2 Chapter 2: ENGL 1020
Amanda Maldonado; Gael Avila Rojas; Jennifer Powell; and Tehani Huntsman
Palliative Care Exposure in PA Program Curriculum
Awarded to Amanda Maldonado for work submitted in Fall 2025 to Dr. Kylie Petrovich in ENGL 1020: Research and Argumentative Writing
When a physician assistant is faced with a terminally ill patient whose treatment has stopped working, is it then time to ask if physician assistant programs should go beyond foundational competence and provide more in-depth knowledge of palliative and end-of-life care (EOL) for future graduates? Physician assistants (PAs) are healthcare providers typically trained as generalist practitioners. They are integral parts of patient care and often the first line in determining next steps in the care plan. End-of-life care, often referred to as hospice, is provided only to those patients within their last six months of life, while palliative care is specific to treatments that will not affect disease course but provide relief to patients with a variety of serious diseases. Though they are applied at differing times during disease course, EOL and palliative care have a large overlap when it comes to their educational components. Even as generalists working throughout a broad spectrum of specialties, PAs will come across many patients who would benefit from palliative care or end-of-life measures.
Schooling on palliative care and end-of-life care is lacking in many PA programs. In a recent study, “One-third of health professions students, reported no didactic training experience related to EOL in their health professions curriculum” (Boucher et al. 615). This was reiterated during my experience at a recent Music City Health Professions Program Expo, where I met with five physician assistant programs and asked how palliative and end-of-life care fit into their curriculum. Each had generalized courses that cover palliative care and EOL, as is required by the Accreditation Review Commission – Physician Assistant (ARC-PA). However, they stated that if I wanted further learning, I could use my elective rotation to obtain that knowledge. While some universities are expanding access to this knowledge either through the programs directly or as a fellowship afterwards, many programs are lacking in this area (Mayo Clinic). Not only as a future PA, but as a previous caregiver, I know firsthand the importance of proper training for providers and how it directly impacts patients and their families. All physician assistants will benefit from deeper exposure to palliative and EOL education within their initial training due to their understanding of patient pain levels, their ability to determine early on when transitioning to end-of-life measures is appropriate, and the role they play in ensuring quality of life for their patients.
PAs often have a deep understanding of the patient’s pain levels and can ensure proper pain management. A physician assistant routinely performs initial and recurring assessments of patients in a hospital setting. Prompt attention to pain management can make a huge difference in patient outcomes. Due to their consistent contact with the patient, the PA could be at the forefront of ensuring a patient’s pain is adequately managed. Yet, without proper training, a PA may default to the inaccuracies perpetuated by the current climate regarding pain management. While Opioid addiction is a real threat, the way pain is currently managed in light of addiction should not be a driving force in prescribing helpful medications for those with serious and life-altering diseases. The hesitation, or bureaucratic red tape, stopping these comfort-level care plans could leave patients suffering unnecessarily. Expanding the PAs’ training in pain management could ease their concerns and alleviate the burden on physicians and NPs who are typically left to manage and prescribe these medications (Schneider 27). This training is crucial for all medical professionals and is especially important for future PAs.
PAs are often one of the first medical professionals to recognize that it is time to transition to end-of-life care and are typically the provider communicating EOL planning options with patients. Early exposure to these topics during PA programs can better prepare them for these discussions. As someone who witnessed the difference comprehensive EOL care made during my husband’s cancer treatment, I’ve seen how a PA’s comfort with end-of-life conversations directly impacts the patient’s care plan. Per a study by the Medical College of Georgia, physician assistants who have received exposure to EOL education are more adept at holding these types of conversations with dying patients (Lanning and Dadig 44). Being uncomfortable with these topics could be detrimental to patient outcomes as providers are more likely to delay the transition to hospice. Furthermore, patients often wait to have palliative or hospice conversations due to lack of understanding on the topics (Dimitrov 51). Without adding requirements specific to end-of-life, ARC-PA standards that require “lifespan” education are still falling short. Many patients are missing advanced directives that could assist with these conversations much earlier during their treatment (Goswami 81). These delays can cost patients valuable time with their families outside the hospital setting. With proper training, PAs can dismantle the stigma surrounding palliative and EOL options and delicately guide patients through these difficult decisions.
Initiating palliative care earlier in treatment for cancer patients or those with serious illnesses leads to better overall quality of life, and PAs are an integral part of determining early treatment options. According to Kathy Kemle, author of Palliative and Serious Illness Management for Physician Assistants, palliative care is crucial to the overall well-being of patients. Studies have shown that early referral to palliative care can not only improve quality of life but also extend the survival time of seriously ill patients (Ramirez 497). With their hands-on approach to patient care, PAs are in a unique position to refer to palliative care early and often. If PAs have the tools to incorporate these techniques earlier into patient care, they can significantly improve management of serious conditions, increase quality of life, and even extend survival time.
Although few programs cover these topics in depth, with some beginning to acknowledge the importance, many current PAs have navigated this issue with grace and compassion. However, there is still a lack of standardization across the US, meaning not every patient will experience the comfort of knowing they have other options. While ARC-PA standards require the full lifespan of care to be taught in PA Programs, and though most programs meet this by lightly touching on pain management and the dying process, all future providers, given their understanding of patient pain levels, ability to influence early care options, and their role in improving the quality of the lives of seriously ill patients, would benefit from more structured learning specific to palliative and end-of-life care. The gap of in-depth palliative / EOL care vs current education exists mostly due to cultural stigma surrounding death and dying, which fails both providers and patients; misunderstandings surrounding the differences between palliative and EOL cause patients to delay getting proper care. Currently, there are both House and Senate bills with intentions to provide funding to grow the palliative care workforce, which would include physician assistants (Senate bill S.2287 – 119th Congress). While this does not inherently offset the recent changes to “professional programs” and their federal funding for education expenses, you can reach out to your representatives to advocate for more palliative care education in general through this bill, which will create an increased need for those of us wishing to enter this field. Check out https://www.congress.gov/members/find-your-member to find your senator and ask them to expand the role of PAs within palliative care through Senate bill S.2287 – 119th Congress! Do you believe in the importance of expanding palliative care education? You can make a change!
