# data[].attributes.headline
Meet Student Activists Fighting Against Gun Violence

# data[].attributes.subject
Meet Student Activists Fighting Against Gun Violence

# data[].attributes.attachment_link.readable_text
They've been all over the news since February, walking out of class, marching for their lives in the streets and dunking on the president of the NRA on Twitter. These are the student activists who are fighting against gun violence. https://www.facebook.com/BetterConversationBetterEducation/videos/814789282053102/

Emma González
A senior at Marjory Stoneman Douglas High School in Parkland, Florida, Emma González has been one of the most prominent faces of the movement since her school lost 17 students and staff on February 14, 2018. "Everybody's getting hurt by this. It's not just schools," she said at the 2018 Education Writers Association (EWA) National Seminar, where she was joined by fellow students from across the country for a panel on gun violence.
David Hogg
A classmate of Emma González's, David Hogg is also a senior from Parkland. He has been adamant that students have long felt the way they do about school shootings. "We've always been this way. You guys are just listening now," Hogg said alongside his classmate at the EWA event.
Alex King
A senior at North Lawndale College Prep High School in Chicago, Alex King has been working on helping victims of gun violence through a group called the Peace Warriors since his 16-year-old nephew was murdered a year ago. "Through my friends and colleagues, I found help to come up out of a dark place," he said at the March for Our Lives, according to The Washington Post. "Everyone doesn't have the same resources or support system as I was lucky to have."
Jackson Mittleman
A resident of Newtown, Connecticut, Jackson Mittleman saw what happened when 26 people-including 20 children-were murdered by a gunman in 2012 when he was 11 years old. After the shooting in Parkland, he leapt to join in solidarity with students he didn't know from hundreds of miles away. "We understand what they're doing and why understand what they've experienced, and we are standing behind them while they're leading this charge for national change," he told Mother Jones during the March for Our Lives.
Emmy Adams
A senior at Golden High School in Colorado, 18-year-old Emmy Adams joined an April 2018 rally near Columbine, where two student shooters killed 13 students and faculty, plus themselves, 19 years previously. "The idea is to unite and empower survivors, to stand together," she told Reuters about the goal of the rally and the overall movement.
Edna Chavez
A student from South Los Angeles, Edna Chavez lost her brother to a bullet. She told the March for Our Lives crowd about that experience and about the sad things she had to learn growing up. "I have learned to duck from bullets before I learned how to read," she said.
Cameron Kasky
​​A 17-year-old senior at Marjory Stoneman Douglas, Cameron Kasky has joined his classmates in being bluntly critical of the elected officials who have not changed gun laws in the wake of school shootings and other mass murder events. "If he's in front of families, he might say something in support of commonsense gun reform. But then when he's at the NRA, he'll say something to get a big cheer," Kasky told CNN about how President Donald Trump's comments on gun reform shift depending on the audience.
Yolanda King
The granddaughter of Martin Luther King, Yolanda King has public speaking in her genes. The 9-year-old joined a Parkland survivor, Jaclyn Corin, at the March for Our Lives, and took the microphone to make a connection to her grandfather's famous speech. "I have a dream that enough is enough. And that this should be a gun-free world, period," she told the crowd.
Lane Murdock
A 16-year-old student at Ridgefield High School in Connecticut, Lane Murdock started the online petition that became the April 20 school walkouts to commemorate the school shootings that have happened since Columbine in 1999. "What could I do to help other kids who felt really powerless?" she said was her motivation, she told Vox.
Naomi Wadler
Unlike her peers in the movement, Alexandria, Virginia, native Naomi Wadler hasn't even reached her teenage years. She's 11, and she spoke at the March for Our Lives. "I represent the African-American women who are victims of gun violence, who are simply statistics instead of vibrant, beautiful girls full of potential," she said in her speech.
Rob Samuelson is a Staff Writer at Education Post and Digital Media Manager for the brightbeam network.

# data[].attributes.attachment_link.title
Meet the Student Activists Fighting Against Gun Violence

# data[].attributes.attachment_link.description
They've been all over the news since February, walking out of class, marching for their lives in the streets and dunking on the president of the NRA on Twitter. These are the student activists who are fighting against gun violence.

# data[].attributes.attachment_link.title
Protect Our Schools - Protect Our Schools

# data[].attributes.attachment_link.description
The problem extends beyond mass shootings. Gun violence affects the lives of our students far too often, inside and outside of schools. Gun violence affects too many youth, especially in communities of color, on a daily basis. It is far past time for our leaders to take real action when it comes to gun violence.

# data[].attributes.attachment_link.readable_text
This Valentine's Day marks a year since seventeen people were killed in a shooting at Marjory Stoneman Douglas High School, in Parkland, Florida. On February 14th, the Web site and social-media feeds of the March for Our Lives, the youth-led gun-control movement that began in the aftermath of the shooting, will go dark. The founders of the movement will not give interviews or make any public comments.

"It's about recognizing that we need to take time for ourselves because we've been going so strongly for the past year without a breather," Jaclyn Corin, a senior at Stoneman Douglas and one of the co-founders of the movement, told me in a recent phone call. "We're giving ourselves that time to be with our friends and our family."

Last year, on February 15th, I travelled to Parkland to cover the tragedy and was surprised to find myself also documenting the rise of a political movement. Along with the rest of the country, I watched as Sarah Chadwick, Cameron Kasky, Delaney Tarr, David Hogg, and their classmates addressed the media and lawmakers with a controlled fury and eloquence made more potent by their youth. Three days later, I attended a rally organized by the Broward County school board in nearby Fort Lauderdale, where a Parkland senior named Emma González made what seems to be the first speech with national resonance by a member of her generation.

Her concluding refrain, " We Call B.S.," has been printed on buttons and painted on signs. It's easy to forget how spontaneous it was, written from a place of raw emotion and delivered with urgency by someone with a preternatural rhetorical talent. It was also informed by being a member of a generation that has had to train for school shootings for years. As González said that day, "The students at this school have been having debates on guns for what feels like our entire lives."

From the beginning, what made the March for Our Lives students seem different was the simple fact that they believed that the worsening epidemic of gun violence in this country could actually be fixed. Only days after the shooting, they directly lobbied representatives in the Florida state capital of Tallahassee and in Washington, D.C. On March 14, 2018, to commemorate a month since the event and to advocate for stricter gun laws, they led more than a million students to walk out of schools across the country. On March 24th, hundreds of thousands of people rallied outside the Capitol for the March for Our Lives, the largest youth protest in Washington since the Vietnam War. Another walkout followed, on April 20th, the nineteenth anniversary of the shooting at Columbine High School, in Littleton, Colorado.

The protest phase of the movement mostly ended there, but the young activists continued their work. They organized two bus tours to encourage young people to vote, one in Florida and one that toured nationwide, and registered thousands of young voters over the summer. They held public meetings and formed alliances with other local youth gun-control activists-Good Kids Mad City and the Peace Warriors-and survivors of mass shootings in Santa Fe, Texas; Aurora, Colorado; and the Red Lake Indian Reservation, in Northern Minnesota, among many other places. They showed their commitment not only to ending mass shootings but to educating the public on the ways that guns increase the likelihood of fatality in acts of suicide, domestic violence, and gang strife. During a fall college tour, they continued their voter-registration push, partnering with Rock the Vote and the N.A.A.C.P.

Previously, mass shootings had been met with collective mourning followed by inaction. The students condemned the inertia. They perfected the art of puncturing the N.R.A.'s attacks on proposals like universal background checks and banning assault rifles. They encouraged voters to see gun violence not as some kind of natural disaster but as rooted in policy decisions made by elected officials who should be held responsible. Fixing the problem would require the will of the people with power. The students asked, rightly: Where was the will? Why were adults so inept at protecting their children?

The March for Our Lives students marked the beginning of a year of youth activism, but it would be a mistake to say that they ignited it. Youth activism had been growing for several years: United We Dream, the youth-led immigrant organization that advocated for the DREAM act and occupied the halls of Congress last spring, was founded in 2008; the anti-racism and anti-police-violence movement Black Lives Matter, which has since grown into the Movement for Black Lives, started in 2013. Young people who worked for Bernie Sanders's 2016 Presidential campaign went on to revive the Democratic Socialists of America as a political force and, in some cases, ran for office themselves. The Sunrise Movement, the youth-led climate-change-advocacy group that has helped put the proposal for a Green New Deal on the Democratic policy agenda, started in late 2017. And, as the Parkland students discovered when they began their work, there was already a network of youth activists working to end the epidemic of gun violence.

A lot of this work coalesced in the 2018 midterms, which were seen even by nonpartisan organizations like March for Our Lives as an opportunity to question the complacency of Congress, where the reëlection rate has traditionally been about ninety per cent. Young former Bernie Sanders staffers started the political-action committee Brand New Congress with the intention of reviving a primary election cycle that in many districts was merely symbolic. Brand New Congress recruited a dozen candidates. One actually won her election: Alexandria Ocasio-Cortez. By that time, the group had merged with Justice Democrats, a political-action committee that supported the candidacies of Ocasio-Cortez, Ayanna Pressley, Ilhan Omar, and Rashida Tlaib. All of these groups emphasized youth-voter turnout-and an estimated thirty-one per cent of eligible voters between the ages of nineteen and twenty-nine turned out in the 2018 elections. The Center for Information and Research on Civic Learning & Engagement, out of Tufts University, reported that that number, as low as it is, represented the highest youth turnout in a midterm election since 1982.

The Green New Deal, gun control, and Medicare for All are now seen as central issues in the 2020 Presidential primaries, but March for Our Lives has chosen to advocate for issues rather than individual candidates. Along with groups like Moms Demand Action and Everytown for Gun Safety, March for Our Lives can claim credit for changing laws. In 2018, according to the Giffords Law Center to Prevent Gun Violence, sixty-seven gun-safety bills were signed into law in twenty-six states and Washington, D.C. On February 6th, March for Our Lives founders joined the parents of slain Stoneman Douglas students at the first House hearings on gun violence in eight years.

As the Parkland students and others from their generation have shown, there is much political momentum to be gained simply by describing what is wrong with greater urgency: a broken health-insurance system; several generations who collectively owe more than one and a half trillion dollars in student loans; the existential threats of climate change, gun violence, police violence, stagnant wages, and widening inequality. But, unlike previous generations of youth activists, the ones today are eager to work within the existing political processes. Asked if a year of close scrutiny of electoral politics had left him disillusioned, Matt Deitsch, one of the March for Our Lives co-founders, told me that it had not. "It's not about being disillusioned, it's about being upset." He quoted Marjory Stoneman Douglas, the namesake of his alma mater, who was an advocate for the preservation of the Everglades: "Be a nuisance when it counts."

Earlier this week, I accompanied a group of Sunrise Movement activists as they visited the Los Angeles office of Dianne Feinstein, a senator from California, hoping to encourage her to support the resolution for a Green New Deal. Like the youth gun-control activists, they describe the issues they face as not abstract but genuine fears.

"People who are in their sixties right now don't need to worry about these things nearly as much as we do," a Sunrise volunteer and third-year student at U.C.L.A. named Natalie Rotstein said. "I'm surrounded by friends who don't want to have kids because they don't feel like they can in good conscience put children into the imminent apocalypse that looks like our future right now. It's such an everyday, grinding kind of acceptance that there's probably going to be an apocalypse within our lifetime, and nobody is really doing anything to stop it, so it's the young people who feel the need to save our own futures because no one else is doing it."

The group of twenty or so activists proceeded across Santa Monica Boulevard into the glossy lobby of a building where Feinstein's office is on an upper floor. Security would not let them upstairs. When two of Feinstein's staffers descended from an elevator to meet with the activists, they found them sitting in a circle on the floor, listening to a song about the recent California wildfires performed by a seventeen-year-old singer-songwriter and high-school student named Arielle Martinez Cohen. The activists were then relocated to an atrium between the office building and the parking deck. Peter Muller, Feinstein's deputy state director, received their complaints under the decorative plant walls there. Asked why Feinstein had not yet endorsed the proposal, Muller replied that the senator is a very deliberative person who reviews things very closely. At this the crowd erupted with anxiety: "We don't have a lot of time!" "There is no time!"

"She's been my representative my entire life, and these issues have existed since I was born!" a twenty-five-year-old Sunrise volunteer named Ruby Dutcher said. Muller agreed to meet with a smaller group of activists in the office upstairs. In a scene I had watched play out many times in the past year, beginning with the lukewarm reception of lawmakers in Tallahassee to their visitors from Parkland, a staffer promised once again to relay the views of the young people to the person in power, as the young people made clear that the time for deliberation had passed.

# data[].attributes.attachment_link.title
From Parkland to Sunrise: A Year of Extraordinary Youth Activism

# data[].attributes.attachment_link.description
This Valentine's Day marks a year since seventeen people were killed in a shooting at Marjory Stoneman Douglas High School, in Parkland, Florida. On February 14th, the Web site and social-media feeds of the March for Our Lives, the youth-led gun-control movement that began in the aftermath of the shooting, will go dark.

# data[].attributes.headline
Youth- United: Gun Violence is a Permanent Issue

# data[].attributes.subject
Youth- United: Gun Violence is a Permanent Issue

# data[].attributes.attachment_link.readable_text
Since the February 2018 school shooting in Parkland, Florida, student resistance to gun violence has garnered massive amounts of media attention, and the number of students participating in walkouts, marches and other types of activism has grown by leaps and bounds. Over the past few months, TT has been in conversation with young gun violence activists from around the country, some of whom are new to the issue and some of whom have been working for years to make their schools and communities safer. Recently, three of these activists spoke to TT-and to each other-about how their lives have changed and what the future holds.

Have the conversations within your respective activist groups and communities changed since the March for Our Lives and the National School Walkout? If so, how?

Alex: Well, here in Chicago, the conversation has gone from "Who's doing what," "Who's doing this," "Who's doing that," to, "OK, the youth are the head of the movement." Now, it's just like, everybody is targeting or focusing on the youth and looking for their next step, well, our next steps, to see what we're going to do next, what other moves we have up our sleeves. How do we continue to keep people into the movement? Things of such sort.

Jenna: In Kalamazoo, [it's] what [Alex] said; it is a lot more about the youth now than it was before, especially since the walkout. People are emphasizing, "Just because we walked out doesn't mean it's done. That's not where political activism ends." Right now we're really emphasizing registering to vote and making sure that everyone is going to be registered to vote when they can, in the midterms in November, and in any other upcoming elections, whether it's for the national level, state level or just local level.

Mary: After the March for Our Lives and some of the sister marches and things that went on, and walkouts, initially our focus was just the gun control, gun reform, and [that] still is our primary focus. We've shifted a little bit to talking about, directly in our community, what we think is best as far as school safety goes, because we're having an election for sheriff. That's what they all want to talk about. There's so many things that they want to implement that we don't.

Right now, we're wanded down every day, and we're searched upon arrival to school. They were looking at maybe metal detectors. They only detect the weight of metals in weaponry, things like that, to get students through quicker and not be as violating to students. Also, the heavy police presence is something that we're really not in favor of. There's so many police at our school now that it really does start to feel like a prison.

How are you keeping the momentum going?

Alex: Well, here in Chicago, we're just still focusing on putting everything on voting, getting the right people in office, taking the wrong people out of office. Aside from that, we are getting contacts. We're trying to get in touch with people who are going through the same things that we are going through, and the same living circumstances that we are in, because we know that once upon a time, our voices weren't heard. Now that our voices are being heard, we still know that there is many voices that haven't been heard. We're trying to reach those people, those voices, to get their info, because every voice matters.

Jenna: Originally, we were a group that was based in Kalamazoo, Michigan. Now, we've extended into other parts of Michigan with our same name. We're all working together as a group and sending people to rally events across the state. We've been also reaching out to other people from across the nation, trying to spread, and figuring out what everyone else is doing, and how we can improve what we're doing, and spreading our ideas as to what can be done.

We've just been continuing to educate people locally, that's for sure, like at our school and our town about gun violence and possible solutions to this issue. Then just making sure we're pushing everyone to vote. We're making sure that people aren't forgetting this time, that they're not going to let the issue of gun violence just die out, because right now, it's a permanent issue. Without a solution, nothing's going to change.

How can activists lift up and coordinate efforts with other activists who might live in different regions of the country or in communities that face different types of issues?

Alex: I try to attack the people's hearts before the minds. People can connect with you a lot more and a lot easier, get more vulnerable faster, if you hit home, if you connect, hit them in the heart to get them to understand the situations. Also, just let everyone know, like, their voice matters. Their thoughts matter. Because nowadays, in our generation and our age, the youth get told they're too young to do this; they don't understand about that. Just encouragement can get the activism started, just letting them know that: "We hear you. We're going to acknowledge that we hear you." And other things like that. Getting them out to vote. If you find something in your community that you don't agree with, it's OK to stand up for that. If you don't agree with it, make change. Because you have the power to make the change.

Jenna: One thing that I think is really important is teaching people about the different types of gun violence. Because one of the main types of gun violence we always see is mass shootings, but that doesn't even account for half the people that die from gun violence. Suicide is a huge issue, and then street violence. I think that it's very important to teach other people the types of gun violence, so to teach someone from Parkland the issues that they face in Chicago, which are totally different situations, but still both situations that need to be fixed.

Just to keep that conversation going, not just about what you can do locally, but what you can do for other cities, too, so you're not only focused about what you can do for your city, but what you can do for anyone across the nation.

Mary: The great thing about [activism] is it's so easy to form communities of other activists. ... For example, we're trying to get in contact with other survivors of school shootings that haven't quite had the traction of those in Parkland, people who have still had shootings at their school where a huge number of people have been injured, or they've only had a few people pass away. At my school, only two people were deceased, but we had 21 injuries. The key word there is casualties. You tell people that only two people died, and it seems minor, but when there are a total of 23 casualties, that's a huge number. I think the real thing that's important with this is as somebody of privilege-and as so many of people in this event have privilege-is to redirect our attention and provide voices to those who may not be in a position like we are to be heard. For example, there's inner city situations where gun violence is a huge problem. ... [I]t's an issue across all races and sexes and sexualities and genders. There's no one person that should have more of a voice than another.

# data[].attributes.attachment_link.title
Youth-United! Gun Violence Is a Permanent Issue

# data[].attributes.attachment_link.description
Teaching Tolerance provides free resources to educators-teachers, administrators, counselors and other practitioners-who work with children from kindergarten through high school. Educators use our materials to supplement the curriculum, to inform their practices, and to create civil and inclusive school communities where children are respected, valued and welcome participants.

# data[].attributes.attachment_link.readable_text
Image

stockphoto-graf/shutterstock

Marine pollution is a growing problem in today's world. Our ocean is being flooded with two main types of pollution: chemicals and trash.

Chemical contamination, or nutrient pollution, is concerning for health, environmental, and economic reasons. This type of pollution occurs when human activities, notably the use of fertilizer on farms, lead to the runoff of chemicals into waterways that ultimately flow into the ocean. The increased concentration of chemicals, such as nitrogen and phosphorus, in the coastal ocean promotes the growth of algal blooms, which can be toxic to wildlife and harmful to humans. The negative effects on health and the environment caused by algal blooms hurt local fishing and tourism industries.

Marine trash encompasses all manufactured products-most of them plastic-that end up in the ocean. Littering, storm winds, and poor waste management all contribute to the accumulation of this debris, 80 percent of which comes from sources on land. Common types of marine debris include various plastic items like shopping bags and beverage bottles, along with cigarette butts, bottle caps, food wrappers, and fishing gear. Plastic waste is particularly problematic as a pollutant because it is so long-lasting. Plastic items can take hundreds of years to decompose.

This trash poses dangers to both humans and animals. Fish become tangled and injured in the debris, and some animals mistake items like plastic bags for food and eat them. Small organisms feed on tiny bits of broken-down plastic, called microplastic, and absorb the chemicals from the plastic into their tissues. Microplastics are less than five millimeters (0.2 inches) in diameter and have been detected in a range of marine species, including plankton and whales. When small organisms that consume microplastics are eaten by larger animals, the toxic chemicals then become part of their tissues. In this way, the microplastic pollution migrates up the food chain, eventually becoming part of the food that humans eat.

Solutions for marine pollution include prevention and cleanup. Disposable and single-use plastic is abundantly used in today's society, from shopping bags to shipping packaging to plastic bottles. Changing society's approach to plastic use will be a long and economically challenging process. Cleanup, in contrast, may be impossible for some items. Many types of debris (including some plastics) do not float, so they are lost deep in the ocean. Plastics that do float tend to collect in large "patches" in ocean gyres. The Pacific Garbage Patch is one example of such a collection, with plastics and microplastics floating on and below the surface of swirling ocean currents between California and Hawaii in an area of about 1.6 million square kilometers (617,763 square miles), although its size is not fixed. These patches are less like islands of trash and, as the National Oceanic and Atmospheric Administration says, more like flecks of microplastic pepper swirling around an ocean soup. Even some promising solutions are inadequate for combating marine pollution. So-called "biodegradable" plastics often break down only at temperatures higher than will ever be reached in the ocean.

Nonetheless, many countries are taking action. According to a 2018 report from the United Nations, more than sixty countries have enacted regulations to limit or ban the use of disposable plastic items.

National Geographic Society

# data[].attributes.attachment_link.description
Marine pollution is a combination of chemicals and trash, most of which comes from land sources and is washed or blown into the ocean. This pollution results in damage to the environment, to the health of all organisms, and to economic structures worldwide.

# data[].attributes.attachment_link.description
Each year, billions of pounds of trash and other pollutants enter the ocean.

# data[].attributes.headline
Is Pollution a Social Issue or an Environmental Issue 

# data[].attributes.subject
Is Pollution a Social Issue or an Environmental Issue 

# data[].attributes.attachment_link.readable_text
Almost every day we read news about high pollution levels in countries all around the world. Whether that's studies that claim around 40 million citizens are living in towns and cities where the levels of harmful nitrogen dioxide (NO2) are above legal limits set by the EU, or doctors campaigning to highlight how children are facing "irreversible lung damage" from diesel fumes and that cars and lorries using the fuel should be taken off Britain's streets as soon as possible.

But it's important to remember that pollution is a social issue because it is caused by human behaviours and because it not only has a negative effect on the planet but also on people and society. This being the case, is pollution an environmental issue or a social one? Is it too much to say that the lines are blurred between what is environmental and social as the two are intrinsically lined now?

Nature regularly faces issues but to the natural world they aren't truly "problematic" per se. A wildfire might help to grow the grass that grows later. A tornado or a flood could serve as a platform for other plants and species to thrive. Nature responds to this. But pollution is something entirely different. Pollution poisons the air and water we all depend on. Pollution is destructive whereas natural occurring "disasters" have the potential to be transformative.

Our over-consumption of fuel and energy has been so prolonged and so rapid now that the earth has failed to respond and adapt accordingly so affecting the regenerating potential of the natural world to decrease. These are not "environmental" problems, no. "The environment" has no "problems". It has defined cycles and patterns, birth and death, the cycle of life. And if that cycle doesn't turn, there are problems.

# data[].attributes.attachment_link.title
Is Pollution a Social Issue or an Environmental One? - Simply Sustainable

# data[].attributes.attachment_link.description
Almost every day we read news about high pollution levels in countries all around the world. Whether that's studies that claim around 40 million citizens are living in towns and cities where the levels of harmful nitrogen dioxide (NO2) are above legal limits set by the EU, or doctors campaigning to highlight how children are ...

# data[].attributes.attachment_link.readable_text
A: Since the Industrial Revolution, the global annual temperature has increased in total by a little more than 1 degree Celsius, or about 2 degrees Fahrenheit. Between 1880-the year that accurate recordkeeping began-and 1980, it rose on average by 0.07 degrees Celsius (0.13 degrees Fahrenheit) every 10 years. Since 1981, however, the rate of increase has more than doubled: For the last 40 years, we've seen the global annual temperature rise by 0.18 degrees Celsius, or 0.32 degrees Fahrenheit, per decade.

The result? A planet that has never been hotter. Nine of the 10 warmest years since 1880 have occurred since 2005-and the 5 warmest years on record have all occurred since 2015. Climate change deniers have argued that there has been a "pause" or a "slowdown" in rising global temperatures, but numerous studies, including a 2018 paper published in the journal Environmental Research Letters, have disproved this claim. The impacts of global warming are already harming people around the world.

What causes global warming?

A: Global warming occurs when carbon dioxide (CO ₂) and other air pollutants collect in the atmosphere and absorb sunlight and solar radiation that have bounced off the earth's surface. Normally this radiation would escape into space, but these pollutants, which can last for years to centuries in the atmosphere, trap the heat and cause the planet to get hotter. These heat-trapping pollutants-specifically carbon dioxide, methane, nitrous oxide, water vapor, and synthetic fluorinated gases-are known as greenhouse gases, and their impact is called the greenhouse effect.

How is global warming linked to extreme weather?

A: Scientists agree that the earth's rising temperatures are fueling longer and hotter heat waves, more frequent droughts, heavier rainfall, and more powerful hurricanes.

In 2015, for example, scientists concluded that a lengthy drought in California-the state's worst water shortage in 1,200 years-had been intensified by 15 to 20 percent by global warming. They also said the odds of similar droughts happening in the future had roughly doubled over the past century. And in 2016, the National Academies of Science, Engineering, and Medicine announced that we can now confidently attribute some extreme weather events, like heat waves, droughts, and heavy precipitation, directly to climate change.

The impacts of global warming are being felt everywhere. Extreme heat waves have caused tens of thousands of deaths around the world in recent years. And in an alarming sign of events to come, Antarctica has lost nearly four trillion metric tons of ice since the 1990s. The rate of loss could speed up if we keep burning fossil fuels at our current pace, some experts say, causing sea levels to rise several meters in the next 50 to 150 years and wreaking havoc on coastal communities worldwide.

What are the other effects of global warming?

A: Each year scientists learn more about the consequences of global warming, and each year we also gain new evidence of its devastating impact on people and the planet. As the heat waves, droughts, and floods associated with climate change become more frequent and more intense, communities suffer and death tolls rise. If we're unable to reduce our emissions, scientists believe that climate change could lead to the deaths of more than 250,000 people around the globe every year and force 100 million people into poverty by 2030.

Global warming is already taking a toll on the United States. And if we aren't able to get a handle on our emissions, here's just a smattering of what we can look forward to:

Disappearing glaciers, early snowmelt, and severe droughts will cause more dramatic water shortages and continue to increase the risk of wildfires in the American West.

Rising sea levels will lead to even more coastal flooding on the Eastern Seaboard, especially in Florida, and in other areas such as the Gulf of Mexico.

Forests, farms, and cities will face troublesome new pests, heat waves, heavy downpours, and increased flooding. All of these can damage or destroy agriculture and fisheries.

Disruption of habitats such as coral reefs and alpine meadows could drive many plant and animal species to extinction.

Allergies, asthma, and infectious disease outbreaks will become more common due to increased growth of pollen-producing ragweed, higher levels of air pollution, and the spread of conditions favorable to pathogens and mosquitoes.

Though everyone is affected by climate change, not everyone is affected equally. Indigenous people, people of color, and the economically marginalized are typically hit the hardest. Inequities built into our housing, health care, and labor systems make these communities more vulnerable to the worst impacts of climate change-even though these same communities have done the least to contribute to it.

Where does the United States stand in terms of global-warming contributors?

A: In recent years, China has taken the lead in global-warming pollution, producing about 26 percent of all CO2 emissions. The United States comes in second. Despite making up just 4 percent of the world's population, our nation produces a sobering 13 percent of all global CO2 emissions-nearly as much as the European Union and India (third and fourth place) combined. And America is still number one, by far, in cumulative emissions over the past 150 years. As a top contributor to global warming, the United States has an obligation to help propel the world to a cleaner, safer, and more equitable future. Our responsibility matters to other countries, and it should matter to us, too.

Is the United States doing anything to prevent global warming?

A: We've started. But in order to avoid the worsening effects of climate change, we need to do a lot more-together with other countries-to reduce our dependence on fossil fuels and transition to clean energy sources.

Despite the lack of cooperation from the Trump administration, local and state governments made great strides during this period through efforts like the American Cities Climate Challenge and ongoing collaborations like the Regional Greenhouse Gas Initiative. Meanwhile, industry and business leaders have been working with the public sector, creating and adopting new clean-energy technologies and increasing energy efficiency in buildings, appliances, and industrial processes. Today the American automotive industry is finding new ways to produce cars and trucks that are more fuel efficient and is committing itself to putting more and more zero-emission electric vehicles on the road. Developers, cities, and community advocates are coming together to make sure that new affordable housing is built with efficiency in mind, reducing energy consumption and lowering electric and heating bills for residents. And renewable energy continues to surge as the costs associated with its production and distribution keep falling. In 2020 renewable energy sources such as wind and solar provided more electricity than coal for the very first time in U.S. history.

Is global warming too big a problem for me to help tackle?

A: No! While we can't win the fight without large-scale government action at the national level, we also can't do it without the help of individuals who are willing to use their voices, hold government and industry leaders to account, and make changes in their daily habits.

Wondering how you can be a part of the fight against global warming? Reduce your own carbon footprint by taking a few easy steps: Make conserving energy a part of your daily routine and your decisions as a consumer. When you shop for new appliances like refrigerators, washers, and dryers, look for products with the government's ENERGY STAR ® label; they meet a higher standard for energy efficiency than the minimum federal requirements. When you buy a car, look for one with the highest gas mileage and lowest emissions. You can also reduce your emissions by taking public transportation or carpooling when possible.

And while new federal and state standards are a step in the right direction, much more needs to be done. Voice your support of climate-friendly and climate change preparedness policies, and tell your representatives that equitably transitioning from dirty fossil fuels to clean power should be a top priority-because it's vital to building healthy, more secure communities.

You don't have to go it alone, either. Movements across the country are showing how climate action can build community, be led by those on the front lines of its impacts, and create a future that's equitable and just for all.

This story was originally published on March 11, 2016 and has been updated with new information and links.

This NRDC.org story is available for online republication by news media outlets or nonprofits under these conditions: The writer(s) must be credited with a byline; you must note prominently that the story was originally published by NRDC.org and link to the original; the story cannot be edited (beyond simple things such as grammar); you can't resell the story in any form or grant republishing rights to other outlets; you can't republish our material wholesale or automatically-you need to select stories individually; you can't republish the photos or graphics on our site without specific permission; you should to let us know when you've used one of our stories.

# data[].attributes.attachment_link.description
What is global warming? Global warming causes, effects, extreme weather, facts, and relation to climate change.

# data[].attributes.attachment_link.readable_text
The effects of global warming can be seen and felt across the planet. Global warming, the gradual heating of Earth's surface, oceans and atmosphere, is caused by human activity, primarily the burning of fossil fuels that pump carbon dioxide (CO2), methane and other greenhouse gases into the atmosphere.

Already, the consequences of global warming are measurable and visible.

"We can observe this happening in real time in many places," Josef Werne, a professor of geology and environmental science at the University of Pittsburgh, told Live Science. "Ice is melting in both polar ice caps and mountain glaciers. Lakes around the world, including Lake Superior, are warming rapidly - in some cases faster than the surrounding environment. Animals are changing migration patterns and plants are changing the dates of activity," such as trees budding their leaves earlier in the spring and dropping them later in the fall.

Here is an in-depth look at the ongoing effects of global warming.

Global warming increases average temperatures and temperature extremes

One of the most immediate and obvious consequences of global warming is the increase in temperatures around the world. The average global temperature has increased by about 1.4 degrees Fahrenheit (0.8 degrees Celsius) over the past 100 years, according to the National Oceanic and Atmospheric Administration (NOAA).

Since record keeping began in 1895, the hottest year on record worldwide was 2016, according to NOAA and NASA data. That year Earth's surface temperature was 1.78 degrees F (0.99 degrees C) warmer than the average across the entire 20th century. Before 2016, 2015 was the warmest year on record, globally. And before 2015? Yep, 2014. In fact, all 10 of the warmest years on record have occurred since 2005, which tied with 2013 as the 10th-warmest year on record, according to NOAA's Global Climate Report 2021. Rounding out the top 6 hottest years on record across the globe are (in order of hottest to not as hot): 2020, 2019, 2015, 2017 and 2021.

For the contiguous United States and Alaska, 2016 was the second-warmest year on record and the 20th consecutive year that the annual average surface temperature exceeded the 122-year average since record keeping began, according to NOAA. Shattered heat records in the U.S. are increasingly becoming the norm: June 2021, for example, saw the warmest temperatures on record for that month for 15.2%of the contiguous U.S. That's the largest extent of record warm temperatures ever recorded in the country, according to the National Centers for Environmental Information.

Global warming increases extreme weather events

As global average temperatures warm, weather patterns are changing. An immediate consequence of global warming is extreme weather.

These extremes come in a lot of different flavors. Paradoxically, one effect of climate change can be colder-than-normal winters in some areas.

Changes in climate can cause the polar jet stream - the boundary between the cold North Pole air and the warm equatorial air - to migrate south, bringing with it cold, Arctic air. This is why some states can have a sudden cold snap or colder-than-normal winter, even during the long-term trend of global warming, Werne explained.

"Climate is, by definition, the long-term average of weather, over many years. One cold (or warm) year or season has little to do with overall climate. It is when those cold (or warm) years become more and more regular that we start to recognize it as a change in climate rather than simply an anomalous year of weather," he said.

Global warming is also changing other extreme weather. According to the Geophysical Fluid Dynamics Laboratory of NOAA, hurricanes are likely to become more intense, on average, in a warming world. Most computer models suggest that hurricane frequency will stay about the same (or even decrease), but those storms that do form will have the capacity to drop more rain due to the fact that warmer air holds more moisture.

"And even if they become less frequent globally, hurricanes could still become more frequent in some particular areas," said atmospheric scientist Adam Sobel, author of " Storm Surge: Hurricane Sandy, Our Changing Climate, and Extreme Weather of the Past and Future" (HarperWave, 2014). "Additionally, scientists are confident that hurricanes will become more intense due to climate change." This is because hurricanes get their energy from the temperature difference between the warm tropical ocean and the cold upper atmosphere. Global warming increases that temperature difference.

"Since the most damage by far comes from the most intense hurricanes - such as typhoon Haiyan in the Philippines in 2013 - this means that hurricanes could become overall more destructive," said Sobel, a Columbia University professor in the departments of Earth and Environmental Sciences, and Applied Physics and Applied Mathematics. (Hurricanes are called typhoons in the western North Pacific, and they're called cyclones in the South Pacific and Indian oceans.)

What's more, hurricanes of the future will be hitting shorelines that are already prone to flooding due to the sea-level rise caused by climate change. This means that any given storm will likely cause more damage than it would have in a world without global warming.

(Image credit: Mariana Suarez/AFP via Getty Images)

Lightning is another weather feature that is being affected by global warming. According to a 2014 study, a 50% increase in the number of lightning strikes within the United States is expected by 2100 if global temperatures continue to rise. The researchers of the study found a 12% increase in lightning activity for every 1.8 degree F (1 degree C) of warming in the atmosphere. NOAA established the U.S. Climate Extremes Index (CEI) in 1996 to track extreme weather events. The number of extreme weather events that are among the most unusual in the historical record, according to the CEI, has been rising over the last four decades. Scientists project that extreme weather events, such as heat waves, droughts, blizzards and rainstorms will continue to occur more often and with greater intensity due to global warming, according to Climate Central. Climate models forecast that global warming will cause climate patterns worldwide to experience significant changes. These changes will likely include major shifts in wind patterns, annual precipitation and seasonal temperatures variations. These impacts vary by location and geography. For example, according to the U.S. Environmental Protection Agency (EPA), the eastern United States has been trending wetter over time, while the West - and particularly the Southwest - have become increasingly dry. Because high levels of greenhouse gases are likely to remain in the atmosphere for many years, these changes are expected to last for several decades or longer, according to the EPA.

Global warming melts ice

One of the primary manifestations of climate change so far is melt. North America, Europe and Asia have all seen a trend toward less snow cover between 1960 and 2015, according to 2016 research published in the journal Current Climate Change Reports. According to the National Snow and Ice Data Center, there is now 10% less permafrost, or permanently frozen ground, in the Northern Hemisphere than there was in the early 1900s. The thawing of permafrost can cause landslides and other sudden land collapses. It can also release long-buried microbes, as in a 2016 case when a cache of buried reindeer carcasses thawed and caused an outbreak of anthrax.

One of the most dramatic effects of global warming is the reduction in Arctic sea ice. Sea ice hit record-low extents in both the fall and winter of 2015 and 2016, meaning that at the time when the ice is supposed to be at its peak, it was lagging. The melt means there is less thick sea ice that persists for multiple years. That means less heat is reflected back into the atmosphere by the shiny surface of the ice and more is absorbed by the comparatively darker ocean, creating a feedback loop that causes even more melt, according to NASA's Operation IceBridge.

Glacial retreat, too, is an obvious effect of global warming. Only 25 glaciers bigger than 25 acres are now found in Montana's Glacier National Park, where about 150 glaciers were once found, according to the U.S. Geological Survey. A similar trend is seen in glacial areas worldwide. According to a 2016 study in the journal Nature Geoscience, there is a 99% likelihood that this rapid retreat is due to human-caused climate change. Some glaciers retreated up to 15 times as much as they would have without global warming, those researchers found.

Sea levels and ocean acidification

In general, as ice melts, sea levels rise. According to a 2021 report by the World Meteorological Organization, the pace of sea level rise doubled from 0.08 inches (2.1 millimeters) per year between 1993 and 2002 to 0.17 inches (4.4 mm) per year between 2013 and 2021.

Melting polar ice in the Arctic and Antarctic regions, coupled with melting ice sheets and glaciers across Greenland, North America, South America, Europe and Asia, are expected to raise sea levels significantly. Global sea levels have risen about 8 inches since 1870, according to the EPA, and the rate of increase is expected to accelerate in the coming years. If current trends continue, many coastal areas, where roughly half of the Earth's human population lives, will be inundated.

Researchers project that by 2100, average sea levels will be 2.3 feet (.7 meters) higher in New York City, 2.9 feet (0.88 m) higher at Hampton Roads, Virginia, and 3.5 feet (1.06 m) higher at Galveston, Texas, the EPA reports. According to an IPCC report, if greenhouse gas emissions remain unchecked, global sea levels could rise by as much as 3 feet (0.9 meters) by 2100. That estimate is an increase from the estimated 0.9 to 2.7 feet (0.3 to 0.8 meters) that was predicted in the 2007 IPCC report for future sea-level rise.

Sea level isn't the only thing changing for the oceans due to global warming. As levels of CO2 increase, the oceans absorb some of that gas, which increases the acidity of seawater. Werne explains it this way: "When you dissolved CO2 in water, you get carbonic acid. This is the same exact thing that happens in cans of soda. When you pop the top on a can of Dr Pepper, the pH is 2 - quite acidic."

Since the Industrial Revolution began in the early 1700s, the acidity of the oceans has increased about 25 percent, according to the EPA. "This is a problem in the oceans, in large part, because many marine organisms make shells out of calcium carbonate (think corals, oysters), and their shells dissolve in acid solution," said Werne. "So as we add more and more CO2 to the ocean, it gets more and more acidic, dissolving more and more shells of sea creatures. It goes without saying that this is not good for their health."

If current ocean acidification trends continue, coral reefs are expected to become increasingly rare in areas where they are now common, including most U.S. waters, the EPA reports. In 2016 and 2017, portions of the Great Barrier Reef in Australia were hit with bleaching, a phenomenon in which coral eject their symbiotic algae. Bleaching is a sign of stress from too-warm waters, unbalanced pH or pollution; coral can recover from bleaching, but back-to-back episodes make recovery less likely.

Plants and animals

(Image credit: Mint Images/ Art Wolfe via Getty Images)

The effects of global warming on Earth's ecosystems are expected to be significant and widespread. Many species of plants and animals are already moving their range northward or to higher altitudes as a result of warming temperatures, according to a report from the National Academy of Sciences.

"They are not just moving north, they are moving from the equator toward the poles. They are quite simply following the range of comfortable temperatures, which is migrating to the poles as the global average temperature warms," Werne said. Ultimately, he said, this becomes a problem when the rate of climate change velocity (how fast a region changes put into a spatial term) is faster than the rate that many organisms can migrate. Because of this, many animals may not be able to compete in the new climate regime and may go extinct.

Additionally, migratory birds and insects are now arriving in their summer feeding and nesting grounds several days or weeks earlier than they did in the 20th century, according to the EPA.

Warmer temperatures will also expand the range of many disease-causing pathogens that were once confined to tropical and subtropical areas, killing off plant and animal species that formerly were protected from disease.

In addition, animals that live in the polar regions are facing an existential threat. In the Arctic, the decline in sea ice and changes in ice melt threaten particularly ice-dependent species, such as narwhals ( Monodon monoceros), polar bears ( Ursus maritimus) and walruses ( Odobenus rosmarus), the World Wildlife Fund (WWF) noted. Animals in the Antarctic also face serious challenges - in Oct. 2022 the U.S. Fish and Wildlife Service declared emperor penguins (Aptenodytes forsteri) as endangered due to the threat of climate change.

A 2020 study published in the journal Proceedings of the National Academy of Sciences suggested that 1 in every 3 species of plant and animal are at risk of extinction by 2070 due to climate change.

Social effects

(Image credit: VCG via Getty Images)

As dramatic as the effects of climate change are expected to be on the natural world, the projected changes to human society may be even more devastating.

Agricultural systems will likely be dealt a crippling blow. Though growing seasons in some areas will expand, the combined impacts of drought, severe weather, lack of accumulated snowmelt, greater number and diversity of pests, lower groundwater tables and a loss of arable land could cause severe crop failures and livestock shortages worldwide.

North Carolina State University also notes that carbon dioxide is affecting plant growth. Though CO2 can increase the growth of plants, the plants may become less nutritious.

This loss of food security may, in turn, create havoc in international food markets and could spark famines, food riots, political instability and civil unrest worldwide, according to a number of analyses from sources as diverse as the U.S Department of Defense, the Center for American Progress and the Woodrow Wilson International Center for Scholars.

In addition to less nutritious food, the effect of global warming on human health is also expected to be serious. The American Medical Association has reported an increase in mosquito-borne diseases like malaria and dengue fever, as well as a rise in cases of chronic conditions like asthma, most likely as a direct result of global warming. The 2016 outbreak of Zika virus, a mosquito-borne illness, highlighted the dangers of climate change. The disease causes devastating birth defects in fetuses when pregnant women are infected, and climate change could make higher-latitude areas habitable for the mosquitoes that spread the disease, experts said. Longer, hotter summers could also lead to the spread of tick-borne illnesses.

Further reading on the impacts of global warming

Many governments and agencies keep up-to-date information on climate change research and statistics online. The most comprehensive and in-depth global reports are produced by the Intergovernmental Panel on Climate Change (IPCC), which released its Sixth Assessment Report on the science of climate change in 2021.

For a historical look at the effects of climate change on Earth (and how modern warming compares), read Peter Brannen's " The Ends of the Earth: Volcanic Apocalypses, Lethal Oceans, and Our Quest to Understand Earth's Past Mass Extinctions" (Ecco, 2017).

For more on the potential impacts of climate change in urban environments, the freely available book chapter Climate Change and its Impacts in the book " Climate Change Resilience in the Urban Environment" (IOP Publishing, 2017) covers the challenges that lay ahead for human populations.

Finally, for a psychological deep-dive on why all of this bad news is hard to take in, try " Don't Even Think About It: Why Our Brains Are Wired to Ignore Climate Change" (Bloomsbury USA, 2015) by climate activist and communicator George Marshall.

Additional resources

This NASA page includes a series of visualizations that illustrate how some of Earth's key climate indicators - sea ice, sea level, global temperature and carbon dioxide - are changing over time.

This NOAA sea-level rise learning module includes educational videos, background for teachers, learning objectives and more.

ClimateBrief has gathered 10 of the best climate change videos on YouTube.

Bibliography

# data[].attributes.attachment_link.description
The effects of global warming will be far-reaching and often devastating, scientists have warned.

# data[].attributes.attachment_link.description
Impacts from climate change are happening now. These impacts extend well beyond an increase in temperature, affecting ecosystems and communities in the United States and around the world. Things that we depend upon and value - water, energy, transportation, wildlife, agriculture, ecosystems, and human health - are experiencing the effects of a changing climate.

# data[].attributes.attachment_link.provider_name
Climate Change: Vital Signs of the Planet

# data[].attributes.attachment_link.readable_text
Our Trajectory

Earth Will Continue to Warm and the Effects Will Be Profound

The potential future effects of global climate change include more frequent wildfires, longer periods of drought in some regions, and an increase in the wind intensity and rainfall from tropical cyclones. Credit: left - Mike McMillan/USFS, center - Tomas Castelazo / Wikimedia Commons / CC BY-SA 4.0, right - NASA.

Global climate change is not a future problem. Changes to Earth's climate driven by increased human emissions of heat-trapping greenhouse gases are already having widespread effects on the environment: glaciers and ice sheets are shrinking, river and lake ice is breaking up earlier, plant and animal geographic ranges are shifting, and plants and trees are blooming sooner.

Effects that scientists had long predicted would result from global climate change are now occurring, such as sea ice loss, accelerated sea level rise, and longer, more intense heat waves.

" The magnitude and rate of climate change and associated risks depend strongly on near-term mitigation and adaptation actions, and projected adverse impacts and related losses and damages escalate with every increment of global warming."

- Intergovernmental Panel on Climate Change

Some changes (such as droughts, wildfires, and extreme rainfall) are happening faster than scientists previously assessed. In fact, according to the Intergovernmental Panel on Climate Change (IPCC) - the United Nations body established to assess the science related to climate change - modern humans have never before seen the observed changes in our global climate, and some of these changes are irreversible over the next hundreds to thousands of years.

Scientists have high confidence that global temperatures will continue to rise for many decades, mainly due to greenhouse gases produced by human activities.

A Degree of Difference

So, the Earth's average temperature has increased about 2 degrees Fahrenheit during the 20th century. What's the big deal?

Read more

The IPCC's Sixth Assessment report, published in 2021, found that human emissions of heat-trapping gases have already warmed the climate by nearly 2 degrees Fahrenheit (1.1 degrees Celsius) since 1850-1900. The global average temperature is expected to reach or exceed 1.5 degrees C (about 3 degrees F) within the next few decades. These changes will affect all regions of Earth.

What's the difference between climate change and global warming?

"Global warming" refers to the long-term warming of the planet. "Climate change" encompasses global warming, but refers to the broader range of changes that are happening to our planet, including rising sea levels; shrinking mountain glaciers; accelerating ice melt in Greenland, Antarctica and the Arctic; and shifts in flower/plant blooming times.

detailed answer

The severity of effects caused by climate change will depend on the path of future human activities. More greenhouse gas emissions will lead to more climate extremes and widespread damaging effects across our planet. However, those future effects depend on the total amount of carbon dioxide we emit. So, if we can reduce emissions, we may avoid some of the worst effects.

" The scientific evidence is unequivocal: climate change is a threat to human wellbeing and the health of the planet. Any further delay in concerted global action will miss the brief, rapidly closing window to secure a liveable future." ²

- Intergovernmental Panel on Climate Change

Future Effects in the U.S.

U.S. Regional Effects

U.S. Regional Effects

Climate change is bringing different types of challenges to each region of the country. Some of the current and future impacts are summarized below. These findings are from the Third and Fourth National Climate Assessment Reports, released by the U.S. Global Change Research Program.

Is it too late to prevent climate change?

Humans have caused major climate changes to happen already, and we have set in motion more changes still. However, if we stopped emitting greenhouse gases today, the rise in global temperatures would begin to flatten within a few years. Temperatures would then plateau but remain well-elevated for many, many centuries.

detailed answer

Northeast. Heat waves, heavy downpours, and sea level rise pose increasing challenges to many aspects of life in the Northeast. Infrastructure, agriculture, fisheries, and ecosystems will be increasingly compromised. Farmers can explore new crop options, but these adaptations are not cost- or risk-free. Moreover, adaptive capacity, which varies throughout the region, could be overwhelmed by a changing climate. Many states and cities are beginning to incorporate climate change into their planning.

Northwest. Changes in the timing of peak flows in rivers and streams are reducing water supplies and worsening competing demands for water. Sea level rise, erosion, flooding, risks to infrastructure, and increasing ocean acidity pose major threats. Increasing wildfire incidence and severity, heat waves, insect outbreaks, and tree diseases are causing widespread forest die-off.

Southeast. Sea level rise poses widespread and continuing threats to the region's economy and environment. Extreme heat will affect health, energy, agriculture, and more. Decreased water availability will have economic and environmental impacts.

Midwest. Extreme heat, heavy downpours, and flooding will affect infrastructure, health, agriculture, forestry, transportation, air and water quality, and more. Climate change will also worsen a range of risks to the Great Lakes.

Southwest. Climate change has caused increased heat, drought, and insect outbreaks. In turn, these changes have made wildfires more numerous and severe. The warming climate has also caused a decline in water supplies, reduced agricultural yields, and triggered heat-related health impacts in cities. In coastal areas, flooding and erosion are additional concerns.

References
References
Header image shows cracked mud stretches across sections of the Panamint Valley. Credit: NPS/Kurt Moses; A degree of concern thermometer image credit: Pixabay/geralt

# data[].attributes.attachment_link.keywords[]
intergovernmental panel on climate change

# data[].attributes.attachment_link.description
Vital Signs of the Planet: Global Climate Change and Global Warming. Long-term effects of global climate change in the United States.

# data[].attributes.attachment_link.readable_text
Stop Bullying on the Spot

When adults respond quickly and consistently to bullying behavior they send the message that it is not acceptable. Research shows this can stop bullying behavior over time.

Parents, school staff, and other adults in the community can help kids prevent bullying by talking about it, building a safe school environment, and creating a community-wide bullying prevention strategy.

# data[].attributes.attachment_link.description
StopBullying.gov provides information from various government agencies on bullying, cyberbullying, prevention and response.

# data[].attributes.attachment_link.readable_text
A month long event to prevent childhood bullying and promote kindness, acceptance, and inclusion. On Unity Day, plan to wear and share the color orange - as a tangible representation of the supportive, universal message that our society wants to prevent bullying, and is united for kindness, acceptance, and inclusion.

Get ideas to participate

# data[].attributes.attachment_link.description
A month long event to prevent childhood bullying and promote kindness, acceptance, and inclusion. On Unity Day, plan to wear and share the color orange - as a tangible representation of the supportive, universal message that our society wants to prevent bullying, and is united for kindness, acceptance, and inclusion.

# data[].attributes.attachment_link.readable_text
Molly Burke begins her speech with a blind joke. There is polite, hesitant laughter from the packed gymnasium at St. Joseph's College, an all-girls school in Toronto. Is it okay to laugh at a blind joke, even if the teller is blind? But Molly keeps them coming. "You're the most attractive audience I've ever seen," she quips.

Molly stands, petite and poised, under the basketball net at one end of the gym. At 19, she is barely five feet tall, with fine, expressive features, long dark hair and a wary smile. Microphone in hand, she stares sightlessly out across her audience and, icebreakers over, tells her story without faltering, even when she gets to the tough parts. The rustling of 650 teenage girls in navy sweaters and kilts quickly subsides.

First, Molly describes what it's like not being able to tell shampoo from conditioner in the shower, or how hard it is to put together a matching outfit when you can't see your reflection in the mirror. But when she gets to the part about the bullying-and the one incident in particular that made her see suicide as the only way out-several girls cover their mouths with their hands. According to the latest stats, at least one in three of Molly's audience members has been bullied, too. And while the girls were uneasy about laughing at her jokes, Molly shows them how the students at a school much like their own had no such reservations when it came to bullying a blind girl.

Molly wasn't born blind. She and her brother, Brady, grew up in a pretty brick two-storey in the small, well-to-do town of Oakville, Ont. As a child, Molly climbed every structure in the playground, was an enthusiastic soccer player and rode her red two-wheeler with tasselled handlebars around the neighbourhood. But, even during those early years, there were signs that something wasn't quite right with her eyes.

As a toddler, Molly's depth perception was off; she'd reach for a cookie and miss. She also bumped into things a lot and didn't see well in the dark. "Molly always wanted books held close and under a light when we'd read to her," says her mother, Niamh (a Gaelic name, pronounced Neeve). "I found myself hanging a little closer to her - it was just an instinctive feeling that I had to be nearby." At first, the doctors weren't overly concerned. "I asked one doctor what we should do and he said, 'Well, just give her more light,' " Niamh says. "So we thought, 'Okay, that's simple, we'll give her more light.' "

When Molly was four and a half, someone at the end of an ophthalmoscope finally noticed freckles on the back of her retina. Molly was diagnosed with retinitis pigmentosa, a rare, degenerative eye disease that would eventually dim her world into darkness. "I remember having this sense of very deep sadness," says Molly's father, Peter. "One of the thoughts going through my mind at the time was whether she'd ever be able to see the faces of her own children. It just suddenly hit me, the meaning of what could happen."

Niamh and Peter tried to make Molly's childhood as normal as possible, but it wasn't easy. Things that other kids took for granted, like Halloween, were especially hard. When Molly's friends went trick-or-treating in a pack of princesses and caped crusaders, Peter had to take Molly on her own, guiding her from house to house and counting the steps up to each door. "Halloween just seemed to tear at our hearts the most," Niamh says. "No matter how happy and okay we tried to make it, it always seemed a little sad and lonely." But they took the advice of their daughter's doctor, letting Molly decide what she could - and couldn't - do, and when it was time to give up the things she loved, like soccer. "Whenever she got to that point, we always tried to find something else," Peter says. "We'd start thinking, 'What activity can she do now that she can maybe do for the rest of her life?' "

Molly learned to ride horses at a therapeutic camp and attended a ski school where she was guided to the bottom of the hill with verbal commands. She revelled in the rush of wind and the feel of snowflakes, like cold cobwebs, on her cheeks. Molly even bested her father on the slopes, skiing black diamond runs, fearless and fast. Her desire to do what everyone else was doing was paramount, despite her fading vision. Not long after her diagnosis, Molly was running with her friends in the playground when she slammed, face first, into a metal pole that everyone else had seen and run around. After that, she started having trouble sleeping. "The playground accident was a pivotal moment for Molly," Peter says. "It shook her confidence and made her realize she was vulnerable."

Before long, Molly - and the kids at school - began to notice she was different. When her classmates started learning French, Molly was taken to another room to learn Braille. "At the time, I just thought, 'This is weird, nobody else is doing this,' " she says. "I refused to practise Braille - it made me different, and I just wanted to be like the other kids." Molly did her best to carry on as normal. She became adept at navigating the world with the confidence of someone fully sighted, even memorizing the eye charts at the doctor's office so that nobody realized how quickly her vision was deteriorating. But by age 13, Molly had lost her colours completely: Blue, brown, black and grey all blurred into one. Her world became increasingly shadowy and unfamiliar, and even bright, sunny mornings looked more and more like dusk.

