HOW RWANDA BEAT THE HEALTHCARE CURVE

By Staff Writer Jennifer Grundman

In 1962, Belgium, which had been granted the formerly German colony of Rwanda-Urundi in the Treaty of Versailles, relinquished control of Rwanda. Finally independent, Rwandans elected their new president, a Hutu man named Gregoire Kayibanda. Though no longer under European rule, Rwanda still suffered the effects of German and Belgian realpolitik: When Germany first claimed Rwanda as its colony, it set about concentrating local power in the minority Tutsi ethnic group, which had long enjoyed a peaceful hegemony over the majority group of Hutus. But with the Europeans gone, the tensions between the two groups, exacerbated by Belgian and German meddling, came to a breaking point. With a brutality that presaged the genocide in the mid-1990s, fighting between Hutus and Tutsis erupted sporadically from 1962 to 1973, often resulting in Tutsis either fleeing or being killed. Then, in 1994, Hutu extremists assassinated President Juvenal Habyarimana, who had taken power in 1973 with a vow to end the strife.16 The assassination sparked a premeditated, 100-day genocide that decimated Rwanda’s infrastructure, destroyed its fledgling health care system, and left close to a million Tutsis dead. This history makes it all the more remarkable that today, only a little over 20 years later, the country that most Western powers dismissed and thought would turn into another failed state has become a pioneer in health care and health equity, with 91 percent of its population, as of 2012, with health insurance.

Just after the genocide, Rwanda’s health care system was in desperate straits, with only 198 healthcare professionals in the country to service thousands of people, with rates of HIV — already high before the genocide — rising due to the extremists’ weaponization of rape, and with a paucity of medical training facilities in a largely agricultural population.4 For six years afterward, the government tried to return to the decentralized management of health care that it had used before, but to little benefit. Though in theory the government offered free healthcare to everyone, the underfinanced system’s lack of resources did not provide adequate care. The government tried to support its health centers through high user-fees, yet the ailing system fared no better: In 2001, a survey revealed that only 23 percent of Rwandans used primary care, and infectious diseases, including HIV, were spreading further throughout the population.7

To reverse this slide required forceful, competent government leadership. Rwanda found just that in Paul Kagame, a member of the Rwandan Patriotic Front, a Tutsi-majority political group that had organized in Uganda prior to the genocide and that had invaded Rwanda in an attempt to stanch the carnage in 1994. After a brief stint as vice president, he succeeded President Pasteur Bizimungu after Bizimungu resigned in 2000.4 Soon after his succession came one of Rwanda’s guiding policies for the future, Vision 2020. This document, whose goal is to transform Rwanda into a middle-income country by 2020, is in some ways grounded in the past, even as it looks to the future. Parts of it, such as its focuses on reducing poverty, providing support for all levels — local and national — of health services, and its recognition of health as a factor in economic growth, hearken back to the Declaration of Alma Ata, which was written in 1978 after an international convention sponsored by UNICEF and WHO met in Alma Ata, then part of the Soviet Union.3,15 The Declaration’s goals, among other things, were to promote primary health care, equalize access to health care, and provide support for a bottom-up approach to health care that started with local communities. Since 1978, Rwanda shared the Declaration’s ambitions; yet in 2000, though the country was again ready to implement them, Vision 2020’s mission was hampered by a lack of funds. This meant that widespread food insecurity, along with AIDS and epidemics of other infectious diseases, continued to wreak havoc on Rwandans. In one telling statistic, only 870 of thousands of HIV-positive Rwandans, most of whom were in Kigali, Rwanda’s richest province, received antiretroviral therapy as of December 2002.4,5 If Vision 2020’s ideals were to have even a hint of realization, Rwanda would need far more funding than it had.

Luckily, such an opportunity came in 2002, in the form of The Global Fund to Fight AIDS, Tuberculosis and Malaria, a nonprofit organization dedicated to stopping epidemics of its titular diseases. Paulin Basinga, who works for the Bill and Melinda Gates Foundation, remarked in 2014 that while many countries failed to produce an application for Global Fund, Rwanda was careful not to miss anything — it needed that grant, and the government made sure it would receive it.6 This money was put into a program for voluntary counseling and testing, or VCT, which focused on reducing HIV and AIDS.4 Since then, Rwanda’s efforts to cut rates of HIV have been rewarded: From 2002 to 2015, the prevalence of HIV in Rwanda fell from 4.2 percent to 2.9 percent, following a precipitous drop from 1994’s high of 6.3 percent.9

