Has humankind driven Earth into a new epoch?

Our mark on Earth is so profound that some argue it’s time to bid goodbye to the current geological time period — the Holocene — in favor of a new one: the Anthropocene.

By Ramin Skibba

In the thousands of years that modern humans have trod the Earth, we have wreaked stunning changes on the planet — the rising CO₂ levels fueling climate change, novel and long-lived radioactive particles from nuclear activity, depleted water resources, toxic waste buildup, desertification and more. To reflect our impact on the globe, some geoscientists and biologists have advanced the concept that we are living in a new geological time period: the Anthropocene, or the epoch of humankind.

The current geological epoch, the Holocene, began 11,700 years ago, after the last major ice age. But in the last 15 years, geologists and other Earth scientists have debated whether we have left enough of a mark on the world that it makes sense to bid the Holocene goodbye.

One proponent of the Anthropocene concept is Yadvinder Malhi of the University of Oxford in England, whose research on tropical forests has revealed the cascading ecological consequences of human-caused pressures such as logging, fires, invasive species and climate change. He reviewed the history of the Anthropocene idea, and debates that surround it, in “ The Concept of the Anthropocene” in the Annual Review Environment and Resources.

This conversation has been edited for length and clarity.

What’s your definition of the Anthropocene?

It’s a term for a new geological epoch that signifies an age where the planet is dominated by human influence. But others wouldn’t agree. They say any significant modification of the environment would count — it doesn’t have to be complete domination.

And so one big debate is whether the Anthropocene is recent, say, starting in the mid-twentieth century, or whether it’s been going on for centuries or even millennia. The debate pivots on whether it’s a continuation of a process where humans have been altering the environment since we started using fire, or with early farming, or whether something dramatic has happened more recently where we started dominating and rupturing the environment in fundamental ways. Something so significant that it’s altering geological records.

For example, the spread of wet rice farming in Asia thousands of years ago may have increased global concentrations of methane, and this may have delayed the onset of the next ice age. Others argue that the extinction of megafauna, like mammoths, in which human hunters probably played a role, may have caused reflective and snow-covered high-elevation grasslands to be replaced by dark, heat-absorbing forests, leading to local warming. These would suggest human alteration of planetary processes, but not the domination of them that we’re seeing today.

What more recent changes would you point to that argue for a distinct Anthropocene epoch now?

The underlying issue is that human activity is so large because there’s so many humans and because of how active they are in consumption and waste production. We’re over-harvesting fisheries and the ocean, and we’re converting large parts of land from natural ecosystems to croplands or pasturelands. Part of it comes from our waste products. Climate change comes under that, through excess CO₂ in the atmosphere, swamping the natural capacity of the carbon cycle to absorb it.

Excess plastics in the ocean are starting to alter food chains of ocean ecosystems, and excess nitrogen in our fertilizers is causing dead zones in lakes and estuaries.

Humans have always affected local environments, depleting resources or putting too much waste into it. There’s little evidence that early civilizations were more sustainable than contemporary ones; they just worked on a smaller scale. The challenge now is that we’re a global, interconnected civilization, so our activities are starting to alter planetary functioning.

Are there geological arguments against formally designating our current period as the Anthropocene?

Some geologists question whether geological time scales are the best forum for what is essentially a political framing or advocacy term. It's also a challenge that a mid-twentieth-century start date is so recent that a clear stratigraphic signal is hard to distinguish.

The Anthropocene Working Group, a collaboration of mostly scientists, recommended in August 2016 to the International Commission on Stratigraphy, the authorities who decide on geological time periods, that Anthropocene should be a formal epoch, and they suggested traces in rocks and sediments to mark it — things like radioactivity and plastics. What’s the status of this?

The working group has converged on a starting date of the Anthropocene in the mid-twentieth century, often termed the “great acceleration,” and the group is spending the next few years building up a strong stratigraphic case for this. If you look at concentrations of atmospheric CO ₂, the amount of tropical deforestation, numbers of rivers dammed, the amount of fish harvested, as well as the total human consumption of food and raw materials, they all show an increase over time but an uptick in the mid-twentieth century.

Would you say the Anthropocene concept has been more useful for scientists or in a public, cultural sense, drawing attention to the impact we’re having on the planet?

I think both. The Anthropocene provided for the sciences a unifying framework that didn’t exist before, drawing together multiple fields to describe the processes changing the Antarctic, tropical forests, the climate, biodiversity, and the ozone layer.

Culturally, it’s even more useful than framing issues just around climate change because it brings in the underlying issue: the metabolic signs of humanity. Our activities, relative to the size of the planet, have become so large that they’ve changed the way we think about ourselves and our history and future. That’s got a huge cultural and political resonance. It’s the zeitgeist, it’s hit a raw nerve of something people felt was there, but needed a way to describe it.

The Anthropocene framing recognizes the world is finite. A century ago, when London and the river Thames were polluted, it led to the realization that the river isn’t infinite, you can’t just dump waste and forget about it. It comes back to bite you. With climate change, if you keep pouring waste into the atmosphere, at some point it feeds back.

This is a way to think about the world around you in a really fundamental way. That’s where you can start imagining different futures. It leads to challenges like, how can an economic model built on perpetual growth fit within a finite planet?

When you’re thinking of global problems, like climate change or species extinctions, which ones could cause the most damage?

It depends on what you think is a threat. For human civilization, I’d say it’s climate change. If we pass some threshold, like if we see Antarctic ice sheets melting and other irreversible tipping points, that would have a huge negative impact on much of humanity.

For the biosphere, the acidification of oceans could prove critical. On land, it’s the loss of large areas of forests, especially tropical forests.

Have you thought about global solutions, whether it be changing consumption patterns in industrial countries, or things like geoengineering to tackle climate change?

There’s a whole gamut of solutions. For me, an ideal mix includes changes in the fundamental economic model, the mass consumption society, coupled with behavioral change at the societal level, along with redesigning our energy systems — with renewables replacing the fossil-fuel economy. Technology plays a role, but also rethinking our priorities as a society.

I’m cautious about geoengineering. It may be necessary at some stage, but it presumes we know more about Earth’s systems than we do. It carries a bit of hubris around it. We could inadvertently do more damage, rather than reverse it.

Are there sociological or moral criticisms you’ve come across of the concept of the Anthropocene?

Some argue that the Anthropocene is a broader environmental concept that concerns us all, rather than just a geological one. It’s about how we think about our relationship with the natural world, how we manage living on a human-dominated planet.

There are criticisms within the social sciences. Political scientists ask, what is this “anthropos”? It creates a sense of all of humanity in this together as a force altering nature, and the term’s ignoring that only a subset of humanity caused the Anthropocene. People outside the West and industrialized Asia played little role in creating it. It diffuses responsibility away from the core that’s responsible.

