By Nancy Gertner

The words on the 911 tape were familiar ones. I have heard them many times before: suspicious, black, teenager, hoodie, touching his waist band, up to no good. This time they were not from a police officer testifying about why he was justified in stopping a young black man and frisking him in the streets of Boston. This time they were the words of George Zimmerman, a civilian on neighborhood watch who was armed. Zimmerman knew just what to say to get the police to investigate. Indeed, he had done it many times before.

Whatever the justification for the 911 call – and it was thin – nothing justified what happened afterwards, not even under Florida’s infamous “Stand Your Ground” law. Florida has led the nation with this law, despite the opposition by prosecutors and law enforcement groups. Palm Beach State Attorney Barry Krisher opposed the law “because it encourages people to stand their ground .. when they could just as easily walk away. To me that’s not a civilized society.” Paul Logli, the president of the National District Attorneys Association said that these laws “give citizens more rights to use deadly force than we give police officers and with less review.” Despite the opposition, many other states followed Florida’s bad example. Indeed, such a law has recently been proposed in Massachusetts by Senator Stephen Breyer and Representative George Peterson.

Before “Stand Your Ground,” all countries in the Anglo-American legal tradition severely limited the circumstances under which a civilian could use deadly force. It was about the sanctity of life, after all. Self defense was permitted as a matter of necessity, but only when there was no time to resort to law enforcement, when he or she was threatened with deadly force, and when the citizen had reasonably tried to avoid the danger. Still, recognizing that one size does not fit all, the self defense laws were flexibly applied: Deadly force was justifiable if retreat was futile. Different rules prevailed in one’s home. The crime was no longer defined in terms of what a “reasonable man” might do. More and more the law took into account the circumstances of women, even battered women.

This wasn’t good enough for Florida. The new bill allows resort to deadly force when the shooter believes he has to do so to prevent “imminent death or great bodily harm.” While his belief has to be “reasonable,” he doesn’t have to bother to try to avoid the danger. Sadly, shooting can be his first reaction, not his last. There is one exception, however, where the shooter “initially provokes the use of force against himself or herself.”

From the facts that have been publicly released, which are changing by the minute, Zimmerman ‘s conduct was not justified even by the Act. In the first 911 tape, Zimmerman obviously did not believe he was in imminent danger. He called on the police non emergency line. The police listened to his – perhaps racist ramblings – and told him to meet them at the front of the gated community and not to follow the man he was worried about. He did not listen. He followed Trayvon.

The only question is what happened when Zimmerman and Trayvon met face to face. Someone is plaintively shouting “help!” Zimmerman claims that it is his voice; Trayvon’s mother says that it’s her son’s. And Trayvon’s girlfriend recounts his call to her moments before his death – his fear about being followed by a white man for no reason.

Zimmerman, through his counsel, tells a different story. Just as Zimmerman knew precisely what to say when he called 911, he knew what to say under “Stand Your Ground” : He was getting back into his car when Trayvon attacked him, punched him and continued to beat him even after he was on the ground. His nose was broken, although he did not seek medical attention. News reports suggest that there is at least one witness who supports this account. (Of course, it is not clear who else was interviewed, how far the police probed Zimmerman’s story.)

Zimmerman’s version is supposedly what keeps the police from arresting him. In a provision of this law literally called “immunity from criminal prosecution,” police are directed not to arrest the person using force unless there is probable cause to believe that the force that was used was unlawful, whether it was self defense under the law. In most jurisdictions, the use of deadly force resulting in the death of an unarmed man – without more – would be enough for an arrest. Whether the shooter claimed self defense would be sorted out later at trial.

Nothing prevents the Sanford police from critically evaluating Zimmerman’s account, as police do in so many situations, and concluding that it was contradicted by the girlfriend’s account, by 911 tapes of other bystanders shortly before the killing, that it makes no sense for Martin to start a fight since Zimmerman obviously had a gun in a holster, was substantially larger than Martin, since the encounter took place close to where Martin was staying and he was moments away from safety.

But even if Martin punched Zimmerman - punching doesn't justify killing, a broken nose doesn't justify a death, even under Florida’s law. If that’s “reasonable fear of great bodily harm,” gang members will easily justify their use of lethal force; even bar room brawls will lawfully become shootings.

So the reason Zimmerman is not being arrested is not the law, however deficient. It is a judgment call by the Sanford, Florida, police. Would they have made the same call if the victim had been white and the aggressor black?

Nancy Gertner, a retired US District Court judge, is a professor at Harvard Law School.

By Sean Cahill

Initial results from clinical prevention trials of pre-exposure chemoprophylaxis (PrEP), in oral pill form indicate that PrEP could be the “game changer” needed to more effectively fight HIV. PrEP involves taking antiretroviral medications to prevent HIV.

PrEP has shown partial efficacy with men who have sex with men (MSM) and heterosexuals. Biomedical prevention interventions such as PrEP have great potential, especially if coupled with traditional prevention approaches, expanded testing, and linkage to treatment and care. Modeling demonstrates the most effective deployment of PrEP will be in combination with scaled-up HIV treatment of people who are known to be HIV-positive, as this was shown to reduce infections.

Guidance from the US Public Health Service and the World Health Organization is expected later this year. The Food and Drug Administration announced February 13th that it would review Gilead Science’s application to use FTC-TDF (brand name Truvada) for PrEP by June 15th. Demonstration projects to develop real world best practices for implementing PrEP are underway or set to launch soon in the United States and in sub-Saharan Africa. While the cost of PrEP in the U.S. would be substantial, private insurers and state Medicaid departments are open to providing coverage. Low-cost generic medications could enable access in low-income countries. The prioritization of highly vulnerable populations could increase the cost-effectiveness of PrEP. Providing PrEP is also much less expensive than treating someone for HIV over the course of a lifetime. Recent modeling of PrEP implementation coupled with scaled up treatment—focusing on MSM in San Francisco, the general adult population in Botswana, and serodiscordant couples in South Africa—predicts that PrEP could significantly reduce HIV incidence and prevalence.

In February 2012, The Fenway Institute released an analysis of PrEP implementation issues, titled Pre-exposure prophyalxis for HIV prevention: Moving toward implementation. This report summarizes the state of PrEP and microbicide research as of early 2012, looks at willingness to use PrEP among various populations, addresses concerns about PrEP that could present obstacles to implementation, offers strategies for effective implementation, and examines policy issues related to cost and how to make PrEP accessible to those most vulnerable to HIV. Based on a review of published research and interviews with policy makers, funders and other stakeholders, it examines regulatory developments and planning underway both within the U.S. and globally.

Fenway was a US site for the global iPrEx PrEP study with gay and bisexual men and transgender women. We are very optimistic about the potential for PrEP to revolutionize HIV prevention and allow us to dramatically reduce new infections here and around the world.

PrEP must be accompanied by sustained care and behavioral interventions to ensure adherence, minimize risk compensation (the fear that people will stop using condoms), and monitor side effects. Because the most at-risk do not access regular clinical care, alternative implementation arrangements will be necessary. National monitoring systems are critical to preventing the spread of drug-resistant HIV.

Some have raised concerns about PrEP related to potential side effects, risk compensation (the idea that people will stop using condoms if PrEP becomes available), and drug resistance. However, reviews of five major clinical trials involving about 6,000 participants by the Forum for Collaborative HIV Research shows no greater risk of side effects, no risk compensation, and no clinically significant development of drug resistance in participants.

The analysis concludes with recommendations for implementation of PrEP, including the following:

• If the FDA, which is considering approving FTC-TDF for use as PrEP, feels that research on PrEP’s efficacy among heterosexuals is inconclusive, it should consider approving PrEP for MSM now separately, and consider heterosexuals, injection drug users, and other populations when the science warrants this.

• The World Health Organization (WHO) should issue guidance on PrEP that takes into account the promising results of the iPrEx study, Partners PrEP, and the Botswana CDC study.

• States should provide access to PrEP as a critical prevention service and prescription medication under the Essential Health Benefits provision of the Affordable Care Act.

•Subsequent to FDA approval, State Medicaid programs should cover PrEP as a cost-saving measure that will improve public health and ultimately save money in health care costs.

•Global funders of HIV prevention and care should make resources available for PrEP and treatment as prevention.

Sean Cahill, is director of health policy research at The Fenway Institute and an adjunct assistant professor of public administration at New York University’s Wagner School of Public Service.

By James Brett and Alexis Henry

When it comes to hiring people with disabilities, many employers are hesitant.

It’s an honest reaction. But that doesn’t make it any less unsettling, given how far businesses have come in hiring practices and policies. We’ve only recently seen meaningful and deliberate efforts to give employers and potential employees the support both sides need, when it comes to employing men and women with disabilities.

We know that fears and uncertainties exist, even though more and more employers have adopted inclusive hiring practices throughout Massachusetts. If we are going to begin to see equitable levels of employment among the approximately 200,000 adults with disabilities in this state who are willing and able to work, yet remain unemployed, more businesses will need to reevaluate how they approach hiring, training and retaining people with disabilities. These are not problems caused by the recession, but long-term conditions fueled by fear and uncertainty.

Without jobs, men and women with disabilities often lead lives defined by poverty and isolation. It doesn’t have to be this way. The best tool to combat both of these ills is a job. Engagement with the workforce is one of the most rewarding experiences in life and that is no different for men and women with disabilities.

While many employers have concerns about hiring people with disabilities, often they want to take the step. They know from their peers that employees with disabilities have proven themselves to be reliable, trustworthy and hard-working. To expand their participation in the workforce, there are two steps that need to be taken. First, it’s critical to help find the right fit between workers and the jobs they hold. Second, there must be support for training both employees with disabilities and their managers who will provide them with important on-boarding and training assistance.

It is important to develop a match between the knowledge, skills and abilities of job seekers with disabilities to the essential functions of the jobs they hold. When employers work to ensure a good match, there is a much higher potential for success. Some assistance may be needed to assure that the prospective employee can learn these essential functions, just as can happen with any new employee. When people with disabilities enter a new workplace, employers should make use of training specialists who can help managers develop effective ways of training and supporting their new employees as they master their job tasks.

Other workplace opportunities like internships, offer a realistic learning setting for an individual with a disability to build a valuable work history through practical experiences. As they do for anyone, internships give people without disabilities the opportunity to learn new skills, explore potential careers and build both resumes and professional networks and references. Employers can serve as both the hiring entity for the job seeker as well as a training resource for those who need real work experiences as they develop their job interests and prepare to enter the job market. These opportunities can also serve employers to develop a culture of true diversity and inclusiveness throughout their companies.

Every year, Massachusetts employers provide thousands of internships to high school and college students, recent graduates, career-changers and parents returning to the workforce. It's part of a natural give and take of the workforce. Let's set a goal to provide at least ten percent of those opportunities to men and women with disabilities who are willing and able to work and provide supports and incentives to the companies who meet this goal. There's no better way to break down barriers between us than when we meet each other face-to-face and learn from one another.