Global Fund is not the only source of aid for Rwanda — Rwanda has several foreign aid and non-governmental organizations assisting it in its health care goals, yet Rwanda is unique in that it avoids the pitfalls that befall other countries which make use of foreign aid. Basinga noted that there is often a disconnect between the aid coming into a country and the local government’s ability to effectively funnel that aid into its own projects, leading to failure in properly channeling the aid where it is needed. Yet Rwanda’s tight control of its foreign donations and the work of NGOs in the country has reduced inefficiencies in the way foreign help is utilized.6 Indeed, Rwanda’s Ministry of Health is unwavering in its requirement that its partners are financially well-managed, transparent, and accountable, and it declines the aid of any NGOs that refuse to work within Rwanda’s overall plans.5

Another example of Rwanda’s practical use of outside funding is its mutual health insurance schemes, Mutuelles de Santé, which became national policy in 2004.4,18  The goals of Mutuelles are to enable people to receive proper health care by cutting down on financial restrictions, to supplement health facilities’ budgets, and to better the quality of health services.4 Since 2008, Rwandans have been required to have some form of health insurance, with Mutuelles being the largest source of insurance for many. Though all members are technically required to pay annually into Mutuelles, the poorest have their membership subsidized by the government.2

As of 2005, the overall health gains of Rwandans were still unsteady. To address the recurrent problems of high child mortality, untreated illnesses, low life expectancy, and financial barriers to health care, the government formulated the Health Sector Policy and the Health Strategic Plan (2005–2009), which was a reform meant to be “the basis of national health planning and the first point of reference for all actors working in the health sector.” It would also “[set] the health policy objectives, [identify] the priority health interventions for meeting these objectives, [outline] the role of each level in the health system, and [provide] guidelines for improved planning and evaluation of activities in the health sector”.10 To meet its aims, the policy pledged to increase the availability of medications, to enhance the availability of medical professionals, to ensure geographic accessibility to well-maintained hospitals, to augment funding for health services from public sources, to develop better ways to control infectious diseases, and to support communities in forming health care systems.10

In addition to all this, the Health Sector Policy affirmed Rwanda’s support for a decentralized health care system whose focus would be on providing proper health care at the community level.10 Rwanda’s health administration is separated into three tiers, with the top tier responsible for creating national health policies, the second tier comprising 30 administrative districts responsible for their respective district’s hospital and primary care facility, and the third tier composed of primary health care facilities.4 Since the years right before the genocide, Rwanda has maneuvered from a centralized health care system to a decentralized, bottom-up system that holds as its basic unit the community and its primary health care centers. 4,10

To support this vision of decentralization, the Rwandan Ministry of Health launched the National Community Health Policy in 2008, with the desire to provide guidance to communities in reaching international health commitments.12 In part, the policy stresses the importance of community health workers — men and women trained in health topics, who bear responsibility for adapting health standards to the culture and needs of their community. In order to satisfy health objectives, the government’s Community Performance-Based Financing, a program introduced to all 30 districts in 2005, ensures that community health workers and local administrators are paid according to how well their community has met its health targets.12

With most of the Health Sector Strategic Plan’s points met before or on track to be met by 2008, the Rwandan government found itself in need of an updated mission.11 It achieved this through the Health Sector Strategic Plan II, the aim of which was to coordinate health-improvement efforts with the Economic Development and Poverty Reduction Strategy, another government program. The policies’ ultimate purpose was to reach the marks of the Millennium Development Goals, which was a U.N.-led initiative to reduce extreme poverty, combat hunger, improve child mortality rates and maternal health, and fight AIDS and other diseases by 2015.11,20

Though Rwanda was making considerable progress, it was still being hamstrung by an outdated, inefficient way of collecting data: It had up to 450 health collecting data, but the machines used to transmit the information were not connected to the web. As such, everything had to be first placed on a flash drive and then sent monthly to one of the district hospitals. This meant that crucial data that could be used to formulate health policies were being assembled in an agonizingly inefficient and ineffective way. To remedy this, Rwanda’s Ministry of Health partnered with the Integrated Health Systems Strengthening Project, a move that was partly bankrolled by the United States Agency for International Development. In this time, IHSSP trained data managers who would be able to process and analyze incoming data from the new system, which was developed to be user-friendly and focused on the most important data points, among other features. 19

