “Mercy Mobile Shelter” video is only available in Spanish.

Thursday, September 14, 2017

Hispanicity and its Challenges

At this time each year and through an act of Congress, we celebrate HISPANIC HERITAGE MONTH.

Hispanic Heritage Month is dedicated to recognizing the presence of Hispanics and "everything Hispanic" in the life of the United States of America. It is an annual opportunity to congratulate ourselves as Hispanics and to recall our historical and cultural origins. Above all, it is a magnificent opportunity to reflect on the presence of the Hispanic community in the fabric of this great nation, a great opportunity for Hispanics to remember our past and review our present as we plan our future in the United States.

Hispanics now number 58 million in the United States, which makes us 20% of the voting population. Politically speaking, we are a community that should wield decisive power and influence in the course and destiny of this American society.

However, these figures do not correspond with an evaluation of our achievements of Hispanics in the United States. Despite our numerical strength, we still do not have laws that protect Hispanics in this nation. We have achieved neither laws nor institutional and state frameworks that advocate for the virtues and values ​​proper to Hispanics, amid an increasingly materialist, consumerist, hedonistic, utilitarian, pragmatic, and individualistic culture.

It is, then, during HISPANIC HERITAGE MONTH that we ask ourselves, dispassionately and honestly, about the cause of our shortcomings, the reasons why our numerical presence does not correspond to our relative importance, influence, and power in the broader framework of American society.

The causes of our low productivity, too-few accomplishments, and negative perceptions as an Hispanic community in America are not to be sought outside ourselves. Within our Hispanic community, we find disorganization, lack of political formation, a pronounced absence of leadership, divisions, and ignorance of ourselves and of the cultures of the countries from which we came – all of us who here are called, generically and globally, Hispanics. We find a lack of interest in the common good; a lack of identity or loss of identity; lack of a global Hispanic agenda; lack of knowledge of our essence, identity, or homogeneity and, in addition, a lack of knowledge of the cultural essence of those who are distinct from us, that is, of the American society.

These shortcomings aggravate the challenges we face as Hispanics in the United States. Add to these difficulties a new external challenge: the rethinking of immigration in general, and for Hispanics in particular, that comes from what we can call the "Trump Phenomenon." This rethinking is a genuine threat to our presence in this nation. And, because we are not properly prepared, we do not respond in solidarity, with one voice, or even correctly; instead we skate, babble, whine, or, as we say in our lands, we respond with “patadas de ahogado,” or the kicks of a drowning man.

It is important that we address and resolve these challenges. It is very important that, living in and integrating ourselves into this society - without assimilating ourselves - we succeed in offering, here and now, the best of our origins and our past, the best of our history and our cultures as Hispanic nations. It is very important that - in an American society increasingly postmodern and increasingly exhibiting the characteristics described above - Hispanics rescue, for example, the value we place on family life and health care.

As Hispanics, against the ‘absolutization’ of pleasure, against  discrimination and intolerance, marginalization, indifference, silence, and all forms of malaise that generate violence, we must offer and privilege love as the first human vocation; democratic forms of participation in societal construction; permanent efforts to build solidarity and peaceful justice; respect for the richness of those different from us; respect for human life over any other value and interest; the importance and primacy of people over things, of being over having, of ethics over technique, of the human being and his work in business and capital, of service over power; of the transcendent over the temporary, transitory, and transient.

Family and health are, here and now, potentially at risk of being subdued and devoured by the postmodernist principles of the dominant culture and against the principles of our Hispanic cultures. In the field of health, a utilitarian and mercantilist interest is evident rather than an interest in solidarity and human service.

This present moment in humanity and, in particular in this nation, challenges the Hispanic community in the United States to marshal the strength of our numbers and, above all, acknowledge the magnitude of the issues within the Hispanic community itself.

Congratulations on this month celebrating Hispanicity. We wish you much encouragement and thoughtful, coordinated efforts in the task of effecting change in the United States, not only by our sheer numbers, but also in the beneficial effectiveness of our presence in North America. Onward!