That October, her annual eye exam began as it always did: Molly's name was called and her doctor greeted her, as she had for the last seven years, with a cheery "How's my princess today?" But then she sat down with Molly's file in her hands. "None of us expected what happened," Molly says. "She told us they didn't know how much longer I'd be able to see. I started to cry." On the way home in the car, Molly looked out at the blurred shapes of trees and telephone poles, wondering how much longer she'd see them.

When she got home and called her best friend to break the news, the response was, "Oh. That sucks." Molly could have been calling to say she had the flu. She got the same reaction from the rest of her friends at school. "They couldn't understand why I wasn't the happy, bubbly Molly I'd been before - and it was hard to expect them to, because I didn't understand either. I didn't know why I couldn't be happy, why I didn't want to go out, why all I wanted to do was sleep."

By November, the rumours had started among staff and students alike: Molly was faking it; she was an attention seeker. Although she had a cane, Molly got around fairly well and didn't exhibit any of the 'blindisms' common to those who have never been sighted. Instead of sitting with her head down, hair falling around her face, Molly has impeccable posture, and when you speak to her, she turns to 'look' at you. Her parents were told she has a rare, almost bat-like gift for mobility, using echolocation to find her way in the dark. "When we walk down the street, Molly knows when we pass a tree," Peter says. "I once asked her how, and she told me, 'Dad, everything makes a noise, you just have to listen.' " But her ability often made things more challenging, because it confused people, Niamh says. "It was almost as though she was a little too good at getting around." For Molly, school became a daily struggle to maintain her dignity. Her once tight circle of friends dwindled until there was no one left, and that's when the bullying began.

On Molly's grade 8 school trip to Ottawa, the friends she'd planned to share a room with no longer wanted her in it. When her teachers assigned her to the room anyway, the girls made her sleep under a desk. Molly turned 14 on the trip, and her roommates promised to make her look pretty. She couldn't see that instead of applying makeup, they wrote on her face, and the "product" they put in her hair was whipped cream. "At that point, I felt so low that I didn't have the confidence to stand up for myself. I wasn't good at confrontation, and I felt cornered." Molly went to her guidance counsellor for help, only to be told she had brought the bullying on herself. "That's when I really realized I was in a bad situation: Not only was I being bullied, but nobody believed me."

Molly thought getting a guide dog might make things better. During March Break, she went to the Mira Foundation in Montreal, a guide dog school that takes students under age 16. "Getting a guide dog isn't easy," she says. "People think, 'Oh, you're blind, you get a dog!' But it doesn't work like that." Molly had to live at the school, being tested every day to show she was capable of doing everything from preparing her own meals to crossing the street. She had to prove she could care for both herself and a dog. Molly was the youngest in her class and the only one to pass.

Yet even with Gypsy, a Lab-Bernese mountain dog cross, by her side, things didn't improve at school. Shortly after returning from Montreal, Molly fell down a flight of stairs but refused to go to the doctor. "I figured this would just be another thing they'd say I was faking," she says. Molly walked on her injured foot for two weeks, until she wound up in a cast. She had to leave Gypsy at home, relying instead on her peers to guide her. Molly's teachers had to assign her reluctant classmates to the task, and one day in May, the job fell to her circle, the group of girls who had been her closest friends only eight months before. When it was time for lunch, they informed her that they weren't hungry. Instead of leading her to the cafeteria, they took Molly outside. "I was hungry, but it wasn't up to me. I figured, 'Well, at least I'm hanging out with someone.' "

It was sunny and warm, and Molly started to sweat in her heavy polyester school uniform as she struggled to keep up on her crutches. First the girls led her down the hill she'd tobogganed on every winter, then across the field she and her brother used to play soccer on. When she felt roots underfoot, she knew they had entered the woods at the edge of the field. By then, she was hot and out of breath. Molly sat down under the trees with her crutches beside her - and one of the girls grabbed them. Laughing, her classmates ran deeper into the woods. She heard someone suggest rolling the crutches in dirt; another voice said to roll them in water first so the dirt would stick. Finally, she heard a loud crack - the girls had broken her crutches against a tree. Molly heard the sound of their laughter fade as they ran back to class, leaving her alone and helpless on the ground. "I panicked. I couldn't see, I couldn't stand and I didn't know what to do. I tried listening to see if I could hear anybody around, but there was no one. Then I remembered I had put my cellphone in my jacket pocket."

Niamh was at work when her phone rang. Her daughter was sobbing and talking fast. "I just said, 'Molly, slow down; I'm coming to get you.' " Niamh ran to her car and drove to the school. She doesn't remember stopping for lights, or signs, or anything, really, although she knows she must have. When she got to the school, she didn't go in. She just ran: down the hill and across the soccer field and to the woods. When she found Molly, she scooped her daughter up into her arms and carried her back to the car. Together they decided that Molly would never go back.

At first, Niamh didn't tell anyone what had happened at the school - not the teachers, not even her husband. "Niamh got through it by herself," Peter says. "I think she realized I would probably have gone ballistic." Niamh used Molly's health, which had been poor, as an excuse to keep her home. Besides, there was only a month left of school, and they had already tried talking to her teachers so many times before. "I just couldn't do it anymore," Niamh says. "It was enough. Everything was getting too out of control."

So Niamh kept Molly at home - and watched her carefully. Before what happened in the woods, Molly had already begun cutting herself, wearing long sleeves and layers of bracelets to hide the marks on her arms. "It was scary, and I was ashamed, but I wanted to feel physical pain instead of emotional pain," she says. "I felt so alone and sad. I just wanted not to exist." Then Peter found searches for "how to kill yourself" on Molly's computer. "The doctor told my parents to take away sharp objects, pills and anything I could use to strangle myself," Molly says. "I felt like I was in a bubble, constantly being watched. I wasn't even allowed to close my bedroom door."

Molly's doctors told Niamh and Peter to do anything they could to bring joy back into her life. "I'd read a lot of books on positive thinking and knew I couldn't let my thoughts turn negative, because then I might crumble," says Niamh. "I told Molly, 'We've got to figure out what you need, what you want, what the next step is.' And Molly knew. She said, 'Mom, I'm never going back there; I need to find another school.' So we immediately went out and looked at schools. Anything she came up with, I'd say, 'Okay, we need to do something about it.' I just kept reminding her: 'There are ways out; you're not trapped.' "

Molly transferred to a school for the blind for grade 9. "I thought it would be a place where I could start focusing on myself and stop trying so hard to help everyone else understand." And, at first, it was. Molly's greatest passion was music, and she started writing lyrics. "It was my healthy new way of getting emotions out that I didn't want inside me. I had felt so guilty about being depressed, but then I realized I needed to feel sad and angry, I needed to grieve the loss of the person I'd been, so I could become someone new." Molly started singing in a band. And she started dating, something she'd been convinced would never happen. "One of the boys in my old school had told me, 'No one would ever marry a blind girl, because it's like buying something that's already broken.'"

But before long, the bullying started again. "That's when I realized I wasn't being bullied because I'm different. There's no reason. It's not my haircut, or how I dress, it's just something in the other person, and they've decided to target me." At first, Molly considered leaving the school. Then she printed all the hurtful Facebook posts (she has software that lets her computer 'talk' to her), marched into the principal's office and asked for help. "I thought, 'I've been through this; I've heard these things before, and the first time I ran. This time, I need to deal with it.' " The principal sat Molly down with the girl at the root of the bullying, and they talked about why what she said about Molly wasn't true, about the things they had in common. The two girls started having lunch together and still keep in touch.

Molly decided to switch back to a sighted school for grade 11. Rachel Stinson, a vision itinerant (a teacher trained to help the visually impaired), helped her transition back. Rachel could relate to Molly - her own parents had pulled her out of school because of bullying. "I remember being so broken down by it," she says. "I thought by becoming a teacher I could prevent it from happening to other kids."

Rachel visited Molly's new school and talked to her teachers about how they could best support her. But at the start of each class, it was Molly who stood up and said, "Hey, I'm Molly. I like shopping. I like boys. I like parties. I can't see, and I'm in your class, so please leave this seat empty for me." She knew it would be less effective coming from Rachel. "I wanted them to see that I was just an average kid, like them." In an attempt to create empathy among Molly's peers, Rachel blindfolded the students in her gym class, then sent them out to experience Molly's world. Once in the halls, they instantly became targets. Other students stuck their feet out to trip them, then stole some of the kids' hats. "I think we made a difference that day, but there's so much ignorance out there that it can feel like you're spinning your wheels in mud," Rachel says. Although Molly made lots of friends at her new school, the bullying never stopped completely. One day she was walking down the hall with her mother when a group of kids pushed a container of ketchup and fries into her path, calling out, "Hey, blind girl, watch where you're going," when she stepped in it. "I was used to it, but my mom was really upset. I just said, 'It's fine, Mom. This is what I deal with. But it's okay. I have friends. I have confidence. I believe in myself and I know I'm going somewhere in life.'"

Molly finished high school and contemplated college, but she still felt she had something to prove. Her brother, Brady, long a source of inspiration, had travelled to Africa to work in an orphanage. Molly wanted to do the same but couldn't find an organization that would take her. Then she discovered Me to We, created by the co-founders of Free the Children. Molly was invited to join one of their youth trips to Kenya to help build a school. While there, she spoke at a local girls' school-and discovered what she wanted to do next.

Last September, Molly joined Me to We's speakers' bureau and shared her story about blindness and bullying with 20,000 people at the Air Canada Centre in Toronto. Before she stepped onstage, one of her fellow speakers (Martin Sheen) pulled her aside and asked whether she was nervous. She was. He opened her hand and placed a rosary in it. "It's from Egypt and is made of olive pits and sterling silver," she says. "I've brought it with me to every We Day event since." During Molly's speech, the crowd rewarded her with two standing ovations. Her family were on their feet, too, clapping until their palms stung. "Seeing her speak was just...I was in awe," Peter says. "Molly has a real ability to inspire people and to help others who are going through something, whether it's a disability, or bullying, or a different set of challenges."

Molly was overwhelmed by the response from her audience. "Four years ago, no one even wanted to sit near me, and people thought I wasn't worth anything. Now there were 20,000 people on their feet supporting me. It was a really cool feeling." Whether she's speaking to thousands at a We Day event or telling her story in a school gymnasium, the response is the same.

Back in the gym at St. Joseph's College , Molly's audience is captivated. When she talks about her music, they chant her name until she gives in and sings the first verse of one of her songs, "Let It Go." Her voice is clear and lovely, and when she is done, the gym explodes. When she gets to the Q&A part of her talk, the girls eagerly queue up at the mic. Molly gets the same questions every time: How do you put on makeup? (She uses a sticker code-a foam bump and a hard bump on an eyeshadow palette mean it's Satin Taupe-and a counting system for application: three swipes across her blush compact, then three across her cheek to ensure everything's even.) What does she see when she dreams? (Molly dreams in sounds, smells and emotions. Visual memories usually last only seven years, but Molly has already lost hers -she no longer remembers what she or her parents look like.) They also want to know what she is proudest of, and that's a tough one.

Sitting with Gypsy's head on her lap in her bright, cheery apartment in Toronto, Molly considers the question. She is proud of overcoming her depression, of coming to terms with her blindness, of getting her own place. The apartment is proof of her independence. It smells subtly of lavender ("I burn incense because although I love candles, no one felt comfortable with me having them"), and everything has texture: The pillows on her sofa are covered in stones, shells and embroidery; even her mugs are decorated with raised bumps and swirls. There are also plenty of knick-knacks scattered about. "Because I don't get any visual stimulation, I like to pick things up, so I can appreciate the feel of them."

But most of all, Molly is proud of how she has taken all the hard things that have happened to her and used them to help other people. She has become an inspiration to the bullied and the bullies alike. "I've had kids come up to me afterwards and say, 'Thank you for helping me realize that it does get better, and that I might feel happy again one day.'" She's also been approached by bullies who tell her they didn't realize what they were doing, and that she's inspired them to change. Molly believes the only way to alter attitudes and prevent bullying is to create understanding and empathy by sharing stories like hers. After a recent speech, she was approached by a group of girls from her old school; one had a sister who'd been in Molly's class in grade 8. "The girl said, 'My sister told me to tell you she didn't know what you were going through. She said to tell you she's sorry.' It was an incredible moment for me, because if she's thinking that, maybe others are thinking it too."

Watch more about Molly's cause in this video below:

Get Chatelaine in your inbox!

Our very best stories, recipes, style and shopping tips, horoscopes and special offers. Delivered every weekday morning.

# data[].attributes.attachment_link.title
Blind and bullied: Teenage activist Molly Burke shares her inspirational story - Chatelaine.com

# data[].attributes.attachment_link.description
Molly Burke begins her speech with a blind joke. There is polite, hesitant laughter from the packed gymnasium at St. Joseph's College, an all-girls school in Toronto. Is it okay to laugh at a blind joke, even if the teller is blind? But Molly keeps them coming.

# data[].attributes.headline
Get Involved: National Bullying Prevention

# data[].attributes.subject
Get Involved: National Bullying Prevention

# data[].attributes.attachment_link.readable_text
Students with Solutions
Engaging students to address bullying through sharing writing, artwork and videos
Opportunity for educators to share an activity or video with students. After participating in the activity or viewing the video, students can follow up with their solutions to addressing bullying expressed through writing, artwork or video and be eligible to receive awards and recognition.

Create a World Without Bullying
Community Resource Toolkit
Resources, activities and giveaways for up to 50 participants to share at a school or community event. This kit, which sells for $50, provides adults or students with everything needed to engage individuals to take action steps in their school and community.

Peer Advocacy
Program for social inclusion for students with disabilities
Designed to empower students with skills, training and education to protect students with disabilities from bullying, provide a peer support system and to offer social inclusion opportunities.

The Unity Awards
Honoring outstanding contributions to the cause! An annual event to recognize and celebrate a few of the many individuals who have made outstanding contributions to address and prevent bullying. This event is presented by The Faces of Change - The Youth Advisory Board of PACER's National Bullying Prevention Center.

Run, Walk, Roll Against Bullying
Raising awareness of bullying prevention in your community with a family friendly event. Find a location, gather sponsors, invite participants and hold the event. Consider planning activities for after the race, such as speakers, drawings and more.

Recognizing community members who are leading change! Thank you to the incredible supporters whose valuable contributions help achieve the mission of leading social change to build safe and supportive communities, which are together against bullying and united for kindness, acceptance, and inclusion.

# data[].attributes.attachment_link.title
Get Involved - National Bullying Prevention Center

# data[].attributes.attachment_link.description
Students with Solutions Engaging students to address bullying through sharing writing, artwork and videos Opportunity for educators to share an activity or video with students. After participating in the activity or viewing the video, students can follow up with their solutions to addressing bullying expressed through writing, artwork or video and be eligible to receive awards and recognition.

# data[].attributes.attachment_link.readable_text
Every day, you see how cyberbullying hurts students, disrupts classrooms, and impacts your school's culture. So how should you handle it? What are the right things to do and say? What can you do today that will help your students avoid this pitfall of our digital world?

Learning the steps you need to fight cyberbullying is the first step to a more caring and safer online community! Common Media has a series of tools designed for instructors to fight cyberbullying:

# data[].attributes.attachment_link.description
I earned the Web Activist badge from zthe BULLY Project by learning more about preventing cyber bullying. The BULLY Project is the social action campaign inspired by the award-winning film BULLY. We've sparked a national movement to stop bullying that is transforming kids' lives and changing a culture of bullying into one of empathy and action.

# data[].attributes.attachment_link.readable_text
A comprehensive overview of current bullying prevention research conducted by government and higher education agencies.

Rates of Incidence

One out of every five (20.2%) students report being bullied. (National Center for Educational Statistics, 2019 )

A higher percentage of male than of female students report being physically bullied (6% vs. 4%), whereas a higher percentage of female than of male students reported being the subjects of rumors (18% vs. 9%) and being excluded from activities on purpose (7% vs. 4%). (National Center for Educational Statistics, 2019)

41% of students who reported being bullied at school indicated that they think the bullying would happen again. (National Center for Educational Statistics, 2019 )

Of those students who reported being bullied, 13% were made fun of, called names, or insulted; 13% were the subject of rumors; 5% were pushed, shoved, tripped, or spit on; and 5% were excluded from activities on purpose. (National Center for Educational Statistics, 2019)

A slightly higher portion of female than of male students report being bullied at school (24% vs. 17%). (National Center for Educational Statistics, 2019)

Bullied students reported that bullying occurred in the following places: the hallway or stairwell at school (43%), inside the classroom (42%), in the cafeteria (27%), outside on school grounds (22%), online or by text (15%), in the bathroom or locker room (12%), and on the school bus (8%). (National Center for Educational Statistics, 2019)

46% of bullied students report notifying an adult at school about the incident. (National Center for Educational Statistics, 2019)

School-based bullying prevention programs decrease bullying by up to 25%. (McCallion & Feder, 2013)

The reasons for being bullied reported most often by students include physical appearance, race/ethnicity, gender, disability, religion, sexual orientation. (National Center for Educational Statistics, 2019)

The federal government began collecting data on school bullying in 2005, when the prevalence of bullying was around 28 percent. (U.S. Department of Education, 2015 )

Rates of bullying vary across studies (from 9% to 98%). A meta-analysis of 80 studies analyzing bullying involvement rates (for both bullying others and being bullied) for 12-18 year old students reported a mean prevalence rate of 35% for traditional bullying involvement and 15% for cyberbullying involvement. (Modecki, Minchin, Harbaugh, Guerra, & Runions, 2014 )

One in five (20.9%) tweens (9 to 12 years old) has been cyberbullied, cyberbullied others, or seen cyberbullying. (Patchin & Hinduja, 2020)

49.8% of tweens (9 to 12 years old) said they experienced bullying at school and 14.5% of tweens shared they experienced bullying online. (Patchin & Hinduja, 2020)

13% of tweens (9 to 12 years old) reported experiencing bullying at school and online, while only 1% reported being bullied solely online. (Patchin & Hinduja, 2020)

Effects of Bullying

Students who experience bullying are at increased risk for depression, anxiety, sleep difficulties, lower academic achievement, and dropping out of school. (Centers for Disease Control, 2019)

Students who are both targets of bullying and engage in bullying behavior are at greater risk for both mental health and behavior problems than students who only bully or are only bullied. (Centers for Disease Control, 2019)

Bullied students indicate that bullying has a negative effect on how they feel about themselves (27%), their relationships with friends and family (19%), their school work (19%), and physical health (14%). (National Center for Educational Statistics, 2019)

Students who experience bullying are twice as likely as non-bullied peers to experience negative health effects such as headaches and stomachaches. (Gini & Pozzoli, 2013 )

Youth who self-blame and conclude they deserved to be bullied are more likely to face negative outcomes, such as depression, prolonged victimization, and maladjustment. (Perren, Ettakal, & Ladd, 2013 )

Tweens who were cyberbullied shared that it negatively impacted their feelings about themselves (69.1%), their friendships (31.9%), their physical health (13.1%), and their schoolwork (6.5%). (Patchin & Hinduja, 2020).

Cyberbullying

Among students ages 12 - 18 who reported being bullied at school, 15% were bullied online or by text (National Center for Educational Statistics, 2019)

Reports of cyberbullying are highest among middle school students, followed by high school students, and then primary school students (Centers for Disease Control, 2019)

The percentages of individuals who have experienced cyberbullying at some point in their lifetimes have more than doubled (18% to 37%) from 2007-2019 (Patchin & Hinduia, 2019 )

When students were asked about the specific types of cyberbullying they had experienced, mean and hurtful comments (25%) and rumors spread online (22%) were the most commonly-cited (Patchin et al., 2019 )

The type of cyberbullying tends to differ by gender. Girls were more likely to say someone spread rumors about them online while boys were more likely to say that someone threatened to hurt them online (Patchin et al., 2019 )

Those who are cyberbullied are also likely to be bullied offline (Hamm, Newton, & Chisholm, 2015 )

Cyberbullying Among Tweens (9-12 Years Old)

One in five tweens (20.9%) has been cyberbullied, cyberbullied others, or seen cyberbullying

49.8% of tweens said they experienced bullying at school and 14.5% of tweens shared they experienced bullying online

13% of tweens reported experiencing bullying at school and online, while only 1% reported being bullied solely online

Nine out of ten tweens use social media or gaming apps (Patchin & Hinduja, 2020)

Tweens shared they were engaging on the following sites, apps, or games: YouTube, Minecraft, Roblox, Google Classroom, Fortnite, TikTok, YouTube Kids, Snapchat, Facebook Messenger Kids, Instagram, Discord, Facebook, and Twitch

Tweens who were cyberbullied shared that it negatively impacted their feelings about themselves (69.1%), their friendships (31.9%), their physical health (13.1%), and their schoolwork (6.5%)

Tweens reported using a variety of strategies to stop the bullying including blocking the person bullying them (60.2%), telling a parent (50.8%), ignoring the person (42.8%), reporting it to the website or app (29.8%), and taking a break from the device (29.6%)

Two-thirds of tweens are willing to step in to defend, support, or assist those being bullied at school and online when they see it

Barriers to helping when tweens witness bullying at school or online included being afraid of making things worse, not knowing what to do or say, not knowing how to report it online, being afraid others kids will make fun of them, being afraid to get hurt, and not knowing who to tell

SOURCE: Patchin, J.W., & Hinduja, S. (2020). Tween Cyberbullying in 2020. Cyberbullying Research Center and Cartoon Network. Retrieved from: https://i.cartoonnetwork.com/stop-bullying/pdfs/CN_Stop_Bullying_Cyber_Bullying_Report_9.30.20.pdf.

Bullying of Students with Disabilities

Students with specific learning disabilities, autism spectrum disorder, emotional and behavior disorders, other health impairments, and speech or language impairments report greater rates of victimization than their peers without disabilities longitudinally and their victimization remains consistent over time (Rose & Gage, 2016 )

When assessing specific types of disabilities, prevalence rates differ: 35.3% of students with behavioral and emotional disorders, 33.9% of students with autism, 24.3% of students with intellectual disabilities, 20.8% of students with health impairments, and 19% of students with specific learning disabilities face high levels of bullying victimization (Rose & Espelage, 2012 )

Researchers discovered that students with disabilities were more worried about school safety and being injured or harassed by other peers compared to students without a disability (Saylor & Leach, 2009 )

When reporting bullying youth in special education were told not to tattle almost twice as often as youth not in special education (Davis & Nixon, 2010)

Successful strategies to prevent bullying among students with disabilities include (Rose & Monda-Amaya, 2012):

Teachers and peers engaging in meaningful and appropriate social interactions

Creating opportunities to increase social competence and positive interactions

Schools adopting appropriate intervention strategies that encourage social awareness and provide individualized interventions for targets with disabilities

Bullying of Students of Color

23% of African-American students, 23% of Caucasian students, 16% of Hispanic students, and 7% of Asian students report being bullied at school (National Center for Educational Statistics, 2019)

More than one third of adolescents reporting bullying report bias-based school bullying (Russell, Sinclair, Poteat, & Koenig, 2012 )

Bias-based bullying is more strongly associated with compromised health than general bullying (Russell et al., 2012 )

Race-related bullying is significantly associated with negative emotional and physical health effects (Rosenthal et al, 2013 )

Bullying of Students Who Identify or Are Perceived as LGBTQ

70.1% of LGBTQ students were verbally bullied (e.g., called names, threatened) in the past year because of their sexual orientation and 59.1% because of their gender expression, and 53.2% based on gender (Kosciw, Greytak, Zongrone, Clark, & Truong, 2018)

28.9% of LGBTQ students were physically bullied (e.g., pushed, shoved) in the past year because of their sexual orientation and 24.4% because of their gender expression, and 22.8% based on gender (Kosciw et al., 2018)

48.7% of LGBTQ students experienced cyberbullying in the past year (Kosciw et al., 2018)

59.5% of LGBTQ students feel unsafe at school because of their sexual orientation, 44.6% because of their gender expression, and 35% because of their gender (Kosciw et al., 2018)

34.8% of LGBTQ students missed at least one entire day at school in the past month because they felt unsafe or uncomfortable, and 10.5% missed four or more days in the past month (Kosciw et al., 2018)

Of the LGBTQ students who reported they were considering dropping out of school, 42.2% indicated they were doing so because of the harassment they faced at school (Kosciw et al., 2018)

Compared to LGBTQ students with no supportive school staff, students with many (11 or more) supportive staff at school were less likely to miss school because they felt unsafe (20.1% to 48.8%) and felt greater belonging to their school community (Kosciw et al., 2018)

LGBTQ students experienced a safe, more positive school environment when their school had a bullying prevention / anti-harassment policy that specifically included protections on sexual orientation and gender identity / expression (Kosciw et al., 2018)

Peer victimization of all youth was less likely to occur in schools with bullying policies that are inclusive of LGBTQ students (Hatzenbuehler & Keyes, 2013 )

Bullying and Suicide

There is a strong association between bullying and suicide-related behaviors, but this relationship is often mediated by other factors, including depression, violent behavior, and substance abuse (Reed, Nugent, & Cooper, 2015)

Students who report frequently bullying others and students who report being frequently bullied are at increased risk for suicide-related behavior (Centers for Disease Control, 2014)

A meta-analysis found that students facing peer victimization are 2.2 times more likely to have suicide ideation and 2.6 times more likely to attempt suicide than students not facing victimization (Gini & Espelage, 2014 )

Students who are both bullied and engage in bullying behavior are the highest risk group for adverse outcomes (Espelage & Holt, 2013)

The false notion that suicide is a natural response to being bullied has the dangerous potential to normalize the response and thus create copycat behavior among youth (Centers for Disease Control, 2014).

Interventions

Bullied youth were most likely to report that actions that accessed support from others made a positive difference (Davis & Nixon, 2010)

Actions aimed at changing the behavior of the bullying youth (fighting, getting back at them, telling them to stop, etc.) were rated as more likely to make things worse (Davis & Nixon, 2010)

Students reported that the most helpful things teachers can do are: listen to the student, check in with them afterwards to see if the bullying stopped, and give the student advice (Davis & Nixon, 2010)

Students reported that the most harmful things teachers can do are: tell the student to solve the problem themselves, tell the student that the bullying wouldn't happen if they acted differently, ignored what was going on, or tell the student to stop tattling (Davis & Nixon, 2010)

As reported by students who have been bullied, the self-actions that had some of the most negative impacts (telling the person to stop/how I feel, walking away, pretending it doesn't bother me) are often used by youth and often recommended to youth (Davis & Nixon, 2010)

Tweens reported using a variety of strategies to stop the bullying including blocking the person bullying them (60.2%), telling a parent (50.8%), ignoring the person (42.8%), reporting it to the website or app (29.8%), and taking a break from the device (29.6%) (Patchin & Hinduja, 2020).

Bystanders

Students need not be the targets of bullying to experience negative outcomes. Observing bullying is associated with adverse mental health outcomes (Rivers, Poteat, Noret, & Ashurst, 2009 )

Bystanders' beliefs in their social self-efficacy were positively associated with defending behavior and negatively associated with passive behavior from bystanders - i.e. if students believe they can make a difference, they're more likely to act (Thornberg et al., 2012 )

Students who experience bullying report that allying and supportive actions from their peers (such as spending time with the student, talking to him/her, helping him/her get away, or giving advice) were the most helpful actions from bystanders (Davis & Nixon, 2010)

Students who experience bullying are more likely to find peer actions helpful than educator or self-actions (Davis & Nixon, 2010)

The Youth Voice Research Project (2010) found that victimized students reported the following bystander strategies that made things better: spent time with me (54%), talked to me (51%), helped me get away (49%), called me (47%), gave me advice (46%), helped me tell (44%), distracted me (43%), listened to me (41%), told an adult (35%), confronted them (29%), asked them to stop

Even students who have observed but not participated in bullying behavior report significantly more feelings of helplessness and less sense of connectedness and support from responsible adults than students who have not witnessed bullying behavior (Centers for Disease Control, 2014)

Two-thirds of tweens are willing to step in to defend, support, or assist those being bullied at school and online when they see it (Patchin & Hinduja, 2020).

Barriers to helping when tweens witness bullying at school or online included being afraid of making things worse, not knowing what to do or say, not knowing how to report it online, being afraid others kids will make fun of them, being afraid to get hurt, and not knowing who to tell (Patchin & Hinduja, 2020).

References:

Centers for Disease Control, National Center for Injury Prevention and Control (2019). Preventing bullying. Retrieved from https://www.cdc.gov/violenceprevention/pdf/yv/bullying-factsheet508.pdf.

Centers for Disease Control and Prevention, National Center for Injury Prevention and Control (2014). The Relationship Between Bullying and Suicide: What we Know and What it Means for Schools. Retrieved from https://stacks.cdc.gov/view/cdc/34163.

Davis, S., & Nixon, C. (2010). The youth voice research project: Victimization and strategies. Retrieved from: http://njbullying.org/documents/YVPMarch2010.pdf.

Hatzenbuehler, M. L., & Keyes, K. M. (2013). Inclusive anti-bullying policies and reduced risk of suicide attempts in lesbian and gay youth. Journal of Adolescent Health, 53, 21-26. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3696185/?tool=pmcentrez .

Kosciw, J. G., Greytak, E. A., Zongrone, A. D., Clark, C. M., & Truong, N. L. (2018). The 2017 National School Climate Survey: The experiences of lesbian, gay, bisexual, transgender, and queer youth in our nation's schools. New York: GLSEN. Retrieved from https://www.glsen.org/sites/default/files/2019-10/GLSEN-2017-National-School-Climate-Survey-NSCS-Full-Report.pdf.

McCallion, G., & Feder, J. (2013). Student bullying: Overview of research, federal initiatives, and legal issues. Congressional Research Service. Retrieved from http://www.fas.org/sgp/crs/misc/R43254.pdf.

Patchin, J.W., & Hinduja, S. (2020). Tween Cyberbullying in 2020. Cyberbullying Research Center and Cartoon Network. Retrieved from: https://i.cartoonnetwork.com/stop-bullying/pdfs/CN_Stop_Bullying_Cyber_Bullying_Report_9.30.20.pdf.

Rose, C. A., & Espelage, D. L. (2012). Risk and protective factors associated with the bullying involvement of students with emotional and behavioral disorders. Behavioral Disorders, 37, 133-148. Retrieved from https://eric.ed.gov/?id=EJ989490

Russell, S. T., Sinclair, K., Poteat, P., & Koenig, B. (2012). Adolescent health and harassment based on discriminatory bias. American Journal of Public Health, 102(3), 493-495. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/22390513 .

Thornberg, T., Tenenbaum, L., Varjas, K., Meyers, J., Jungert, T., & Vanegas, G. (2012). Bystander motivation in bullying incidents: To intervene or not to intervene? Western Journal of Emergency Medicine, 8(3), 247-252. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3415829/ .

U.S. Department of Education, (2015). New data show a decline in school-based bullying. Retrieved from https://www.ed.gov/news/press-releases/new-data-show-decline-school-based-bullying .

Updated: November, 2020

# data[].attributes.attachment_link.description
Almost one out of every four students (22%) report being bullied during the school year (National Center for Educational Statistics, 2015). Rates of bullying vary across studies (from 9% to 98%).

# data[].attributes.attachment_link.title
ERROR: The request could not be satisfied

# data[].attributes.attachment_link.readable_text
Why Gender Equality

Everyday, women and girls around the world face violence and discrimination. 1 in 3 women will experience physical or sexual violence in their lifetime, regardless of age, background or country, and every country in the world has laws that treat women and girls as second-class citizens. Sexual exploitation, violence, harmful cultural practices and systemic inequalities violate their human rights and prevent them from reaching their potential.

This kind of inequality is bad for everyone, not just for women: research shows that where women and girls are treated unfairly, there is more societal conflict and less economic stability.
When societies treat women and girls fairly, there is less societal conflict and more economic stability. At Equality Now we use the power of the law to dismantle deep rooted discrimination and inequality and build a just world for women and girls.

# data[].attributes.attachment_link.description
Everyday, women and girls around the world face violence and discrimination. 1 in 3 women will experience physical or sexual violence in their lifetime, regardless of age, background or country, and every country in the world has laws that treat women and girls as second-class citizens.

# data[].attributes.headline
Gender Inequality & Women In the U.S. Labor Force

# data[].attributes.subject
Gender Inequality & Women In the U.S. Labor Force

# data[].attributes.attachment_link.title
Gender Inequality and Women in the US Labor Force

# data[].attributes.attachment_link.description
Gender pay gaps persist around the world, including in the United States. According to public information collected by the International Trade Union Confederation (ITUC), the global gender pay gap ranges from 3 percent to 51 percent with a global average of 17 percent (ITUC 2009).

# data[].attributes.attachment_link.readable_text
SARAH LARSEN, REPORTER: These days we tend to think of boys and girls as being pretty much equal. You can both get an education. When you turn 18 you'll both be able to vote. You'll both be able to work in just about any field you want. And either one of you could become the prime minister. But it wasn't that long ago that the scales weren't nearly so even.

If you were a woman in the 1800's you couldn't have done the same things as men. Your main job would have been seen as getting married and having children. Then, everything you had would belong to your husband. You wouldn't even be allowed to vote. And it was in the late 1800's that many women started to demand change. They called them suffragettes.

REPORTER: Suffrage means the right to vote for politicians to represent you. In a democracy every vote counts and it means your opinion is just as important as anyone else's.

Some argued that women shouldn't be allowed to vote because they were too emotional and not smart enough to understand politics and that their place was at home. But the suffragettes fought hard to change their minds. They debated, wrote articles and petitions, protested, even faced arrest. And eventually it paid off.

REPORTER: It was in this building 119 years ago that the Government of South Australia became one of the first in the world to give women the right to vote and the first anywhere to also give them the right to run for parliament.

It was the first tip of the scales towards equality. The first and then the second world wars had a big effect on the role of women in society. With so many men called off to fight, women were asked to do all sorts of jobs they ever done before. Many enjoyed what they did. And they were good at it.

But when the war was over they were expected to go back to being housewives. They could learn, they could vote and they could work but women still weren't equal. They faced discrimination in the workplace and the media. They were generally paid less than men for doing the same job and were expected to stop working when they got married.

LINE FROM THE INDESTRUCTIBLE MAN: Just about an hour ago I had you fired. What? Why did you do that? I thought being my wife would take up all of your time.

In the 60's and 70's women again fought for their rights. There were some big revolutions like the birth control pill which meant women could control when they had children. Women protested for equal pay, equal opportunities, even the right to drink in bars with men.

And the world kept changing. Women led countries and businesses. They went to space and they were ordained as religious leaders. Australia got female judges and a governor general and three years ago the country elected its first ever female prime minister.

So do women now have equal rights with men? Some say yes. It's now against the law in Australia to discriminate against women. But others say not quite. On average women still earn less money than men. Fewer women run big companies and fewer sit in parliament.

And some reckon women are still judged differently to men. But at least in Australia the scales are definitely more even than they were and you can enjoy your equality thanks to the efforts of the many Aussie women who went before.

# data[].attributes.attachment_link.description
There's been a lot of talk in the media recently about whether women are treated equally to men. It's called sexism and it's something even the Prime Minister says she's been a victim of. But while people disagree about how fairly women are treated today there's no doubt they weren't treated equally in the past.

# data[].attributes.attachment_link.readable_text
A look back at history shows that women have made great strides in the fight for equality, including women's suffrage and inroads in equal opportunity in the workplace and education.

Despite the tremendous progress made in the struggle for gender equality, women still face violence, discrimination, and institutional barriers to equal participation in society.

Through litigation, advocacy, and public education, the ACLU Women's Rights Project pushes for change and systemic reform in institutions that perpetuate discrimination against women, focusing its work in the areas of employment, violence against women, and education.

In the employment realm, laws and workplace policies that exclude women from certain job sectors and allow them to be forced out of the workplace when they become pregnant or return to work after having a baby cause persistent disparities in women's income, wealth, and economic security.

Survivors of gender-based violence face discrimination when police, schools, landlords, and other institutions fail to adequately address and prevent violence and also when laws and policies penalize them, impeding the ability of women and girls to live safely and with dignity.

In the education sector, many public schools have introduced programs based on unfounded stereotypes about the learning abilities and preferences of boys and girls, limiting equal educational opportunities for all.

# data[].attributes.attachment_link.title
Women's Rights | American Civil Liberties Union

# data[].attributes.attachment_link.description
Today, gender bias continues to create huge barriers for many women. Ongoing struggles include ensuring equal economic opportunities, educational equity, and an end to gender-based violence.

# data[].attributes.attachment_link.description
Women's rights activists have continued the call for full-fledged equality from voting rights to fair treatment in the workplace and the pursuit of reproductive

# data[].attributes.attachment_link.readable_text
This year's International Women's Day theme was Balance for Better, which focused on bringing gender balance to business, education, government and beyond.

As this March marks 2019's Women's History Month, I turn my attention to the women making history today - the woman leading the charge for innovation and global progress in gender equality.

These are some the female activists to look out for right now.
Yara Shahidi
An actor, an activist and a Harvard student, Yara Shahidi has packed a lot into her 18 years. After finding initial success on the US sitcom Black-Ish, Yara has used her considerable platform to bring attention to important issues such as structural racism and gender equality. She has worked alongside Michelle Obama on the Let Girls Learn initiative as well as in conjunction with the UN to create a Young Women's Leadership Network, which encourages young women from low income communities to access better opportunities.

Her forthrightness, conviction and wisdom make her a role model for young people - particularly people of colour - wanting to make an impact on the world.
Sampat Pal Devi
After witnessing a man in her North Indian village beat his wife, Sampat Pal Devi founded the Gulabi Gang: a vigilante group of women who protect the powerless and fight against traditions such as child marriage and domestic violence.Recognisable by their pink saris, these women offer support and training to others to ensure they have the skills and confidence to support and protect themselves.

Sampat was taken out of school to marry at the age of 12 and had her first child at 15, so now tirelessly campaigns to prevent other young girls experiencing the same fate.

Since its conception in 2006, the Gulabi Gang has gained thousands of members, all of whom work throughout the Uttar Pradesh region to ensure social justice.

It is Sampat's ability to use her own negative experiences to affect positive change that makes her such a uniquely inspiring person.

Find out more about the Gulabi Gang here.
Marley Dias
Disappointed with the lack of diversity in children's books, in 2015, Marley Dias started a social media campaign with the hashtag #1000BlackGirlBooks, encouraging people to bring forward any books they knew of that had a black female protagonist.

Now four years old, the drive has collected over 10,000 books - many of which have found their way to the hands of girls in Africa. As an avid reader and passionate feminist, Marley continues to speak publicly for the need for more diverse representation in popular culture - perhaps most notably, at the United State of Women Summit. She was named on the Forbes' 30 under 30 in 2018 as one of the most influential young people in media.
Leymah Gbowee
Leymah has spent the majority of her adult life fighting for gender equality in Liberia but it was her work leading the Women of Liberia Mass Action for Peace movement, which helped end the second Liberian Civil War, that brought her global recognition in the form of the 2011 Nobel Peace Prize. Since then, she has gone on to found the Gbowee Peace Foundation Africa, which provides education and leadership opportunities to women, girls and young people in West Africa. As a member of the African Women's Leadership Network and the African Feminist Forum, she has used her position of power to speak up for the marginalised and silenced people in her community. Today she continues to travel the world, bringing to light the issues of gender inequality and gender based violence.

It is her steady, peaceful protests that highlight her as a fearless pioneer for good and a spokesperson for the vulnerable.
Manal al-Sharif
Manal grew up in Saudi Arabia, where women's rights are continually kept tightly reined in by the men who seek to control them. After founding and leading the #Women2Drive movement back in 2011, Manal was imprisoned for 'driving whilst female' and only released on the condition that she never drive or speak of the driving ban again. Despite this, Manal continued with her campaign and helped bring about the end to Saudi's women driving ban in 2018. Since then, she has continued to speak out against oppression of Arabian women and put pressure on governmental bodies to give women more control and freedom over their own live

... Read More

# data[].attributes.attachment_link.title
Change Makers: The Female Activists Fighting For Gender Equality

# data[].attributes.attachment_link.description
This year's International Women's Day theme was Balance for Better, which focused on bringing gender balance to business, education, government and beyond. As this March marks 2019's Women's History Month, I turn my attention to the women making history today - the woman leading the charge for innovation and global progress in gender equality.

# data[].attributes.attachment_link.provider_name
Pew Research Center's Social & Demographic Trends Project

# data[].attributes.attachment_link.readable_text
Democrats sharply divided along educational lines on whether life is easier for men than for women

Women in the United States have made significant strides toward closing the gaps that have kept them from achieving equality with men. But the country is sharply divided over how much work remains to be done, and those divisions are rooted mainly in the growing partisan schism that pervades American values and culture these days.

A new Pew Research Center survey finds that Democrats are largely dissatisfied with the nation's progress on this issue - 69% say the country hasn't gone far enough when it comes to giving women equal rights with men. Among Republicans, more than half (54%) say things are about right, while only 26% say the country has more work to do.

Democrats are also much more likely than Republicans to say that men have easier lives than women these days: 49% of Democrats say this compared with 19% of Republicans. A majority of Republicans (68%) say neither men nor women have it easier today (compared with 45% of Democrats). Those who see an advantage for men often say these inequities are rooted in the workplace.

Politics also underpins views about who has benefited from the changing roles of men and women. Among Democrats and Republicans, more see an upside for women than for men as women have taken on a greater role in the workplace and men have assumed more responsibility for child care and housework, but Democrats are far more likely than Republicans to see benefits flowing from this societal shift.

Roughly six-in-ten Democrats (58%) say that changing gender roles have made it easier for women to lead satisfying lives; about a third of Republicans (36%) say the same. And while about half of Democrats (48%) say these changes have made it easier for men to lead satisfying lives, only 30% of Republicans share this view. In addition, Democrats are more likely than Republicans to say changing gender roles have made it easier for parents to raise children, for marriages to be successful and for families to earn enough money to live comfortably.

To be sure, men and women have different perspectives on how far the country has come in achieving gender equality, but these differences are relatively narrow when partisanship is considered. More than half of women (57%) say the country hasn't done enough to give women equal rights with men, while 33% say things are about right. For their part, men are equally split between saying there is more work to be done (42%) and things are about right (44%). And women are much more likely than men to say that men have it easier these days (41% vs. 28%). Among Democrats, a majority of women (74%) and men (64%) say the country hasn't gone far enough when it comes to achieving gender equality. And while Republican women are more likely than their male counterparts to share this view (33% vs. 20%), relatively small shares of each group do so.

The nationally representative survey of 4,573 adults was conducted online Aug. 8-21 and Sept. 14-28, 2017, using Pew Research Center's American Trends Panel. Among the key findings:

Democrats are divided along educational lines in their views on gender equality

About eight-in-ten Democrats with a bachelor's degree or higher (81%) and 73% of those with some college experience say the country has not gone far enough in giving women equal rights with men; 55% of those with a high school degree or less education say the same. Among Republicans, views are consistent across educational groups.

The education gap among Democrats is even wider when it comes to whether men or women have easier lives these days. Among Democrats with a bachelor's degree or higher, 69% say men have it easier. By comparison, 52% of Democrats with some college education and only 27% of those with a high school degree or less education say the same. Again, Republicans are more consistent in their views, regardless of educational attainment.

Democrats are also divided in their assessments of how the changing roles of men and women have affected women's lives. Roughly seven-in-ten Democrats with a four-year college degree (71%) say these changes have made it easier for women to live satisfying lives. Only about half of Democrats with some college experience (54%) or less education (49%) share that view.

Republican views of the benefits of changing gender roles are also divided along educational lines. Those with a bachelor's or higher degree are more likely than those with less education to say the changing roles of men and women have had a positive impact, particularly when it comes to women's success at work: 62% of Republicans with at least a bachelor's degree say these changes have made it easier for women to be successful at work, compared with 49% of those with less education.

Millennial women are more likely than those in older generations to say men have it easier these days

In spite of the gains women have made in the labor force in recent decades, today's young women are no less likely than older generations to say the country has more work to do in bringing about gender equality. And Millennial women are significantly more likely than Generation X, Baby Boomer or Silent Generation women to say that men have it easier than women these days - roughly half (52%) of Millennial women say this compared with 37% or fewer among the older generations.

The views of Millennial women differ sharply from those of Millennial men on the question of whether changing gender roles have made it easier for women to live more satisfying lives. While 61% of Millennial men say women have benefited from these changes, only 48% of Millennial women agree. Among older generations of adults, there is no similar gender gap.

Views of the country's progress on gender equality are linked to personal experiences with gender discrimination

Overall, about four-in-ten women (43%) say they have experienced discrimination or been treated unfairly because of their gender; far smaller shares of men (18%) say this has happened to them. Democratic women are significantly more likely than Republican women to say they have experienced gender discrimination (51% vs. 34%). Among men, it's Republicans who more often say they have been discriminated against because of their gender (20% compared with 14% of Democratic men).

Among women who say they have faced gender-based discrimination or unfair treatment, a solid majority (71%) say the country hasn't gone far enough when it comes to giving women equal rights with men. About half (46%) of women who don't share these experiences say the same.

And while a relatively small share of the public says the country has gone too far when it comes to gender equality, men who say they have been discriminated against because of their gender are particularly likely to hold this view: 23% among this group say it has gone too far, compared with one-in-ten men who say they haven't experienced gender discrimination.

Experiences with gender discrimination are often related to workplace practices

Among both women and men who say they have faced discrimination because of their gender, more cite situations related to hiring, pay or promotion than any other example of unfair treatment they have experienced.

About four-in-ten women (38%) who say they have experienced discrimination or have been treated unfairly because of their gender cite experiences in the workplace, and this is particularly the case among older women. About half of Boomer women (51%) who say they have faced gender discrimination cite situations related to hiring, pay or promotion, compared with 36% of Gen X and 26% of Millennial women.

Among men who say they have faced gender discrimination, experiences related to the workplace are by far the most common. About a third of these men (35%) say they were discriminated against or treated unfairly in hiring, pay or promotion. By comparison, 7% say people made assumptions about their personality because of their gender, the second-most cited example among men who say they have experienced gender discrimination.

Women have made gains in the labor force, while men have seen losses; still, inequality persists

In many ways, the workplace has represented the front lines in the battle for gender equality in the U.S. Over the past half century, the role of women in the workplace has been transformed as they have increased their labor force participation, seen their wages increase and made inroads into occupations that were previously dominated by men. Even so, women still lag behind in several key leadership realms.

Today women make up 47% of the U.S. labor force - up from 30% in 1950. The share of women in the labor force grew throughout the second half of the 20th century, but has leveled off since then. Previous analysis by the Center indicates that in the coming decades women will continue to be slightly less than half of the labor force and that their share may even dip below the current 47%.

This overall trend is linked to labor force participation, another area where women have seen tremendous growth over the past several decades - narrowing the gap with their male counterparts. In 2016, 57% of women (ages 16 and older) were either employed or looking for work. That share is higher than it was in 1980 (51%) but down somewhat from its peak of 60% in 1999.

Over the period in which women's labor force participation was increasing, men's presence in the labor force was on the decline, and this trend among men has since continued. In 1980, 77% of men (ages 16 and older) were employed or looking for work; in 2016, 69% were in the labor force. The falloff in men's labor force participation has been particularly sharp among men with no education beyond high school.

Gender gaps persist in earnings and hours worked

As women have increased their presence in the labor force, they've seen their wages grow. At the same time, men's wages have fallen. In 2016, women's median hourly earnings were $16.00, up from $12.48 in 1980. Men earned a median hourly wage of $19.23 in 2016, down slightly from $19.42 in 1980. Wages have declined more sharply for young men (those ages 25 to 34) than for other age groups. In 2016, young men earned, on average, $17.31 per hour, compared with $20.81 in 1980.

Higher earnings for women and lower earnings for men have resulted in a narrower gender wage gap. In 2016, women earned, on average, 83 cents for every dollar earned by men. In 1980 women earned 64 cents for every dollar earned by men.

Still, the gender wage gap persists, and the reasons for that are complex. Women's earnings tend to decline roughly 10 years into their work lives as many face the challenges and trade-offs that come with balancing work and family life. There are also other factors that are difficult to quantify, such as gender discrimination, the persistence of gender stereotypes and women's limited access to male-dominated professional networks.

The gains women have made in wages have been driven in part by their increased presence in more lucrative occupations. Today, women are just as likely as men to be working in managerial occupations. In 1980, men were twice as likely as women to have these types of jobs. In the past, women were more highly concentrated in lower-paying clerical or administrative occupations than they are today.

Men still dominate top leadership positions

Even as women have made inroads in a wide range of leadership positions in recent decades, the gender gap remains quite wide in this area. Women made up roughly 5% of Fortune 500 CEOs in the first quarter of 2017 and about 20% of Fortune 500 board members in 2016. Only about 20% of members of Congress and about a quarter of members of state legislatures are women. Currently, there are six female governors and four females in executive branch Cabinet-level positions (not including those serving acting positions).

Click here for a more detailed look at data on women leaders.

Little consensus on views of the current state of gender equality

Americans across demographic and partisan groups agree that women should have equal rights with men. About eight-in-ten Americans (82%) say it is very important for women to have equal rights with men in our country, and another 14% say this is somewhat important. Just 4% of Americans say gender equality is not too or not at all important.

Asked whether the country has gone too far, not gone far enough or been about right when it comes to giving women equal rights with men, half of the public says the country still has work to do, while 39% say things are about where they should be; one-in-ten Americans believe the country has gone too far in giving women equal rights with men. These views differ by gender, education and, most of all, partisanship.

About seven-in-ten Democrats or Democratic-leaning independents (69%) say the country hasn't gone far enough when it comes to giving women equal rights with men, compared with 26% of Republicans and independents who lean Republican. In turn, just over half of Republicans (54%) - vs. 26% of Democrats - say things are about right and 18% say the country has gone too far in giving women equal rights with men (just 4% of Democrats say the country has gone too far).

Among Democrats, those with at least some college education are far more likely than those with no college experience to express dissatisfaction with the current state of gender equality. About eight-in-ten Democrats with a bachelor's degree or more education (81%) and roughly three-quarters of those with some college (73%) say the country hasn't gone far enough when it comes to giving women equal rights with men. A far smaller share of Democrats with a high school diploma or less education (55%) share this view. There are no significant education gaps among Republicans in views of the state of gender equality.

The survey also finds that men and women express considerably different views about the current state of gender equality, but this gender gap narrows when partisanship is taken into account. Overall, among women, far more say the country hasn't gone far enough (57%) than say it has been about right (33%) when it comes to giving women equal rights. Men, however, are about evenly divided: 42% say the country hasn't gone far enough and 44% say it's been about right.

Among Democrats, a somewhat higher share of women than men say the country has work to do to achieve gender equality, but majorities of both groups say this is the case (74% of Democratic women and 64% of Democratic men). And while Republican women are more likely than their male counterparts to say the country hasn't gone far enough when it comes to giving women equal rights with men, relatively small shares in each group express this view (33% and 20%, respectively). About one-in-five Republican men (22%) and 14% of Republican women say the country has gone too far.

Roughly a third of adults say men have it easier in our country these days; 9% say women do

Far more Americans say men have it easier in our country these days than say things are easier for women (35% vs. 9%); still, a majority (56%) say there is no difference. Perceptions vary considerably by gender, educational attainment and partisanship.

Women are more likely than men to say men have it easier: 41% of women say this is the case, compared with about a quarter of men (28%). And while relatively few men or women say women have it easier, men are about three times as likely as women to offer this view (14% vs. 5%, respectively).

Partisanship also plays a large role in perceptions of how things are going for men and women in the U.S. Among Democrats and Democratic-leaning independents, similar shares say men have it easier (49%) as say there is no difference (45%). In contrast, most Republicans and Republican-leaning independents (68%) say there is no difference, while 19% say men have it easier and 12% say women do.

Adults with a bachelor's degree or more education are far more likely than those with less education to see an advantage for men, but this educational gap is driven entirely by differences among Democrats. About seven-in-ten Democrats with at least a bachelor's degree say men have it easier than women in our country these days, compared with about half of those with some college (52%) and about a quarter of those with a high school diploma or less education (27%). In contrast, among Republicans, views of who has it easier are consistent across levels of educational attainment.

Among those who say men have it easier, more cite pay gap than any other example

When those who say men have it easier than women in our country these days are asked in what ways this is so, most of the reasons focus on inequality in the workplace: 43% specifically mention that men are paid more than women and 29% cite greater employment opportunities or preferential treatment for men. About one-in-ten or fewer say men have fewer family or household responsibilities (10%), get more respect (9%), have more political power (9%), have better health care (7%), don't experience sexual harassment to the same extent as women (4%) or don't have to worry as much about their physical safety (4%). (The question was open-ended and respondents could give multiple answers.)

For the most part, men and women who say men have it easier offer similar explanations for their answer, but a larger share among women than among men cite differences in pay (47% vs. 37%). Still, the gender pay gap tops the list for both men and women who say things are easier for men in our country these days.

Democrats who say men have it easier than women are far more likely than their Republican counterparts to cite higher wages when asked in what ways men have it easier: 46% of Democrats and Democratic-leaning independents say this, compared with 31% of Republicans and Republican-leaning independents. Democrats are also more likely than Republicans to volunteer that men have more political power than women (12% vs. 2%). Other answers are mentioned about equally by Democrats and Republicans who say men have it easier than women.