In 2010, business leaders responded to Governor Deval Patrick’s call to make Massachusetts a model employer for people with disabilities. Despite a sluggish economy, many of these recommendations are being implemented, but more needs to be done. The best first step is helping employers overcome their fears about hiring people with disabilities. The next step is creating opportunities where both employers and employees can see where the future will take them.

James Brett is president of the New England Council. Alexis Henry is the principal investigator of Work Without Limits at UMass Medical School.

By Anna Goldman

“Why don’t you aim higher? You’re too smart for that.”

It’s a familiar reaction when medical students tell their teachers they are considering a career in primary care. On the first day of my third year of medical school, the palliative care physician I was assigned to work with wrinkled her nose when I told her I wanted to go into primary care. “You should think long and hard before you choose to do that,” she warned, “If you want a decent life, don’t do it.”

I used to know with certainty that I wanted to be a primary care doctor. Before beginning medical school at Mount Sinai School of Medicine, I did a Masters in Public Affairs and learned about the importance of primary care both for patients and for the ailing health care system. It seemed simple: I could help meet society’s need for more primary care physicians while engaging in personally fulfilling work. I imagined my future practice as a wholesome alternative to pressured, “get-‘em-in, get-‘em-out” primary care practices —money-making be damned. I would linger and listen.

I assumed that money, or the lack of it, was the main reason why primary care had become such an unpopular specialty choice. Time pressure during office visits was also a problem. But, these challenges appeared relatively minor given the positive impact I could have as a primary care doctor. When I began my training, however, I learned that the medical school environment, in many ways, can discourage aspirations toward primary care.

Early on, I noticed that conversations surrounding specialty choice did not reflect the concern in the outside world over the shortage of primary care physicians. The questions commonly posed by doctors speaking in an advisory capacity to students start with: “What do you find most fascinating?”; “Do you enjoy working with your hands? Doing procedures?” And then the perennial questions about lifestyle: “How hard do you want to work? How much money do you want to make?” “What time do you want to go home?”

With primary care come a lower salary and hectic working conditions. But medical students considering primary care also face another type of deterrent: less respect from many colleagues who regard primary care as less rigorous and intellectually intense than the medical specialties. Primary care’s power to improve patient outcomes and its critical role in health care reform has so far not been enough to boost the field’s prestige and counterbalance negative perceptions that persist among physicians.

How can we improve things? We can start by including in medical school curricula a substantive education on health policy and the problems faced by our national health care system. Specialty choice must be contextualized for students so that they understand the ramifications of their career decisions for the system as a whole. Currently, key issues are absent from the dialogue. For example, by becoming a specialist, you undoubtedly “help people” in the sense of helping a patient who is right in front of you. But, you do not necessarily help the community. When a region is oversaturated with doctors practicing the same specialty, it can lead, according to several studies, to unnecessary procedures being performed (a case of supply creating demand) and further drives up health care costs without improving outcomes for patients. Greater awareness of issues like these can help realign values of both medical students and teachers to match the interests of society.

On a national level, we can restructure our reimbursement system to channel resources toward primary care and away from specialty medicine. Not only will this result in better patient care and more efficient use of health care dollars, it will also ease time and financial pressure on primary care physicians, making the job more attractive to medical students. In addition, we can strengthen programs that invest in medical students who pursue primary care, such as the National Health Service Corps.

I have applied to residency programs in both internal medicine and family medicine, and I will find out where I’ll end up on March 16, “Match Day”. Despite my concerns, I still plan to pursue primary care. .

Primary care must be prioritized and genuinely valued in academic medical training. It’s the only way that more medical students will aspire to enter this crucial field.

Anna Goldman is a medical student at Mount Sinai School of Medicine in New York.

By Thomas M. Menino and Laura Perille

In the 1840s, Horace Mann, the great champion of public education, insisted that each and every Boston child – not just the wealthy or the talented – should learn how to draw. Today, Boston is renewing this promise by reestablishing high quality arts education for all students as a core part of excellent schools.

At a time of great stress on Boston’s school budget, private philanthropists and charitable foundations launched an initiative to raise $10 million to increase access, equity and quality of arts learning for all students. The city and its schools stepped up with increased public funding for arts teachers.

It’s a model that can be replicated in cities and towns across the Commonwealth and the nation.

This year, 14,000 more Boston students are experiencing the arts in schools than three years ago. Nine of 10 students in the elementary and middle grades now receive weekly, year-long arts instruction in school, up from two-thirds in 2009. In the same period, twice as many high school students are accessing arts learning during the school day.

The Wallace Foundation recently announced a $4 million commitment to help further expand access to arts education in the city’s schools. Local donors, including the Barr Foundation the Boston Foundation, have already matched this with more than $4 million in contributions. The city has increased public spending on arts education by $2 million annually since 2009, adding 24 new arts teachers.

Why invest in arts education at a time when schools seem laser-focused on improving performance in reading and math skills?

Evidence shows that the arts matter. Arts have a positive impact on student achievement, motivation and engagement, critical and creative thinking, collaboration and team work skills.

Arts have the biggest impact on students of color and low income students. Yet nationally, African-Americans and Latinos are 50% less likely to have had access to arts instruction.

In many communities, arts education has suffered from years of neglect. The decline started with significant public budget shortfalls in the 1970s and 1980s that led school districts to drastically cut programs deemed not central to the academic mission. More recently, federal education requirements and the test-based accountability mechanisms of state standards-based reforms caused schools to focus on the subjects that were to be tested -- reading and mathematics -- at the expense of other subjects.

Surveys by the Center for Education Policy found that 44 percent of districts had increased instruction time in elementary school English language arts and math while decreasing time on other subjects. A follow-up analysis showed that 16 percent of districts had reduced elementary school class time for music and art -- and had done so by an average of 35 percent, or fifty-seven minutes a week. Recently, school districts in Pittsburgh, Philadelphia, Los Angeles and San Diego proposed plans to cut arts programs and teaching positions to help balance their budgets.

Arts education is especially important here in Boston.

We have a thriving and dynamic cultural and artistic community that enriches our city for residents and visitors. Music, theater, and the visual arts give Boston a special identity. Participation in arts education is the strongest predictor of almost all types of arts participation as an adult. We need to maintain these unique assets by cultivating a population that appreciates the arts.

In making arts education a priority, Superintendent Carol Johnson has tapped the energy of our arts community to expand opportunities for our young people. At the school level, the expansion of arts education means that at the Edison K-8 School in Brighton, partnerships with the Boston Symphony Orchestra and a set design teaching artist have enabled the school’s four full-time art teachers to create a rich performing arts program and engaging school climate for their 850 students. Students with special needs and English language learners have shined on stage as lead actors in musicals and Shakespearean productions, while other students learn about stage management. The Dever-McCormack School in Dorchester is building a strong music program through a partnership with the Community Music Center of Boston, together with the school’s music specialists.

We view arts expansion as a catalyst for renewed energy in schools, increased engagement by students, and improved school choices for families. Over the long term it will enrich our young people, our schools, our neighborhoods, and our economy.

Thomas M. Menino is the mayor of Boston. Laura Perille is executive director of EdVestors, a nonprofit school reform organization.

By Laurie Martinelli

There are approximately 105,000 people between the ages of 21 and 64 enrolled in both Medicare and Medicaid here in Massachusetts. These individuals, known as “dual eligibles,” represent some of the toughest cases in health care.

The question now before the state is how best to provide care for this unusually vulnerable population.

Dual eligibles represent some of the most expensive patients in the health-care system. And it’s not merely the high cost that causes trouble -- the crisscrossed payment systems create bureaucratic overlap that results in mismanaged treatments and administrative waste, as well as endless headaches for patients and families who must navigate a maze of competing health systems.

Differing eligibility rules force beneficiaries to construct treatment regimes in fragments, and make it difficult, if not impossible, to coordinate care between the two systems. The lack of coordination can mean that patients don’t have access to the care they need. Limits on access to behavioral health services are particularly problematic -- especially given that two thirds of the state’s dual eligibles have some sort of behavioral diagnosis.

But thanks to the Affordable Care Act – the federal health-care reform law that passed in 2010 – 15 states have an opportunity to test out reforms designed to streamline the system, giving patients the choice of services and ease of access they need.

Massachusetts is one of the states planning a demonstration project to combine the funding streams for dual eligibles in hopes of reducing friction between the programs and improve care. The state’s proposal to integrate care between systems is a good start toward necessary reforms. In particular, it will give dual eligibles access to managed care programs – such as PACT teams (Programs for Assertive Community Treatment), partial hospitalization, and intensive outpatient treatment.

But reorganizing the care of such a vulnerable and complex population is no easy task, and the details matter. Coordination efforts must be carried out with patient interests in mind, and a focus on expanding access and choice while minimizing disruptions to their health services.

One of the ideas in the integration proposal is to create what’s called a “Patient Centered Health Home.” Health Homes would create a team of specialists to provide primary care to a population with special needs – such as individuals with mental illness -- to ensure better coordination between multiple providers. But for the two thirds of under-65 dual eligibles in Massachusetts who have behavioral health problems, the current proposal leaves a critical question unanswered. Can these new “Health Homes” be housed or led by a behavioral health specialist? Mental health has been the poor step child of physical health for far too long. “Patient Centered Health Home” is a chance for behavioral health to be the primary focus.

Transportation is a major issue for many dual eligibles with mental illness as well. Any attempt to coordinate care must consider a patient’s transportation needs as part of their overall health plan: Without it, these individuals are effectively blocked from visiting health providers -- making other efforts to expand access futile.

Nor can these reforms be used as an excuse to skimp on provider reimbursements. Lower reimbursement for health services rates inevitably affect access, as health providers leave the program when rates drop too low. Current Medicaid rates for inpatient hospital stays are lower than Medicare reimbursement rates. NAMI knows this all too well as inpatient psychiatric beds have dried up across the state. Many people, including the state’s Attorney General have noted that the reimbursement rates for psychiatric services are already woefully inadequate.

Ultimately, the goal must be to ensure the equality, stability and continuity of care: Dual eligibles should not be forced to disenroll from their current prescription drug plans. Every effort must be made to avoid allowing budget-stressed state programs to cut prescription drug benefits. And those with low incomes should be treated the same as other Medicare enrollees.

Many of the proposal’s suggested policies already offer obvious benefits. Reforming the confusing appeal process for dual eligibles, for example, is certainly worthwhile. A single appeal and grievance process, rather than a fractured system without jurisdiction over all of a patient’s treatments, should help ensure that beneficiaries are protected and can take full advantage of their rights.

In other words, there’s much that’s worthwhile in the proposal already. But there’s also much that could be improved. The Bay State's proposed dual eligible integration demonstration is off to a good start -- but if it’s worth doing, it’s worth doing right.

Laurie Martinelli is executive director of the National Alliance on Mental Illness of Massachusetts.

By Rich Barlow

The Federal Reserve’s recent announcement that interest rates will stay low for the next three years confirmed how sick the economy remains. The Fed simultaneously declared it would hold inflation to just 2 percent annually. But that policy also is looking sickly. What we need is higher inflation.

At a time when businesses blame their slow hiring on consumers shunning their goods, sticker shock may sound like Kevorkianomics. Yet it’s not just some economists, including N. Gregory Mankiw, an adviser to George W. Bush, who’ve prescribed medicinal inflation during this recession. That best teacher of all, experience, suggests it could work.