Thursday, April 13, 2017

Easter, for Abundant Life

Lack of life purpose. Vices and escapism. Family separations, abortion. Economic, food and housing instability. Unemployment. Lack of economic resources, education, or training to get ahead. Social stratification, inequality, and social injustice. Epidemics and pandemics, inability to access social health systems. Old age unprotected by social security systems. Administrative, political, and governmental corruption. Poor quality of public services. War, violence, crime. Migration movements, displaced persons. Natural disasters. Just a few elements in a wide range of personal, family, and social evils and conflicts that represent, in short, a thousand forms of death or what has come to be called a CULTURE OF DEATH.

At this time of year, the Catholic Church celebrates the founding event of Christianity: The profession of faith by which the Crucified Savior transformed life for the first witnesses, men and women; a transformation through which these so-called first Christians proclaimed Him RESURRECTED and LIVING in their midst, and which started their personal and communal experience as children of God and brothers and sisters of one another.

For two thousand years, from those first witnesses of the public ministry of Jesus, from the conflicts that this ministry caused him, from his judicial and passionate trial and death on the cross, until today, Christians profess their faith in the Crucified Jesus of Nazareth living in every Christian and in every Christian community that lives the same life that Jesus himself lived and taught.

This profession of faith in the Resurrected Savior implies, at the same time, a belief that the definitive and ultimate message that God, the Father, delivered on the life of Jesus of Nazareth, acknowledged as His Son by the Christians, was one not of death and failure, but instead one of LIFE – indeed, ABUNDANT LIFE, (cf. Jn 10:10) eternal life, full life, happy life.

Christianity, in general, and every believer in Christ, in particular, has – as the foundation and main profession of faith – religious certainty and commitment that favors life over death in the thousand forms in which death is manifested. The entire life of Jesus of Nazareth, His Gospel, and His way of relating us to God (as children) and to others (as brothers and sisters), His life and His teachings are testament to Christianity as a proposal-protest in favor of life, abundant Life and, therefore, we could say, the programmatic-doctrinal foundation and lifestyle (personal and communal) that encourages what we can call a CULTURE OF LIFE (as opposed to the aforementioned "Culture of Death").

Our personal, family, and social lives pass by, it has already been said, in the midst of a thousand forms of death. Each one of us (personally and socially) suffers from shortcomings, longs for better living conditions, hopes for better days of greater justice and equity, days of abundant access to social opportunities, times of greater solidarity, freedom, and brotherhood. We all long for "the new heaven on the new earth." We would say that this is the hope that defines our present and that motivates our existence and our daily life.

THE RESURRECTION OF CHRIST encourages this hope because it encourages the need for better education, housing, and health systems; greater levels of equity and justice, a greater search for the common good in the administration of justice and public funds. The Resurrection of Christ, also called, CHRISTIAN EASTER urges us all to commit ourselves to a better, kinder world, more humane, more fraternal, more solidary, more livable.

This CULTURE OF LIFE, based on the experience and profession of faith in a Creator God and in the abundant Life in the Resurrection of Christ, and by Him, with Him, and in Him, in our own resurrection must be demonstrated especially in the societies in which we mostly call ourselves "Christians," although our public experience of faith is celebrated in religious congregations with different denominations.

In other words, the manifestations of the Culture of Death are contradictory and scandalous in societies where – as in our case – we predominantly profess ourselves publicly to be "Christians," because these manifestations clash and contradict God's fundamental mission in Christ, His Resurrection, which is an abundance of life, against the abundance of death.

If we live our profession of faith as "Christians" in the midst of situations where life is precarious for some relative to the abundance of a few; if while millions live poorly or subsist while minorities swim in extravagance; if government decisions do not seek good for all and – with them – we are building persecution, inequality, disunity, divisions, discrimination, and intolerance; if – in the end – we still fail to build a more humane world for the fraternal and just, then our religious experience is false because it is hypocritical, because we construct personal and social environments that contradict the beliefs, principles, and values of the Gospel of the Life of Jesus Christ.

Christian Easter, for the Resurrection of Christ, is a time for us to examine our personal and family commitments and our fruits as an American society. Time for us to ask ourselves if the fruits and values with which we are designing the construction of our society - populated mostly by "Christians" – correspond coherently and authentically to the mission and culture of the ABUNDANT LIFE for all that emanates from the Gospel.