In their own words: In what ways would you say MEN have it easier in our country these days?
"They on average make more money than women for the same job. They control the country and most businesses." "You simply need to look at the percentages of male CEOs and relative salaries to see there is likely a systematic advantage to being male." "Because most of them don't have to work outside the home and take care of the children and everything else a woman normally does. A woman's work is never done." "Women are most often the primary caregiver for children, even when working full time. Women in general tend to earn less than men." Man, 38 "Men are not second-guessed like women are in the workplace." "They have a higher pay scale and don't deal with discrimination and aren't sexualized constantly." "They are paid more even when the jobs are identical. They seem to be taken more seriously than women. Women usually carry the load when it comes to family life." "Men have traditionally held seats of power in government and the corporate world. You don't see women making law on health issues related to men, but men certainly pass legislation regarding birth control, abortion or community health organizations." "They still make more money for doing the same work and don't have to worry about losing a job in order to start a family." "Men dominate almost all of the top-paying professional fields." "Male privilege allows men to be free to move about in public without threat of harassment. When they speak, they are assumed to have some authority without having to prove it. They still earn more money than women, on average, even in comparable jobs." "They aren't held to the same standards as women and there is still this common misconception that certain jobs can or should only be held by men. For example, when hearing the words 'doctor,' 'lawyer,' 'police officer,' 'judge,' 'CEO,' 'engineer,' etc., most people think of men holding that position. This makes it harder for women to be considered for these positions and makes them less likely to apply or work in related fields." "They generally don't have to question if their gender is holding them back." Man, 55 Man, 30 Woman, 54 Woman, 46 "If there's a choice between a man and a woman for a promotion, I feel the woman would be given preference." "Lower standards for the same positions in order to get more women for those positions." "Women have many legal advantages. High-school-age girls, especially minorities, get more scholarships. Everyone is on the prowl for perceived injustice and attempts to elevate women of all ages. Not so much for males." Man, 46 "They are given so much. They are catered and pandered to, and taught they are entitled to things." "They can choose to be taken care of by getting married or to be independent and have a career for themselves. I think it is still required for a man to provide for himself and family if he has one." "Take a look at any television show. Women are allowed to slap and belittle men constantly on TV. Never the reverse. That is real life today." "If something goes wrong they can cry sexism, or just cry. I think that there is a sympathy thing, but also too many women bash men for being men." "It seems like men have trouble being men in the workplace. People are too offended by everything. Also, there is no affirmative action for being male." "In divorces they wind up with the kids and the man continues to support the woman and children while trying to maintain a household for themselves, ultimately creating a great financial burden on the male." "Compared to white, heterosexual men, who have no laws or workplace policies to protect them from racial, sexual, and gender discrimination, women, particularly non-white women, fare better in the workplace, education institutions, and socially." "Having worked in a large organization, all the rules are tailored to their benefit. With fewer women than men putting career first, there is a demand to push women ahead to achieve 'numbers,' but not enough qualified to do it, honestly. Many highly qualified women simply choose raising a family as a priority over a money-oriented career, so they are not in the workplace." Man, 64 Woman, 67 Man, 47 Man, 35 Woman, 43 Man, 59 Man, 46 Woman, 34 Man, 53 Woman, 60 years old Woman, 21 Man, 58 Woman, 61 Woman, 39 Man, 29 Woman, 65 Man, 29 Woman, 55 years old CORRECTION (October 2017): An earlier version of this report stated that the differences in views of Millennial women compared to older women when it comes to who has it easier in our country these days were due, in part, to the political leanings of younger women. In fact, the generational differences on this question are particularly pronounced among Democratic women, suggesting that the overall generational gap is not driven by the fact that Millennial women are more Democratic than older generations of women.
"A working mother has to go to work and then deal with the kids, homework, laundry, etc. Men come home and kick back. I know it's supposed to be changing, but I haven't seen it." Woman, 62

Job opportunities and preferential treatment top the list for those who say women have it easier than men

When those in the relatively small share of Americans who say that women have it easier in this country today are asked to elaborate on their answers, 30% point to more job opportunities or preferential treatment in employment as ways in which women have it easier - far more than offer any other example.

About one-in-ten or fewer say laws or the courts favor women (9%), women are always believed when they make accusations of sexism, sexual harassment or sexual assault (8%), men aren't respected or are portrayed unfairly in the media (5%), women have more choices when it comes to work and family (5%), women have more access to government assistance (4%), or women have more educational opportunities (3%). (Due to small sample sizes, it is not possible to analyze responses across demographic or partisan groups.)

In their own words: In what ways would you say WOMEN have it easier in our country these days?

"They are given preferential treatment in every way. If they 'feel' slighted or decide to be vindictive they scream sexual harassment, whether true or not, with no consequence to themselves for a false claim." Man, 56

Women are more than twice as likely as men to say they have experienced gender discrimination

About four-in-ten women (43%) say they have personally experienced discrimination or been treated unfairly because of their gender; 18% of men say this has happened to them.

Among women, those with more education are more likely to say they have experienced gender discrimination. About six-in-ten women with a bachelor's degree or more education (57%) say this has happened to them, compared with 45% of those with some college and 31% of those with a high school diploma or less education. In contrast, among men, similar shares across educational levels say they have experienced discrimination or been treated unfairly because of their gender.

Democratic women are far more likely than their Republican counterparts to report that they have experienced discrimination or been treated unfairly because of their gender. About half of women who identify with the Democratic Party or lean Democratic (51%) say this has happened to them, compared with 34% of Republican or Republican-leaning women. Among men, the opposite pattern emerges: Republican men are somewhat more likely than Democratic men to say they have experienced gender discrimination, although relatively small shares of both groups say this has happened to them (20% vs. 14%, respectively).

For men and women who say they have experienced gender discrimination, work is the most common setting

About four-in-ten women who say they have faced gender discrimination (38%) cite experiences related to hiring, pay or promotion; 26% say they have had their abilities questioned or were treated as if they weren't smart because of their gender; and one-in-ten cite sexual harassment or catcalling.

Across generations, Boomer women who say they have experienced gender discrimination are particularly likely to cite situations related to hiring, pay or promotion as examples: About half (51%) cite these as examples of ways in which they have been discriminated against, compared with 36% of Gen X women and 26% of Millennial women.

Men who say they have faced discrimination or have been treated unfairly because of their gender are five times as likely to mention experiences related to hiring, pay or promotion (35%) as they are to say people have made assumptions about their personality because of their gender (7%), the second most cited example among men who say they have personally experienced gender discrimination.

As gender roles shift, more see benefits for women than for men

Since the 1970s, a greater share of women in two-parent families are working outside the home either full-time or part-time. At the same time, fathers report spending more time on child care and household chores. While there is some ambivalence among the public about the impact of these changing gender roles, more say these changes have made things easier for women than say they have made things easier for men.

Just over half of the public (54%) says changing gender roles - in particular, the fact that more women are working outside the home and men are more involved in housework and child care - have made it easier for women to be successful at work. Far fewer (25%) say these changes have made it easier for men to be successful at work; 49% say they haven't made much difference and 25% say they have made it harder for men to be successful at work. And while about half (48%) say these changing gender roles have made it easier for women to lead satisfying lives, fewer (40%) say they have made it easier for men to lead satisfying lives.

When it comes to the impact of changing gender roles on family life, about half of Americans (47%) say these changes have made it easier for families to earn enough money to live comfortably; a quarter say they have made things harder and 27% say they haven't made much difference.

About four-in-ten (41%) say changing gender roles have made it easier for parents to raise children, but a third say these changes have made parenting harder. Similarly, while 38% say these changes have made it easier for marriages to be successful, 30% say they have made this harder.

As with views about the state of gender equality, attitudes about the impact of changing gender roles on men, women and families vary sharply across party lines, with Democrats far more likely than Republicans to see benefits in many areas. For example, roughly six-in-ten Democrats (58%) say these changes have made it easier for women to lead satisfying lives; just 36% of Republicans share this view. Double-digit party gaps are also evident when it comes to views of whether changing gender roles have made it easier for marriages to be successful (a gap of 21 percentage points), for men to lead satisfying lives (18 points), for parents to raise children (16 points) and for families to earn enough money to live comfortably (14 points). Democrats and Republicans offer similar views on the impact of changing gender roles on men's and women's ability to be successful at work.

Attitudes about the impact of changing gender roles also vary sharply by education, and these differences mostly hold up among Democrats and Republicans alike. At least six-in-ten adults with a bachelor's degree or more education say changing gender roles have made it easier for women to be successful at work (67%) and to lead satisfying lives (61%); about half or fewer of those with some college or less education say this is the case (49% say these changes have made it easier for women to succeed at work and 43% say the same about women leading satisfying lives).

Similarly, by double-digit margins, college graduates are more likely than adults with less education to say changing gender roles have made it easier for families to earn enough money to live comfortably (a gap of 14 percentage points), for men to lead satisfying lives (14 points) and for marriages to be successful (10 points).

For the most part, men and women offer similar views of the impact of changing gender roles on society, but there are striking gender differences among parents of children younger than 18 when it comes to the impact of these changes on raising children: 45% of mothers say they have made it easier for parents to raise children, compared with 29% of fathers.

And while similar shares of married and unmarried adults say changing gender roles have made it easier for marriages to be successful, there are gender differences among married women and men who say this is the case. About four-in-ten married women (42%) say changing gender roles have made it easier for marriages to be successful, compared with three-in-ten married men.

# data[].attributes.attachment_link.description
Democrats sharply divided along educational lines on whether life is easier for men than for women Women in the United States have made significant strides toward closing the gaps that have kept them from achieving equality with men.

# data[].attributes.attachment_link.readable_text
In a recent JAMA Forum, Ashish Jha, MD, MPH, wrote about tackling the social determinants of health as a process that will require taking "small steps on a long journey" ( http://bit.ly/1JM5hFM). I agree with him about the complexity raised by the social issues affecting health. And his admonition that investments in social determinants such as education, housing, and nutrition may not reduce spending on medical care-especially in the near term-are important warnings.

I want to use a different rationale in advocating more attention to the social determinants of health: they reflect our best opportunity to improve health outcomes reported for the United States that are relatively poor, despite how much we spend on medical care.

For many years, the United States has focused on the need to slow spending on health care. Although levels of spending increases for health care have been historically low during the last 7 years, the higher spending reported for 2014 is expected to continue for the next decade, averaging 5.8% per year ( http://bit.ly/1JsXPgt). That would bring the share of the gross domestic product (GDP) spent on health care from 17.5% to 19.6% by 2024. The estimated spending growth rate may not be precisely correct, but the end of the recession and the continued numbers of baby boomers entering retirement age guarantee continued upward pressure on health care spending.

Fortunately, there are many strategies available to help slow health care spending, some of which are currently being tried. Some of the most promising pilot projects include various types of payment changes, including bundled payments across clinicians and institutions that reward improved value, as well as changes that encourage the delivery of more integrated, evidence-based care. There are also efforts to provide better, more reliable and easily accessible information on quality and prices.

I'm not suggesting that sustaining a slower rate of growth will be easy. The mixed results reported thus far for many accountable care organizations (ACOs), including the more experienced Pioneer ACOs, suggests otherwise ( http://bit.ly/1fmhGlo). But sustained efforts in these directions should produce results.

The reason to focus on social determinants of health is the relatively poor health outcomes the country reports, particularly disturbing given our high rate of spending. Even though it should be possible to improve outcomes with increased use of evidence-based medicine and comparative effectiveness research, along with more cogent use of electronic medical records and payment incentives, a more effective way to improve health is to focus on social determinants.

There is substantial evidence that addressing social or nonmedical determinants of health such as early childhood development, economic opportunities, and education is more important than medical care per se for better health outcomes and avoiding premature death. And the role of social determinants for health is as important for developed countries as it is for developing countries. People know that life expectancy tends to be low in the developing world compared with the developed world. But differences in life expectancy for the poorest vs wealthiest populations or for minorities vs the majority population in developed countries are also large ( http://bit.ly/1pGedxt). Life expectancy, for example is just 63 years for black men in Washington, DC, compared with 80 years for white men in affluent, adjacent Montgomery County.

I and the other 19 commissioners on the World Health Organization (WHO) Commission on the Social Determinants ( http://bit.ly/1Xvb04r) advised the agency that beyond health legislation, improving health and reducing differences in health outcomes required more focus on the social factors affecting health: daily living conditions, healthy places to live and work, investments in early childhood development, and recognizing the health effects resulting from all legislation. When so much attention has been focused on the health care system these past 7 years-an understandable preoccupation when 15% to 16% of the population is without health insurance-it is easy to forget how much more effective focusing on the social determinants can be for improving health outcomes, especially for children.

Former US Surgeon General David Satcher, MD (another WHO commissioner) and I raised this point in an article jointly written ( http://bit.ly/1Z0I1GU) after the commission reported its recommendations for action to the WHO's Director-General ( http://bit.ly/1U7Yji7). Improving the conditions that shape early childhood development can enhance opportunities for health throughout a lifetime. Conditions such as obesity, cardiovascular disease, cancer, and mental health problems often have their roots in the early years of life. Programs that address the needs of children with very low food security are important, as are the various food programs for pregnant and postpartum women. Similarly, investing in early childhood education, especially for individuals living in poverty, can be a cost-effective strategy for preventing disease and increasing productivity later in life.

Efforts to reduce substance abuse are also important for young adults and for pregnant women in particular. Too many children start life with serious medical challenges because their mothers had substance abuse problems. These women almost always are covered by Medicaid or other insurance, but for various reasons don't receive the help they need-a reminder that coverage is important but frequently not sufficient to ensure that care is available.

Securing a healthy start in life for children and improving living conditions for adults will require a more integrated policy environment than typically occurs in the United States, although the increase in capitated health care make this easier to occur than the past silos of health care. Responsibility for full health care encourages insurers to look beyond the narrow provisions of traditional health care plans. However, most plans focus primarily on better aligning the provision of traditional medical care than expanding their mission to include the social determinants of care.

The potential flexibility for states to innovate in the delivery of care that seemed to be part of the ACA with its 1332-waiver process is now looking to be more constrained. The waivers are limited to direct ACA coverage, require budget neutrality in each year, with at least the same number of people covered and receiving as much coverage as without the waiver. More importantly, the waiver process doesn't create opportunities to count savings from other government programs, such as Medicaid, for purposes of calculating budget neutrality ( http://bit.ly/1SF1mxt).

When I was a policy adviser to President George H. W. Bush, the city leaders of Atlanta, with assistance from the Carter Center, approached the White House with a request to be allowed to pool their federal resources to provide their residents with better care and support through health and other social service programs. The federal resources, along with commitments of support from the business community, were believed to be adequate-just in the wrong buckets, with too many silos separating (and duplicating) programs. The White House was very supportive but recognized the prospect of getting all the committees of jurisdiction to waive control over all the federal programs in question was too daunting.

We spend enough money on health care and other social services to improve health outcomes. We just spend it badly.

Corresponding Author: Gail Wilensky, PhD ( gwilensky@projecthope.org).

Published Online: March 16, 2016, at http://newsatjama.jama.com/category/the-jama-forum/.

Disclaimer: Each entry in The JAMA Forum expresses the opinions of the author but does not necessarily reflect the views or opinions of JAMA, the editorial staff, or the American Medical Association.

Additional Information: Information about The JAMA Forum is available at http://newsatjama.jama.com/about/. Information about disclosures of potential conflicts of interest may be found at http://newsatjama.jama.com/jama-forum-disclosures/.

# data[].attributes.attachment_link.title
Addressing Social Issues Affecting Health to Improve US Health Outcomes

# data[].attributes.attachment_link.description
In a recent JAMA Forum, Ashish Jha, MD, MPH, wrote about tackling the social determinants of health as a process that will require taking "small steps on a long journey" (http://bit.ly/1JM5hFM). I agree with him about the complexity raised by the social issues affecting health. And his admonition...

# data[].attributes.headline
Social Movements in the Time of Pandemic

# data[].attributes.subject
Social Movements in the Time of Pandemic

# data[].attributes.attachment_link.title
Opinion | Social Movements in Times of Pandemic: Another World Is Needed

# data[].attributes.attachment_link.description
Times of pandemic bring big challenges for the activists of progressive social movements. They are not a time for street activism or politics in the squares. Freedoms are restricted, social distancing makes the typical forms of protest impossible to carry out.

# data[].attributes.attachment_link.readable_text
We hope you're staying safe and sanitized during this difficult time!

Here at TAG, we're fortunate to be able to safely work from home, and advance the fight against HIV, tuberculosis, and hepatitis C - and now against COVID-19.

As we fight back against horrors of political indifference, inaction, and injustice reminiscent of the early AIDS response, TAG's scientific expertise and relationships are crucial. As this recent Washington Post story notes, when meeting with U.S. National Institute of Allergy and Infectious Diseases (NIAID) Director Dr. Tony Fauci, HIV activists "always brought along Mark Harrington, an ACT UP member who would later win a MacArthur 'genius grant,' because he could press Fauci on the science."

Our evidence-based foundation, and our legacy working with NIAID, and myriad other U.S. and global institutions and community partners, make TAG uniquely poised to fight back against COVID-19.

Here are the ways we're fighting back against this new epidemic:

TAG has over three decades of experience fighting pandemics. We know what's needed, and we're working with our networks and allies to make a difference.

TAG is fully mobilizing with our community, scientific, and public health allies and is working to protect all New Yorkers - and everyone else - from the COVID-19 outbreak itself and from its economic and social consequences.

We're co-facilitating the COVID Working Group which brings together activist and scientific expertise to strategize on action steps through the ever-changing situation.

We've catalyzed action by City and State leaders and public health officials.

We're working through our Federal connections to articulate and respond to the needs of health workers and communities.

We're developing new resources on the pipeline of potential prevention, treatment, and diagnostics in development to respond to SARS-CoV-2/COVID-19.

We're putting TAG's over 30 years of expertise fully into this fight. We are so grateful that you're part of the TAG family, and will keep you posted about critical developments.

In the meantime, please take care of yourselves, your colleagues, your loved ones, and your community.

# # #

# data[].attributes.attachment_link.title
Science-Based Activism to End Epidemics, from AIDS to COVID-19 - Treatment Action Group

# data[].attributes.attachment_link.description
We hope you're staying safe and sanitized during this difficult time! Here at TAG, we're fortunate to be able to safely work from home, and advance the fight against HIV, tuberculosis, and hepatitis C - and now against COVID-19.

# data[].attributes.headline
Social Issues in Healthcare and Disease Prevention

# data[].attributes.subject
Social Issues in Healthcare and Disease Prevention

# data[].attributes.attachment_link.readable_text
Social Issues

Healthcare is full of social issues for both the healthcare provider and for the client. Social issues in this lesson will be defined as a health issue that each patient will have to evaluate based on his or her values, beliefs, and unique situation. Social issues are often headlines in the newspaper and the top story of the news hour. They can be polarizing topics bringing out strong feelings and opinions. We will explore a few of these issues: religious beliefs, child vaccinations, organ donation, and end of life care.

Religious Beliefs

Strongly held religious beliefs play a large role in healthcare decisions. For some people, religious beliefs will dictate which treatments will be considered and which treatments will not be considered. For example, Jehovah's Witnesses will not take blood from another person, or in some cases even their own stored blood. This can raise some concerns if the person has a traumatic accident or has a major operation that would typically require a blood transfusion. Healthcare providers need to respect the religious beliefs of the patient even if it might be difficult.

Childhood Vaccinations

The current standard of care is for all children to have certain vaccinations administered at certain ages throughout childhood. The purpose of a vaccine is to prevent a life-threatening or life-limiting disease. Some vaccines have dead infectious organisms in them. Others have weakened organisms. The body recognizes the dead or weakened organisms as something foreign and attacks it. Then the next time the body sees that organism, it will attack it quicker and stronger, preventing the disease from occurring. There is some fear that some vaccines may have side-effects, like autism. Autism is a term for a group of diagnoses in which the person has impaired social interaction and communication. This is a debated topic, and one we will only mention here. Vaccines do, however, prevent terrible diseases such as Polio, Measles, Rubella, and some types of hepatitis. These diseases have devastating effects on children. Parents need to carefully consider the decision not to vaccinate.

Another consideration for vaccines is the phenomenon of herd immunity. Herd immunity means that if enough people are vaccinated, then the disease cannot reproduce and in effect, people who are not vaccinated have some added protection. Not everyone needs to have a vaccine for it to work, but the majority of people do. One concern from healthcare professionals about the fear of vaccines is that if enough parents refuse to vaccinate their children, the diseases that modern medicine is capable of eradicating will come back stronger. This is a societal concern.

End of Life Care

In the United States, death is typically an avoided topic. Many people do not discuss with their loved ones what they expect death to be like or what medical treatment they do or do not want in such a situation. Unfortunately, this taboo topic is very important to discuss. In addition to discussing belongings and burial, healthcare decisions are best talked about before a decision needs to be made. The United States has many great technologies, but individuals need to consider their values, beliefs, and unique situation before agreeing to a full treatment plan.

# data[].attributes.attachment_link.keywords[]
social issues in health care & disease prevention | study.com

# data[].attributes.attachment_link.title
Social Issues in Health Care & Disease Prevention | Study.com

# data[].attributes.attachment_link.description
Healthcare is full of social issues for both the healthcare provider and for the client. Social issues in this lesson will be defined as a health issue that each patient will have to evaluate based on his or her values, beliefs, and unique situation.

# data[].attributes.headline
Let's treat the social Causes of illness rather than just disease

# data[].attributes.subject
Let's treat the social Causes of illness rather than just disease

# data[].attributes.attachment_link.readable_text
Almost all diseases (as well as social outcomes) show a strong relationship with socioeconomic measures. Shutterstock

Fiona Stanley is the director of this year's Melbourne Festival of Ideas: The Art and Science of Wellbeing, which opens today and continues until October 6, 2013. Here she explains the ethos of the Festival's program.
Diseases are complex and their causes myriad. A relatively new field of research known as the "social determinants of health" shows that merely treating illness is not the best approach to what ails us, we need a comprehensive overhaul of what we are doing and to address underlying social mechanisms that harm well-being.

My medical training in the 1970s focused on the diagnosis and treatment of diseases - it rarely addressed the question of why people got them.

But as a young doctor working in child health, particularly with Aboriginal children, it became obvious to me that prevention of disease was by far the best way to practice medicine; it's more humane and definitely more cost-effective.

In 1972, I left Australia to study epidemiology and public health in the United Kingdom and then the United States, where these disciplines were well advanced. I learnt of the limitations of modern medicine, that prevention was the key to health and that many diseases commenced in social adversity.

The most exciting thing for me was that it was also the beginning of the push for disease registers, large population data sets and data linkage - all skills I brought back to Australia.

Wide open road

Coming back to Australia in 1977, I was excited to be returning to a virtual "desert" waiting to be populated with databases of evidence to help start successful preventative activities here.

Australia has led the world in road accident prevention, tobacco control, vaccination coverage, and in HIV/AIDS. All these efforts needed population-level data to obtain accurate prevalence rates and determine risk and protective factors. This evidence was then applied to create environments for prevention.

My particular interest in child health has resulted in the mandatory fortification of flour with folate to prevent spina bifida. And in establishing some of the best population databases internationally to monitor, research and evaluate a range of child and adolescent problems in health, education, child protection, disabilities and juvenile justice.

These major public health successes are hugely cost-effective because they help us prevent diseases for which costs are spiralling. But even bigger gains can (and must) be made by addressing the social determinants of health across the whole of society.

It's becoming more common to hear people talk about the social determinants of health, so let me explain what they're all about.

Social determinants

Within populations, even in wealthy ones such as Australia, analyses of almost all diseases, as well as educational outcomes, disabilities, mental illness, substance abuse, child abuse and neglect and criminal behaviour show a strong relationship with socioeconomic measures.

That means there's a gradient across society with more problems occurring as you move from the better off to those worse off (in terms of resources).

There are also interesting international comparisons between countries that show a strong relationship between measures of health (such as infant mortality, or life expectancy) and the socioeconomic parameters, such as gross domestic product (GDP).

Patrick Nouhailler

On the whole, the pattern is the same - greater economic prosperity leads to lower disease rates. But, interestingly, above a certain level of wealth, the rates flatten out.

And there are some paradoxical countries whose patterns are opposite to the overall trends. Cuba, for example, is one of the poorest countries in the world but has better life expectancy and infant mortality than its neighbour, the United States, which also happens to be the world's wealthiest country!

Literacy and numeracy rates in Cuba are close to 100% and the country's free health and education systems focus on prevention and enhancing positive outcomes rather than waiting for disease and then treating it (as happens in United States and, increasingly, in Australia).

Saudi Arabia, one of the world's richest countries, has very high infant mortality and low life expectancy. Literacy rates there, particularly among women, are very low. Cuba is poor but socially egalitarian while Saudi Arabia is wealthy but socially divided.

But why are diseases and almost all of our societal problems so strongly influenced by social factors and what can we do about it?

Following Mexico's example

When we study the paths into these problems in health and well-being, we find that many people start in a position of disadvantage, with poor living conditions, low levels of education, and unhealthy lifestyles. Early intervention is crucial if we are to influence the causes of irreversible conditions.

Inequalities are bad for everyone's health. We need to invest in social, environmental, and community infrastructure for health. And we need to ensure the budget is more evenly distributed (as is done in both Sweden by proportional taxing and Japan by having more equality in salary levels).

In the early 2000s, the Mexican health minister developed a social determinants of health model. Each government department (education, transport, water, housing, finance, infrastructure, as well as health) had to prepare a plan for better health.

The result was a superb blueprint for a society totally committed to prevention. Mexico still has problems of poverty but has leapt ahead in terms of health and development.

The new government in Australia could use this kind of blueprint for the nation's future health and well-being - we need to convince them that this is a crucial investment.

# data[].attributes.attachment_link.title
Let's treat the social causes of illness rather than just disease

# data[].attributes.attachment_link.description
Fiona Stanley is the director of this year's Melbourne Festival of Ideas: The Art and Science of Wellbeing, which opens today and continues until October 6, 2013. Here she explains the ethos of the Festival's program. Diseases are complex and their causes myriad.

# data[].attributes.headline
Economic and social impacts of epidemics and pandemic influenza

# data[].attributes.subject
Economic and social impacts of epidemics and pandemic influenza

# data[].attributes.attachment_link.readable_text
Amidst the human suffering caused an influenza epidemic it is all too easy to overlook the disease's wider social and economic impact. Not only does influenza impose huge infrastructure demands on health care systems, but it exacts substantial economic costs in terms of sickness-related absenteeism, disrupted work schedules and lost productivity to society at large. Influenza accounts for around 10% of sickness-related absence from work in Europe where the likely cost of lost productivity in France and Germany, for example, ranges from 5.6 billion pounds to 8.5 billion pounds per year, according to ESWI estimates. But how to assess the full economic impact of influenza? The direct costs are easily enough identified, but what about the indirect costs? How should these be measured? How for example, does one assess the cost of lost opportunities, and what are the economic gains of vaccination regarding avoided costs? Finally, which target groups for vaccination would generate the greatest avoided costs? Leaving aside the moral implications of such a question, the fact remains that politicians and health policymakers need the cold hard figures to optimally allocate the costs of vaccination and preventative health campaigns. These issues and more were clearly delineated during this session, co-chaired by Drs. T. Szucs of the University of Zurich and K. Nichol of the University of Minnesota.

# data[].attributes.attachment_link.title
Economic and social impact of epidemic and pandemic influenza.

# data[].attributes.attachment_link.description
Amidst the human suffering caused an influenza epidemic it is all too easy to overlook the disease's wider social and economic impact. Not only does influenza impose huge infrastructure demands on health care systems, but it exacts substantial economic costs in terms of sickness-related absenteeism, disrupted work schedules and lost productivity to society at large.

# data[].attributes.headline
Pandemics: Risks, Impacts and Mitigation

# data[].attributes.subject
Pandemics: Risks, Impacts and Mitigation

# data[].attributes.attachment_link.readable_text
Corresponding Author: Nita Madhav, MSPH, Metabiota, San Francisco, California, United States; moc.atoibatem@vahdamn.

INTRODUCTION

The international community has made progress toward preparing for and mitigating the impacts of pandemics. The 2003 severe acute respiratory syndrome (SARS) pandemic and growing concerns about the threat posed by avian influenza led many countries to devise pandemic plans ( U.S. Department of Health and Human Services 2005). Delayed reporting of early SARS cases also led the World Health Assembly to update the International Health Regulations (IHR) to compel all World Health Organization member states to meet specific standards for detecting, reporting on, and responding to outbreaks ( WHO 2005). The framework put into place by the updated IHR contributed to a more coordinated global response during the 2009 influenza pandemic ( Katz 2009). International donors also have begun to invest in improving preparedness through refined standards and funding for building health capacity ( Wolicki and others 2016).

Despite these improvements, significant gaps and challenges exist in global pandemic preparedness. Progress toward meeting the IHR has been uneven, and many countries have been unable to meet basic requirements for compliance ( Fischer and Katz 2013; WHO 2014). Multiple outbreaks, notably the 2014 West Africa Ebola epidemic, have exposed gaps related to the timely detection of disease, availability of basic care, tracing of contacts, quarantine and isolation procedures, and preparedness outside the health sector, including global coordination and response mobilization ( Moon and others 2015; Pathmanathan and others 2014). These gaps are especially evident in resource-limited settings and have posed challenges during relatively localized epidemics, with dire implications for what may happen during a full-fledged global pandemic.

For the purposes of this chapter, an epidemic is defined as "the occurrence in a community or region of cases of an illness . . . clearly in excess of normal expectancy" ( Porta 2014). A pandemic is defined as "an epidemic occurring over a very wide area, crossing international boundaries, and usually affecting a large number of people" ( Porta 2014). Pandemics are, therefore, identified by their geographic scale rather than the severity of illness. For example, in contrast to annual seasonal influenza epidemics, pandemic influenza is defined as "when a new influenza virus emerges and spreads around the world, and most people do not have immunity" ( WHO 2010).

This chapter does not consider endemic diseases-those that are constantly present in particular localities or regions. Endemic diseases are far more common than pandemics and can have significant negative health and economic impacts, especially in low- and middle-income countries (LMICs) with weak health systems. Additionally, given the lack of historical data and extreme uncertainty regarding bioterrorism, this chapter does not specifically consider bioterrorism-related events, although bioterrorism could hypothetically lead to a pandemic.

This chapter covers the following findings concerning the risks, impacts, and mitigation of pandemics as well as knowledge gaps:

Risks

Pandemics have occurred throughout history and appear to be increasing in frequency, particularly because of the increasing emergence of viral disease from animals.

Pandemic risk is driven by the combined effects of spark risk ( where a pandemic is likely to arise) and spread risk ( how likely it is to diffuse broadly through human populations).

Some geographic regions with high spark risk, including Central and West Africa, lag behind the rest of the globe in pandemic preparedness.

Probabilistic modeling and analytical tools such as exceedance probability (EP) curves are valuable for assessing pandemic risk and estimating the potential burden of pandemics.

Influenza is the most likely pathogen to cause a severe pandemic. EP analysis indicates that in any given year, a 1 percent probability exists of an influenza pandemic that causes nearly 6 million pneumonia and influenza deaths or more globally.

Impacts

Pandemics can cause significant, widespread increases in morbidity and mortality and have disproportionately higher mortality impacts on LMICs.

Pandemics can cause economic damage through multiple channels, including short-term fiscal shocks and longer-term negative shocks to economic growth.

Individual behavioral changes, such as fear-induced aversion to workplaces and other public gathering places, are a primary cause of negative shocks to economic growth during pandemics.

Some pandemic mitigation measures can cause significant social and economic disruption.

In countries with weak institutions and legacies of political instability, pandemics can increase political stresses and tensions. In these contexts, outbreak response measures such as quarantines have sparked violence and tension between states and citizens.

Mitigation

Pathogens with pandemic potential vary widely in the resources, capacities, and strategies required for mitigation. However, there are also common prerequisites for effective preparedness and response.

The most cost-effective strategies for increasing pandemic preparedness, especially in resource-constrained settings, consist of investing to strengthen core public health infrastructure, including water and sanitation systems; increasing situational awareness; and rapidly extinguishing sparks that could lead to pandemics.

Once a pandemic has started, a coordinated response should be implemented focusing on maintenance of situational awareness, public health messaging, reduction of transmission, and care for and treatment of the ill.

Successful contingency planning and response require surge capacity-the ability to scale up the delivery of health interventions proportionately for the severity of the event, the pathogen, and the population at risk.

For many poorly prepared countries, surge capacity likely will be delivered by foreign aid providers. This is a tenable strategy during localized outbreaks, but global surge capacity has limits that likely will be reached during a full-scale global pandemic as higher-capacity states focus on their own populations.

Risk transfer mechanisms, such as risk pooling and sovereign-level catastrophe insurance, provide a viable option for managing pandemic risk.

Knowledge Gaps

Spending and costs specifically associated with pandemic preparedness and response efforts are poorly tracked.

There is no widely accepted, consistent methodology for estimating the economic impacts of pandemics.

Most data regarding the impacts of pandemics and the benefits and costs of mitigation measures come from high-income countries (HICs), leading to biases and potential blind spots regarding the risks, consequences, and optimal interventions specific to LMICs.

PANDEMIC RISKS AND CONSEQUENCES

Importance of Pandemics

Pandemics can cause sudden, widespread morbidity and mortality as well as social, political, and economic disruption. The world has endured several notable pandemics, including the Black Death, Spanish flu, and human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) ( table 17.1).

Because the definition of pandemic primarily is geographic, it groups together multiple, distinct types of events and public health threats, all of which have their own severity, frequency, and other disease characteristics. Each type of event requires its own optimal preparedness and response strategy; however this chapter also discusses common prerequisites for effective response. The variety of pandemic threats is driven by the great diversity of pathogens and their interaction with humans. Pathogens vary across multiple dimensions, including the mechanism and dynamics of disease transmission, severity, and differentiability of associated morbidities. These and other factors determine whether cases will be identified and contained rapidly or whether an outbreak will spread ( Fraser and others 2004). As a result, pathogens with pandemic potential also vary widely in the scale of their potential health, economic, and sociopolitical impacts as well as the resources, capacities, and strategies required for mitigation.

One must distinguish between several broad categories of pandemic threats. At one extreme are pathogens that have high potential to cause truly global, severe pandemics. This group includes pandemic influenza viruses. These pathogens transmit efficiently between humans, have sufficiently long asymptomatic infectious periods to facilitate the undetected movement of infected persons, and have symptomatic profiles that present challenges for differential diagnosis (particularly in the early periods of infection). A second group of pathogens presents a moderate global threat. These agents (for example, Nipah virus and H5N1 and H7N9 influenzas) have not demonstrated sustained human-to-human transmission but could become transmitted more efficiently as a result of mutations and adaptation. A third group of pathogens (for example, Ebola, Marburg, Lassa) has the potential to cause regional or interregional epidemics, but the risk of a truly global pandemic is limited because of the slow pace of transmission or high probability of detection and containment.

Among all known pandemic pathogens, influenza poses the principal threat because of its potential severity and semiregular occurrence since at least the 16th century ( Morens and others 2010). The infamous 1918 influenza pandemic killed an estimated 20 million to 100 million persons globally, with few countries spared ( Johnson and Mueller 2002). Its severity reflects in part the limited health technologies of the period, when no antibiotics, antivirals, or vaccines were available to reduce transmission or mortality ( Murray and others 2006).

During the 1918 pandemic, populations experienced significantly higher mortality rates in LMICs than in HICs, likely as a result of higher levels of malnutrition and comorbid conditions, insufficient access to supportive medical care, and higher rates of disease transmission ( Brundage and Shanks 2008; Murray and others 2006). The mortality disparity between HICs and LMICs likely would be even greater today for a similarly severe event, because LMICs have disproportionately lower medical capacity, less access to modern medical interventions, and higher interconnectivity between population centers.

Origin of Pandemics

Most new pandemics have originated through the "zoonotic" transmission of pathogens from animals to humans ( Murphy 1998; Woolhouse and Gowtage-Sequeria 2005), and the next pandemic is likely to be a zoonosis as well. Zoonoses enter into human populations from both domesticated animals (such as farmed swine or poultry) and wildlife. Many historically significant zoonoses were introduced through increased human-animal interaction following domestication, and potentially high-risk zoonoses (including avian influenzas) continue to emerge from livestock production systems ( Van Boeckel and others 2012; Wolfe, Dunavan, and Diamond 2007). Some pathogens (including Ebola) have emerged from wildlife reservoirs and entered into human populations through the hunting and consumption of wild species (such as bushmeat), the wild animal trade, and other contact with wildlife ( Pike and others 2010; Wolfe, Dunavan, and Diamond 2007).

Zoonotic pathogens vary in the extent to which they can survive within and spread between human hosts. As shown in table 17.2, the degree of zoonotic adaptation spans a continuum from transmission only within animal populations (stage 1) to transmission only within human populations (stage 5). Most zoonotic pathogens are not well adapted to humans (stages 2-3), emerge sporadically through spillover events, and may lead to localized outbreaks, called stuttering chains ( Pike and others 2010; Wolfe and others 2005). These episodes of "viral chatter" increase pandemic risk by providing opportunities for viruses to become better adapted to spreading within a human population. Pathogens that are past stage 3 are of the greatest concern, because they are sufficiently adapted to humans to cause long transmission chains between humans (directly or indirectly through vectors), and their geographic spread is not constrained by the habitat range of an animal reservoir.

Pandemic Risk Factors

Pandemic risk, as noted, is driven by the combined effects of spark risk and spread risk. The foci of both risk factors often overlap, especially in some LMICs (such as in Central and West Africa and Southeast Asia), making these areas particularly vulnerable to pandemics and their negative consequences.

Burden of Pandemics

Quantifying the morbidity and mortality burden from pandemics poses a significant challenge. Although estimates are available from historical events ( table 17.1), the historical record is sparse and incomplete. To overcome these gaps in estimating the frequency and severity of pandemics, probabilistic modeling techniques can augment the historical record with a large catalog of hypothetical, scientifically plausible, simulated pandemics that represent a wide range of possible scenarios. Modeling can also better account for changes that have occurred since historical times, such as medical advances, changing demographics, and shifting travel patterns.

Scenario modeling of epidemics and pandemics can be achieved through large-scale computer simulations of global spread, dynamics, and illness outcomes of disease ( Colizza and others 2007; Tizzoni and others 2012). These models allow for specification of parameters that may drive the likelihood of a spark (for example, location and frequency) and determinants of severity (for example, transmissibility and virulence). The models then simulate at a daily time step the spread of disease from person to person via disease transmission dynamics and from place to place via incorporation of long-range and short-range population movements. The models also can incorporate mitigation measures, seasonality, stochastic processes, and other factors that can vary during an epidemic. Millions of these simulations can be run with wide variation in the initial conditions and final outcomes.

These millions of simulations can be used to quantify the burden of pandemics through a class of probabilistic modeling called catastrophe modeling, which the insurance industry uses to understand risks posed by infrequent natural disasters such as hurricanes and earthquakes ( Fullam and Madhav 2015; Kozlowski and Mathewson 1997). When applied to pandemics, this approach requires statistically fitting distributions of the parameters. These parameter distributions provide weightings of the likelihood of the different events. Through correlated statistical sampling based on the parameter weights, scenarios are selected for inclusion in an event catalog of simulated pandemic events. A schematic diagram shows how the catastrophe modeling process is used to develop the event catalog ( figure 17.1).

Analysis of the event catalog yields annual EP curves (for example, as shown in figure 17.2), which provide a metric of the likelihood that an event of a given severity, or worse, begins in any given year. The EP curve is a visualization of the event catalog, in which the number of estimated deaths for each event is ranked in descending order. Because the event catalog includes scenarios incorporating spark probabilities and estimates of disease propagation, the EP curve includes the combined impacts of both spark risk and spread risk. Although a global curve is shown in figure 17.2, EP curves can be estimated for other geographic resolutions, such as a country or province.

The EP curve is a powerful tool that yields several key findings regarding the frequency and severity of potential pandemics. Applied to influenza pandemics, we find the following:

An influenza pandemic having the global mortality rate observed during the 2009 Swine flu pandemic (0.2-0.8 deaths per 10,000 persons) or worse has about a 3 percent probability of occurring in any given year.

In any given year, the probability of an influenza pandemic causing nearly 6 million pneumonia and influenza deaths (8 deaths per 10,000 persons) or more globally is 1 percent.

The annual probability of an influenza pandemic's meeting or exceeding the global mortality rate of the 1918 Spanish flu pandemic (111-555 deaths per 10,000 persons) is less than 0.02 percent.

As indicated by the heavy tail of the EP curve, most of the potential burden from influenza pandemics comes from the most severe pandemics.

Table 17.4 shows select EPs for influenza pandemics in low-, middle-, and high-income countries, based on further analysis of the event catalog. For example, in any given year, all LICs combined have a 3 percent probability of experiencing at least 140,000 deaths attributable to an influenza pandemic and a 0.1 percent chance of experiencing at least 8.3 million deaths. LICs bear a substantial burden of mortality risk from influenza pandemics. Strikingly, LICs contain only about 9 percent of the global population, yet they would contribute nearly 25 percent of deaths during an influenza pandemic.

Based on the event catalog, the average estimated global mortality from pneumonia and influenza during an influenza pandemic is more than 7.3 million deaths. However, because influenza pandemics occur on average once every 25-30 years, the average annual pneumonia and influenza mortality from influenza pandemics is a little more than 230,000 deaths. This is comparable to seasonal influenza, which worldwide causes at least 250,000 deaths annually ( WHO 2016b). Although both numbers reflect an annual average, they differ in the combination of frequency and severity. Seasonal influenza deaths occur every year, but pandemic influenza deaths occur much less frequently, are concentrated in larger spikes, and affect a younger demographic.

When pandemics cause large morbidity and mortality spikes, they are much more likely to overwhelm health systems. Overwhelmed health systems and other indirect effects may contribute to a 2.3-fold increase in all-cause mortality during pandemics, although attribution of the causative agent is difficult ( Simonsen and others 2013). If indirect deaths are taken into account, the average annual global deaths from influenza pandemics could be greater than 520,000, although there is a significant uncertainty in the estimate.

Pandemics caused by pathogens other than influenza also must be considered. Novel coronaviruses (such as SARS-CoV), filoviruses (such as Ebola virus), and flaviviruses (such as Zika virus) have caused large epidemics and pandemics. These viruses, like influenza, are ribonucleic acid viruses that have high mutation rates. Noninfluenza viruses typically cause more frequent, smaller epidemics but also an overall lower burden of morbidity and mortality than pandemic influenza. For diseases caused by coronaviruses and filoviruses, the lower burden stems from the mode of transmission, which often requires closer and more sustained contact than influenza does to spread.

Consequences of Pandemics

Trends Affecting Pandemic Risk

In recent decades, several trends have affected pandemic probability, preparedness, and mitigation capacity. Various factors-population growth, increasing urbanization, greater demand for animal protein, greater travel and connectivity between population centers, habitat loss, climate change, and increased interactions at the human-animal interface-affect the likelihood of pandemic events by increasing either the probability of a spark event or the potential spread of a pathogen ( Tilman and Clark 2014; Tyler 2016; Zell 2004). With global population estimated to reach 9.7 billion by 2050 and with travel and trade steadily intensifying, public health systems will have less time to detect and contain a pandemic before it spreads ( Tyler 2016).

As for poverty, the trends are mixed. On the positive side, enormous gains in poverty reduction have decreased the number of people living in extreme poverty. This may attenuate the mortality shock of a mild pandemic somewhat. On the negative side, extreme poverty is now concentrated in a small number of low-growth, high-poverty countries ( Chandy, Kato, and Kharas 2015). In such countries, progress in building health system capacity also has been far slower.

Likewise, for a subset of countries with endemically weak institutions, building institutional capacity for complex tasks like pandemic mitigation and response is likely to be a slow process even under the most optimistic assumptions ( Pritchett, Woolcock, and Andrews 2013). Many of these countries are in areas with high spark risk, particularly in Central and West Africa, and thus may remain vulnerable and require significant international assistance during a pandemic.

Other environmental and population trends that could increase the severity of pandemics include the persistence of slums, unresponsive health systems, higher prevalence of comorbidities, weaker sanitation, and aging populations ( Arimah 2010; UNDESA 2015). The increasing threat posed by antibiotic resistance also could amplify mortality during pandemics of bacterial diseases such as tuberculosis and cholera and even viral diseases (especially for influenza, in which a significant proportion of deaths is often the result of bacterial pneumonia coinfections) ( Brundage and Shanks 2008; Van Boeckel and others 2014).

PANDEMIC MITIGATION: PREPAREDNESS AND RESPONSE

Pandemic preparedness and response interventions can be classified by their timing with respect to pandemic occurrence: the prepandemic period, the spark period, and the spread period, as shown in box 17.1.

Whereas some interventions clearly fall under the purview of a single authority, responsibility for implementing and scaling up many critical aspects of preparedness and response is spread across multiple authorities, which play complementary, interlocking, and, in some cases, overlapping roles ( Brattberg and Rhinard 2011). The governance of pandemic preparedness and response is complex, with authority fragmented across international, national, and subnational institutions, as well as among multiple organizations with functional responsibility for specific tasks ( Hooghe and Marks 2003). Pandemic preparedness requires close coordination across public and private sector actors: vaccine development requires close coordination between government and vaccine producers; whereas critical response measures-such as managing quarantines-requires engagement between nonprofit organizations (hospitals, clinics, and nongovernmental organizations), public health authorities, affected communities and civil society groups, and the security sector.

Situational Awareness

Situational awareness-in the context of pandemic preparedness-can be defined as having an accurate, up-to-date view of potential or ongoing infectious disease threats (including through traditional surveillance in humans and animals) and the resources (human, financial, informational, and institutional) available to manage those threats ( ASPR 2014). Situational awareness is a crucial activity at all stages of a pandemic, including prepandemic, spark, and spread periods. It requires the support of health care resources (such as hospitals, doctors, and nurses), diagnostic infrastructure, and communications systems. It also requires the population to have access to and trust in the health care system.

Situational awareness supports policy decisions by tracking if and where disease transmission is occurring, detecting the most effective methods to reduce transmissibility, and deciding where to allocate resources. During a pandemic, situational awareness allows for monitoring to understand the course a pandemic is taking and whether intervention measures are effective.

The ability to detect the presence of a pandemic requires the health care workforce to recognize the illness and to have the technical and laboratory capacity to identify the pathogen (or rule out known pathogens) and respond to surges of clinical specimens in a timely manner. Rapid identification reduces risk by enabling infected persons to be isolated and given appropriate clinical care. During the 2003 SARS pandemic, a one-week delay in applying control measures may have nearly tripled the size of the outbreak and increased its duration by four weeks ( Wallinga and Teunis 2004).

Endemic infectious diseases can affect pandemic detection by complicating the differential diagnosis and rapid identification of pandemic cases. Overlapping symptoms between endemic and emerging pathogens-for instance, between dengue and Zika or between malaria and Ebola-have hampered the early identification of cases ( de Wit and others 2016; Waggoner and Pinsky 2016). This difficulty suggests a role for investment in the development and deployment of rapid diagnostic tests in regions with a high burden of endemic pathogens and high risk of disease emergence or importation ( Yamey and others 2017). Additional constraints affecting epidemic and pandemic situational awareness in LMICs are described in box 17.2.

Preventing and Extinguishing Pandemic Sparks

Although most pandemic preparedness activities focus on reducing morbidity and mortality after a pandemic has spread widely, certain activities may prevent and contain pandemic sparks before they become a wider threat. At the core of pandemic prevention is the concept of One Health, an approach that considers human health, animal health, and the environment to be fundamentally interconnected ( Zinsstag and others 2005). Activities that focus on understanding and controlling zoonotic pathogens may prevent spillover events and subsequent pandemics ( Morse and others 2012).

To understand the etiology of pandemics, important One Health activities include the surveillance of zoonotic pathogens of pandemic potential at the human-animal interface, the modeling of evolutionary dynamics, the risk assessments of zoonotic pathogens, and other methods of understanding the interplay between environmental changes and pathogen emergence ( Paez-Espino and others 2016; Wolfe and others 2005). For example, the PREDICT project of the U.S. Agency for International Development (USAID) has invested a significant amount of resources in understanding and characterizing zoonotic risk ( Anthony and others 2013).

Countries can focus their spark mitigation efforts on policies designed to control animal reservoirs; monitor high-risk populations such as people working at the animal interface (for example, those involved in animal husbandry, animal slaughter, and so on); and maintain robust animal health infrastructure, biosecurity, and veterinary public health capacities ( Jonas 2013; Pike and others 2010; Watts 2004; Yu and others 2014).

Risk Communications

Risk communications can play a significant role in the control of an emerging epidemic or pandemic by providing information that people can use to take protective and preventive action ( WHO 2013c). The dissemination of basic information (such as how the pathogen is transmitted, guidance on managing patient care, high-risk practices, and protective behavioral measures) can rapidly and significantly reduce the transmission of disease.

The way in which risk communications are framed and transmitted matters a great deal; they must be clear, simple, timely, and delivered by credible messengers. Factors such as literacy rates, cultural sensitivities, familiarity with scientific principles (such as the germ theory of disease), and reliance on oral versus written traditions all have implications for how messages should be designed and delivered ( Bedrosian and others 2016).

Public health officials also need to identify and address misinformation, rumors, and anxieties. This can be a significant challenge. During the 2014 West Africa Ebola epidemic, many communities reached for culturally familiar explanations of disease transmission and rejected disease control practices that clashed with their traditional healing and burial practices ( Roca and others 2015). Still other individuals spread rumors about the source of the infection; for example, in Liberia some community leaders claimed that the disease was created by the government ( Epstein 2014).

Rumors can impede disease control and can be amplified by mistrust of government officials, which is a significant challenge in LMICs with high levels of corruption or legacies of violent conflict and social division. Research has found that in unstable contexts, people tend to believe rumors that confirm their preexisting beliefs and anxieties ( Greenhill and Oppenheim 2017). This finding suggests that countering rumors with facts alone will not be sufficient. Risk communications need to be both factual and empathetic, addressing unfolding events and underlying fears through the lens of community experiences, histories, and perceptions.

The effectiveness of risk communications is difficult to measure. However, previous risk communication efforts have brought forth overarching themes that may be beneficial during the next epidemic or pandemic. One notable model comes from a Nipah virus outbreak in Bangladesh in 2010. In that outbreak, investigators found that messages about the sources of infection and potential strategies to reduce risk were more effective when conveyed by trusted local leaders and in terms that were relevant and grounded in the shared experiences of the affected community ( Parveen and others 2016).

Reducing Pandemic Spread

Once a pandemic has begun in earnest, public health efforts often focus on minimizing its spread. Limiting the spread of a pandemic can help to reduce the number of total people who are infected and thus also mitigate some of the indirect health and economic effects. Strategies to minimize pandemic spread include the following ( Ferguson and others 2005):

Curtailing interactions between infected and uninfected populations: for example, through patient isolation, quarantine, social distancing practices, and school closures

Reducing infectiousness of symptomatic patients: for example, through antiviral and antibiotic treatment and infection control practices

Reducing susceptibility of uninfected individuals: for example, through vaccines.

During the prepandemic period, plans for implementing those measures should be developed and tested through simulation exercises.

Curtailing Interactions between Infected and Uninfected Populations

The methods for curtailing interactions between infected and uninfected populations include patient isolation, quarantine, social distancing practices, school closures, use of personal protective equipment, and travel restrictions.

The practice of quarantine began in the fourteenth century in response to the Black Death and continues today ( Mackowiak and Sehdev 2002). Quarantine and social distancing (such as the prohibition of mass gatherings) during the 1918 influenza pandemic reduced spread and mortality rates, particularly when implemented in the early stages of the pandemic ( Bootsma and Ferguson 2007; Hollingsworth, Ferguson, and Anderson 2006). During SARS and Ebola outbreaks, health agencies and hospitals limited disease spread by isolating symptomatic patients, quarantining patient contacts, and improving hospital infection control practices ( Cohen and others 2016; Twu and others 2003). During the 2003 SARS pandemic, none of the health care workers in hospitals in Hong Kong SAR, China, who reported appropriate and consistent use of masks, gloves, gowns, and hand washing (as recommended under droplet and contact precautions) were infected ( Seto and others 2003).

Travel restrictions are sometimes implemented by governments to curtail disease spread. Fear and lack of scientific understanding may motivate the imposition of travel restrictions ( Flahault and Valleron 1990). As such, these measures are sometimes implemented for inappropriate pathogens or too late to contain an outbreak and can cause substantial economic damage and public anxiety. Travel restrictions are more beneficial for pathogens that do not have a significant asymptomatic carrier state and have a relatively long incubation period (for example, SARS and Ebola). However, such restrictions may be of limited efficacy for influenza pandemics unless initiated when there are fewer than 50 cases at the spark site ( Ferguson and others 2005).

Reducing Infectiousness and Susceptibility

If available, vaccines can reduce susceptibility. Significant efforts have focused on speeding up vaccine development and scaling up production. However, the availability of vaccines-particularly in LMICs-depends on the affected area's capacity for distribution (including the scale and integrity of the cold chain), its capacity for last-mile delivery to rural areas, and the population's willingness to adopt the vaccine. Vaccination strategies targeting younger populations may be especially beneficial, in part because influenza transmissibility is higher among younger populations during pandemics ( Miller and others 2008).

The effectiveness of antivirals, antibiotics, and vaccines in reducing spread diminishes if the pandemic is already global, if LMICs cannot afford adequate vaccine stocks for their populations, or if specific populations (for example, the poor or the socially vulnerable) cannot access vaccines. Additionally, pandemics may be caused by a pathogen without an available vaccine or efficacious biomedical therapy. Efforts to improve the vaccine development pipeline are underway ( box 17.3).

Care and Treatment to Reduce the Severity of Pandemic Illness

During a pandemic, health authorities work to reduce the severity of illness through patient care and treatment, which can help decrease the likelihood of severe outcomes such as hospitalizations and deaths. Treatments may range from nonspecific, supportive care to disease-specific drugs. During the prepandemic period, plans to implement these measures should be developed and tested through simulation exercises.

Potential for Scaling Up

The term scaling up refers to the expansion of health intervention coverage ( Mangham and Hanson 2010). In the context of pandemic preparedness, successfully scaling up requires health systems to expand services to accommodate rapid increases in the number of suspected cases. Scaling up is facilitated by surge capacity (the ability to draw on additional clinical personnel, logisticians, and financial and other resources) as well as preexisting operational relationships and plans linking government, nongovernmental organizations, and the private sector. Ultimately, scaling up consists of having both local surge capacity and the absorptive capacity to accept outside assistance.

Stockpiling of vaccines, medicines (including antibiotics and antivirals), and equipment (such as masks, gowns, and ventilators) also can be useful for building local surge capacity ( Dimitrov and others 2011; Jennings and others 2008; Morens, Taubenberger, and Fauci 2008; Radonovich and others 2009). During a pandemic, health systems can tap into stockpiles more quickly than they can procure supplies from external sources or boost production. However, there are five important considerations for keeping stockpiles:

Prepandemic vaccines may not be closely matched to the pathogen causing the pandemic.

The optimal size of a stockpile can be challenging to determine.

Stockpiles need to be refreshed regularly, because pharmaceuticals and equipment can reach expiration dates.

Robust health systems and channels for disseminating and using the stockpiles also must exist.

Boosting local production capacity for necessary supplies may be a viable strategy for pandemic preparedness and may circumvent some of the challenges associated with amassing stockpiles.

The 2009 influenza pandemic demonstrated how scaling up can affect the success rate of a mass vaccination campaign ( table 17.5). Vaccination rates increased according to country income level, suggesting that vaccination campaigns were most successful in HICs, likely because of the size of their stockpiles, increased manufacturing capacity for vaccines, increased availability of vaccines, and more streamlined logistics in vaccine deployment.

Building local capacity to scale up is challenging, especially in LMICs. The biggest challenges include infrastructural gaps (such as weak road, transportation, and communications networks) and shortfalls in human resources (such as logisticians, epidemiologists, and clinical staff). Bilateral and multilateral aid organizations have channeled substantial funding into building and sustaining local technical capacities in LMICs. This type of investment is critically important. But, particularly in LMICs with weak health system capacity, progress in expanding local surge capacity likely will be slow.

Another key component of scaling up, especially in LMICs, is the ability to use external assistance effectively. During the 2014 West Africa Ebola epidemic, a surge of foreign clinicians, mobile medical units, and epidemiologists and other public health personnel was required to bolster limited local resources. LMICs can improve systems to facilitate and coordinate surges of foreign support in the following ways:

Streamline customs processes for critical medical supplies and drugs.

Establish mechanisms to coordinate the deployment and operations of foreign medical teams.

Build mechanisms to coordinate between military and humanitarian units involved in crisis response.