Works Cited
Boucher, Nathan A., et al. “Developing the Future End-of-Life Health Care Workforce: Lessons Learned From a Survey of Advanced Health Professions Students.” AMERICAN JOURNAL OF HOSPICE & PALLIATIVE MEDICINE, vol. 39, no. 6, June 2022, pp. 613–18. EBSCOhost, https://doi.org/10.1177/10499091211035711.
Dimitrov, Nadya. “Ethical Tools for Physician Assistant Students: Implementation of Palliative Care Training in an Ethical Framework.” Journal of Physician Assistant Education (Physician Assistant Education Association), vol. 24, no. 1, Mar. 2013, pp. 50–53. EBSCOhost, research.ebsco.com/linkprocessor/plink?id=220e1695-0ff8-3463-9e05-1c733b236748.
Dimitrov, Nadya and Kathy Kemle. Palliative and Serious Illness Patient Management for Physician Assistants. Oxford University Press, 2021.
Goswami, Poonam, et al. “Advance Care Planning: Advanced Practice Provider–Initiated Discussions and Their Effects on Patient-Centered End-of-Life Care.” Clinical Journal of Oncology Nursing, vol. 24, no. 1, Feb. 2020, pp. 81–87. EBSCOhost, https://doi.org/10.1188/20.CJON.81-87.
Lanning, Lisa C., and Bonnie A. Dadig. “A Strategy for Incorporating Palliative Care and End-of-Life Instruction into Physician Assistant Education.” Journal of Physician Assistant Education (Physician Assistant Education Association), vol. 21, no. 4, Dec. 2010, pp. 41–46. EBSCOhost, https://doi.org/10.1097/01367895-201021040-00006.
Mayo Clinic College of Medicine and Science. “Nurse Practitioner or Physician Assistant Hospice and Palliative Medicine Fellowship (Minnesota) – Health Sciences Education – Mayo Clinic College of Medicine & Science.” Mayo Clinic College of Medicine and Science, college.mayo.edu/academics/health-sciences-education/nurse-practitioner-or-physician-assistant-hospice-and-palliative-medicine-fellowship-minnesota/. Accessed 19 Nov. 2025.
Ramirez, Carey T., and Ravnyssa K. Verma. “Early Palliative Care Improves Patient and Caregiver Quality of Life.” Clinical Journal of Oncology Nursing, vol. 28, no. 5, Oct. 2024, pp. 496–501. EBSCOhost, https://doi.org/10.1188/24.CJON.496-501.
Schneider, Jennifer. “Jenniferschneider.” Emerging Role of NPs and PAs in Pain Management, June 2008, www.jenniferschneider.com/pdf/PPM_Jun08_Schneider_NPsPAs.pdf.
S.2287 – 119th Congress (2025-2026): Palliative Care and Hospice Education and Training Act | Congress.Gov | Library of Congress, www.congress.gov/bill/119th-congress/senate-bill/2287. Accessed 10 Dec. 2025.
Van Rhee, James A. “Palliative Care the Physician Assistant Role.” Physician Assistant Clinics, vol. 5, no. 3, July 2020, pp. xi–xii. EBSCOhost, https://doi.org/10.1016/j.cpha.2020.05.002.
Detained and Deprived
Awarded to Gael Avila Rojas for work submitted in Spring 2025 to Candie Moonshower in ENGL 1020: Research and Argumentative Writing
In a country that prides itself on liberty and justice for all, there are locked doors, fluorescent lights that never dim, and cages that house people, not because of crimes, but because of where they were born. Stories from within U.S. detention centers tell of children separated from their parents, individuals denied basic medical care, and others kept in overcrowded, unsanitary conditions for months on end. The so-called land of the free becomes a paradox behind barbed wire fences. Though many argue that detention centers are simply part of the immigration process, their current conditions raise ethical red flags that demand national attention. These facilities do more than detain; they dehumanize, often in ways that violate the very rights the U.S. claims to defend. The inhumane conditions of U.S. detention centers violate international human rights standards, cause lasting psychological harm, and reflect deep systemic failures in the American immigration system.
U.S. immigration detention centers have long been under scrutiny for their failure to meet the basic human rights standards established by international law, particularly under the United Nations’ Universal Declaration of Human Rights and the U.S. government’s obligations under international treaties like the International Covenant on Civil and Political Rights (ICCPR). These detention centers are frequently accused of subjecting detainees to conditions that violate these rights, with multiple reports exposing systemic issues related to the denial of essential resources, healthcare, and humane treatment. One of the most significant reports shedding light on these abuses is the American Civil Liberties Union (ACLU) of Northern California’s publication “California’s Immigration Detention Facilities Plagued by Human Rights Abuse.” The ACLU’s findings focus on the persistent lack of access to fundamental necessities such as food, water, and healthcare in California’s detention facilities. Detainees are often left without timely medical care, facing long delays or outright denials of treatment for serious health conditions (“California’s”). This neglect of detainee well-being is further established by unsanitary living conditions that exacerbate physical and mental health issues. Perhaps most alarmingly, the ACLU highlights a troubling trend of U.S. Immigration and Customs Enforcement (ICE) agencies refusing to report deaths that occurred under their care, a practice that casts a shadow on the transparency and accountability of these institutions. The ACLU labels these practices “systemic abuse,” suggesting that the violations are not isolated but part of an ingrained pattern within the immigration detention system. The organization’s findings call into question whether such conditions can be reconciled with U.S. obligations under international human rights law, especially considering the role of these centers in detaining individuals who have not been convicted of any crime.