Others argue that it creates a sense of inevitability, like this geological age was going to come to pass, ignoring that perhaps political or economic decisions, such as the creation of the capitalist world system, lie behind this, by creating a resource-intensive exploitation of the world.

What are the next steps for research on the Anthropocene?

The really interesting questions are not how we define the Anthropocene, but how do we navigate it?

I’ve been reading work on “doughnut economics” by Kate Raworth, who describes herself as a “renegade economist.” She thinks about how we can reach this goal of getting enough people out of deprivation — the hole of the doughnut is the inner circle of deprivation — while staying within the outer ring. It’s this challenge of reconciling human improvement and welfare while maintaining the environmental stability of the planet and leaving enough space for other organisms that live on it. How do we stay in that doughnut? It’s a mixture of research and policy action.

Will the Anthropocene just continue indefinitely?

At least for some time in the future. We’re currently in the Cenozoic Era, which started with the asteroid that killed the dinosaurs. That was planet-altering. Perhaps the alterations we’re doing now, if they played out for a century, if we pushed climate change beyond tipping points so that it accelerates, then “Anthropocene” — an epoch — is too modest a designation. People argue that what’s happening now is so substantial and profound it should be something like the “Anthropogene” [a period] or the “Anthropozoic” [an era], since the scale of the change may be so large that “epoch” is too low in the geological hierarchy of time scales to be appropriate. It’s too soon to decide that.

Ramin Skibba is an astrophysicist turned science writer and freelance journalist, based in San Diego. Reach him at  raminskibba@gmail.com or @raminskibba.

This article originally appeared in Knowable Magazine, an independent journalistic endeavor from Annual Reviews.

Making Your Home Safe for Baby

Your little one’s on-the-go adventures mark a huge milestone for his or her development and your family. Before you allow your baby to trek freely from room to room, get your home ready for a child on the move with these safety steps and precautions:

Prepare before the birth
First-time parents are likely to embark upon a new life filled with late nights, sleep deprivation and a world of stresses they’ve never experienced or considered. Prepare your home before the baby is born to avoid the panic of waiting until the last minute.

Tour like your tot
The first step toward ensuring your home is ready for a mobile child is to see the world from the same level. Take a crawling tour around your home to see things that may be in the way or discover hazardous items that are within easy reach. Use all of your senses to assess any potential dangers.

Latch it up
Protect your little one from sharp objects and heavy items by installing child protection latches on all cabinets and drawers. For an added layer of protection, keep any sharp objects and harmful chemicals in high places only adults can reach.

Evaluate leaning objects
Bookshelves, bedside tables and the items placed on them, such as television sets and other large appliances, can be a threat to the safety of a small child trying to pull him or herself up and balance on two feet. Ensure these items are properly secured or keep them put away unless in use to avoid them being pulled on top of your child.

Other safety measures
To properly prepare your home for a mobile child, don’t forget to take steps such as:

• Covering electrical outlets with safety plugs
• Placing safety gates at the top and bottom of staircases
• Installing fireplace screens
• Adding foam padding to sharp furniture corners and edges
• Placing a soft cover over the bathtub waterspout
• Removing blinds with looped cords or installing safety tassels and cord stops
• Stocking your first aid kit
• Putting non-slip pads under rugs

Find more tips to child-proof your home at eLivingtoday.com,

When criminals rule the land

In Latin America, tens of millions of people live in territories that are governed by outlaws — from powerful drug cartels to crime syndicates. What can be done to restore legitimate law and order?

By Pablo Fonseca Q.

At the beginning of 2023, the state of Sinaloa endured hours of violence as Mexican authorities hunted down and captured Ovidio Guzmán, the son of the famous drug trafficker Joaquín “El Chapo” Guzmán. Blockades, shootings and citizens locked in their homes: It was a stark demonstration that in Latin America, there are places where the state does not govern but, instead, the criminals — in this case the Sinaloa Cartel — are in charge. Wresting back control, even momentarily, comes at a high cost (29 people died in this operation, including military personnel and alleged criminals).

Mexico is an iconic case, but not the only one. In Ecuador, for example, the state has lost control in its overcrowded prisons, where criminal organizations extort money from detainees and their families, and also carry out massacres inside prison walls. Seven such massacres in 2021 and 2022 claimed the lives of more than 350 people, according to Human Rights Watch.

Latin American magical realism seems to have leapt from the pages of literature and landed into real-life politics and law enforcement. This has helped to transform Latin America into a place that, in the absence of armed conflict, has the highest rates of violence in the world. According to 2018 data from the Economic Commission for Latin America, the region has 10 times more homicides (23 per 100,000 inhabitants) than Europe (2.1 per 100,000) and about eight times more than Asia (2.7 per 100,000). Of these homicides, 93 percent are concentrated in Brazil, Colombia, Mexico, Venezuela, El Salvador, Guatemala and Honduras, countries that are home to only 68 percent of Latin America’s population.

Part of this violence is the product of criminal governance, the process by which criminals — paramilitary groups, vigilantes, death squads, guerillas, drug cartels, organized crime groups and gangs — take over the traditional role of the state and govern or co-govern a territory and a population. There are areas in Latin America where criminals have taken charge of maintaining public services, building infrastructure and even dispensing justice.

“Most societies in this region are grappling with patterns of criminal governance through which state officials, political authorities and organized crime actors co-govern. While the phenomenon is certainly not new, it has attained greater prominence as ever more influential and powerful criminal syndicates have entered into the bloodstream of many societies, transforming traditional forms of governance,” write political scientists Andreas Feldmann of the University of Illinois Chicago and Juan Pablo Luna of the Pontificia Universidad Católica de Chile, in a 2022 article in the Annual Review of Sociology on the state of criminal governance in Latin America.

Knowable Magazine spoke with Feldmann about this parallel order in which rules are imposed on citizens by criminal organizations, often with the collaboration of state agents. This interview has been edited for length and clarity.

What is criminal governance and how does it differ from the organized crime we can find in any country?

The difference has to do with the notion of governance. Organized crime is motivated by profit; its objective is not to govern. Criminal governance is a context in which criminal groups govern spaces, population and territory. The Sinaloa Cartel in Mexico governs several communities where the population knows that the state does not have the capacity to intervene. In Rio de Janeiro, the Amigos dos Amigos gang rules Rocinha, one of the main favelas of this Brazilian city.

Why would criminal groups want to embark on such an arrangement? Because it’s good for business. To the extent that you control a territory and a population, it facilitates the organization and productivity of your business.

What do the formal authorities get out of such an arrangement?

People tend to think that states are inevitably corrupt. There is something of that in many officials, but often what happens is that they are also threatened, and they have no alternative but to bow to this order: To the extent that the state loses its monopoly on the use of coercion, it has difficulties in confronting groups that are powerful and that threaten officials or extort money from them.