Even so, local absorptive capacity (that is, the ability to channel and use foreign assistance effectively) has its limits. Constraints in bureaucratic capacity, financial controls, logistics, and infrastructure all are likely to be most severe in the countries that most need foreign assistance to manage infectious disease crises.

Furthermore, although external assistance is a viable strategy during localized epidemics, it has limitations that are likely to arise during large-scale pandemics. First, supply constraints exist, including limits to the number of medical personnel (especially those with crisis response and infectious disease competencies) and the number of specialized resources (such as integrated mobile medical clinics available for deployment).

Second, during a severe pandemic, countries are likely to use such resources locally before providing medical assistance abroad. The global humanitarian system provides a critical reservoir of crisis response capacity and shock absorption. However, the humanitarian system currently is straining under the pressure of other crises, including upsurges in violent conflict ( Stoddard and others 2015). A severe epidemic or pandemic can quickly outstrip international resources. Médecins Sans Frontières (Doctors Without Borders), an international health organization with deep experience providing Ebola treatment, found itself "pushed to the limits and beyond" during the 2014 West Africa Ebola epidemic ( MSF 2015).

Risk Transfer Mechanisms

As with any other type of natural disaster, the risk from pandemics cannot be eliminated. Despite prevention efforts, pandemics will continue to occur and will at times overwhelm the systems that have been put in place to mitigate their health, societal, and economic effects. The residual risk may be significant, particularly for LMICs that lack the resilience or resources to absorb shocks to public health and public finances. Risk transfer mechanisms (such as specialized insurance facilities) offer an additional tool to manage this risk.

Risk-based insurance products are increasingly deployed in LMICs to pay for remediation and reconstruction costs following natural catastrophes such as hurricanes, floods, and droughts ( ARC 2016; IFRC 2016). Insurance products for epidemics and pandemics require specific characteristics. First, insurance policies should be designed to release discretionary funds early in the course of an outbreak. In situations where financing poses a constraint to mobilizing personnel, drugs, or other supplies, payouts can be used to mobilize a public health response and mitigate further spread of disease, reducing the potential health and economic impacts of the pandemic. Second, because pandemics do not stay contained in national borders, a strong case can be made for mobilizing bilateral and multilateral financing of LMICs' insurance premiums as a cost-effective way to improve global preparedness and support mitigation efforts. Third, risk transfer systems require the availability of rigorously and transparently compiled data to trigger a payout. In the context of pandemic insurance, the development of risk transfer systems requires countries to build the following capacities, among others:

Robust surveillance data to identify when an outbreak has reached sufficient scale to require the release of funds

Laboratory capacity to confirm the causative agent

Predefined contingency and response plans to spend the funds effectively upon their release.

Insurance facilities can create positive incentives for LMICs to invest in planning and capacity building. Insurance mechanisms may have other positive externalities: most notably, the potential release of funds may provide a strong incentive for the timely reporting of surveillance data. However, insurance facilities also may introduce perverse incentives (including incentives to distort surveillance data) and potential moral hazards (such as permitting riskier activities). These incentive problems may be mitigated in the design of the risk transfer mechanism, such as by providing coverage only when minimum requirements for surveillance accuracy are met, by having preset phased triggers for payouts, and by including incentive payouts for successfully containing an outbreak.

Relative to investments in basic health provision, building capacity in infectious disease surveillance systems and other dimensions of pandemic preparedness has uncertain and potentially distant benefits. In LICs where near-term health needs are acute, this can complicate the political and economic logic for investing in pandemic preparedness ( Buckley and Pittluck 2016). The use of catastrophe modeling tools (such as EP curves) can clarify the benefit-cost rationale and the relevant time horizon for investments in preparedness, and it can inform the design and financial structure of pandemic insurance policies.

Figure 17.3 shows a country's hypothetical pandemic preparedness budget allocation and the portion of risk transfer in estimated total costs of spread response. In this example, a country has a total budget of US$100 million to cover all aspects of pandemic preparedness during the prepandemic, spark, and spread periods. After allocating half of the funds for prepandemic and spark response activities, US$50 million is left for pandemic spread response. On the basis of its risk tolerance, the country makes a decision to manage its risk at the 3 percent annual probability point on its EP curve. Modeling estimates indicate that a successful response to a pandemic at this level would require at least US$125 million, which would fund spread response activities, shown in box 17.1. Because only US$50 million is left after allocation to prepandemic and spark response activities, this would leave a shortfall of US$75 million. Some or all of this shortfall could be offloaded to another entity, such as a catastrophe risk insurance pool, which would give the country access to a payout during a pandemic.

Innovations in pandemic financing have been developed in response to the significant burden that a pandemic can place on a country's financial resources. One such innovation is the World Bank's Pandemic Emergency Financing Facility (PEF) ( Katz and Seifman 2016). A type of disaster risk pool, the PEF provides poorly resourced countries with an infusion of funds to help with the costs of response in the early stages of an epidemic or pandemic. The maximum total coverage over a three-year period is US$500 million. Notably, the US$500 million coverage is much lower than the estimated US$3.8 billion cost of the multinational response to the 2014 West Africa Ebola epidemic ( USAID and CDC 2016). Because the PEF is designed to trigger early in an outbreak, the anticipated funding is less than would be required for a full-fledged response once a widespread pandemic is under way.

Risk transfer mechanisms such as insurance offer an injection of financial resources to help insured parties rapidly scale up disease response activities. As such, the utility of risk transfer mechanisms depends, in large part, on the absorptive capacity of the insured party. A country must have the ability to use insurance payouts effectively to access additional human resources (clinicians, community health workers), personal protective equipment and other medical equipment consumables, and vaccines and therapeutics, from either domestic or international resources.

Adequacy of Evidence on Pandemics in LMICs

Much of the available data regarding pandemics (including the morbidity and mortality impacts of historical pandemics) and the effectiveness of different preparedness efforts and interventions come from HICs and upper-middle-income countries. Understanding of the prevalence of risk drivers, especially regarding spark risk, has improved markedly in both high- and low-income contexts. However, gaps in surveillance and reporting infrastructure in LMICs mean that, during a pandemic, many cases may never be detected or reported to the appropriate authorities ( Katz and others 2012). Particularly in LICs, empirical data on outbreak occurrences may be biased downward systematically.

Additionally, the means to disseminate collected data rapidly may not exist. For example, data may be kept in paper archives, so resource-intensive digitization may be required to analyze and report data to a wider audience. Data dissemination challenges are further compounded by a publication bias that results in overrepresentation of HICs in the scientific literature ( Jones and others 2008).

SUMMARY OF PANDEMIC INTERVENTION COSTS AND COST-EFFECTIVENESS

Few data are available regarding costs and cost-effectiveness of pandemic preparedness and response measures, and they focus almost exclusively on HICs. The available data suggest that the greatest cost-related benefits in pandemic preparedness and response are realized from early recognition and mitigation of disease-that is, catching and stopping sparks before they spread. Costs can be reduced if action is taken before an outbreak becomes a pandemic. Similarly, once a pandemic has begun, preventing illness generally is more cost-effective than treating illness, especially because hospitalizations typically have the highest direct cost per person. High costs also may occur as a result of interventions (such as quarantines and school closures) that lead to economic disruption. These interventions may be more cost-effective during a severe pandemic.

Program and Health System Costs

No systematic time-series data exist on global spending on pandemic preparedness, and arriving at an exact figure is complicated by the fact that many investments in building basic health system capacity also support core dimensions of pandemic preparedness. An analysis of global health spending found that roughly 1 percent of global ODA spending on health in 2013 (approximately US$204 million) focused specifically on pandemic preparedness ( Schäferhoff and others 2015). Other, non-ODA spending on pandemic preparedness is similarly difficult to measure but likely to be significant; in 2013, the U.S. Department of Defense spent roughly US$256 million on efforts to build global biosurveillance and response capacities ( KFF 2014).

Globally, the current funding for pandemic preparedness and response falls short of what is needed. In 2016, the international Commission on a Global Health Risk Framework for the Future recommended an additional US$4.5 billion annual global investment for upgrading pandemic preparedness at the country level, for funding infectious disease research and development efforts, and for establishing or replenishing rapid-response financing mechanisms such as the World Bank's PEF ( Sands, Mundaca-Shah, and Dzau 2016).

Costs for efforts associated with prepandemic preparedness activities also are not well quantified, although investment in One Health activities is likely to be cost-effective ( World Bank 2012). The USAID PREDICT project has estimated that discovery and detection of the majority of zoonotic viruses would cost US$1.6 billion ( Anthony and others 2013). The Global Virome Project, a more comprehensive study aiming to characterize more than 99 percent of the world's viruses, is estimated to cost US$3.4 billion over 10 years ( Daszak and others 2016). Building on efforts to identify and describe the ecology of potential pandemic viruses, the Coalition for Epidemic Preparedness Innovations (CEPI) estimated a cost of US$1 billion over five years to develop vaccine candidates against known emerging infectious diseases (for example, Ebola virus) and to build technology platforms and production facilities to accelerate vaccine response to outbreaks of known or unknown pathogens ( Brende and others 2017).

Instituting response measures after a pandemic has begun can be expensive, with most of the direct cost borne by the health care sector, although response costs typically are not reported in a cohesive manner. As noted, the response to the 2014 West Africa Ebola epidemic cost more than US$3.8 billion, including donations from several countries ( USAID and CDC 2016). Additionally, the World Bank Group mobilized US$1.6 billion from the International Development Association and the International Finance Corporation to stimulate economic recovery in the three worst-affected countries of Guinea, Liberia, and Sierra Leone ( World Bank 2016). Taken together, at US$5.4 billion, these values amount to a cost of US$235 per capita for these three countries.

When total costs for response are not available, unit costs for response activities provide valuable insights. Figure 17.4 shows estimated unit costs for selected response measures, based on modeling studies for pandemic influenza in HICs. Vaccinations and medicines have the lowest unit costs; in LMICs, large-scale purchasing and subsidies could push drug costs down even more. Conversely, hospital care has the highest unit costs. Costs per day of hospitalization (especially those with ICU involvement) can add up quickly when aggregated at the national level. However, these medical care costs are potentially bounded by capacity limits (such as a finite number of hospital beds), especially during more severe pandemics.

Pandemic severity itself can play a role in the drivers of cost and the effects of mitigation efforts. One study based on modeling simulations in an Australian population found that, in low-severity pandemics, most costs borne by the larger economy (not just the health care system) come from productivity losses related to illness and social distancing. In higher-severity pandemics, the largest drivers of costs are hospitalization costs and productivity loss because of deaths ( Milne, Halder, and Kelso 2013).

Costs per Death Prevented

Figure 17.5 depicts a compilation of data from 18 scientific publications that examined costs and benefits associated with response during the 2009 influenza pandemic. The lowest costs per deaths prevented were found for contact tracing, face masks, and surveillance. Pharmaceutical interventions such as vaccines and antiviral therapies were in the midrange.

Measures that decreased person-to-person contact, including social distancing, quarantine, and school closures, had the greatest cost per death prevented, most likely because of the amount of economic disruption caused by those measures. Social distancing includes avoidance of large gatherings and public places where economic activities occur. School closures often lead to lost productivity because they cause workplace absenteeism among caretakers of school-age children. Macroeconomic model simulations also have identified school closures as a potential source of GDP loss during a moderately severe pandemic ( Smith and others 2009).

The information shown in figure 17.5 is subject to several caveats:

The data come from only a few studies covering a handful of countries.

Cost-utility analyses of pandemic preparedness and response for LMICs are rare. Because the underlying data for these studies were drawn primarily from HICs, the estimates may not accurately represent the relative benefit-cost of interventions in LMICs. For example, in countries with high unemployment and underemployment, school closures may not lead to increased workforce absenteeism and thus might have a lower cost per death prevented.

The 2009 influenza pandemic is considered a relatively mild pandemic. In a more severe influenza pandemic, the cost per death prevented could decrease for some interventions, such as school closures.

Results are sensitive to assumptions about the value of a prevented death and estimated costs of different interventions.

The data cover only pandemics caused by influenza. For pandemics caused by other types of pathogens, the cost-utility values may be different, and not all intervention measures may be available.

Data on antiviral stockpiles provide some insight into how the cost utility of pandemic preparedness efforts may vary by country income level. Figure 17.6 shows the cost utility of antiviral stockpiling by country income level, based on simulation studies.

A more recent study found that antiviral stockpiling in Cambodia (a lower-middle-income country) would cost between US$3,584 and US$115,168 per death prevented; however, this result is highly sensitive to assumptions about the timing between pandemics ( Drake, Chalabi, and Coker 2015).

Although based only on a handful of countries, the results suggest that antiviral stockpiling in LICs has an extremely high cost per death prevented, whereas countries at other income levels are clustered within much lower ranges. Antiviral stockpiling is not cost-effective or feasible for LICs, primarily because of the high cost of antiviral agents. For stockpiling to be a cost-effective strategy for LICs, almost all of the costs would have to be subsidized. The associated costs also may be reduced by the increased availability of generic antiviral drugs. Additionally, the efficacy of antivirals is not assured, particularly for LICs, which may not be able to identify cases early enough to administer antivirals efficaciously.

Cost-Effectiveness

Pérez Velasco and others ( 2012) synthesized information from 44 studies that contained economic evaluations of influenza pandemic preparedness and response strategies in HICs ( figure 17.7). In their analysis, the following interventions among the general population had the potential to provide cost savings: vaccines, antiviral treatment, social distancing, antiviral prophylaxis plus antiviral treatment, and vaccines plus antiviral treatment. The cost savings from antiviral drugs found in this study are likely to be diminished in LMICs, as inability to deploy antivirals in a timely manner poses a serious challenge to their efficacious use.

Depending on the characteristics of a pandemic and how mitigation efforts are implemented, some mitigation strategies could become highly cost- ineffective. For example, a costly vaccination campaign that is carried out in an area well after a pandemic peaks is not nearly as effective in reducing transmission as having vaccines available and distributed earlier in the pandemic.

Allocation of limited resources (by creating priority groups for vaccines and antivirals) is an important consideration during a pandemic. Modeling studies from the 2009 influenza pandemic investigated the most cost-effective strategies for allocating vaccines. Those studies found that vaccinating high-risk individuals was more cost-effective than prioritizing children. Favoring children decreased the overall infection rate, but high-risk individuals were the predominant drivers of direct costs during the pandemic, because they were more likely to be hospitalized ( Lee and others 2010). However, these studies did not account for the indirect costs of school closures and absenteeism. Consideration of these factors could reveal increased cost savings from vaccinating children.

Another key question for benefit-cost analyses related to pandemics is the extent to which stockpiles of vaccines, antiviral drugs, and protective equipment should be assembled in advance of a pandemic. Vaccines for a novel influenza virus can take several months to develop, and vaccines for other pathogens (for example, Ebola and Zika) can take even longer to develop. Studies have examined the cost-effectiveness of stockpiling prepandemic vaccines that have lower efficacy than reactive vaccines but can be deployed more quickly. One study found that cost savings can be obtained as long as prepandemic vaccines have at least 30 percent efficacy. However, cost-effectiveness differs by pandemic severity and the percentage of the population that receives the vaccine during the vaccination campaign ( Halder, Kelso, and Milne 2014).

Antiviral drugs to fight pandemic influenza also can be stockpiled ahead of time. However, the optimal number of doses to stockpile depends on factors including the effectiveness of concurrent interventions and the likelihood of antiviral wastage on noninfluenza respiratory infections ( Greer and Schanzer 2013).

Most pandemic-related benefit-cost studies focus on pharmaceutical interventions for high-income and upper-middle-income countries. The studies have largely neglected the question of how to allocate strained resources in low- and lower-middle-income countries. Furthermore, few evaluations have been conducted of the cost-effectiveness of general investment in health systems, infrastructure, and capacity building as a means to achieve pandemic preparedness ( Drake, Chalabi, and Coker 2012).

CONCLUSIONS AND RECOMMENDATIONS FOR PRIORITIZING INVESTMENTS TO MITIGATE PANDEMIC RISK IN RESOURCE-LIMITED SETTINGS

Preparing for a pandemic is challenging because of a multitude of factors, many of which are unique among natural disasters. Pandemics are rare events, and the risk of occurrence is influenced by anthropogenic changes in the natural environment. In addition, accountability for preparedness is diffuse, and many of the countries at greatest risk have the most limited capacity to manage and mitigate pandemic risk.

Unlike most other natural disasters, pandemics do not remain geographically contained, and damages can be mitigated significantly through prompt intervention. As a result, there are strong ethical and global health imperatives for building capacity to detect and respond to pandemic threats, particularly in countries with weak preparedness and high spark and spread risk.

Investments to improve pandemic preparedness may have fewer immediate benefits, particularly relative to other pressing health needs in countries with heavy burdens of endemic disease. Therefore, characterizing pandemic risk and identifying gaps in pandemic preparedness are essential for prioritizing and targeting capacity-building efforts. Thinking about risks in terms of frequency and severity, notably using probabilistic modeling and EP curves, can quantify the potential pandemic risks facing each country and clarify the benefit-cost case for investing in pandemic preparedness.

No single, optimal response to a public health emergency exists; strategies must be tailored to the local context and to the severity and type of pandemic. However, overarching lessons emerge after multiple regional epidemics and global pandemics. For example, because of their high spark and spread risks, many LMICs would benefit most from building situational awareness and health care coordination capacity; public health response measures are far more cost-effective if they are initiated quickly and if scarce resources are targeted appropriately.

Building pandemic situational awareness is complex, requiring coordination across bureaucracies, across the public and private sectors, and across disciplines with different training and different norms (including epidemiology, clinical medicine, logistics, and disaster response). However, an appropriately sized and trained health workforce (encompassing doctors, nurses, epidemiologists, veterinarians, laboratorians, and others) that is supported by adequate coordination systems is a fundamental need-the World Health Organization has recommended a basic threshold of 23 skilled health professionals per 10,000 people ( WHO 2013a).

Increasing the trained health workforce also will increase the capacity to detect whether any particular population (for example, human, farm animal, or wildlife) is suffering from a pathogen with high pandemic risk. Increasing the health workforce also will improve the overall resiliency of the health system, an improvement that can be applied to any emergency that results in morbidity and mortality shocks.

Additionally, building situational awareness will require sustained investment in infectious disease surveillance, crisis management, and risk communications systems. Investments in these capacities are likely to surge after pandemic or epidemic events and then abate as other priorities emerge. Hence, stable investment to build sustained capacity is critical.

Risk transfer mechanisms such as catastrophe risk pools offer a viable strategy for countries to manage pandemic risk. Further developing these mechanisms will allow countries to offload portions of pandemic risk and response that are beyond their immediate budgetary capacity. For this reason, risk transfer solutions should be designed with the needs and constraints of LMICs in mind. However, countries must have predefined contingency and response plans as well as the absorptive capacity to use the emergency financing offered by such solutions. Broad and effective use of pandemic insurance will require parallel investments in capacity building and emergency response planning.

Finally, researchers must address the significant knowledge gaps that exist regarding LMICs' pandemic preparedness and response. Improving the tracking of spending and aid flows specifically tied to pandemic prevention and preparedness is vital to tracking gaps and calibrating aid flows for maximum efficiency. Systematic data on response costs in low-income settings are scarce, including data regarding spending on clinical facilities, supplies, human resources, and response activities such as quarantines. Bridging these data gaps can improve pandemic preparedness planning and response through evidence-based decision making and support efforts to prevent and mitigate epidemics and pandemics.

ACKNOWLEDGMENTS

The authors would like to thank Ron Waldman, Dean Jamison, Steve Morse, Peter Sands, Mukesh Chawla and the Secretariat of the International Working Group on Financing Preparedness, Kimberly Dodd, Mary Guttieri, Patrick Ayscue, Damien Joly, Sarah Barthel, Joseph Krilanovich, Jonathan Koshi, Mike Gahan, Kierste Miller, Cathine Lam, Catherine Planey, Nicole Stephenson, Volodymyr Serhiyenko, Ming Yii Goh, Alessandro Vespignani, Qian Zhang, Matteo Chinazzi, Ana Pastore y Piontti, Marco Schäferhoff, and Jessica Kraus for their valuable technical and editorial contributions to the chapter.

Notes

This chapter uses World Bank Income Classifications for 2018 as follows, based on estimates of gross national income (GNI) per capita for 2015:

Low-income countries (LICs) = US$1,005 or less

Middle-income countries (MICs) are subdivided:

1. lower-middle-income = US$1,006 to US$3,995

2. upper-middle-income countries (UMICs) = US$3,996 to US$12,235

High-income countries (HICs) = US$12,236 or more

1

One Health considers individual, community, and animal health as interconnected and requires the collaboration of human, animal, and environmental health professionals to recognize and alleviate the problems on one level to reduce the downstream health effects on another level (for example, rabies in animals and humans). For more information, see the U.S. Centers for Disease Control and Prevention's webpage, https://www​.cdc.gov/onehealth​/basics/index.html.

2

PREDICT, a project of USAID's Emerging Pandemic Threats Program, was initiated in 2009 to strengthen global capacity for detection and discovery of zoonotic viruses with pandemic potential. Working with partners in 31 countries, PREDICT is building platforms for conducting disease surveillance and for identifying and monitoring pathogens that can be shared between animals and people. Using the One Health approach, the project is investigating the behaviors, practices, and ecological and biological factors driving the emergence, transmission, and spread of disease. For more information, see the project website, http://www​.vetmed.ucdavis​.edu/ohi/predict/.

3

References

1. ARC (African Risk Capacity). 2016. "African Risk Capacity Strategic Framework 2016-2020." Strategy and policy document, ARC, Johannesburg, South Africa.

2. Arimah B C. 2010. "The Face of Urban Poverty: Explaining the Prevalence of Slums in Developing Countries." In Urbanization and Development: Multidisciplinary Perspectives, edited by Beall Jo, Guha-Khasnobis Basudeh, Kanbur Ravi., 143-64. Oxford: Oxford University Press.

3. ASPR (Assistant Secretary for Preparedness and Response). 2014. "Public Health and Medical Situational Awareness Strategy." Strategy document for situational awareness implementation plan U.S. Department of Health and Human Services, Washington, DC.

4. Brattberg E, Rhinard M. 2011. "Multilevel Governance and Complex Threats: The Case of Pandemic Preparedness in the European Union and the United States." Global Health Governance 5 (1): 1-21.

5. Burns A, Mensbrugghe D Van der, Timmer H. 2006. "Evaluating the Economic Consequences of Avian Influenza." Working Paper 47417, World Bank, Washington, DC.

6. Chandy L, Kato H, Kharas H. eds. 2015. The Last Mile in Ending Extreme Poverty. Washington, DC: Brookings Institution Press.

7. Chisholm H. 1911. "Cholera." Encyclopedia Britannica 11 (6): 265-66.

8. Cohn S K. 2007. "The Black Death and the Burning of Jews." Past and Present 196 (1): 3-36.

9. Daszak P, Carroll D, Wolfe N, Mazet J. 2016. "The Global Virome Project." International Journal of Infectious Diseases 53 (Suppl): 36.

10. Diamond J. 2009. Guns, Germs, and Steel: The Fates of Human Societies. New York: Norton.

11. Dixon S, McDonald S, Roberts J. 2001. "AIDS and Economic Growth in Africa: A Panel Data Analysis." Journal of International Development 13 (4): 411-26.

12. Elbe S. 2002. "HIV/AIDS and the Changing Landscape of War in Africa." International Security 27 (2): 159-77.

13. Epstein H. 2014. "Ebola in Liberia: An Epidemic of Rumors." New York Review of Books 61 (20): 91-95.

14. Falcone R E, Detty A. 2015. "The Next Pandemic: Hospital Response." Emergency Medical Reports 36 (26): 1-16.

15. Fan V Y, Jamison D. T, Summers L S. 2016. "The Inclusive Cost of Pandemic Influenza Risk." NBER Working Paper 22137, National Bureau of Economic Research, Cambridge, MA.

16. Fearon J D, Laitin D D. 2003. "Ethnicity, Insurgency, and Civil War." American Political Science Review 97 (1): 75-90.

17. Fullam J D, Madhav N. 2015. "Quantifying Pandemic Risk." The Actuary 12 (1): 29-34.

18. Greenhill K, Oppenheim B. 2017. "Rumor Has It: The Adoption of Unverified Information in Conflict Zones." International Studies Quarterly 61 (3).

19. Hooghe L, Marks G. 2003. "Unraveling the Central State, but How? Types of Multi-Level Governance." American Political Science Review 97 (2): 233-43.

20. ICG (International Crisis Group). 2015. The Politics behind the Ebola Crisis. Crisis Group Africa Report 232, International Crisis Group, Brussels, October 28.

21. IFRC (International Federation of Red Cross and Red Crescent Societies). 2016. World Disasters Report, Resilience: Saving Lives Today, Investing for Tomorrow. Geneva: IFRC.

22. Jonas O B. 2013. "Pandemic Risk." Background paper for World Development Report 2014: Risk and Opportunity; Managing Risk for Development, World Bank, Washington, DC.

23. Jun K. 2015. "MERS Outbreak Prompts South Korean Stimulus Package." Wall Street Journal, June 25.

24. Kozlowski R T, Mathewson S B. 1997. "A Primer on Catastrophe Modeling." Journal of Insurance Regulation 15 (3): 322.

25. McCoy T. 2014. "Why the Brutal Murder of Several Ebola Workers May Hint at More Violence to Come." Washington Post, September 19.

26. McKibbin W J, Sidorenko A A. 2006. "Global Macroeconomic Consequences of Pandemic Influenza." Analysis, Lowy Institute for International Policy, Sydney, Australia.

27. MSF (Médecins Sans Frontières). 2015. Pushed to the Limit and Beyond: A Year into the Largest Ever Ebola Outbreak. Report, MSF, London.

28. Oppenheim B, Gallivan M D, Madhav N, Brown N, Serhiyenko V., and others. 2017. "Global Preparedness for the Next Pandemic." Unpublished manuscript.

29. Park J, Kim J. 2015. "Hong Kong Sets 'Serious' Response to South Korea's MERS Outbreak." Reuters, June 8.

30. Platt C. 2014. King Death: The Black Death and Its Aftermath in Late-Medieval England. Oxon U.K.: Routledge.

31. Porta M., ed. 2014. A Dictionary of Epidemiology. 6th ed. Oxford: Oxford University Press.

32. Price-Smith A T. 2001. The Health of Nations: Infectious Disease, Environmental Change, and Their Effects on National Security and Development. Cambridge, MA: MIT Press.

33. Price-Smith A T. 2009. Contagion and Chaos: Disease, Ecology, and National Security in the Era of Globalization. Cambridge, MA: MIT Press.

34. Pritchett L, Woolcock M, Andrews M. 2013. "Looking Like a State: Techniques of Persistent Failure in State Capability for Implementation." Journal of Development Studies 49 (1): 1-18.

35. Stoddard A, Harmer A, Haver K, Taylor G, Harvey P. 2015. The State of the Humanitarian System: 2015 Edition. London: Active Learning Network for Accountability and Performance in Humanitarian Action/Overseas Development Institute.

36. Thomas M R, Smith G, Ferreira F H G, Evans D, Maliszewska M., and others. 2015. "The Economic Impact of Ebola on Sub-Saharan Africa: Updated Estimates for 2015." Working Paper 93721, World Bank, Washington, DC.

37. Tyler T. 2016. "IATA 2016 Annual Review." Annual review publication, International Air Transport Association (IATA), Montreal.

38. UNDESA (United Nations Department of Economic and Social Affairs). 2015. "World Population Prospects: The 2015 Revision, Key Findings and Advance Tables." Report ESA/P/WP.241, UNDESA, New York.

39. UNDP (United Nations Development Programme). 2014. "Assessing the Socio-Economic Impacts of Ebola Virus Disease in Guinea, Liberia, and Sierra Leone: The Road to Recovery." Synthesis report, UNDP, New York.

40. UNDP (United Nations Development Programme). 2017. "A Socio-Economic Impact Assessment of the Zika Virus in Latin America and the Caribbean: With a Focus on Brazil, Colombia, and Suriname." Synthesis report, UNDP, New York.

41. USAID (U.S. Agency for International Development) and CDC (Centers for Disease Control and Prevention). 2016. "West Africa-Ebola Outbreak, Fact Sheet #11, Fiscal Year (FY) 2015." Fact sheet, USAID, CDC, June 24.

42. U.S. Department of Health and Human Services. 2005. "HHS Pandemic Influenza Plan." Strategic, guidance, and operational planning document U.S. Department of Health and Human Services, Washington, DC.

43. U.S. Homeland Security Council. 2006. "Implementation Plan for the National Strategy for Pandemic Influenza." Plan document U.S. Homeland Security Council, Executive Office of the President of the United States, Washington, DC.

44. WHO (World Health Organization). 2005. International Health Regulations. Geneva: WHO.

45. WHO (World Health Organization). 2013a. "Global Health Workforce Shortage to Reach 12.9 Million in Coming Decades." News release, November 11.

46. WHO (World Health Organization). 2013b. Global Survey on National Vaccine Deployment and Vaccination Plans for Pandemic A(H1N1) 2009 Vaccine-2010. Report of survey findings, WHO, Geneva.

47. WHO (World Health Organization). 2013c. "IHR Core Capacity Monitoring Framework: Checklist and Indicators for Monitoring Progress in the Development of IHR Core Capacities in States Parties." International Health Regulations (2005) document, Reference WHO/HSE/GCR/2013.2, WHO, Geneva.

48. WHO (World Health Organization). 2014. "Summary of States Parties 2013 Report on IHR Core Capacity Implementation: Regional Profiles." International Health Regulations (2005) document, Reference WHO/HSE/GCR/2014.10, WHO, Geneva.

49. WHO (World Health Organization). 2015a. "Successful Ebola Responses in Nigeria, Senegal, and Mali." In One Year into the Ebola Epidemic: A Deadly, Tenacious, and Unforgiving Year. Paper Series, January 2015, WHO, Geneva.

50. WHO (World Health Organization). 2015b. "WHO Model List of Essential Medicines, 19th ed." WHO, Geneva.

51. WHO (World Health Organization). 2016a. Ebola Situation Report. Weekly data report, April 15.

52. WHO (World Health Organization). 2016c. "Pandemic Influenza Preparedness Framework Partnership Contribution: Annual Report 2015." Document WHO/OHE/PED/2016.01, Pandemic Influenza Preparedness (PIP) Secretariat, WHO, Geneva.

53. WHO (World Health Organization). 2017. Situation Report: Zika Virus, Microcephaly, Guillain-Barré Syndrome. Weekly data report, February 2.

54. World Bank. 2012. People, Pathogens, and Our Planet, Volume 2: The Economics of One Health. Report 69145, World Bank, Washington, DC.

55. World Bank. 2014. "The Economic Impact of the 2014 Ebola Epidemic: Short and Medium Term Estimates for Guinea, Liberia, and Sierra Leone." Working Paper 90748, World Bank, Washington, DC.

# data[].attributes.attachment_link.title
Pandemics: Risks, Impacts, and Mitigation

# data[].attributes.attachment_link.description
Pandemics are large-scale outbreaks of infectious disease that can greatly increase morbidity and mortality over a wide geographic area and cause significant economic, social, and political disruption. Evidence suggests that the likelihood of pandemics has increased over the past century because of increased global travel and integration, urbanization, changes in land use, and greater exploitation of the natural environment (Jones and others 2008; Morse 1995).

# data[].attributes.attachment_link.readable_text
Epidemics and Society: From the Black Death to the Present Frank M. Snowden Yale University Press (2019)

When will we learn never to declare the end of anything? Only 50 years ago, two prominent US universities closed their infectious-disease departments, sure that the problem they studied had been solved. Now, cases of measles and mumps are on the rise again in Europe and the United States, new infectious diseases are emerging at an unprecedented rate, and the threat of the next pandemic keeps philanthropist Bill Gates awake at night.

So it's a shame that to make this point, Epidemics and Society, Frank Snowden's wide-ranging study on this rolling human reality, repeats the urban myth that in 1969, US surgeon-general William Stewart said, "It is time to close the book on infectious diseases, and declare the war against pestilence won." Even though Stewart never said this, it's clear that there was a pervasive, dangerously complacent attitude in the late 1960s. International public-health authorities were predicting that pathogenic organisms, including the parasite that causes malaria, would be eliminated by the end of the twentieth century. Snowden's broader thesis is that infectious diseases have shaped social evolution no less powerfully than have wars, revolutions and economic crises.

It's not a new message, but it bears repeating. Snowden, a historian at Yale University in New Haven, Connecticut, has assembled a vast amount of evidence, some the fruit of his own research. His global history spans more than a millennium of outbreaks, covering diseases from bubonic plague to smallpox, malaria, the respiratory illness SARS, Ebola and beyond. He rehashes the long history of scapegoating, violence, mass hysteria and religiosity that have accompanied epidemics, but only to speculate on their longer-term social, political and cultural consequences.

When cholera struck Paris in 1832 - in an epidemic that eventually killed nearly 19,000 Parisians - a conspiracy theory spread that the unpopular government under King Louis Philippe was poisoning wells with arsenic. The police and army were barely able to contain the violence that ensued. The institutional memory of those events fuelled dread of the "dangerous classes": poor people. That, Snowden argues, might help to explain why the two most egregious examples of class-based repression in the nineteenth century also took place in the French capital. These were the violent crushing of the 1848 revolution and the bloody destruction of the Paris Commune, the revolutionary government that briefly ruled the city 23 years later.

The synergy between wars and epidemics in shaping history has long been recognized. Napoleon Bonaparte's nineteenth-century imperial expansion westwards across the Atlantic Ocean was halted by yellow fever, which his army encountered in France's Caribbean colony of Saint-Domingue (now Haiti). His eastern ambitions were thwarted by dysentery and typhus. (The typhus epidemic that ravaged the Grande Armée during its retreat from Moscow might have prompted an unparalleled die-off by some measurements, as Snowden claims. But it was surely not in terms of "deaths per capita".)

Security threat

An odd omission from the book is the 1918 'Spanish' influenza pandemic, which overlapped with the First World War and is estimated to have killed between 50 million and 100 million people. Snowden might have felt that it garnered enough attention around its centenary. But a future flu pandemic is currently ranked among the leading threats to global security, and there has been surprisingly little research on the long-term consequences of the 1918 catastrophe. Furthermore, it might have been interesting to explore the possible links between that pandemic and the ongoing epidemic of AIDS in South Africa, which the book does cover.

There is evidence that white scapegoating of black South Africans in 1918 precipitated the first legislative steps towards apartheid. As Snowden discusses, by restricting the land available to people of colour, apartheid accelerated the growth of a migrant labour system that divided black families. It also encouraged new forms of social and sexual behaviour. Both developments, in turn, hastened the spread of AIDS once it arrived. Young men growing up away from their families, for instance, often developed standards of masculinity that promoted sexual conquest and violence; South Africa now has one of the highest rates of rape in the world ( K. Naidoo S. Afr. Med. J. 103, 210-211; 2013). The crowning tragedy of these depressing events was President Thabo Mbeki's endorsement, from 1999, of a US AIDS denialist's theory that the disease is not caused by the HIV virus. That resulted in the avoidable deaths of an estimated half a million South Africans.

In the twenty-first century, we seem to be repeating many of the mistakes that triggered or exacerbated epidemics in the past. That is presumably why Snowden refers ominously to this century's first major epidemics, of SARS and Ebola, as "dress rehearsals". Although many people espouse health care for all, our globalized economic system militates against it - because profits are rarely invested where they were extracted - and we still seem to think that borders will keep disease out, even though they never have. Since Snowden completed his book, the administration of US President Donald Trump has announced that an immigrant's chances of getting permanent residence will now be linked to the burden they put on the public purse - including health-care costs. That makes it more likely that recent arrivals will avoid doctors, and infectious diseases will go undetected.

The starkest reminder that the battle is not won, however, is that only one infectious disease has been eradicated globally: smallpox. Others that those optimists of the 1960s thought would have vanished by now have been hard to dislodge - and could easily flare up again. The strife-ridden Democratic Republic of the Congo is harbouring more than Ebola. There is also a measles outbreak, and a circulating strain of polio that mutated from the live, weakened one in the oral vaccine. There have been successful local disease eradications, but they often came at a price. A sustained campaign of DDT application helped eliminate malaria from the Italian island of Sardinia by 1952, for example, but in 2001, the pesticide was banned globally under the Stockholm Convention, after it was found to be dangerous to wildlife and the environment.

For Snowden, the lesson from more than 50 years of such experiments - successes and failures - is that eradication is most likely to work when doctors, politicians, drugmakers, the media and citizens work together. Salus populi suprema lex, he reminds us: public health must be the highest law. He has preached that message to generations of Yale undergraduates, and repeats it in this book. The risk is only that he is preaching to the converted.

# data[].attributes.attachment_link.description
Epidemics and Society: From the Black Death to the Present Frank M. Snowden Yale University Press (2019) When will we learn never to declare the end of anything? Only 50 years ago, two prominent US universities closed their infectious-disease departments, sure that the problem they studied had been solved.

# data[].attributes.attachment_link.readable_text
No one wants to think of one crisis in the middle of another, but it's exactly now, when we see first hand how quickly things can change, that it's time to think about crisis preparedness in general. As the coronavirus pandemic unfolds, the work of climate activists can help us respond to this moment - just as this moment is a critical learning period for future climate crises.

A recent New York Times headline expresses what climate activists know all too well: "Before Virus Outbreak, a Cascade of Warnings Went Unheeded." And because we don't heed such warnings we'll see increasing large-scale social crises: pandemics; mass displacements due to flooding, fires and droughts; social upheaval; and economic fallout. All these are more likely in an age of climate change and ecological breakdown.

This pandemic reminds us that life can change quickly in almost unimaginable ways.

But climate activists, who have been thinking about how to prepare for and help prevent or mitigate such moments, can provide much valuable guidance. The four "demands" of Extinction Rebellion, the network of volunteer activists I joined last year, are useful principles for addressing coronavirus - or any crisis. Think of them as "pillars" that can guide us to a safer future.

1) Tell the truth.

The first necessary ingredient in addressing any situation successfully is to tell the truth. Because China's authoritarian government withheld information about the truth of the outbreak of the new virus in Wuhan, the outbreak was not contained from the start.

Similarly, at every stage of the virus's development, denialism has put us at more risk - as we've seen in both Italy and the US. The Trump administration's denial and downright obstruction of the truth about both the coronavirus and the climate and ecological crisis puts us all in grave danger.

Politicians, business leaders and citizens cannot be experts in subjects like pandemics and ecological breakdown. Scientists are. We must listen to scientists, report on their findings, and follow their lead.

2) Act now.

As we have seen with coronavirus, crises can develop suddenly, and if we're not prepared from the start we're at greater risk. The more pro-active countries have been with coronavirus, the less damage they've seen. Singapore, which started preparing for the COVID crisis in early January, has had very few deaths, though it's right next to China.

By contrast, in 2018, Trump cut funding for the US Center for Disease Control (CDC). His argument was that as long as there wasn't an active pandemic, CDC workers were superfluous. To save money, in other words, he prioritized business "efficiency" over social resilience; he failed to act in the present to prepare for the future. As a result, America was dangerously ill prepared.

But even in our belated and hurried response to COVID-19 we can prepare for future crises. This is a unique moment when government will be pouring money into the economy, and the scientific consensus is clear: we must act on the climate and ecological crisis today.

Rather than re-investing in fossil fuel infrastructure like airlines or road-widening, we should be transitioning to green energy, transportation and green agriculture. We have only a few years, at most, to be able to keep global temperatures from spiking above two degrees of warming - a level whose feedback loops will fundamentally alter life on earth. Our time is running out.

3) Move beyond partisan politics.

The coronavirus infects Republicans, Democrats, Liberals, Conservatives and Socialists alike. It knows no international or state boundaries. To address the pandemic - just like the climate crisis - we must come together across party and national lines. We must listen to scientists who are the experts, whose knowledge does not adhere to partisan divides. And we must move beyond the bottlenecks that such politics can create so that government can take the necessary action.

As we have seen with both the pandemic and the climate crisis, individual action alone is insufficient to address the situation. Only large-scale government direction is able to create the kinds of changes we need.

The danger, however, is that such action will curtail individual freedoms and lead to authoritarian forms of government. The other challenge is that, because people are mistrustful of government and especially mistrustful of the "other side," the swift, necessary actions we need get snarled up in congress or parliament.

To address this concern, Extinction Rebellion is calling for a Citizen's Assembly to oversee important decisions and take responsibility for actions on climate and ecological issues. Like a jury, such assemblies would be made up of randomly-chosen citizens with decision-making powers.

We need truly democratic systems to oversee our government's actions and instill trust again in government itself. With citizen's assemblies, we can be more confident that power won't be abused.

4) Focus on a just transition.

The coronavirus pandemic makes clear that in a crisis, the most vulnerable are at the greatest risk. The pandemic exposes the deep insecurities that are built into American life -a highly-inequitable healthcare system, for example; the 58% of Americans who have less than $1000 in savings; and no sick leave for families. In short, there is hardly any safety net, and as coronavirus threatens to send us into a massive economic depression, our response has to consider those who are most in need.

Similarly, the most vulnerable are on the front lines of the climate crisis. We must prepare now for a just transition to protect people from the devastating physical and economic effects of climate and ecological breakdown. We need policies like the Green New Deal that put workers, people of color and poor people front and center - not big corporations

5) Build regenerative cultures.

The aim of these four pillars is 'regenerative culture,' meaning a culture that prioritizes humanity and ecosystems over profit, and one that is that is democratic and life-affirming, joyful and non-hierarchical.

We do have the capacity as societies to take care of one another through such a culture. Though this pandemic has often been mishandled, it also displays our ability to work together and make individual sacrifices for the common good. It shows we can radically alter our habits and behavior. This is important, inspiring and encouraging.

Satellite images over China and the US show pollution clearing as a result of the economic slowdown induced by Covid-19. What will it take for us to realize that in order to prevent even greater catastrophes, we need to keep the skies clear in the future?

The coronavirus, real in itself, is also a testing ground for the climate crisis, just as the climate crisis helps us understand what's needed to address the pandemic.

With its hurricanes and fires and droughts, summer will be upon us before we know it. This pandemic is showing how little resilience we have as a society, and how quickly we can all be at mortal risk. So let's use the coronavirus crisis as a wake-up call to create a more resilient and life-affirming culture.

This pandemic shows us how ordinary life can be disrupted. As the climate scientist James Hanson has written "The climate system is capable of abrupt changes and surprises. Once [this] occurs it can be difficult or impossible to reverse the...change."

Therefore we must tell the truth, act now, move beyond partisan politics, and mobilize a just transition both for today's crisis and tomorrow's. The death toll from the climate emergency threatens to be exponentially greater than that from even the worst-case scenario of the coronavirus. Now is the moment to act.

I want to be able to tell my grandchildren that we paid attention and made the changes that were necessary for their future.

# data[].attributes.attachment_link.title
Coronavirus and climate activism: five common lessons

# data[].attributes.attachment_link.description
No one wants to think of one crisis in the middle of another, but it's exactly now, when we see first hand how quickly things can change, that it's time to think about crisis preparedness in general.

# data[].attributes.attachment_link.readable_text
No one wants to think of one crisis in the middle of another, but it's exactly now, when we see first hand how quickly things can change, that it's time to think about crisis preparedness in general. As the coronavirus pandemic unfolds, the work of climate activists can help us respond to this moment - just as this moment is a critical learning period for future climate crises.

A recent New York Times headline expresses what climate activists know all too well: "Before Virus Outbreak, a Cascade of Warnings Went Unheeded." And because we don't heed such warnings we'll see increasing large-scale social crises: pandemics; mass displacements due to flooding, fires and droughts; social upheaval; and economic fallout. All these are more likely in an age of climate change and ecological breakdown.

This pandemic reminds us that life can change quickly in almost unimaginable ways.

But climate activists, who have been thinking about how to prepare for and help prevent or mitigate such moments, can provide much valuable guidance. The four "demands" of Extinction Rebellion, the network of volunteer activists I joined last year, are useful principles for addressing coronavirus - or any crisis. Think of them as "pillars" that can guide us to a safer future.

1) Tell the truth.

The first necessary ingredient in addressing any situation successfully is to tell the truth. Because China's authoritarian government withheld information about the truth of the outbreak of the new virus in Wuhan, the outbreak was not contained from the start.

Similarly, at every stage of the virus's development, denialism has put us at more risk - as we've seen in both Italy and the US. The Trump administration's denial and downright obstruction of the truth about both the coronavirus and the climate and ecological crisis puts us all in grave danger.

Politicians, business leaders and citizens cannot be experts in subjects like pandemics and ecological breakdown. Scientists are. We must listen to scientists, report on their findings, and follow their lead.

2) Act now.

As we have seen with coronavirus, crises can develop suddenly, and if we're not prepared from the start we're at greater risk. The more pro-active countries have been with coronavirus, the less damage they've seen. Singapore, which started preparing for the COVID crisis in early January, has had very few deaths, though it's right next to China.

By contrast, in 2018, Trump cut funding for the US Center for Disease Control (CDC). His argument was that as long as there wasn't an active pandemic, CDC workers were superfluous. To save money, in other words, he prioritized business "efficiency" over social resilience; he failed to act in the present to prepare for the future. As a result, America was dangerously ill prepared.

But even in our belated and hurried response to COVID-19 we can prepare for future crises. This is a unique moment when government will be pouring money into the economy, and the scientific consensus is clear: we must act on the climate and ecological crisis today.

Rather than re-investing in fossil fuel infrastructure like airlines or road-widening, we should be transitioning to green energy, transportation and green agriculture. We have only a few years, at most, to be able to keep global temperatures from spiking above two degrees of warming - a level whose feedback loops will fundamentally alter life on earth. Our time is running out.

3) Move beyond partisan politics.

The coronavirus infects Republicans, Democrats, Liberals, Conservatives and Socialists alike. It knows no international or state boundaries. To address the pandemic - just like the climate crisis - we must come together across party and national lines. We must listen to scientists who are the experts, whose knowledge does not adhere to partisan divides. And we must move beyond the bottlenecks that such politics can create so that government can take the necessary action.

As we have seen with both the pandemic and the climate crisis, individual action alone is insufficient to address the situation. Only large-scale government direction is able to create the kinds of changes we need.

The danger, however, is that such action will curtail individual freedoms and lead to authoritarian forms of government. The other challenge is that, because people are mistrustful of government and especially mistrustful of the "other side," the swift, necessary actions we need get snarled up in congress or parliament.

To address this concern, Extinction Rebellion is calling for a Citizen's Assembly to oversee important decisions and take responsibility for actions on climate and ecological issues. Like a jury, such assemblies would be made up of randomly-chosen citizens with decision-making powers.

We need truly democratic systems to oversee our government's actions and instill trust again in government itself. With citizen's assemblies, we can be more confident that power won't be abused.

4) Focus on a just transition.

The coronavirus pandemic makes clear that in a crisis, the most vulnerable are at the greatest risk. The pandemic exposes the deep insecurities that are built into American life -a highly-inequitable healthcare system, for example; the 58% of Americans who have less than $1000 in savings; and no sick leave for families. In short, there is hardly any safety net, and as coronavirus threatens to send us into a massive economic depression, our response has to consider those who are most in need.

Similarly, the most vulnerable are on the front lines of the climate crisis. We must prepare now for a just transition to protect people from the devastating physical and economic effects of climate and ecological breakdown. We need policies like the Green New Deal that put workers, people of color and poor people front and center - not big corporations

5) Build regenerative cultures.

The aim of these four pillars is 'regenerative culture,' meaning a culture that prioritizes humanity and ecosystems over profit, and one that is that is democratic and life-affirming, joyful and non-hierarchical.

We do have the capacity as societies to take care of one another through such a culture. Though this pandemic has often been mishandled, it also displays our ability to work together and make individual sacrifices for the common good. It shows we can radically alter our habits and behavior. This is important, inspiring and encouraging.

Satellite images over China and the US show pollution clearing as a result of the economic slowdown induced by Covid-19. What will it take for us to realize that in order to prevent even greater catastrophes, we need to keep the skies clear in the future?

The coronavirus, real in itself, is also a testing ground for the climate crisis, just as the climate crisis helps us understand what's needed to address the pandemic.

With its hurricanes and fires and droughts, summer will be upon us before we know it. This pandemic is showing how little resilience we have as a society, and how quickly we can all be at mortal risk. So let's use the coronavirus crisis as a wake-up call to create a more resilient and life-affirming culture.

This pandemic shows us how ordinary life can be disrupted. As the climate scientist James Hanson has written "The climate system is capable of abrupt changes and surprises. Once [this] occurs it can be difficult or impossible to reverse the...change."

Therefore we must tell the truth, act now, move beyond partisan politics, and mobilize a just transition both for today's crisis and tomorrow's. The death toll from the climate emergency threatens to be exponentially greater than that from even the worst-case scenario of the coronavirus. Now is the moment to act.

I want to be able to tell my grandchildren that we paid attention and made the changes that were necessary for their future.

# data[].attributes.attachment_link.title
Coronavirus and climate activism: five common lessons

# data[].attributes.attachment_link.description
No one wants to think of one crisis in the middle of another, but it's exactly now, when we see first hand how quickly things can change, that it's time to think about crisis preparedness in general.

# data[].attributes.attachment_link.readable_text
Nutritious foods in adequate amounts are essential for everyone but particularly for children. In early childhood, adequate nutrition can ensure healthy growth, proper organ formation and function, a strong immune system, and neurological and cognitive development. Nutrition, too, has increasingly been recognized as a basic pillar for social and economic development. Well-nourished people can learn new skills, think critically and contribute to their communities. Improving child nutrition impacts global, national and regional child survival, primary education, women's empowerment, and maternal and child health rates.

On the flip side, child malnutrition hurts cognitive function and contributes to poverty by impeding people's ability to lead productive lives. Poverty is the leading cause of hunger, but poverty also results from hunger, in a cyclical relationship. In spite of the importance of childhood nutrition and significant progress in the last 25 years, global childhood hunger is still rampant.

Overall, 5.6 million children under age five died in 2016, nearly 15,000 daily (World Health Organization [WHO], 2016). The risk of a child dying before five years of age is highest in Africa (76.5 per 1000 live births), about 8 times higher than in Europe (9.6 per 1000 live births) (WHO, 2016).

Approximately 3.1 million children die from undernutrition each year (UNICEF, 2018a). Hunger and undernutrition contribute to more than half of global child deaths, as undernutrition can make children more vulnerable to illness and exacerbate disease (UNICEF, 2018a).

Children who are poorly nourished suffer up to 160 days of illness each year (Glicken, M.D., 2010). Undernutrition magnifies the effect of every disease including measles and malaria. The estimated proportions of deaths in which undernutrition is an underlying cause are roughly similar for diarrhea (61%), malaria (57%), pneumonia (52%), and measles (45%) (Black, Morris, & Bryce, 2003; Bryce et al., 2005). Malnutrition can also be caused by diseases, such as the diseases that cause diarrhea, by reducing the body's ability to convert food into usable nutrients (Black, Morris, & Bryce, 2003; Bryce et al., 2005)

66 million primary school-age children attend classes hungry across the developing world, 23 million whom live in Africa, which greatly impacts their ability to learn (World Food Programme [WFP], 2012).

Source: Mercy Corps, 2018

UNDERSTANDING CHILDHOOD MALNUTRITION

Source: Global Alliance for Improved Nutrition [GAIN], 2017

STUNTING (children significantly below standard height for their age)

Globally, about 151 million under-five-year-olds are estimated to be stunted in 2013.(UNICEF, WHO and The World Bank, 2018).

The global trend in stunting prevalence and numbers affected is decreasing. Between 2000 and 2017, stunting prevalence declined from 33% to 22% and numbers declined from 198 million to 151 million (UNICEF, 2018a). However, the regions of West and Central Africa have actually seen an increase in numbers of stunted children - from about 23 million to 29 million (UNICEF, 2018a).

In 2017, about half of all stunted children lived in Asia and over one third in Africa (UNICEF, WHO & The World Bank, 2018). Stunting is a public health problem but often goes unrecognized.

UNDERWEIGHT (children significantly below standard weight for their age)

Globally, 99 million under-five-year-olds were underweight in 2013, most of whom lived in Asia and Africa (Krasevec et al., 2014).

The global trend in underweight prevalence continues to decrease; going from 25% to 13.5% between 1990 and 2017 (The World Bank, 2017).

The underweight prevalence in Africa decreased from 23% in 1990 to 17% in 2013, while in Asia, for the same period, the prevalence was reduced from 32% to 18%. In Latin America and the Caribbean the underweight prevalence decreased from 8% to 3% (Krasevec et al., 2014).

WASTING (children significantly below standard height to weight ratios)

Globally, 51 million under-five-year-olds were wasted and 16 million were severely wasted (UNICEF 2018a) Wasting prevalence is estimated at 7.5% and severe wasting prevalence at 2.4% (UNICEF, 2018a).

Wasting in the under-five-year-olds group decreased by 13% from 1990 to 2013.

In 2017, approximately two thirds of all wasted children lived in Asia (mostly in South-Central Asia) and about one-quarter in Africa, with similar proportions for severely wasted children (UNICEF, 2018a)

MICRONUTRIENT DEFICIENCIES (Micronutrient - vital minerals and vitamins - deficiencies are caused by disease or inadequate consumption of nutritious foods).

Vitamin A deficiency affects about a third of children in low and middle-income countries, which increase a child's risk of contracting infectious diseases by weakening the immune system (UNICEF, 2018b).

Zinc deficiency in low-income countries affects the immune and gastrointestinal systems, contributing to a major cause in under-five deaths - diarrhea (UNICEF, 2018b).

About 30% of the world's population lives in areas where diets do not contain sufficient amounts of iodine,
resulting in poor brain development (UNICEF, 2018b).

The lack of micronutrients in children can be greatly influenced by the mother's health, especially during pregnancy. In low-income countries, pregnant women who are malnourished may lack essential micronutrients for fetal development, such as iodine, zinc, iron, folate and vitamin D (Gernand et al., 2016). For example, low iron in the mother can result in low birthweight of the infant, increasing the infant's susceptibility to disease, a known contributor in the cycle of malnutrition (Gernand et. al., 2016). According to UNICEF (2018b), about 40% of pregnant women and 40% of children under five years of age in developing countries are anemic, half of whom are estimated to be iron deficient.

THE DOUBLE BURDEN OF MALNUTRITION (The coexistence of undernutrition and overnutrition within individuals, families or populations)

Malnutrition encompasses both undernutrition and overnutrition. Some countries face this double burden of malnutrition, where undernutrition occurs along with overweight, obesity or diet-related diseases (WHO, 2017). In some countries, like Egypt, Iraq and Vanuatu, for example, stunting is greater than 20% of their under-five population, while adult obesity is greater than 20% (FAO et al., 2017). This double burden is becoming increasingly common in low and middle-income countries (WHO, 2017).

Globally, about 41 million children under five years old were overweight or obese (WHO, 2017).

