Getting Social Security on a more stable path is hard but essential – 2 experts suggest a way forward

No big Social Security reforms have taken effect since the Reagan administration. David Hume Kennerly/Getty Images

Andrew Rettenmaier, Texas A&M University and Dennis W. Jansen, Texas A&M University

Social Security is in trouble.

The retirement and disability program has been running a cash-flow deficit since 2010. Its trust fund, which holds US$2.7 trillion, is rapidly diminishing. Social Security’s trustees, a group that includes the secretaries of the departments of Treasury, Labor, and Health and Human Services, as well as the Social Security commissioner, project that the trust fund will be completely drained by 2033.

Under current law, when that trust fund is empty, Social Security can pay benefits only from dedicated tax revenues, which would by that point cover about 77% of promised benefits. Another way to say this is that when the trust fund is depleted, under current law, Social Security beneficiaries would see a sudden 23% cut in their monthly checks in 2034.

As economists who study the Medicare and Social Security programs, we view the above scenario as politically unacceptable. Such a sudden and dramatic benefit cut would anger a lot of voters. Unfortunately, the actions necessary now to avoid it – like raising taxes or cutting benefits – aren’t getting serious consideration today. But we believe there are strategies that could work.

Where the money for benefits comes from

Roughly 67 million Americans, most of whom are 65 or older, receive Social Security benefits. The agency disburses more than $1 trillion annually. It’s the government’s largest single expenditure, constituting nearly 20% of the total federal budget.

Social Security is funded by a payroll tax of 12.4% on wages split equally between workers and employers. Self-employed people pay the entire 12.4%. This payroll tax applies to earnings up to $160,200 as of 2023. The government increases this cap annually based on increases in the National Average Wage Index – a measure that combines wage growth and inflation. The program also receives about 4% of its revenue from a tax on Social Security benefits, though not everyone who receives them has to pay this tax.

Social Security tax revenue stayed relatively flat after 1990. But the costs of the program rose sharply in 2010, in part because of early retirements in response to the Great Recession.

Social Security spending has recently been growing more rapidly because of a wave of baby boomer retirements, which added to a decline in the number of workers per retiree.

Costs of the program are expected to further exceed the money that’s coming in, which will continue to drain the trust fund, according to the program’s trustees.

Barring immediate action by the government, the trust fund’s exhaustion is only a little more than a decade away. And yet few members of Congress seem willing to do something about it. For example, Social Security reform was not even on the table during the 2023 negotiations over the debt ceiling and spending cuts.

Trust fund

Where did the trust fund, which helps cover the program’s costs, come from?

While the Social Security program was collecting surpluses from 1984 to 2009, that extra money funded other spending – keeping other taxes lower than they would have been otherwise and partially covering the budget deficit.

During Social Security’s years of surplus, the excess revenues were credited to the trust fund in the form of special-issue government bonds that yielded the prevailing interest rates. When those bonds are needed to pay for Social Security expenses, the Treasury redeems them.

Those bonds are components of the government’s $31.4 trillion gross debt.

Last reformed during the Reagan administration

Reducing the benefits current retirees receive would be extremely unpopular. Likewise, people now in the workforce who are nearing retirement would certainly object strongly if they were told to expect lower benefits in retirement than they have been promised throughout their careers.

The last time the government made big changes to Social Security was in 1983, during the Reagan administration, when the government enacted reforms that slowly reduced benefits over time. These changes included raising the full retirement age, a change that is still being phased in. Because of those changes, workers born in 1960 or later cannot retire with full benefits until age 67 – two years later than the original retirement age.

The 1983 reforms also included increases in the Social Security payroll tax rate from 10.4% in 1983 to 12.4% by 1990, and for the first time levied federal income taxes on higher-income retirees’ benefits. Workers bore the burden of the payroll tax increases and higher-income retirees bore the burden of the tax on benefits.

Those changes bolstered the program’s finances, but they no longer suffice.

The bipartisan 2001 Commission to Strengthen Social Security tried – and failed – during George W. Bush’s presidency to get Congress to enact reforms to shore up the program’s finances. There’s been no momentum toward resolving the problem since then.

George W. Bush sought to reform Social Security early in his presidency. Brooks Kraft LLC/Sygma via Getty Images

4 principles

We believe that policymakers and lawmakers need to follow four principles as they consider how to move forward.

1. The program should be self-funded in the long run so that its annual revenues match its annual expenses. That way the many questions that arise related to trust fund accounting and whether Social Security tax revenues are being used for their intended purposes would be eliminated.

2. The reform burden should be shared across generations. Current retirees can share the burden through a reform that reduces the cost-of-living adjustment. Today’s workers can share the burden through an increase in the cap on income subjected to Social Security taxes so that 90% of total earnings are taxed. Continued gradual increases in the retirement age to keep pace with anticipated longevity gains would also be borne by current workers.

3. The government should make sure that Social Security benefits will be adequate for lower-income retirees for years to come. That means reforms that slow the benefit growth of future retirees would be designed to affect only higher-income retirees.

4. Any changes to Social Security should help constrain the future growth of federal spending, given the current and projected growth in the budget deficit.