Further supporting the ACLU’s claims, NPR’s Tom Dreisbach reported on a 2023 government investigation that exposed shocking conditions within ICE detention facilities. The investigation included statements from government officials themselves, who described the conditions as “barbaric” and “negligent” (Dreisbach). Among the most troubling revelations were reports of overcrowding, spoiled food, and moldy showers, all contributing to a toxic environment that undermines detainees’ physical and psychological well-being. More disturbingly, access to medical services was often blocked or severely delayed, even for detainees in urgent need of care. These findings were not just from outside observers but from within the very institution responsible for detaining individuals, underscoring the gravity of the situation. Internal government investigators themselves acknowledged the inhumane and dangerous conditions within these facilities, further undermining any claims that such reports are politically motivated or exaggerated.
Figure 1: Average Number of People Detained by ICE Daily (NIJR).
The psychological trauma inflicted on detainees, particularly children, due to prolonged separation from family, constant surveillance, and uncertainty, has lifelong consequences on mental health and well-being. Solitary confinement, often used as punishment in detention facilities, exacerbates these conditions. A report by Physicians for Human Rights titled “Endless Nightmare” found that “solitary confinement in immigration detention is rarely used as a last resort,” and that the practice has resulted in widespread psychological harm, including suicidal ideation, trauma, and depression (“Endless Nightmare”).
This harm is especially intense for children. According to Refugees International, policies like Title 42 led to forced family separations at the border without due process or explanation. Children were left alone in detention centers, often unaware of their parents’ location or fate. The report features first-hand accounts from young detainees showing signs of emotional collapse, including “panic attacks, self-harming behaviors, and withdrawal from speech” (“Advocates Report”). These psychological impacts often persist long after release and can alter the developmental trajectory of children. Peer-reviewed medical studies reinforce these findings. In a study published by JAMA, Dr. Homer Venters found a direct correlation between solitary confinement and increased risk of self-harm among immigrant detainees, especially youth (Venters). Detention environments marked by uncertainty, surveillance, and isolation are not just uncomfortable; they are damaging to the human psyche, and in some cases, permanently so.
These inhumane conditions are not isolated mistakes but rather symptoms of a broader, systemic failure in immigration policy that prioritizes punishment over protection. The U.S. relies heavily on detention as the default method of immigration enforcement, despite evidence that alternatives are more humane and effective. According to the American Immigration Council, privately run detention centers, which make up a large portion of the system, are especially problematic. They report higher rates of abuse, lack of oversight, and worse medical care than government-run facilities (“Landscape of Immigration Detention”). Privatization incentivizes cost-cutting and high turnover, often at the expense of detainees’ health and rights.
The National Immigrant Justice Center emphasizes that ICE’s failure to report abuses, deaths, and internal misconduct shows a disregard for legal accountability. In their policy brief “Snapshot of ICE Detention,” they note that “ICE operates with minimal transparency and oversight,” and that detainees often lack access to legal representation and translation services, violating due process (“Snapshot”). Even those with legal claims for asylum are kept in limbo for months or years without a proper hearing or legal counsel. The U.S. has legal obligations under international law, including the Universal Declaration of Human Rights and the Convention Against Torture, to uphold the dignity and well-being of all individuals, citizen or not. Yet, as Amnesty International argues in its “Free Them Now” campaign, the U.S. has created a system that does just the opposite: “prolonged detention causes irreparable harm while failing to meet its stated goals” (“Free Them Now”).
Figure 2: Number of Detention Facilities Used by ICE, Fiscal Year 2015 (AIC).
Despite these harsh realities, alternatives to detention (ATDs) do exist. Programs such as community-based case management have proven effective in ensuring court compliance while preserving human dignity. According to a study by Refugees International, these alternatives have over 90% compliance rates and are significantly cheaper than traditional detention (“Advocates”). Yet, funding and political will remain centered on expanding detention infrastructure rather than reforming it. Public pressure and awareness are essential for shifting immigration policy toward humane, rights-respecting alternatives. Advocacy organizations such as the ACLU, Amnesty International, and the Robert F. Kennedy Human Rights group continue to expose abuses and push for policy changes. Their efforts underscore that the fight for immigrant dignity is not just a legal battle, but a moral one.
Figure 3: Number of Immigrants on ICE’s Alternatives to Detention Program by Technology Type as of 3/11/2025 (Kocher).
The harsh realities within U.S. detention centers, where basic human rights are neglected, psychological scars are etched into young minds, and systemic cruelty is disguised as policy, reveal a country at odds with its own ideals. These aren’t isolated incidents of mismanagement; they represent an intentional neglect embedded within the immigration system. If the U.S. hopes to truly embody the principles it preaches, it must confront the conditions within these centers and commit to reform. The barbed wire may keep people in, but it also keeps justice out. Until we change that, the promise of liberty and justice for all remains just that: a promise unfulfilled.
Works Cited
“Advocates Report Egregious Due Process and Rights Violations at U.S.-Mexico Border.” Refugees International, 2023, www.refugeesinternational.org/advocacy-letters/advocates-report-egregious-due-process-and-rights-violations-at-u-s-mexico-border.
“Average Number of People Detained by ICE Daily.” National Immigrant Justice Center, 20 September 2024, https://immigrantjustice.org/research-items/policy-brief-snapshot-ice-detention-inhumane-conditions-and-alarming-expansion. Line Graph.
“California’s Immigration Detention Facilities Plagued by Human Rights Abuse, New Report Finds.” ACLU of Northern California, 17 Oct. 2019, www.aclunc.org/news/californias-immigration-detention-facilities-plagued-human-rights-abuse-new-report-finds.
Dreisbach, Tom. “Government’s Own Experts Found ‘Barbaric’ and ‘Negligent’ Conditions in ICE Detention.” NPR, 16 Aug. 2023, www.npr.org/2023/08/16/1190767610/ice-detention-immigration-government-inspectors-barbaric-negligent-conditions.
“Endless Nightmare: Torture and Inhuman Treatment in Solitary Confinement in U.S. Immigration Detention.” Physicians for Human Rights, 2021, www.phr.org/our-work/resources/endless-nightmare-solitary-confinement-in-us-immigration-detention.
“Free Them Now.” Amnesty International USA, www.amnestyusa.org/campaigns/free-them-now/. Accessed 26 April 2025.