With Rwanda’s data collection process streamlined, IHSSP aided the Ministry of Health in creating the Health Sector Strategic Plan III (2012–2018). Though Rwanda met several of the Millennium Development Goals before 2015, this policy maintains the country’s overall objectives to improve maternal and child health, combat infectious diseases, increase access to health care, and enhance the quality of provided care.14,19

As of 2011, Rwanda had around 45,000 community health workers and a sizeable population of nurses and doctors. Yet the quality of health care still had much to improve upon: Those health care professionals had received either very basic education in health, which was instrumental in cutting down on the rate of infectious disease, or they were general physicians. This left a vacuum in the health care system where specialists were concerned, and the quality of health care suffered for their absence. However, in 2011, the Ministry of Health requested that the Clinton Health Access Initiative, an organization it had worked with in the past, aid the country in creating partnerships with U.S. universities to help train Rwandan medical specialists. Through this plan, named the Human Resources for Health Program, U.S. university faculty members have and will come to Rwanda to train at least 500 physician specialists by 2018.1

Rwanda’s Demographic and Health Survey (2014–2015) confirms the effects of the country’s diffuse efforts to improve public health. For example, the number of children born to women in 2005 was 6.1; in 2014–2015, that number was cut to 4.2. The mortality rate of children under five has also fallen, from 196 out of 1000 children dying in 2000, to 50 out of 1000 in 2014–2015.13 Finally, Rwanda’s life expectancy at birth has risen from 50.781 in 1985 — the highest number before and after the genocide until 2003 — to 63.966 in 2014.8

Yet despite Rwanda’s admirable gains, there remains much to work on. Rwanda is still a poor country, with 63.2 percent of Rwandans living below the poverty line as of 2011.17 Rwanda’s health programs also face a sustainability problem — Rwanda’s reliance on foreign aid that can be precarious in times of global economic crises has proved worrying.21 In addition, the country needs to make continual progress on its fight against infectious diseases, poverty, financial barriers to health care, and many of its other focuses. But from climbing their way back up from the destruction of a civil war and genocide, Rwandans can enjoy their new vantage point.

Image By Evan Blaser

Sources:

  1. Binagwaho, Agnes, Patrick Kyamanywa, Paul E. Farmer, Tej Nuthulaganti, Benoite Umubyeyi, Jean Pierre Nyemazi, Soline Dusabeyesu Mugeni, Anita Asiimwe, Uzziel Ndagijimana, Helen Lamphere Mcpherson, Jean De Dieu Ngirabega, Anne Sliney, Agnes Uwayezu, Vincent Rusanganwa, Claire M. Wagner, Cameron T. Nutt, Mark Eldon-Edington, Corrado Cancedda, Ira C. Magaziner, and Eric Goosby. “The Human Resources for Health Program in Rwanda — A New Partnership.” New England Journal of Medicine 369.21 (2013): 2054-059. Web.
  2. Binagwaho, Agnes, Renate Hartwig, Denyse Ingeri, and Andrew Makaka. Mutual Health Insurance and the Contribution to Improvements in Child Health in Rwanda. N.p.: n.p., n.d. African Development Bank. Web. 25 Nov. 2016.
  3. Declaration of Alma-Ata. N.p.: n.p., Sept. 1978. PDF.
  4. Desmond, Chris, Nadjeda Marques, and Habtamu Fuje. “Case Studies from Rwanda.” The Cost of Inaction: Case Studies from Rwanda and Angola. By Sudhir Anand. Cambridge: Francois-Xavier Bagnoud Center for Health and Human Rights, 2012. 23-53. Print.
  5. Farmer, Paul, Cameron T. Nutt, Claude Sekabaraga, Tej Nuthulaganti, Jonathan L. Weigel, Didi B. Farmer, Antoinette Habinshuti, Soline D. Mugeni, Jean-Claude Karasi, and Peter C. Drobac. “Reduced Premature Mortality in Rwanda: Lessons from Success.” The BMJ(2013): n. pag. The BMJ. The BMJ, 18 Jan. 2013. Web. 26 Nov. 2016.
  6. Insider Conversation: Rwanda — What Is Replicable? – The Science of Global Health: What’s Next? San Diego, California, 7 Jan. 2015. UCSD TV. Web. 20 Nov. 2016.
  7. Kayonga, Caroline. Proc. of Towards Universal Health Coverage in Rwanda. Brookings Global Economy and Development, n.d. Web.
  8. Life expectancy at birth, total (years).” The World Bank. The World Bank, n.d. Web. 28 Nov. 2016.
  9. “Prevalence of HIV, Total (% of Population Ages 15-49).” The World Bank. The World Bank, n.d. Web. 20 Nov. 2016.
  10. Rwanda. Ministry of Health. Health Sector Policy. N.p.: n.p., n.d. World Health Organization. Web. 26 Nov. 2016.
  11. Rwanda. Ministry of Health. Health Sector Strategic Plan: July 2009 – June 2012. Healthy Futures, n.d. Web. 27 Nov. 2016.
  12. Rwanda. Ministry of Health. National Community Health Policy. Www.advancingpartners.org, 2008. Web. 26 Nov. 2016.
  13. Rwanda. Ministry of Health. Rwanda Demographic and Health Survey 2014-15 Key Indicators. Ministry of Health, June 2015. Web.
  14. Rwanda. Ministry of Health. THIRD HEALTH SECTOR STRATEGIC PLAN JULY 2012 – JUNE 2018. N.p., n.d. Web. 28 Nov. 2016.
  15. Rwanda. National Development Planning & Research. Rwanda Vision 2020: Revised 2012. N.p.: n.p., n.d. Web.
  16. “Rwanda.” PBS. PBS, n.d. Web. 25 Nov. 2016.
  17. “Rwanda: Statistics.” UNICEF. UNICEF, n.d. Web.
  18. “Sharing the Burden of Sickness: Mutual Health Insurance in Rwanda.” Bulletin of the World Health Organization 86.11 (2008): 823-24. National Center for Biotechnology Information. Web. 21 Nov. 2016.
  19. THE RWANDAN HEALTH MANAGEMENT INFORMATION SYSTEM: Improving Collection and Management of Health Service Data to Support Informed Decision Making. N.p.: Management Sciences for Health, n.d. PDF.
  20. “UN Millennium Project | About the MDGs.” UN Millennium Project | About the MDGs. UN Secretary General, n.d. Web. 27 Nov. 2016.
  21. Rwanda. Ministry of Health. Health Financing Sustainability Policy. N.p., Mar. 2015. Web.