I conclude here with an invitation: That our professions of "Christian" faith and our "Christian" worship finally manifest themselves in "Christian" social institutions, structures, and relationships in favor of LIFE (in all its expressions) and against Death (in its many forms). HAPPY EASTER!

Sunday, April 9, 2017

Health Care Reform Must Become a Strictly Non-partisan Objective

The American public has been treated to a sad spectacle in recent weeks. With the fate of the Affordable Care Act (ACA) hanging in the balance, the country’s political leadership—from the President on down—engaged in an off-putting war of words and partisan sniping. All the players clung to unbending ideological positions, exhibiting a stubborn determination to seek political advantage.

Utterly lost in this first chapter of the battle for healthcare reform under the new Administration—the first of many political skirmishes, undoubtedly—was the fate of millions of poor or relatively poor Americans. Their access to quality healthcare depends on what their representatives in the nation’s capital manage to come up with. Their well-being, not politics, should take center-stage. The duty and high calling to serve the common good—as inscribed in the country’s founding documents—should guide legislators on both sides of the aisle.

Sadly, things are off to a very poor start; and with the battle for tax reform looming large as the next showdown in Washington, D.C., it is to be feared that genuine healthcare reform may get lost in the shuffle. As a result, the ACA, for better and for worse, will hobble onward for the foreseeable future—continuing to protect some, while raising the financial burden for many others as premiums rise and the pool of insurers shrinks, not to mention a host of other unresolved, compounding difficulties dogging the program.

On a practical note, it must be remembered that the ACA was not solely the invention of the Obama Administration. The pursuit of providing healthcare to the legions of uninsured Americans dates back some 30 years, to the efforts, however imperfect, of the First Lady during the first Clinton Administration. The simplistic, jingoistic slogan “repeal and replace” badly fails to do justice to the complexities involved. Still more seriously, such an approach overlooks the urgent needs of the ultimate beneficiary of any reform: vulnerable and needy Americans of all backgrounds.

It is clear that the ACA bears improvement. All stakeholders—legislators, insurers, drug companies, medical device makers, health care providers., as well as the American people at large—are in agreement that there is a need for a certain repair and degree of transformation. However, common sense and a focus on the common good should guide the necessary process—not self-serving partisan politics that play fast and loose with the physical, emotional, and mental well-being of untold numbers of ordinary Americans.

Saturday, April 1, 2017

Medical Mission in Dominican Republic

The Dominican Medical-Dental Society once again organized a medical mission in Dominican Republic. This year, 120 doctors assisted, including 30 dentists, 40 surgeons, 20 optometrists, 30 pediatricians.  The medical mission took place on the outskirts of the city in a neighborhood called “La Nueva Barquita”, recently inaugurated with new homes for low income families. More than 4000 surgeries took place during this mission. Over 6000 people approached the mission to request medical assistance.

Click here to view photos.

Tuesday, March 21, 2017

The Bible in America—reasons for hope, cause for concern

Recently, Pope Francis—speaking both figuratively and literally—suggested that people keep a Bible on hand to consult with the same alacrity with which they turn to their smartphones for entertainment, news, or keeping up with the goings on of friends and family.

For sure, there are plenty of Bible smartphone apps that make this a reasonable and practical idea for just about everyone. In terms of outreach to millennials and teens, such tools are golden. At the same time, the Pontiff put his finger on a troublesome issue that is, or ought to be, a concern for Christian Churches of all stripes: Engagement with and appreciation of the Bible as the objective embodiment of the Word of God is declining across the West and across all age groups.

This trend is true in particular among those who rarely attend worship services or have stopped going to church altogether. It is especially the case, of course, for those—young and old—who regard the Scriptures as simply man-made storytelling or, still worse, as a source of oppression in terms of homophobia and other forms of alleged denials of human liberty.

The Barna Group—in partnership with the American Bible Society — has performed an extraordinary service with its publication of “The Bible in America: The Changing Landscape of Bible Perceptions and Engagement,” a compilation of comprehensive research that is the fruit of 14,000 interviews with American adults and teenagers over the past six years. The study features extensive demographic segmentation, from teens to baby boomers and seniors, recording the views of both believers and non-believers, churchgoers and “de-Churched” believers, with respondents belonging to the Catholic tradition as well as to both the mainline and non-mainline Protestant Churches.