Kocher, Austin. “Number of Immigrants on ICE’s Alternatives to Detention Program by Technology Type as of 3/11/2025.” Substack, 27 March 2025, https://austinkocher.substack.com/p/ice-detention-approaching-50000-immigrants. Bar Graph.
Moore, John. “2-Year-Old Honduran Girl Crying as Mother is Detained by Border Patrol.” World Press Photo, 12 June 2018, McAllen, Texas. Photograph.
“Number of Detention Facilities Used by ICE, Fiscal Year 2015.” American Immigration Council, 2022, www.americanimmigrationcouncil.org/sites/default/files/research/the_landscape_of_immigration_detention_in_the_united_states.pdf. Graph.
“Policy Brief | Snapshot of ICE Detention: Inhumane Conditions and Alarming Expansion.” National Immigrant Justice Center, 20 September 2024, https://immigrantjustice.org/research-items/policy-brief-snapshot-ice-detention-inhumane-conditions-and-alarming-expansion.
“The Landscape of Immigration Detention in the United States.” American Immigration Council, 2022, www.americanimmigrationcouncil.org/sites/default/files/research/the_landscape_of_immigration_detention_in_the_united_states.pdf.
Venters, Homer. “Solitary Confinement and Risk of Self-Harm Among Jail Inmates.” Journal of the American Medical Association (JAMA), vol. 3, no. 7, 2020, https://pmc.ncbi.nlm.nih.gov/articles/PMC7348446/.
The Impact of Dollar Stores on Chronic Health Conditions Across the South
Awarded to Jennifer Powell for work submitted in Spring 2025 to Amy Fant for ENGL 1020: Research and Argumentative Writing
One meal per day at roughly one hundred grams of carbohydrates is all my patient with diabetes eats. As I sit across my desk from him, he explains that his one meal daily is incredibly carbohydrate-dense, sending his blood sugar into above-average numbers every evening. He describes barriers to caring for his diabetes, such as his limited resources for food, often relying on items such as highly processed foods obtained from the closest store to his home: Dollar General. His lack of food access, combined with limited knowledge about what to eat to support his health, has resulted in his need for an insulin pump and in multiple hospital stays across the course of his diagnosis. With limited options for retailers nearby, he finds it difficult to make healthy choices to stabilize his blood sugar. This is not an uncommon problem affecting many of the patients my staff work with. Another patient, whose blood sugar numbers frequently soared into the three and four hundreds, once described their struggle to afford healthy food, relying on fast food restaurants when coming to town for doctors’ visits, and convenience and dollar stores with limited food items that were nearer to where she lived outside of town. According to the USDA’s food access atlas, an estimated 53.6 million people now live in areas with low food access. These areas are often referred to as “food deserts,” a term coined by the Farm Bill in 2008, and defined by the lack of accessibility to nutritious food, making it more difficult for people to lead healthy lifestyles, and are often associated with low-income or socioeconomic status (“Food Access Research Atlas”). While food deserts are lacking in grocery or large box stores that offer fresh foods, they often appear to have a surplus of convenience stores and small retailers, such as “dollar stores.” These areas also tend to have a significantly higher incidence of health disparities among their populations. While many communities have only small retailers to rely on, stronger regulations need to be enforced on convenience and dollar stores in areas of low food access and quality because they contribute to worsening complications for chronic health conditions by excluding healthier options.
According to the CDC and the Office of Disease Prevention and Health Promotion, food insecurity is one of the leading issues connected to a multitude of public health concerns (“Nutrition and Healthy Eating”). Food and nutrition-related issues are so prevalent across the United States, that the offices have identified twenty-seven nutrition-related health objectives they aim to improve on in the Healthy People 2030 Initiative (“Nutrition and Healthy Eating”). Of all the topics outlined in this initiative, the healthy eating category had the highest number of objectives, indicating the crucial role it plays in health and wellness. Yet many individuals still face barriers to food access and education, leaving them at greater disadvantages regarding improving their health and extending their lives. According to data collected by the CDC, an estimated 10.4% of households across the United States were food insecure between the years 2019 and 2021, with the highest rates of food insecurity predominantly in the southern states (“Chronic Disease Indicators”). In addition to many southern states being ranked above the national average for food insecurity, they also ranked above average for related chronic health conditions, such as high blood pressure, diabetes, arthritis, mental health, and more (“Chronic Health Indicators”). The data collected over the last decade by the CDC shows that both the incidence of chronic health issues and poor food access are of higher concern in the South in comparison to other areas across the country. Some believe that a contributing factor to these health detriments may be the increased density of dollar stores, which frequently fail to offer nutritious food options. An article by the Tufts University School of Medicine draws attention to a study that examines the growth of dollar stores in areas already suffering from chronic health issues (“Dollar Stores Are Growing”). In the article, Sean Cash, senior researcher and professor of Global Nutrition at the Friedman School of Nutrition Science and Policy, describes the South as a “hot spot,” explaining that “The dollar store business model originated in the South. They have more distribution centers there, and consumers have supported their growth,” (“Dollar Stores Are Growing”). While many grocery stores have struggled to keep their foot holds, data compiled by the National Retailer Federation showed that Dollar General and Dollar Tree had the highest number of stores across the United States in 2023 of all retailers, with 20,583 and 16,440 locations respectively, beating out even Walmart, CVS and Walgreens (National Retail Federation). This indicates significant saturation across the country in dollar stores, in comparison to other retailers that offer wider varieties of food and household items. By examining the rates of food insecurity and access, chronic health conditions, and the status of dollar stores across the South, I’ve inferred that there is a connection between these small box retailers and the rates of chronic health issues.