Advantages of ending the delay

It appears that the U.S. – citizens and elected officials included – are deferring serious debate on this urgent matter until the trust fund’s depletion is imminent. That’s unwise. Acting sooner rather than later would leave more options available to gradually resolve the program’s financial shortfalls.

Ending this procrastination would also give the millions of people who rely on Social Security benefits, taxpayers and businesses more time to prepare for any changes required by overdue reforms.

Andrew Rettenmaier, Executive Associate Director of the Private Enterprise Research Center, Texas A&M University and Dennis W. Jansen, Professor of Economics and Director of the Private Enterprise Research Center, Texas A&M University

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

Atlantic hurricane season 2023: El Niño and extreme Atlantic Ocean heat are about to clash

Hurricane Florence, seen from the International Space Station in 2018. Atlantic hurricane season runs from June 1 to Nov. 30. NASA

Christina Patricola, Iowa State University

The Atlantic hurricane season starts on June 1, and forecasters are keeping a close eye on rising ocean temperatures, and not just in the Atlantic.

Globally, warm sea surface temperatures that can fuel hurricanes have been off the charts in the spring of 2023, but what really matters for Atlantic hurricanes are the ocean temperatures in two locations: the North Atlantic basin, where hurricanes are born and intensify, and the eastern-central tropical Pacific Ocean, where El Niño forms.

This year, the two are in conflict – and likely to exert counteracting influences on the crucial conditions that can make or break an Atlantic hurricane season. The result could be good news for the Caribbean and Atlantic coasts: a near-average hurricane season. But forecasters are warning that that hurricane forecast hinges on El Niño panning out.

Ingredients of a hurricane

In general, hurricanes are more likely to form and intensify when a tropical low-pressure system encounters an environment with warm upper-ocean temperatures, moisture in the atmosphere, instability and weak vertical wind shear.

Warm ocean temperatures provide energy for a hurricane to develop. Vertical wind shear, or the difference in the strength and direction of winds between the lower and upper regions of a tropical storm, disrupts the organization of convection – the thunderstorms – and brings dry air into the storm, inhibiting its growth.

How hurricanes form. National Geographic.

The Atlantic Ocean’s role

The Atlantic Ocean’s role is pretty straightforward. Hurricanes draw energy from warm ocean water beneath them. The warmer the ocean temperatures, the better for hurricanes, all else being equal.

Tropical Atlantic Ocean temperatures were unusually warm during the most active Atlantic hurricane seasons on recent record. The 2020 Atlantic hurricane season produced a record 30 named tropical cyclones, while the 2005 Atlantic hurricane season produced 28 named storms, a record 15 of which became hurricanes, including Katrina.

The top images show where Atlantic tropical storms traveled in 2005, on the left, and in 2020, on the right. The lower images show the corresponding sea surface temperature anomalies for the August-October peak of the hurricane season compared with the August-October 1991-2020 average in degrees Celsius. NOAA

How the Pacific Ocean gets involved

The tropical Pacific Ocean’s role in Atlantic hurricane formation is more complicated.

You may be wondering, how can ocean temperatures on the other side of the Americas influence Atlantic hurricanes? The answer lies in teleconnections. A teleconnection is a chain of processes in which a change in the ocean or atmosphere in one region leads to large-scale changes in atmospheric circulation and temperature that can influence the weather elsewhere.

Three examples of of how sea surface temperatures in the tropical Pacific change during El Niño events. Christina Patricola

One recurring pattern of tropical Pacific climate variability that initiates teleconnections is the El Niño-Southern Oscillation.

When the tropical eastern-central Pacific Ocean is unusually warm, El Niño can form. During El Niño events, the warm upper-ocean temperatures change the vertical and east-west atmospheric circulation in the tropics. That initiates a teleconnection by affecting the east-west winds in the upper atmosphere throughout the tropics, ultimately resulting in stronger vertical wind shear in the Atlantic basin. That wind shear can tamp down hurricanes.

How El Niño conditions affect the Walker Circulation’s air flow, which can affect weather around the world. Fiona Martin/NOAA Climate.gov

That’s what forecasters are expecting to happen this summer. The latest forecasts show a 90% likelihood that El Niño will develop by August and stay strong through the fall peak of the hurricane season.

A tug of war between Atlantic and Pacific influences

My research and work by other atmospheric scientists has shown that a warm Atlantic and a warm tropical Pacific tend to counteract each other, leading to near-average Atlantic hurricane seasons.

Both observations and climate model simulations have shown that outcome. The National Oceanic and Atmospheric Administration’s 2023 forecast calls for a near-average 12 to 17 named storms, five to nine hurricanes and one to four major hurricanes. An earlier outlook from Colorado State University forecasters anticipates a slightly below-average season, with 13 named storms, compared with a climatological average of 14.4.

Sea surface temperature anomaly in degrees Celsius forecast for August to October 2023 shows a warm season relative to the 1991-2020 average for the same months. Based on NCEP Climate Forecast System version 2 (CFSv2)

The wild cards to watch

Although tropical Atlantic and Pacific Ocean temperatures often inform skillful seasonal hurricane forecasts, there are other factors to consider and monitor.

First, will the forecast El Niño and Atlantic warming pan out? If one or the other does not, that could tip the balance in the tug of war between the influences.