About 155 million children under five years old were chronically undernourished (WHO, 2017).

* Undernourishment is a general term for receiving insufficient food and nutrients for growth (Merriam-Webster, 2018). It may lead to a child being underweight, a term that describes an individual below the median body measurements (weight for age) for a population (UNICEF, n.d.).

Source: WHO, 2018

What are some contributors? The prevalence of stunting, wasting and underweight among children under-five years of age worldwide has significantly decreased since 1990. This is good news, but overall progress on malnutrition is insufficient, and millions of children remain hungry. Any child suffering from these conditions is at substantial increased risk of severe, acute malnutrition, illness and death.
COMBATING CHILD HUNGER

Medical Treatment of Child Malnutrition

While some hunger prevention practices involve better access to nutritious foods and health care, as well as improving water and sanitation, short-term solutions for severe undernutrition commonly use ready-to-use therapeutic food (RUTF). Used to treat undernourished children under five years of age, RUTF is ideal for treatment at home; it contains micronutrients, does not need to be cooked, and can be stored for a long time (UNICEF, 2015).
Large Scale Approaches
In the 2030 Agenda for Sustainable Development, the United Nations sets global goals to eradicate extreme poverty and hunger (FAO et al., 2017). Approaches by international organizations and programs to combat child hunger in lower-middle-income countries involve agriculture sustainability; emphasis on maternal health, education and empowerment; community and household education on nutrition; and partnerships with governments to fortify micronutrient levels in food. Below are examples of some of the work in eradicating child hunger:
UNICEF (UNICEF, 2018b)

Community-based approach to promote breastfeeding and encourage diet diversity, involving a variety of local foods;

Vitamin A supplementation programs for children under-five-years old;

Support of government programs to supplement iron folic acid supplementation during pregnancy to ensure proper fetal development;

Support governments in implementing mass food fortification - for example, universal salt iodization.
World Food Programme (WFP, 2018)

Invest in the agricultural supply chain and rural infrastructure (roads to transport food and ways to store food);

Encourage the expansion of social protection (in some countries, in the form of cash transfers) for the poorest 2 billion in the world, creating the potential for economic growth so that poor households can afford proper food and medical care.
Action Against Hunger (Action Against Hunger, 2017)

Provision of local, accessible outpatient treatment for undernourished children (community management of acute malnutrition - CMAM);

Educating and supporting mothers in best feeding practices to ensure healthy child development;

Ensuring access to supplementary foods for particularly vulnerable populations;

Capacity building by training health workers to treat undernutrition and working to strengthen local health care systems.

(Updated July 2018 with the assistance of Crystal Lam, George Washington University, MPH candidate)

References
Action Against Hunger. (2017). Nutrition and health. Retrieved from https://www.actionagainsthunger.org/impact/nutrition.

Glicken, M. D. (2010). Social work in the 21st century: An introduction to social welfare, social issues, and the profession. Thousand Oaks, CA: Sage.

Black, R. E., Morris, S. S., & Bryce, J. (2003). Where and why are 10 million children dying every year?, The Lancet, 361(9376), 2226-2234.

Bryce, J., Boschi-Pinto, C., Shibuya, K., Black, R. E., & WHO Child Health Epidemiology Reference Group. (2005). WHO estimates of the causes of death in children. The Lancet, 365(9465), 1147-1152.

FAO, IFAD, UNICEF, WFP and WHO. (2017). The State of Food Security and Nutrition in the World 2017. Building resilience for peace and food security. Retrieved from https://docs.wfp.org/api/documents/WFP-0000022419/download/?_ga=2.58209514.1314642926.1528665631-1013504369.1528665631.
Gernand, A. D., Schulze, K. J., Stewart, C. P., West Jr, K. P., & Christian, P. (2016). Micronutrient deficiencies in pregnancy worldwide: Health effects and prevention. Nature Reviews Endocrinology, 12(5), 274.
International Food Policy Research Institute. (2015). Global nutrition report 2015: Actions and accountability to advance nutrition and sustainable development. Retrieved from http://www.thousanddays.org/wp-content/uploads/2015-Global-Nutrition-Report.pdf.

Krasevec, J., Thompson, A., Blössner, M., Borghi, E., Feng, J., Serajuddin, U. for The United Nations Children's Fund, the World Health Organization and the World Bank. (2014). "Levels & trends in child malnutrition - UNICEF-WHO-The World Bank joint child malnutrition estimates". Retrieved from http://www.who.int/nutgrowthdb/summary_jme_2013.pdf.

Mercy Corps. (2018). Quick facts: What you need to know about global hunger. Retrieved from https://www.mercycorps.org/articles/quick-facts-what-you-need-know-about-global-hunger.

The New York Academy of Sciences. (2014, October 23). Micronutrients: Supplementation, fortification, and beyond. Retrieved from https://www.nyas.org/podcasts/media/podcast/micronutrients-supplementation-fortification-and-beyond/.

The World Bank. (2017). Prevalence of underweight, weight for age (% of children under 5). Retrieved from https://data.worldbank.org/indicator/SH.STA.MALN.ZS?view=chart.

Undernourished. 2018. In Merriam-Webster.com. Retrieved July 14, 2018 from https://www.merriam-webster.com/dictionary/undernourished.

UNICEF. (2015, December 23). Severe acute malnutrition. Retrieved from https://www.unicef.org/nutrition/index_sam.html.

UNICEF. (2018a). Malnutrition rates remain alarming: stunting is declining too slowly while wasting still impacts the lives of far too many young children. Retrieved from http://data.unicef.org/topic/nutrition/malnutrition/#.

UNICEF. (2018b). Micronutrients. Retrieved from https://www.unicef.org/nutrition/index_iodine.html.

UNICEF. (n.d.). Definitions: Nutrition. Retrieved from https://www.unicef.org/infobycountry/stats_popup2.html.

UNICEF, World Health Organization, & The World Bank. (2012, September 20). Key facts and figures. UNICEF/WHO/World Bank Group Joint Child Malnutrition Estimates. Retrieved from http://www.who.int/nutgrowthdb/key_facts_figures.pdf.

UNICEF, World Health Organization & The World Bank. (2018, May 14). Levels and trends in child malnutrition. UNICEF / WHO / World Bank Group Joint Child Malnutrition Estimates Key findings of the 2018 edition. Retrieved from http://data.unicef.org/wp-content/uploads/2018/05/JME-2018-brochure-.pdf.

World Food Programme. (2012). Two minutes to learn about: School Meals. Retrieved from https://documents.wfp.org/stellent/groups/public/documents/communications/wfp220221.pdf?_ga=2.263020492.1314642926.1528665631-1013504369.1528665631.

World Food Programme. (2018). Zero Hunger. Retrieved from http://www1.wfp.org/zero-hunger.

World Health Organization. (2016). Global Health Observatory (GHO) data. Retrieved from http://www.who.int/gho/child_health/mortality/mortality_under_five/en/.

World Health Organization. (2017). Policy brief. Geneva: The double burden of malnutrition. Retrieved from http://apps.who.int/iris/bitstream/handle/10665/255413/WHO-NMH-NHD-17.3-eng.pdf;jsessionid=6CC6C4506E1E43112CD1EF845ACC99A1?sequence=1.

World Health Organization. (2018). Nutrition. Retrieved from http://www.who.int/nutrition/double-burden-malnutrition/infographics/en/.

# data[].attributes.attachment_link.title
World Child Hunger Facts - World Hunger Education - World Hunger News

# data[].attributes.attachment_link.description
Nutritious foods in adequate amounts are essential for everyone but particularly for children. In early childhood, adequate nutrition can ensure healthy growth, proper organ formation and function, a strong immune system, and neurological and cognitive development. Nutrition, too, has increasingly been recognized as a basic pillar for social and economic development.

# data[].attributes.headline
Facts about  Childhood Hunger In America

# data[].attributes.subject
Facts about  Childhood Hunger In America

# data[].attributes.attachment_link.readable_text
According to the latest estimates, as many as 9 million children in the United States live in "food insecure" homes. That phrase may sound mild, but it means that those households don't have enough food for every family member to lead a healthy life.

The number of children living with hunger had fallen steadily over the past decade, but the coronavirus pandemic dealt a terrible blow to our progress as a nation - one that No Kid Hungry and other organizations will work to reverse during the long recovery ahead.

Poverty and Childhood Hunger

As you might imagine, hunger is a problem that most often affects children from low-income families. A common way we measure poverty is the federal poverty level, a number set by the U.S. Department of Health and Human Services. The federal poverty level is the minimum amount of money a family needs each year to afford the necessities of life: food, clothing, shelter, and transportation.

In 2021, the federal poverty level was $26,500 for a family of four. Of course, this number is a minimum. Families making twice that much are still considered low-income by most experts, and many struggle to make ends meet.

How many Americans live in poverty? 37 million, or 11.4% of all Americans, according to 2020 data from the U.S. Census Bureau. 12 million of those were children. This number, though shockingly high for a country of such enormous wealth, had fallen in recent years, but the coronavirus pandemic put a huge burden on already-struggling families, and the impact of that is not yet fully known.

For a more comprehensive understanding of food insecurity, we recommend the USDA's annual report on Household Food Security in the United States.

Federal Food Programs

One of the most effective ways to help families and children is through federal nutrition programs.

Some of the nutrition programs you may be familiar with are SNAP, WIC and the national school lunch program. These are critical lifelines for families in need.

No Kid Hungry supports these important programs, though we focus our efforts on other federal programs that we know can make an enormous difference for hungry kids, such as the school breakfast program, the national summer meals program and the afterschool meals program.

School Breakfast

Making breakfast part of the regular school day, just like lunch, has a powerful effect on kids. That's why we work with educators, political leaders and local nonprofits across the country to change the way schools serve breakfast.

Summer Meals

Millions of kids rely on school for regular meals. But in the summer, those meals disappear. No Kid Hungry is helping community leaders with the funding and know-how they need to start summer meals sites, as well as advocating for needed changes to the national summer meals program.

Currently, the national summer meals programs reaches just a fraction of the children who need help when school is out of session.

Afterschool Meals

The Afterschool Meals Program, part of the Child and Adult Care Food Program (CACFP), helps kids get the nutritious meals they need in a safe, supervised location after the school day ends. This program is the newest federal child nutrition program, so No Kid Hungry is working to ensure that more kids, families and teachers know about it and are able to take advantage of it.

SNAP & WIC

The Supplemental Nutrition Assistance Program (SNAP), sometimes known as food stamps, provides low-income families with money to purchase food each month.

What is SNAP and why is it so important?

SNAP is one of the most effective and efficient federal programs, as well as one of the most responsive, providing additional assistance to needy families during economic downturns. It's also one of the most-needed: 41 million Americans rely on SNAP benefits to buy food each month, according to the USDA. Two-thirds of these benefits go to households with children.

What can you buy with SNAP benefits?

SNAP benefits are used to purchase food, including things like bread, cereal, fruit, vegetables, meat, fish, dairy products and snacks. You can't use SNAP benefits to purchase alcohol, cigarettes, pet food, paper products and household supplies.

What is WIC and who is it for?

In addition to SNAP, one of the largest and most effective federal nutrition programs is the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). WIC benefits are primarily for children under the age of five or women who are pregnant or breastfeeding. WIC serves 53 percent of all infants born in the United States, according to the latest figures from the USDA.

Through WIC, moms can get nutritious foods for their young children, as well as access to important services at WIC clinics, including nutrition education, counseling and referrals to local health and welfare agencies.

# data[].attributes.attachment_link.title
Child Hunger in America Statistics & Facts | No Kid Hungry

# data[].attributes.attachment_link.description
Child hunger in America statistics unveil a significant concern. More than 13 million children in the United States live in "food insecure" homes, according to recent research from the USDA. Learn how No Kid Hungry is solving the issue of child hunger.

# data[].attributes.attachment_link.readable_text
Hunger is a problem that most often affects low-income families, because living in poverty means that people are often going without basic needs such as food, clothing, and adequate shelter.

In order for a child to have a chance at a bright future, they need to eat healthy meals every day. When they're hungry, children are more likely to be hospitalized, and they face a higher risk of health conditions because they have weakened immune systems. A brain starved of vital nutrients is one that can't concentrate, setting hungry kids up for failure in school.

Without enough food or proper nutrition, kids face a variety of setbacks that can derail their path out of poverty.

Even if they are consuming an adequate volume of food, children may not be receiving enough of the vitamins and minerals they need to grow up healthy, and are therefore malnourished. Without enough food or proper nutrition, kids face a variety of setbacks that can derail their path out of poverty.

Global child hunger facts

- Every year, 3.1 million children (8,500 children per day) die due to poor nutrition

- Today, there are 815 million people in the world who do not have enough to eat

- Approximately 28% of all children in developing countries are considered to be underweight, or have had their growth stunted as a result of malnutrition

- Worldwide, malnutrition contributes to almost half of the deaths of kids under the age of 5, claiming the lives of over 3 million children per year

National child hunger facts

- In America, 1 in 6 children don't know where they will get their next meal from

- Nearly 13 million kids in the U.S. face hunger

- 5 out of 6 kids who rely on free or reduced-price school meals aren't getting free meals in the summer

- For every 100 school lunch programs, there are only 87 breakfast sites, and just 36 summer food programs

What Children Incorporated does to alleviate hunger for children

Children Incorporated provides basic necessities such as food, clothing, healthcare, and educational support to children living in poverty in the United States and abroad through our child sponsorship program. These essentials are vital to a child's growth and success in school. We also assist feeding programs in the United States and internationally that ensure that children are receiving meals during the week, and that they are provided with food to take home on the weekends. Additionally, we make contributions toward school gardens so that children living in poverty have the opportunity to obtain fresh, nutritious food, which they would likely otherwise go without.

How you can help

You can help a child who faces hunger in a few different ways. One way is by sponsoring a child with us. For $30 a month, you provide basic needs, including food, for a child in need, while also making an investment in their future.

You can also help children in need by donating to either our U.S. Feeding Programs Fund or our International Feeding Programs Fund. Donations supporting our U.S. Feeding Programs Fund support such endeavors such as our Backpack Feeding Program, which gives children in Eastern Kentucky food to take home on the weekends and in the summer when school is out. The purpose of our International Feeding Programs Fund is to feed enrolled children who would otherwise go hungry, so that they can be alert at school and ready to learn. This fund supports programs in the Philippines, Kenya, and Ethiopia to buy grains, meats, vegetables, and cooking supplies to feed children.

References:
http://www.thp.org/knowledge-center/know-your-world-facts-about-hunger-poverty/ http://www.feedingamerica.org/hunger-in-america/child-hunger-facts.html https://www.wfp.org/node/646670 http://www1.wfp.org/zero-hunger https://www.nokidhungry.org/who-we-are/hunger-facts https://www.dosomething.org/facts/11-facts-about-hunger-us
***

HOW DO I SPONSOR A CHILD with Children Incorporated?

You can sponsor a child with Children Incorporated in one of three ways: call our office at 1-800-538-5381 and speak with one of our staff members; email us at sponsorship@children-inc.org; or go online to our donation portal, create an account, and search for a child that is available for sponsorship.

# data[].attributes.attachment_link.title
Facts About Child Hunger and Poverty - Children Incorporated

# data[].attributes.attachment_link.description
Hunger is a problem that most often affects low-income families, because living in poverty means that people are often going without basic needs such as food, clothing, and adequate shelter. In order for a child to have a chance at a bright future, they need to eat healthy meals every day.

# data[].attributes.attachment_link.readable_text
Who Experiences Hunger

Anybody can experience hunger at any time. But certain groups and people living under certain conditions are more at risk of hunger. Bread is concerned about hunger throughout the entire U.S. and world, and so we speak in broad, general terms in the descriptions below. However, we understand that there are exceptions to the rule and that not every person in these groups experiences hunger.

People in poverty

Poverty is the major cause of hunger. Bread often speaks about hunger with poverty as issues that need to be addressed together.

In the U.S., hunger is not caused by a scarcity of food, but rather the continued prevalence of poverty. To the surprise of many, most Americans (51.4 percent) will live in poverty at some point before age 65. That means any one of us - or our friends or family members - may be affected.

Although we live in the world's wealthiest nation, a reported 14.5 percent of U.S. households - nearly 49 million Americans - struggle to put food on the table. Further, more than one in seven people in the U.S. lives below the poverty line, an income of $22,113 for a family of four in 2010.

Outside the U.S., many people suffer from hunger and poverty. Nearly 1.2 billion people in developing countries live in extreme poverty, living on less than $1.25 a day. The vast majority of the world's hungry people live in developing countries, where 13.5 percent of the population is undernourished.

Millions of people in developing countries produce their own food as smallholder farmers. This is a precarious existence. The challenges they face include growing enough food to feed their families, depending on the weather for a sufficient crop each year, or getting sufficient nutrition to maintain their health. These living conditions and other challenges that can come and go put many people at risk of hunger.

Children

Children are at high risk of hunger because they are dependent on adults for their care. And their younger and growing bodies are more vulnerable to the other problems hunger causes.

Every year, 2.6 million children die as a result of hunger-related causes. In the U.S., nearly 16 million children - one in five - live in households that struggle to put food on the table. Even short-term episodes of hunger can cause lasting damage to a child's development. Hunger puts children at risk of a range of cognitive, behavioral, emotional, and physical problems.

It is vitally important that children get a good start in life from a nutrition point of view. Bread has focused many of its efforts on the movement to provide adequate nutrition to children during the 1,000 days from a woman's pregnancy to her child's second birthday. This is a critical time of growth and development for children.

Studies show hunger among children can lead to:

aggression, tardiness, and absenteeism

health problems

a decrease in attention and lower test scores

Children who are fed and nourished adequately learn better in school. This translates into a better education. As better-educated children grow into adulthood, they are more likely to be productive and have higher-paying jobs.

Ending hunger among children has many benefits. It can break the cycle of poverty that often continues across generations.

Farmers

Three-fourths of all people living in extreme poverty live in rural areas of developing countries and work in agriculture. Some are small-scale farmers or landless laborers who work on farms that others own. Many live hand to mouth and can grow only what they need to feed their families, with perhaps a little extra to sell to meet their other needs.

Smallholder farmers are a unique group. The vast majority of Americans are far removed from the source of their food - the farms where food is grown mostly on a massive scale. Farmers in developing countries live on the land and know daily how closely dependent they are on it.

As a result, Bread sees the potential for a high payoff in providing smallholder farmers with resources and tools to improve the ways they grow food. Strengthening farmers and their role in providing food means families and communities can also grow stronger. The U.S. government has programs that are doing this.

Family farmers that are able to grow more food and more nutritious food have extra produce to sell to others. Ensuring farmers have access to markets and have a good product to sell is also important. This gives farmers more income, which they can use for other needs - better housing, medical care, and school fees.

Women

Despite milestones in human rights and women's empowerment over the last half century, women around the world struggle with food insecurity.

Bread believes that gender discrimination is a cause of persistent hunger. Bread for the World Institute's 2015 Hunger Report, When Women Flourish...We Can End Hunger, addresses this issue. The report says that empowerment of women and girls is essential in ending hunger, extreme poverty, and malnutrition around the world and in the U.S.

In many countries, women and girls are more likely to suffer from hunger and malnutrition than men and boys. Poverty and lack of education contribute to this disparity. However, giving women greater control of their income and assets would increase their bargaining power in the household and the market economy. Research has shown that this benefits their families and leads to widespread improvements in a country.

The report also shows that women's willingness to share men's breadwinning responsibilities has not been matched by men's willingness to share unpaid household work or caregiving responsibilities. Though domestic work is a public good in the same way that education, clean water, clean air, and the food supply are, it is not recognized as such. Women constitute half the global population.

A cost-effective way of combating global malnutrition is to invest in improving the lives of women farmers. Women produce well over half the global food supply. Studies show that women are more likely to spend additional income on food when their economic circumstances improve. Yet 60 percent of the world's hungry people are women and girls.

Seniors

Many Americans age 65 and over want to be enjoying their retirement. Instead, many struggle because of food insecurity.

Seniors make up 12.9 percent of the U.S. population. The number of those seniors living below the poverty line: 3.9 million. Is this how we want to treat our beloved parents, grandparents, and elders in what should be their golden years?

The number of seniors experiencing hunger increased by 88 percent between 2001 and 2011. If trends continue, seniors who are hungry will increase by 50 percent by 2025.

In 2040, there will be 79 million seniors in the United States - baby boomers who are retiring and aging. This generation has the potential for many among them to be hungry.

Rural Communities

In the United States and globally, residents of rural communities are more likely to be hungry and poor because they have less access to opportunities. Bread for the World Institute's 2005 Hunger Report, Strengthening Rural Communities, shows that the rural U.S. and rural areas around the world are hit hard by hunger and political neglect.

The report shows the isolation of our nation's rural communities:

Farm consolidation and the impact of globalization on manufacturing are creating rural enclaves of hunger and poverty.

"Food deserts" - areas without access to grocery stores or any affordable healthy food - have become an increasingly common feature of the rural landscape.

The report also examines why there are so many rural people in the developing world who are hungry and poor.

The majority of the world's hungry people live in developing countries. And in those countries, millions of people live on small farms where they grow the food to feed themselves. These farms are in rural areas. These rural areas are often isolated because of poor roads and few transportation options.

However, because most farming in developing countries happens in rural areas, that's where there is the most promise for ending hunger.

Urban communities

Many people who are at risk of hunger have jobs - even more than one - and work hard just to get by and put food on the table for their families. This group is often referred to as "the working poor." Most in this group live in cities - where most of the jobs are. And many people in this group work in low-paying, service-oriented jobs, which are prevalent in urban areas.

And even though cities can efficiently provide most of what people need, sometimes they fall short in providing access to food. Cities sometimes have the challenge of food deserts - a situation in which people have to travel great distances to buy food or to find nutritious food.

A person working full-time at the minimum wage earns about $14,500 a year. The federal government's poverty line for a family of three - one parent with two children - is $17,568. Low-income households already spend a greater share of their income on food. Food accounts for 16.4 percent of spending for households making less than $10,000 per year compared to the U.S. average of 12.7 percent.

Cities often have high costs for transportation and rent. All of these demands on a low income can squeeze low-income families and put them at risk of hunger.

"God is in the midst of the city."

Psalm 46:5

# data[].attributes.attachment_link.description
Anybody can experience hunger at any time. But certain groups and people living under certain conditions are more at risk of hunger. Bread is concerned about hunger throughout the entire U.S. and world, and so we speak in broad, general terms.

# data[].attributes.headline
6 Startling Facts about child hunger in the U.S

# data[].attributes.subject
6 Startling Facts about child hunger in the U.S

# data[].attributes.attachment_link.readable_text
When Americans think of childhood hunger, they might picture the skeletal frames and swollen bellies of children from faraway nations - but that isn't the full story.

According to Feeding America, 1 in 7 people in the U.S. face hunger every year. The rates of hunger in children are even higher, with about 1 in 5 lacking proper access to food at some point during the year.

"You see a lot of PSAs about international hunger and how hunger is threatening lives around the world," Clay Dunn, chief communications officer at nonprofit No Kid Hungry, tells Mashable. "What most people don't realize is that we have an epidemic of hunger right here."

"We have an epidemic of hunger right here."

It's called food insecurity, and it's a metric tracked by the U.S. Department of Agriculture to pinpoint how many households struggle during the year to provide food for their families.

"[Food insecurity] looks like lots of things," Dunn says. "It looks like empty cupboards in some households. It looks like having to choose between paying the electric bill or buying groceries in other households. There are a lot of families struggling to make ends meet, stretching money to cover costs, including food."

In the U.S., hunger is caused by the prevalence of poverty, not food scarcity. Stable food access is often blocked for low-income families that struggle to balance the need for food with other basic necessities.

Whether your realize it or not, this is an issue in your community, too. Feeding America found that food insecurity exists in every county and congressional district in the country.

The realities of food insecurity often mean that kids especially lack food access in summer months - a time when families can't rely on free or reduced lunch programs to pick up some of the burden of feeding their children.

"About 21 million children receive free or reduced lunch in school," Ross Fraser, director of media relations at Feeding America, tells Mashable. "And, of those, about 10 million also receive free breakfast. When schools close, about 18 million of those kids lose access to free meals in the summer."

With such a large issue impacting our local and national communities, here are six illuminating facts about child hunger in the United States - and what you can do to help.

1. 16 million American kids struggle with hunger each year.

An estimated 48.8 million Americans, including 16.2 million children, live in households that lack the means to get enough nutritious food on a regular basis.

As a result, about 1 in 5 children go hungry at some point during the year.

2. 62% of teachers say children in their classrooms are coming to school hungry.

Educators in the U.S. are acutely aware of childhood hunger's massive impact. About 3 out of 4 American teachers notice their students aren't able to access adequate amounts of food.

"Children come to school hungry, and a hungry child can't learn," Dunn says. "We need to make sure their stomachs are full so they are hungry for knowledge, not food."

School lunches - and the uptick of school breakfast programs - help curb some of the barriers in access. But lacking stable food access at home can have devastating impacts on a child's ability to get the most out of their education.

3. Children facing hunger are twice as likely to repeat a grade in elementary school.

Children who go hungry are more likely to miss school and receive poorer grades - which leads to trouble keeping up in class.

"There is a direct correlation between lack of nutrition and thwarted development."

Hunger is also associated with stomachaches, headaches, depression, anxiety and a decreased ability to focus - all of which have an impact on educational attainment.

Research shows that hungry kids also struggle socially and behaviorally, making their experiences in school less than enjoyable. Studies have found that children from food-insecure families are more likely to drop out of high school before graduation.

"Not only is it tragic for kids to go hungry, but there are terrible ramifications," Fraser says. "We know there is a direct correlation between lack of nutrition and thwarted development."

4. Nearly half of all food stamp recipients are children.

The Supplemental Nutrition Assistance Program - also known as SNAP, or food stamps - was put in place to help curb hunger in the U.S. Though the program is heavily stigmatized due to misconceptions that adults collect assistance they don't truly need, that myth is shattered by the fact that the program mostly serves children at risk of hunger.

Approximately 8.5 million American children received SNAP in 2010, the latest figures available. Perhaps most surprisingly, a staggering 49.2% of American kids will receive SNAP benefits at some point in their childhoods.

5. 20% of food-insecure families are not eligible for government assistance.

Though 8.5 million American children receive government assistance like SNAP to combat hunger, that doesn't address the full problem. Around 1 in 5 families with children with children experiencing food insecurity do not qualify for assistance-based programs, whether it's due to household income, employment requirements or otherwise.

Being locked out of government programs means these families face unique obstacles, not quite qualifying for safety nets, but not being able to make ends meet either.

6. Black and Latino children experience hunger at double the rate of white children.

More than 1 in 4 black households lack food security, compared to 1 in 10 white households. For Latino families, food insecurity affects 1 in 5 households.

Wealth inequality and a general lack of access to financial opportunity have a major impact on the amount and quality of food many non-white families can put on the table.

What you can do to help
Advocate
Dunn says the single most important thing people can do is become vocal advocates for children who do not have enough to eat - especially when it comes to federal funding for hunger-related programs.

"There are lobbyists for a lot of things out there," Dunn says. "But hungry kids don't have lobbyists."

While hungry children know they are hungry, they often don't have the platform to have their voices and needs heard - especially on a national scale. That's why advocates are essential.

"We need people to say that we can do better for our kids."

"Senators and congressmen respond to the will of the people," Fraser says. "And if we can have 50,000 advocates call and say, 'For God's sake, don't cut food stamps. What are you thinking?' - that does make a difference."

Fraser says Feeding America encourages advocates to call Congress to show their passion for the issue. To read up on the impact of federal programs, visit before calling your representative. Contact information for congressional representatives can be found .

Dunn says No Kid Hungry uses an email list to connect individuals with both local and national opportunities to advocate. To join the list, click .

"We need people to say that we can do better for our kids, and that no child deserves to grow up hungry," Dunn days.
Volunteer
Volunteering can have an immediately tangible impact on your local community. Food banks need volunteers who will sort, package and distribute food to food-insecure families - which directly helps hungry children in those families.

"Finding a local organization that really speaks to your needs and asking them how you can help is hugely beneficial," Dunn says.

Feeding America's nationwide network of food banks provides programs year-round that address the needs of 46 million people in the United States experiencing hunger, Fraser says. For more information on how you can volunteer at a Feeding America effort in your local area, visit .
Donate
You have options when it comes to donating to address hunger. Perhaps the most apparent option is donating food via food drives and in-person donations to food banks. But another option is supporting nonprofits doing the work to address the issue.

"Our organization, and organizations like ours on the local level, need resources to do the work we do," Dunn says.

To donate to No Kid Hungry's efforts, which includes summer meal programs and classes to help vulnerable families learn cooking skills, visit . To donate to Feeding America, which operates large-scale programs including summer food programs and in-school distribution of food through its Backpack Program, visit .
Spread awareness
Hunger in a national context is often unaddressed, leaving both children and families silenced and underserved due to stigma. Dunn and Fraser both say their organizations' programs to curb summer hunger are highly underutilized - in part because many families in need do not know they exist.

While spreading awareness of the issue in your local community, also share information about efforts to curb it, so those in need can reach the services created to help them. Parents and kids, for example, can easily find free summer meals provided by No Kid Hungry in their neighborhoods by texting FOOD to 877-877.

Fraser also recommends sharing the issue of hunger with children in your life, especially since they are probably encountering it in the classroom.

"When you donate food, tell the kids, 'I'm buying this jar of peanut butter because there are kids down the street who can't afford a jar of peanut butter,'" he says.
Have something to add to this story? Share it in the comments.

# data[].attributes.attachment_link.title
6 startling facts about child hunger in the U.S. -- and how you can help

# data[].attributes.attachment_link.description
When Americans think of childhood hunger, they might picture the skeletal frames and swollen bellies of children from faraway nations - but that isn't the full story. According to Feeding America , 1 in 7 people in the U.S. face hunger every year.

# data[].attributes.attachment_link.readable_text
Hunger by the Numbers

The world produces enough food to feed all 7.5 billion people

Despite this, 1 in 9 people around the world go hungry each day

Somalia is the world's hungriest country as of 2021

According to the 2021 Global Hunger Index, 47 countries will fail even to reach Low hunger status by 2030 - an increase of 10 countries compared to 2020's report

Since 2012, hunger has increased in 10 countries with Moderate, Serious, or Alarming hunger levels

14 countries have achieved significant improvements in hunger, with a reduction of 25% or more between their 2012 and 2021 GHI scores

The long-term effects of the COVID-19 pandemic are expected to include 30 million more people undernourished globally in 2030

What Causes Global Hunger?

The world produces enough food to feed all 7.5 billion people, yet more than 10% of the population goes hungry each day.

Why?

As part of the United Nations Sustainable Development Goals, Concern is working to eliminate hunger and malnutrition by 2050. But we need to know what we're really fighting. Here are 10 of the most popular causes of world hunger - and how you can help advance the fight for Zero Hunger.

1. Poverty

Poverty and hunger exist in a vicious cycle. Families trapped in the cycle of poverty usually can't afford nutritious food, leading to undernourishment. In turn, undernourishment makes it difficult for people to earn more money so that they can afford healthy food. Families living in poverty might also sell off their livestock or tools to supplement their income. This buys short-term relief, but perpetuates a longer-term pattern of hunger and poverty that is often passed down from parents to children.

The , recognized year over year as one of the Democratic Republic of Congo world's poorest countries, has a population of 89.56 million, the majority of whom live below $1.25/day. As of 2021, over 37 million Congolese aren't getting the minimum amount of nutrients they need each day.

2. Food shortages

Across regions like the Sahel and the Horn of Africa, farming families experience periods before harvests known as "hunger seasons." These are the times of year when food supplies from the previous harvest are exhausted, but the chance to replenish supplies is still some time off. This leaves families forced to skip one (or more) meals each day in the period before the next harvest - which could be months away.

3. War & conflict

Conflict and hunger form another vicious cycle. In South Sudan , civil war has led to mass displacement and abandoned fields. The result is crop failure which, combined with a soaring inflation rate that makes imported food unaffordable, has left 7.2 million people in a food crisis. Likewise, Yemen's ongoing conflict has led to over half the country (approximately 17 million people) in need of urgent action in the absence of ongoing humanitarian food assistance.

4. Climate change

Countries like enjoy relative peace and political stability. However, they are also plagued by hunger due to climate change. Too little - or too much - rainfall can destroy harvests or reduce the amount of animal pasture available. These fluctuations are made worse by the weather system, and are likely to increase due to changes in climate. Extreme climate patterns also tend to affect the poorest regions of the world the most. The World Bank estimates that climate change has the power to push more than 100 million people into poverty over the next decade.

5. Poor nutrition

Hunger isn't simply a lack of access to food: It's a lack of access to the right nutrients. In order to thrive, humans need a range of foods providing a variety of essential health benefits. Families living in poverty often rely on just one or two staple foods (like corn or wheat), which means they're not getting enough critical macronutrients and vitamins, and may still suffer the effects of hunger.

A lack of nutrition is especially important for pregnant and breastfeeding women and young children: Nutrition support during pregnancy and up to the age of five can help protect children for their entire lives. Proper nutrition reduces the likelihood of disease, poor health, and cognitive impairment. Through the LANN project, communities in countries like Sierra Leone are learning how to identify nutrient-rich wild foods that are safe to eat in order to make the most of their available resources. This is one of the many ways we look for sustainable solutions for malnourished communities.

6. Poor public policy

Systemic problems, like poor infrastructure or low investment in agriculture, often prevent food and water from reaching the populations that need them the most.

7. Poor economy

Much like the poverty-hunger cycle, a country's economic 's overall economic troubles deepened after the resilience has a direct effect on its nutritional resilience. For example, Ebola outbreak in 2014. Five years after the end of the epidemic, 50% live below the poverty line. Working towards economic stability overall will have a ripple effect on other causes of world hunger cited on this list.

8. Food waste

According to the , one-third of all food produced - over 1.3 billion tons of it - is never consumed. What's more, producing this wasted food also uses other natural resources that, when threatened, have a ripple effect in the World Food Programme countries that are already hit hardest by hunger, poverty, and climate change . Producing this wasted food requires an amount of water equal to the annual flow of Russia's Volga River - and adds 3.3 billion tons of greenhouse gases to the atmosphere.

9. Gender inequality

In its Sustainable Development Goals, the UN reveals: "If women farmers had the same access to resources as men, the number of hungry in the world could be reduced by up to 150 million. " Female farmers are responsible for growing, harvesting, preparing, and selling the majority of food in poor countries. Women are on the frontlines of the fight against hunger , yet they are frequently underrepresented at the forums where important decisions on policy and resources are made.

10. Forced migration

Hunger can be a cause of forced migration, but to produce the forced migration can also be a cause of hunger. Many refugees living abroad live in neighboring countries with limited resources to begin with. In Lebanon, for example, nearly a third of the population are refugees , placing a huge strain on resources. Each year, Concern partners with Welthungerhilfe Our 2018 edition Global Hunger Index. underlines the connection between hunger and forced migration, a problem which can only be resolved by a political solution.

The causes of world hunger: How you can help

While the causes of hunger are complex, change is possible and there is hope in action. Supporting Concern means that $0.93 of every dollar donated goes to our life-saving work in 25 countries around the world. Last year, we were able to reach over 11.4 million people with our health and nutrition initiatives.

# data[].attributes.attachment_link.description
The world produces enough food to feed all 7.5 billion people Despite this, 1 in 9 people around the world go hungry each day Somalia is the world's hungriest country as of 2021 According to the 2021 Global Hunger Index, 47 countries will fail even to reach Low hunger status

# data[].attributes.headline
6 Civil rights Struggles going on right now

# data[].attributes.subject
6 Civil rights Struggles going on right now

# data[].attributes.attachment_link.readable_text
Advertisement

Martin Luther King Jr. had a lofty, but much longed-for, dream. To paraphrase the good reverend, he hoped that character would someday matter more than skin color. That people of all races could come together in unity, rather than in discord.

Although the indelible images and unforgettable speeches of the American civil rights movement are typically associated with race, "civil rights" actually reach even further into society. According to Cornell University School of Law, "A civil right is an enforceable right or privilege, which if interfered with by another gives rise to an action for injury."

Protected civil rights in the U.S. include the right to vote, equality in public places, freedom from involuntary servitude, as well as freedom of press, assembly and speech. When a person's civil rights are hindered or denied because they belong to a specific class or group it is considered "discrimination."

Measures have been taken to protect people from discrimination due to race, religion, national origin, sexual orientation, age and gender. But often, these safeguards are disrespected. And there are other areas of discrimination that are as yet not protected by law.

Here are six current examples of civil rights issues that are, unfortunately, alive and well:

LGBT Employment Discrimination

Background: The LGBT community experienced a major coup when the Supreme Court legalized same-sex marriage in 2015, but its equality struggle is hardly over. Although there are employment discrimination laws in place to protect general civil rights, LGBT people lack legislation specifically protecting them at a national level. In fact, gender identity and sexual orientation are still valid reasons to terminate an employee in 28 states.

Where Things Stand Now: The Equality Act (which addresses this issue) was introduced in July 2015 and has been endorsed by President Barack Obama. Despite the changing tide, experts believe it's unlikely that the legislation will pass before he leaves office.

Human Trafficking

Background: Slavery was abolished in the U.S in 1865, but that doesn't mean it disappeared completely. Human trafficking ( defined as the illegal movement of people typically for forced labor or commercial sexual exploitation) is unfortunately alive and well. In North America alone, 1.5 million people are currently victims of human trafficking.

Where Things Stand Now: Many human trafficking victims (as well as a huge portion of undocumented immigrants) work in the restaurant industry or as domestics for far less than the current labor standard, often also in violation of overtime regulations. Sex trafficking is also out of control, with Atlanta's illegal industry alone bringing in $290 million a year. And often it's Americans exploiting other Americans, in addition to women from other countries.

Police Brutality

Background: Although the majority of law enforcement officers strive to keep the peace, some highly publicized incidents and ongoing concerns from the black community have caused major debate about the use of excessive force. Cases including those involving the deaths of unarmed black men like Michael Brown Jr. and John Crawford III have put police culture and training under serious scrutiny.

Where Things Stand Now: In 2015, 987 people were killed by police, according to a Washington Post report. Nine percent of the shootings involved an unarmed person, mostly a black man. Unarmed black men were seven times as likely to die from police gunfire as unarmed white men. It is important to also note that nearly 80 percent of all those killed were armed with a gun or other weapon, and a quarter were mentally ill. To date, a solution to this complex issue has yet to be found, with plenty of controversy regarding how and when deadly force is justified. Indictments of police tripled in 2015 compared to previous years. Numerous protests (and the Black Lives Matter movement) have occurred in response to the issue.

Disability Discrimination in the Workplace

Background: A couple decades have gone by since the Americans With Disabilities Act (ADA) was passed, which protects people with mental or physical impairment. Functionally, workplaces have improved thanks to additions like wheelchair ramps, automatic doors and parking spaces for the handicapped.

Where Things Stand Now: Disabled people are still employed at a drastically lower rate than their able-bodied counterparts. One study showed 79 percent of disabled people were unemployed, with 73 percent of the opinion that their disability was the cause. The ADA Amendments Act was passed in 2008 to expand the range of disabilities covered under the ADA and to provide more guidance for employers and employees.

Pregnancy Discrimination

Background: In 1978, the Pregnancy Discrimination Act (an amendment to the 1964 Civil Rights Act) was passed. It allows for pregnancy-related sick leave, guaranteed pregnancy disability leave and for pregnant women to be treated in the same manner that a company would treat any other temporarily disabled employee. The act also says an employer can't refuse to hire a woman who is pregnant as long as she can perform the job.

Where Things Stand Now: Pregnancy discrimination cases are on the uptick. In fact, 2013 alone saw more than 5,000 complaints issued to the Equal Employment Opportunity Commission, compared with 3,900 in 1997. Corporate giant UPS is currently embroiled in a major court case because the company allegedly forced an employee into unpaid leave without medical insurance when she requested transfer to a position that didn't require heavy lifting.

Weight Bias

Background: Do you see weight as a civil rights issue? Consider this: A 2008 study published in the International Journal of Obesity revealed that obese workers are likely to earn $100,000 less than thinner co-workers over a 40-year career. Another study found weight and height discrimination rates are about the same as racial discrimination rates. And overweight people can be fired because of their size even if their job performance is good.

Where Things Stand Now: Just one state (Michigan) and six cities currently have laws against weight discrimination. The health care industry has begun to employ weight bias training in medical school and as ongoing education. However, since many people seeking their degrees have long-formed opinions, it is an ongoing, difficult process. Businesses are also educating employees on identifying their personal biases.

# data[].attributes.attachment_link.title
6 Civil Rights Struggles Going on Right Now

# data[].attributes.attachment_link.description
Advertisement Martin Luther King Jr. had a lofty, but much longed-for, dream. To paraphrase the good reverend, he hoped that character would someday matter more than skin color. That people of all races could come together in unity, rather than in discord.

# data[].attributes.attachment_link.readable_text
The politics of race has been the most dramatic backdrop to the 1992 election season. The Supreme Court nomination of Clarence Thomas raised messy race and gender issues. President Bush's detractors tried to lay blame for the flare-up of racial tensions in the May Los Angeles riots to the president's neglect of domestic issues. Two significant pieces of civil rights legislation were passed during the past four years: the sweeping Americans with Disabilities Act of 1990 and the Civil Rights Act of 1991. The new civil rights bill was bitterly contested legislation that countered Supreme Court decisions making it harder for workers to bring and win job discrimination lawsuits. It also allows limited damage payments for victims of harassment and other intentional discrimination based on sex, religion, or disability. BUSH

The Clarence Thomas-Anita Hill battle may have nullified any political points he might have scored for nominating a black to the Supreme Court. He finds fault with most affirmative action programs, calling them "racial quotas."

On these grounds, he vetoed an early version of the Civil Rights Act, causing a major rift with some black leaders. Has appointed several high-profile blacks, including General Colin Powell as chairman of the Joint Chiefs of Staff.

He wholeheartedly threw himself behind the Americans with Disabilities Act, willing to risk alienating his private-sector supporters who fear being saddled with expensive compliance measures. CLINTON

Caused uncomfortable relations with the Rev. Jesse Jackson when he criticized rap singer Sister Souljah for encouraging violence.

The Rev. Jackson, who is campaigning for Gov. Bill Clinton, is still very cool in his comments about the Democratic candidate.

Governor Clinton has been liberal in appointing blacks to the Arkansas judiciary and his governor's staff, which is 28 percent minority and at one time included four black cabinet members.

But he hasn't been able to win passage of a civil rights law in Arkansas, one of only two states without one.

Opposes racial quotas, but supports the Civil Rights Act, the Americans with Disabilities Act, and expanded civil rights for homosexuals (with exemptions for religious organizations).

He strongly supports the death penalty, which - because it is disproportionately meted out to black offenders - is considered by some liberals to be a form of racial discrimination. PEROT

His biggest political gaffe involved race. He made references to "your people" in an address to the National Association for the Advancement of Colored People and, as a result, was branded "condescending" and "insensitive" by many blacks.

He says each person should be judged on merit and that discrimination based on gender, race, or sexual orientation should not be tolerated. He speaks negatively about affirmative action.

"I am not closing my eyes to the real world. I realize that some groups have advantages and that others have disadvantages, but we don't pull anyone up by pulling somebody else down," he says.

# data[].attributes.attachment_link.description
The politics of race has been the most dramatic backdrop to the 1992 election season. The Supreme Court nomination of Clarence Thomas raised messy race and gender issues. President Bush's detractors tried to lay blame for the flare-up of racial tensions in the May Los Angeles riots to the president's neglect of domestic issues.

# data[].attributes.attachment_link.readable_text
nonfiction

Credit... Derek Brahney

AMERICAN POISON
How Racial Hostility Destroyed Our Promise
By Eduardo Porter

A white liberal progressive - as this reviewer would be labeled - confronts the issue of race in America with beliefs that make it difficult to face a reality that their fellow citizens of black or Hispanic origin take for granted. Basic to the liberal creed, for example, is the idea, as Barack Obama liked to say, echoing Martin Luther King Jr., that the arc of history bends toward justice. For many Americans, the arc never bends in any direction, least of all toward justice. Likewise, liberals believe that we can "empathize," truly understand the racial pain of Americans of color and the racial resentments of an abandoned white working class that thinks their salvation lies with Donald Trump. If any moral quality has been strained to the breaking point in the polarization of our era, it is empathy, ours included.

This liberal astigmatism - our belief that history is a story of racial progress, and our faith in our own empathy - makes Eduardo Porter's "American Poison" a tough read. It is a learned, well-written but relentless survey of social science studies on the racial polarization, animosity and social fragmentation of American life. A black or Hispanic American reader is likely to finish Porter's summary of the evidence and say, "So what else is new?" For a white liberal, the book leaves many an illusion in tatters.

One such illusion is that increasing racial proximity by integrating schools and housing is a good way to break down racial animosities and paranoias. Porter cites one study from Chicago that demonstrates the reverse. It was only when project housing for blacks was torn down that the attitudes of nearby whites toward blacks actually improved. Empathy seems to increase with social distance.

Empathy, Porter argues, has always waged an unequal struggle against the racial animus that courses through American history, poisoning both those who hate and those who are hated. Race has contaminated American solidarity, making it impossible for poor whites, threatened by job loss, globalization and the death of carbon-intensive industries, to make common cause with African-Americans, Hispanic-Americans and immigrants. He writes, "Unwilling to share the bounty of state with people of other races and creeds, heritages and colors, real Americans - the white ones - have prevented the erection of a welfare state at all."

The great achievement of American liberalism - Franklin Roosevelt's social security state - was passed, Porter argues (following lines of thought developed by the political scientist Ira Katznelson), only by a devil's bargain with Southern segregationist senators. Liberal social security systems perpetuated black exclusion until Lyndon Johnson's Great Society reforms of 1964. Johnson knew these reforms would cost him the South politically but, Porter says, no liberal anticipated the larger historical consequence: "Johnson failed to grasp the scale at which inviting people of color into the network of rights and assurances created in the 1930s by F.D.R. to protect the well-being of white American workers would undermine support for the safety net altogether."

Porter, who writes about economics for The New York Times, is at his strongest when he points out the tragic irony of a white working class, decimated by deindustrialization and wasted by substance abuse, focusing their hatreds on minorities and turning against the very social programs - Obamacare, for example - that might actually help them: "The America that built the most prosperous working class the world had ever seen collapsed into a heap of pathologies - deaths of despair - simply due to a lack of empathy. The greatest irony is that while the black and the brown suffered most intensely from the fallout, the collapse in social trust wiped away the American dream of working-class whites too."

This is a powerful argument, but it has a couple of problems. The first is that it overestimates race and underestimates class and a free market political culture in explaining why America collects a far smaller percentage of national income in taxes compared with European countries that have more adequate public health, education and welfare services. The second problem is that Porter treats racial hatred as a fixed dose of poison coursing through the veins of the public and neglects politics, the systematic way in which Republican politicians from Richard Nixon onward fed the poison with envenoming rhetoric about "welfare queens," "dysfunctional black families" and the shame of welfare dependency.

Yet here too it's not the case that race alone - or even Republican populism - drove the critique of welfare dependency in the 1970s and 1980s. Charter liberal grandees like Daniel Patrick Moynihan, who cannot be accused of racial animus toward blacks, worried that welfare was passing dependency from one generation to the next in some poor black families.

Porter's pessimism is a bracing wake-up call for liberal readers and may confirm the darkest fears of many a black and Hispanic reader. Yet it is not the first passionate polemic to damage its impact by overstating its case. Racial polarization, Porter claims, has led to the collapse not only of "Americans' support for the safety net," but also of "their general support of public goods and the entire apparatus of government."

This book came out around the start of the pandemic emergency, and so it is unfair to criticize Porter for failing to anticipate the all but universal cry right now for an effective "apparatus of government." Even so, Porter's jeremiad makes it impossible to understand the equally tenacious history of American progressive government: from Roosevelt himself, through Truman's integration of the United States military, the Supreme Court ban on racial covenants in housing in 1948, the Civil Rights Act of 1964, the struggle to desegregate American schools and finally - an achievement barely mentioned in Porter's story - the passage of the Affordable Care Act. The point here is not to retreat into complacent liberal banalities, but to observe that a story of American race relations that makes no attempt to account for the unending battle to lift its hateful curse ends up being no kind of story at all.

# data[].attributes.attachment_link.description
nonfiction AMERICAN POISON How Racial Hostility Destroyed Our Promise By Eduardo Porter A white liberal progressive - as this reviewer would be labeled - confronts the issue of race in America with beliefs that make it difficult to face a reality that their fellow citizens of black or Hispanic origin take for granted.

# data[].attributes.attachment_link.readable_text
At the Urban Institute, we examine how structural racism continues to disproportionately segregate communities of color from access to opportunity and upward mobility by making it more difficult for people of color to secure quality education, jobs, housing, healthcare, and equal treatment in the criminal justice system.

Throughout this country's history, the hallmarks of American democracy - opportunity, freedom, and prosperity - have been largely reserved for white people through the intentional exclusion and oppression of people of color. The deep racial and ethnic inequities that exist today are a direct result of structural racism: the historical and contemporary policies, practices, and norms that create and maintain white supremacy.

At the Urban Institute, we examine how structural racism continues to disproportionately segregate communities of color from access to opportunity and upward mobility by making it more difficult for people of color to secure quality education, jobs, housing, healthcare, and equal treatment in the criminal justice system.

For decades, our researchers have called attention to the role of race and racism in our public and private institutions and offered evidence-based solutions for how to address these inequities. Our scholars will play a crucial role as we continue to elevate the public discourse around race and racism in America.

Urban Next50 What would it take to overcome the damaging effects of structural racism and ensure a more equitable future?

Interim Project Director, Housing Crisis Research Collaborative

# data[].attributes.attachment_link.description
At the Urban Institute, we examine how structural racism continues to disproportionately segregate communities of color from access to opportunity and upward mobility by making it more difficult for people of color to secure quality education, jobs, housing, healthcare, and equal treatment in the criminal justice system.

# data[].attributes.attachment_link.description
Racism in America news, photos, videos, and opinion.

# data[].attributes.headline
The Leadership Conference of Civil and Human Rights

# data[].attributes.subject
The Leadership Conference of Civil and Human Rights

# data[].attributes.attachment_link.provider_name
The Leadership Conference on Civil and Human Rights

# data[].attributes.attachment_link.readable_text
At The Leadership Conference, we are promoting a just, inclusive, and fair democracy - one that works for everyone

Learn how you can be part of our work to promote and protect civil and human rights.

The America We Find

Without a functional democracy that represents everyone, we cannot make progress on critical civil rights issues. But, at every turn, President Trump has eroded the rule of law and our democracy, and his administration has aggressively worked to undercut the power of communities of color and those historically excluded from our political process. When our democracy is in peril, so too are our civil rights.

The America We're Building

This moment calls us to recognize democracy as the fundamental value upon which equality and inclusion rest. America is overdue for a 21st century democracy - and our coalition is committed to getting us there. By working to end racial discrimination in voting, ensure a fair and accurate 2020 Census, and demand impartial judges who will uphold civil rights, we are building a democracy where every voice matters and every vote valued.

The America We Find

Despite the steady progress of the civil rights movement, systemic racism and injustice persist in the nation's legal system. The Trump administration has worsened the crisis by restarting the disastrous War on Drugs and promoting policies of fear and division - policies that scapegoat immigrants and communities of color for political advantage. For our nation to be truly free, we must insist on equal protection under the law.

The America We're Building

Justice reform offers an opportunity for hope, and an opportunity to realize our nation's promise of equal justice. Through our coalition, we push back on the glaring criminalization of communities of color and hold state and national leaders accountable. Together, we fight for the rights and safety of immigrants and work toward transforming the legal system into one that is just and equitable for all.

The America We Find

The struggle for equal opportunity and civil rights are inextricably bound. But throughout our nation's history, America has locked too many people out of education, employment, and economic opportunities. Rather than expand access to safe schools, fair working environments, and inclusive communities, the Trump administration has rolled back civil rights protections and fanned the flames of prejudice, making us all less safe.

The America We're Building

Access to equal opportunity is at the heart of the American dream. Our coalition creates pathways for people to invest in their futures, choose safe and inclusive schools for their children, and pursue new opportunities without fear of discrimination. We are also working to ensure that every person can access the technology and information necessary to participate in democracy and meaningfully contribute to their communities.

# data[].attributes.attachment_link.title
Our Work - The Leadership Conference on Civil and Human Rights

# data[].attributes.attachment_link.description
At The Leadership Conference, we are promoting a just, inclusive, and fair democracy - one that works for everyone Learn how you can be part of our work to promote and protect civil and human rights. The America We Find Without a functional democracy that represents everyone, we cannot make progress on critical civil rights issues.

# data[].attributes.attachment_link.description
Read the latest articles and commentary on civil rights at US News.

# data[].attributes.attachment_link.readable_text
Is there a more urgent problem in the world today than war? And when I say "war" in this post, I mean also militarism, the culture of war, the armies, arms, industries, policies, plans, propaganda, prejudices, rationalizations that make lethal group conflict not only possible but also likely.

My answer to the above question: No, there is no more urgent problem than war. Not climate change, pollution, overpopulation, oppression, poverty, inequality, hunger, disease.

If you seek solutions to any of these problems, you should also devote at least some effort to ending war, for several reasons. First, war exacerbates or perpetuates our other problems, either directly or by draining precious resources away from their solution. War subverts democracy and promotes tyranny and fanaticism; kills and sickens and impoverishes people; ravages nature. War is a keystone problem, the eradication of which would make our other social problems much more tractable.

Second, war is more readily solvable than many other human afflictions. War is not like a hurricane, earthquake or Ebola plague, a natural disaster foisted on us by forces beyond our control. War is entirely our creation, the product of human choices. War could end tomorrow if a relatively small group of people around the world chose to end it.

Third, more than any of our other problems, war represents a horrific moral crime. Particularly when carried out by the U.S. and other nations, or by groups that aspire to or claim the legitimacy of states, war makes hypocrites of us and makes a mockery of human progress. We cannot claim to be civilized as long as war or even the threat of war persists.

Yes, annual war casualties have declined sharply since the cataclysmic first half of the 20 th century. Over the last few decades, war has killed far fewer people than cancer or automobile accidents. But in our heavily-and nuclear-armed world, war is a few decisions away from becoming exponentially more destructive. And even the killing of a single child by a U.S. drone, Israeli rocket or Syrian tank is an abomination that corrupts us all.

I wrote The End of War, which is being published today in paperback by McSweeney's, to start a conversation about why we fight and how we can stop. The new edition includes a forward by anthropologist Douglas Fry, an authority on warfare, and an index. The End of War addresses in a sustained, concise fashion topics that I've written about over the past few years on this blog and elsewhere (see FURTHER READING below).

While writing The End of War, I sometimes fretted that war might end before my book was published, rendering it obsolete. That's a bad joke, especially today, as war rages in Syria, Ukraine, Gaza, Afghanistan, Pakistan and Iraq, which the U.S. is bombing once again. (For data on these and other armed conflicts around the world, see the Uppsala University Conflict Data Program.)