Dollar stores and similar retailers are contributing to chronic health issues by stocking primarily ultra-processed and low-quality foods in stores as opposed to fresh and healthy foods. While some dollar stores offer milk, eggs, and some processed meats, such as deli meats or bacon, that’s the furthest extent that many of them provide regarding fresh food items. An analysis of small retailers in Minnesota published in the Journal of Public Health Nutrition collected data regarding the types of food stocked in non-traditional stores that provided food. The study found that of the dollar stores in the area, all supplied canned fruits and vegetables, but none provided fresh produce and according to interviews conducted with employees of the stores, the variety was limited (Caspi et al. 543). Additionally, only around half or fewer of the stores supplied what researchers defined as healthy items, like whole grain products, 100% juice, or even frozen fruits and vegetables (Caspi et al. 543). Still, some argue that a select few stores offer fresh foods to consumers. In an article for Civil Eats, Wesley Brown reports that a spokesperson for Dollar General indicated that approximately 2,100 of their more than 18,100 stores provided fresh produce to communities. However, that’s only 11.6% of their entire store base, which does not imply that many consumers reap the benefits of fresh foods when comparing their other 16,000 or more stores that don’t offer anything beyond pre-packaged shelf-stable products and junk foods. A quick stroll through many local dollar stores shows that they are generally saturated with candies, snack items such as chips and cookies, sodas, and other items of low nutritious value. They lack the variety of grocery stores and cannot fill the gap for those with low food security to support better health outcomes.
Cleanliness and quality standards, or rather the lack thereof, are also of great importance when defining whether a retail store contributes to the health and well-being of its consumers. In February of 2021, Family Dollar became the focus of numerous health violations when an FDA inspector found evidence of contamination of food products by rodents and birds throughout their distribution center in Arkansas, due to poor storage conditions and subpar standards for cleaning and maintaining the facility (Brown). According to Brown, a report from the FDA detailed both live and dead animals, feces, and nesting and gnawing throughout the stored products within the distribution facility, which served many of the southeastern states. The contamination primarily affected food and other household items and resulted in most of those products being recalled and removed from more than four hundred Family Dollar stores across six states (Brown). The lack of sanitary conditions in the distribution facility directly impacted the ability of the stores to stock any food items during this time, resulting in even more limitations on food access than there had been before the recalls. In response to the health violations found at the site, FDA Associate Commissioner Judith McMeekin stated, “No one should be subject to products stored in the kind of unacceptable conditions that we found in this [Family Dollar] distribution facility… These conditions appear to be violations of federal law that could put families’ health at risk,” (Brown). The Commissioner’s statement further demonstrates the serious implications of the contaminated food as being a health risk for consumers shopping at the stores. Despite this, Brown reports that continued health violations and serious issues with rodents at the same facility were reported by the FDA for months after the initial product recalls. Not only is the company in violation of the FDA, but with OSHA as well with more than twenty million dollars in fines levied against them over the past two decades, and hundreds of safety violations putting the wellbeing of both their employees and customers at risk (Brown). The long history of health and safety violations across dollar stores has proven time and time again that these companies do not take the quality of their products sold to consumers, or the health of their customers and employees alike seriously. The lack of care for the health and safety of consumers is a shock when considering the effect dollar stores have on the health of local communities. These implications serve to add more complexities to the issue of food access and create additional barriers for those who shop there.
Many grocery stores struggle to stay afloat in areas of lower economic development. However, dollar stores are expanding tirelessly, even into underdeveloped areas with historically vulnerable populations. Some see this as positive, and I must admit that some options are better than none. However, the presence of these stores and their limitations could mean further strain on the residents or even deter the development of healthier options in these neighborhoods. Sriya Shrestha, one of the researchers on a study conducted in Dekalb County Georgia that examined the detrimental health impact dollar stores had on the county, found that retailers such as Dollar General appeared to be targeting their growth in communities with individuals living below the federal poverty line, or those making less than $40,000 annually (Brown). Brown references one of her recent interviews in which Shrestha points out that women with families who fell under this socioeconomic bracket were especially prone to shopping at these stores, often purchasing only what was necessary and affordable, however, the cost per unit for the items was found to be higher in dollar stores in comparison to larger grocery and box stores (Brown). This demonstrates that while the cost for items may appear cheaper to the consumer at face value, they are marked higher based on unit price, and offered in smaller quantities, which can contribute to continued resource allocation issues for families of lower income. Essentially, the consumer is not getting as much bang for their buck as they are led to believe.
In the Tufts University study, published in the American Journal of Public Health, trends in food purchases and access were examined by collecting data from more than fifty-thousand households from 2008 to 2020, and identified rural communities as being associated with increased challenges in acquiring healthy food, as they are more likely to be further away from food stores (Feng et al, 331). Researchers observed that dollar stores saw double the spending from households in rural areas compared to years prior and increased their share of food purchases by more than 100%, even beating growth in food sales at wholesale clubs and supercenters (Feng et al, 333). These findings demonstrate a change in the allocation of rural household spending, showing more families in low-income and rural areas are spending more of their money at dollar stores in comparison to traditional grocers. Additionally, the data collected by Feng and his associates shows considerably higher rates of household spending at dollar stores in the rural South, as well as higher rates among those with income below $45,000 per year and significantly more spending of individuals of Black or African American ethnicity (333). People of color have a long history of increased risks for chronic health issues like high blood pressure, heart disease, diabetes, and more, as do families living below the poverty line, who face barriers in supporting their well-being when the cost of goods and services are more than they can afford. In Brown’s article for Civil Eats, one Dekalb County Commissioner points out that there are seventy such stores in their county alone, and that the areas where they are most densely populated overlap with neighborhoods that have the lowest household incomes and highest residency rates of people of color. By targeting these communities and offering limited low-quality food items coupled with the hazardous health conditions in which food is stored, these stores are causing more harm than they are contributing to closing the gap in food-related health disparities.