The Atlantic Coast should be rooting for El Niño to develop as forecast, since such events often reduce hurricane impacts there. If this year’s expected Atlantic Ocean warming were instead paired with La Niña – El Nino’s opposite, characterized by cool tropical Pacific waters – that could have led to a record-breaking active season instead.

Two other factors are also important. The Madden-Julian Oscillation, a pattern of clouds and rainfall that travels eastward through the tropics on a time scale of 30 to 90 days, can either encourage or suppress tropical storm formation. And dust storms from the Saharan air layer, which contains warm, dry and dusty air from Africa, can suppress tropical cyclones.

Christina Patricola, Assistant Professor of Atmospheric Sciences, Iowa State University

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

Drone strikes hit Moscow and Kyiv – in the growing world of drone warfare, anything goes when it comes to international law

Russian security forces take measures near a damaged site following a drone strike on May 30, 2023. Sefa Karacan/Anadolu Agency via Getty Images

Tara Sonenshine, Tufts University

At least eight drone strikes hit Moscow in the early morning of May 30, 2023, damaging several buildings and injuring civilians.

This follows Russia’s targeting residential buildings in Ukraine with a wave of drone attacks in late May, killing civilians.

While Ukraine has said it is not “directly” responsible for the strikes on Moscow, Russia’s government has called the strikes a “terrorist attack.”

For more than a year, daily life in Ukraine has been marked by aerial vehicles known as drones littering the sky, creating unease and inflicting real damage in the war with Russia.

Both Russia and Ukraine are using drones in this war to remotely locate targets and drop bombs, among other purposes.

Today, drones are used in various other conflicts but are also used to deliver packages, track weather and entertain drone hobbyists.

Military drones range from small consumer quadcopters to remotely piloted warplanes – and all types are being used by militaries around the world.

As a scholar of public diplomacy and foreign policy – and a former United States undersecretary of state for public diplomacy and public affairs – I know how important it is for people to understand drones and their proliferation, given the risks of war, terrorism and accidental drone clashes in the world today.

A Ukrainian soldier launches a drone from his hand in November 2022 in Zaporizhzhia, Ukraine. Elena Tita/Global Images Ukraine via Getty Images

A buying spree

The U.S. is among more than 100 countries using drones in times of conflict.

Terrorists have also been known to deploy drones because they are relatively low-cost weapons with high degrees of civilian damage.

Consumer drone shipments, globally, topped 5 million units in 2020 and are expected to surpass 7 million by 2025.

Sales of drones globally were up 57% from 2021 to 2022.

With the exponential rise in drone purchases over the last few years, there are few constraints for buyers, creating a wild, wild west of uncontrolled access and usage.

Each country is free to decide when and where drones fly, without answering to any other country or international authority governing drones. There is little on-the-ground guidance on the rules of the sky.

Different purposes

Each country has a unique interest in getting and using drones.

China is increasingly using sophisticated drones for covert surveillance, especially in international waters to patrol the disputed islands in the South China Sea. Its expanding drone program has influenced other countries like the U.S. to also invest more in the technology.

Turkey’s military has a highly sophisticated drone, the Bayraktar TB2, which is capable of carrying laser-guided bombs and small enough to fit in a flatbed truck.

The United Arab Emirates imports drones from China and Turkey to deploy in Yemen and Libya to monitor warlords in case conflict breaks out.

And South Korea is considering starting a special drone unit after it failed to respond to a recent North Korean drone incursion. When North Korea deployed five drones toward its southern neighbor in December 2022, South Korea had to scramble its fighter jets to issue warning shots.

No rules in the air

The countries with armed drones are individually navigating their own rules instead of an international agreed-upon set of regulations.

International law prohibits the use of armed force unless the United Nations Security Council authorizes an attack, or in the case of self-defense.

But short of launching a full war, drones can legally be deployed for counterterrorism operations, surveillance and other non-self-defense needs, creating a slippery slope to military conflict.

Figuring out the national and international rules of the sky for drone usage is hard.

For 20 years, experts have tried to create international agreements on arms – and some countries supported an informal 2016 U.N. agreement that recommends countries document the import and export of unmanned aerial vehicles.

But these efforts never evolved into serious, comprehensive standards and laws that kept pace with technology. There are several reasons for that. In order protect their national sovereignty, governments do not want to release drone data. They also want to avoid duplication of their technology and to maintain their market share of the drone trade.

A MQ-9 Reaper drone awaits its next mission over the U.S.-Mexico border in November 2022. John Moore/Getty Images

US and drones

The U.S. has wrestled with how to balance drone warfare as it became involved in overseas operations in Iraq, Afghanistan, Syria and other conflict zones.

The U.S. killed a top al-Qaida leader with a drone strike in Afghanistan in 2022.

But there have been other instances of drone strikes that resulted in unintended casualties and damage.

In 2021, The New York Times reported that a U.S. drone strike on a vehicle thought to contain an Islamic State bomb resulted in the deaths of 10 children – not three civilians, as the U.S. said might have happened.

There is scant public opinion research on how American feel about the use of drones overseas, which makes building public support for their military use difficult.

Drone dangers

Drone dangers are real.