Inflation helped end the two worst depressions in American history. Most people know that Franklin Roosevelt started jobs programs in the 1930s; fewer may recall that he also took the country off the gold standard to facilitate higher prices, which he declared good for the country. After the Great Depression, our grimmest economic crash was that of the 1890s, when unemployment approached 20 percent. We were on the gold standard then; the cavalry came to the rescue in the form of a string of gold strikes and improvements in gold refining. Both developments flooded the economy with gold; the money supply, prices, and prosperity mushroomed as a result.

Unlike today’s crisis, those depressions brought deflation, in which prices relentlessly plunge, neutering profits and spiking joblessness. But our Great Recession became great because, like the 1890s and 1930s, it came overlaid with a financial collapse-and now the Fed has confirmed that recovery will continue to be glacial, January’s heartening drop in unemployment notwithstanding. Long-term unemployment is at a six-decade high, and economists routinely couch talk of better times in caveats about how Europe’s debt crisis could send our recovery AWOL.

Suppose the Fed were to announce a modestly higher inflation target, say, 4 to 6 percent? Advocates say that would stimulate the consumer demand in two ways. First, in any recession, there are people who could part with some disposable income but cling to it out of fear that the economy will stay bad, their job might be on the line, etc. The realization that that iPad or blouse they’ve been eyeing is going to be pricier in the near future would pry some of their dollars loose. Second, workers whose employers give cost-of-living raises would find their paychecks bigger, and some would spend the windfall.

Critics of this course include former Fed chairman Paul Volcker, who decries the "siren song" of easier money. Volcker fears that to be effective, inflation would have to run so long that the public would come to expect it as far as the eye could see, robbing it of any stimulative punch. That’s what happened in the 1970s, when Volker, then head of the Fed, engineered a recession that finally strangled runaway inflation. But economist Paul Krugman argues that in a depressed economy, there’s more leeway to boost the money supply without prices going amok.

Others will complain that inflation erodes the value of savings, and I’m no happier about a haircut to my pension and my son’s college plan than the next guy. But we savers are getting clobbered with the Fed’s eternally low interest rates, which analysts suggest won’t work anyway, since the problem isn’t that money’s too costly; it’s that people can’t afford to borrow or are afraid to spend with the outlook so gloomy. And if we’re worried about savers, how about some sympathy for those who can’t save anything because they can’t find a job?

It’s worth remembering that the late Milton Friedman, the conservative monetarist genius, gave unlikely praise to the populist William Jennings Bryan, whose 1896 presidential campaign proposed inflation to end that era’s depression. Barring optimists’ hopes for a real recovery, we may be singing a twist on Simon and Garfunkel in 2012: "Where have you gone, Jennings Bryan?"

Rich Barlow writes for BU Today, Boston University’s news website.

By Julie Burkhart

More and more, in states across the country, it is becoming clear; birth control is the new abortion.

Abortion has always been a divisive issue, wrapped up in questions of morality and human rights. Birth control, on the other hand, has enjoyed widespread popularity and support for decades.

However, a national fight to require health insurance to cover birth control, state laws that begin to edge over the line from anti-abortion to anti-contraception, and new “personhood” bills across the country suggest that some lawmakers are trying to change this.

Not only would these “personhood” bills make abortion illegal, they would endanger a woman’s right to access even basic contraceptives, including birth control, IUDs and Plan B. Bent on protecting the unborn at the expense of women’s health, the bills have the potential to turn the tragedy of a miscarriage into a witch hunt for wrongdoing on the part of the mother. Above all, they puts women’s lives and health in serious jeopardy, taking family-planning decisions away from the families themselves and giving them over instead to the state, the government, doctors and pharmacists.

Next year, in a small town in Kansas, Illinois, Iowa, or Oklahoma, a young mother will walk in to a doctor’s office. Her husband has just lost his job, and although they are excited to have more children, adding to their family will need to wait a few years. Because she cannot take hormonal medication – she is prone to blood clots and she wants to be a healthy mother to the two children she already has – she will ask her doctor to insert an IUD, which she has used in the past. New “personhood” bills in these states, which declare that life begins at “conception,” when a sperm meets an egg, will make birth control which prevents the implantation of a fertilized egg in the womb illegal. The IUD is one such form of birth control. The doctor will not be allowed to prescribe it.

It seems unbelievable – ridiculous even – but this is a very real future for women across the country. And while these states seem far away to many people, anti-birth control legislation is being pushed even in states like Pennsylvania and New Hampshire. A federal judge just recently overturned a law in Chicago requiring pharmacists to distribute emergency contraception, saying that these employees have a moral and religious right to refusal. Has the state confused churches and drugstores now?

“Personhood” bills seem like extreme examples, but they are real threats to our reproductive rights, and they have a real chance of passing in many states. More straightforward anti-birth control bills, however, are already passing, chipping away at our access while we are distracted by threats of trans-vaginal government intrusion. New Hampshire, a state which has mandated insurance coverage of birth control for over a decade, now wants to overturn the law. Individual states are banding together to fight a federal law that would require that birth control be covered by insurers nation-wide.

I have long worried my daughter will grow up in a world where her basic reproductive rights would be threatened. Now, the battle has moved from what she is allowed to do once she gets pregnant, to whether or not she has any choice in the pregnancy itself. We must fight for a better world for our children than the one our parents fought to give to us. But with bills such as these, young women may find that ever more difficult.

The Trust Women Commitment

Trust Women deeply values the freedom of each woman to make her own choices about her fertility with the support of her physician without coercion or fear of persecution from the government or any individual. We are committed to mounting a vigorous defense of these freedoms, wherever and whenever they must be defended to protect women’s rights. It is our intention to be proactive and forward thinking. We will engage those who want to limit our freedoms in the political process and not wait until they’ve closed reproductive health care clinics across America or restricted our rights through the courts.

The Trust Women Mission

Trust Women is a pro-woman, pro-choice organization that focuses on the Southern and Midwestern Regions of the United States. Trust Women focuses on expanding access to full spectrum reproductive health care, builds community involvement in reproductive health clinics and rights, and creates model comprehensive public policies to expand abortion care and improve maternal health. Additionally, Trust Women educates voters about candidates so they can make informed voting decisions that will protect their reproductive freedom. During the legislative session, Trust Women lobbies legislatures in target states in support of bills that protect the reproductive rights of women, while working to defeat any harmful legislation that would potentially turn back the clock on women’s rights.

Julie Burkhart is founder and director of Trust Women.

By JD Chesloff

Young children are inquisitive learners who ask an average of 76 questions per hour. They are natural scientists and engineers who learn Science, Technology, Engineering, and Math (STEM) concepts through play. Research confirms that the brain is particularly receptive to learning math and logic between the ages of 1 and 4.

The Globe recently reported on an amazing partnership between IBM and the Mattapan Family Service Center Head Start that is helping to spark and nurture kids’ interest in math and science. Teachers are incorporating special computer stations donated by IBM into the curriculum to great effect for the children and their families.

This is important to Massachusetts’ long term competitiveness because today’s young children are tomorrow’s workforce, and workers who are fluent in STEM competencies will be more prepared and qualified to fill the jobs that will drive our economy into the future. Yet, according to a recent study by McKinsey & Company, STEM positions are the hardest for employers to fill, especially with fewer degrees awarded in STEM than other areas, such as business, humanities and social sciences. STEM occupations are expected to increase over the next decade, so there is a mismatch between projected future jobs requiring STEM skills and the projected supply of qualified workers to fill them.

Recognizing this phenomenon, and at the urging of the Massachusetts Business Roundtable and a coalition of business leaders working closely with Lt. Governor Tim Murray, Governor Deval Patrick created the Governor’s STEM Advisory Council in 2009. The Council is implementing a state STEM agenda that would ensure that the education pipeline – from pre-K through higher education – is producing workers skilled in STEM competencies. Massachusetts is a national leader in developing a long-term STEM plan and a strategy to implement it.

Part of this leadership has been the state’s recognition of the important and powerful link between early childhood education and STEM, officially recognizing that “inquiry and exploration are foundations for math and science and are also the foundations for early learning.” In fact, the STEM Advisory Council set goals for improving students’ STEM achievement in the Commonwealth, including a recommendation to increase the number of educators trained in STEM subjects in pre-kindergarten through grade 12. As the Early Education for All Campaign, organized by Strategies for Children, Inc., points out, high-quality early education provides essential supports for future success in life and in school and is the basis for children’s aptitude in STEM in later years.

This leadership recently paid tangible dividends, as Massachusetts was selected as one of nine grant award winners in President Obama's Early Learning Challenge (ELC) competition, and will receive $50 million over the next four years to expand high quality early education services and close achievement gaps in education. The state’s application specifically focuses on giving early educators the opportunity to “build a systemic, intentional practice around STEM concepts.”

The link between early childhood and STEM is indisputable. Early exposure to STEM – whether it be in school, at a museum, a library, or just engaging in the natural trial and error of play – supports children’s overall academic growth, develops early critical thinking and reasoning skills, and enhances later interest in STEM study and careers. Massachusetts is now a recognized leader in both individually and, more importantly, collectively. We must continue to connect these two agendas as we drive policy forward in each. High-quality early learning environments provide children a structure in which to build upon their natural inclination to explore, to build, and to question – no matter how many times per hour they do it.

JD Chesloff is executive director of the Massachusetts Business Roundtable, chair of the Governor’s STEM Advisory Council’s Executive Committee, and chairman of the Massachusetts Board of Early Education and Care.

By Helen Drinan

In a few short months, thousands of newly minted college graduates will leave Boston with dreams of future success. According to the U.S. Census, more than half of these students will be women; and according to the consulting firm McKinsey & Co, if we check back with these women in several years, they will not have attained the same level of success as their male counterparts.

Research by McKinsey and the women’s advocacy group Catalyst shows that women account for more than half of entry-level professionals in the largest American industrial corporations, but only 14 percent are on executive committees. Women represent just 3 percent of Fortune500 CEOs, and less than 15 percent of corporate executives at top companies worldwide. The sad truth is that only minimal progress has been made in the past few decades for women to make a significant break-through into leadership positions.

The reasons for this disparity are multifaceted, yet one of the strongest answers to this problem, I believe, can be found at some of America’s most enduring institutions: women’s colleges. As a graduate and president of a women’s college, I have no doubt that these educational outlets continue to play a vital role in educating and preparing women for leadership positions, helping our nation tap into an enormous segment of underutilized talent.

At women’s colleges, women are the ones receiving their university’s top prizes, prestigious graduate fellowships, or holding major campus-wide leadership roles. This experience rang true for Secretary of State Hillary Clinton, a Wellesley graduate, who said her all-female college experience “guaranteed a focus on academic achievement and extracurricular leadership we might have missed at a coed college…Women not only ran all the student activities – from student government to newspaper to clubs – but we also felt freer to take risks, make mistakes and even fail in front of one another.”