Numerous municipalities across the U.S. have begun issuing bans and restrictions on the expansion of dollar stores and similar retailers, including Dekalb County Georgia (Brown). While the rise of dollar stores has left much to be desired regarding the quality and variety of food, in addition to the hazardous public safety and sanitary concerns, many argue that eliminating dollar stores is not the solution. An article by Joseph Sunde for the Acton Institute argues that while the communities enforcing zoning restrictions and new regulations on these retailers may have the best of intentions, they are effectively limiting affordable household necessities that fall outside of the food category. Sunde also references other studies with conflicting evidence, stating that simply establishing supermarkets in neighborhoods previously designated as food deserts did not increase spending on healthful food products. The article voices concern about eliminating dollar stores, arguing that this may hurt communities and ignore their needs outside of improving nutrition and food access (Sunde). If dollar stores are removed or restricted further, the implications could result in a lack of sufficient access to food at all. Additionally, removing or barring dollar stores could lead to increased limitations in other goods, such as the variety of other products that these stores carry. Sunde goes on to discuss possible solutions such as incentivizing the purchase of fresh produce through federal food stamp programs, such as SNAP or WIC, and utilizing educational campaigns surrounding the benefit of these foods. While these are fair points, it does not resolve the issue of poor food access in neighborhoods that are pre-disposed to health conditions worsened by low-quality food or limited access. Subsidizing healthy food and providing education is a step in the right direction, but without retailers that offer those healthier solutions, it does nothing to empower those individuals to whom the education and benefits are provided, nor does it move the needle for changing purchasing behaviors.
Residents living in food deserts can benefit from more informed education about nutrition-related health outcomes and stricter regulations for retailers in their communities to supply higher-quality food items. Numerous approaches may be taken to resolve the issue but increasing the fresh and healthy food options in stores that are already in the area seems like the first logical step. Stephan Bisaha for NPR and Gulf States Newsroom reported that as of August of 2024, the chain Dollar General had increased the number of stores carrying fresh produce to 5,000 locations, with plans to add 1,500 more in the coming years. Despite this forward progress, there is room for growth as the parent company still struggles with the storage, handling, and turnover rate of fresh products, and continues to be fined for safety violations (Bisaha). With continued demand for fresh foods and a close eye on the storage and handling of those products, positive change is possible for dollar stores and the communities where they are embedded.
Another possible solution is incentivizing organizations and communities to plant community gardens and support one another through empowering local agriculture. One example of success is in Baltimore, where Pastor Heber Brown III developed a community garden at his church, which eventually led to the development of a network of volunteers, comprised of more than twenty-four church congregations to make up the Black Church Food Security Network, providing healthy food from farms and local gardens to families lacking access to fresh food (Sunde). Here in Middle Tennessee, I’ve located a nonprofit organization, Vine Branch Fellowship, which aims to increase nutrition education and food access by building and caring for community gardens and partnering with the University of Tennessee’s Cooperative Extension to provide healthy cooking classes. The founders, Shene and Alex, cite their own family’s health hardships as one of the driving factors in their pursuit of community health education. In one conversation we had, Shene described the impact healthy eating had on regular blood sugar management for their son, a child with Type I Diabetes, and her husband, who suffered from bouts of low blood sugar, in addition to her own allergies and conditions. The Scotts and their organization are another outstanding example of how improving access to fresh, healthy foods can improve the quality of life for those living with chronic illnesses.
Chronic conditions have long plagued communities across the United States, especially in the South with above-average rates of health concerns, as have the incidence of food insecurity and the development of food deserts. While dollar stores fill a void in communities that otherwise would be lacking any retailers, the convenience and perceived affordability do not translate to improving access to nutritious food that supports health. In my work, I have witnessed patients who have been successful in lowering their average blood sugar and maintaining a healthy lifestyle by shifting their purchasing and dietary habits to include fresh and nutritious foods and reducing low-quality alternatives. However, those living in food deserts are robbed of those opportunities when their local retailers fail to provide fresh food and sanitary conditions to those communities. Food insecurity is still a prominent issue that must be addressed, and local governing authorities must demand better for their communities, especially in the rural and underdeveloped areas of the South. Intentional education, better access to community resources, and more variety in local food retailers can result in more positive outcomes, leading to healthier, happier communities.
Works Cited
Bisaha, Stephan. “Dollar General Stores Now Sell Fresh Produce. Could It Improve Rural Food Access?” NPR, 2 Aug. 2024, http://www.npr.org/2024/08/02/nx-s1-5058487/dollar-general-stores-now-sell-fresh-produce-could-it-improve-rural-food-access.
Brown, Wesley. “As Dollar Stores Proliferate, Some Communities Push Back.” Civil Eats, 30 Nov. 2022, civileats.com/2022/04/13/dollar-stores/.
Caspi, Caitlin Eicher, et al. “Differences in Healthy Food Supply and Stocking Practices Between Small Grocery Stores, Gas-marts, Pharmacies, and Dollar Stores.” Public Health Nutrition, vol. 19, no. 3, 28 Sept. 2015, pp. 540–547, https://doi.org/10.1017/s1368980015002724.
“Chronic Disease Indicators.” Centers for Disease Control and Prevention, cdi.cdc.gov/?location=ALL&category=SDOH&indicators=SDH04.
“Dollar Stores Are Growing as Food Retailers in the U.S.” School of Medicine, Tufts University, https://medicine.tufts.edu/news-events/news/dollar-stores-are-growing-food-retailers-us.
Feng, Wenhui, et al. “Dollar Stores and Food Access for Rural Households in the United States, 2008‒2020.” American Journal of Public Health, vol. 113, no. 3, Mar. 2023, pp. 331–336, https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2022.307193.
“Food Access Research Atlas – Documentation.” Economic Research Service, United States Department of Agriculture [USDA], 5 Jan. 2025, https://www.ers.usda.gov/data-products/food-access-research-atlas/documentation.
National Retail Federation. “Number of U.S. Stores of Leading Retailers in The United States in 2023.” Statista, Statista Inc., 10 Jul 2024.
“Nutrition and Healthy Eating.” Healthy People 2030, Office of Disease Prevention and Health Promotion, odphp.health.gov/healthypeople/objectives-and-data/browse-objectives/nutrition-and-healthy-eating.
Sunde, Joseph. “Why Banning Dollar Stores Won’t Save ‘Food Deserts.’” Religion & Liberty Online, Acton Institute, 8 June 2021, rlo.acton.org/archives/115036-why-banning-dollar-stores-wont-save-food-deserts.html.