These findings, derived from an extensive and highly nuanced probe of attitudes and perspectives regarding the Bible and its role in private and communal life, should prove to be a power tool for American Church leaders in their urgent task of stemming a definite and alarming decline in Bible engagement in the United States.

Let’s be clear: love and use of the Bible has remained steady among Church-goers and committed believers. In fact, thanks in part to a revival of the ancient practice of Lectio Divina among both Catholics and Protestants—a method, ultimately, of reading the Scriptures as a gateway to contemplative prayer and mysticism—the Bible has become still more rooted in countless people’s lives.

Much credit and deep gratitude go to the American Bible Society  for giving me the opportunity to produce a multi-lingual series of Lectio Divina manuals during my extremely fruitful years heading the ABS Catholic Ministries department. Though Catholics continue to trail Protestants in Bible engagement, the Catholic Church has made huge strides since Vatican II.

Yet, the Barna research sounds a dire warning: in 2016, the number of American “Bible skeptics” has grown to 22 percent, with the percentage of “Bible engaged” Americans standing at 17 percent. Back in 2011, just 1 in 10 Americans was skeptical of the Bible and 45 percent of respondents confirmed that “God regularly speaks to them through the Bible.” That is a huge shift, although one tempered by the finding that, in 2015, 61 percent indicated that they “wish they read the Bible more.” In 2016, 53 percent of Americans believed politicians could do a better job “if they read the Bible more often.”

Nonetheless, the Barna research finds there is a decline in Bible engagement in the U.S. that is most dramatic among the young, millennials and teens in particular, especially the un-Churched. In his preface to the study, Jason Malec, managing director of ABS’s Mission U.S., does not mince words. Confirming that the Bible “has had a more profound impact on our culture than any other book,” he warns that “if the current trends continue, the Bible will certainly lose its place as our leading culture-shaping factor.”

Barna Group President David Kinnamon attributes the decline in use of the Bible and an attendant drop in Bible literacy to increased skepticism about the “origins, relevance and authority of the Scriptures” and, according to what he calls “a new moral code,” more people (even including Christians) who “embrace self-fulfillment as the highest good.” This orientation makes the culture more resistant to Bible-based faith that espouses “God’s moral order leads to human and societal flourishing” rather than an all-consuming pursuit of self-determination and self-improvement.

On the bright side, Kinnamon notes that “digital access” is a boon in the form of “new tools and technologies that are making the Bible… more accessible than ever before.” Of course, access without accompanying education and guidance is no guarantee of a deepening of Biblical faith and engagement.

“If these trends hold steady,” the report warns, “there will be continuing downward pressure on the number of people (especially young people) who see the Bible as sacred” and the source of the deepest wisdom about life and the nature of ultimate reality. The heart of the problem is that, “increasingly, Americans are rejecting external sources of moral authority, both spiritual and civic.” Still, “2 out of 32 millennials and 7 out of 10 teens hold an orthodox view of the Bible,” the report finds. Yet, lack of time prevents one-third of millennials who practice their faith from reading the Bible.

The study presents a checkered landscape. Again and again, problematic findings are punctuated by hopeful signs. For example, 68 percent of U.S. adults “strongly or somewhat agree”—whether they regularly read the Bible or not—that the Scriptures are a “comprehensive guide to a meaningful life.” Notably, this conviction is strongest among African Americans, stronger among women than men, and strongest—not surprisingly—in the South, and weakest on both the East and West Coasts.

Despite the contradictory findings, the report notes that “many Americans seem to experience little cognitive dissonance between their acceptance of the new moral code [endorsing the pursuit of self-fulfillment] and their view of the Bible as a guide for life.” One could argue, of course, that these particular respondents’ actual grasp of Scripture—beyond a broad, if vague sense of appreciation for the Bible as a patrimony of Judeo-Christian civilization to be valued and respected—is rather superficial.