MENTAL ILLNESS: INDIA’S SCARLET LETTER


By Nishad Maggirwar
Staff Writer

1.252 billion people, the population of the ever growing nation of India. With almost 18% of the world’s population residing in India, events that occur there tend to have a ripple effect throughout the world. One of the ripples that occurs in this growing nation is India’s inability to deal effectively with its mentally disabled/ill population. India is desperately struggling with its ability to deal effectively with its mentally disabled/ill population not only because of a staggeringly low number of trained mental health professionals, but also due to the outright neglect and public ridicule that these people receive. Mentally ill patients are the scorned population of India, and are not treated like everyday members of society. These people bear the Scarlett Letter upon their existence in society.

Studies done by the National Institute of Mental Health and Neurosciences (NIMHANS) have reported that 13.7% of India’s population have mental health issues, 10.6% are in a dire mental condition, and 1.9% have severe mental disorders (Yasmeen n.pag). Adding on to these statistics, 54% of the severe disorders recorded were Alzheimer’s disease, and 39% was vascular dementia (Koshy n.pag). Although 1.9% does not seem like a large number, keep in mind that 1.9% of India’s population is around 23 million people, which is larger than many South American and European countries. It is quite hard to imagine every person in a nation such as the Netherlands, with a population of around 17 million people, with a crippling mental disorder such as Alzheimer’s disease.

The treatment that mentally ill people receive in India is akin to a toddler’s wild imagination. Mentally ill people are believed to simply be “pretending” that they are disabled in order to receive attention and special treatment, and are somewhat told to simply “stop doing that”. Dr. Kersi Chavda, a senior psychiatrist at P.D. Hinduja Hospital in Mumbai explains how, “an anxiety-ridden or a depressed patient, is usually given tips like, ‘snap out of it’, ‘go for a movie and you will be fine’, or ‘just cheer up;” (“Mental” n.pag). It is as if mental illness is not even regarded as a legitimate illness, for there is a common conception that mental illness isn’t real but rather something someone brings upon themselves. An unsettling number of people believe that mentally ill people can simply get over their problems and move on (Batra n.pag).