Many drone experts, including myself, believe it is unsafe for each country’s military to make its own decisions on drones with no rules guiding drone transfers, exports, imports and usage – and no major forum to discuss drones, as the technology continues to evolve.

Multiple drones can communicate with each other remotely, creating shared objectives rather than an individual drone path or pattern. Like a swarm of bees, these drones form a deadly and autonomous aerial army ripe for accidents.

With the advent of artificial intelligence and more sophisticated unmanned aerial vehicles, drones can change speed, altitude and targeting in seconds, making them even more difficult to track and investigate. Attacks can happen seemingly out of the blue.

Drone detection is another complication, especially on the battlefield.

Ukrainian and Russian forces each want to know exactly where a drone originated. That can be difficult to determine, especially at night, as drones are fast-moving vehicles. Traditional radar detection has grown more sophisticated with new drone detection platforms to more accurately decipher the exact location of the drone operator.

In my view, the world needs new and consistent rules on drone usage for the decade ahead – better international monitoring of drone incursions and more transparency in the outcome of drone attacks.

This is an updated version of an article originally published on May 19, 2023.

Tara Sonenshine, Edward R. Murrow Professor of Practice in Public Diplomacy, Tufts University

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

Cedar Creek Nursery

4 Ways to Promote Positive Maternal Mental Health

The joys of raising and nurturing a baby are practically endless for new parents, yet there remain challenges to overcome. While it may be natural to focus attention and energy on caring for a new baby, it’s equally important for mothers to maintain their own mental health.

According to Malina Malkani, MS, RDN, CDN, maternal mental health (MMH) is often negatively affected by the belief that there is only one “right” or “best” way to feed a baby. Mothers are exposed to this message through peer-to-peer communication, social media, health care providers and more.

To combat negativity, Malkani promotes the importance of family, friends, online communities and others contributing a positive impact toward MMH by recognizing all babies are different, acknowledging there’s no one “right” way to feed a baby, refraining from parent-shaming and judgement, and remembering caregivers have personal feeding decisions to make based on a variety of factors.

The saying “it takes a village” is as applicable today as ever, which is why Plum Organics and the Policy Center for Maternal Mental Health partnered to share resources and information mothers can use to find support in their communities. Consider these ways moms can nurture their little ones along with their own mental well-being.

Understand the Signs of Mental Health Conditions
Depression and anxiety are the most common complications in pregnancy and postpartum, affecting 1 in 7 women, according to the Policy Center for Maternal Mental Health. If you feel any of these symptoms, seek help from a health care provider: overwhelmed, weepy, anxious or nervous, angry, scared by your thoughts, like you’re not yourself, guilt, regret or shame.

Engage in Self-Care
Spending your time thinking about baby is natural, but it’s important to take care of yourself, too. Watch a movie, socialize with friends, meditate, rediscover hobbies – whatever you enjoy doing, prioritize making it part of your life again.

Join a Supportive Movement
Creating a “village” is a key step toward positive mental well-being for moms as it allows them to build support systems showing they’re not alone in their struggles. To continue efforts to destigmatize mental health challenges for moms and deliver research and support, Plum Organics and the Policy Center for Maternal Mental Health are asking mothers (and their loved ones) to sign a “Pin-tition,” wherein a pin is placed on the U.S. map to indicate where participants want to build a village of support.

The movement encourages participants to put a pin on the map if:

• You think moms suffering from postpartum depression should have access to a professional trained in MMH disorders
• You think moms suffering from MMH disorders should have access to mental health providers within driving distance
• You think moms should be screened for MMH disorders during prenatal and postpartum periods
• You think OBGYNs should discuss mental health at the beginning of pregnancy
• You think mental health care is health care
• You think providers should be reimbursed by insurance for MMH care

Prioritize Physical Health
Taking care of yourself includes physical health as well as mental health. Doing yoga, walking or working out 15-30 minutes a day and nourishing your body with nutrient-rich foods can help restore your sense of balance and provide a boost in self-esteem.

Find more information and drop a pin to shed light on your area by visiting PlumOrganics.com.

Mapping Out Maternal Mental Health
Intended as a resource for policy action, funding drivers and strategic planning, the Maternal Mental Health Risk Factors and Resource Maps developed by Plum Organics and the Policy Center for Maternal Mental Health revealed these findings:

• The highest risk factor levels were concentrated in the Deep South with severe conditions identified in the Mississippi Delta region, Gulf Coast, greater Appalachia, New Mexico and Arizona.
• Higher risk factor levels tend to be associated with rural and less-populated regions. Conversely, most major metropolitan areas in the U.S. tend to have comparatively moderate or lower risk factor scores.
• More than 600,000 mothers will suffer from a MMH disorder in the U.S. every year. Left untreated, these disorders can have devastating impacts on a mother’s health and functioning, the baby’s health and development, and overall family stability.

SOURCE:
Plum Organics

Drugs that melt away pounds still present more questions than answers, but Ozempic, Wegovy and Mounjaro could be key tools in reducing the obesity epidemic

Despite the promise of drugs that can help people shed pounds, healthy lifestyle choices are still key to overall health. Zing Images / DigitalVision via Getty Images

Wesley Dudgeon, College of Charleston

In the past five years, several new drugs have been brought to market that could lead to a profound, if not revolutionary, change in how health care providers – and the public – view weight loss.