What can compel people, regardless of age, to seek greater engagement with the Bible? When asked, the number one response is coming to an understanding that reading and studying the Bible is “an important part of my faith journey,” followed by a “difficult experience in my life” and a “significant” event in life, such as marriage or the birth of a child.

For ministers, pastors, and lay catechists, these are teachable moments that must be seized proactively, windows of opportunity to demonstrate the power of Scripture that often quickly close again. Church leadership must be more vigilant than ever before. Above all, writes ABS President Roy Peterson, the teachers of the flock “must be actively engaging” the Bible themselves, “creating daily opportunities to be shaped and guided by God’s word of life.” Only then will they “become living witnesses to the power of Christ to transform the human heart.” Meanwhile, the Barna Group and American Bible Society have given Church leaders a formidable arsenal of actionable research.

Purchase here

Monday, March 20, 2017

Take Courage (Jn 16:33)

1.-The human being: seeker of happiness ...
There are many concepts with which we philosophically seek to define and embrace the entirety of the human being. One of these concepts describes the human being as a tireless, permanent, eternal seeker of happiness because in the daily minutia of everything we do and experience, we want to be happy. Everything we live, then, is conditioned, has meaning, courage and truth in so much as it makes us happy.

2.- The Christian religious experience is, then, for the happiness of the human being ...

Particularly, religious experience, as a model of the mission, vision and values ​​in the lives of human beings and social institutions, plays an important role in this search for happiness. The different religious experiences and institutions must help to make the follower and believer happy. The Christian religious experience, therefore, must help us, the believers in Christ, to be happy. This must happen so that the life and mission of Christ has, then, validity for his disciples.

Twenty centuries of the Church’s evangelizing work in the world has not succeeded in showing and establishing the synonymy and coincidence between salvation and happiness, between eternal life and happiness, between the full and abundant life that Christ brings us and the happiness that every man and woman seeks while they live.

This explains the inconsistencies, hypocrisies and the permanent divorce between our faith and our daily life. For, on the one hand and in the margins of our personal, family and social histories, we seek the salvation that Christian religious faith offers us and, on the other hand, further away and almost always in contrast with our religious experience, we seek happiness.

This divorce, these inconsistencies, and hypocrisies disappear from the lives of Christ’s disciples when we discover that the health, salvation and eternal life offered by God through His Son, Our Lord Jesus Christ, fundamentally coincide with the ceaseless yearning for happiness that every human being experiences; when we discover  that, as was beautifully expressed in the Second Vatican Council, "the truth is that only in the mystery of the incarnate Word does the mystery of man take on light.” (GS22); when we discover that our life is illuminated and interpreted from and in the life of Christ; when we discover that our search for happiness and humanization finds in Christ and in his Gospel "the Way, the Truth and the Life" that makes us happy, that is, that saves us; when we discover that our choices, works, loves, sacrifices, renunciations, crises and achievements are understood and acquire meaning from the life, the options, the passion, the cross, the death and resurrection of this same Christ.

Thus, one can form an understanding of the human and ceaseless search for happiness from this beautiful and wise definition given to us by Saint Augustine: "You have made us, Lord, for Yourself, and our heart is restless until it rests in You.”

3.- The search for happiness and religious experience is lived in  context ...

But the pursuit of happiness and Christian religious experience, like all religious experience, is lived in time and in space, not in a bubble; that is to say, in historical, social and cultural context. The pursuit of happiness is experienced by each person in the here and now of their personal, family and social conditionings and historical-social circumstances. That historical-social context is different and changing in the history of each human being and of all humanity and, therefore, produces and introduces nuances, interpretations, changes, and variations in the notion of happiness.

4.- Our current historical-social context: transition from modernity to postmodernity ...

To those who are here, to the inhabitants of the planet Earth of this time in which we live in a context that we call: the transition from modernity to postmodernity, it is a context and a historical moment with globalized characteristics that make us how we are, think as we think and act as we act today, unlike how our ancestors lived, felt, thought, acted and hoped.