In contrast, a recent study at an Ivy League college revealed that at 10 of the most prestigious co-educational institutions, women undergraduates were less likely to receive the university’s top prizes, prestigious graduate fellowships, or hold major campus-wide leadership roles, despite the fact that they outperformed their male counterparts in all academic achievement.

Not only do women’s colleges provide more opportunities, but they also provide students with strong female role models, particularly in fields traditionally dominated by men such as science, engineering, and mathematics. (At women's colleges, the majority of the presidents are women, and more than half of the faculty members are women.)

Among the more profound advantages of women’s colleges is that they encourage women to take risks during the course of their careers, without fear of failure. That failure can be a necessary part of the path to leadership. This is a liberating and revolutionary way to make life choices, and one women’s colleges have been promoting for years.

The success of women’s college graduates compels us to persevere and share with the world what we know about the power of women’s colleges in producing leaders like Clinton (Wellesley), Kathleen Sebelius, U.S. Secretary of Health and Human Services (Trinity Washington University), Pulitzer Prize winning author and playwright Suzan Lori-Parks (Mount Holyoke College) and national broadcast journalist Gwen Ifill (Simmons College).

Certainly, a woman’s college isn’t for everyone; single-gender education has many detractors. A recent study by the journal Science magazine declared sex-segregation to be “misguided,” asserting there was no empirical evidence that boys and girls learn differently. Others will debate that unless you learn in a coed environment, you are unprepared to work with the opposite sex.

But why is it, that in spite of the fact that women now have access to the same institutions of higher learning as men, and outperform them in both academic achievement and completion rates, that this success is not translating into equal achievement in their careers?

Clearly something is not working. Women’s colleges have been educating women for leadership and achievement for years, and that work is needed more now than ever. If you influence a girl or woman in your life who aspires to leadership opportunities, do her a favor and suggest she attend a women’s college. Chances are, she will thank you later from a position of success.

Helen Drinan is president of Simmons College.

By George Nethercutt

Newsweek published an article months ago entitled “How Dumb Are We?” It addressed the results of a 20-question survey to 1,000 American adults, testing their knowledge of basic American history and posing the same questions that immigrants must answer in order to become American citizens. The results were disappointing—and illuminating. Too many Americans don’t know basic American history and the circumstances, governing principles and developments that have made our country what it is today. Such findings require national attention.

In 2008, the Intercollegiate Studies Institute (ISI) administered a survey to 2,500 American adults, testing their knowledge of basic American history, economics, world affairs and government. The results were dismal: Every participant flunked the test. It gets worse -- those who admitted serving in public office scored five points lower than the average American adult.

But it’s not just adults; in 2006, ISI tested 14,000 students from 50 universities across America, and asked them 60 multiple-choice questions, testing their knowledge of government, history, foreign affairs and economics. Students from 49 universities failed the survey. Only the bright young minds at Harvard could muster a passing D+. Similarly, the 2011 National Assessment of Educational Progress, administered by schools under the auspices of the U.S. Department of Education, showed that 4th, 8th and 12th graders are woefully under-educated about American history and government, rendering them civically illiterate.

Historian David McCullough once spoke about returning to his alma mater, Yale University, to talk with students. When he asked, “Who can tell me who George C. Marshall was?”, only a few of the students could answer correctly. One student reportedly inquired, “Wasn’t he the guy who invented martial law?” McCullough thoughtfully concluded that many of today’s students are like “cut flowers — bright and refreshing, but without roots.”

The sad fact is that too many students, adults and public officials don’t know the story of America, its history and lessons nor the principles which have guided our nation for over 235 years. Harvard students and I are taking steps to change that sorry condition.

The Harvard Civics Program connects students with fifth graders in Boston to teach them more about the United States and its system of government. Harvard students and I are devising a test for federal candidates that will be modeled on the same immigrant citizenship test that foreigners seeking American citizenship must take. It’s not rocket science —i t’s just basic American history and knowledge necessary to contribute to our free and progressive society.

Most of us are familiar with Jay Leno’s “Jaywalking” segment, in which The Tonight Show host asks ordinary Americans basic civics questions. We may slap our heads and chuckle at the ignorance of those who fail to answer simple questions about American history or current events. Yet, most viewers acknowledge that Americans ought to have basic knowledge about our country. At Harvard, we are developing a similar program and hope that Harvard students can compete satisfactorily when questioned about basic American facts, concepts and information. Arguably, the thousands of immigrants who seek American citizenship each year from other countries are smarter about the United States than those of us who are born here with automatic American citizenship. And that’s too bad.

Perpetuating American ideals, knowing our national story and having principled leaders knowledgeable about where our nation has been throughout its history, will help us all gain more studied opinions of where we’re headed in this new century and how much progress we’ve made -- as a nation and as a people. Knowing about America makes us all better Americans.

Former US Representative George Nethercutt of Washington is a fellow at Harvard's Institute of Politics.

By Peter Rothstein

Governor Patrick’s recently announced merger deal between Northeast Utilities and Nstar does more than just protect against rate increases for years to come – it enhances the state’s national leadership in the clean energy innovation economy and positions us for the key benefits from the emerging clean energy industry: jobs, economic growth and a sustainable energy infrastructure.

The clean energy industry currently employs 64,000 people in Massachusetts; the sector is on track to grow 11 percent this year after 7 percent growth last year. By expanding Nstar’s efficiency programs and commitments to purchase renewable power, the merger agreement will stimulate private investment in this fast-growing industry and create thousands of additional new jobs every year.

This increased private investment aligns with the Commonwealth’s work to promote the clean energy industry as an engine of job creation. Massachusetts has crafted a strong clean energy strategy that enjoys broad customer support, and which sets market signals for investment and growth of cost-effective efficiency and renewables. As a regulated utility playing a central role in the implementation of these policies, Nstar’s agreement signals its clear readiness to work as an active supporter and partner in the state’s strategy. These clean energy investments in efficiency and renewables are on a path to stabilize and bring down energy costs over time, and keep more of our dollars in the regional economy instead of purchasing imported fossil fuels.

Nstar’s commitment to expanding its energy efficiency programs, purchasing additional generation from solar and investing in demonstrations of electric vehicle recharging all signal to private companies and jobs seekers that Massachusetts offers increased opportunities for the newest, most innovative and cost-effective technologies to come to market. The resulting investment dollars flowing into the Commonwealth will support such job-creation opportunities as solar project development and expansion and wind turbine manufacturing – including materials manufacturers expanding from ship building to turbine blade manufacturing. Truly, the clean energy innovation economy is being built right here in the Bay State.

This is exactly where Massachusetts should be – at the vanguard of an exciting new industry driven by disruptive technologies and forward-looking innovators. After all, this state leads the country in awarded research and development grants from the Department of Energy’s Advanced Research Projects Agency – Energy (ARPA-E) program, designed to explore creative “outside-the-box” technologies that promise genuine transformation in the ways the nation generates, stores and utilizes energy. We also benefit from our proximity to top-tier local universities, which continue to spin out clean energy startups and innovation talent that make us the envy of the nation.

So what’s important about the announcement isn’t Cape Wind. Rather, it’s about confirming that Nstar is on a path to become the largest utility in New England with a deeper commitment to be a partner in our transition to a clean energy economy, stabilizing and reducing our long-term energy costs, and creating jobs and markets for our global-leading innovation economy. This merger, quite simply, makes a strong investment in the future of Massachusetts, and that benefits everyone who lives, works and invests in this state.

Peter Rothstein serves as president of the New England Clean Energy Council

By Steven Grossman
and Gloria Cordes Larson

When The Boston Club reported in its 2010 census of the 100 largest public corporations in Massachusetts that only 11.3 percent of their board seats were filled by women, our reaction was “what’s wrong with this picture?” Most recently, after the organization of women business and professional leaders reported that the number had fallen to 11.1 percent, perhaps we should modify the question: what’s terribly wrong with this picture?

Only 88 women fill the 836 seats on those 100 boards. Further, a total of 41 companies have no women on their boards at all. Particularly troubling is the fact that the critical manufacturing and technology sectors recorded only single-digit percentages.

The Boston Club census didn’t contain all bad news. Sixty-eight women now hold 9.6 percent of the 710 executive officer positions in the companies surveyed, up from 8.9 percent in 2010, marking a second consecutive year of improvement. However, both the number and percentage of women executive officers remain well below the 11% peak recorded in 2006-2007. Further, when compared to other states with a similar range of companies, Massachusetts fares poorly.

These facts paint a picture that is inconsistent with the progressive reputation of the Commonwealth. This is not just bad for women. It is bad for business.

Professors Anita Woolley of Carnegie Mellon University and Thomas Malone of the MIT Sloan School of Management reporting on their research in a recent article in Harvard Business Review pointed out: “There’s little correlation between a group’s collective intelligence and the IQs of its individual members. But if a group includes more women, its collective intelligence rises.” The article’s title: “What Makes a Team Smarter? More Women.”

Their research confirms what we would have assumed as a matter of common sense: if you exclude half the population, you exclude half the potential talent in the population. As a result, corporations with overwhelmingly or all-male boards are limiting the range of expertise they have among their directors to the detriment of corporate performance.

Moreover, boards with no women also often have other features that governance experts associate with threats to shareholder value, such as too few directors, too few outside directors, or too many directors who have served together for so long that their independence from management can be questioned. And numerous reports show that the presence of women directors is associated with greater attention to ethics and to risk, surely among today’s most pressing needs.

Fortunately, Massachusetts can boast of several large public companies, including Akamai Technologies, Biogen Idec, Staples and TJX, that have at least 20 percent of the combined number of board and executive positions held by women. That these are also among the most successful corporations in Massachusetts underscores our point.

There are steps that can be taken to promote diversity, primarily by leveraging positions of leadership. For example, Massachusetts’ pension fund recently adopted new proxy policies that support pro-diversity resolutions presented to shareholders and make diversity a criteria in voting on director candidates. In addition, Bentley’s newly created Center for Women and Business combines innovative research and programming to enable women leaders at each stage of their lives to realize their full potential and to enable the global business community to successfully harness that potential.

Other activities can be undertaken at the grassroots level. We encourage people to go to http://www.thebostonclub.com, get the latest survey, and direct their business to the companies that scored well in The Boston Club study. The most important thing, however, is for the leadership of our Massachusetts companies to finally get the message: this is a changing society and successful businesses must change with it.

We know some of the executives involved in lagging firms. We don’t think they are sexist or intentionally discriminatory. The problem typically is that they don’t like to go outside their comfort zone or that diversity is simply not at the top of their agenda. In the long run, however, this is not a path that leads to maximizing the business success they seek.

Inclusion will make their companies stronger, and positive change in the boardroom and executive ranks is long overdue. It is time for corporate leaders to see the picture – and change it. Now.

Steven Grossman is the state treasurer of Massachusetts and Gloria Cordes Larson is president of Bentley University in Waltham.

By Michael J. Ashe Jr.

Recently, the state released a “Corrections Master Plan” in response to a mandate by Governor Deval Patrick to “define the most cost effective approach for investing capital to create a more integrated and efficient (correctional) system.”