Three drugs in particular – sold under the brand names Wegovy, Ozempic and Mounjaro – have shown remarkable effects on weight loss in clinical trials.

While Wegovy is approved by the Food and Drug Administration for weight loss, the other two medications are only approved as treatment for type 2 diabetes, though they do also contribute to significant weight loss. This has led to increased demand for these drugs, causing a shortage of Ozempic and Mounjaro in early 2023 that threatened the availability of these drugs for diabetes patients.

Globally, more than 650 million people are obese, and by 2030, an estimated 1 billion adults will be obese. This makes obesity the most prevalent chronic disease in the world.

As an exercise science scholar, I have spent more than 15 years studying the effects of diet and exercise on the human body, primarily focused on body composition changes such as gaining skeletal muscle or losing body fat, or both. In my lectures, I present data on the detrimental impacts on personal health of being overweight or obese. Then I show that, aside from surgical intervention, the best way to lower body fat is with starting an exercise program and improving dietary habits.

These new drugs have now altered what I teach in the classroom, and as a researcher I believe they raise many questions about the current approach to weight management and health. While these medications hold promise, they are not wonder drugs. In my view, they warrant much more research before they become the basis for a new weight management protocol.

This woman lost 80 pounds after taking Mounjaro for seven months.

How these drugs work

Ozempic and Mounjaro are FDA-approved for the treatment of type 2 diabetes, which affects more than 37 million people in the U.S. On top of that, nearly 100 million people are considered prediabetic, meaning that together over 40% of the U.S. population suffers from an inability to properly manage blood sugar.

Obesity and type 2 diabetes are closely related conditions, so much so that some experts are now calling the two conditions “diabesity.” These dire figures are what prompted pharmaceutical companies to search for new weight loss treatments.

Type 2 diabetes is a condition in which your body no longer responds to the hormone insulin, which in healthy people regulates glucose, or sugar, levels in the blood. Prolonged elevated blood sugar, if left untreated, can lead to heart disease, vision loss and even death.

Wegovy and Ozempic are a class of drug known as a semaglutide. Since people with type 2 diabetes are unable to properly manage blood sugar, injections with this class of drug help the body release the proper amount of insulin after eating by mimicking a naturally occurring hormone called GLP-1.

At the same time, semaglutides also reduce the release of the hormone glucagon, which works opposite of insulin to increase blood sugar. In non-diabetics, these two hormones work together to maintain normal blood sugar levels. But since this mechanism is not functioning properly in diabetics, which leads to high blood sugar, semaglutides help to control blood sugar and also reduce appetite.

For this reason, Ozempic received approval from the FDA in 2017 as a treatment for type 2 diabetes. But during the clinical trials for type 2 diabetes, pharmaceutical companies quickly recognized Ozempic’s potential as a weight loss tool.

This led to the release of a new drug, Wegovy, which has a higher dose of semaglutide. A 2021 study showed that once-weekly injections of Wegovy over the course of 68 weeks resulted in about a 15% loss of body weight in adult participants with obesity.

The other novel medication in the news lately, Mounjaro, acts like a semaglutide, stimulating GLP-1, but it also mimics a second hormone called glucose-dependent insulinotropic polypeptide. This dual-hormone action works to not only lower blood sugar levels and increase insulin sensitivity, but also slows the digestive system and decreases appetite.

Staggering results

In early 2021, scientists began analyzing the data from a clinical trial program focused on using semaglutide treatments in people with obesity, which included more than 4,000 patients. Over 80% of participants lost more than 5% of their body weight, with the most common side effects being nausea, diarrhea, vomiting and constipation.

This data on effectiveness and efficacy led the FDA to officially approve Wegovy as a weight loss drug in the summer of 2021. The huge demand that ensued led to the recent shortages of Wegovy, forcing many physicians to look for other options. That’s when Ozempic and Mounjaro entered the picture as off-label weight loss medications, even though they are only FDA-approved to treat type 2 diabetes.

In April 2023, the pharmaceutical company Eli Lilly released the results of the second phase 3 clinical trial of Mounjaro. The results were, quite frankly, amazing: Compared to a placebo, the 938 obese or overweight adults with type 2 diabetes lost more than 34 pounds, or roughly 15% of their body weight, with no required fitness and nutrition program.

This most recent study tracked with the first clinical trial of Mounjaro, published in July 2022, that resulted in more than a 20% reduction in body weight in 2,539 adults. Similar to Wegovy and Ozempic, Mounjaro’s most commonly reported side effects are general gastrointestinal distress such as nausea, vomiting and diarrhea.

Obesity accounts for nearly half of the cost of chronic disease in the U.S. Peter Dazeley/The Image Bank via Getty Images

Costs of obesity

The latest data from the National Institutes of Health estimates that more than 40% of U.S. adults are obese and another 30% are overweight, meaning that 7 in 10 adults need to lose weight. The World Health Organization estimates that, based on a 2017 global burden of disease study, more than 4 million people across the world are dying every year due to being overweight or obese, a trend that is also growing rapidly in children.