Western Perspectives Versus Native Hawaiin Narratives on the Annexation
Awarded to Tehani Huntsman for work submitted in Fall 2025 to Honey Denson for ENGL 1020: Research and Argumentative Writing
Introduction
The phrase “History is told through the lens of its victor” is a widely accepted phrase that-although may not be true in today’s time- can be related to the annexation of Hawai’i in 1898. This event is frequently framed as a beneficial and natural extension of the US in speeches, educational curriculum, and older newspapers. Often, educational and official stimulus disregard what happened to Native Hawaiians during US occupation, how their ways of life were impacted, and what happened to Queen Liliuokalani.
The annexation remains a highly contested event that is often told through the western lens while overshadowing the native Hawaiian’s narratives, shaping the public’s perception and justifying U.S imperialism. However, recently western-trained historians are realizing that they have been continuing colonialist attitudes in their “Objective histories” (Binney) By including narrative inclusive curriculum in education, especially those of native Hawaiians, the U.S can stop furthering the idea of a Tropical paradise, undiscussed cultural appropriation, and move towards a balanced historical narrative to provide an accurate telling of US history.
Western Justifications
In the 1820s, Christian missionaries, primarily from United States, arrived on the Islands- home to the independent and respected Kingdom of Hawaii- to spread the protestant religion and to help do “good.” In doing so, they discovered the rich, sugar cane friendly soil and climate, leading to Hawai’i becoming the sugar cane capital for the United States economy. (Kennedy et al.) In 1849, Hawai’i and United States agreed upon the Treaty of Friendship, Commerce, and Navigation and Extradition which warned other powers to not intervene with the islands and paved the way to annexation. In another treaty, Pearl Harbor was established in 1887, guaranteeing naval-bases rights and U.S domination of the Pacific Ocean. (US Department of state) The longstanding sugar empires began to crumble after the Mckinley Tariff rose, making shipping and production incredibly expensive. Following this, White American planters renewed their efforts to annex the kingdom of Hawaii but was blocked by Queen Liliuokalani who insisted Hawaii stayed in the hands of Native Hawaiians.
Despite plantation owners being a small minority, they were able to organize a successful revolt in 1893 and were assisted by American troops. (Kennedy) This led to the establishment of the territory of the Republic of Hawai’i and its president Standford Dole. For nearly 59 years, Hawai’i remained a territory leaving Native Hawaiians and other non-white residents with no rights as US citizens and no representation in Congress until when it joined the US as a state in 1959 (US Department of state)
This description is similar to the one located in The American Pageant where, according to National Geographic learning-Cengage,” The reputable authors of The American Pageant combine excellent scholarship with a witty, engaging narrative style and creative look at U.S. History”. (Cengage) With highly reputable authors, it’s involvement with AP US History, and popular reputation, the American Pageant is a highly credible source where many build their knowledge of American history. Although this description, among a multitude of other documents, isn’t wrong, it often overlooks the resistance and burdens held by Native Hawaiians.
Native Hawaiian Resistance
One commonly disregarded event by modern explanations is the arrest of Queen Lili’uokalani for allegedly conspiring to overthrow the government of the Republic of Hawai’i, she was forced to relinquish all claims to the throne and was convicted and fined. She was sentenced to five years in hard labor but was later reduced to imprisonment upstairs of Iolani Palace for 8 months. (Iolani Palace) Contrary to the dominate western narrative, Native Hawaiians actively opposed annexation. Yet, dominant narratives continue to ignore this, reinforcing the event was inevitable. Rodney Roberts, Associate Professor of Philosophy at East Carolina University (Roberts) explains that this framing “obscures the injustice and illegality” of annexation, creating a public understanding of history that denies Native Hawaiians’ legitimate claim to sovereignty.
In 1897, over 21,000 Native Hawaiians, more than half of the Native population, signed the Kūʻē Petitions opposing the U.S. annexation of Hawaiʻi. (Schamel) These petitions showed overwhelming resistance and ultimately helped defeat an annexation treaty in the Senate (Sai ). In a petition from Lāhainā, Native signers warned that “This kingdom will pass into [foreigners’] hands, and…we, to whom the land has belonged…shall all dwindle away”. (Langer) This demonstrates a clear awareness of the colonial threat and the danger held by foreign control. Resistance, based on sovereignty and cultural identity, was based on historical consciousness and the need for political freedom. However, the U.S. annexed Hawai ‘i anyway in 1898 through a Joint Resolution, bypassing legal norms. Queen Liliʻuokalani’s efforts to restore the monarchy showed an organized and peaceful strategy. As Commissioner James Blount reported, her attempt to enact a new constitution was both legal and constitutional, and the U.S. military’s role in her overthrow constituted “an act of war” (Sai). Yet narratives portraying Native Hawaiians as politically disengaged persist, effectively erasing the resistance that occurred both on the ground and diplomatically.
Five years later the anniversary of the annexation, nearly about 38,000 of the remaining 40,000 Native Hawaiians signed petitions against the act.” As of today, there have been many advancements against the “political occupation and mental colonization” of the Hawaiian Islands. This includes campaigns to revitalize the Hawaiian language/culture in schools and homes and to return to spiritual roots. (Langer) The Native Hawaiian resistance to foreign powers, although beginning in late 17th century after first missionary contact, continues to push through foreign odds.