One aspect of the plan relates to offender community reentry. From a public safety standpoint, reentry is of paramount importance because 93 percent of state prisoners and 100 percent of county prisoners will re-enter the cities and towns of our Commonwealth.

In Massachusetts, an individual sentenced to 2 ½ years or less is sent to our county system, administered by our county sheriffs, and anyone receiving a sentence of more than 30 months is sent to our state prison system, administered by the state Department of Correction. Each year, 17,000 offenders are released from our county system and 3,000 are released from our state system. We want these people to be full participants in community life, not shadows on the sidelines.

The Corrections Master Plan calls for the state Department of Correction to utilize county sheriffs to reintegrate state prisoners back into their local communities at the end of their sentences. This is because, by virtue of being embedded in these locales, sheriffs are best suited to provide reentry supervision and support.

Simple common sense tells us that some of this is a matter of geography; that the closer an offender is to the support and resources of his community, the better the possibility of a seamless transition into positive, productive, law-abiding, community life. County sheriffs can help offenders tap into local organizations that can assist in the success of their reentry through proposed regional pre-release centers administered by the sheriffs.

At the Hampden County Sheriff’s Department we make a great effort to challenge those in our custody to pick up the tools and directions to build a law-abiding life while they are inside the fences of our county House of Correction.
Indeed, we say that “vommunity reentry begins on day one of incarceration."

But all of our efforts inside our secure fences, and along our continuum of lesser security, can be for naught if, upon release, offenders fall off a cliff into a chasm of old ways and old days. That is why the Hampden County Sheriff’s Department established an After Incarceration Support Systems program to stay involved with offenders during the first crucial months of reentry, to be a bridge to community life, if you will. These first few months are the crucial time when the offender either takes root in the positive elements of the community or fails to do so. To assist us with this effort, we have established over 300 “community partnerships,” with local agencies. To borrow a phrase: "It takes a village to reenter an offender."

The results of our efforts speak for themselves. After one year, over 80 percent of those released from the Hampden County correctional system are still free and functioning in our county. This is despite the fact that our typical inmate profile includes substance abuse, dropping out of high school, and no appreciable job record or marketable skills. This is despite the fact that 30 percent of those released face potential homelessness. This is despite the fact that the crimes committed by those in county custody include those crimes with the highest rates of recidivism, such as burglary, larceny, auto theft, possessing stolen property, drug charges, etc.. And this is despite the fact that the average county-sentenced inmate spends only an average of eight months in our custody for males and five months for females after being brought to us in shackles and chains with a long history of social maladjustment.

We at the Hampden County Sheriff’s Department demonstrate daily what can be done to give inmates every opportunity to become a contributing citizen, supervised and supported by his county correctional system. What this Master Plan puts in place is, in essence, a team approach to corrections through which the state Department of Correction and the county Sheriffs work in unison for the best possible offender re-entry policies and practices. This is indeed a more integrated and efficient correctional system. We believe that the plan to utilize county corrections to supervise and support our state prisoners’ re-entry into their communities through regional pre-release centers administered by the Sheriffs is a wise one, providing for the optimal opportunity for our cities and towns, and the citizens therein, to have the safety and security, the peace and tranquility, on their streets and in their homes, that they seek and deserve.

Michael J. Ashe Jr. is sheriff of Hampden County.

By Ed Davis and Swanee Hunt

Abraham Lincoln abolished slavery in this country. A century and a half later, people are still bought and sold – here in Boston.

Attorney General Martha Coakley warns that human trafficking is the fastest growing criminal industry in Massachusetts. The term “trafficking” evokes images of people smuggled across borders; but FBI, UN, and Congressional definitions describe any children, women, or men coerced into physical violence, mental abuse, and even death.

Take a look (or don’t) at backage.com, so-called massage parlors and escort services, as well as the seediest or most upscale bars and hotels across the Commonwealth. It’s right under our noses.

Organized crime has to be fought with organized action: we’re teaming up to bust those abusing the most vulnerable among us. On Sunday, the nation’s strongest anti-trafficking legislation went into effect. The new law supports victims of human trafficking (which includes most prostitution), increases punishment of pimps and complicit businesses, and – focusing on cause, not effect – targets those fueling the sex market: the buyers.

Want to buy sex in Massachusetts? Think again.

It will now cost a buyer a minimum of $1,000 – but could set him back as much as $5,000. Or he may get two and a half years in jail to reflect on how his actions perpetuated an inherently violent and misogynist industry.

Buying in Boston? Our Boston Police Department was cracking down on “johns” even before this legislation; now the heat is getting hotter.

Over Super Bowl weekend, Boston police arrested 15 buyers — including two charged with trying to purchase a 15-year-old girl. Most were white, married, in their forties. The operation was part of the second “National Day of Johns Arrests,” organized by Cook County (Illinois) Sheriff Tom Dart, which brought together more than a dozen local and federal agencies across eight states to nab 359 would-be-buyers.

Across the Unites States, the growing trend among criminal justice professionals, legislators, and non-profits is to stress not just the supply (mostly women and children) or distribution (pimps and other traffickers), but the demand (johns). Sure it’s hard to stop men from acting on destructive urges. But that will happen more quickly than solving problems that generate the supply: like racism (still pervasive), poverty (22 percdnt of America’s kids), and child abuse (which produce runaways, picked up almost immediately by pimps).

Many countries – beginning 13 years ago with Sweden – are demonstrating how stopping demand dramatically decreases the number of prostituted people. In the United States:

• Billboards tower above highways in Florida, Georgia, and Illinois, break the news to buyers with messages such as “Dear John, It’s over.”

• Eighty communities are running “john schools” -- classes that expose first-time offenders to the realities of the sex trade and warn them of future penalties. (The US Justice Department contracted with Boston’s Abt Associates, which found that a San Francisco one-day course designed by a survivor, showed forty percent less recidivism).

• Indiana Attorney General Greg Zoeller signed a pledge to end public tolerance for the sex industry as part of his anti-demand awareness campaign during the Super Bowl. His efforts are part of the National Association of Attorneys General platform, which includes demand reduction.

Other communities and police from Seattle to Denver to New York City are educating boys to prevent them from becoming buyers, forming neighborhood watch groups to report trolling men, and sending letters home notifying johns to appear in court. Some are considering adding buyers to sex offender registries or collecting their DNA.

Opponents argue that picking up “consenting adults” for a “victimless crime” is Victorian.
But what’s outdated is the notion that prostitution is harmless. Both of us have seen firsthand the devastation on those whose bodies are bought, on families and communities, and on the buyers themselves.

Granted, a small percentage of women in prostitution claim they’re opting for a career like any other. But in the US, females enter “the life” in their early teens and are statutorily raped thousands of times before they are “consenting adults.” At that point, what are their options?

Adds Mary Setterholm, “For some of us, our dignified choice to support our families led us into this socially 'undignified' sex trade. But to combine consent with extreme sexual objectification is like saying women demanded liberty to be slaves. The new law is shifting a spotlight on the core issue - demand, not choice.”

Long story short, solid public policy doesn’t shape laws to protect the wishes of a small minority when evidence of harm to the majority is crushing.

But will higher penalties against buyers make a difference? Boys will be boys, right? Wrong. We cracked that myth with domestic violence. Now we charge the abuser even if his partner “chooses” to stay with him.

In a recent study commissioned by Demand Abolition, purchasers say that levying higher fines and jail time, impounding cars, and notifying family members would deter them. But all those depend on police action. That’s why the Boston PD is docking the buyers and supporting the bought. We must remember that every girl victimized by a buyer or pimp is someone's daughter, and we must work together to end exploitation. Some guys may be shamed, but the Great Emancipator would be proud.

Ed Davis is Boston's police commissioner. Swanee Hunt, chair of Demand Abolition, is a lecturer in public policy and a senior adviser for trafficking research at Harvard’s Kennedy School of Government.

By S. Michael Ross

We are on the edge of a cliff. In the United States, we are spending more on healthcare and deriving far less value than most other countries. The current national healthcare spending trajectory — $2.6 trillion in 2010 —i s unsustainable.

Fragmented care is a leading reason that costs are so high. It also jeopardizes patient safety. More than 50 percent of Medicare beneficiaries have five or more chronic conditions such as diabetes, arthritis, hypertension, or kidney disease, and, on average, visit 14 different providers at various facilities annually. The resulting uncoordinated treatment can lead to redundant care, superfluous testing, increased exposure to medical error, and unnecessary costs.

What if a health plan could reach members at the moment of care through their most trusted advisers — their physicians? According to a Microsoft study, 90 percent of people trust their doctors over all other forms of health information. One strategy for nationwide health improvement is fostering the physician-patient relationship. This can be highly effective because it encourages patients to engage in their own treatment plans. We are rapidly moving to a system in which more of the accountability for clinical outcomes is being transferred to the providers, and the economic incentives are being aligned. Equipping providers with the right information to be delivered at the right time is an essential tactic to bend the cost trend and enables the accountable provider to deliver better quality of care.

The patient-centered medical home (PCMH) is one collaborative value-based model gaining traction in the medical community as an antidote to fragmented care. However, for collaborative models to achieve desired cost and clinical results, communication between health plans and providers must be better cultivated..

Increased coordination means chaos if the data is not synchronized. Health information technology (HIT) plays a pivotal role in enabling providers, health plans, patients, and others within the healthcare continuum to share information. Merging clinical information from the provider side with financial and administrative data from the health plan side, for instance, delivers unified intelligence and permits everyone access to a more complete picture to support patient care. One way that this goal can be accomplished is through a single, multi-payer, secure, real-time source of patient-related clinical information.

One essential aspect to achieving the desired outcomes is workflow integration. In order to effectively coordinate care — and to avoid confusion at the provider level — data must be presented in a standardized, uniform manner across all health plans. In addition, the information must be easily accessible. Providers need to be able to access data across a variety of technology platforms, including portals, smart phones, and tablets.

When information is delivered by a provider at the moment of care — as opposed to a health plan — it carries far more credibility with patients. The ability to integrate health plan claims-derived gaps in care with provider electronic health record, practice management, and scheduling systems results in a far more timely and accurate approach to communicating with patients about preventive and chronic care. By acknowledging that physicians are the most effective channel for this communication, health plans can help strengthen the provider/patient relationship, increase the quality of patient care, and save on administrative costs.

Today, health-care communication networks are starting to make the vision of care collaboration a reality. Early pilot results on PCMH confirm that this model saves money and improves clinical quality. By bringing health plans and providers together through real-time data exchange, the health-care industry can coordinate care and align reimbursement with patient outcomes. From there, it is a much shorter step to the end goal of reducing costs while improving the quality of care. We have the opportunity to rapidly achieve better health of our people — and to bend the cost curve.

Dr. S. Michael Ross is chief medical officer of NaviNet, a health-care communications network.
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By Steve Crosby
and David Tebaldi

American political discourse seems to be on a path to paralysis. Extremist rhetoric and demagoguery, half-truths and outright lies, and the politics of personal destruction permeate every level of public debate, from Congress to traditional media to the Internet. This lack of civility appears to threaten central features of our democracy and is a cause of increasing alarm among the general public.