Our biggest challenge is making the transition from our world, which is still armed and dangerous, to a world in which war and even the threat of war have vanished. I am not an absolute pacifist. If someone attacks me or a loved one-or even a stranger--I would do my best to stop him. Sometimes violence is morally justified, even necessary, to thwart greater violence.

So the question is, how should we react to lethal group violence when it erupts in the world today? How, for example, should the U.S. have reacted to the 9/11 attacks? Or to the current advances of ISIS militants in Iraq? How should Palestinians react to Israeli violence, and vice versa? How should Russia respond to violent unrest in Ukraine?

My answer is that nations and other groups should act in a manner consistent with the ultimate goal of eradicating war once and for all. This is what I call the "end-of-war rule," which I spell out in more detail in The End of War. My own country, the U.S., is the world's most egregious violator of the end-of-war rule, and not only because over the past dozen years Americans have waged two major wars that have killed hundreds of thousands of civilians. The U.S. also maintains by far the biggest military in the world, in terms of spending, and it is the biggest arms dealer.

According to surveys I've carried out for more than a decade, the overwhelming majority of people view war as inevitable, a permanent feature of human existence. This fatalistic outlook is wrong, both empirically and morally. Empirically because it contradicts what science and history tell us about war. Morally because it perpetuates war by discouraging us from seeking solutions.

Even the most cynical fatalists, if asked whether they would prefer to live in a world without war, say, Of course! Every sane person wants peace. If you disagree with me about why wars happen and how we can end them, I'd love to hear your ideas. If we all join together in pursuing the end of war, we will surely succeed, not in some hazy, distant future but soon.

FURTHER READING:

The End of War, paperback, forward by Douglas Fry, McSweeney's, 2014. http://www.amazon.com/End-War-John-Horgan/dp/1938073126/ref=sr_1_1_title_0_main?s=books&ie=UTF8&qid=1407671952&sr=1-1&keywords=the+end+of+war

World Beyond War, a self-described global movement "to end war and establish a just and sustainable peace," provides information on the destructive effects of war and on alternatives to violence at http://www.worldbeyondwar.org.

JUST WAR THEORY AND NONVIOLENCE

"We Need a New Just-War Theory, Which Aims to End War Forever." https://blogs.scientificamerican.com/cross-check/2013/04/24/we-need-a-new-just-war-theory-which-aims-to-end-war-forever/

"How Can We Condemn Boston Murders But Excuse U.S. Bombing of Civilians?" https://blogs.scientificamerican.com/cross-check/2013/04/19/how-can-we-condemn-boston-murders-but-excuse-u-s-bombing-of-civilians/

"Did the U.S. Overreact to the 9/11 Attacks?" https://blogs.scientificamerican.com/cross-check/2012/09/10/did-the-u-s-overreact-to-the-911-attacks/

"Barack Obama Should Call for End of All War, Not Just War on Terror." https://blogs.scientificamerican.com/cross-check/2013/05/24/barack-obama-should-call-for-end-of-all-war-not-just-war-on-terror/

"U.S. Lacks Moral Authority to Criticize Russia for Intervening in Ukraine." https://blogs.scientificamerican.com/cross-check/2014/03/02/u-s-lacks-moral-authority-to-criticize-russia-for-intervening-in-ukraine/

Egypt's Revolution Vindicates Gene Sharp's Theory of Nonviolent Activism." https://blogs.scientificamerican.com/cross-check/2011/02/11/egypts-revolution-vindicates-gene-sharps-theory-of-nonviolent-activism/

CAUSES OF WAR

"New Study of Foragers Undermines Claim That War Has Deep Evolutionary Roots." https://blogs.scientificamerican.com/cross-check/2013/07/18/new-study-of-foragers-undermines-claim-that-war-has-deep-evolutionary-roots/

"New Study of Prehistoric Skeletons Undermines Claim that War Has Deep Evolutionary Roots." https://blogs.scientificamerican.com/cross-check/2013/07/24/new-study-of-prehistoric-skeletons-undermines-claim-that-war-has-deep-evolutionary-roots/

"Survey of Earliest Human Settlements Undermines Claim That War Has Deep Evolutionary Roots." https://blogs.scientificamerican.com/cross-check/2013/08/02/survey-of-earliest-human-settlements-undermines-claim-that-war-has-deep-evolutionary-roots/

" Quitting the hominid fight club: The evidence is flimsy for innate chimpanzee-let alone human-warfare." https://blogs.scientificamerican.com/cross-check/2010/06/29/quitting-the-hominid-fight-club-the-evidence-is-flimsy-for-innate-chimpanzee-let-alone-human-warfare/

"The Warrior Gene Makes Me Mad (Whether or Not I Have It)." https://blogs.scientificamerican.com/cross-check/2011/04/26/code-rage-the-warrior-gene-makes-me-mad-whether-i-have-it-or-not/

"Are We Doomed to Wage Wars Over Water?" https://blogs.scientificamerican.com/cross-check/2012/03/26/are-we-doomed-to-wage-wars-over-water/

"Margaret Mead's War Theory Kicks Butt of Neo-Darwinian and Malthusian Models." https://blogs.scientificamerican.com/cross-check/2010/11/08/margaret-meads-war-theory-kicks-butt-of-neo-darwinian-and-malthusian-models/

"RIP Military Historian John Keegan, Who Saw War As Product of Culture Rather than Biology": https://blogs.scientificamerican.com/cross-check/2012/08/04/rip-military-historian-john-keegan-who-saw-war-as-product-of-culture-rather-than-biology/

MILITARIZATION OF SCIENCE

"Neil deGrasse Tyson, Please Speak Out about Militarization of Science!" https://blogs.scientificamerican.com/cross-check/2014/03/07/neil-degrasse-tyson-please-speak-out-about-militarization-of-science/

"My Exchange with Neil deGrasse Tyson about Science and War." https://blogs.scientificamerican.com/cross-check/2014/03/09/my-exchange-with-neil-degrasse-tyson-about-science-and-war/

"Why You Should Care about Pentagon Funding of Obama's Brain Initiative." https://blogs.scientificamerican.com/cross-check/2013/05/22/why-you-should-care-about-pentagon-funding-of-obamas-brain-initiative/

"Should Scientists and Engineers Resist Taking Military Money?" https://blogs.scientificamerican.com/cross-check/2012/11/12/should-scientists-and-engineers-resist-taking-military-money/

"Programs for Troubled Vets Don't Work, So How About Ending War?" https://blogs.scientificamerican.com/cross-check/2014/02/22/programs-for-troubled-vets-dont-work-so-how-about-ending-war/

DRONES, CYBER WAR AND SURVEILLANCE

"The Drones Come Home." http://ngm.nationalgeographic.com/2013/03/unmanned-flight/horgan-text

"Why drones should make you afraid. Very afraid." https://blogs.scientificamerican.com/cross-check/2013/02/16/why-drones-should-make-you-afraid-very-afraid/

"Drone assassinations hurt the U.S. more than they help us." https://blogs.scientificamerican.com/cross-check/2011/10/03/drone-assassinations-hurt-the-u-s-more-than-they-help-us/

"Don't Believe Scare Stories about Cyber War." https://blogs.scientificamerican.com/cross-check/2011/06/03/dont-believe-scare-stories-about-cyber-war/

"What Ancient Greeks Can Teach Us about Drones and Cyber War." https://blogs.scientificamerican.com/cross-check/2012/06/12/what-ancient-greeks-can-teach-us-about-drones-and-cyber-war/

"Grass Roots Spying Might Make World Peace Possible." https://blogs.scientificamerican.com/cross-check/2010/04/28/grassroots-spying-might-make-world-peace-possible/

"New Book Cuts Through Fog of Hype Cloaking Cyber War." https://blogs.scientificamerican.com/cross-check/2014/02/04/new-book-cuts-through-fog-of-hype-cloaking-cyberwar/

"Are We Ready for a World in Which Everyone Spies on Everyone Else?" https://blogs.scientificamerican.com/cross-check/2013/01/07/are-we-ready-for-a-world-in-which-everyone-spies-on-everyone-else/

"Will 'Persistent Surveillance' Turn U.S. into a Panopticon?" https://blogs.scientificamerican.com/cross-check/2013/07/01/will-persistent-surveillance-turn-u-s-into-one-big-panopticon/

MISCELLANEOUS

"Prominent Economist Touts Benefits of War in The New York Times-Really." https://blogs.scientificamerican.com/cross-check/2014/06/15/prominent-economist-touts-benefits-of-war-in-new-york-times-really/

"50 Years Later, JFK "Peace Speech" Still Inspires-and Has Been Scientifically Validated!" https://blogs.scientificamerican.com/cross-check/2013/06/10/50-years-later-jfk-peace-speech-still-inspires-and-has-been-scientifically-validated/

"Will War Ever End?" (review of Better Angels of Our Nature, by Steven Pinker). http://www.slate.com/articles/Arts/books/2011/10/steven_pinker_s_the_better_angels_of_our_nature_why_should_you_b.2.html

"No, War Is Not Inevitable" (review of The Social Conquest of Nature, by Edward Wilson). http://discovermagazine.com/2012/jun/02-no-war-is-not-inevitable#.UefeMRZ8LlI

"Lets Begin Talking About How to End Wars." https://blogs.scientificamerican.com/cross-check/2012/02/20/lets-start-talking-about-whetherand-howwe-can-stop-waging-wars/

# data[].attributes.attachment_link.title
War Is Our Most Urgent Problem--Let's Solve It

# data[].attributes.attachment_link.description
Is there a more urgent problem in the world today than war? And when I say “war” in this post, I mean also militarism, the culture of war, the armies, arms, industries, policies, plans, propaganda, prejudices, rationalizations that make lethal group conflict not only possible but also likely

# data[].attributes.attachment_link.description
Although war may financially benefit a country and stimulate the economy, it has detrimental effects on politics, economics and society.

# data[].attributes.attachment_link.title
The Toll of War: The Economic and Social Consequences of the Conflict in Syria

# data[].attributes.attachment_link.description
This study assesses the economic and social consequences of the Syrian conflict as of early 2017. The conflict has inflicted significant damage to the Syrian Arab Republic's physical capital stock (7 percent housing stock destroyed and 20 percent partially damaged), led to large numbers of casualties and forced displacement (between 400,000 and 470,000 estimated deaths and more than half of Syria's 2010 population forcibly displaced), while depressing and disrupting economic activity.

# data[].attributes.attachment_link.readable_text
Pet "overpopulation" encompasses two primary factors: (1) allowing cats and dogs to reproduce with little chance to find homes for the offspring and (2) pets being relinquished by owners who can no longer keep their animals, or who no longer want them.

Every year, millions of cats and dogs are euthanized in our nation's animal shelters because there are more pets than there are responsible homes for them. Until this issue is resolved, American Humane believes that all cats and dogs adopted from public or private animal care and control facilities should be spayed or neutered (i.e., sterilized). Such sterilization includes prepubertal spaying and neutering of kittens and puppies. American Humane supports the passage of laws and regulations mandating that all cats and dogs adopted from public or private animal care and control facilities be sterilized. It is less certain that community-wide mandatory spay/neuter laws are effective in addressing pet overpopulation. More information needs to be gathered on the benefit of prior legislative initiatives to determine long-term benefits.

American Humane encourages the veterinary profession to assist, whenever and however possible, in reducing the number of unwanted pets. This involvement includes supporting the neutering of cats and dogs adopted from public or private animal care and control facilities - thereby controlling the ongoing contribution of offspring to pet overpopulation. Veterinarians should continue to use their best judgment when recommending appropriate sterilization ages for individual cats and dogs owned by clients, especially those clients who are wellknown and likely to permit an unwanted pregnancy to occur prior to surgery. Short-term and long-term health risks for each animal should always be assessed. American Humane encourages research into the development and use of nonsurgical methods of sterilization.

American Humane also supports research to assess the causes for pet relinquishment. Prior research studies suggest that 7 to 20 percent of pets entering a home are no longer in that home six months after acquisition. These animals often end up at shelters, contributing to the pet "overpopulation" issue. Thus, American Humane wishes to understand individual, cultural and community issues that lead to pet relinquishment and to develop practical and effective intervention strategies.

What you can do to combat pet overpopulation:

1. If you are adding a pet to your family, make sure the pet comes from a legitimate shelter, nonprofit rescue group or a responsible, humane breeder.

2. Always spay and neuter your pets.

3. Consider all the responsibilities and consequences of pet ownership before deciding to get a pet and always make a lifetime commitment to your pet.

4. Educate your children, friends, family members and co-workers about pet overpopulation, adoption and the importance of spaying and neutering.

You can help stop generations of suffering. Have your female pet spayed and your male pet neutered. Don't allow them to breed and add to the pet overpopulation problem.

# data[].attributes.attachment_link.description
Pet "overpopulation" encompasses two primary factors: (1) allowing cats and dogs to reproduce with little chance to find homes for the offspring and (2) pets being relinquished by owners who can no longer keep their animals, or who no longer...

# data[].attributes.attachment_link.description
The Shelter Pet Project’s goal is to make shelters the first place potential adopters turn when looking to get a new pet.

# data[].attributes.attachment_link.readable_text
How many pets are in the United States? How many animals are in shelters?

Facts about U.S. Animal Shelters:

The terms "humane society" and "SPCA" are generic; shelters using those names are not part of the ASPCA or The Humane Society of the United States. Currently, no government institution or animal organization is responsible for tabulating national statistics for the animal protection movement. These are national estimates; the figures may vary from state to state.

Approximately 6.3 million companion animals enter U.S. animal shelters nationwide every year. Of those, approximately 3.1 million are dogs and 3.2 million are cats. We estimate that the number of dogs and cats entering U.S. shelters annually has declined from approximately 7.2 million in 2011. The biggest decline was in dogs (from 3.9 million to 3.1 million).

Each year, approximately 920,000 shelter animals are euthanized (390,000 dogs and 530,000 cats). The number of dogs and cats euthanized in U.S. shelters annually has declined from approximately 2.6 million in 2011. This decline can be partially explained by an increase in the percentage of animals adopted and an increase in the number of stray animals successfully returned to their owners.

Approximately 4.1 million shelter animals are adopted each year (2 million dogs and 2.1 million cats).

About 810,000 animals who enter shelters as strays are returned to their owners. Of those, 710,000 are dogs and 100,000 are cats.

*These estimates are based in part on Shelter Animals Count data and other known and estimated sources, 2019. These are national estimates based on data obtained from shelters and rescues; the figures may vary from state to state.
Facts about Pet Ownership in the U.S.:

It's estimated that 78 million dogs and 85.8 million cats are owned in the United States. Approximately 44% of all households in the United States have a dog, and 35% have a cat. (Source: American Pet Products Association 2015-2016 (APPA))

Approximately 40% of dog owners and 46% of cat owners learned about their pet through word of mouth. (Source: APPA)

According to the APPA, these are the most common sources from which primary methods cats and dogs are obtained as pets (Note: this information was based on a multiple response question, which results in the total % exceeding 100% individually for cats and dogs. In addition, the 'other' category includes all source categories that were reported by <10% of both dog and cat owners):

APPA reports that 34% of dogs are purchased from breeders, while 23% of dogs and 31% of cats are obtained from an animal shelter or humane society.

Around 27% of cats are acquired as strays, down from 35% in 2012. (Source: APPA)

According to the ASPCA's National Rehoming Survey, pet problems are the most common reason that owners rehome their pet, accounting for 47% of rehomed dogs and 42% of rehomed cats. Pet problems were defined as problematic behaviors, aggressive behaviors, grew larger than expected, or health problems owner couldn't handle.

The preceding data are ASPCA estimates unless otherwise indicated.
You may also wish to visit:

American Pet Products Association
https://www.americanpetproducts.org/

The National Council on Pet Population Study & Policy (NCPPSP)
https://theaawa.org/page/nationalcouncil

The American Veterinary Medical Association
https://www.avma.org/ (see U.S. Pet Ownership and Demographics)

# data[].attributes.attachment_link.description
How many pets are in the United States? How many animals are in shelters? Get the answers to these and other questions about pet statistics.

# data[].attributes.attachment_link.authors[].name
Melissa L. Kauffman, Group Editorial Director Catster/Dogster

# data[].attributes.attachment_link.title
Meet the Teen Animal Activist Who Took Two Shelter Dogs to Prom - Dogster

# data[].attributes.attachment_link.description
Dogster is a publication where dog lovers come together to get the latest expert advice about dog behavior, health, news and entertainment.

# data[].attributes.attachment_link.readable_text
An animal shelter, by definition, is: an establishment, especially one supported by charitable contributions, that provides a temporary home for dogs, cats, and other animals that are offered for adoption. An establishment that temporarily provides a home until the animal is adoptable. Sounds good, right?
However, this definition is more in line with no kill animal shelters. These shelters will either keep animals as long as possible, or give them to some other organization that can attempt to adopt out the animals. They will do all in their power to find a great new home for animals that may have been homeless, abused, or a victim of hoarding. Through these types of organizations and charities, animals are given a second chance at life, love, and happiness.
Not only do the animals benefit, but those who adopt them do as well. They can receive some of the best animals and friends from places such as these, (as I know from experience.) While animals may come from any condition, if they are healthy, and great with people, even if it so happens to be as a result of many months or years of training, they will get another chance to be happy and to know love like they should.
Programs like these are great and can really help people in many conditions. There are many success stories out there that will make one want to go adopt every single animal from a shelter that they can, or at the very least, help them.
On the contrary, when comparing no kill shelters to ones without the same beliefs, the results often are not so 'successful.' These shelters may take in animals from the streets, and give them what they need, if only for a little amount of time depending upon their policies.
To clarify, there are some shelters that will let an animal stay for two weeks before euthanizing it. Others give only 3 days. According to research, some shelters may give an animal 3 days, then an additional 7, should the owner come looking for the animal. Meanwhile, other shelters may give the animals a few months, a few weeks, a few days, or even just an hour.
These particular shelters may have excuses, such as "we don't have enough room, we don't have enough money to keep them alive, or they aren't young or 'cute' enough and nobody will want to adopt them." While it may be true that there is no room for the animal or not enough money, the shelters could give the animals to a no kill shelter or an adoption organization.
I personally believe that all animals, no matter what age, as long as they are healthy and gentle, are "adoptable." The excuse that the animal is not young or cute enough has no support, seeing as many ages and kinds of animals are adopted all the time.
Animal shelters that do not have no kill policies don't give the animals enough time. It may take more than 3 days, 7 days, or even a couple of weeks for someone to come to the shelter. But the people coming to adopt are not to blame, because the shelter could put out fliers or notices that there are adoptable pets waiting to find their 'furever homes.'
Though some shelters may do this, and may even genuinely care about the animals, there are always those who just look at the animals as profit. Maybe they think keeping the animals alive is too much money or that there's less hassle with less animals, but clearly, the animals' best interest is not in mind, as it is at a no kill shelter.
Sure, maybe this is the first time in the animal's life that they've had shelter or food and water, but is it beneficial if the animal will not even get a fair chance at life? The animals don't know what's going on, and they may be scared from the past, traumatized, or extremely shy, but they haven't done anything at all to deserve to die.
So while not all shelters can 'afford' to keep the animals, they could find people who will foster the animals until adoption, or some other, positive alternative. Why, if an animal is not a harm to others, should it be killed without any choice? The animals can't speak for themselves. Their fates depend on us to be their voice. Are you up for the challenge? I know I am.

# data[].attributes.attachment_link.title
Animal Shelters: another chance at life or death

# data[].attributes.attachment_link.description
An animal shelter, by definition, is: an establishment, especially one supported by charitable contributions, that provides a temporary home for dogs, cats, and other animals that are offered for adoption. An establishment that temporarily provides a home until the animal is adoptable. Sounds good, right?

# data[].attributes.attachment_link.readable_text
Welcome to Petside, the impartial and trusted source to help you care for your pet. Our helpful resource and library of articles, reviewed and complied by experts and animal lovers, is designed with one thing in mind - to assist you in becoming a better pet owner.

Whether you're looking for the right dog food for your pup, want to learn more about certain canine breeds, spoil your kitty with the best cat toys, or simply find the right aquarium for your fish, you're guaranteed to find exactly what you need here.

Our mission is to protect the welfare of animals and become the world's largest accessible and reliable reference point to help educate our visitors with the best advice and products that the pet market has to offer.

# data[].attributes.attachment_link.description
Welcome to Petside, the impartial and trusted source to help you care for your pet. Our helpful resource and library of articles, reviewed and complied by experts and animal lovers, is designed with one thing in mind - to assist you in becoming a better pet owner.

# data[].attributes.attachment_link.readable_text
Our relationships with the animals we keep are highly personal. They provide us with unconditional love, and we take on a personal responsibility for making sure that they are well cared for. But when the bond between an animal and his guardian is broken, as when an animal is lost, abandoned, or surrendered to a shelter, who then has responsibility for the animal and his care?

Most people would say it's the local animal shelter's responsibility. And that's true. We take on the function of caring for animals other people don't want or can't care for. And we acknowledge our special role in speaking for the voiceless and upholding the moral status of animals in our communities. But if you were to ask the people at the shelter whose responsibility it is to care for lost, mistreated, and abandoned animals, they'd insist that it's the community's as a whole.

That's because we can't do this work by ourselves. Animal shelters rely on the community for funding, homes, volunteer help, and most importantly, we need people to care for their animals properly and not contribute to the problem. That's why we insist that animal welfare is a community responsibility and that success in this field comes through partnerships with people outside of the shelter.

In fact, just a few weekends ago we had an amazing adoption event -- a real example of community partnership. We got 65 animals into new homes in just two days. We kept our adoption trucks moving back and forth from the shelter to their temporary station in front of Friendship Hospital for Animals all weekend.

This private veterinary hospital, the largest in the nation's capital, understands the need for community involvement in animal welfare. Thanks to them, we have a thriving humane education program, ready veterinary interns and staff to help for events and patient care, and now... 65 new homes for our animals. It's exactly the kind of partnership we're always looking for.

With the help of that hospital, we made a lot of new friends and found many new homes. The astonishing thing to me though, was not the number of adoptions. We'd like to do that every weekend. It's the fact that by simply bringing animals to where our adopters live, and not keeping them in our shelter, which, let's face it, is not exactly on the beaten track of metro D.C.'s population (most shelters are tucked away near landfills, railroad tracks, airports, and other well-healed neighborhoods!), we literally tripled our adoptions for the weekend. One obvious conclusion -- we've got to get out more!

And that's exactly what we bought our new adoption truck to do -- bring our animals literally into the waiting arms of adopters. Easy enough to say, but not so simple to do. Especially in a city like Washington, in which parking a 22-foot truck has its challenges. So we need partners: businesses like Friendship Hospital for Animals that can host adoption events and provide us with venues to meet the public and tell them about our work.

At the same time, it's incumbent upon us in the animal welfare business to make our shelters welcoming places that the public doesn't have to be afraid to visit. So many times I hear from donors or other supporters that they love what we do, but don't want to visit because it's so sad to see all those animals without homes or hope.

But that's exactly what you won't see at the Washington Animal Rescue League or in any of the new "breed" of animal shelters being built all over the country. What you'll see at the League are contented dogs and cats acting like dogs and cats. That means you'll see them playing, eating, sleeping, and wagging their tails or stretching their paws in greeting. You'll also see funny bowls and buckets holding treats and messages from our behavior staff asking you to toss a few treats to help train our dogs to be household pets.

Every shelter needs to become a place of hope, education, and engagement -- not despair. They should be places where you can bring kids to adopt a pet, learn about the animals, or just practice compassion for all living things. But above all, places where you can teach responsible animal care, which includes spaying and neutering and adopting from shelters, not from Craig's List. Places where they are taught kindness and that it's important to be part of the world's solutions. Which includes ending animal homelessness. Put us out of business -- please.

November 6-12 is National Animal Shelter Appreciation Week. (But you knew that already, didn't you?) It's a great time to get to know your local animal shelter and show them that you're ready to become part of the solution. Every shelter needs adopters, donors, and volunteers. But here are few other ways you might get involved:

1. Help publicize the animals who are looking for homes. Hang a picture and description of an adoptable animal at your workplace or school. You can pull them straight from the shelter's website.

2. Consider donating used towels, blankets, toys, and treats to the shelter. Shelters go through a lot of these. You might even use your neighborhood list serve to organize a drive.

3. Host an adoption event at your work, school, or community group. Even if the event doesn't manage to find too many homes for animals -- and some are more successful in this regard than others -- you will introduce lots of people to the shelter and the work it does.

4. Learn about the services that your local shelter offers -- spay/neuter programs, low-cost vaccination clinics, dog training classes, help for feral cats, and the like -- so that you're ready to talk to friends and neighbors about how they can find help caring for their pets properly.

5. Offer to organize a tour of the shelter for a group of young people. Almost every shelter will happily talk to children about what they do and introduce them to their animals.

It's all about community. What Friendship Hospital showed us this weekend was that community partnerships work. Animal shelters need community support. And this starts by taking good care of all of our own animals. But if it's easier for the mountain to come to Mohammed, we'll do that too, like we did last weekend.

Because when the problem of animal homelessness becomes all of our problems, by spaying and neutering, giving proper veterinary care and teaching compassion for all living things, the animals will finally win. Sixty five dogs and cats who got to sleep in their new beds last week can attest to that.

Related

Animal Welfare abandoned animals animal shelters dc homeless-animals

# data[].attributes.attachment_link.title
Animal Homelessness Is a Community Challenge

# data[].attributes.attachment_link.description
November 6-12 is National Animal Shelter Appreciation Week. It's a great time to get to know your local animal shelter and show them that you're ready to become part of the solution.

# data[].attributes.attachment_link.readable_text
Thank you for the kind introduction and a special thanks to Dean Gallagher for welcoming me to campus today to celebrate the Rossier School of Education's centennial at the University of Southern California.

I'd like to start by acknowledging that even as we observe this milestone anniversary for Rossier, this community and its neighbors also have experienced sudden and staggering loss.

The shooting in nearby Thousand Oaks last week resulted in a dozen precious lives cut short at an event for college students. The "Camp Fire," the most destructive and potentially deadliest wildfire in California's history, is still burning. The blaze has claimed more than 40 lives and charred an area of land larger than the city of Detroit. And not too far from us here in Los Angeles, about 200,000 people have been displaced by the Woolsey Fire, even as fire departments are responding to another blaze just west of Thousand Oaks.

Amid this heartbreak, there are stories of heroic first responders and people coming together, doing what they can with what they have to aid their neighbors.

In a community a few dozen miles from here, I read about a man named Tim Biglow who, with a determined group of neighbors, took to the streets as ash from the fires rained down from the sky. The group used their own fire hoses to fight flames and knocked down fences and cleared brush, trying to remove anything from people's properties that could fuel the fire. Before city officials could arrive to sweep their streets, this group of volunteers shut off gas lines and helped people evacuate.

And that, really, is the true essence of America. People standing up to support those who need help ... people identifying a need and leading from where they are to make their communities even stronger.

It's that spirit that I'd like to talk with you about today.
I'd like to take a little time to reflect on how everyone in this room can lead from where you are, can stand up from wherever you sit, to be an activist for the most pressing issue in education today ... the need to vastly expand educational equity.
Because that's exactly what we need in these times: unapologetic activists for an excellent education that opens doors of opportunity to every child.

We know the stakes are so high.

Now, perhaps more than ever before, a quality education is vital to individual prosperity, the health of our democracy, and the strength of our nation.

But today, a child's zip code, the color of her skin, the language she speaks at home, and the socioeconomic status of her family still all weigh too heavily in the determination of that child's future.

Still, today, far too many young people-especially youth of color and youth from low-income backgrounds-do not have access to the opportunities that a great education makes possible.

Children of color and children living in poverty often have the least access to quality preschool, high academic expectations, and safe schools. They often are cut off from challenging coursework and outstanding teachers. They are suspended, expelled, and drop out of school at higher rates than their peers. And they are less likely to make it to post-secondary success, as so many of you have achieved or are striving for.
In America, our children's potential is ubiquitous-but educational opportunity is not evenly distributed-and we know these disparities translate into inequities in academic achievement and in outcomes in our society.
Nationally, greater shares of Black and Latino students perform at below basic levels in math and reading in elementary school than their White peers. And there are gaps of 10- and 20-percent between the high school graduation rates for Black and Hispanic students and White students.

We see disparities play out in society when the median household wealth of White families is about $142,000, while the household wealth of Hispanic families is just $13,000 ... and Black families fare worse at only $11,000. That's a wealth gap of more than $130,000 between White and Black families.

We see disparities in California, too.

While there are successes to celebrate ... steadily increasing high school graduation rates and more students of color entering the state's public colleges and universities ... there are significant challenges that need to be addressed.

Recent national test results show a backward slide for California's Black students in both fourth and eighth grade math. There isn't one California county where the majority of Latino students is meeting proficiency standards in math or English language arts, which is particularly worrisome for a population of children that makes up the majority of students in California's public school system. And students from low-income backgrounds in California are performing next to last in the nation in fourth grade math.

California also demonstrates some of the greatest income inequality in the nation. Here in Los Angeles, households in the top income percentile ($271,041) earn about 11 times as much as households in the bottom 20 percent ($25,190).
Certainly, California has an exciting opportunity to build on promising work already being done to address disparities in education with the recent election of a new governor, lieutenant governor, and the soon-to-be decided state superintendent of public instruction. All of these leaders have the powerful choice to stand up for educational equity from where they now sit. I'd like to suggest a few things to consider in this equity-advancing work, particularly for state leaders, in California and, indeed, all over the country. Part of the work should entail continuing to invest in meaningful systems of accountability that direct attention to the schools and districts that are struggling most.
California's School Dashboard-which gives educators, families, students, and advocates a more holistic look at school performance-is a start. It can include even more vital information that's currently disbursed across multiple places in the state system, and the dashboard can be more user friendly so that data can be understood and leveraged by everyone as a real tool to promote education improvement.
State leaders also can stand up for educational equity by adequately funding public schools while ensuring that the resources generated for students with the greatest needs are allocated equitably.
One of the biggest misconceptions around the term "equity" is that it means the same thing as equality, and that these words can be used interchangeably, especially in education.

But understanding that historically underserved students need additional resources to achieve is a matter of equity, not equality. Students who have not been well served by our systems need more, not equal and certainly not less, supports in order to thrive.

This is an especially salient issue in California, which ranks 41st nationally in per-pupil spending after adjusting for differences in the cost of living. The state also has more students per teacher, per administrator, and per school counselor than any other state.

My organization, The Education Trust, recently analyzed school funding in states across the country and found that the U.S. spends approximately 7 percent - or $1,000 - less per pupil on students educated in our nation's highest poverty districts than those educated in the wealthiest.

Fortunately, in California, the state's Local Control Funding Formula has helped to make district funding more equitable, and in many communities, families and students have a greater voice in decisions affecting them, and made by their schools and districts. Those are things to be celebrated. Policymakers can take important steps to adequately fund LCFF and make investments in equity paramount.
To stand up for educational equity, state leaders across the country and here in The Golden State also must expand access to rich, rigorous learning opportunities for all students, from preschool through high school.
California has smartly increased funding for public preschool, yet there's still an unmet need.

Only 37 percent of 4-year-olds and a little over 10 percent of 3-year-olds in California are enrolled in public preschool-when we know that quality early learning can give children, especially those who are most vulnerable, a strong foundation for success in school and in life.

And in a state known for its science, tech, and engineering industries, students lack access to rigorous coursework in these subjects.

Almost 40 percent of California public high schools, for example, do not offer physics and a quarter do not offer chemistry. How can California students make the choice to become the marine biologists working along our coasts, the researchers discovering cures for disease, and the computer scientists building the tools of tomorrow if they cannot enroll in the classes that are foundational to these fields, and that are often required for college level study?
There's work for state leaders to do here, and-particularly relevant for this audience and this moment when the Rossier School of Education is celebrating 100 years and looking to the next century and the challenges that must be solved-there is vital work to do to strengthen and support the teacher workforce.
Rossier has a strong legacy in this regard, stretching back to the 1800s when Los Angeles was a frontier town crisscrossed with dirt roads. Since that time, the school of education has trained thousands and thousands of teachers and school administrators. More than 200 Rossier graduates also have led California school districts, including more than 75 current superintendents.
To be sure, schools of education play a crucial role in leading for educational equity. One important way that ed schools can do this, especially today, is to use data to determine where the real needs are in our public schools and then do work to fulfill those needs.
For example, 60 percent of children ages zero to five in California speak a language other than English at home. This means that future educators, particularly in this state, will need to be equipped to serve dual-language learners.

It's critically important that more schools of education offer bilingual credentials, that more bilingual young people choose to go into teaching, and that more teachers who already are fluent in one or more languages earn their bilingual authorization.

As Rossier has done since its inception, it is responding to a demonstrated need with action.

Just last year the World Masters in Language Teaching program launched to address the growing demand for bilingual education teachers. Now, candidates are developing teaching fundamentals in two languages and cultures and getting the chance to spend part of their time studying at partner universities abroad.
Education schools also lead with equity in mind when they prepare teachers and school leaders to be activists for students who have been-and continue to be-underserved by our systems.
If, as the late civil rights leader Julian Bond once said, " is Black children going to school for 12 years and receiving six years' worth of education," then for Black and other disenfranchised youth is receiving the education they need for liberation from all forms of oppression.

Here at Rossier, 78 percent of graduates from the Master of Arts in Teaching program are working in high-needs schools. Your field programs are supporting students from low-income backgrounds so they may successfully make the transition from high school to college. And your Center for Education, Identity, and Social Justice is helping educators to combat discrimination and to see how race, gender, religion, sexual orientation, and ethnicity intersect.
Ed schools-and Rossier is a model-can lead for educational equity by supporting teacher candidates to recognize and confront their own biases, which every person carries, Indeed, one of the most powerful ways that ed schools-and any postsecondary institution-can stand up for equity is through an explicit focus on diversity. before they get into the classroom; to learn about the systemic and institutional barriers to equity that they are likely to face when they start teaching, and to equip them to dismantle those barriers in their classrooms, schools, and communities.
More than 60 percent of students at Rossier are students of color. Diversity in terms of race, socioeconomic status, ethnicity, sexual orientation, religion, and language, enriches education.

When students here learn with diverse peers and from diverse faculty, perspectives are broadened and empathy and tolerance increase-all good things for future and practicing educators and the work they ultimately do in service of young people.

USC has been a leader in lifting up the importance and value of diversity in higher education.

The university's Race and Equity Center is producing rigorous, actionable research and tools to advance racial equity for institutions of higher education, businesses, and other organizations all over the country. I'm also heartened to see USC launch a new Center for Excellence in Diversity and Inclusion, which will serve as a focal point for these endeavors across the university. And I'm encouraged by USC's new $50 million effort that aims to broaden and deepen the university's cultural diversity and ensure that faculty more closely reflect the rich makeup of USC's student body.

USC's commitment to diversity, in fact, just might be rubbing off on the city.

Recently, in an effort to boost diversity, inclusion, and engagement between the growing technology industry in Los Angeles and the surrounding community, more than 80 venture capitalists and tech leaders joined with LA Mayor Eric Garcetti and the Annenberg Foundation to launch a new effort called PledgeLA.

As part of this initiative, venture capitalists will support organizations that are making a difference in the community. And entrepreneurs, investors, and tech companies have pledged to actively improve diversity, equity, and inclusion, both in their investment decisions and at all levels in their organizations.
I've spoken with you today about how policymakers and schools of education can lead for educational equity, but now I'd like to turn to the educators and aspiring educators in the room.
This is a step in the right direction, especially when recent reports show that a lack of diversity and an abundance of unconscious bias are threatening the innovation economies in both LA and Silicon Valley. A study released this spring by the National Urban League, for example, revealed that at companies including Twitter, Google, Uber, and Facebook, fewer than 3 percent of tech workers identify as Black.

Strictly from a focus on the bottom line, this is bad for business. ... Especially when diversity has been linked to enhanced financial performance and increases in productivity for many companies.

Educators are at the forefront of a new era in the struggle for equity and social justice.

Educators teach children affected by the water crisis in Flint. Educators teach children who have witnessed shooting deaths of unarmed Black men and women at the hands of police. Educators teach children who fear that their parents might be next, or that their families will be ripped apart by cruel immigration enforcement. Educators teach children in crumbling schools in Detroit and Compton. And educators teach children who listen to racist, sexist, xenophobic, divisive political rhetoric and question whether they can still find themselves in the American Dream.
Teaching for social justice means nurturing in your students an awareness of the things that still need solving in our communities and in our country-even as you help students to build a strong foundation in academic learning.
Educators become activists, as Bettina Love, associate professor at the University of Georgia has said, when they "disrupt, agitate, and abolish systems, policies, and instruction that deny children of color not only their education, but their humanity."

Today, I'd like to suggest that educators can stand up to be activists for educational equity in three key ways: by teaching for social justice, by empowering others in this movement, and by loving your children-which will require you to truly see their humanity.

It means teaching students the history of resistance to slavery and of the ongoing movement for civil rights, about Black and Brown engineers, artists, authors, and inventors, and reminding young people of color that their brilliance is wrapped up in the genius of those who came before them.

Teaching for social justice also means helping students develop the skills to become activists for issues that they care about. Young people in this country, in fact, long have been marching toward equity and justice and have urged adults also to fight with urgency.

In the 1960s, students right here in East LA-just a few miles from USC's campus-walked out of their classrooms to demand that California's public education system provide the same educational opportunities to Latino students as it did to White students.

And about three years ago at a rally sponsored by The Education Trust-West, 1,000 high school and community college students marched from the California Department of Education to the steps of the state capitol building. They marched to assert that Black Minds Matter-and to call for a renewed commitment to equity in California's public schools and colleges.
Today, I'd also like to suggest that, to be activists for equity, teachers and those aspiring to work in schools must build the larger movement for social justice in education.
Indeed, today, students all across the country are driving a national push to increase voter participation in our elections, to ensure that public schools are safe and free from gun violence, and to demand that colleges are accessible, diverse, and inclusive.

Teaching for social justice means empowering our young people. And to all the high school students in the room today, it's you who, in so many ways, are already poised to be activists and leaders yourselves.
My final recommendation for educators who wish to lead for educational equity is simple on its face, but more complex in practice: Love your children.
Help your students to envision themselves as teachers and school leaders. Mentor other educators of color. Push your schools and districts to recruit and retain diverse teachers. Stand up for the supports that those educators need once they are hired and teaching in classrooms.

Increasing educator diversity is such a vital part of this work-especially when a majority of students in our public schools are students of color, but when only 18 percent of teachers in America are teachers of color. California's educators also don't reflect the diversity of students in the state. While 54 percent of California students are Latino, just 21 percent of teachers are. And while 6 percent of students in California are Black, only 4 percent of teachers are Black.

All educators go into the field because of an abundance of care for students, but to be an activist for educational equity, you must love your children enough to see their full humanity.

So many students experience incredible adversity. Difficult family circumstances. Poor health. Violence. Poverty. Hunger. Mental health challenges. Addiction.

As educators, you must challenge yourselves to see those things. Truly see those things. You must seek to understand what your students may be struggling with at home and in their community. And even as you identify challenges, you must do the work to recognize your students' assets and strengths.

For those of you studying at the Rossier School of Education, your experience here has shown you that students' success in school is dependent upon more than quality instruction and high expectations, although both are important. There are other things that matter, too.

You have learned that student success also requires you to meet children's social, emotional, and behavioral needs in schools and classrooms that are welcoming and safe. You know that students' success relates to their engagement in school-which is dependent on the relevancy of classroom assignments and other factors that the new USC Center EDGE is studying and communicating about. You know that student success requires monitoring chronic absenteeism and creating systems to ensure no student falls through the cracks. And you know that supporting student success also often requires connecting students with wraparound services from transitional housing, to health clinics, to food pantries.

Great educators who love the whole child and recognize a child's humanity-even and especially the challenging parts of that child's life-can make a tremendous difference.

I know this from personal experience.

My mom passed away when I was eight, my dad when I was twelve. During the years when I lived with my father, he struggled with undiagnosed Alzheimer's disease. Life at home was scary and unpredictable. I did not know what my dad would be like from one night to the next. And as he got sicker, I took on more and more responsibility for figuring out how to pay the bills, get food, and manage the household. But throughout that period, school-and my New York City public school teachers-provided a refuge. They created a space where I felt safe, challenged, and engaged-where I could be a kid when I couldn't be a kid outside of school.

Now, no life is a straight line. After my dad passed away, I moved around between family members and schools. I struggled with the losses I experienced in my youth and I was angry. I made bad choices and I got kicked out of high school. I often say I was the first Secretary of Education to have been kicked out of high school, but I hope I won't be the last-because I recognize the power of second chances.
Closing
After I was kicked out of high school, I was again fortunate to have public school teachers, and family members, and counselors who chose to invest in me. They could have looked at me as an African-American, Latino young man with a family in crisis, and they could have given up on me. But, instead they saw my potential. They gave me hope for the future.

I know many of you will encounter a student with a story like mine. Those of you who choose to be activists for educational equity will see the promise in that child.

I'll close by noting that so often, when those who are advantaged hear the word "equity" in education, they think about what might be taken away from them and their kids and given to someone else and someone else's kids over there ... those people who aren't " us." Especially today, there is a tendency to "other-ize"-to put people into categories. And those who are advantaged can sometimes be jealous with their resources.

It's here where the words of Dr. Martin Luther King, Jr. come to my mind.

In his famous Letter from a Birmingham Jail, Dr. King wrote that injustice anywhere is a threat to justice everywhere. And throughout his life he argued that we are all caught up in an "inescapable network of mutuality, tied together in a single garment of destiny."

As he said in his Commencement address to Oberlin College in 1965, "Whatever affects one directly, affects all indirectly. I can never be what I ought to be until you are what you ought to be. This is the interrelated structure of reality."

That is why I believe that equity, in fact, benefits us all. And in this way, equity really is justice.

I'm grateful to be an activist for educational equity and justice alongside all of you gathered here today. And I cannot wait to see the ways in which the USC Rossier School of Education will help California and the entire nation deliver on the promise of educational opportunity for a new century and for all our children.

Thank you.

# data[].attributes.attachment_link.title
Stand Up to be an Activist for Educational Equity from Wherever You Sit - The Education Trust

# data[].attributes.attachment_link.description
Thank you for the kind introduction and a special thanks to Dean Gallagher for welcoming me to campus today to celebrate the Rossier School of Education's centennial at the University of Southern California. I'd like to start by acknowledging that even as we observe this milestone anniversary for Rossier, this community and its neighbors also have experienced sudden and staggering loss.

# data[].attributes.attachment_link.readable_text
ABSTRACT

CCC-14-0003.0 This case takes readers into the world of advocacy, and the benefits and risks of various strategies and tactics. Equal Education started in 2008 as a member-based organization with the mission of obliging the government to meet its own goals for making a decent education accessible to all South Africans. Based in Cape Town, it started with a campaign to fix broken window in a single school and grew to encompass libraries, bathrooms, and electricity. By 2012, it was nationwide with a membership of over 5,000 students. But in May 2013, it faced a dilemma. EE had sued the minister of basic education to issue basic norms and standards for school infrastructure, but she had missed yet another deadline and requested an extension. EE polled its members, who voted to deny an extension; EE legal counsel, however, advised granting it. The leadership had to decide what to do.

Students will have the opportunity to follow the growth of a grassroots organization as it matures from a local entity to one with national reach and influence. The leadership skills required at different stages keep shifting, and the learning curve of EE founders is steep. Ask students to discuss the membership model EE adopts, and its strengths and weaknesses. They could also discuss the role of nonprofits in post-apartheid South Africa, and how civil society changes when a long-term foe is vanquished. Finally, ask them to look at the various types of protests EE adopts, from sit-ins to marches to legal suits. Which tactic seems best suited to what kind of situation? Does EE's track record match its ambitions?

Use this case for a class discussion of the role of activism in social change. Ask how education is part of sustainable development, and who might be the natural allies of EE. The organization works for the most part within the system, including the courts-is this the best way of achieving change? What about the choice of high school students as members? Is that the correct demographic, or would it be better off restricting membership to university-level or older? What about leadership change-is it time for the founders to hand off to a new generation?

Use this case in a course/class on education reform, social activism, sustainable development or organizational management.

Credits

This case was written by Eric Smalley for the Case Consortium @ Columbia and the Global Association of MDP Programs. Funding was provided by the Open Society Foundations. (0714)

# data[].attributes.attachment_link.title
Fighting for Equality in Education: Student Activism in Post-apartheid South Africa

# data[].attributes.attachment_link.description
ABSTRACT CCC-14-0003.0 This case takes readers into the world of advocacy, and the benefits and risks of various strategies and tactics. Equal Education started in 2008 as a member-based organization with the mission of obliging the government to meet its own goals for making a decent education accessible to all South Africans.

# data[].attributes.attachment_link.readable_text
Resources, Inspiration And Expert Advice For Making A Difference On And Off Campus
Student activism has surged in the last decade, with young campaigners calling on leaders both on and off campus to right wrongs, erase inequalities and secure the future of our planet. But this is nothing new: Student activists led the charge during the Civil Rights Movement and were early adopters of environmentalism. While peaceful protests and petitions are still important parts of their toolbox, today's student activists are expanding by bringing activism to the web and social media. The following guide explains what it means to be a student activist and where to find support for certain causes. It also provides tools and guidance on how to create goal-oriented, effective rallies for change.
How to Become a Student Activist

While you may already have causes you're passionate about, gathering supporters and developing a thoughtful plan to enact change are just as important as the initial idea. The timeline below can help budding activists develop a measured approach to achieving their goals.

Take Action: Common Methods of Student Activism

Iconic scenes of protestors taking over a square or marching down a busy road pop into most people's minds when they think of activists, but there are several other methods of taking action to make a change.

Campus Activism by Cause: Examples & Resources

Student activists are on the forefront of championing many issues. Whether opting to tackle sexual health and safety, gender discrimination, religious freedom, or another issue, they can draw inspiration and clarify their purpose by using the resources outlined in this section.

Diversity & Racism

Although the Civil Rights Movement began more than half a century ago, racism and lack of diversity continue to be issues both on college campuses and across the country. In the context of higher education, poor race relations can fester, eventually manifesting in learning distractions or threats to student safety. Although these issues have greatly improved in recent decades, there is still much work to be done.

Resources

Black Lives Matter - Created in 2012, BLM has hundreds of chapters throughout the U.S., including on college campuses.

Dismantling Racism Works - dRworks is a group of organizers and trainers who help activists reverse racial inequities.

History of Diversity, The - This timeline of racial equality at Sarah Lawrence College is an example of something student activists can ask their college to create. It highlights strides as well as work still to be done.

Race, Equity & Diversity - The University of Washington Tacoma provides this resource page and stance on supporting diversity on campus - an excellent example of something student activists can push for on their campus.

Rada Films Group - The mission of Rada is to celebrate diversity by telling compelling stories about multiculturalism.

Real-life examples

Reclaim Harvard Law School. - Reclaim Harvard Law is an ongoing call for racial equality in education. The group has used demonstrations, social media campaigns and speaker series to raise awareness.

Woolworth's Sit-in - In 1960, college students in Greensboro, North Carolina, staged the first lunch counter sit-ins at a Woolworth's to protest the restaurant's "whites only" policy. By doing so, they spurred the formation of the Student Nonviolent Coordinating Committee, a major player within the Civil Rights Movement.

Environmentalism & Sustainability

The concept of "going green" - or enacting environmentally friendly and sustainable policies - has been discussed on hundreds of college campuses in recent years. Whether pushing for more recycling receptacles, encouraging faculty to shift from paper essays to online ones, or installing water stations for refillable bottles, there are many ways to promote the preservation of natural resources in higher education settings.

Resources

350.org - Don't know how to facilitate a training, structure a workshop or start a petition campaign? 350.org has a database of activities activists can use, plus primers on fossil fuel divestment, offshore drilling and other environmental flashpoints.

EcoLeaders - The National Wildlife Federation has developed step-by-step student guides to designing environmental projects on campus. Just as importantly, its web portal encourages students to connect and implement projects on their own campus.

Environmentalism at the Crossroads: Green Activism in America - This piece by the Foundation for Economic Education discusses how to move the conversation on sustainability forward.

UIC Office of Sustainability - Lots of campuses now have sustainability departments that student activists can partner with to affect change. The University of Illinois' efforts are particularly expansive. Look to the Campus Resources section for ideas that can be implemented on campus, or connect with the Office of Sustainability at your school.

Real-life examples

Brown University Environmental Justice Track - In 2014, Brown University students began gathering signatures for the Environmental Studies and Sciences Department to add an academic track exploring how different groups of people are unequally affected by environmental changes and policies. The university responded by creating the environmental justice track.

Fossil Free Stanford - In 2013, Stanford University activists created this group to protest the university's investments in 200 fossil-fuel extraction businesses. It used demonstrations, petitions and pledges to make its point. One year later, the institution divested from all coal companies.

LGBTQ & Gender Equality

The first widespread LGBTQ activism efforts began in the late 1960s and stemmed from wider issues surrounding second-wave feminism and the Civil Rights Movement. Student activists were on the frontlines of this movement, and many campuses' LGBTQ groups started during that time. Some of the issues directly affecting students include equal access to housing and transgender bathrooms.

Resources

Campus Pride - Campus Pride offers an array of resources and helpful information for students who want to address inequalities on their campus.

Gay-Straight Alliance - GSA represents a network of student-run clubs that provide safe places for discussions and push back against homophobia and transphobia.

LGBTQ Student Groups at University of Michigan - The University of Michigan lists the LGBTQ student groups that fight against campus-based discrimination. It's a good starting point to see what national organizations are out there looking for local chapters.

Out for Work - This nonprofit works with LGBTQ students and their allies as they prepare to join the workforce.

Top 10 Factors LGBTQ Youth Look for in Choosing a College Campus - In addition to helping prospective students find a welcoming campus, this article also helps student activists identify areas where their campus may need work.

Real-life examples

Anti-HB2 protests - In 2016, North Carolina passed a law mandating that people must use the bathroom of the biological sex they were born with, regardless of the gender they identify with. The University of North Carolina system announced it would adhere to the state law in April, resulting in waves of protests at appearances by the university president as well as sit-ins at campus bathrooms and administration buildings. By May, the university said it would not enforce the law.

University of Georgia lawsuit - In 1972, a group of LBGTQ students sued the University of Georgia after it refused to let gay and lesbian students fully participate in social functions. The courts ruled in their favor, and later that year the plaintiffs held a dance for LGBTQ students on campus.

Politics & Government

Decisions made within the political arena by government officials have long been scrutinized by student activists, with examples ranging from local government intervention in education to national issues like the Vietnam War. Many student-led political groups originated from other student clubs focused on conservative and liberal platforms.

Resources

Activism & Politics - Organized through the Swarthmore College's Peace & Conflict Studies program, this is an excellent resource for student activists passionate about political issues.

Democracy Matters - Democracy Matters works with college students on initiatives that ensure democracy for generations to come.

Mobilize - This nonpartisan organization encourages students to participate in politics and civic engagement to change political systems.

The Project on Student Debt - Student activists looking for research and talking points on the student debt crisis can find ample resources via this project from the Institute for College Access & Success.

Real-life examples

Pay It Forward Tuition Plan - In 2012, students at Portland State University called for legislators to create a plan for students to graduate from public institutions without massive debt. In response, the Oregon legislature passed a bill allowing students to finish their degrees without paying in exchange for a 24-year payment plan tied to their income. Other states are now considering this option.

Student Strike of 1970 - As part of the largest student strike in American history, more than four million students protested the military's invasion of Cambodia and the killing of student protestors at Kent State University. Students at more than 450 secondary and postsecondary campuses held protests over two months.

Sexual Health & Safety

Student activists run the gamut on issues surrounding sexual health, with some working to expand abstinence programs in high school and others seeking to increase access to birth control. Sexual harassment is an area where most people come together to lessen the number of incidents by providing greater campus security and educating men and women about anti-harassment policies.

Resources

Amplify Your Voice - Amplify focuses on empowering students to advocate for positive and realistic approaches to sexual health. Its toolkits for youth activists and condom campaigns are particularly useful.

National Partnership for Women and Families - NPWF champions sexual health and safety and helps student groups push for comprehensive sex education in their schools.

No More - With a focus on ending domestic violence and sexual assault, No More provides a range of campus resources for student activists, including a free toolkit with branded advocacy materials.

Our Bodies, Ourselves - This nonprofit offers evidence-based research on reproductive health and sexuality for girls and women.

SAFER - This organization works with student-led groups who are fighting against interpersonal and sexual violence on college campuses.

Real-life examples

Boston College's Students for Sexual Health - Students at BC gained national coverage when, after petitioning the school for a sexual health referendum to provide greater access to birth control and sex education, the school threatened to discipline the students.

Carry that Weight - After Columbia University found a male student not responsible for the sexual assault of a female student, she began carrying a mattress around campus to protest the school's handling of the case and draw attention to the emotional burden survivors of rape bear.

Social Justice Movements

A wide ranging concept, social justice is concerned with any mistreatment of an individual by society. In the case of student activism, this may relate to student mistreatment by the school administration. Issues span from racism and sexism to access to healthcare or education, and students often join with larger activism groups to amplify their collective voice.

Resources

5 Approaches to Social Justice Activism - EdChange offers five ideas on how to create meaningful social justice campaigns.

5 TED Activists that Are Fighting for Social Justice - Students looking to be inspired by the work of other social justice activists can tune into these five motivating TED Talks.

9 Ways to Make Social Justice Movements Less Elitist and More Accessible - This is a great read for student activists looking to appeal to the masses.

Social Justice Activism Is Forming a More Just (and Enduring) Union - The National Education Association wrote this op-ed on the importance of working for social justice.

Responsible Endowments Foundation - Focused on getting universities to use their money ethically, REF has basic guides on what endowments are and how to lead a divestment campaign, as well as tools to push administrators toward alternative investments.

Real-life examples

Rethink - Rethink is youth activist organization formed in 2007 to raise awareness via multimedia about issues important to young people, such as bullying. One of its biggest projects is Rethink Violence, a call for restorative justice for young people.

Seattle Pacific University activists push for social equality - After forming the SPU Justice Coalition in 2015, student activists created a website, engaged social media and protested on campus to address what they perceived to be racist and sexist hiring policies.

Tips for Safe & Effective Student Activism

As they saying goes, "Learn to walk before you run." The same holds true for student activism. Students can fall into some common pitfalls if they rush to deploy their plans. Use these tips and tricks to increase your chances of success:

Before taking up the fight for any cause, it's important for students to understand their rights. While all Americans are entitled to free speech under the First Amendment, some colleges dictate where free speech - be it handing out leaflets, gathering signatures for a petition or picketing - can be done on campus. Some schools may even threaten students with suspension or expulsion for engaging in certain types of activism. Students must know their rights. The American Civil Liberties Union provides a comprehensive guide on First Amendment rights and what students should do if they feel their rights have been violated.