The Lasting Impact
The results of the 1893 overthrow were notable by the suppression of the Hawaiian language, customs, and spiritual practices. For example, in 1896, the Hawaiian language was removed which caused a notable decrease in native press which ultimately distanced future generations from their history and culture (Smith) The US Government’s 1993 Apology Resolution acknowledges that the annexation occurred “without the consent of or compensation to the Native Hawaiian people” and led to the “suppression of the inherent sovereignty of the Native Hawaiian people” as land was sold to foreigners, the monarchy was destabilized, and most cultural practices were declared illegal. (Langer) The impact of the cultural genocide is devastating. Language bans, land dispossession, and the exploitation of Hawaiian Culture which is all supported by western narratives that stripped Hawaiians of their political and cultural identities
Aside from history books, popular culture continues to misrepresent Hawaiian culture. Films like Disney’s 2016 Moana romanticize the Pacific as a tropical paradise and misrepresent colonial history. Vicente Diaz, Filipino-Pohnpeian writer and Associate Professor of American Indian Studies and Anthropology at University of Illinois, describes this portrayal as the “long history of Western “Polyface” that serves to ‘whitewash colonialism and normalize its attendant violence and devastation of land, sea and tradition’” (Alexeyeff & McDonnell). While some Pacific Islanders celebrate Moana for representing their culture, others argue it covers deeper issues of appropriation and oversimplification. This tension highlights how the media can both restore and mute Native voices. Representation can reinforce colonial or western ideologies by creating the illusion of inclusion without addressing actual damage.
The overthrow’s consequences have been endured for generations. Native Hawaiian identity, sovereignty, and cultural practices have been systematically diminished. The Apology Resolution formally recognized that the overthrow was illegal and occurred “without the consent of or compensation to the Native Hawaiian people” (Langer). Yet the resolution failed to deliver reparations or structural change. Showing the US wants to be seen as taking responsibility, but on its own terms and without risking liability.
Need for education reform
For generations, school curriculum in Hawai‘i and the mainland United States have either misrepresented or ignored the illegal overthrow, the sovereignty of the Hawaiian Kingdom, and the resistance of Native Hawaiians. As a result, many Native Hawaiian students have grown up unaware of their people’s historical agency, fostering a sense of alienation from their own identity and history.
Efforts to reform education have become central to Native Hawaiian resistance today. Movements like the Hawaiian language immersion schools (Nā Leo Kāko‘o) and programs at institutions such as the University of Hawai‘i at Mānoa are reclaiming space for Indigenous languages, histories, and ways of knowing. These programs not only teach students about the illegal overthrow but also encourage a reconnection to Hawaiian history and cultural pride. (Luning) However, these institutions remain underfunded and often overlooked within broader educational spectrums. The Apology Resolution acknowledged that “the health and well-being of the Native Hawaiian people is intrinsically tied to their deep feelings and attachment to the land” (Langer) yet failed to mandate educational reform or require accurate historical narratives in public schools. The resolution shows America’s intention of recognition with no reconciliation.
Conclusion
The illegal overthrow and annexation of the Hawaiian Kingdom in 1893 was just the tip of the cultural suppression, political instability, and history erasure of the Native Hawaiians. The dominant narratives pushed by media, education, and government institutions fail to address Hawaiian adversities and strong resistance. From Queen Liliʻuokalani’s peaceful protest, sovereignty movements, multiple petitions against annexation, and the revitalization of Hawaiian language and history in schools, Native Hawaiians have continuously asserted their identity, rights, and history. However, these efforts are still met with the lasting harm of misrepresentation and dismissal. Education remains a gray area where Native knowledge and perspectives are overshadowed by western narratives. And if this view dominates classrooms and public perceptions, the injustices of the past will continue to follow and dismiss Native Hawaiians. Reconciliation needs more than empty apologies; it needs structural change. By adding narrative inclusive curriculum and teaching Native Hawaiians as well as other Americans the indigenous truth of the annexation of Hawai’i, we can honor Native voices and culture. That way the US as a nation can take a step towards cultural inclusivity, awareness, and respect.
Work Cited
Alexeyeff, Kalissa, and Siobhan McDonnell. Media, Indigeneity and Nation in South Pacific Islands. University of Hawaiʻi Press, 2018.
Binney, Judith. “Māori Oral Narratives, Pakeha Written Texts: Two Forms of Telling History.” New Zealand Journal of History, vol. 38, no. 2, Oct. 2004.
Cengage. The American Pageant: A History of the American People. National Geographic Learning, 2025, sngl.cengage.com/search/productOverview.do. Accessed 27 Mar. 2025.
Iolani Palace. “Queen’s Imprisonment – Iolani Palace.” 2019, www.iolanipalace.org/history/queens-imprisonment/.
Kennedy, David M., et al. The American Pageant: A History of the American People. 17th ed., Cengage Learning, 2019, pp. 622–623.
Langer, Elinor. “Famous Are the Flowers.” The Nation, vol. 286, no. 16, Apr. 2008, pp. 15–29. EBSCOhost, research.ebsco.com/linkprocessor/plink?id=f46aca76-304d-3555-a10f-814a047add38.
Luning, Rebecca J. I. The Effects of a Hawaiian Language Immersion Program on Student and Family Development. University of Hawaiʻi at Mānoa, 2007.
Roberts, R. C. “Reificatory Justice and the Kānaka Maoli of Hawaiʻi.” Social Philosophy Today, vol. 36, 2020, pp. 89–103. DOI.org, doi.org/10.5840/socphiltoday2020121774.
Sai, Keanu. “The Illegal Overthrow of the Hawaiian Kingdom Government.” neaToday, National Education Association, 2 Apr. 2018, www.nea.org/nea-today/all-news-articles/illegal-overthrow-hawaiian-kingdom-government.
Schamel, Wynell, and Charles E. Schamel. “The 1897 Petition against the Annexation of Hawaii.” National Archives, 15 Aug. 2016, www.archives.gov/education/lessons/hawaii-petition.
Smith, Tom. “History, ‘Unwritten Literature,’ and U.S. Colonialism in Hawaii, 1898–1915.” Diplomatic History, vol. 43, no. 5, Nov. 2019, pp. 813–39. DOI.org, doi.org/10.1093/dh/dhz038.
U.S. Department of State. “Annexation of Hawaii, 1898.” Office of the Historian, 2019, 2001-2009.state.gov/r/pa/ho/time/gp/17661.htm.
Media Attributions
- Average-Number-of-People-Detained-by-ICE-Daily-1
- number of detention facilities
- number of immigrants on ice’s alternatives to detention program