The WHO defines obesity as when an adult or child has a body mass index, or BMI, over 30; a BMI over 25 is considered overweight. In children, doctors often rely on percentiles, rather than an absolute number.

BMI is calculated by taking a person’s weight and dividing it by the square of their height – a technique that isn’t the most accurate for assessing body composition. But it is valuable for classifying millions of people where more accurate techniques such as skinfold measurements are not feasible.

Being overweight or obese greatly increases risks for other significant health complications, such as heart disease, type 2 diabetes, hypertension, osteoarthritis, stroke and asthma. In fact, obesity is responsible for nearly half of the total cost of chronic disease in the U.S. Studies show that obesity also leads to a decrease in life expectancy.

Recent data suggests that the direct medical costs of a person being obese in the U.S. is more than US$2,500 annually. And researchers estimate that the total cost of chronic diseases due to obesity in the U.S. is more than $1.7 trillion annually, which is 9.3% of the country’s gross domestic product. Predictions show the annual cost of obesity will be more than $4.3 trillion worldwide by 2030.

Current list prices for Mounjaro and Ozempic top $1,000 per month for off-label use, meaning for weight loss and not for type 2 diabetes. In this scenario, which is becoming more common, insurance companies are less likely to cover the medication.

Since most Americans can’t afford these drugs, it’s reasonable to ask whether more should be done to decrease costs and increase access.

Many people are unaware of the health risks tied to obesity and being overweight.

The age-old benefits of exercise and a healthy diet

Still, these new drugs that can aid in weight loss present a dilemma for doctors and other health care providers: Where do they fit in with the decadeslong gospel of healthy eating and increasing physical activity?

Traditionally the most effective mechanism for weight loss has been a twofold lifestyle intervention: dietary modification resulting in an overall caloric deficit combined with 250 minutes or more of moderate-intensity exercise per week.

Research has long since established that being physically active improves mental health, including memory, depressive symptoms and mood, as well as immune function and bone health. Being active also reduces the risks of developing conditions like heart disease, type 2 diabetes and some cancers.

But given that more than two-thirds of the U.S. adult population is now overweight or obese, Americans are clearly not meeting these guidelines. The most recent data shows that only a quarter of adults are getting the necessary aerobic and muscle strengthening activity each week.

For all these reasons, many clinical recommendations now suggest the use of anti-obesity medications as a primary means of addressing overweight and obesity.

The health care field now has a new strategy for meaningful weight loss, but there are still more questions than answers.

Will losing weight with only drugs still provide these same health benefits? What about the long-term efficacy of using these medications? Are there complications we don’t know about yet because we simply haven’t had these drugs available long enough to study? Researchers are also just beginning to understand what happens when you stop using these new weight loss medications.

Given the gravity of the obesity epidemic and the health costs that come with it, I believe the potential risks of using these drugs for weight loss may be worth the reward of lessening the burden on the health care system and improving the quality of life for hundreds of millions of people.

Wesley Dudgeon, Professor of Exercise Science and Interim Dean of the School of Health Sciences, College of Charleston

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

Cytomegalovirus lies dormant in most US adults and is the leading infectious cause of birth defects, but few have heard of it

Cytomegalovirus belongs to the same virus family, Herpesviridae, as cold sores and chickenpox. Callista Images/Image Source via Getty Images

Laura Gibson, UMass Chan Medical School

“Why didn’t anyone tell me about this virus?” is a frequent response I hear from parents upon learning their newborn is infected with cytomegalovirus, or CMV. Although more than half of the U.S. population will be infected with CMV by the age of 40 and the disease is common worldwide, few people have ever heard of it.

CMV belongs to the same virus family as cold sores and chickenpox and, like those viruses, lives in the body for life. Most children and adults experience very mild or even no symptoms with their initial infection. A healthy immune system is typically able to keep CMV under control so people don’t become sick or even know the virus is living in their body.

So if most people are unlikely to get sick from CMV at any age, then why is the virus so important to understand? As an infectious disease and immunology specialist, I have focused on this question for most of my two-decade career. One major reason is that CMV – unlike the other viruses in its family – can pass from mother to fetus during pregnancy.

Congenital CMV, or cCMV, is the most common infection before birth and the leading infectious cause of birth defects. About one in every 200 infants – typically 20,000 to 30,000 infants in the U.S. – are born with cCMV per year, and nearly 20% of them have permanent neurodevelopmental disabilities such as hearing loss or cerebral palsy. Every year, more children are affected by cCMV than several familiar childhood conditions like Down syndrome and fetal alcohol syndrome. Compared to later stages of pregnancy, CMV infection in the first trimester carries the highest risk of stillbirth or severe effects when the immune system and organs like the brain are developing.

Rates of cCMV differ significantly by race, ethnicity and other demographic factors, with Black and multiracial infants twice as likely to have cCMV compared to other groups. Black and Native American infants also have a higher risk of death from cCMV compared to white infants.

Herpesviruses share the ability to stay latent in the body for life.

Looking for CMV during pregnancy

Screening for rubella, HIV and syphilis is routine for early prenatal care in the U.S. Counseling to avoid kitty litter to prevent toxoplasmosis is also common. If CMV can infect a fetus and cause birth defects, then why aren’t pregnant people tested and treated for this virus too?