Ideas & Inspiration: Small Acts of Activism

Although securing a change to the law or getting the President to create a new anti-discriminatory task force may make the news, smaller acts of civic engagement can make an incremental difference in your school community and the world. Here are some examples of what students of all ages are doing:

For Educators & Parents: Benefits of Student Activism

Student activists have been at the heart of social progress for decades, serving as instrumental participants in movements against sexism and racism and for more civil rights and freedoms. College campuses often serve as incubators of these movements, providing a setting where students discover their passions and develop skills to combat prejudice and inequality. While parents and educators may worry about these activities, there are several benefits of student activism for students, schools, communities and the nation.

Advice from the Expert: Activism on Campus and Online

Eddie Thompson is no stranger to activism. His parents started attending rallies when Eddie was young, and he's worked on numerous grassroots initiatives in Florida. He has mobilized voters to elect like-minded candidates while also promoting specific public policy changes. He plans on raising his children to be vocal and passionate activists.

Additional Resources for Student Activists

Campus Activism - Students looking to address issues and fight for change can find a one-stop-shop for tools and resources at Campus Activism.

Do Something -This resource allows users to explore recent campaigns to find ideas and inspiration - and even join.

Student Nation - The Nation magazine features a section highlighting activism efforts on college campuses throughout America.

Youth Activist's Toolkit - Advocates for Youth publishes a holistic manual covering how activism works and how to get the best results.

# data[].attributes.attachment_link.title
Student Activism In School Getting Your Voice Heard | Accredited Schools Online

# data[].attributes.attachment_link.description
Resources, Inspiration And Expert Advice For Making A Difference On And Off Campus Student activism has surged in the last decade, with young campaigners calling on leaders both on and off campus to right wrongs, erase inequalities and secure the future of our planet.

# data[].attributes.attachment_link.readable_text
The political landscape that we hoped for - and in many places worked to create - did not happen after the election, and so people are still trying to figure out the significance. What are the real implications of living in a Trump America? And for a lot of people, those are scary realities, not just because of the man himself, but because of the people that he awakened, the ideas that he appealed to, and people are concerned that those ideas seem to have won.

So that's the context. The priorities, then, are still being shaped, but what is emerging is that there is a real need for us to push back and invalidate claims around the role of the private sector as it relates to education. In a speech that Donald Trump gave a month before the election, he said, "We've got to break up the monopoly that is public education," and he plans to push a choice agenda. And so we've got to really invalidate the claim that what we need is more choice. And to really launch an effort that says, "What we actually need is real and deep investment in Black and Brown communities, with real dollars being invested in our public schools and our public infrastructure." We need to lift up the value and power of neighborhood-based community schools that have the curriculum, the teachers, the resources that we know make education successful.

The second priority is to really build in infrastructure that can run strong campaigns, at the local and state level. Because, as it relates to the progressive agenda, the federal landscape is a lot more complicated and perhaps unyielding. So we need to really be thinking about, "What can we do at the city and state levels to build a strong coalition?" That can then enliven an agenda that produces wins at the city level and at the state level.

And then a third priority is being very clear that to the extent that the current administration is anti-Black, anti-immigrant, anti-public education, that we need to build a really powerful force that can counter and push back in real ways against that agenda.

Questions and advice for the field

You know, we have a new education law in the form of the Every Student Succeeds Act (ESSA). How is that an opportunity for us to fight, or to run campaigns, at the state level?

How do we, at the city and state levels, scale up community schools as the alternative, as the solution, to the challenges that many schools face?

And then how do we fight for money - again, at the city and state levels? Because we understand that our schools don't just fail like the weather changes from hot to cold. Our schools are made to fail because we do not invest the kind of resources that we know it takes for them to succeed.

I know that a lot of people are concerned, and they are concerned for good reason. I think we have to be clear about the new political reality which we find ourselves in. And so I think we have to be prepared to build and to take action that is bold and creative, that forms a real resistance to any threat against our communities. That's one thing. I think really build on strong and powerful organizations. There's so much energy that people have right now, and how do organizations capture some of that energy? And say, "Hey, we've been fighting, come join us. Come join our ranks." I think it's an opportunity to do real recruitment, and really strengthen the infrastructure that folks have at the local level.

I also think for people who have resources - foundations or philanthropies - I think this is a moment to really invest. We cannot have a resistance that is not resourced to fight the kinds of fights that we will have over the next four years. I think we may have to throw out some of the old ways of doing things, when it comes to resourcing campaigns and organizations, and really invest and invest big, because folks will need it in order to rise to this moment.

Local victories

I think some of the local election results provide some hope. Like in California, where you have Kamala Harris going to the Senate, and you have Tammy Duckworth in Illinois. There were some real wins that suggested that progressives won. For our particular work in Georgia, we beat back a referendum that was really anti-public schools. In Massachusetts, we beat back a charter agenda. So, the electorate at the local level really showed up in a number of places and delivered what we think are real victories, and so that's really hopeful.

I think this is a moment for us to interrogate those stories and lift them up, to point the way that all of America is not Trump America. I think another thing to really lift up in the moment is that, for what it's worth-the candidate that the progressive community was most behind won the popular vote. And there is some comfort in the notion that almost two million more voters voted in favor of us than the current president. And I think that's a hopeful moment, because it says to us that we are still in the majority. I think we really ought to capture that as a win, that more votes were cast in our direction and our favor than for the presidency.

So when we see the alt-right in a meeting with 200 people, saying really awful things, that can be a blow to us, it can be devastating, but we should not forget that there are more people in America who stand for the right of young people to have good public education than those who are opposed to it. There are more people in America who stand for progressive immigration reform than those who are against it. There are more people in America who are for racial justice than those who are opposed to it. And the numbers actually bear that out. The ultimate victory is a bit daunting and a lot more complicated, but the numbers and the way people voted actually bears out differently. And for me, that's a hopeful light, out of the November elections. I admit it may be naïve. And I think we sometimes meet absurdity with absurdity, so I accept that I might sound absurd right now, but the moment is absurd, and so a little bit of absurdity might be the thing we need.

Sources of hope

I just spent seven days in West Africa and got a chance to visit the slave capitol on the coast of Ghana. And that slavery occurred in the US-still blows my mind, I cannot fathom it. But as a black man, the descendent of slaves, I was able to stand as a free man in the doorway of the dungeons where slaves were held. To me, as it relates to the community that I come from - we are not unaccustomed to fighting, resisting, and winning. And so for me, when I tell people, "I am a descendent of slaves," that means a lot for me. Because we won that fight. And there is power in that.

And I think in a lot of ways, what Donald Trump and his administration might do in four years pales in comparison to the kind of resistance that many of the folks that I work with have forged and won, and that is really hopeful for me - that in moments of crisis, we have been able to organize and resist and build, and ultimately turn the tide in our favor. And I think we have a moment here to do that. And to define what it means to be radical, and define what it means to be revolutionary, and define what it means to build really a democratic America. And I think people are thinking seriously about that, and that is encouraging.

And I think as it relates to public education, people see this as a call to really stand up, and say, "Our schools will be safe places. Our schools will be sanctuaries. We will have good public schools in our communities, and we will fight for them." And I think people are becoming sensitized to the kind of risks, the kind of momentum that we have to build in order to make sure that at the end of these four years, that we have strong public education and public schools in the communities that are most vulnerable.

# data[].attributes.attachment_link.title
Education Activism: A Moment to Stand Up

# data[].attributes.attachment_link.description
The political landscape that we hoped for - and in many places worked to create - did not happen after the election, and so people are still trying to figure out the significance. What are the real implications of living in a Trump America?

# data[].attributes.attachment_link.readable_text
Drawing hijabi characters - with style: A Q&A with artist Areeba Siddique

The unexpected star of my college lectures - my mom

Breaking chains and building dreams: Nicol Duran-Peña's journey through exalt

A conversation with junior Olympic athlete and student organizer Nora Wang on celebrating diversity & student voices

A week in the life of a 17-year-old assisting human rights research at Stanford University

From bias to bonds: challenging my bias, empowering girls and building community through science

When women excel, society follows: advocating for Guyanese girls' education

Kalyla's 4-step guide to dealing with academic burnout

A week in the life of a 15-year-old girls' rights advocate in Pakistan

10 girl-powered moments to celebrate on Day of the Girl

"Young and Restless" author Mattie Kahn shares how girls shaped American history

Strokes of protest: the Afghan artist painting a brighter future

What's your favourite extracurricular activity and why?

My body, my sanctuary: how body shaming affects girls beyond self-esteem

How mental health affects girls' education

For the love of the game: the Afghan Youth National Team reflects on life after leaving home, making a documentary and the Youth World Cup

Two years on, the world has failed us

Meet the Afghan women leading alternative learning initiatives

Echoes of separation: letter to a lost homeland

How a salon in the Dominican Republic helped me embrace my curly hair

# data[].attributes.attachment_link.title
Malala Fund | Working for a world where all girls can learn and lead

# data[].attributes.attachment_link.description
Founded by student and Nobel laureate Malala Yousafzai, Malala Fund invests in girls' education programmes to help girls go to school and reach their full potential.

# data[].attributes.attachment_link.title
Girls Can Change the World-But We Have to Invest in Them First

# data[].attributes.attachment_link.description
Activist Malala Yousafzai writes that if we want a brighter future-for them and for ourselves-we must invest in female education today.

# data[].attributes.attachment_link.readable_text
Photo: Christopher Furlong/Getty Images

Women across the world are not always in a position to feel empowered, make life-changing decisions of their own, or take a stand for what they believe in. One woman, however, defied the Taliban, stood her ground, and fought for something that she deeply believed in.

Her passion for gender equality and equal education opportunities for girls everywhere is remarkable and inspiring. And because of the opportunity she had to go to school at a young age, she has been able to brighten the future and open up a world of opportunities for young girls across Pakistan and across the globe.
Malala Yousafzai
Malala Yousafzai is a Pakistani education advocate who, at age 17, became the youngest person to receive the Nobel Peace Prize. She was born in Mingora, Pakistan July 12, 1997. Although people in her home country did not value girls as highly as boys, Malala's father wanted nothing more than to provide her a life filled with all of the opportunities a boy would have.

Malala's father ran an all-girls' school, where he also taught. In 2008, it closed after the Taliban took control. Many things were banned, such as television, music, and education for girls. Although this meant the end of something she loved and the end of seeing her classmates, Malala wasn't going to give up on what was her right, and the right of all girls-an education.
Nothing Stood in Her Way
Sometimes however, taking a stance in what you believe in can have a painful price tag. On October 9, 2012, a masked gunman got on Malala's school bus, asked for her by name, and shot her on the left side of her head. She was only 15 years old. Ten days after the shooting, she woke up in a hospital bed to learn what happened and that the world was on her side, praying for her recovery. After months of surgeries and rehabilitation, she relocated to be with her family in the U.K. This was a turning point for Malala.

"I could live a quiet life or I could make the most of this new life I had been given. I determined to continue my fight until every girl could go to school."
- Malala Yousafzai
A Warrior for Women and Girls
With her father's help, Malala established the Malala Fund to provide girls the opportunities to achieve the futures they want.

Her milestones and accomplishments for gender equality didn't stop there. In 2013, on her 16th birthday, she gave a speech to the United Nations and published her first book, I Am Malala. During her speech, Malala urged world leaders to change their policies and focus on women's rights and equal education opportunities, as well as illiteracy, poverty, and terrorism. In 2014, at age 17, she became the youngest person to receive the Nobel Peace Prize. She was awarded the Nobel along with Indian children's rights activist Kailash Satyarthi.

"She is (the) pride of Pakistan. She has made her countrymen proud," Pakistani Prime Minister Nawaz Sharif said when congratulating her triumph. "Her achievement is unparalleled and unequaled. Girls and boys of the world should take lead from her struggle and commitment." Former U.N. Secretary-General Ban Ki-moon described Malala as "a brave and gentle advocate of peace who, through the simple act of going to school, became a global teacher."

For her 18th birthday in July 2015, Malala embarked on one of her greatest journeys yet - she opened a school. The school, funded by the Malala Fund, is designed to admit nearly 200 Syrian refugee girls age 14 to 18 in Lebanon.

Today, Malala is studying philosophy, politics, and economics at the University of Oxford.

"The terrorists thought that they would change our aims and stop our ambitions, but nothing changed in my life except this: weakness, fear and hopelessness died. Strength, power and courage were born."
- Malala Yousafzai

# data[].attributes.attachment_link.title
One Girl's Courage Leads Women to Equal Education Opportunities

# data[].attributes.attachment_link.description
Women across the world are not always in a position to feel empowered, make life-changing decisions of their own, or take a stand for what they believe in. One woman, however, defied the Taliban, stood her ground, and fought for something that she deeply believed in.

# data[].attributes.attachment_link.readable_text
As the number of vaping-related illnesses and deaths in the U.S. continues to rise, government officials at the federal, state and local levels have focused on curbing - and, in some cases, banning - the sale of e-cigarette and vaping products, especially those appealing to minors.

As of early November, there had been more than 2,050 confirmed and probable cases of severe lung disease and 39 deaths in 24 states linked to vaping in the U.S., with some of the patients in their teens. The reaction has been swift: The Trump administration signaled a forthcoming ban on all non-tobacco flavored e-cigarette products, while governors in New York, Massachusetts, Michigan, Rhode Island and Washington have moved to sharply restrict or even eliminate sales of e-cigarette products. California is cracking down on illicit and bootleg e-cigarettes, and retail giant Walmart announced it would stop selling the devices in its stores. Internationally, India banned the sale of all e-cigarettes, citing newly found health risks.

On Nov. 5, federal health officials identified vitamin E acetate -- an oily, sticky substance sometimes used as a thickening agent in vaping products -- as a possible cause of the illnesses; the substance was found in 29 samples of lung fluid from patients who had fallen ill after vaping.

E-cigarettes and vape pens go by many names, including e-cigs, e-hookahs, mods, vapes, tank systems and electronic nicotine delivery systems, or ENDS. They come in many shapes and sizes, but all have three main components: a heating element, a liquid that typically contains flavorings and nicotine, and a mouthpiece.

What is an electronic cigarette?

What is a vape pen? How does it work?

What is a Juul? What is Juuling?

What is in vaping liquid?

Ultrafine particles that can be inhaled deep into the lungs

Diacetyl, a chemical linked to a serious lung disease

Volatile organic compounds

Cancer-causing chemicals

Heavy metals such as nickel, tin and lead

"Anyone who uses e-cigarette products should not buy these products off the street (e.g., e-cigarette products with THC, other cannabinoids) and should not modify e-cigarette products or add any substances to these products that are not intended by the manufacturer," officials said in a joint statement at the time.

Is vaping safer than smoking traditional cigarettes?

Is secondhand smoke or vapor from e-cigarettes harmful?

Is vaping or are e-cigarettes regulated?

Why were e-cigarettes allowed on the market without FDA approval?

Is it safe for kids, teens or young adults to vape?

How can I tell if my kid is vaping?

Increased thirst

Desire for flavor

Nosebleeds

Acne

Cutting back on caffeine

Pneumonia

Unfamiliar USB drives, battery chargers or spare parts in their rooms, clothing, bags, school lockers and around the home

What are the health risks of vaping?

Does vaping cause cancer?

Are there any benefits to vaping?

What are the symptoms of the lung disease people are getting from vaping?

Is the government doing anything to stop vaping?

As the FDA waits for e-cigarette manufacturers and retailers to submit their products for review, federal officials announced on Sept. 11 their intent to ban all non-tobacco flavors for e-cigarette products in an effort to curb what officials have called an epidemic of youth vaping. The FDA has also cracked down on retailers in undercover blitz operations to eliminate youth access to e-cigarette products. Meanwhile, the CDC activated its Emergency Operations Center on Sept. 16 to expedite and strengthen interagency responses across the U.S. to its investigations of severe lung disease associated with vaping or e-cigarette use. The CDC and FDA are also working together to investigate recent e-cigarette product use among patients and to test the substances or chemicals within e-cigarette products used by case patients, and they have warned consumers not to buy their e-cigarette products off the streets.

Meanwhile, authorities in Oregon's legal marijuana market have asked store owners to review the products on their shelves and pull any they think may be harmful to users' health, while authorities in New York and North Carolina have pursued legal action against vaping product companies to learn more about what's in their products, what safety regulations are in place and to stop their marketing and sales of e-cigarettes to teens. Several state health departments, including Massachusetts', are also working to collect data tied to potential cases of lung disease related to the use of e-cigarettes.

# data[].attributes.attachment_link.title
Vaping and E-Cigarettes : The New Public Health Problem

# data[].attributes.attachment_link.description
As the number of vaping-related illnesses and deaths in the U.S. continues to rise, government officials at the federal, state and local levels have focused on curbing - and, in some cases, banning - the sale of e-cigarette and vaping products, especially those appealing to minors.

# data[].attributes.attachment_link.provider_name
Centers for Disease Control and Prevention

# data[].attributes.attachment_link.readable_text
The use of e-cigarettes is unsafe for kids, teens, and young adults.

Most e-cigarettes contain nicotine. Nicotine is highly addictive and can harm adolescent brain development, which continues into the early to mid-20s.1

E-cigarettes can contain other harmful substances besides nicotine.

Young people who use e-cigarettes may be more likely to smoke cigarettes in the future.

Find Data on E-cigarette Use Among Youth

E-cigarettes are electronic devices that heat a liquid and produce an aerosol, or mix of small particles in the air.

E-cigarettes come in many shapes and sizes. Most have a battery, a heating element, and a place to hold a liquid.

Some e-cigarettes look like regular cigarettes, cigars, or pipes. Some look like USB flash drives, pens, and other everyday items. Larger devices such as tank systems, or "mods," do not look like other tobacco products.

E-cigarettes are known by many different names. They are sometimes called "e-cigs," "e-hookahs," "mods," "vape pens," "vapes," "tank systems," and "electronic nicotine delivery systems (ENDS)."

Using an e-cigarette is sometimes called "vaping."

Some e-cigarettes look like regular cigarettes, cigars, or pipes.
Some look like USB flash drives, pens, and other everyday items.

E-cigarettes produce an aerosol by heating a liquid that usually contains nicotine, flavorings, and other chemicals that help to make the aerosol.

The liquid used in e-cigarettes often contains nicotine and flavorings. This liquid is sometimes called "e-juice," "e-liquid," "vape juice," or "vape liquid."

Users inhale e-cigarette aerosol into their lungs. Bystanders can also breathe in this aerosol when the user exhales it into the air.

E-cigarette devices can be used to deliver marijuana and other drugs.

News outlets and social media sites report widespread use of JUUL by students in schools, including classrooms and bathrooms.

JUUL is a brand of e-cigarette that is shaped like a USB flash drive. Like other e-cigarettes, JUUL is a battery-powered device that heats a nicotine-containing liquid to produce an aerosol that is inhaled.

All JUUL e-cigarettes have a high level of nicotine. According to the manufacturer, a single JUUL pod contains as much nicotine as a pack of 20 regular cigarettes.2

JUUL is one of a few e-cigarettes that use nicotine salts, which allow particularly high levels of nicotine to be inhaled more easily and with less irritation than the free-base nicotine that has traditionally been used in tobacco products, including e-cigarettes.

News outlets and social media sites report widespread use of JUUL by students in schools, including classrooms and bathrooms.

Approximately two-thirds of JUUL users aged 15 - 24 do not know that JUUL always contains nicotine.

Although JUUL is currently the top-selling e-cigarette brand in the United States, other companies sell e-cigarettes that look like USB flash drives. Examples include the MarkTen Elite, a nicotine delivery device, and the PAX Era, a marijuana delivery device that looks like JUUL.

Additional information about USB-shaped e-cigarettes and actions that parents, educators, and health care providers can take to protect kids is available at CDC's Infographic [PDF - 1.2MB]

Most e-cigarettes (vapes) contain nicotine-the addictive drug in regular cigarettes, cigars, and other tobacco products.

A CDC study found that 99% of the e-cigarettes sold in assessed venues in the United States contained nicotine.1

Some vape product labels do not disclose that they contain nicotine, and some vape liquids marketed as containing 0% nicotine have been found to contain nicotine.

Nicotine can harm the developing adolescent brain.2 The brain keeps developing until about age 25.

Using nicotine in adolescence can harm the parts of the brain that control attention, learning, mood, and impulse control.2

Each time a new memory is created or a new skill is learned, stronger connections - or synapses - are built between brain cells. Young people's brains build synapses faster than adult brains. Nicotine changes the way these synapses are formed.

Using nicotine in adolescence may also increase risk for future addiction to other drugs.2

When a person is dependent on (or addicted to) nicotine and stops using it, their body and brain have to get used to not having nicotine. This can result in temporary symptoms of nicotine withdrawal.

Nicotine withdrawal symptoms include irritability, restlessness, feeling anxious or depressed, trouble sleeping, problems concentrating, and craving nicotine.3 People may keep using tobacco products to help relieve these symptoms.4

Youth may turn to vaping to try to deal with stress or anxiety, creating a cycle of nicotine dependence. But nicotine addiction can be a source of stress.

What may start as social experimentation can become an addiction.

The most common reason U.S. middle and high school students give for trying an e-cigarette is "a friend used them." 5

The most common reason youth give for continuing to use e-cigarettes is "I am feeling anxious, stressed, or depressed." 5

Youth e-cigarette and cigarette use have been associated with mental health symptoms such as depression.9, 10

Yes. As long as a person stays quit, withdrawal symptoms will fade over time as the brain gets used to not having nicotine.

Scientists are still learning about the effects of quitting vaping on mental health. Quitting smoking cigarettes is associated with lower levels of anxiety, depression, and stress, as well as improved positive mood and quality of life.9

Scientists are still learning about the long-term health effects of e-cigarettes.

Some of the ingredients in e-cigarette aerosol could also be harmful to the lungs in the long-term. For example, some e-cigarette flavorings may be safe to eat but not to inhale because the gut can process more substances than the lungs.1

Defective e-cigarette batteries have caused some fires and explosions, a few of which have resulted in serious injuries.

Children and adults have been poisoned by swallowing, breathing, or absorbing e-cigarette liquid through their skin or eyes. Nationally, approximately 50% of calls to poison control centers for e-cigarettes are for kids 5 years of age or younger.

E-cigarette aerosol is NOT harmless "water vapor."

The e-cigarette aerosol that users breathe from the device and exhale can contain harmful and potentially harmful substances, including:

Nicotine

Ultrafine particles that can be inhaled deep into the lungs

Flavorings such as diacetyl, a chemical linked to a serious lung disease

Volatile organic compounds

Cancer-causing chemicals

Heavy metals such as nickel, tin, and lead1

The aerosol that users inhale and exhale from e-cigarettes can expose both themselves and bystanders to harmful substances.

It is difficult for consumers to know what e-cigarette products contain. For example, some e-cigarettes marketed as containing zero percent nicotine have been found to contain nicotine.3

E-cigarettes come in various flavors, including fruit, candy, mint, and menthol.

A study from 2013-2014 showed that most youth who use e-cigarettes first start with a flavored variety, and flavors are the primary reason youth report using e-cigarettes.⁶

In 2023, most youth who reported using e-cigarettes used flavored varieties (89.4%). Among middle and high school students who currently used any type of flavored e-cigarette in 2023, the most commonly used flavors were fruit (63.4%), candy, desserts, or other sweets (35%), mint (27.8%), and menthol (20.1%).¹¹

On January 2, 2020, the U.S. Food and Drug Administration (FDA) finalized an enforcement policy that prohibits the sale of prefilled cartridge e-cigarettes in any flavor other than tobacco or menthol, unless authorized by FDA. FDA has since taken additional steps to prohibit certain companies from selling youth-appealing, flavored disposable e-cigarettes and flavored e-liquids without authorization.⁷

Several states and communities have restricted the sale of flavored tobacco products, including menthol-flavored products.⁸

E-cigarettes are also advertised using the same themes and tactics that have been shown to increase youth initiation of other tobacco products, including cigarettes. In 2021, approximately 76% of students reported exposure to tobacco product marketing through traditional sources and approximately 74% of students who used social media had seen e-cigarette-related posts or content.¹²

Widespread advertising for e-cigarettes, including via media for which advertising for conventional tobacco products is prohibited (e.g., TV), and the lower costs of some e-cigarettes relative to regular cigarettes has contributed to use among youth.¹

Many youth also report using e-cigarettes because they are curious about these products.¹

Many young people who use e-cigarettes also smoke cigarettes.1 There is some evidence that young people who use e-cigarettes may be more likely to smoke cigarettes in the future.

Specifically, a 2018 National Academy of Medicine report found that there was some evidence that e-cigarette use increases the frequency and amount of cigarette smoking in the future.4

E-cigarettes also can be used to deliver other drugs, including marijuana; in 2016, approximately one-third of U.S. middle and high school students who have ever used an e-cigarette reported using marijuana in the device.

But e-cigarette use among young people is still unsafe, even if they do not progress to future cigarette smoking.

E-cigarettes expose users to fewer harmful chemicals than burned cigarettes.1

But burned cigarettes are very dangerous, killing half of all people who smoke long-term.

The use of any tobacco product, including e-cigarettes, is unsafe for young people.

Yes. In August 2016, the regulatory authority of the FDA was extended to cover e-cigarettes through the agency's "deeming rule."

Through authority granted by the Family Smoking Prevention and Tobacco Control Act (FSPTCA), FDA has authority to develop regulations that address the manufacturing, marketing, and sale of e-cigarettes.

There are some strategies that the FDA does not have authority to implement, such as including e-cigarettes in smoke-free policies or increasing the minimum legal sales age for these products, unless directed to do so by Congress. However, the FSPTCA does not prevent states and communities from including e-cigarettes in smoke-free policies or from regulating the sale and distribution of e-cigarettes. These types of strategies can include further raising the minimum legal sales age, licensing retailers, implementing price policies, and restricting or prohibiting the sale of tobacco products.

Yes. In 2018, the FDA expanded its successful youth tobacco prevention campaign, "The Real Cost," to reach the more than 10 million youth aged 12-17 who have used e-cigarettes or are open to trying them. The campaign educates youth about the potential risks of using e-cigarettes.

The "Real Cost" reaches teens where they spend most of their time: in school and online. The campaign is also placing e-cigarette prevention materials in high schools across the nation, both in school bathrooms and on educational digital platforms accessed by students during the school day.

Heated tobacco products (HTPs) like IQOS and Eclipse, sometimes marketed as "heat-not-burn" technology, represent a diverse class of products that heat the tobacco leaf to produce an inhaled aerosol. They are different from e-cigarettes, which heat a liquid that can contain nicotine derived from tobacco.

HTPs are available in at least 40 countries and several have been authorized for sale in the United States by the FDA. In 2018, few U.S. adults (2.4% of all surveyed, including 6.7% of people who currently smoke surveyed) had ever used HTPs. In 2023, 1.0% of U.S. middle and high school students, combined, reported having used heated tobacco products in the past 30 days.¹¹

Scientists are still learning about the short-term and long-term health effects of HTPs, but the available science shows they contain harmful and potentially harmful ingredients. Youth use of any tobacco products, including heated products, is unsafe.

It is important that we continue to modernize proven tobacco prevention and control strategies to include newer products entering the market such as HTPs.

Talk to your child or teen about why e-cigarettes are harmful for them. It's never too late.

Set a good example by being tobacco-free and ensure that your kid is not exposed to the secondhand emissions from any tobacco products, including e-cigarettes.

If you use tobacco, it's never too late to quit. For free help, visit smokefree.gov or call 1-800-QUIT-NOW.

Talk to your child or teen about why e-cigarettes are harmful for them. It's never too late.

Get the Talk With Your Teen About E-cigarettes [PDF - 5.2MB] tip sheet for parents. Start the conversation early with children about why e-cigarettes are harmful for them.

Let your child know that you want them to stay away from all tobacco products, including e-cigarettes, because they are not safe for them. Seek help and get involved.

Set up an appointment with your child's health care provider so that they can hear from a medical professional about the health risks of tobacco products, including e-cigarettes.

Speak with your child's teacher and school administrator about enforcement of tobacco-free school grounds policies and tobacco prevention curriculum.

Encourage your child to learn the facts and get tips for quitting tobacco products at Teen.smokefree.gov.

Fact Sheet for Educators:

Conversation Card for Educators:

1. U.S. Department of Health and Human Services. Smoking Cessation: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2020 [accessed 2022 April 4].

2. Truth Initiative Mental Health x Vaping Headline Survey Internal Data - August 2021.

3. Gentzke AS, Wang TW, Cornelius M, et al. Tobacco Product Use and Associated Factors Among Middle and High School Students - National Youth Tobacco Survey, United States, 2021. MMWR Surveill Summ 2022;71(No. SS-5):1-29. DOI: http://dx.doi.org/10.15585/mmwr.ss7105a1.

4. U.S. Department of Health and Human Services. The Health Consequences of Smoking-50 years of Progress: A Report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.

5. Birdsey J, Cornelius M, Jamal A, et al. Tobacco Product Use Among U.S. Middle and High School Students - National Youth Tobacco Survey, 2023. MMWR Morb Mortal Wkly Rep 2023; 72(44);1173-1182.

6. Cooper M, Park-Lee E, Ren C, Cornelius M, Jamal A, Cullen KA. Notes from the Field: E-cigarette Use Among Middle and High School Students - United States, 2022. MMWR Morb Mortal Wkly Rep 2022;71:1283-1285. DOI: http://dx.doi.org/10.15585/mmwr.mm7140a3

# data[].attributes.attachment_link.title
Quick Facts on the Risks of E-cigarettes for Young People

# data[].attributes.attachment_link.description
Learn quick facts on the risks of e-cigarettes for kids, teens, and young adults, including how they work, why nicotine is unsafe, what is in e-cigarette aerosol, and resources for parents to prevent their child from using e-cigarettes or help them stop.

# data[].attributes.attachment_link.readable_text
Highlights

*

England had more pro-smoking but less pro-vaping norms overall.

*

Canada and US differed on friend smoking only, which was greater in Canada than US.

*

Country differences cannot easily be explained by prevalence or policies.

*

Smokers had more pro-smoking norms, vapers had more pro-vaping norms.

*

There were also some cross-product associations between norms and product use.

Abstract

Background

This study assesses differences in social norms towards smoking and vaping among youth across countries (England, Canada, US) and smoking and vaping status.

Methods

Data are from the 2017 ITC Youth Tobacco and Vaping Survey, among youth age 16-19 in England (N = 3444), Canada (N = 3327), and US (N = 3509). Prevalence of friend smoking, friend vaping, peer approval of smoking, and peer approval of vaping were estimated. Adjusted logistic regression models were estimated for each norm to assess associations with country, smoking status, and vaping status, adjusting for sociodemographics, alcohol use, and marijuana use.

Results

47% and 52% reported friend smoking and vaping respectively. Perceived peer approval of vaping (44%) was almost double that of smoking (23%). Compared with England, fewer Canadian and US youth reported friend smoking (Canada: AOR = 0.71 [95% CI = 0.62-0.82]; US: AOR = 0.54 [0.47-0.62]) and peer approval of smoking (Canada: AOR = 0.74 [0.63-0.87]; US: AOR = 0.78 [0.67-0.91]), yet more reported peer approval of vaping (Canada: AOR = 1.23 [1.08-1.41]; US: AOR = 1.30 [1.14-1.48]). More Canadian than English youth reported friend vaping (AOR = 1.17 [1.02-1.36]). Friend smoking, peer approval of smoking, and friend vaping were more common among smokers and vapers (all p < .02). Peer approval of vaping was more common among vapers but less common among smokers (all p < .044).

Conclusions

Youth had more positive vaping than smoking norms. English youth reported the most pro-smoking but least pro-vaping norms in adjusted models; this was unexpected given country differences in regulatory environments. Norms towards both products were associated with use, with some evidence of cross-product associations between norms and behaviours.

View Abstract

# data[].attributes.attachment_link.title
Social norms towards smoking and vaping and associations with product use among youth in England, Canada, and the US

# data[].attributes.attachment_link.description
England had more pro-smoking but less pro-vaping norms overall. * Canada and US differed on friend smoking only, which was greater in Canada than US. * Country differences cannot easily be explained by prevalence or policies. * Smokers had more pro-smoking norms, vapers had more pro-vaping norms. * There were also some cross-product associations between norms and product use.

# data[].attributes.attachment_link.readable_text
​Would you recognize an e-cigarette if you saw one? Not all e-cigarettes look alike, and vaping is easy to hide.

Why is vaping easy for teens to hide?

Electronic nicotine devices can look like a pen, a computer memory stick or flash drive, a car key fob, or even an asthma inhaler. Instead of inhaling tobacco smoke from a cigarette, e-cigarette users inhale vapor from liquid "e-juice" that has been heated with a battery-powered coil. This is called vaping. The juice is flavored and usually contains nicotine and other chemicals.

E-cigarettes are unhealthy and addictive.

The Centers for Disease Control and Prevention (CDC) are investigating an outbreak of severe lung disease related to vaping that has caused severe illness and death in many US states. The American Academy of Pediatrics joins the CDC to remind parents that e-cigarette use is never safe for youth, young adults, or pregnant and/or breastfeeding women.

Additional Information:

Adapted from AAP News (Copyright © 2018 American Academy of Pediatrics)

# data[].attributes.attachment_link.keywords[]
vaping~ juul~ vaping risks~ smoking risks~ e-cigarette~ ecigarette~ e-cig~ nicotine and teens~ cigarettes and teens~ tobacco products

# data[].attributes.attachment_link.title
Vaping: Dangerous, Available & Addicting

# data[].attributes.attachment_link.description
​Would you recognize an e-cigarette if you saw one? Not all e-cigarettes look alike, and vaping is easy to hide. Electronic nicotine devices can look like a pen, a computer memory stick or flash drive, a car key fob, or even an asthma inhaler.

# data[].attributes.attachment_link.readable_text
The Impact of Vaping On Individuals And Society

An examination of issues resulting from a global shift away from smoking toward ecigarette use: the global impact of declining cigarette sales and non-smokers becoming vapers

Note on perspective
Financial pressures

1. The benefits and drawbacks of the shift to vaping for society
- Public health impact
- Economic impact
- Environmental impact, planetary impact

2. The benefits and drawbacks for the individual
- Health impact for the individual
- Economic benefits for the individual
- Social benefits for the individual

3. Issues surrounding non-smokers initiating nicotine use via ecigs
- The Swedish experience
- The real impact of nicotine consumption

4. Conclusion
- The questions
- Impossibility of predicting scale
- When new technology eliminates the old: the timescales

Perspective

This material describes a UK / EU viewpoint. It may be transferable, but caution needs to be applied, especially with regard to application of any specifics to the USA: the money supply for anti-THR activities there is enormous by UK standards and probably twenty times the scale. As a direct result, the pressures are different and above all, the actors are different. As examples of this:

The MSA funding channels billions of dollars into protecting cigarette sales against any threat. This enormous pool of funds generates the most powerful multi-layered resistance to any threat to cigarette sales seen anywhere, and it has a global spillover. The size of the MSA funds makes the USA unique in the scale of its anti-THR activity.

US States have a vested interest in protecting cigarette sales - see, for example, the actions of California in 2015. Their large-scale and costly pushback against the new threat to cigarette sales posed by vaping, powerfully assisted by the pharmaceutical industry and its principal local spokesperson, shows the lengths they will go to protect the vast, multi-channel revenues generated by smoking. The twin-layer government is not unique since it parallels the EU apparatus, and the individual States appear just as willing to crush any threat to cigarette sales as EU countries; but they act faster and with more autonomy. EU countries are more ponderous and lumbering in their actions.

A clinical trial of low-nicotine cigarettes recently finished in the USA, at a reported cost of $29 million. This is just slightly more than the cost of the average CT in the UK...

A well-known anti-THR spokesperson in the USA receives a documented $6.6 million a year to fund their activities, and colleagues receive similar amounts. Leaving aside the possibility this does not include all their likely sources of income, such a figure is impossible in the UK. (A cynic might say this is why there is far less resistance to vaping in the UK, but it is perhaps best to avoid that line of thought.)

Financial pressures

Money is everything in the legislative and regulatory area of tobacco and smoking cessation, and it is more accurate to think of this area as a subset of fiscal policy rather than health policy.

In the USA, for instance, only a tiny fraction of the individual States' billions in MSA funding is assigned to smoking-related health initiatives, and the bulk of the money is assigned to the general fund. One State uses it to fund staff pensions. Therefore the security and maintenance of supply of these funds is a crucial issue for States and can even affect their solvency. The MSA fee payments to each State are directly related to the amount of cigarettes sold; there are some buffers and inflation hedges but essentially the MSA fees relate to the stick volume. This is a conflict of interest of indescribable proportions since States are in effect forced to protect smoking, and some clearly do everything in their power to remove any threat to the revenues.

Serious COIs are everywhere in the revenue distribution channels that connect government with cigarette sales and the pharmaceutical and Public Health industries; they can be considered as normal and universal. Strong financial pressures combined with greed and incompetence ensure that smoking-related revenues are robustly protected.

Money is also the principal driver in the Public Health industry and it is crucial to remember this: it defines all action, policy and affiliation. 'Public health' organisations not directly connected to street-level interventions by statutory order tend to be lobbying groups with an agenda dictated by their funders. The health of the public is quite low on the list of priorities for many of them.

The difference in the money supply and its origins in the USA, EU and UK clearly results in differences between the respective approaches, players, public perspective and regulatory outcomes.

1. The benefits and drawbacks for society

There are three ways to measure advantage or disadvantage to society from the shift to EV use (electronic vapourisers) and away from smoking: public health, economic impact, and planetary impact.

Public health impact

General THR issues
THR or tobacco harm reduction refers to substitution of cigarette smoking with alternative, smokefree products. Consumers should be given the choice of which products they wish to use, since that is an inalienable right assuming that they pay for any personal or societal costs. If government wishes to manage or influence that choice, this should be subject to a public debate unrestricted in any way since it significantly affects personal health. Modern technology gives us many more choices: for example clean nicotine products, purified smokeless tobacco products, clean nicotine delivery systems such as EVs, and reduced-smoke HnB systems. Some of these modern products appear to have an absolute risk elevation too low to worry about, and compared to smoking they are multiple orders of magnitude safer. Government policy is the only thing stopping consumers moving en masse to far safer products, and therefore we can legitimately question whether this is about health or money.

The most intensively studied product, Swedish Snus (the local, specially-processed oral tobacco popular in Sweden) has a health impact in the modern era too small to be reliably measured with regard to specific health risks [1]. Since about 20% of the adult population are Snusers and about 10% are smokers and there are decades of facts and data on this phenomenon, which has resulted in unique national health figures for Sweden, the basic facts of THR are no longer in dispute: unrestricted access to safer products results in huge public health gains.

The biggest problem with smoking is that it provides enormous funds for government; this is not compatible with free choice for the individual, since in effect tobacco is a government business - they make far more from it than anyone else. To illustrate the problem, in the UK 18 out of 20 cigarettes are bought directly from the government, and the frontend revenues (typically £12bn/year) are almost certainly equalled by the backend savings, and then added to by other channels such as corporation taxes and income tax; the concept that such enormous wealth can be willingly relinquished is simply not logical. Threats to the revenue channels are resisted by direct legislation, or by delegation of the legislation to a senior authority (here, the EU), and by mobilising the recipients of some of the funds generated to lobby for removal of the threat by the use of spurious objections and propaganda.

So, these are the fundamental issues surrounding vaping or any other really effective approach to the reduction of smoking prevalence. It is clear that:

Smoking creates fabulous wealth, most especially for government, and this is the mother of all conflicts of interest

It creates substantial revenues for giant transnational industries, and these are the external actors that have most influence within government

It helps to fund pressure groups who lobby for removal of any threat to the revenue channels, and who generate most of the propaganda used to manipulate public perception

It therefore pays for a continuous, poisonous torrent of propaganda and lies about any effective threat to cigarette sales

It creates a feedback loop that protects smoking and perpetuates it: tobacco tax revenues pay for more propaganda to resist any threats to cigarette sales from THR, and the bigger the threat the more alarm is created among the beneficiaries of the funds, and so more funds are allocated to the propaganda campaign, so the noise gets louder, and so more funds are allocated since the 'danger' appears to be growing

The only 'danger' is to cigarette sales, drug sales for treating smoking-related disease, and government funds - but the propaganda assault is designed to camouflage this. A country that allows full, unhindered, unrestricted access to THR products has a steadily reducing smoking prevalence, disappearing smoking-related morbidity and disappearing smoking-related mortality. And, unfortunately, an inexorably-reducing pile of money generated by smoking, disease and early death - which is the main problem. Only Sweden has ever had the courage to put public health above greed.

Thus, any benefit to society or the individual has to first face almost insurmountable odds.

Health effects
We know from Sweden's unique national health statistics (the facts) and their vast data resources (the evidence for the mechanisms that result in facts) that lifetime Snus consumption has an average expectation of lifespan reduction of 6 weeks. This compares with about 8 years for all smokers on average, and about a 23-year lifespan reduction for those dying of smoking related disease before age 55 on average. The negative health impact of Snus is too small to be statistically identifiable with any reliability. In the modern era, Snus has no association with cancer of any kind, or CVD of any kind. For example it has no association with oral cancer, and indeed Sweden has the lowest male oral cancer rate in Europe (Snus is mostly consumed by men); it has no association with pancreatic cancer (an earlier apparent risk elevation was disproved); it has no elevation of risk for stroke, but there does appear to be a small increase in risk for non-survivable episodes. All the numbers involved are so small that identification of any risk is difficult at best; it has been demonstrated that lifetime consumption of this type of modern, ultra low risk product has less health impact than 3 months of smoking.

The only way that any issues at all can be identified is due to the enormous size of the data resource - it dwarfs the resources available for NRTs.

The 'modern era'
When discussing these issues it is important to use facts and data from modern, Western low-risk products, since that is what the issues revolve around. We are not concerned with historic smokeless tobacco products such as the old US 'chew', since modern products such as Snus are not comparable in any way: they comply with the Gothiatek manufacturing standard and most carcinogens are removed by modern processing methods.

South Asian oral tobacco-containing products such as gutka and paan are another irrelevancy in the Western debate. They have known risk elevations that have no relevance whatsoever to Snus consumption, for example, and attempts to conflate the two are probably best regarded as fraudulent. There is a concerted effort by cigarette market protectionists to conflate use of South Asian ST products and historic Western products with use of modern ultra low risk THR products, and this must be guarded against. For example:

Smoking has around ten times the elevation of risk for oropharyngeal cancer (mouth, neck and head cancer types) than even the worst-performing oral tobacco products

The principal risk elevators for mouth cancers in the West are smoking, drinking and HPV (especially when combined) [2]

Snus has no measurable association with mouth cancer

Snus vs ecigs
An important question is whether or not other modern products will achieve the same safety profile as Snus. Due to its hundred-year plus history in Sweden, we know the health impact precisely. We don't have even a fraction of this data resource for NRTs, which have been available since 1984, never mind any of the modern THR products such as dissolvables and EVs. (Dissolvables are the oral dissolving tobacco and nicotine products; 'EV' or electric/electronic vaporiser is a more accurate term for an 'ecig'.)

Some think EVs will be as safe as Snus, some think safer (somehow), some think not. There is some potential for lung issues with EVs, especially with regard to the flavourings. It is difficult to see how anything more serious than stage 1 COPD in a small number of cases could result, given the seemingly innocuous profile of the vapour, but until we have long-term data it is impossible to say. There is certainly a clear risk for aggravation of pre-existing serious lung disease caused by smoking, but that is another matter. For example, emphysema patients are at risk of contracting pneumonia, and it is possible that some types of EV refill might pose an issue here.

In general, EVs appear to have a safety profile similar to Snus, although this is simply speculation until we have the long-term data. The signs are certainly good though: with 10 years' use, over 25 million users globally, and therefore approaching 100 million user-years at 2015, no disease paths specific to EVs can be demonstrated.

Why THR?
It is generally recognised that THR is the most efficient way to allow smokers to quit, once education and other measures have reduced smoking prevalence to around 20% of the adult population from a figure originally more than double this. In fact no other method has ever worked (see the 20% Prevalence Rule).

In one or two countries it has been suggested that very high tobacco tax revenues have pushed the prevalence rate significantly below 20%, but when this claim is examined we find that (a) the smoking prevalence rate has been measured in a different way in order to achieve a lower figure (by use of the 'daily smoker' rate instead of the 'past 30 day' rate, for example), and/or by ignoring the large black market in cigarettes and loose tobacco created by high prices. Such claims can be disregarded as they appear to have the hallmarks of disinformation.

The health impact from modern THR products is difficult to measure as risk elevation is so low in absolute terms. There is no comparison at all with smoking. Even the most conservative medical professionals expert in THR issues say that vaping has at the most 5% of the risk of smoking and therefore a risk reduction of 20 times; this is a worst-case scenario and most likely by a very long way indeed, in order to ensure such professionals cannot be caught out later. Entire panels of the most senior tobacco control professionals in the world have stated this view repeatedly at conferences. If people such as Derek Yach (who developed the FCTC), John Britton (the RCP's principal spokesperson on tobacco) and JF Etter (continental Europe's most senior tobacco control professional) are telling us vaping has a fraction of the risk of smoking, then any contrary opinion held by enormously wealthy propagandists with a tiny fraction of the medical expertise is not really worth serious consideration - especially when their funding and continued employment is directly linked to cigarette tax revenues, MSA funds and drug sales.

Smokers have the right to manage their own health and reduce risk, so they should be allowed to buy safer products. If society makes the decision to reduce smoking prevalence, then free access to THR products is the ethically and morally correct route to doing so, rather than coercion. Indeed, free access to THR solutions is much more efficient and effective than coercion, as can be clearly seen from the Swedish experience. It is also cost-free; but we must note that a solution to society's costs from smoking may be cost-free to the state in terms of outlay, but financially crippling in terms of the loss of very substantial revenues and savings. After all, this is why no one really wants to solve the smoking problem - it is all just meaningless bluster and hot air. Smoking generates too much money for too many people, including those who make the laws, for there to be any realistic prospect of getting rid of it.

If smoking prevalence has been reduced to around 20% from above 40%, then it appears extremely unlikely that any approach other than unrestricted access to THR will then have any significant effect at all, since no country is an exception to the 20% Prevalence Rule where it applies. This the principal reason THR is unwelcome anywhere except Sweden.

Why people smoke
There must be dozens of reasons for this. One significant reason is self-medication, and there are multiple divisions of this aspect alone. We now know that nicotine is a normal part of the diet (it is contained in many vegetables); it is an active component in the diet since it has multiple functions, much like its sister and co-located compound nicotinic acid (vitamin B3); everyone consumes it; everyone tests positive for it (the measurable nicotine blood plasma background level in persons with a good diet is 2 or 3ng/ml); and it is very likely that - as is normal for all nutrients - some people need to supplement it, depending on genetic make-up.

Nicotine prevents and treats several neurodegenerative, auto-immune and inflammatory diseases, and assists in some forms of cognitive dysfunction. It is an essentially harmless, normal dietary ingredient that is almost certainly a nutrient that will eventually be given a B vitamin classification once the smoking/nicotine taboo has expired. If people wish to supplement their diet then they should be allowed to do so by the use of consumer products, there is no need to pay for licensed medicines for this purpose.

Modern low-risk products
There is no longer any need to smoke tobacco in order to gain the benefits. Modern products have too low a health impact to worry about - long-term coffee consumption of significant volume is likely to have a greater health impact. All other lifestyle decisions will certainly have a far greater effect on health - diet and exercise choices, and sedentary versus active lifestyles, will have a much greater effect on health than THR products in the modern era.

THR for smokers
Smokers will benefit by switching to a modern ultra low risk THR product. In Sweden, we can see that smokers who switch to Snus and smokers who totally quit all tobacco and nicotine use have the same health outcomes. All become non-smokers in terms of health outcomes. Any difference in outcomes is too small to be clinically significant.

Taking up smoking
If a person takes up smoking then at some point it usually becomes difficult to quit. Smoking, unlike pure nicotine consumption*, causes dependence. This dependence can legitimately be called addiction due to the significant risk of harm. It would be better if people started to vape rather than smoke, since at this point in time no identifiable health consequences attributable to vaping can be seen.
* NB: it is impossible to clinically demonstrate any potential for dependence for nicotine. Multiple clinical trials for investigation of treatments for assorted diseases have shown that no matter how much nicotine was administered daily to never-smokers for up to 6 months, no subject ever displayed the smallest sign of dependence. (See References pages here.)

Taking up vaping
Because it is impossible for the death and disease burden from vaping compared to smoking to be any less than a 100-fold reduction, public health will see the largest boost since the discovery of antibiotics. Some think vaping will prove at least 1,000 times safer than smoking. It is also perfectly reasonable to state that an individual consumer with a mind to maximising risk reduction, at the cost of reducing some consumer benefits, can easily ensure their chosen vaping solution has something of the order of 10,000 times less risk than smoking; low-power unflavoured-refill vaping presents hardly any identifiable risk of any scale.

For society as a whole, if people who would have smoked instead take up vaping, and never transition to smoking, then this is a huge public health benefit.

This applies especially to youth because smokers tend to start young, and since more than one in five youths are reported to be smokers then removing that initial start as a smoker would qualify as a huge benefit to health overall. If young people start vaping instead of smoking, there are clearly massive benefits to public health, as long as there is no gateway effect.

The question then becomes, is there is a gateway from vaping to smoking - and if this existed, then would it create more smokers than already existed; in other words would even more youth (and adults) smoke than do already. From the exceptionally honest and current UK statistics obtained by YouGov and administered by Prof West, we see that - in the UK - there is no gateway effect. The only gateway is out of smoking.

Obviously we can see from Sweden that THR eventually eliminates smoking and smoking-related disease, or at least a locally-acceptable smokeless tobacco product does. Male smoking prevalence will have fallen to only 5% by around 2016. Therefore, no hypothetical objections have any value - if there is no smoking, then, rather obviously, there is no smoking. If there is no smoking, and tobacco-related disease stats fall through the floor, then QED no objections have any validity.

(There is one partly-valid objection: if tobacco or nicotine use is proscribed due to zealotry in some form - religion or some form of warped ideology perhaps - then indeed there might be an objection to people consuming products not available in a simple rural lifestyle extant a thousand years ago; so presumably coffee, tea, chocolate, sugar, wine, whisky, beer or anything other than plants, roots and berries would be off-limits as well. This point of view does not seem reasonable in the modern era. Zealots of any/all types are perfectly free to go off and create their own communities with their own rules, and many have done so; it seems best if they leave the rest of us alone. The practical problem with this approach is that such action does not convey the enormous salaries that well-funded zealotry attracts in modern society. Thus, in practice, it appears that most zealots prefer giant salaries, respected positions within the power structure and a comfortable lifestyle to living in communities that actually accord with their ideals.)

As far as vaping is concerned, the only hard data is from the UK, where (at 2014) youth smoking is at an all-time low, no statistically-measurable number of youths (under-18s) who are regular vapers can be found, 33% of vapers have quit smoking, 18% of smokers have switched to vaping, and as this figure has tripled in two years it means that soon 25% of smokers will have switched; as vaping grows, smoking will decline. So, as far as the UK is concerned, the answer is clear: vaping is killing off smoking. Whatever way the figures are interpreted, it's all good: if smoking continues to decline significantly, then even if new and apparently negative factors appear temporarily, they cannot ultimately be of any importance because with very low levels of smoking there are obviously no negatives. This point is obvious from the switch to Snus and away from smoking that has occurred in Sweden. As far as the health issue is concerned, the elimination of smoking means that there cannot be any negatives. Unless there is no health benefit from the substitution, of course; but in Sweden it is clear that there has been an unprecedented boost to public health, with rather obvious metrics available such as the lowest rate of tobacco-related mortality of any developed country by a wide margin, and the lowest rate of male lung cancer and oral cancer in the EU. You can't really argue with that.

However the UK stats for 2013/14 are the first to really show this effect, so we are at the start of the curve and there is no proof it will stay that way. Logic dictates that things will continue as they are, since the effects can be seen to be growing, but this is not proof. The regulatory climate is also important, since this is designed to slow down the replacement of smoking by vaping in order to protect the status quo (the cigarette market is the foundation of the world's largest gravy train, worth more than $1 trillion a year, which we call 'the smoking economy'; it is an immensely powerful machine that is well-protected).

The US statistics can be ignored, as it is clear the CDC are so corrupt that both the validity of the US smoking-related stats and certainly their presentation and interpretation are not only suspect but more than likely fraudulent [3]. Luckily we have access to those from other countries, and where these all paint a very different picture to that presented by the CDC - such as those from the UK and France, which in contrast are honestly and efficiently obtained and presented rapidly in full - we can choose which to believe.

Non-smokers becoming vapers
If people who would not have smoked take up vaping (including youth), then there is very little negative effect for public health that can be seen at this time; the balance of advantage versus disadvantage is strongly positive.

One factor here is dependence on nicotine created by vaping, but this is undemonstrated despite how easily it could be shown in clinical trials if it were possible. Dependence on nicotine created by smoking but then continued without smoke has much the same health or social impact as dependence on coffee, although it has been suggested that coffee may the worst of the two as regards health [4].

No clinical significance can be demonstrated for nicotine consumption - on average it has no measurable impact on health (outside of smoking, of course). We already know that consumption of supra-dietary nicotine at population level without smoke has no clinical significance, so that no significant harm appears likely from a new way of consuming nicotine. It is also becoming clearer that since nicotine is an active ingredient in the normal diet, and a closely-related compound is a vitamin (nicotinic acid is vitamin B3), and it has measurable beneficial effects on some medical conditions [5], and it has a measurable preventative effect for some of these conditions, then (a) nicotine in the diet is beneficial, and (b) once it is widely accepted as beneficial then it may be allocated a B vitamin number, at some point in the future as the taboo gradually becomes less powerful.

Currently nicotine is viewed in the same way as smoking, but this is an erroneous conflation; it has no relation to fact and is a fabricated construct. Nicotine supplementation is likely to be a good thing for a proportion of the population.

Can vaping cause disease?
This seems unlikely at large scale, but we know that it is inevitable in very low numbers since any/all activities have some negative effects. We may see a non-statistically measurable number of cases of COPD, for example.

Sub-ohming 20ml of buttercream-flavoured refill liquid daily is a different matter, and abuse is just as likely to result in negative health impact as it is for any other consumption type.

It seems highly unlikely that vaping will create statistically-identifiable numbers of persons who become dependendent on nicotine supplementation, as this is impossible to demonstrate in clinical trials with other forms of nicotine delivery with never-smokers. However it may be possible that an ultra-efficient delivery system may create a small and statistically-invisible number of cases of dependence, especially if high-power devices can also by accident or design deliver nicotine potentiators such as high levels of aldehydes and additional tobacco alkaloids. It seems extremely unlikely that clinically-significant numbers of dependent cases could be created unless this was the design objective. (Anything can be made to cause dependence if any amount of any ingredient is allowed.)

We should also examine the benefit side.