We can succinctly say that the man of today seeks happiness by exercising power that tramples, crushes and oppresses. That today, we confuse happiness with the pursuit of the pleasure of the senses as the absolute beginning and end and regardless of the means to achieve it. We achieve this power and pleasure by accumulating material possessions, goods, riches in a network of interpersonal, social and regional relationships in which one’s power and pleasure grow as the money one boasts of, manages, and accumulates increases. All this stands in total and absolute opposition to the principles and values
​​that emanate from the life and ministry of Jesus of Nazareth who taught us that we are brothers, children of the same Father, who understands power as service, finds pleasure in the generous surrender of one's own existence at the service of our most helpless brothers, and who has the capacity and ability to share whole-heartedly, compassionately, and harmoniously.

We find ourselves in a historical-social context, moreover, that is characterized and lived in the middle of conflicts and crises of the following types:

·       Personal (especially, the loss of absolute truths and with it, the meaninglessness of life),
·        Family (especially divorces, separations, and new family models),
·        Social (problems in politics, labor, health, education and housing, injustice and inequality, administrative corruption in governments and a thousand forms of violence, inefficiency in public services, etc.)
·        Regional, national and international (clashes between different political, ideological, governmental and economic models, internal violent conflicts and bellicose conflicts between nations, migration conflicts, displacements, famines, etc.)
·        Natural (earthquakes, hurricanes, floods, tsunamis, etc.)

All these circumstances of our current historical-social context push our beliefs, our faith, our hope, our Christian religious experience to begin to be lived less by tradition and more by conviction; less as a set of external rites and displays divorced from our everyday reality and more like a lifestyle - according to the gospel of Jesus Christ - that permeates our personal and family lives and relationships and our social, political, cultural, economic, national, and international institutions.

Our historical-social context pushes and conditions us, here and now, so that our search for happiness-salvation through our Christian religious experience is "like one who is going to construct a tower or who is marching into battle..." (Lk 14:28ss). That is, a reasoned, reasonable, free, informed and intelligent Christian religious experience that allows us to "always be ready to give an explanation to anyone who asks us for a reason for our hope" (1 Pet 3:15). Christian experience that becomes in us a fundamental option of life for the person, the life and the gospel of Jesus Christ, until we can shout like Paul of Tarsus. "I live, no longer I, but Christ lives in me" (Gal 2:20).

5.-Christian Happiness-Salvation ...

Throughout these reflections, I have been showing what forms the notion of happiness for the disciples of Christ: to live their own life, to live daily the life and teachings of Jesus of Nazareth. To live each moment of our lives as children of God and brothers of all in order to establish personal, family and social relationships that enable and build "abundant happiness and life" (Jn 10:10) for all. ...

6.- An invitation: to live the Christian experience without fear, without apprehensiveness ...

The historical-social context described above, in which we are pilgrims and live our faith and our Christian hope is, due to those who seek controversy or do not believe in the Gospels, challenging. For "the harvest is abundant but the laborers are few" (Lk 10:2).

What do we do as Christians in today's world and before the panorama so briefly described here? Are we to become disheartened, discouraged?

Press on today, listen, one more time, to the voice of Paul that encourages us, telling us: "We are persecuted, but not abandoned; struck down, but not destroyed… (2 Cor 4:9),  because it strengthens our certainty of happiness-salvation in Christ, who tells us: " Take courage, I have conquered the world” (Jn 16:33).

I invite you to return to our first Christian vocation: that of being a light in the midst of darkness and salt (Mt 5:13) in the midst of our current circumstances made unsavory by inhumanity.

I renew your invitation so recently made to all of today’s disciples of Christ by Pope Francis in the Apostolic Exhortation "Evangelli Gaudium”: to live a newly happy, joyful and rejoicing Christian experience. To be witnesses to the happiness-salvation that Christ gives us in the daily routines of our personal, professional, family and social lives. To live without fear of our baptismal commitment. To live with the joyful trust of the children of God and, consequently, to be able to establish relationships of compassion and mercy - as God loves us - with all the men and women within our lives. To live as missionaries of the joyful hope and good news of the gospel in the world today, as daily witnesses of the happiness-salvation that we find in Christian life. As men and women who are happy and transformed in Christ, with vision that - from and through the gospel - allows us to see everything with the joyful confidence and hope of those who know that "the bridegroom is with them" (Mt 9:15), "always until the end of the age" (Mt 28:20).