Prenatal CMV screening is not standard of care due to several limitations of the current testing approach. Some available tests can be difficult for health care providers to interpret. Testing provides information about whether the parent has CMV, but it does not sufficiently predict the risk of fetal transmission or severe symptoms.

Prenatal screening for a healthy person with a normal pregnancy does not usually offer useful information. That’s because anyone can have a baby with cCMV regardless of whether they tested positive or negative for it before or earlier in pregnancy. CMV testing may be useful for pregnant people who are experiencing acute illness, such as prolonged fever and fatigue, or who have an abnormal fetal ultrasound.

Even if more accurate tests were available, there are currently no medical interventions approved by the Food and Drug Administration to reduce the risk of fetal CMV infection. Biweekly antibodies against CMV seem to reduce fetal transmission when given around conception or during the first trimester, but CMV is rarely diagnosed that early in pregnancy.

Most available drugs to treat CMV are unsafe to take during pregnancy. FG Trade/E+ via Getty Images

Researchers are currently evaluating the drug valacyclovir as a potential treatment to prevent fetal transmission. Valacyclovir is commonly used to prevent or treat genital herpes during pregnancy. Findings from a recent clinical trial in Israel suggest that valacyclovir may reduce the risk of CMV transmission to the fetus.

In general, valacyclovir does not work as well as other CMV drugs that people cannot take during pregnancy. As a result, a much higher dose is required to reduce the risk of fetal CMV infection, which may cause significant side effects for pregnant people.

Although the use of valacyclovir to prevent cCMV is not standard in the U.S., and research on its effectiveness remains limited, the drug is used for this purpose in some areas of the world.

Screening newborns for CMV

Like pregnant people, babies are screened for many potentially serious conditions. An accurate CMV test for newborns is available, and many studies support the benefit of early CMV diagnosis. So why isn’t there universal CMV screening for infants?

While some birth centers provide early CMV testing, most U.S. states do not mandate newborn CMV screening. My team and I surveyed 33 hospitals in Massachusetts from late 2020 to early 2021 and found that less than half are consistently screening infants for cCMV infection. Of those, only a few have a written testing protocol. Only two hospitals performed cCMV screening on all infants admitted to the newborn nursery.

Standardizing public health education and CMV screening guidelines could help reduce the incidence and burden of cCMV disease on children and their families. In July 2013, Utah became the first state to pass legislation mandating a CMV public education program and testing for infants who do not pass the newborn hearing screen. In February 2022, Minnesota became the first – and remains the only – state to require CMV screening of all newborns, although Massachusetts and Indiana have pending universal screening bills. So far, 17 states have enacted laws requiring cCMV education or targeted screening of newborns who meet certain criteria, and many others are considering similar options.

Negative health effects from cCMV may not show for a newborn until later. Juanma Hache/Moment via Getty Images

On the other hand, designing, funding and implementing a new infant screening program is complex and time-consuming, and may potentially divert resources from other equally important health initiatives. Most newborns with cCMV appear physically normal at birth and develop normally over their lifetime, leading some to question the benefits of CMV screening for those children.

However, infants may have abnormalities that are not visible at birth, and there isn’t a reliable way to predict whether they will have progressive health problems. Without screening all newborns for CMV, those who appear normal at birth will not be fully evaluated, considered for treatment or monitored for effects that develop later, such as hearing loss.

Spreading CMV awareness, not infection

Decreasing the incidence of cCMV infection is unlikely without increasing awareness. Most people have not heard of CMV or are unwaware of what they can do to reduce their chances of getting CMV during pregnancy.

Many adults are repeatedly exposed to one of the major risk factors for CMV infection: a young child who regularly attends large-group child care. Infections like CMV spread easily among children in settings where group play, meals and diaper changes become daily opportunities for transmission. Children can appear quite healthy but carry CMV in their saliva and urine for weeks or even months after infection. When an unsuspecting pregnant caretaker comes into contact with those body fluids, they can become infected as well.

For people who are pregnant, simple behavior changes such as kissing a child on the head instead of the lips, not sharing food or utensils, and frequent handwashing can significantly reduce the risk of getting CMV.

Educating the public, policymakers and health care providers will improve the diagnosis, prevention and treatment of cCMV, so no parent suffers the thought “If I had only known…”

Laura Gibson, Associate Professor of Medicine and of Pediatrics, UMass Chan Medical School

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

Understanding the Cost of Replacing Diesel Buses

Diesel school buses are not only expensive to operate, they pose risks to children’s health and the environment. There are two practical energy choices for clean student transportation: propane and electric. However, when evaluating the complete life-cycle emissions and cost of electric buses, the economic and environmental benefits of propane buses are clear, according to the experts at the Propane Education & Research Council. With or without available funding, propane buses cost a fraction of electric buses, allowing school districts to replace their aging diesel fleets faster and further reduce harmful emissions. Learn more at BetterOurBuses.com.

SOURCE:
Propane Education & Research Council

Automation risks creating a two-tier workforce of haves and have-nots

Workplaces could become “anti-human”: centred around technology rather than people. PaO_STUDIO / Shutterstock

Siddhartha Bandyopadhyay, University of Birmingham

The recent news that BT would reduce its workforce by as many as 55,000 by 2030, including about 10,000 jobs replaced by artificial intelligence (AI), is part of a growing trend of job losses globally due to various forms of automation.