It is the old dictum of Pablo Escobar, the notion of money or lead ( plata o plomo): “I buy you or I kill you.”

The Colombian drug trafficker Pablo Escobar, leader of the Medellin Cartel until he was killed in 1993, gave many citizens what the state did not give them, such as houses for the poor and soccer fields for the neighborhoods. Are these types of actions also a form of criminal governance?

Absolutely. Many times, you talk to people in the communities, and they prefer the criminals to the state because the rules are clearer, and because they are bothered by the double discourse of the state agents — who on the one hand say they operate according to the law, but on the other hand commit the same abuses, or sometimes even worse abuses than the criminals.

There are studies in Brazil on how these criminal groups administer justice in sectors where there is no justice, where there is total impunity with respect to robberies, sexual assaults and other incidents in the communities. These organized crime groups have a parallel justice system where they manage these types of problems, and the communities value this very much, as in the case of Rocinha, in Rio. Inhabitants of this favela say they feel safe, and criminal groups have been shown to settle property rights issues between neighbors and provide public services, recreation and sports.

A few decades ago, Latin America was full of clearly anti-democratic regimes. Since then, the quantity and quality of democratic regimes in the region have increased. Yet, so has criminal governance: According to a recent study by Benjamin Lessing of the University of Chicago, 13 percent of the population in Latin America, nearly 80 million people, live under a criminal governance system. Why is there this contradiction?

I think we always thought that this was a contradiction. We had the hope and the illusion, perhaps a little naively, that as we moved towards more democratic regimes, we were going to see more integrity and honesty in the exercise of power.

But that illusion quickly collapsed, and we began to observe societies where democratic regimes coexist with enormous amounts of abuses, human rights violations and violence. Mexico and several countries in Central America, such as El Salvador and Honduras, have seen how the transition to democracy coincided with atrocious human rights violations. In Mexico, it is estimated that more than 100,000 people have disappeared in the last decade — although no one knows for sure, and the number may be much higher. And Salvadorans have been living under a state of exception since the end of March 2022, under which a variety of serious abuses have been committed. Many of these — torture, forced disappearances, assassinations — are committed in the name of fighting organized crime.

At the same time, we have seen how organized crime forces have developed in a very forceful way in authoritarian regimes, as in Venezuela.

And then there are countries that are democratic and have developed systems where violence has multiple causes. Take Brazil, where a mixture of structural conditions (poverty, inequality, marginalization and hopelessness) generates violence, and the state, through its coercive arm (police, army, security forces) acts violently, often committing abuses that are not investigated, let alone punished, in an atmosphere of impunity. A plurality of actors use violence to achieve their ends. Different manifestations of violence overlap: criminal, political and economic.

Prisons, surely, are places where the state should exercise control. What does it tell us that in Latin America we have several cases where the convicts themselves have a significant level of control over the prisons? In Ecuador, for example, some inmates must even pay a monthly fee to the mafias that control part of the prison in order to not be assaulted. Cases of similar control have been reported in Brazil and El Salvador.

This is the most fascinating case of all. This, from a conceptual point of view, is complex to understand, because if there is a place where the state has a monopoly on the legitimate use of violence, it is the prison.

Two alternatives explain this counterintuitive phenomenon: The state deliberately abandons prisons because it chooses not to exercise its power in that space; or it lacks the coercive capacity to control the individuals and organizations housed there.

And a third possible alternative is that they become spaces of criminal governance where the state and criminal groups co-govern.

What is at the root of the birth of violent structures in Latin America? Is it due to inequality, poverty, ambition, corruption, the weakness of the states?

It is a tremendously complex phenomenon. I would say it is all these factors combined. The problem of violence is an issue of marginalization, of societies that do not give people opportunities to develop as individuals and participate in dignified conditions. A significant portion of the population lives marginalized from society, with low schooling, high poverty and high unemployment, and one of their few existing options is to join a criminal structure.

At the same time, there is a very important cultural phenomenon in which criminal organizations are attractive because of what they offer. Materialism and nihilism are recurring themes for the youth who enter this type of structure. They long for a life of glamour and a life of consumption and are willing to pay the ultimate sacrifice. Many of them tell you: I would rather spend five years as a sicario (hit man), but live them well, than spend 50 years in a demeaning job, being exploited, and overwhelmed by so much scarcity.

Finally, I would say that there is a strong state issue: states that are not capable of providing alternatives, or whose models are not attractive. The formal model of studying, of trying to get ahead, is very uncertain: It requires a lot of sacrifice and is not necessarily seen as attractive.

Many academic studies of this issue focus on homicides, drug trafficking and major crimes, and leave out less violent situations and regions. Are we underreporting the true level of criminal governance?

Absolutely. Contexts of criminal governance in countries like Uruguay and Costa Rica are very prevalent and go under the radar because people focus on the most emblematic cases, like Mexico, Brazil, Colombia, Venezuela, Guatemala, El Salvador and Honduras. But this is a much deeper problem and has to do with the weakening of state structures and the loss of the state’s legitimacy. These two elements undermine state capacity.

If you look at the levels of violence, this is a very strong indicator of how the coercive apparatus of the state in countries like Costa Rica and Uruguay has been weakening in the last 10 or 15 years. Homicide rates, although lower than in other nations in the region, have doubled in those two countries.

Some people may think that the solution to criminal governance is simply a stronger state. Is this view correct?

A truly strong state would be one with greater levels of legitimacy. What we observe today is that states are ineffective, they do not solve people’s problems and, at the same time, they are unjust, violent, corrupt. And rather than looking out for the welfare of the people, they often undermine their citizens. Public opinion studies from sources such as Latinobarómetro and the Latin American and Caribbean Public Opinion Project have been recording for years a decline in the levels of trust of the population towards their authorities, and an evident drop in the adherence to democracy: The population is more willing to live in less democratic regimes as long as their daily problems are solved. What is happening today in El Salvador is proof of this.

The problem in Latin America could be solved if the strength of the state — in terms of its legitimacy and its infrastructural power — improved. But it must be both, not just one. It is not just a matter of coercion; it is not just a matter of shooting bullets and trying to control these groups. Organized crime is a manifestation of acute social problems. These groups have many avenues of communication with the population, particularly in low-income communities where they interact with the population, know their fears and aspirations, and take advantage of that knowledge to achieve their objectives. Remember that most of the time criminals are members of a community. People know them and have personal ties of friendship and kinship with them.

What is the responsibility of the formal authorities in the establishment of criminal governance systems?

Enormous. Either they are complicit or their level of effectiveness and the public policies they implement — in one way or another — do not account for this reality.

The problem of criminal governance, and many problems that society has today, are structural problems that no political administration can solve in the time frame that each presidential term has. I have strong doubts that democratic regimes can address these types of problems unless the political sectors agree to a great pact, unless they understand the seriousness of the situation and act in unison.