According to one recent poll, two-out-of-three Americans consider a general lack of civility to be a major problem for the nation. Nearly half the American people (49 percent) are tuning out government and politics, and almost two-thirds of those people (63 percent) cite the general tone and level of civility as a major factor in their decision. Forty-six percent of the people are tuning out opinion pieces and editorials in the media, and 45 percent cite incivility as a major factor. Thirty-eight percent are tuning out news coverage and reporting and half of them (50%) attribute their actions to the lack of civility.

Historians respond that American political discourse has ever been fractious and uncivil, never more so than during the earliest days of the Republic. And at this very moment we are commemorating the sesquicentennial of the most uncivil period in American history – a civil war that lasted four years and cost some 600,000 lives.
The question isn’t whether civility in our public discourse is essential to the survival of our democracy. Clearly it is not. Nor does it matter whether earlier periods in our history were more or less civil than the one we are suffering through now. The crucial question is whether civility is a critical element in the success of our political system. Is it a defining feature of what can — and has — made us unusual? As Judge Learned Hand put it in a famous speech in Central Park at the height of World War II, "the spirit of liberty is the spirit which is not too sure that it is right; the spirit of liberty is the spirit which seeks to understand the minds of other men and women; the spirit of liberty is the spirit which weighs their interests alongside its own without bias."

President Obama echoed this sentiment in his Notre Dame Commencement speech when he urged his listeners to “temper our passions, and . . . be wary of self-righteousness . . . to remain open, and curious, and eager to continue the moral and spiritual debate . . . within our vast democracy.” The President continued, “This doubt should remind us to persuade through reason, through an appeal whenever we can to universal rather than parochial principles, and most of all through an abiding example of good works, charity, kindness, and service that moves hearts and minds.”

But there is another great tradition in American political and social life that seems to require an abandonment of civility in favor of an even higher good -- justice. This is the tradition of dissent, without which, some would argue, progressive reforms from the abolition of slavery to the Civil Rights Act of 1964 to the Goodridge decision legalizing same-sex marriage in Massachusetts could have been achieved. From this perspective, calls for civility can be seen as a puerile virtue, as a smokescreen for maintaining the status quo.

As the Rev. Martin Luther King, perhaps America’s most revered dissenter, eloquently stated in his Letter from Birmingham Jail, “[W]e must we see the need for nonviolent gadflies to create the kind of tension in society that will help men rise from the dark depths of prejudice and racism to the majestic heights of understanding and brotherhood.” Or, in the blunter words of Harvard Law professor Randall Kennedy, “If you are in an argument with a thug (as Dr. King often was), there are things much more important than civility.”

This is true, of course. However we would argue that it is civility that enables a complex, diverse society to tolerate dissent, reconcile conflicts, find common ground, appreciate compromise—all to the end of both keeping the society stable, but also facilitating the ideological, philosophical, ethical, and practical evolution and renewal that keep us vibrant and healthy as a society. Without civility—properly defined, there cannot be rigorous dissent; without civility, there cannot be reconciliation of opposites and profoundly different values; without civility, there cannot be stability, renewal, evolution and change.

This week the Center for Civil Discourse at UMass Boston will launch its inaugural event, “Civility and American Democracy: A National Forum.” Co-sponsored by the McCormack Graduate School of Social and Global Policy, Mass Humanities and WBUR-FM, the forum brings a stellar cast of public intellectuals and political observers together for a day-long exploration of the meaning, value and practice of civility in our past, present and future. It is an important discussion to have, and it will be civil.

Steve Crosby is dean of the McCormack Graduate School of Public Policy and Global Studies at UMass-Boston. David Tebaldi is executive director of Mass Humanities.

By Tom Putnam

Fifty years ago today, Jacqueline Kennedy introduced herself to the nation.
In many ways, the public already knew Kennedy through her roles as the president’s wife, mother of two children, and as the woman who charmed world leaders like Khrushchev and De Gaulle. Yet on Feb. 14, 1962 it was a more substantive Jacqueline Kennedy who guided viewers on a televised tour of the White House. And the nation was transfixed.

Forty-six million Americans watched that night – and an additional 10 million tuned in days later. The reviews were laudatory describing Kennedy as a virtuoso performer and an art critic of “subtlety and standard.”

The success came as no surprise to those who knew her. Though only 31 when she entered the White House, Jacqueline Kennedy’s life and studies prepared her well for this role.

Claiming that her first responsibility was to her husband and her children, Kennedy delegated to others many of the official duties normally associated with first ladies. Yet at the same time, she also expanded her portfolio, most notably, leading a scholarly restoration of the White House and its historic surroundings. She set out to make the president’s home one of the nation’s most significant museums that would recount our national story through the lives of its former residents.

Her efforts were an early example of what foreign policy experts refer to as “soft power.” She understood that as the United States came of age we needed to celebrate our artistic and cultural achievements just as we promoted our commercial and military might.
She used the White House as an international stage inviting distinguished artists such as Pablo Casals to perform, hosting state dinners for visiting dignitaries, and organizing gatherings like the 1962 dinner for Nobel laureates. She opened the doors to increase public visitation, created the first White House Guidebook, and welcomed young artists for jazz and dance performances.

As the Kennedy presidency unfolded, she expanded her reach - negotiating with the French for an unprecedented foreign loan of the Mona Lisa and raising funds to save the Egyptian temples of Abu Simbel.

This week the Kennedy Library opens Jacqueline Kennedy’s papers chronicling her years in the White House. The documents show her attention to detail and the incredible range of her understanding of art, history, and aesthetics.

The Kennedy presidency was cut too short, in many ways. Yet Boston continues to reap many benefits from Jacqueline Kennedy’s promotion of the arts and her belief in the importance of studying the past. In a city with no dearth of museums, visitors to the Kennedy Library are offered a unique experience. While most come to relive a key moment in the history of our country, they are also afforded, through the efforts of Jacqueline Kennedy, the opportunity to experience an array of precious artifacts including an Egyptian statue from the Great Pyramid of Giza; a replica of Michelangelo’s Pieta (a gift from Pope Paul VI); an 18th century American chest of drawers given by President Martin Van Buren to his grandson; and a 2nd century stucco Buddha head from Afghanistan (made all the more precious after the Taliban’s recent efforts to destroy similar icons throughout that region). These ancient relics contrast smartly with the iconic modernist building designed by I.M. Pei who was personally chosen by Mrs. Kennedy for this historic commission.

In what was perhaps her greatest cultural gift to this city, Jacqueline Kennedy Onassis facilitated the donation of Ernest Hemingway’s papers to the Kennedy Library – one of Boston’s most significant literary collections. Hemingway revolutionized literature as we know it – and these materials allow the Kennedy Library to serve as the host to unparalleled literary and cultural events such as the bestowing of the annual PEN/Hemingway Award and the Hemingway Centennial conference featuring four former winners of the Nobel Prize for Literature.

Such celebrations and exhibits are guided by the spirit of a young woman who assuredly entered the nation’s living rooms 50 years ago today – echoing like encores to that virtuoso performance.

Tom Putnam is the director of the John F. Kennedy Presidential Library and Museum.

By Richard P. Campbell

Former Chief Justice Margaret Marshall, reflecting on her early years as a citizen in South Africa, uses a metaphor to explain the importance of the rule of law. “When you are breathing oxygen you don’t notice it, when you cut off the supply you will notice it very quickly.”

For most of us, the American judicial system has been one of the few constants throughout our lives. Courts and the judges who sit in them have been models of stability, equipoise, and scholarship. When political leaders like Arkansas Governor Orval Faubus prohibited African American children from entering Central High School in Little Rock or Mississippi Governor Ross Barnett and the Trustees of the University of Mississippi blocked James Meredith from matriculating, our courts and judges righted those wrongs. If captains of industry, like the CEO’s of WorldCom, Enron, Tyco, and Global Crossing, crossed the boundary of proper business conduct and engaged in criminality, our courts and judges removed them from their corporate suites and provided alternate, supervised housing for them. Revolutionaries, like Raymond Luc Levasseur, could not destroy our system of justice by detonating bombs in our courthouses. Instead, the business of the courts continued without fear. The day-to-day enforcement of criminal and civil laws has always gone forth quietly, surely, and swiftly, promoting great predictability to our lives.

Most of us never step back and ask ourselves what “the rule of law” means. And few of us, if any, ever consider it at risk. But what would happen if the rule of law in this country simply failed?

What would the evil, violent, people in our midst do if there were no courts? Would they take advantage? Would we be safe in our homes and communities? How about the captains of industry? Would they cheat and steal from us? Could we trust our landlords or bankers? Would our children and incomes be secure from estranged spouses?

Let’s call the collective sum of all public and private services related to the reading, interpretation, guidance, application and enforcement of statutory and common law the “law economy.” There are obvious public employee stakeholders in the law economy (judges, prosecutors, court administrators, clerks, and court officers). And, there are equally obvious private employee stakeholders as well (lawyers, law firms, paralegals, investigators, and the like). It is easy, however, to view the law economy myopically and to lose sight of the fact that the public at-large are stakeholders in it too (businesses and consumers, employers and employees, purchasers and sellers, lenders and borrowers).

The foundation of the law economy in the Commonwealth of Massachusetts is full, adequate public financial support for the courts. But the truth of the matter is the public (and our elected officials) do not properly support the courts. As a result, the law economy is crumbling all about us. Courts are closing; judges are retiring early; support staff are laid off or just not replaced.

The most important point for all stakeholders to note as they ponder the decline in the law economy is the erosion in the rule of law and with it the decline in the quality of life in the cCommonwealth. The employee who works hard for two straight weeks expects her employer to deliver a paycheck and make good on promises of health insurance and other benefits. The tenant who pays her rent expects the building heat and electricity to work when she turns on switches.

By underfunding the justice system, we put at risk the way in which we live our lives and with it our hopes and dreams for ourselves and our children and grandchildren.

The Massachusetts Bar Association is undertaking the cause of educating the citizens of the commonwealth on the risks of an underfunded and non-functional judiciary. Through billboards alongside the Expressway, the Massachusetts Turnpike, and other interstate highways, videos posted on YouTube, and public appearances in schools and local communities, the MBA will forewarn the community of the risks at hand. Hopefully, the community will listen.

Richard P. Campbell is president of the Massachusetts Bar Association.

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By Fred Salvucci

To understand the transformation that Kevin White brought to our city, you have to look back and remember how profoundly destructive and self-hating the city politics and policies of the 1950s and 1960s were, and the dramatic infusion of energy and self-confidence Kevin White instilled in the city.

In the early 1950s and 1960s, much of the culture and momentum of the "New Boston" was about destroying the Old Boston with a wrecking ball. The eradication of the West End and New York Streets neighborhoods, severing the connection of Charlestown from its waterfront with the Tobin Bridge and the city from the North End and Waterfront and the sea with the elevated Central Artery, the intrusions of the Bowker overpass into the Back Bay and Fens, and of Storrow Drive into the Esplanade, were destructive at a scale hard to imagine today. Depriving the people of East Boston of the magnificent Olmstead-designed Wood Island Park and obliterating Madison Park in Roxbury were destructive of the very soul of these neighborhoods. The heart of Boston's abolitionist history -- the old Brattle Bookstore -- was destroyed without leaving a trace.