“Tum paagal ho”, or “You are crazy” in Hindi, is what is often bluntly said to a mentally ill patient seeking medical help. Mentally ill individuals in India are often subject to public ridicule and discrimination. While people carelessly throw around the words “asylum” and “paagal” (crazy), mentally ill individuals are very hesitant to admit that they are seeing a therapist (“Mental” n.pag). Tannika Majumdar Batra, a resident of India living with bipolar disorder, explains that, “mental illness is seen as a sign of imperfection, humiliation, rejection by family, friends, and relatives” (Batra n.pag). Unfortunately, it has reached the point where mentally ill individuals in India are not a part of everyday society; they are social outcasts. These individuals often find it near impossible to get an adequate job, as explained by Dr. Harish Shetty, of Nityanand Clinic in Mumbai, who points out that “people are thrown out of jobs if they are mentally ill” (“Mental” n.pag). Perhaps the reason why people are so afraid to admit that they are mentally ill, if it isn’t already obvious or determined by a medical professional, is that this exclamation is what attaches the dreaded scarlet letter onto an individual’s life. The situation of mental illness in India has reached a point where suicide takes more lives than any other physical problem (Batra n.pag).

Among the myriad of social problems in India, ranging from human rights abuses to backwards ideologies that stunt the technological advancement of the nation, the outright neglect to take care of mentally ill patients, the clear lack of facilities capable of providing help, and the social stigma attached to mental disorders are definitely notable social issues. This stigma has given rise to the reality that 80% of people with crippling mental disorders, such as vascular dementia, do not quickly receive any form of care. Many of these people have been sick for over 12 months before finally acquiring low quality medical attention (Yasmeen n.pag).

India is a nation with many medical professionals, but among those medical professionals, there is only 1 psychiatrist for every 400,000 Indians (Koshy n.pag). In addition to this, there are less than 10,000 mental health care takers (social workers, psychologists, and psychiatrists) in the entire subcontinent (Koshy n.pag). Perhaps this is due to the fact that mental health is not of importance to India’s health agenda, which is quite surprising seeing as over 23 million individuals are suffering from serious psychological disorders. As a result of India’s rejection of this issue as pertinent, those seeking to pursue careers as mental health professionals are not in luck because there are only 1,022 college seats for people wanting to enter the field (Mascarenhas n.pag).

The future of India’s mental health patients looks grim because as the population of India increases to new heights, the aforementioned statistics are only going to increase unless the nation opens its eyes to the millions of people who are quietly suffering and waiting for some form of medical assistance. A clear example of India’s negligence towards this pressing issue is the lack  of mental health hospitals in certain parts of the country. Six states in the northern and eastern regions of India with a cumulative population of 56 million people, do not have access to a single mental health hospital (Mascarenhas n.pag). To put this into perspective, South Africa has a population of around 53 million people. Those who do not receive medical attention, and succumb to their mental illness, turn to suicide. Due to the lack of helplines and anti-depression resources, suicide rates have been increasing lately. In fact, three to four people in Mumbai commit suicide every day, despite knowing that suicide is a criminal act in India (“Mental” n.pag).

However, there is some light in this darkness since  the District Mental Health Programme (DMHP) is making some efforts to change this morbid reality. The DMHP is a governmental organization under the NMHP (National Mental Health Programme), who are focused on providing mental care to patients in various states across India. The quality of care varies from state to state because different regions in India have different local policies. It is possible that medical attention can be restricted due to restrictions on funding, not enough employment, and low motivation (Mascarenhas n.pag). Adding onto this, 40% of patients seeking medical attention must travel over six miles to get care from DHMP services (Mascarenhas n.pag). When considering the large number of impoverished people in India, this commute will most likely occur by foot.

It is extremely confounding how such a forward moving nation has neglected such a large demographic, and has seemingly allowed suicide rates to increase every year. It is appalling how the Government of India still believes that mental illness is not a legitimate illness, and has not appropriated funds and effort to help suffering individuals. A hospital in Mumbai was described to have its mental health ward located near its most neglected area; the morgue (“Mental” n.pag). The Government of India needs to institute major reforms to its health agenda in order to save millions of Indians from being outcasts, and brining their diseases into the light.

Works Cited

“Are Mental Health Facilities in India Adequate?” The Times of India. The Times of India, 29 Dec. 2014. Web. 31 Oct. 2016.

Batra, Tannika Majumdar. “Dealing with the Loneliness of Mental Illness in India.” International Bipolar Foundation. International Bipolar Foundation, n.d. Web. 31 Oct. 2016

Koshy, Jacob. “World Mental Health Day: India’s Mental Health Crisis in Numbers.” The Huffington Post. The Huffington Post, 10 Oct. 2015. Web. 31 Oct. 2016.