I think we are at a point where that would probably be the only solution with any degree of viability. But politics in the background is pointing to something totally different: There is a great level of fragmentation and paralysis in the political arena. Ergo, what we see is that the problems are increasing every decade.

How do you think the issue of criminal governance will evolve in the next five years in the Latin American region?

I think, unfortunately, that the phenomenon is going to increase. The growing social and economic problems and the impotence of states to address them have opened spaces for criminal groups.

In country after country, states have withdrawn from many areas because they don’t have the capacity — and sometimes the will — to govern those areas. That vacuum has been filled by criminal actors. The only hope is that societies and political actors understand the seriousness of the issue and act accordingly, and together.

The region needs governments of national unity in which politically antagonistic sectors put aside extremist attitudes, make concessions and seek common solutions to the problems of governance. It is essential to forge a sustainable development model that provides the state with the conditions to raise the population’s standard of living. The challenge is monumental.

Pablo Fonseca Q. is a journalist based in Costa Rica. He holds a postgraduate degree in political science from the University of Costa Rica.

This article originally appeared in Knowable Magazine, an independent journalistic endeavor from Annual Reviews.

The lasting anguish of moral injury

Psychologists are finding that moral code violations can leave an enduring mark — and may require new types of therapy

By Constance Sommer

On a Sunday evening in September 1994, David Peters drove to a church service in Beckley, West Virginia, as the sun set over the horizon. He was 19 years old, just back from Marine Corps boot camp. He hadn’t been behind the wheel of a car all summer.

The road curved, and Peters misjudged the turn. Rays from the dipping sun blinded him. The car hit the median and headed straight at an oncoming motorcycle. And then, Peters says, “Everything went crash.”

His friend, sitting in the passenger seat, seemed fine. Peters got out of the car. The driver of the motorcycle was alive, but the woman who’d been riding behind him was now laid out on the pavement. Peters quickly realized she was dead.

Now an Episcopal priest in Pflugerville, Texas, outside Austin, Peters says there have been periods during the last 28 years when he’s found the knowledge that he killed someone almost unbearable. “I felt like I wasn’t good anymore,” he says. At times, he even wished he were dead. Years after the accident, he purchased a motorcycle, thinking “that'd be sort of justice if I died on a motorcycle.” 

Peters may have experienced what some psychologists and researchers have begun to call “moral injury,” a concept introduced by a psychiatrist to describe the devastation he witnessed in Vietnam War veterans and others who believed they’d been ordered to act in ways that violated their personal moral code. The term encompasses a constellation of signs and symptoms that go beyond mere guilt and shame and can be so severe that people lose a sense of their own goodness and trustworthiness, leading to drastic impacts on daily functioning and quality of life. 

Moral injury results from “the way that humans make meaning out of the violence that they have either experienced or that they have inflicted,” says Janet McIntosh, an anthropologist at Brandeis University who wrote about the psychic wounds resulting from how we use language when talking about war in the 2021  Annual Review of Anthropology. 

Although research on moral injury began with the experiences of veterans and active-duty military, it has expanded in recent years to include civilians. The pandemic — with its heavy moral burdens on health care workers and its fraught decisions over gathering in groups, masking and vaccinating — intensified scientific interest in how widespread moral injury might be. “What’s innovative about moral injury is its recognition that our ethical foundations are essential to our sense of self, to our society, to others, to our professions,” says Daniel Rothenberg, who codirects the Center on the Future of War at Arizona State University.

Yet moral injury remains a concept under construction. It is not an official diagnosis in psychiatry’s authoritative guide, the Diagnostic and Statistical Manual of Mental Disorders (DSM). And until the recent publication of a major study on the subject, researchers and clinicians lacked well-defined criteria they could use to determine if someone has moral injury, says Brett Litz, a clinical psychologist at VA Boston Health Care System and Boston University. “The prevalence of moral injury is utterly unknown, because we haven’t had a gold standard measure of it,” he says. 

‘It starts working on your head’

Moral injury was first described by Jonathan Shay, a psychiatrist in Boston, who defined it as a sense of “betrayal of what’s right, by someone who holds legitimate authority (in the military — a leader), in a high-stakes situation.” In his 1994 book, Achilles in Vietnam, Shay quotes a soldier whose platoon fired on people at the beach one night, having been told by commanders that their targets were unloading weapons. But when daylight came, the soldiers realized they’d killed a bunch of fishermen and their children. “So it starts working on your head,” the soldier told Shay. “So you know in your heart it’s wrong, but at the time, here’s your superiors telling you that it was OK.” Incidents like this, Shay argued, are not just upsetting, but also damaging.

As the years passed, some researchers felt that Shay’s definition focused too narrowly on betrayal by leaders or country. In 2009, Litz and colleagues expanded the definition to include more personal types of moral injury, such as the lasting impact of “perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations.” 

In a 2019 study, researchers devised a list of potentially morally injurious events to civilians by reviewing previous literature and research, as well as consulting experts and people who suffered from memories of morally distressing events. The researchers came up with 31 events that seemed to distress people enough to lead to moral injury, including a car accident while texting, sexual assault, working within a corrupt organization, witnessing abuse of power at work, cheating on a romantic partner and stopping providing for dependent children. But not everyone reacts to troubling events in the same way, and not everyone who experiences a particular event will suffer a moral injury, says study coauthor Matt Gray, a clinical psychologist at the University of Wyoming. What really makes a difference, he says, is “people’s moral framework and their appraisal of their actions or inactions.”

Because such actions and encounters can be traumatic, people with moral injury may appear to have post-traumatic stress disorder. But a diagnosis of PTSD does not capture the entirety of this kind of suffering, Shay and therapists who came after have found.

Many researchers view PTSD and moral injury as distinct conditions, although they overlap in their symptoms and the types of events that trigger them. PTSD is characterized by anxiety that develops after a serious physical threat of injury, sexual violence or death. But that triggering event doesn’t necessarily have to be morally injurious — it could be a natural disaster, say. For moral injury, on the other hand, the triggering event is always morally injurious but it may or may not involve a physical threat; it could be something like causing financial distress to others due to a gambling addiction.

Both conditions can involve intrusive memories of the traumatic event, avoidance of reminders of the event, lack of interest in pleasurable activities and detachment from others, Litz and colleagues wrote recently in  Frontiers in Psychiatry  (some researchers have categorized the overlapping symptoms differently). But moral injury is more likely to lead to other symptoms, Litz says, including alterations in self-perception, loss of meaning and loss of religious faith. 