More destructions were scheduled: the Inner Belt Highway and I-95 were to tear through Hyde Park, Roslindale, Jamaica Plain, and the Fens between the Isabella Stewart Gardner Museum and the Museum of Fine Arts; the discontinuation of the Old Colony Rail service to the South Shore was to be followed by wrecking the landmark South Station, eliminating commuter rail service to the Back Bay and North Station; the Science Park and Lechmere Green Line were slated for destruction.

Incredibly, these massive disruptions of the city fabric had been promoted and celebrated by the city government of that period. Entire neighborhoods and ethnic groups were excluded from the political life of the city. You had to look very hard to find a person of color, an Italian, a Jewish person, or a woman, in the Boston city government of the early 1960s. Young people were treated as unimportant. After a teenage scuffle in the 1950s, the city suspended use of municipal buildings for "record hops" for close to a decade!

Kevin White didn't change this urban disaster in a programmatic way, but in a symbolic and celebratory flurry of actions. Instituting "Summer Thing," Kathy Kane's brilliant citywide celebration of performing arts, spoke volumes. Performances of opera in city parks, boxing matches in city squares, rock music, and art said that all the left-out neighborhoods and social groups matter, and the city cared about us! Some of us remember when the new Mayor's opening of city government and jobs to people of color resulted in his being called "Mayor Black."

On the theory that actions speak louder than words, names began to appear in city decision-making roles like Bruce Bolling, "Jeep" Jones, and Paul Parks; Barney Frank, Ira Jackson, Olins, Rosenblum, Schwartz, Shadrawy, Weinberg; Kathy Kane, Emily Lloyd, Nancy Huntington, Joanne Prevost, Micho Spring, and Ann Finacune; Anzalone, Cassazza, Forgione, and Vitagliano -- and a Police Commissioner named Di Grazia.

The Mayor's instinctive brilliance in grasping at performances by James Brown and the Rolling Stones to maintain the public peace is legend, but the overwhelming subliminal theme from this new mayor was that young people, including their taste in music -- matter, and are part of this city. The Little City Hall network and youth activity commission established connections and communication, and delivered a mayor committed to fight for his city, successfully fighting the scheduled invasion of Interstate highways into the city's neighborhoods. As the political advertisement of the 1971 campaign celebrated: "Logan Airport had plans to tear up East Boston -- Kevin White tore up those plans." When the Tregor Decision threatened to disrupt the social fabric of the city with huge property tax increases in the residential neighborhoods and decreases in business taxes, Kevin responded with the successful classification amendment drive -- an impossible dream then; an established practice today.

The investment in Quincy Market was not the first new investment in downtown Boston. But it was the first investment that celebrated the value of the Old Boston in creating a new economy. That is why Quincy Market will always be Kevin's gift to the city -- a huge political risk at the time; conventional wisdom today.
The visit of the Tall Ships, and the "return" of the Queen of England to Boston were brilliant ways to celebrate our historic link to the sea, and our worthiness to be a world-class city.

And there was busing. Some urged the mayor to use his charisma and leadership skills to convince people that busing would be good for the education of our kids and for the city. Others argued that spending millions busing kids out of their neighborhoods to equally under-performing schools in other neighborhoods was a crazy waste of money that would undermine support for the schools, hurt education, and set back relations among the ethnic groups of the city, and urged Kevin to convince Judge Garrity to abandon the idea.

Kevin believed that his responsibility was to recognize that he couldn't succeed at either task, and that his responsibility was to prevent the rancor and anger of the issue from endangering the safety of the kids and the city, and he worked tirelessly, and thanklessly, to keep the peace. I believe that he delivered beyond the limits of his health and strength, with substantial damage to his political standing from all sides. But he did deliver.

Some have raised the criticism that Kevin eventually became the "Downtown Mayor" he had defeated. I believe that criticism misunderstands Kevin's contribution. He was always fighting for the entire city, including its downtown economy. Fighting to stop I-95 and the Inner Belt from destroying neighborhoods, and saving commuter rail services to Back Bay and South and North Stations were complementary parts of a winning strategy that has served both downtown and the neighborhoods, but it was a battle that Kevin had to win without the help of the downtown business community.

Kevin's real gift to the city and all of its neighborhoods is the gift of rising expectations. The belief that all of us matter, and deserve to be included in city politics and policy making, makes it much harder for the mayor to run the city, but is an invaluable gift and legacy to all the people of this city. Leaders raise expectations, sometimes beyond their capacity to deliver, risking their political support for the greater good. "Anti-leaders" lower expectations so that they can always deliver. Kevin was a true leader, and the rising expectations he unleashed are still benefiting the city.

Each of us who had the privilege of working for this great mayor has our own memories of him, of both his incredible willingness to take a chance on young people with crazy ideas, and support us. He was the first, and for a long time the only, significant elected official to support the removal of the elevated Central Artery. We also all remember his knack for rapping us on the knuckles to remind us who was boss. But mostly, I remember a mayor who became a second father to me, who I will miss incredibly.

Fred Salvucci was a transportation adviser to Kevin White and later served as state transportation secretary.

By Robert L. Turner

Numbers are important in evaluating Mitt Romney, but the focus should not be on the $250 million estimated fortune he amassed at Bain Capital, or the $374,00 in speaking fees he took in last year, or even on the roughly 15 federal percent tax rate he paid.
The most important number is 47 — Massachusetts’s rank in job creation when he was governor. This is the number that most calls into question Romney’s own current job application.

No job is comparable to the presidency, but the closest thing to it is governor of a large state — an executive position in public office, where the welfare of millions of people is the charge. Unlike a corporate executive, whose overriding goal is to make profits for investors, the president and governors have the same central goal — improving the well-being of the entire population. The first priority, usually, is the overall economy.
Indeed, Romney won office in 2002, after shouldering aside Acting Governor Jane Swift, with a pledge to use his business experience and connections to bring jobs to Massachusetts. He failed, dreadfully.

The 47 figure is one Romney cannot escape. During his four years in office, Massachusetts ranked 47th in overall job growth — only 0.9 percent compared with 5.3 percent nationally. Romney has countered that the unemployment went down appreciably — from 5.6 percent to 4.7 percent during his term.

How could so few new jobs translate into a healthy-looking decline in unemployment? The answer is simple — and not so healthy: Working-age adults were packing up and moving out. Many were replaced, fortunately, by immigrants. But overall, Massachusetts was one of only two states to have no growth in its resident labor force during Romney’s term.

Another part of that answer is that the national economy was doing well; Romney left office after one term in January, 2007, before the nation and its leaders were tested by the Great Recession.

Now, Romney emphasizes his success making profits in the private sector as his primary credential for the presidency, largely ignoring his record as governor except when, under pressure, he washes his hands of the health care bill that was his singular accomplishment in Boston.

Too many have bit. America has always been fascinated by wealth. And aspects of Romney’s success story are undeniably interesting But the question of whether his work at Bain Capital led to the creation or loss of jobs is an exercise in arithmetic that is not nearly as relevant as his performance as governor.

Romney has attempted to add political capital from his Bain Capital career by suggesting that his record of making enormous profits for himself and some investors means that President Obama is opposed to profit. (Obama might do well to parrot Bill Clinton’s remark that he hoped America would create a record number of new millionaires in his term, which turned out to be the case. And Obama has some ammunition — the number of new millionaires jumped by 8 percent in 2010.) More to the point, Romney’s Republican opponents, and much of the press, are allowing Bain to be a huge distraction.

The single most telling frame through which to view Romney as a potential president, by far, is his performance for four years as governor of Massachusetts. When he was head of Bain, money was flowing in. When he was governor of Massachusetts, people were filing out.

Robert L. Turner, a former Globe columnist, is a senior fellow at the McCormack Graduate School of Policy and Global Studies at UMass Boston.

By Ellen Story

Postpartum depression hits approximately 15 percent of new moms during the first year of their babies' lives, and is often marked by severe despair, guilt, anxiety, and fears of hurting oneself or one's baby. Although awareness of postpartum depression is improving, the illness is often hidden by new moms' successful covering-up of these painful symptoms for fear of being deemed a "bad mother." The illness is also frequently missed by health care providers who feel unprepared to deal with the consequences of digging deeper into moms' mental health. Fortunately, however, if addressed early, this depression is eminently treatable, and any adverse consequences it has had on children can be successfully remedied.

Many states are addressing this issue through various new screening protocols, public and professional education programs, and innovative pilot programs. Massachusetts should match these efforts.

As I began to work on a state bill that addresses postpartum depression, I discovered outsanding work that was already being done here. I met Dr. Howard King, a pediatrician from Newton ,who has found innovative solutions to addressing the illness and developed a training program to help other pediatricians see mental health issues in a more holistic, family-oriented way. I learned about regional nonprofits like MotherWoman in Western Mass., the North Shore Postpartum Depression Task Force, and the Cape and Islands Maternal Depression Task Force, that are working locally to get women the treatment they need. I got to know the state Department of Public Health's Maternal and Infant Mental Health Project, focusing on prevention and treatment of postpartum depression through home-visiting and other programs for at-risk moms. I learned that the nation's pioneering work on the safe use of antidepressants and other psychiatric medications sometimes necessary for pregnant and nursing women is being done right here at Mass. General's Center for Women's Mental Health.

Wanting to build on the good work of these leaders and many others, I brought together health care providers, activists, mothers, and policymakers in both small and large groups to learn from each other, prioritize top issues, and finally, to draft a bill.

What I learned from these experts was that an effective solution to postpartum depression must be comprehensive: all women must be screened. Moreover, it's useless to screen if you have nowhere to refer women for treatment. Also doctors and families need a better understanding of the illness to be able to identify and support suffering moms. The bill, called "An Act Relative to Postpartum Depression,'' addressed all these areas.

In January 2010 our bill received a hearing before the Legislature's Joint Committee on Financial Services. Doctors, child psychiatrists, survivors, spouses, and many others offered powerful testimony about the painful effects of postpartum depression on moms, babies, and families -- and also about how it can be treated. With strong momentum from this hearing, the legislation passed in August 2010.

As the bill made its way through the legislative process, however, it was changed. The heart of the bill, universal screening, raised concerns for insurers and doctors. And funds for the bill's other provisions, such as public education, were nearly nonexistent. Fortunately, the law that passed does take important steps forward. It calls on the state Department of Public Health, a strong partner throughout the process, to issue regulations on best practices and data collection for screening. They are making excellent progress.

The law also created a diverse 34-person Commission, including health care providers, insurance representatives, survivors, legislators and state agency representatives, and many others, charged with advancing best practices in screening, referrals, treatment, and public and professional education.

I am co-chair of this commission, which held its first meeting in mid-December. I am hopeful about the group'ss ability to develop systemic solutions to postpartum depression like the ones in our original bill, and to be sure those solutions are really working to get women and their families successful treatment. If we succeed, we will all benefit.

Ellen Story is a Democratic state representative from Amherst.