Mascarenhas, Anuradha. “Mental Illness India’s Ticking Time Bomb, Only 1 in 10 Treated.” The Indian Express. The Indian Express, 19 May 2016. Web. 31 Oct. 2016.

Yasmeen, Afshan. “India Needs to Talk about Mental Illness.” The Hindu. The Hindu, 23 Oct. 2016. Web. 31 Oct. 2016.

Image By: Amen Clinics Photos

WHY PROP 64 SHOULD PUFF, PUFF, PASS

cannabis-sativa-plant

By Nick Vacchio
Senior Editor

*Recently, Prospect Journal of International Affairs started collaborating with The UCSD Guardian, UCSD’s student-run newspaper. The following is a piece that one of our senior editors wrote for the Opinion Section of The UCSD Guardian which can be viewed here.

One of the most widely-discussed issues on California’s ballot box this coming Tuesday is Proposition 64. The proposal regards whether or not marijuana should be legalized for recreational use. Formally titled the Control, Regulate and Tax Adult Use of Marijuana Act, Prop 64 will allow citizens over 21 years of age to legally carry an ounce of marijuana or up to eight grams of concentrated cannabis. Additionally, the measure will allow Californians to legally cultivate as many as six marijuana plants for their personal use. 

California is the largest of five states considering the matter this November, alongside Massachusetts, Arizona, Nevada and Maine. Other states like Florida, Montana, Arkansas and North Dakota will hold a similar vote, but on whether cannabis can be used for solely medicinal purposes. A bill like this has never had enough momentum to pass and as such, there are rational arguments being made from both sides of the issue. But now is finally the time. The proposition will better define, and even solidify, a fundamental aspect of California’s cultural identity and economy. 

Rolling Down & Out

The main arguments against Prop 64 stem from the fear of the unknown, illustrating a conservative value of better protecting one’s family and the greater community. 

Regarding wellness, the “No On 64” campaign cites a report from UC San Francisco stating that the proposal “contains minimal protections for public health.” It is argued that legalizing marijuana also increases the chances that people will drive under the influence and thus be a danger on the roads. This fear against recreational marijuana use is justified to some extent, as driving accidents involving marijuana use have increased in Colorado. However, the data supporting this outcome is not exactly clear-cut. Furthermore, an early study on marijuana use and its effects on driving found that “impairment is typically manifested by subjects decreasing their driving speed.” Personally, I would much rather have people drive slower on the roads than the opposite.

Some also claim that the potential expansion of marijuana use concerns addiction. However, Michael Taffe, associate professor at the Scripps Research Institute in La Jolla, found that dependence on marijuana is around nine percent whereas other drugs have dependencies in the double digits.

The Case for Cannabis

Outweighing arguments that California needs more time to formulate a better plan for legalization, though, are the plentiful benefits that Prop 64 will bring. Most importantly, marijuana will be decriminalized and Californians will no longer be incarcerated for minor marijuana-related drug offenses. This is an encouraging potential development especially for communities of color, who are disproportionately targeted for drug arrests and face punishments far greater than is deserved. Michelle Alexander, a law professor and civil rights activist, points out that “mass incarceration operates as a tightly networked system of laws, policies, customs, and institutions that operate collectively to ensure the subordinate status of a group defined largely by race.” Decriminalizing marijuana will hopefully go a long way in helping to deconstruct some of these institutional barriers. Having fewer people in prison is good for individual communities, puts less burden on taxpayers and benefits the state of California as a whole. Prop 64 is supported by California’s chapter of the NAACP, the California Medical Association, former Facebook President Sean Parker, Lieutenant Governor Gavin Newsom and House Minority Leader Nancy Pelosi.

Additionally, marijuana will be treated similarly to alcohol, and the drug will be heavily controlled, regulated and taxed. The state Finance Director Michael Cohen noted that this will reduce taxpayer costs by tens of millions annually. It will also raise as much as $1 billion in new taxes which will go towards teen drug prevention, law enforcement training and supporting the communities most negatively impacted by the the current legal treatment of marijuana and those convicted for its use.Criticisms against the proposition are justified. I don’t like every detail about the proposal but compromise is necessary, and, all in all, additional tax revenue and decriminalization will be immeasurably beneficial to the state of California. This alone grossly outweighs the potential harm that may be caused.

Photo courtesy of Public Domain Pictures