The two conditions may have different effects on the brain. In a 2016 study, active-duty military personnel seeking trauma treatment were asked to lie in a darkened room with their eyes closed for 30 minutes, after which they underwent a brain scan. Those who had been traumatized by a physical threat exhibited elevated resting neuronal activity in their right amygdala, a part of the brain associated with emotional responses, particularly fear. But those who were haunted by something they did or witnessed had more activity in their left precuneus, a part of the brain that is related to sense of self.

Over time, the moral injury research lens has expanded to include nonmilitary populations such as police officers,  teachers,  refugees and  journalists. One 2019 study, for instance,  surveyed teachers and other K-12 professionals in an urban Midwest school district, where some schools were white and affluent, some were racially and economically mixed, and others were largely made up of impoverished students of color. The less affluent and the more segregated the students, the more likely the teachers were to experience moral injury, writes the study’s author, Erin Sugrue, a social worker at Augsburg University in Minneapolis. “Professionals in these schools may experience moral injury as they come into close contact with the impact of racism and income inequality, two inherently immoral social forces, on the daily lives of their students.” 

During the pandemic, researchers have turned their focus to the medical front lines. One recent study led by Jason Nieuwsma, a clinical psychologist at Duke University School of Medicine, analyzed data from a March 2021 survey of health care workers. They  reported potentially morally injurious experiences that included hospital policies that  prohibited dying patients from receiving visitors, watching some people refuse to wear masks to protect those who were more vulnerable, and being too overworked to provide optimal care. One wrote: “My line in the sand was treating patients in wheelchairs outside in the ambulance bay in the cold fall night. I got blankets and food for people outside with IV fluid running. I was ashamed of the care we were providing.”

Roughly half of the health care workers reported they were troubled by witnessing others’ immoral acts, and just under a fifth (18.2 percent) reported that they were troubled by having acted in ways that violated their own morals and values. “It begs the question of whether that experience will persist over time,” Nieuwsma says. “It’s something health care systems need to pay attention to.”

Still, Nieuwsma, who has largely studied moral injury in a military context, says he and other researchers have been reluctant to apply the term to the civilian population. “We want to preserve the intensity” of the description, he says.

To distinguish between normal moral stress and abnormal distress at levels that may require therapeutic intervention, Litz and Patricia Kerig, a clinical psychologist at the University of Utah, propose a moral continuum. At one end is the kind of moral frustration one might experience over an upcoming local or national election, events that are not immediately personal. Then there are more distressing events involving a personal, moral transgression (like if you behave hurtfully to someone you love or steal someone else’s idea). A person may lose sleep over such issues, but they are not disabling and do not define the person in question. At the far end of the spectrum is the type of debilitating moral injury that consumes a person with intense guilt or shame.

But what exactly are the parameters of that injury? So far researchers and clinicians have lacked an objective measure of moral injury. To rectify that, Litz and 10 colleagues, along with a broad consortium of other experts, recently sent questionnaires to hundreds of active-duty service members and military veterans in the United States, Canada, the United Kingdom, Australia and Israel who had suffered potentially morally injurious experiences. From their responses, the researchers identified 14 reactions that indicate the presence of moral injury. The list includes statements like “I have lost pride in myself” and “I am disgusted by what happened.” The researchers believe their new “moral injury outcome scale,” will be a useful tool for future studies.

Forward-looking therapy

Nearly 30 years ago, Shay saw that a diagnosis of PTSD didn’t encompass all that Vietnam veterans were dealing with. And today, psychologists recognize that the treatments don’t directly translate, either. Treatment for PTSD typically involves drugs that treat depression and anxiety, as well as therapy intended to help patients reframe negative thoughts about the trauma and gain control by facing negative feelings. With PTSD, “we’re trying to reappraise and reinterpret and recontextualize that event, and we’re trying to get you, in the here and now, not to be as reactive to it,” says Gray. In a sense, such therapy is “backwards-acting,” he says. 

For someone struggling with moral injury, however, it may not be possible to recontextualize the inciting event, because in some cases it’s truly what it appears to be: a violation of a person’s moral code. As a result, Gray says, therapy for moral injury needs to be forward-looking, or what he, Litz and colleagues describe in a 2017 book as “adaptive disclosure.” 

This form of therapy attempts to help the patient come to terms with their moral injury by shifting their perspective. A patient may blame themselves or others for what went wrong, and this may be objectively true, the authors write. But in therapy, the patient can be encouraged to take ownership of the act; consider forgiving themselves; commit to actions that have real or symbolic reparative value (such as someone who harmed another by driving while drunk agreeing to speak to high school students about the dangers of mixing driving and alcohol consumption); and recognizing that condemning themselves for the horrific act cannot erase it, but can prevent them from doing good in the world going forward. It essentially tells the person, “You have things that you can still contribute, and that ultimately will be more productive and more meaningful than just isolation and self-loathing,” Gray says.

If this sounds a lot like traditional religious teachings, that’s not far off, says Harold G. Koenig, a psychiatrist at Duke University School of Medicine. “This is something that religions have dealt with, and continue to deal with, since the beginning of time,” he says. Koenig and colleagues have been developing what he calls “spiritually integrated” therapies for moral injury based on the scriptures of the world’s major religious traditions, as well as interventions designed specifically for chaplains to help them treat people of any faith or even those without a faith. 

One example of the latter intervention is called “pastoral narrative disclosure.” It’s based on the idea that confession and absolution are key to redemption. As described in a 2018 paper, it involves helping the patient reflect on what happened, attempting to place it within the context of the person’s entire life, and then creating an absolution ritual that has spiritual meaning for the patient.

As for Peters, he’s connected with a support group of people who have accidentally killed someone, and he’s writing a book to help others in his position. He’s also taken comfort in the concept of a  city of refuge, described in the Old Testament as a place for accidental murderers to stay safe from possible avengers. “I had to build a city of refuge for myself,” Peters says. 

His “city” includes art, theology, the comfort derived from the community he found online and a mission to reduce dependence on cars. It’s a place, he says, “where I am able to live, but also live with the awareness that I’ve done this thing.” 

10.1146/knowable-071522-2

Constance Sommer is a freelance health and science writer in Los Angeles. Follow her @constancesommer and see more of her work at constancesommer.com.

This article originally appeared in Knowable Magazine, an independent journalistic endeavor from Annual Reviews.

Jupiter’s moons hide giant subsurface oceans – two upcoming missions are sending spacecraft to see if these moons could support life

The surface of Europa – one of Jupiter’s moons – is a thick layer of solid ice. NASA/JPL-Caltech/SETI Institute, CC BY-SA

Mike Sori, Purdue University

On April 13, 2023, the European Space Agency is scheduled to launch a rocket carrying a spacecraft destined for Jupiter. The Jupiter Icy Moons Explorer – or JUICE – will spend at least three years on Jupiter’s moons after it arrives in 2031. In October 2024, NASA is also planning to launch a robotic spacecraft named Europa Clipper to the Jovian moons, highlighting an increased interest in these distant, but fascinating, places in the solar system.