Jan. 12 marks two years since Haiti’s devastating earthquake. Though the tragedy was billed a “natural disaster,” an earthquake is not enough to explain the loss of hundreds of thousands of lives and the destruction of millions of homes. It isn’t enough to explain the acute food shortage immediately following the quake or the humanitarian crisis that continues today, with more than half a million Haitian people tented in over-crowded, sweltering IDP camps without access to basic services, and the cholera epidemic that has infected more than 500,000 people in the past 15 months. What has happened in Haiti is better termed an “unnatural disaster.”

To place blame solely on the earthquake is to miss the political and historical underpinnings of poverty in Haiti.. The damage was far worse than it should have been because Port-au-Prince was home to hundreds of thousands of slum dwellers whose fragile shanty homes folded like cards. The slums existed in part because the collapse of the farming sector led rural poor to the city in search of nonexistent jobs. The farming sector collapse, in turn, was caused by factors including U.S. free trade and food aid policies that flooded Haiti’s market with cheap imported food for decades. And all of these problems were compounded by the fact that the institution charged with confronting and solving these challenges – the government – lacked the infrastructure and ability to respond and itself was decimated by the earthquake.

A country this fragile, whose citizens largely lived on less than $2 per day, lacked the resources to ride out a natural disaster. Unfortunately, the kind of aid Haiti has received in response to an acute problem didn’t address the country’s chronically underfunded sectors of health, education, and agriculture.

Haiti doesn’t only need short-term aid. Every aspect of Haiti’s recovery – from acquiring food security to providing health care – requires long-term support grounded in a rights-based approach to development. Only this approach can fix systemic inequalities in order to create a stronger and more self-sufficient society. American Jewish World Service and Partners In Health have used the rights-based approach for decades by empowering community groups and government institutions to build local capacity.

Haitian community groups like AJWS grantee Lambi Fund are at the helm of creating long-term, sustainable change. The Fund supports projects on rural development, crop diversification, grain storage and agricultural processing as well as organizational development. Over the past two years, Lambi Fund has helped rural women and peasant groups respond to the post-quake out-migration from cities to the countryside with food and essentials while also providing seeds, tools and equipment to plant crops to feed these communities into the future. It supports rebuilding of community enterprises central to the economic livelihoods of these areas that were lost in the earthquake such as grain mills, sugar cane mills and rainwater cisterns for safe drinking water. Additionally, Lambi Fund is recapitalizing micro-credit funds run by grassroots organizations so that people can replenish and continue their small businesses.

But community groups cannot change the country on their own. They need capable, accountable government institutions as partners in this work. For Lambi Fund, that means a functional Ministry of Agriculture. For Partners in Health, it means working with the Haitian Ministry of Health in 12 health centers and hospitals for over a decade to improve infrastructure and train and support Ministry staff. This year, the doors will open to a national reference and teaching hospital in Mirebalais. PIH supported the Ministry in its development and construction because the hospital represents a long-term investment in access to state-of-the-art care in Haiti and in providing hands-on training for future generations of Haitian doctors, nurses and other health professionals.

From the outset, grassroots organizations have been marginalized and excluded from the most important decisions about Haiti’s future, with key meetings held almost exclusively in the capital or outside the country entirely and in English or French instead of Kreyol. Capacity building for Haitian institutions has been ignored by donors who have thrown up their hands at the idea of creating a robust, functional government. Instead, they prefer aid projects with outcomes measured in days or weeks, not months and years. This might be the easy choice for donors, but it’s not the right choice for Haiti.

International actors in Haiti including foreign governments and organizations like ours must not forget that our role is to support the aspirations of the Haitian people and help build the backbone for a sustainable society. Haitians are the true experts and leaders who should be charting the nation’s future. They are the ones who will need to hold their government accountable for its promises long after the international spotlight is gone.

Two years after the earthquake, Haiti’s needs remain acute but the resilience of the Haitian people remains unshakable. It is up to us to demand that international policy makers invest in Haiti for the long term. Haiti deserves an independent, bright future.

Dr. Joia Mukherjee is chief medical officer at Partners in Health, an associate professor at the Department of Global Health and Social Medicine, Harvard Medical School and an associate physician at the Division of Global Health Equity, Brigham & Women’s Hospital.

Ruth W. Messinger is president of American Jewish World Service.

By Francisca Rojas and David Luberoff

With the onset of winter, the persistent problem of tardy school buses in Boston is about to get worse. In addition to being late, students now will be waiting for those buses in the cold, in the dark, and sometimes in rain, sleet or snow.

Some help is on the way in the form of a new smart phone app. But more could easily be provided at a very low cost if the Boston Public Schools take a page out of the MBTA’s book and make it easy to get data on which buses are late and when they are going arrive at specific stops.

To BPS’s credit, only about 12 percent of all school buses – about 70 routes in all – consistently are late, down from over half of all buses when school started in the fall. However, the problem likely will worsen in winter if piles of plowed snow will further narrow Boston’s already cramped streets.

Wouldn’t it be great if students, parents, guardians, and educators could find out if a particular bus was going to be late and when it was likely to arrive?

In fact, there’s already an app for that called "Where's My School Bus?" Built for Boston by a young software developer working with the city Office of New Urban Mechanics through the Code for America fellowship program, the program is accessible through a smart phone or a computer connected to the Internet. BPS currently is testing it with three parent groups and soon will roll it out to the current students and their families.
While this is step in the right direction, BPS can and should go further. In particular, BPS should make information about its buses available to people who have only regular cell phones, land lines, or no phones at all. To do so, BPS should learn from the MBTA, which has made information about the location of its buses and trains available to programmers and application developers.

As a result of this “open data” policy, there now are over 30 different ways to find out when an MBTA bus will arrive at a specific stop. This information is available not only via smart phone and computers but also via text messages, homemade digital signs, and old-fashioned land lines.

Based on our research on the impact of the MBTA’s efforts and similar initiatives undertaken by other major U.S. transit agencies, we believe an “open data” strategy at BPS would produce three important benefits.

• Less waiting: people who use various applications will spend less time waiting outside for their bus.

• Better information: by creating competition among various applications, opening data for developers improves the quality of apps and web sites people use to find out when a particular bus is going to arrive.

• Improved service: by giving users the information they need to hold providers accountable, the open data approach should lead to improvements in service.
There is a legitimate concern about giving everyone access to information about when a particular school bus is going to arrive at a particular stop. We think this fear is overblown.

First, transporting students in bright yellow buses that travel the same route every day already makes that information available to anyone who wants it. Second, any potential harm is far outweighed by the benefits of not having kids wait for buses in unpleasant and sometimes dangerous winter weather. Finally, it may be possible to address some concerns by requiring that users register with the school department.

In short, opening up the school bus data is a low-cost opportunity to marshal civic innovation and entrepreneurship to improve a vital public service.

Francisca Rojas is research director at the Transparency Policy Project at Harvard’s Kennedy School of Government. David Luberoff is executive director of Harvard’s Rappaport Institute for Greater Boston.

By Nancy Gertner

Why is Massachusetts moving in a direction opposite that of other states -- retaining life without parole for juveniles, refusing to enact post conviction DNA testing statutes and more recently, proposing a new version of the discredited “Three Strikes and You’re Out” crime approach?

As the Globe reported, Massachusetts is the only New England state with life without parole for juveniles. The Supreme Court has recognized that the adolescent brain is sufficiently different from that of an adult that the death penalty is inappropriate -- even for murder, as is life without parole in non-murder cases. And it is inconsistently applied. The story is a familiar one: The law is enacted because of one juvenile’s horrific crime, but is then applied in very different cases - to impulsive crimes, nowhere near as brutal as the offense that motivated the law, committed by teenagers with little or no prior record.

The failure of the DNA bill is more mystifying. No one is interested in the imprisonment of an innocent man. Yet, a bill requiring DNA testing has failed to pass every year since 2003. As the Globe reported, some prosecutors claim to be worried about the cost of DNA testing, costs which have not materialized in states that permit testing.

If costs are at issue, why enact a “Three Strikes” bill? While we are not yet where California is – California has to release more than 30,000 prisoners because of “Three Strikes” overcrowding – that’s where we are heading. Existing get-tough policies have pushed our system to the breaking point.

Overcrowding averages 143 percent over capacity; one unit at MCI Framingham is even at 331 percent over capacity. Parole releases – influenced by administration policies -- have dropped by 56 percent in 2011 (according to the Department of Correction). The Commonwealth faces additional prison costs of approximately $100 million dollars per year. And if the new law increases the prison population as it is likely to do, the Commonwealth will have to build more capacity fast – costing $100,000 per cell. This is on top of the $1 billion a year the state spends on incarceration. Worse yet, since the current system is too strained to meaningfully invest in keeping prisoners from reoffending, we are doomed to keep paying to house some of the same prisoners over and over.

The issue is not being “soft on crime.'' Real reform saves millions and increases public safety. Real reform recognizes that every dollar spent on prison is a dollar taken away from reentry initiatives. Even Newt Gingrich, among others across the political spectrum, agree that imprisonment is an expensive resource to be carefully targeted.

The proposed "three-strikes'' bills are not. Both House and Senate versions create two categories of “habitual offenders” – those convicted of any felony after two prior felony convictions, and those convicted a third time of certain listed crimes. In the first category, the bill amends the law which already mandates the maximum sentence on the third felony. It changes parole eligibility from half of a sentence to two-thirds. “Felony” sounds serious but there are 688 felonies in Massachusetts; most are non-violent.

Those in the second category convicted of one of the nearly 60 listed offenses after two prior convictions on the list (and who meet other requirements) also get the maximum punishment but now without parole,. While the bills limit the no-parole category, the list is still too broad. The Senate version includes breaking and entering, a crime that homeless people are charged with when they seek shelter in an abandoned building. No parole may mean that these offenders are released without supervision, just a bus ticket.

If we are concerned about the inconsistent application of juvenile life without parole, we should be especially concerned about “three strikes.” The charging decision, the decision to plead to a lesser sentence, depends entirely upon the preferences of different district attorneys across the state. Make no mistake about it: With mandatory sentences, prosecutors sentence; judges do not.

States as different from Massachusetts as Mississippi and Texas are implementing smart prison reform. By reserving prison space for the most violent and instituting programs for low level offenders, Mississippi has cut its population by 22 percent, saving roughly $450 million, according to one study. Texas enacted similar reforms in 2007, saving an additional $2 billion. And the crime rates in both states have substantially declined..

Since violent crime has also fallen in Massachusetts, why is this bill necessary? The answer: Domenic Cinelli. Whatever the issues concerning Cinelli’s parole after concurrent life terms, he was out of prison for nearly two years before he tragically killed a police officer. It was a failure of supervision, which we will repeat if we spend limited dollars on imprisonment rather than reentry. To prevent future Cinellis, we should focus at best deny parole only to those serving multiple life sentences who remain violent– nothing more.

If this bill passes one thing will be clear: We will have chosen bumper-sticker politics that does nothing about crime, and costs millions, just when we can ill afford it. Unwilling to pay the price for exonerations or treatment, we are too willing to pay the cost to imprison.

Nancy Gertner is retired judge from the US District Court for the District of Massachusetts.