This is borne out by several industry reports, including one from McKinsey Global Institute (MGI) acknowledging that as many as 800 million jobs may be lost globally due to changes in technology by 2030.

In our book Work 3.0, the author and business adviser Avik Chanda and I contend that, due to automation as well as newer ways of working, workplaces can become “anti-human” and centred instead around AI and technology.

While the term “anti-human” can be interpreted in different ways, surveys on workplace happiness provide compelling evidence on just how unhappy workers are. For example, The Global Workplace 2022 published by Gallup states that on the whole, workers seem to be significantly worse off in their overall wellbeing than they were in 2020. In fact, only 20% of respondents reporting they were engaged at work.

There has been an unprecedented increase in technological disruption in recent years. At the same time, work by Gallup has revealed a global rise in unhappiness. Gallup’s latest Positive Experiences Index showed a decline in happiness, even from 2020 levels. “Enjoyment”, “smiling” and “feeling well-rested” seemed to have almost vanished. On the other hand, the survey’s negative experience index continues to record a rise, with “sadness”, “stress” and “worry” reaching record levels.

Historical biases

AI is being used in the workplace as an evaluative and decision-making tool — which would be a positive development if it eliminated human error. But, as eloquently analysed in Cathy O'Neil’s book Weapons of Math Destruction, most of these decision-making algorithms use data that contains biases against historically disadvantaged groups. If these biases are incorporated into algorithms that help determine who gets bank loans or that screen job applications, they can perpetuate an already unjust situation.

Automation is likely to have a bigger effect on some roles versus others. Suwin / Shutterstock

However, it remains the case that more jobs are being created than are being destroyed due to automation. The size of the net impact is widely debated, but theories suggest job roles that complement automation will do well, at least in terms of better wages. Nevertheless, surveys such as the one by Gallup suggest that stress and unhappiness in the workplace will affect almost all workers.

Perhaps unsurprisingly, those workers that perform tasks capable of being completely automated will stand to lose most. This last category of worker includes many blue collar roles, though a number of white collar middle management jobs will also disappear.

A recent study by the economists Daron Acemoğlu, Hans Koster and Ceren Ozgen, using data from the Netherlands, supports suggestions from theoretical work that automation affects different groups of workers in different ways. The team argues that “directly affected workers seem to lose from robot adoption, while indirectly affected workers gain (from it)”.

Be adaptable

When workplaces become anti-human, they become focused on automated processes and the use of technological solutions rather than around the well-being of employees. This suggests that those with skills suited for this new workplace will thrive, while the future may be bleak for others, whose salaries may stagnate or fall.

This warning echoes what Brynjolfsson and McAfee predicted in their book, The Second Machine Age:

There’s never been a better time to be a worker with specialist skills or the right education, because these people can use technology to create and capture value. However, there’s never been a worse time to be a worker with only ‘ordinary’ skills and abilities to offer, because computers, robots, and other digital technologies are acquiring these skills and abilities at an extraordinary rate.

This separation of workers into two categories could spread around the globe very quickly. As a result, inequality could become more pronounced within countries than between countries. In Work 3.0, we noted that inequality between nations represented only 32% of total global inequality in 2020, while inequality within economies accounted for an astonishing 68%. Back in 1980, the situation was very different, with inequality between countries accounting for as much as 57% of the global total.

Falling wages

While this trend makes for grim reading, governments can have an important influence. In India, which has recorded large rises in inequality over past decades, polices such as the National Rural Employment Guarantee Act 2005 (MGNREGA) have helped reduce the gap. MNGREGA offers guaranteed employment as well as a food subsidy as part of an effort to boost livelihoods in rural areas.

The economists Surjit Bhalla, Karan Bhasin and Arvind Virmani analysed extreme poverty (defined as an income of US$1.9 per person per day, at purchasing power parity of the 2011 dollar) in India and found that it had fallen to quite low levels in 2019 and had remained so despite the pandemic. This was put down to the impact of the food subsidy.

While this has been contested, other studies have also found a decline in poverty – though they differ in the magnitude of that reduction. This suggests that countries can manage the worst effects on workers through active state intervention.

Policies by the Indian government helped secure livelihoods in rural areas. PRASANNAPIX / Shutterstock

But subsidies are a short-term fix to protect those workers most at risk of losing their jobs or seeing their wages fall. Longer-term solutions need to focus on reskilling workers to adapt to the changing nature of demand. Educational institutions, from schools to universities, need to play a lead role in this regard.

The skills needed in the workplace are changing at a blistering pace. We argue in Work 3.0, that the challenge today for educational institutions is to instil in the workers of the future a highly adaptable mindset.

This mindset would be assisted by an educational curriculum that is more multi-disciplinary and augments traditional STEM skills. This will be a major step for many educational institutions as it will force them to step outside disciplinary silos.

However, the effort would pay off by creating an adaptable and diverse workforce able to meet the changing demands of the 21st-century workplace.

Siddhartha Bandyopadhyay, Professor of Economics, University of Birmingham

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