I’m a planetary scientist who studies the structure and evolution of solid planets and moons in the solar system.

There are many reasons my colleagues and I are looking forward to getting the data that JUICE and Europa Clipper will hopefully be sending back to Earth in the 2030s. But perhaps the most exciting information will have to do with water. Three of Jupiter’s moons – Europa, Ganymede and Callisto – are home to large, underground oceans of liquid water that could support life.

This composite image shows, from top to bottom, Io, Europa, Ganymede and Callisto next to Jupiter. NASA, CC BY-ND

Meet Io, Europa, Ganymede and Callisto

Jupiter has dozens of moons. Four of them in particular are of interest to planetary scientists.

Io, Europa, Ganymede and Callisto are, like Earth’s Moon, relatively large, spherical complex worlds. Two previous NASA missions have sent spacecraft to orbit the Jupiter system and collected data on these moons. The Galileo mission orbited Jupiter from 1995 to 2003 and led to geological discoveries on all four large moons. The Juno mission is still orbiting Jupiter today and has provided scientists with an unprecedented view into Jupiter’s composition, structure and space environment.

These missions and other observations revealed that Io, the closest of the four to its host planet, is abuzz with geological activity, including lava lakes, volcanic eruptions and tectonically formed mountains. But it is not home to large amounts of water.

Europa, Ganymede and Callisto, in contrast, have icy landscapes. Europa’s surface is a frozen wonderland with a young but complex history, possibly including icy analogs of plate tectonics and volcanoes. Ganymede, the largest moon in the entire solar system, is bigger than Mercury and has its own magnetic field generated internally from a liquid metal core. Callisto appears somewhat inert compared to the others, but serves as a valuable time capsule of an ancient past that is no longer accessible on the youthful surfaces of Europa and Io.

Most exciting of all: Europa, Ganymede and Callisto all almost certainly possess underground oceans of liquid water.

Warmth from Europa’s interior and tidal energy from Jupiter likely maintain a massive liquid ocean beneath the moon’s icy surface. NASA/JPL-Caltech/Michael Carroll

Ocean worlds

Europa, Ganymede and Callisto have chilly surfaces that are hundreds of degrees below zero. At these temperatures, ice behaves like solid rock.

But just like Earth, the deeper underground you go on these moons, the hotter it gets. Go down far enough and you eventually reach the temperature where ice melts into water. Exactly how far down this transition occurs on each of the moons is a subject of debate that scientists hope to resolve with JUICE and Europa Clipper. While the exact depths are still uncertain, scientists are confident that these oceans exist.

The best evidence of these oceans comes from Jupiter’s magnetic field. Saltwater is electrically conductive. So as these moons travel through Jupiter’s magnetic field, they generate a secondary, smaller magnetic field that signals to researchers the presence of an underground ocean. Using this technique, planetary scientists have been able to show that the three moons contain underground oceans. And these oceans are not small – Europa’s ocean alone might have more than double the water of all of Earth’s oceans combined.

An obvious and tantalizing next question is whether these oceans can support extraterrestrial life. Liquid water is an important piece of what makes for a habitable world, but far from the only requirement for life. Life also needs energy and certain chemical compounds in addition to water to flourish. Because these oceans are hidden beneath miles of solid ice, sunlight and photosynthesis are out. But it’s possible other sources could provide the needed ingredients.

On Europa, for example, the liquid water ocean overlays a rocky interior. That rocky seafloor could provide energy and chemicals through underwater volcanoes that could make Europa’s ocean habitable. But it is also possible that Europa’s ocean is a sterile, inhospitable place – scientists need more data to answer these questions.

The Jupiter Icy Moons Explorer spacecraft will travel for eight years before reaching Jupiter. ESA/ATG medialab/NASA/JPL/University of Arizona/J. Nichols

Upcoming missions from ESA and NASA

JUICE and Europa Clipper are set up to give scientists game-changing information about the potential habitability of Jupiter’s moons. While both missions will gather data on multiple moons, JUICE will spend time orbiting and focusing on Ganymede, and Europa Clipper will make dozens of close flybys of Europa.

Both of the spacecraft will carry a suite of scientific instruments built specifically to investigate the oceans. Onboard radar will allow JUICE and Europa Clipper to probe into the moons’ outer layers of solid ice. Radar could reveal any small pockets of liquid water in the ice, or, in the case of Europa, which has a thinner outer ice layer than Ganymede and Callisto, hopefully detect the larger ocean.

Magnetometers will also be on both missions. These tools will give scientists the opportunity to study the secondary magnetic fields produced by the interaction of conductive oceans with Jupiter’s field in great detail and will hopefully give researchers clues to salinity and volumes of the oceans.

Scientists will also observe small variations in the moons’ gravitational pulls by tracking subtle movements in both spacecrafts’ orbits, which could help determine if Europa’s seafloor has volcanoes that provide the needed energy and chemistry for the ocean to support life.

Finally, both craft will carry a host of cameras and light sensors that will provide unprecedented images of the geology and composition of the moons’ icy surfaces.

Maybe one day, a spacecraft will be able to drill through the miles of solid ice on Europa, Ganymede or Callisto and explore oceans directly. Until then, observations from spacecraft like JUICE and Europa Clipper are scientists’ best bet for learning about these ocean worlds.

When Galileo discovered these moons in 1609, they were the first objects known to directly orbit another planet. Their discovery was the final nail in the coffin of the theory that Earth – and humanity – resides at the center of the universe. Maybe these worlds have another humbling surprise in store.

Mike Sori, Assistant Professor of Planetary Science, Purdue University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

The race against radon

Scientists are working to map out the risks of the permafrost thaw, which could expose millions of people to the invisible cancer-causing gas

By Chris Baraniuk

Deep in the frozen ground of the north, a radioactive hazard has lain trapped for millennia. But UK scientist Paul Glover realized some years back that it wouldn’t always be that way: One day it might get out. 

Glover had attended a conference where a speaker described the low permeability of permafrost — ground that remains frozen for at least two years or, in some cases, thousands. It is an icy shield, a thick blanket that locks contaminants, microbes and molecules below foot — and that includes the cancer-causing radioactive gas radon.

“It immediately occurred to me that, well, if there is radon underground, it will be trapped there by a layer of permafrost,” recalls Glover, a petrophysicist at the University of Leeds in England. “What happens if that layer suddenly isn’t there anymore?” Ever since then, Glover has worked on methods to estimate how much radon — which is released as the element radium decays — might be liberated as climate change causes the permafrost to thaw. 

Significant areas of Arctic and sub-Arctic ground  contain permafrost — but today it is melting, and the rate of that thaw is accelerating. In  a report published in January, Glover and coauthor Martin Blouin, now technical director at the mapping software firm Geostack, used modeling techniques to show that homes with basements built on areas of permafrost could be exposed to high levels of radon gas in the future. “As the permafrost melts, this reservoir of active radon can flood to the surface and get into buildings — and by being in buildings, cause a health hazard,” Glover says.

No one knows exactly how quickly radon diffuses through icy ground, but by using the rate of diffusion of carbon dioxide and adjusting for the properties of radon, Glover came up with a figure that he could use in the model. Based on 40 percent permafrost thaw, the calculations reveal that radon emissions could raise radioactivity levels to more than 200 becquerels per meter cubed (Bq/m3) for a period of more than four years in homes with basements at or below ground level. This happens when the 40 percent thaw occurs in 15 years or less.

According to the World Health Organization, the risk of lung cancer increases by about 16 percent with every 100 Bq/m3 of long-term exposure. Some countries,  including the UK, set the safe level of average exposure at 200 Bq/m3. But without testing for radon in areas where the geology suggests it’s present, people will not know whether they are at risk — because the gas is odorless, colorless and tasteless.

Glover stresses that the model in the paper is an early attempt to understand how permafrost thaw could affect people’s exposure to the gas. It doesn’t, for example, account for seasonal variation in the rate of permafrost thaw or the effects of soil compaction when ice within it melts, something which could pump yet more radon to the surface.

Some 3.3 million people live on permafrost that will have completely melted away by 2050, according to estimates in  a 2021 study. Not all of these people live in areas prone to radon but many do: For example, in parts of Canada, Alaska, Greenland and Russia. And the link between  radon exposure and lung cancer is well-established, as is the fact that  smoking further increases one’s risk, says Stacy Stanifer, oncology clinical nurse specialist at the University of Kentucky’s College of Nursing. She points to studies suggesting that radon  could be behind up to 1 in 10 lung cancer deaths, of which there are 1 million in total worldwide every year.

“Breathing radon is dangerous for everyone, but it’s even more harmful when you also breathe tobacco smoke,” says Stanifer. Smoking is prevalent in Arctic and sub-Arctic communities; for example, a 2012 study reported that nearly two-thirds of Canadian Inuit age 15 and over who live within the Inuit homeland said they smoke cigarettes daily, compared with 16 percent of Canadians overall.

Scientists don’t know how much radon is actually emanating from areas with melting permafrost today, says Nicholas Hasson, a geoscientist and PhD student at the University of Alaska Fairbanks: “I would call this a blank spot.” He notes that, in real life, permafrost layers are complex and irregular, and agrees with Glover that field measurements are essential to validate the model. Instead of a uniform sheet of ice underground, imagine permafrost as more of a higgledy-piggledy Swiss cheese of ice, with some areas much thicker than others and places where groundwater courses through it, exacerbating the thaw. 

Hasson and colleagues have studied locations where permafrost is thawing unusually quickly and emitting methane, a greenhouse gas many times more potent than carbon dioxide. Similar “chimneys” could be spewing out elevated amounts of radon gas in some places, he suggests.

For human health, what really matters is the amount of radon that gets into people’s homes. Scientists and even homeowners themselves can use radioactivity detectors to assess this. A study published online in February 2022, which is yet to be peer-reviewed, measured levels of radon over the course of a year in more than 250 homes in three towns in Greenland. Out of 59 homes in Narsaq, for instance, 17 were found to have radiation levels above 200 Bq/m3. 

Lead author Violeta Hansen, a radioecologist at Aarhus University in Denmark, stresses that these are early results based on a small number of homes. It would take much more research, she says, before she could evaluate the health risks associated with radon in properties like these across Greenland. She is now leading an international project that will run field experiments and gather radon measurements from homes in various countries, including Canada and Greenland. “We need to come back to the public with low-cost and effective, validated mitigation measures,” Hansen says.

It is important to avoid panicking people without solid data and solutions on hand, says Aaron Goodarzi, a radiobiologist at the University of Calgary in Canada. The good news is that there are tried-and-tested methods of lowering levels of radon inside a house once the homeowner knows it is there. Goodarzi points, for example, to a technique called sub slab depressurization, in which a sealed pipe is inserted below the house and connected to a fan. This sucks any radon out from below the building before blowing it away into the atmosphere. “Think of it simply like a bypass,” he says.

The type of building matters. Glover’s model found that homes built on piles or stilts, and thus separated from the ground, did not experience a boost in radon levels. Fortunately, many homes in the Arctic and sub-Arctic are constructed in this fashion. But for those that aren’t, the cost of mitigating radon could be prohibitive for low-income communities in these regions. “That’s an equity issue that has to be considered, certainly,” says Goodarzi, who notes that the onus might be on social housing administrators in some areas to ensure that the housing they provide is healthy.

A spokesperson for Health Canada says that the government agency currently recommends that homeowners test radon levels in their properties and use certified suppliers to install mitigation technologies if such are required.

Many people may not think about radon very much, given the fact that it is invisible. Glover says that getting informed now, before the permafrost thaw worsens, could save lives. 

“We know that people die from it,” he says. “But at the same time, there’s so much that we can do to protect ourselves.”

Lea en español

Chris Baraniuk is a freelance science journalist and nature lover who lives in Belfast, Northern Ireland. His work has been published by the BBC, the Guardian, New Scientist, Scientific American and Hakai Magazine, among other publications.

This article originally appeared in Knowable Magazine, an independent journalistic endeavor from Annual Reviews.

The US abortion decision is already having global impacts

OPINION: The reversal of Roe v. Wade is a tragedy not just for the United States, but for women everywhere

By TK Sundari Ravindran By Pascale Allotey By Sofia Gruskin

The past decades have brought modest improvements to women’s reproductive health around the world. Over the last 30 years, global rates of unintended pregnancies have thankfully declined by almost 20 percent, presumably in part because of better access to education and contraceptives. In 1973, the US Supreme Court, ruling in  Roe v. Wade, declared an American woman’s right to an abortion to be fundamental and constitutionally protected. This landmark decision helped inspire many countries around the world to enshrine the individual right to bodily autonomy in law or expand access to abortion services — including  Canada and  India. Many women have been able to access safe abortions and post-abortion care.

Then the 2022 US Supreme Court overturned Roe v. Wade. 

The ramifications of this reversal will be felt across the globe, threatening to set back modest policy gains, strengthen anti-abortion advocates and hamper progress in reproductive health and human rights.

Of course, unintended pregnancy is bound to happen. Sometimes, horrifically, it is the result of violence. From 2015 to 2019, there were 121 million unintended pregnancies a year on average — that’s 64 for every 1,000 women ages 15 to 49. This March, a study produced the  first global estimates of unintended pregnancy and abortion rates for 150 countries. In sub-Saharan Africa the rates are particularly high: In Uganda, unintended pregnancy affects 145 women per 1,000.

The important thing is whether these women have access to good information and health services. Many of them are increasingly seeking abortion: From 1990 to 2019, the rate of abortion for unintended pregnancies globally has increased from 51 percent to 61 percent. Not surprisingly, and appallingly, the new report notes that the rate of unsafe abortions is nearly 45 times higher in countries with highly restrictive abortion laws than in countries where abortion is legal and available.

Unsafe abortion is already one of the leading causes of maternal injury and death, killing an estimated 22,800 to 31,000 women annually worldwide. Every year, 7 million women suffer complications from unsafe abortions. This is entirely avoidable, but only with a supportive legal framework and a health system capable of delivering needed information and services.

Global advocates fear that the overturn of  Roe v. Wade will erode progress in that direction.

Already we have seen and heard alarming things in international meetings about women’s reproductive health that indicate a change in the tide. On July 19, for example, a UK-hosted joint multi-national human rights statement was amended, removing any mention of “abortion,” “sexual and reproductive health and rights” and “bodily autonomy” from the document. The advocacy group Humanists UK is protesting the change.

And Right to Life UK reports that India is now planning its first national March for Life for August; one of its organizers said she hopes the march will “carry on for years to come until the day the [Medical Termination of Pregnancy] Act is completely revoked just like  Roe v. Wade was revoked this year.”

A major concern is that power and funding will now increase for US-based anti-abortion groups that are already active in many countries around the world, including Human Life International, which has campaigned against contraception and abortion in sub-Saharan Africa for more than a decade; the East African Center for Law and Justice, a Christian organization with roots in the socially-conservative, anti-abortion American Center for Law and Justice; and Heartbeat International and Human Life International, two anti-abortion groups that have set up “crisis pregnancy centers” in practically every continent to dissuade women seeking abortions from terminating their pregnancies.

An emboldened anti-abortion movement is a threat to the hard-won gains in sexual and reproductive health and rights worldwide.

It is already hard for low-income nations to fund women’s reproductive health services. The use of US foreign aid funds specifically for the performance of an abortion as a method of family planning is illegal under the 1973 Helms Amendment (this July, Democratic senators introduced a bill attempting to repeal this amendment). And while the Bill and Melinda Gates Foundation, the major US private donor to global health, does  fund family planning programs, it does not fund abortion advocacy, information or services. This already makes it hard for countries that are significantly dependent on external funding for their health sector to provide safe abortion services and post-abortion care; the new court decision may make it even harder. 

The US Supreme Court’s decision blatantly ignores public health and the plethora of data that demonstrates the harms caused by these sorts of restrictions. We can only hope that other nations will learn from places where abortion is now safe and legal, such as Argentina, Ireland and, more recently, Sierra Leone, and stop turning to the US as a defender of human rights, or as an example of educated policymaking.

10.1146/knowable-083022-3

TK Sundari Ravindran is a principal visiting fellow at the United Nations University International Institute for Global Health and senior editor of the journal Sexual and Reproductive Health Matters.

Pascale Allotey is a principal visiting fellow and former director of the United Nations University International Institute for Global Health.

Sofia Gruskin is a professor at and director of the University of Southern California’s Institute on Inequalities in Global Health.

This article originally appeared in Knowable Magazine, an independent journalistic endeavor from Annual Reviews.

3 Health Care Trends for 2023

With many people preparing for health and wellness resolutions in the new year, understanding the state of access to care and other patients’ booking choices may give a sense of optimism for 2023.

To examine the outlook for 2023, Zocdoc, a free platform where people can find and book in-person or virtual health care appointments across more than 200 specialties and 12,000 insurance plans, analyzed appointment booking trends and conducted a provider survey. The results are reflected in the report, “Healthcare Hope For the Holidays: 2022,” which provided three key insights.

Happier Providers, Happier Patients
Provider and health care staff burnout can have a negative effect on patient experience, and 52% of providers surveyed indicated they agreed or strongly agreed practices will face increased financial challenges in 2023. However, savvy providers and support staff are taking steps to run more efficient practices, including using technology. This saves providers time and stress, giving them more time to focus on patient care.

In 2022, positivity pervaded providers’ perspectives on technology:

• 64% of providers indicated they agreed or strongly agreed their scheduling software helped their practice run more efficiently.
• 57% agreed or strongly agreed their telehealth solution was easy and intuitive to use.
• 36% agreed or strongly agreed insurance verification and eligibility software helped their practice run more efficiently.

This perspective paints a positive picture for patient-provider relationships in 2023:

• 71% of providers agreed or strongly agreed scheduling software will help run a more efficient practice.
• 69% agreed or strongly agreed technology will help practices run more efficiently.
• 59% agreed or strongly agreed their telehealth solution will become more intuitive and easier to use.

Technology Can Speed Up Access to Care
Amidst the unprecedented landscape of labor and supply costs rising, and physician and staff burnout a reality, innovation is driving positive change for patients. With a growing number of people embracing technology as a driver of access to an improved health care experience, and patients and providers aligned on telehealth as a supplement to in-person care, there are reasons for optimism.

Expediting patients’ access to care by surfacing the 20-30% of appointments that become available last minute due to cancellations and rescheduled appointments allows Zocdoc to enable faster speed-to-appointment for patients, compared to the averages reported in the Merritt Hawkins 2022 Survey of Physician Appointment Wait Times.

• Cardiology: Typically 1-3 days with 39% seeing a cardiologist within 48 hours, compared to 26.6 days national average appointment wait time
• Dermatology: Typically 1-3 days with nearly 30% seeing a dermatologist within 48 hours, compared to 34.5 days national average appointment wait time
• OB-GYN: Typically 1-3 days with nearly 26% seeing an OB-GYN within 48 hours, compared to 31.4 days national average appointment wait time
• Orthopedic surgery: Typically 1-3 days with nearly 38% seeing an orthopedic surgeon within 48 hours, compared to 16.9 days national average appointment wait time
• Family medicine (PCP): Typically 1-3 days with 42% seeing a PCP within 48 hours, compared to 20.6 days national average appointment wait time

Looking Back to Look Forward
Unique, actionable insights into consumers’ health care behavior can be derived from 2022 data, providing a glimpse into what’s to come. Examining the industry’s journey affords the opportunity to predict what may continue to resonate in 2023.

For example, patients got back to regular care appointments after delaying or canceling appointments following the COVID-19 pandemic’s onset.

Additionally, telehealth usage declined in all specialties except mental health, moving virtual care toward being a specialty- and case-specific care modality. Consider these appointment trends from January-November:

• 18% of appointments across all specialties were conducted via telehealth.
• Excluding mental health, just 9% of booked appointments were conducted via telehealth.
• 88% of mental health appointments were conducted via telehealth.

To find more information or book an appointment, visit Zocdoc.com.

SOURCE:
Zocdoc