Many new vapers who did not smoke, if/when such a phenomenon appears, will be protected against genetic predisposition to neurodegenerative and auto-immune / inflammatory diseases by the nutritional mega-supplement effect. Nicotine has a prophylactic effect against such conditions.

Patients with these conditions will benefit from the nicotine therapy implicit in vaping.

Vapers are less likely to become obese, as it looks as if the sweet flavours substitute for snacking and in particular the increase in snacking often caused by smoking cessation. There are endless accounts of people not gaining weight after smoking cessation as would often be expected, and of even losing excess weight as a result of vaping; and in contrast few who report they put on weight.

So for the population level health area - public health - vaping by never-smokers almost certainly has a neutral impact no matter the pathway into vaping and at whatever age. However this does not cover all societal pros and cons, there is also an economic issue and an over-population issue (a global / planetary issue if preferred).

Second-hand vapour
ETS (environmental tobacco smoke or 2nd-hand smoke) may have a public health impact, but 2nd-hand vapour will never be shown as harmful to health. This is because there are no toxic levels of ingredients that can be found in exhaled vapour - there is no 'sidestream' vapour as with cigarettes, any vapour present has been exhaled. There are certainly materials to be found that would be toxic in high doses, but trace levels of most contaminants (some would say all) cannot be said to be harmful.

When examining an analysis of vapour, the first question that must be asked is: is this vapour exhaled? The ingredient profile of mainstream vapour and exhaled vapour is different, as it has been filtered. There is no agreed lab protocol for machine filtering of vapour, therefore it must be exhaled by human subjects in a sealed chamber. The second question is: was the chamber also tested with the subjects using a dummy device to simulate the inhalation/exhalation cycle but with no chemical load? This is vital since people normally exhale materials such as formaldehyde, for example, and the levels may change according to the inhalation vacuum and not be related to any chemical inhaled; so a subtraction procedure is necessary. Tests run by independent researchers have failed to locate any exhaled materials of potential toxicity in any significant amount, and the general levels of such materials, where present, are about 1,000 times lower than present in tobacco smoke.

Vapour only persists in the atmosphere for a short time as it is a water-based aerosol. Unlike tobacco smoke, it disappears without trace, fairly quickly. Therefore any impact is reduced to those present at the time of exhalation. In general it would need direct inhalation of exhaled vapour by mouth-to-mouth contact before any measurable absorption could take place.

The 2nd-hand nicotine issue
Before any measure of nicotine in the atmosphere or absorbed by bystanders is discussed, it is important to recognise that nicotine is present in the diet and measurable in everyone. All large-scale clinical trials report that everyone tests positive for nicotine, without exception - even in a clinical trial with 800 subjects, every subject tested positive. In the healthy individual with a proper diet, at least, nicotine and/or its metabolytes can easily be measured.

In the past, it was said that a background level of up to 3ng/ml plasma nicotine level could be measured in the normal non-smoker with a healthy diet (source: Benowitz), since nicotine is present in many vegetables, and in other foodstuffs such as tea. Presumably this level will decrease as diets become worse, with fewer people eating fresh vegetables or in lower volume. Note that test kits for identifying smokers that use nicotine, cotinine or 3-Hcot (metabolytes) as the identifier always need to have a substantial and non-zero minimum start point for a positive result, since everyone tests positive for nicotine from dietary sources; this is why an exhaled carbon monoxide test machine is the only reliable way to test for smoking status.

It is extremely unlikely that inhalation of environmental vapour could ever produce nicotine levels in subjects that approach the levels present in a person with a healthy diet. Even if it could, it certainly cannot not be regarded as a health hazard or some kind of negative; otherwise people would be warned against eating tomatoes and potatoes. Indeed, there is more likely to be a problem with unhealthy diets reducing the availability of active, beneficial ingredients; dietary nicotine supplementation is likely to be beneficial for a significant proportion of the population. We already know from the amounts needed for vitamin B3 supplementation (up to 2,000mg per day) that supplementation of dietary nicotine compounds to show observable benefit, in this case for cognitive function improvements, is not limited to small-scale additions: substantial amounts may be needed. Perhaps this is why smokers are protected from some medical conditions when measured at or before middle age: they receive a significant nutritional boost. However, smokers eventually become too ill on average to show such benefits, so this effect must be measured before smoking takes its toll. Nicotine consumption and smoking are not the same and should never be treated as the same; in fact treating smoking and nicotine consumption as the same or similar is the classic sign of a liar.

Nicotine is present in the normal diet and everyone tests positive for nicotine. More than 40 clinical studies report that smoking protects against Parkinson's disease. It is tempting to assign the protective effect to nicotine, especially as it shows benefits in treatment of such conditions, but exclusive assignment of this to nicotine alone may be premature (nicotine is an anti-inflammatory; but anatabine for example, another alkaloid present in tobacco, is an even more powerful anti-inflammatory).

Economic impact

The regional or national economic effect of vaping removing smoking revenues will be substantial.

Government, major industries, US cities, US States, and whole economies depend partly on the smoking money machine. If/when that is taken away and the cost of extended pensioner life is added, there will be a massive hole in their budgets. In the UK it is easy to calculate that this will be at least 5% of GDP, and the knock-on effect could even go higher. This is because in a socialised state such as the UK everyone receives free healthcare, pensions and care in old age; if you take away the money that pays for that and simultaneously enable millions of people to live at least 8 years longer into old age, the effect is going to be disastrous. It will be far less dramatic in places where individuals don't receive automatic state pensions and just die if they don't have the funds to pay for treating serious illness or for care in old age.

There are various reports on the current situation with regard to the MSA payments to US States. Some say that these fees had already started to slide at Q2 2014, way ahead of the predicted time this would happen. 2018 was one estimate for the first sign of this effect - but like all estimates for anything to do with ecigs, it could be inaccurate as far as the timescale is concerned. Ecigs are an unstoppable avalanche that will overtake you much sooner than you expected, whoever you are and wherever you live. Take a look at how quickly and dramatically Malcom McClean changed the world if you don't understand this [6]. Han Li [7] may well do the same, and perhaps even faster.

The pain caused by this economic impact is already being felt: US States' Attorneys General are screaming in protest and demanding action; indeed, some have taken action already by supporting bans on or taxes on ecig products of various kinds in their States and are working hard to protect cigarette sales. Countries like Italy are yelling in agony and have placed huge taxes on ecigs that have absolutely nothing to do with health, in order to replace the lost tobacco tax revenues. In other words they all want to tax the cessation of smoking, to make up for the lost revenues from smoking. This should make the utter hypocrisy and murderous corruption of health policy quite clear to those who thought it might be based on health, or science, or something like that.

There is no health policy in reality - just fiscal policy.

Jobs
Many jobs in tobacco growing, cigarette making, and distribution/retail will be lost. Retail tobacco shops - tobacconists, in Britain - are going to go out of business unless they have new alternative equally-profitable product lines (such as EVs). An equal number of jobs will be created in EV manufacture since it is a labour-intensive process (perhaps more). The jobs will on balance be transferred to south-east and south Asia as is to be expected, as general manufacture now takes place where labour is cheapest (this is the 'McClean effect' [6]).

Environmental impact

The effect of a switch from burning vegetable matter to battery-powered nebulising should be examined.

Batteries: the lithium cells used in EVs are toxic to the environment when disposed of incorrectly. In general the technology is changing from small cells integral to the device, with a short lifespan, to larger removable cells with a longer lifespan. Over time, it is likely that disposal of old lithium batteries will decrease per 100 units sold, as batteries become larger, more reliable and have a longer lifespan (more recharge cycles). However, this technology improvement will be eclipsed by growing sales, which are already in the tens of millions per year and will reach hundreds of millions per year.

It is doubtful if ecig batteries will ever be disposed of correctly by product-specific recycling. On the other hand this impact can never equal the disastrous, corruption-driven, legally-enforced changeover to 'long-life' lightbulbs in the EU, which has intoduced billions of mercury-containing expired light bulbs into the environment (especially since the description 'long life' is frequently a misnomer). As bulbs will break in the trash disposal process, very large amounts of mercury in total will be released; but batteries are more likely to retain their chemical load. The immense volume of incorrectly disposed-of lightbulbs plus their tendency to break open means that the environmental impact of 'longlife' bulbs is thousands of times worse than the largest possible volume of disposed lithium cells. Old batteries are a problem, but there are many worse issues.

Heads: the technology has changed from atomisers to cartomisers to tanks of various types, in terms of sales volume. The materials used are steel tubes, plastic or glass tanks, very small amounts of nichrome and kanthal heater wire, silica wicks, plus other materials in tiny quantities such as nitrile O-rings and sealants. There is no significant environmental impact from disposal of these materials over and above normal domestic waste.

Tobacco production
It is difficult to calculate the effect of removing a significant amount of tobacco production for western consumption in cigarettes. Whatever the final outcome in twenty or thirty years or so, in the West, much will remain for cigarette manufacture for other markets, for non-cigarette products, and for nicotine extraction. Third-world countries do not appear to be able to afford EVs, so smoking will grow in such countries until incomes allow the choice of alternative products.

Some say tobacco agriculture has a negative environmental impact, others it is neutral. The remaining tobacco crops will be mostly found in China and India (also Africa), as that is where cheap cigarette tobaccos are grown and the nicotine extraction takes place, and corresponds with the largest remaining cigarette markets. Small-scale tobacco growing will remain in the USA and EU, addressing high-quality or locale-specific smoked products - there will always be a market for Perfectos Finos or Balkan Sobranie-type cigarette products, but at a fraction of the current size. The cigar market will be unaffected, although in time it might even be positively impacted - cigar smokers are unlikely to be affected in any way, and although vapers may not smoke cigarettes any more, some may now smoke the occasional cigar when they have never done so before.

Planetary impact
The global effect due to hundreds of millions of smokers not dying is hardly inconsequential in a time of massive over-population. The planet simply cannot support life indefinitely with the current number of people, never mind any increase.

It is reported that a billion people will die from smoking this century. If they all switched to vaping then very few will die. Leaving aside the likelihood of this happening or not, if a hypothetical situation developed where most/all smokers switched to vaping or started in the first place as vapers and never smoked, it might be seen as an environmental disaster for the planet. The more people who die the better, when a planet is as disastrously over-populated as ours is and no large-scale wars or disease epidemics help reduce the human population.

Keep in mind that Hawking says we only have another 200 years to go before disaster strikes: huge numbers of people mean that all fuels will have run out, all metals run out, the bulk of the population is forced back into the stone age, only an elite have access to metals, plastics and fuels, toxic waste has built up to such a degree that the food chain is irrevocably compromised, new diseases and cancers affect almost everyone, and the entire planet is a toxic waste dump. Others say that time is further off - but it will come one day. Therefore saving a billion lives isn't necessarily a good thing for the planet.

The politics of vaping
One can therefore at least partly sympathise with the Greens, who bloc-vote with the Socialists to ban vaping, as they are in effect voting to save the planet or at least prolong its usefulness to us by enabling an early death for those who choose it or can be forced into it, by the protection of smoking and the removal of all other options.

The Socialists vote to ban vaping, on the other hand, in order to maintain control of the production apparatus, centralise revenue generation, maximise revenues, protect existing revenue channels from independent interlopers, and prolong control of the smoking economy for as long as possible; in other words they vote to kill for profit. Thus an individual smoker or vaper voting Green or Socialist (Democrat is the nearest equivalent in the USA) is voting for their own death, though it is of course their right to do so.

You might say that at an individual level this is murder; but politicians are never convicted of it although their policies clearly cause it (it's called 'desk murder'). The best example of this seems to be the EU, who deliberately kill at least 70,000 European citizens every year in order to protect the smoking economy. The Snus ban most likely prevents at least 10% and perhaps as many as 20% of smokers from switching - note that 66% of those where it is permitted and promoted have done so, e.g. Sweden - so that it is perfectly reasonable to suggest that just 10% of the annual 700,000 claimed as smoking-related deaths in the EU are caused by the ban (at least one genuine expert, Prof Rodu, believes it to be much higher). Mortality associated with Snus consumption is so low that it cannot be reliably measured.

In the UK, it therefore appears that around 10% or more of the 100,000 reported annual smoking-related deaths are caused by the EU, although the UK government is of course complicit in the ban - smoking is a huge revenue generator and cost-saver for government, which is why it is so carefully protected. There was no reduction in smoking in the UK in the 5 years between 2008 and 2013, and in fact the number of smokers grew by about 0.5 million; you are most unlikely to have been told this since it is so well suppressed, and the public perception, carefully crafted, is that smoking is being reduced. The tobacco control industry depend on falsifications of this type in order to maintain their employment. Smoking prevalence started to fall again only in 2014, caused by the switch to vaping: the reduction in smoking closely aligns with the the number who switched or quit via vaping.

Government, together with the pharmaceutical industry, who derive around 15% of their gross income from smoking in the UK, are heavily invested in protecting the status quo. This aligns well with the aims of the tobacco control industry, who are wholly or partly funded by government and/or the pharmaceutical industry depending on location, who can make no further impact on smoking prevalence once the 20% Prevalence Rule operates; although this is never broached in public. Only substitution is efficient after that point (switching to THR products).

2. The benefits and drawbacks for the individual

These can be summed up in the health, economic and social benefits.

Health impact for the individual

How much an individual benefits from switching from smoking to vaping depends on numerous factors applicable to that individual. Overall we can expect an average of a 100-fold reduction or greater in serious health issues, since it is obvious from the innocuous ingredient profile of ecigs and the lack of any serious health issues so far, with 10 years' use and approaching 100 million-user years experience, that there is no disease factor of any consequence. This does not eliminate issues for those with pre-existing morbidity, genetic predisposition to certain morbities, the possibility of minor to medium severity lung issues for some in the long term, morbidity resulting from abuse, morbidity resulting from contaminated refills, and the nicotine dependence issue.

Health benefits
People do experience benefits from smoking, otherwise they would not smoke. Unfortunately most such benefits are eventually cancelled out by the long-term health impact of smoking. It is well-demonstrated that if smokers quit by age 35, on average no negative health impact can be measured. It is well-demonstrated that smoking protects against some diseases, until the point is reached at which harm equals and then overrides any benefit.

If the smoke is removed then we are left with pure benefit. Clearly, nicotine supplementation prevents some neurodegenerative and auto-immune diseases (this is why at least one is known as 'the non-smokers' disease'). Some vapers will not present with such diseases when, without vaping, they would have done so. Since such diseases are massively harmful and life-changing, this is not an inconsequential effect: preventing hundreds of cases of such diseases is of quite considerable importance. To the individual in a family with a genetic predisposition to such conditions, a method with a significant prophylactic effect that cannot be supplied by any medicine and with none of the negatives associated with smoking is of enormous importance. Indeed, if you have any close knowledge of such families, you will appreciate this rather well. No longer will doctors faced with this dilemma have to secretly advise, as they do, "Two cigarettes a day and no more and no less"; they can state quite openly and honestly: "Vape in moderation".

Nicotine dependence
There are unsupported arguments that (a) nicotine dependence may be created in those using EVs who never smoked; and that (b) such dependence has negative consequences.

There is no evidence whatsoever for any potential for nicotine to create dependence (in humans) without exposure to tobacco smoke or tobacco consumption of some kind. There is no published clinical trial that reports administration of pure nicotine to never-smokers resulted in any measure of reinforcement, dependence or 'addiction' [8], and there are multiple clinical trials that did exactly this (for various purposes such as testing its benefit for a variety of medical conditions, which, in contrast, has been established) and no dependence potential was reported.

So let's get this absolutely straight, so there is no misunderstanding:

There is not a shred of evidence that pure nicotine can create dependence in never-smokers

There is a growing body of evidence, including multiple clinical trials, that this is impossible

Vapers routinely reduce their nicotine consumption, and they do this with ease

Therefore we can derive two hypotheses from this:

1. Smokers who successfully switch to vaping may be able to reduce their nicotine consumption, and they may become less dependent on it. In practice it appears that vaping is equal to or close to abstinence, in terms of its effect on nicotine dependence after smoking cessation.

2. Non-smokers who start to vape are at extremely limited risk of becoming dependent on nicotine. The brain chemistry change that creates dependence appears to require that nicotine is delivered along with either compounds that create the reinforcing potential or synergens that multiply it, or both. These potentiators are known to include MAOIs, and other compounds implicated include other ingredients in tobacco smoke such as other active alkaloids like anatabine, plus the pyrolytic aldehydes.

There is a great deal of anecdotal evidence to support the first of these positions, plus a growing body of clinical evidence. There is no evidence whatsoever that nicotine can create dependence without tobacco. In addition it would also be necessary to demonstrate clinically-significant levels of dependence, which is a greater measure of impact than an insignificant number of reports or even a statistically-visible effect. This evidence is clearly extremely difficult or impossible to provide, since it should be easy to locate given the extraordinarily high level of interest in this topic and the number of researchers highly-paid to provide exactly this type of material. The funds on offer to produce this type of work are immense. For example, $850,000 was given to one researcher to watch Youtube videos of vapers in order to construct a pointless study about the harmful appearance of the inhalation methods used. Without a shadow of a doubt, millions will have been offered to produce evidence that pure nicotine can cause dependence in never-smokers. There is none.

Simply because of this anomalous lack of any evidence at all while its existence would be extremely profitable, it is probably reasonable to state that it cannot be demonstrated: nicotine cannot create dependence outside of delivery in tobacco. If by chance it is possible for a small number of individuals unexposed to tobacco, this seems likely to be a statistically-invisible number.

It has been proposed that some individuals may be susceptible to dependence and the actual material or its delivery route are not critically important: such persons are likely to become dependent on something or other sooner or later (this is a theory advanced by some schools of psychology). For example, there are apparently some reported cases of dependence on carrot juice. No doubt if carrot juice could be delivered in a high-power inhalation system and supplied to millions of people, the two or three cases of dependence on record might be doubled.

However, the creation of dependence on nicotine by a high-power high-efficiency managed-profile inhalation vector is an interesting concept. One promising direction for the creation of 'brand loyalty' appears to be the provision of high-power devices with a refill that includes plenty of WTAs, raw aldehydes, and a propensity to form further aldehydes with the application of heat. No doubt the cigarette trade will examine such a direction. We might hope that regulations could eventually prevent such manipulation of the ingredient profile - but regulations clearly have nothing to do with safety and public health, and everything to do with protecting tobacco tax revenues and profitable levels of disease.

Individual health
In total we should expect that the average individual will experience a huge reduction in risk when switching from smoking to vaping. The actual incidence of subsequent disease will align with past smoking history rather than current vaping habits; risk of presenting with a smoking-related disease reduces over time and depends mostly on how much was smoked and for how long. Lung cancer that appears related to smoking can appear 20 years after smoking cessation, though cardiac event risk decreases more rapidly.

Economic benefits for the individual

People can expect to save a substantial amount of money when vaping as compared to smoking - provided that low-cost choices are made and the environment allows. This cost-saving is part of the problem for the state.

It depends on the cost of smoking (the tax levels), as well as the product choices made and the regulatory climate. If all factors are suboptimal then it is possible that the cost may be higher: it certainly will be for example if cigarette tax is low, if the vaper uses prefilled cartos on a mini ecig, and if the law imposes excessive costs (taxes and/or regulatory compliance conditions) that are unrelated to actual health impact (as all additional taxation is and virtually all regulation is, in this area).

Therefore the individual may need to make specific choices in order to save money: use of refillable devices, and/or use of DIY refills, and buying on the black market if/when the regulatory/taxation climate becomes unrealistic in order to protect the smoking economy [9].

Social benefits for the individual

Vaping is not smoking, and the health and economic benefits are reflected in improved social standing for the individual. In a climate where a smoker is regarded as abnormal and even anti-social, not smoking is an improvement in social status.

3. Non-smokers initiating nicotine use via ecigs

One of the key issues connected with growing EV (electronic vapouriser) sales is the effect of large numbers of non-smokers initiating use. This will inevitably become a major topic for debate when significant numbers of people start vaping without previous smoking - as they inevitably will if the Swedish scenario is repeated, as seems likely.

We can clearly see the effect where it has happened before: in Sweden, tobacco users both switched from smoking to Snus and also initiated with Snus, with the user statistics at 2013 showing that there are now twice as many Snusers as smokers, and that male smoking prevalence is reducing dramatically by 1% per year and has done so since 2003 when it was 17%, with a uniquely-low 5% male prevalence therefore expected by 2016.

Four things are abundantly clear:

Smoking in Sweden is dying out: Sweden is the world leader in the reduction of smoking prevalence

Smoking-related mortality (aka 'tobacco-related mortality') is falling dramatically, in parallel with the move to Snus: Sweden is the world leader in the reduction of smoking-related death

Smoking-related morbidity (aka 'tobacco-related morbidity') is falling dramatically, in parallel with the move to Snus: Sweden is the world leader in the reduction of smoking-related disease

The move to Snus away from smoking is nothing but good even though tobacco consumption prevalence overall remains static - the health impact of Snus consumption is about invisible at population level

A lifetime of Snus consumption has less health impact than 3 months of smoking

A smoker who switches to Snus becomes a non-smoker in terms of the health outcomes: on average there is no significant difference between quitting totally and switching. The same may or may not be true of vaping; it seems possible that the additional risk of lung issues will be cancelled out by the virtual impossibility of any form of cancer since there is no smoke, and no tobacco carcinogens are present above trace values. Therefore even the almost invisible number of cases of cancer attributed to Snus consumption, which are too small to be statistically identifiable, would not be present among vapers.

Nicotine consumption has no clinical significance. If smokers switch to clean nicotine delivery systems the only result is huge gains for public health. If non-smokers initiate with vaping and continue, the public health impact is invisible. At an individual level, there are benefits to nicotine supplementation that outweigh any possible negatives, for a percentage of the population (those who require nicotine supplementation to assist cognitive function; those who would otherwise present with an auto-immune disease; those who might develop early Alzheimers or Parkinsons; and those who can mitigate the symptoms of such diseases with additional nicotine). For the rest, it is no different to any other enjoyable but virtually harmless habit. Although nicotine has been described as a 'wonder drug', it is more likely that it is simply an active dietary ingredient that some miss out on due to erroneous and damaging propaganda.

4. Conclusion

The principal questions
The main question, then, is whether something that is clearly massively beneficial for the individual and for public health is a benefit for society in every way. There are many possible issues such as the major ones: the economic impact, and if gains for the individual are also gains for society and/or the planet; and the rather minor ones by comparison including the exact potential of nicotine for dependence when delivered in a highly efficient system even without previous exposure to tobacco; and if there is any such potential, whether a harmless dependence is of any consequence when placed alongside all the other such dependencies in modern urban lifestyles, especially set against the significant benefits for some.

The impossibility of predicting scale
It is impossible to guess at some issues and especially the scale: if someone had stated in public a guess at even one-hundredth of the effect on the UK of containerised shipping in 1975, they would have been dismissed as a lunatic. Containerisation drastically changed the UK to an extent that is probably still not appreciated even today [6]. Indeed, some of its obvious effects have been attributed to Mrs Thatcher, an achievement (or destructive effect) impossible even for a Prime Minister.

These things are clear enough with hindsight - given enough distance - but impossible to predict at the time. Or perhaps, guessed at but kept quiet by those who may envisage some of the results, in order to avoid being called crazy.

Timescales: new tech vs the old
What we do know is that we face at least another 20 years of bitter strife as the new technology replaces the old, and the beneficiaries of the old system fight desperately for survival (as they always do - they have to). The key issue in this war is that those in power benefit hugely from smoking, and therefore the changeover will be a vicious and bloody war of the powerful versus the population, in which the public are forced to smoke and die whether they want to or not and until such time as they can sweep away the oppression.

Notes

Article notes
This is a UK-centric evaluation and some adjustment may need to be made if specifics are applied to other countries.

An attempt has been made to provide a balance between the positive and negative effects of THR. If you feel the balance is unfairly weighted at any point, please use our Contact page and point out where and why - thank you.

Numbers are written numerically e.g. 3, not three, to make them easier to locate and compare.

References for all statements of fact or evidential citations are given on the References pages accessed from the right-hand menu. Only those points that may not be clear to those new to the debate are clarified in the notes below.

More citations are always welcome - thank you.

---------------------------------

[1] Snus is the local oral tobacco of Sweden. Because it has been used for over 100 years and has been intensively studied for more than 30 years, the facts of its use are clear. Sweden's national health statistics are unique, as a direct result.

The data resource on smoke-free tobacco use and long-term nicotine use without smoke is of vast size (hundreds of clinical studies and an unequalled raft of incontestible facts), and now used for such purposes as long-term NRT licensing applications, since the NRT data resource is tiny in comparison.

Men mostly use Snus. Male smoking prevalence was 17% in 2003 and has fallen at 1% every year since then, and is expected to reach 5% by 2016. Female smoking prevalence is a few points higher, but continually being dragged downward by the male/Snus effect (very few males smoking, and this number reducing year on year, may result in a denormalisation of smoking that has lead to the low female smoking rates even when women do not switch to Snus). Sweden may be the only country to have a male smoking prevalence lower than the female. Sweden was the first EU country to break the 20% prevalence barrier and will be the first country to reach the 5% overall smoking prevalence level one day - the level said to be 'an insignificant smoking prevalence' - perhaps by around 2020. Currently this seems impossible for any other country, by any date (restrictions on smoking are a device probably designed to operate in name only; they simply lead to more smuggling in order to supply the demand, which stays static once the 20% Prevalence Rule operates).

Sweden provides us with the foundation for THR science: Sweden's national health statistics are unique. Sweden has the lowest tobacco-related mortality of any developed country by a wide margin, and the lowest male lung cancer and oral cancer rate in the EU. Bans on Snus in other countries are therefore rather obviously kept in place for economic reasons since such bans are clearly enormously harmful to public health: they keep smoking disease and death rates high for economic advantage.

[2] The world authority on the oral pathology of tobacco consumption is Prof Brad Rodu, whose work should be consulted on these issues.

[3] The CDC has recently hidden all health statistics related to smokeless tobacco consumption by avoiding the collection of this data, and by not publishing reports that specifically collected such data (the same being true of positive research on nicotine, which has been deliberately withdrawn from public view). This is believed to coincide with the lack of any demonstrable health impact from modern US ST products, which align more closely with Swedish Snus in their health risks rather than with historic products, and is unacceptable to the CDC's ideology and/or commercial aims. In addition they have deliberately misrepresented statistics on ecig use particularly with regard to youth use (or non-use). Thus, their statistical presentation in this area can be described as fraudulent.

[4] For example, the Mayo Clinic published a study in which they reported some significant health concerns for extended coffee consumption. On the other hand, Mayo appear to think that anything apart from staying in bed is seriously harmful, so perhaps this needs to be taken into account.

[5] Auto-immune / inflammatory diseases, neurodegenerative diseases such as Alzheimers and Parkinsons, cognitive dysfunction (multiple separate types).

[6] See: http://www.ecigarette-politics.com/blog/the-impact-of-technology-change.html

[7] Han Li is his own preferred Latinised spelling of his name, often seen written as Hon Lik in the past - see the board of directors of Dragonite.

[8] The current use of the term 'addiction' means dependence plus harm as a result. This cannot be applied to nicotine since we have absolute proof that consumption of nicotine without tobacco smoke causes no clinically-significant elevation of risk for any medical condition. A consumer of nicotine is probably at less risk than a consumer of coffee, with equal relative levels of consumption. For example, roast coffee contains about 1,000 compounds, only about 30 of which have been tested for carcinogenic potential, and more than half tested positive. Nicotine is not associated with cancer (in humans) in any way and there is absolute proof of this.

[9] To provide the maximum possible benefit to public health, ecigs should be tax-free in order to assist smokers to switch; and the only factor that requires regulation over and above normal consumer protections is refill liquid quality. So far, all regulatory proposals have avoided refill quality provisions and concentrated on factors that will reduce EV sales for no discernible health benefit, revealing that the basis of ecig regulation is to protect cigarette sales (in practice, most often in order to protect tobacco tax revenue and pharmaceutical industry income) rather than to improve safety.

# data[].attributes.attachment_link.title
The Impact of Vaping On Individuals And Society

# data[].attributes.attachment_link.description
An examination of issues resulting from a global shift away from smoking toward ecigarette use: the global impact of declining cigarette sales and non-smokers becoming vapers Note on perspective Financial pressures 1. The benefits and drawbacks of the shift to vaping for society - Public health impact - Economic impact - Environmental impact, planetary impact 2.

# data[].attributes.attachment_link.readable_text
(NicolasMcComber, Getty Images)

One of the toughest challenges for those fighting the problem of vaping in schools may be getting people to realize how big the problem is in the first place.

Many teachers and parents don't know that the number of teens using e-cigarette devices has grown rapidly in just the past several years. Adults might not even recognize the most popular vape products, which look more like something out of Silicon Valley than Marlboro Country.

Students, meanwhile, often are unaware they're inhaling addictive, potentially dangerous chemicals.

"They think it's harmless," said Jordan Roberts, who manages a youth smoking prevention program for the Kansas Department of Health and Environment. "Their peers are doing it, and it's part of what it takes to be cool."

Vaping's growth has been stunning.

According to the Centers for Disease Control and Prevention, nearly 21% of high school students used e-cigarettes in 2018. That was an increase of nearly 78% in just one year. Among middle school students, the growth rate was 48.5%, from 3.3% to 4.9%.

The best-known vape product is Juul - a sleek device often compared to a portable USB drive and "so popular that it's its own verb," Roberts said.

News reports tell of the challenges from coast-to-coast. A high school principal in California told the Sonoma West Times & News that vaping was his school's No. 1 disciplinary issue. In New York, schools in the Utica area have turned to extra security checks and vape detectors in bathrooms, according to the Observer-Dispatch.

"It's everywhere," Roberts said. "It's not limited to urban areas at all. It's even those small 1-A schools that are dealing with this issue."

Schools, she said, are at the "core of the vape epidemic because that's where kids are the majority of the time."

Hailey Kisner just graduated from high school in Hutchinson, Kansas. The 18-year-old said her peers don't see vaping as related to smoking. "Smoking to them? Completely a big no-no. It causes cancer, and death. And they're like, 'Juuling? It's fine.'"

Psychologist Thomas J. Payne said that attitude is common. Payne directs the ACT Center for Tobacco Treatment, Education and Research and is a professor at the University of Mississippi Medical Center.

In explaining vaping's potential risks, he said it was "a young area of research." But even so, "there is sufficient evidence, with respect to physiological effects and the nature of the toxins delivered, that raises grave concerns that these products carry significant health risks," Payne said.

"The strength of the evidence strongly suggests we cannot wait 30 years to see what the long-term health effects might be before we take action."

E-cigarettes typically contain addictive nicotine, which can harm young brains and affect cognitive ability, mental health and personality. Evidence suggests vaping may damage blood vessels, raise blood pressure and increase the risk of clots. Some studies also show kids who start with vaping are more likely to try traditional tobacco products.

Payne said combating vaping will require the type of wide-ranging campaign that has helped reduce cigarette smoking in the U.S. to an all-time low among adults.

One response, Roberts said, should be comprehensive school policies that send a clear, consistent anti-vaping message. Such policies, she said, should prohibit tobacco use of all kinds among school staff, visitors and parents on school grounds, in school vehicles and at school-sponsored events.

Reaching elementary students before they contemplate starting is also essential, Roberts said. Using fellow students might be key to connecting with all youths.

"When you're 15, you really think you're invincible. You think, 'Death is not close to me right now.' But what young people really, really do care about is their social structure. Who they're friends with, what their friends think of them."

As a student, Kisner worked with Roberts in just such a role, through Kansas' Resist program. The anti-tobacco effort has a statewide council of 15 students in grades 8-12, plus regional and local chapters that often are embedded in student councils, Boys and Girls Clubs and other groups.

Kisner said although being the same age as her student audiences gave her some advantages in being relatable, she thinks anyone could take her same approach.

"I always start my presentation by saying, 'I am not against what you are doing. I am not against you or your parents, or the smokers. I'm against the tobacco industry. All I'm here to do is inform you and educate you."

The response can be dramatic.

"They're like, 'Holy cow! I really just thought it was water vapor!'" Kisner said. One student even came up to ask, "How do I quit? I don't want to do this anymore."
If you have questions or comments about this story, please email editor@heart.org.

# data[].attributes.attachment_link.title
Amid an 'epidemic' of school vaping, a search for solutions

# data[].attributes.attachment_link.description
One of the toughest challenges for those fighting the problem of vaping in schools may be getting people to realize how big the problem is in the first place. Many teachers and parents don't know that the number of teens using e-cigarette devices has grown rapidly in just the past several years.

# data[].attributes.attachment_link.readable_text
The Largest Population

Most people who experience homelessness are single adults.

Single Adults

Every Child Deserves a Home

Homelessness is devastating, regardless of age. But for children, in particular, it can have serious physical, emotional and psychological implications.

Children and Families

Ending Homelessness for Our Veterans

Our nation's veterans may face invisible wounds of war that may make them more vulnerable to homelessness.

Veterans

The Most Vulnerable

Physical and mental health conditions can be both the cause, and a result, of homelessness. For some, these health challenges can mean years or decades on the streets and in shelters.

Chronically Homeless

Young and Homeless

Each night, thousands of young people living on their own go to sleep without the safety, stability and support of a family or a home.

Youth and Young Adults

# data[].attributes.attachment_link.title
Who Experiences Homelessness? - National Alliance to End Homelessness

# data[].attributes.attachment_link.description
Most people who experience homelessness are single adults. Single Adults Homelessness is devastating, regardless of age. But for children, in particular, it can have serious physical, emotional and psychological implications. Children and Families Our nation's veterans may face invisible wounds of war that may make them more vulnerable to homelessness.

# data[].attributes.attachment_link.readable_text
People experiencing homelessness can be individuals, children, or families. As of 2015, 37% of people experiencing homelessness were in families with children, 64% experienced homelessness as individuals, and 6% were children.1

They can be currently without housing, but are also considered eligible for homeless services if they will be without housing in 14 days (i.e., eviction) or if their current housing situation is life-threatening (i.e., domestic violence).2

SPECTRUM OF SEVERITY:

On the Streets

Abandoned Building/Vehicle

Shelters/Missions

Transitional Housing

Single Room Occupancy (SRO)

Precariously "Doubled Up"

2+ Moves within 60 Days

These unstable situations result in a spectrum of homelessness severity, ranging from those who have simply moved more than twice in 60 days, to those living on the streets. Each of these situations can reasonably be included in the full definition of homelessness.3

From the system perspective, a society with a lack of supportive and health services, a suffering economy, or a lack of affordable housing can be challenging for individuals on the brink of homelessness. From an individual perspective, these people can be classified as those unable to work without assistance, those able to work but are unemployed, and those who are employed. The grey areas in between, where the individual can't seem to succeed within the broader socio-political environment (however flawed it may be), is where conflicts happen that result in someone heading toward homelessness.

Some people experiencing homelessness are actually employed and reasonably able to afford most of the things they need-except for affordable housing. Perhaps they have been foreclosed on or evicted, or maybe their neighborhood has undergone gentrification. Regardless, with a lack of affordable housing reasonably available to this population, despite having jobs that pay above minimum wage, they risk becoming homeless.

Also in the category of those able to work but are unemployed (or underemployed) are those who are not particularly suffering a personal hardship: instead they have found themselves experiencing an economic hardship, such as job loss or chronic unemployment, because of a system-wide suffering economy. As the economy improves, or as these individuals can re-establish themselves in a changing economy, their chances of economic suffering decline.

... or the ability to call upon friends and family to help in a time of need. Those who experience homeless not only experience system-individual conflict, but they have fallen through this personal safety net. In a time of need, with dwindling personal connections to rely on, faced with the overwhelming systemic challenges described above, they become homeless.

From the system perspective, a society with a lack of supportive and health services, a suffering economy, or a lack of affordable housing can be challenging for individuals on the brink of homelessness. From an individual perspective, these people can be classified as those unable to work without assistance, those able to work but are unemployed, and those who are employed. The grey areas in between, where the individual can't seem to succeed within the broader socio-political environment (however flawed it may be), is where conflicts happen that result in someone heading toward homelessness.

Also in the category of those able to work but are unemployed (or underemployed) are those who are not particularly suffering a personal hardship: instead they have found themselves experiencing an economic hardship, such as job loss or chronic unemployment, because of a system-wide suffering economy. As the economy improves, or as these individuals can re-establish themselves in a changing economy, their chances of economic suffering decline.

... or the ability to call upon friends and family to help in a time of need. Those who experience homeless not only experience system-individual conflict, but they have fallen through this personal safety net. In a time of need, with dwindling personal connections to rely on, faced with the overwhelming systemic challenges described above, they become homeless.

The housing first approach simply gives homes to people experiencing homelessess, regardless of whether they are sober, have jobs, or have health problems. Being homeless is a traumatic event in itself, and so providing stability with a home first makes other issues more conquerable.11 The housing first model has proven to be very effective, retaining people in homes at higher rates while surprisingly cost-effective.12

This approach goes one step beyond alleviating symptoms to empower those experiencing homelessness-which in turn provides them with more choices about their own futures. Approaches in this category include efforts like job seeker assistance, life skills training, and education, with the hope that these stepping stones, in addition to basic provisions like food and shelter, will be enough to launch them to success.

This most traditional approach involves organizations alleviating the symptoms of homelessness (such as providing people with shelter, clothing, or mental health resources). The hope is that these supportive essential services will be enough to help them get back on their feet, and eventually enable them to establish themselves in a home of their own.

Ready to learn more?

EXPLORE DATA

Use an interactive map and chart interface to view the homelessness issue in the U.S. and compare related factors. Zoom to your city to examine local trends.

BROWSE STRATEGIES

Browse a set of strategies that cities and organizations worldwide are already testing. Find the solution that best fits your resources and needs.

II. HISTORY

The complexity of this definition was not always so broad; in fact the term "homeless" did not originate until the mid-20th century. SOURCE People without homes have surely always existed, but the form that homelessness has taken has evolved in recent decades.

1800-1860

In the pre-Civil War era, the homeless were called hobos or tramps, following where jobs led them. This era of rapid industrialization included a shift toward wage labor (as opposed to practicing trades), which resulted in jobs being less stable because workers were easier to replace. Young men followed railroad jobs west or migrated to the city for factory jobs, living wherever they could find shelter.

1860-1930

After The Civil War, this population of job-seeking workers expanded as veterans and freed slaves joined the ranks. The suffering economy of the post-war depression combined with unregulated capitalism served only to create more instability for workers - requiring them to be even more migratory to find work. The Bowery Mission in New York City was formed in 1879, one of the first shelters designed to support young men struggling to find work.

1930-1950

After the Great Depression, the negative economic impact spread to include entire families, instead of just young men - migrant workers became the norm. Skid rows began to develop in cities across the country, as these growing misplaced communities sought to create shelters for themselves. Homelessness began to be a widespread impact.

1950-1970

In the mid-19th century, the United States began to implement systemic changes that shifted the articulation of homelessness. Skid rows were cleared in the name of urban renewal, and new housing regulations (zoning, plumbing, fire codes, etc.) resulted in nightmarish tenements being torn down. While these regulations raised the bar for the condition of housing structures, low income populations were left out. Housing was now more expensive to build and maintain, and single room occupancy (SROs) were significantly depleted - meaning that low income populations, or those without jobs altogether, had even fewer housing options.

1970-2000

Beginning in the 1970s, more shelters and service organizations sprang up to help fill this void, including Rosie's Place in Boston, the first shelter specifically for women. At the same time, several court cases established "right to shelter" and homeless assistance at the federal level. However, federal budget cuts for social service programs further exacerbated the problem - and the deinstitutionalization of mental health hospitals nationwide caused a major influx of homeless people. These vulnerable populations, those people most in need of care and attention, often had nowhere to go when they were forced out of the hospitals. This era was the beginning of modern homeless as we know it today: a chronic problem embedded in the system.

# data[].attributes.attachment_link.description
People experiencing homelessness can be individuals, children, or families.

# data[].attributes.attachment_link.readable_text
Keeping schools safe allows children to look forward to being in an encouraging environment that promotes social and creative learning. When their basic safety needs aren't met, children are at risk for not feeling comfortable at school and may stop showing up, or they may remain on edge throughout the day. Promoting school safety creates an open space for kids to explore, learn and grow.

Keeping Children Safe at School

A safe learning environment is essential for students of all ages. Without it they are unable to focus on learning the skills needed for a successful education and future. When violence is part of the educational setting, all students are affected in some way. Even though your child may not be the actual victim of violence in school, there is a very good chance that he or she will witness violent acts throughout the educational years. Research continues to illustrate children who feel unsafe at school perform worse academically and are more at risk for getting involved in drugs and delinquency.

The issue of school safety is a major concern at all levels of government, from local to federal. School boards meet with teachers and parents to listen to their concerns and suggest solutions. State and federal governments are taking steps to improve school safety and law enforcement as the nation realizes the importance of this issue and how it impacts children's futures.

Increased Violence in Schools

Although there are experts that say violence has always existed in schools, many are concerned about the increased number of violent acts taking place there. Some even argue violence in certain areas has reached epidemic proportions, desensitizing many students and leaving them feeling violence is a normal part of their school life. Sadly, violent acts in schools occur at all educational levels with 8 percent of students reporting they have been involved in at least one physical fight at school, and 6 percent reporting missing school at least once in a month long survey period because they did not feel safe.

Every child should feel safe from violence in their school, yet there are many that do not. Today, it is not unusual for students to violently attack other students, teachers, security guards, and school personnel, showing a complete lack of respect for authority. These attacks often result in injury and at times, death. Witnessing these acts can also cause intense fear and anxiety within other students as well as staff members, making the school environment a psychologically distressing place to be.

Prioritizing Digital Safety

With a higher number of teachers using technology to educate their students, the need to better understand and promote safe internet usage is critical. Online, children are at risk for being bullied by peers or anonymous users and being taken advantage of by adults preying on younger folks. Exposure to inappropriate content and disturbing images and language should also be considered when using computers or tablets in the classroom.

Safety online is just as important as physical safety. An estimated 55 percent of LGBT students report being cyber bullied, and 15 percent of high school students have experienced this as well. Kids who are in an environment where bullying takes place are more at risk for suicidal behaviors compared to students who are not exposed to bullying. Programs that support safe use of technology can greatly impact the mental health of the students using it.

Why Is School Safety Important?

When considering violence in schools, the horrific acts that occurred at Columbine High School, Virginia Tech, and Northern Illinois University come to mind. These incidents, and others like them, are some of the worst cases of violence in schools. It can be difficult to think about the increase of school violence and what that means for students.

School safety is important to protect all students and school personnel from violence that includes:

Assaults

Bullying

Victimization

Theft

Classroom disorder

Fights

Robbery

Use of weapons

Sexual attacks

Violent crime

The Need for School Safety

The following are a few of the many incidents that exemplify the need for school safety.

A first grader from Michigan shot and killed another first grade child.

A 14-year-old student attending a school in Ohio for high achieving students shot and killed two students and two teachers and then himself. The day before he had been suspended because of a fight with another student.

A Philadelphia kindergartner repeatedly punched his pregnant teacher in the stomach during an attack.

A teen from Milwaukee physically assaulted his teacher during class.

A California high school student threatened to shoot students at their school and was later taken into custody.

A pregnant teacher in Ohio was brutally attacked by a student.

In Texas, a ten year old boy was set on fire in the school playground by a group of kids.

Within two years of the Columbine High School shootings there were eight similar school attacks, each resulting in severe injuries and death.

The crisis of violence in schools has devastating effects. All necessary steps and precautions need to be taken to ensure the safety of all students. Zero tolerance policies and violence prevention programs need to be instituted in schools. Parents, schools and communities need to work together to take measures to make their schools a safe place for everyone.

Encouraging Healthy Environments

Safety in schools is necessary to support the academic success of each child, giving them the opportunity to learn and achieve in a safe and nurturing environment. Strict policies on school safety promote increased learning, feelings of school unity, higher levels of pro-social behavior and decreased levels of violence.

# data[].attributes.attachment_link.title
Why Is School Safety Important | LoveToKnow

# data[].attributes.attachment_link.description
Keeping schools safe allows children to look forward to being in an encouraging environment that promotes social and creative learning. When their basic safety needs aren't met, children are at risk for not feeling comfortable at school and may stop showing up, or they may remain on edge throughout the day.

# data[].attributes.attachment_link.readable_text
Following the Parkland school shooting, state lawmakers across the nation developed a newfound interest in a previously little-known means for separating volatile people from deadly weapons.

Red flag laws - also known as Extreme Risk Protection Orders (ERPOs) or Gun Violence Restraining Orders (GVROs) - enable law enforcement, and sometimes family members and other concerned parties, to petition a judge to remove guns from individuals who pose a threat to themselves or others. For more on the history of the policies, read The Trace's explainer .

Since Parkland, red flag laws have engendered support from lawmakers of both major political parties and groups on both sides of the gun-policy divide. In 2018, eight new red flag bills were signed into law.

Pushback from the NRA has slowed the advance of red flag laws in several state capitols, but the sustained enthusiasm for the measures remains striking.

Please scroll on to see the status of red flag laws in your state. We'll be updating this tracker as the legislative calendar progresses.

# data[].attributes.attachment_link.title
Red Flag Laws: Where the Bills Stand in Each State

# data[].attributes.attachment_link.description
Following the Parkland school shooting, state lawmakers across the nation developed a newfound interest in a previously little-known means for separating volatile people from deadly weapons. Red flag laws - also known as Extreme Risk Protection Orders (ERPOs) or Gun Violence Restraining Orders (GVROs) - enable law enforcement, and sometimes family members and other concerned parties, to petition a judge to remove guns from individuals who pose a threat to themselves or others.

# data[].attributes.attachment_link.readable_text
When RubySam Youngz was singled out by a bully at the age of 10 in her last year of primary school, she felt isolated and confused. She'd just moved with her family from England to Wales and the bully honed in on her accent. They then started mocking her appearance. "Nothing really made sense to me," she says. "I'm in a new place, I don't really know anyone, no one likes me, and I really do not know why."

Youngz says the relentless bullying, which continued through secondary school, had a knock-on effect in all areas of her life, and she took up smoking and drinking in an attempt to cope. Now aged 46, it is only in the past year that she has come to terms with the effect that the bullying had on her.

"I felt like 'no one else likes me, so I don't like me'," she says.

Her experience underlines a painful truth. Children, for all their innocence and inexperience of the world, can be some of the most vicious bullies. Their actions, perhaps less hindered by the social norms we learn in later life, can be merciless, violent and shocking. And they can have life-long implications for the victims.
You might also like:
* Can this technology put an end to bullying
* The transformational power of how you talk about your life
* What is the best way to stop internet trolls

But what makes a child become a bully?

"For the longest time, in the research literature, we thought there was just one type of bully: a highly aggressive kid that had self-esteem issues that may come from a violent home or neglectful home," says Dorothy Espelage, a professor of education at the University of North Carolina at Chapel Hill. That picture is now changing.

The definition of bullying that academic researchers have adopted states that it's a form of aggression between individuals or groups that have different levels of power. It perhaps fails to capture the terrible toll it can have on victims or the complex reasons why people become bullies in the first place. But one key element is the difference in power.

"It could be that you're bullying me, and you're popular, and I'm not popular, and that power differential makes it difficult for me to defend myself," says Espelage. While domestic violence and sibling aggression are still risk factors for children becoming bullies, they're not the only reason, she adds. Children who grow up in violent homes but go to a school with an anti-bullying programme and a supportive atmosphere won't necessarily become bullies.

Researchers' picture of the typical school bully has become more nuanced in recent years. Aside from the blunt and open aggressor, another more Machiavellian kind of bullying has come to be recognised. Children who fall into this category tend to have better social skills, are often charismatic and liked by teachers - far from the "oafish" stereotype of bullies. Crucially, these children can turn on and off their bullying to suit their needs.

"Socially dominant bullies want to be the leader of the crowd," says Espelage. "And the way that they do that is to push kids down the hierarchy."

Other research backs up this idea that bullying is often more about the bully themselves, rather than their victims. In a study of school children in Italy and Spain, pupils took part in an exercise that entailed thinking about a bullying situation from the point of view of the bully. The researchers also gave the children a questionnaire about their peers to categorise each child as either a bully, a victim or an outsider.

Those who were categorised as bullies by their peers were more likely to respond to the hypothetical bullying incident with statements that focused on how the incident affected the bully themselves (saying things like "I would feel great because I got the attention of other children!") or statements that showed a lack of empathy (such as "I don't feel guilty because I don't think about it" and "I would feel indifferent because the victim doesn't suffer").

Bullying has also taken on new forms in recent years. One common characteristic of bullying as previously defined by academics is that the aggression towards the victim is repeated. But the online world is blurring this due to the potential impact that just one instance of cyberbullying can have.

"Does it have to happen more than once, when you've posted something that's gone to a million people?" asks Espelage. "Probably not."

In fact, there's such a big crossover between school bullying and cyberbullying that some researchers argue they are becoming one and the same - especially now that children often have their phones with them in class. "In my research it was found that many times school bullies continue the harassment online," says Calli Tzani-Pepelasi, an investigative psychology lecturer at the University of Huddersfield. "They may be sitting next to each other but prefer to bully each other through social media, as that way their actions can be viewed by more and they feel a false sense of fame."

So what should you do if you think your child may be bullying other children?

Getting to the bottom of their motivations is a good first step. "If somebody called me and said your child is engaging in these behaviours, I would want to say [to the child], 'OK, what are you getting from that? Why are you doing this?'," says Espelage. "It may be that your child... is in a school where that's what they're expected to do."

It's also worth considering whether your own actions may be influencing your child's. "For some parents, their interpersonal style may be may be modelling that behaviour," she says.

One way to address school bullying could be a buddy system designed to foster peer support, where younger students are assigned an older mentee to show them the ropes when they start school.

"The fact that younger students have the opportunity to model the right behaviour from the older students" is one advantage of such a system, says Tzani-Pepelasi. But having a supportive school environment in general is also important when it comes to tackling bullying. "It takes a lot of persistence, and consistency from the teachers and the school staff in general, as without them the system cannot function," she says.

Espelage agrees that strong relationships between teachers and among peers are key. "What we know from our research is those schools where they pay attention to the issues of connectedness, making sure every kid feels like they belong in that school, there's less bullying," she says.

Often, though, that support isn't there. In 2014, Espelage and her colleagues published a five-year study showing a worrying link between bullying and sexual harassment in schools. It revealed that bullying among younger children often involves homophobic insults, which then escalates to sexual harassment in later school years.

But the children involved in sexual harassment - both the perpetrators and the victims - often didn't seem to understand how serious the incidents were, perhaps because teachers may not be stepping in to prevent them.

"That continuum of aggression from bullying, to homophobic name-calling, to sexual violence, to teen dating violence is real," says Espelage.

As for whether kids grow out of bullying once they leave school, Espelage says some may do so - or find a different outlet for their aggression - but not all. "I would argue, based on my experience, that some [school bullies] go into professions in which that type of behaviour works for them, whether that's a police officer, a professor at a university, a lawyer."

Perhaps saddest of all, however, is that the impact of bullying on victims can last for decades, leading to poorer physical and psychological health. Youngz, who was bullied throughout secondary school, has now trained as a grief recovery specialist, and hopes to be able to help others who have been through similar kinds of loss.

"The bullying has been part of that because it was loss of feeling normal, loss of trust, loss of safety and security," she says.

Her main bully contacted her via Facebook earlier this year to apologise. When she received the message, Youngz felt angry. "It did nothing for me at all personally to relieve any pain that she put me through," she says. "It might have helped her, I don't know."

But when it comes down to it, she thinks the apology - just like the bullying that had such a negative impact on her life - was really more about the bully than about Youngz herself.

"I have compassion towards her because I can understand maybe why she did what she did, because she may have been having troubles at home as well," she says. "But I'm not agreeing with what she did."

--
If you liked this story, sign up for the weekly bbc.com features newsletter, called "The Essential List". A handpicked selection of stories from BBC Future, Culture, Worklife, and Travel, delivered to your inbox every Friday.

# data[].attributes.attachment_link.description
Bullying behaviour often emerges in childhood, and the consequences for victims can last a lifetime. What makes a child become a bully?

# data[].attributes.headline
What are the Best Ways to Prevent Bullying in Schools?

# data[].attributes.subject
What are the Best Ways to Prevent Bullying in Schools?

# data[].attributes.attachment_link.readable_text
All 50 U.S. states require schools to have a bullying prevention policy.

But a policy, alone, is not enough. Despite the requirement, there's been a slight uptick in all forms of bullying during the last three years. Bullying can look like experienced basketball players systematically intimidating novice players off the court, kids repeatedly stigmatizing immigrant classmates for their cultural differences, or a middle-school girl suddenly being insulted and excluded by her group of friends.

Bullying occurs everywhere, even in the highest-performing schools, and it is hurtful to everyone involved, from the targets of bullying to the witnesses-and even to bullies themselves. October is National Bullying Prevention Month, so it's a good time to ask ourselves: What are the best practices for preventing bullying in schools? That's a question I explored with my colleague Marc Brackett from the Yale Center for Emotional Intelligence, in a recent paper that reviewed dozens of studies of real-world bullying prevention efforts.

As we discovered, not all approaches to bullying prevention are equally effective. Most bullying prevention programs focus on raising awareness of the problem and administering consequences. But programs that rely on punishment and zero tolerance have not been shown to be effective in the U.S.; and they often disproportionately target students of color. Programs like peer mediation that place responsibility on the children to work out conflicts can increase bullying. (Adult victims of abuse are never asked to "work it out" with their tormentor, and children have an additional legal right to protections due to their developmental status.) Bystander intervention, even among adults, only works for some people-extroverts, empaths, and people with higher social status and moral engagement. Many approaches that educators adopt have not been evaluated through research; instead, educators tend to select programs based on what their colleagues use.

We found two research-tested approaches that show the most promise for reducing bullying (along with other forms of aggression and conflict). They are a positive school climate, and social and emotional learning.

Building a positive school climate

School climate can be difficult to define, though possible to measure. It is the "felt sense" of being in a school, which can arise from a greeting, the way a problem is resolved, or how people work together; it is a school's "heart and soul," its "quality and character." Schools with a positive climate foster healthy development, while a negative school climate is associated with higher rates of student bullying, aggression, victimization, and feeling unsafe.

The elements of a positive climate may vary, but may often include norms about feelings and relationships, power and how it is expressed, and media consumption. Social norm engineering is a conscious process that builds a positive culture among student peers and school adults that becomes self-reinforcing. Like a healthy immune system, a positive school climate promotes optimal health and reduces the chances of dysfunction or disease.

Leadership is key to a positive climate. Is bullying minimized as a "normal rite of childhood," or is it recognized as the harmful peer abuse that it is? Do leaders understand that uninterrupted, severe bullying can confer lifelong negative consequences on targets of bullies, bullies, and witnesses? Are school leaders committed to promoting all children's positive psychological health, or do they over-rely on punishing misbehavior? Can they discern between typical developmental processes that need guidance versus bullying that needs assertive intervention? Are educators empathic to their students, and do they value children's feelings?

Next, are teachers prepared to deal with bullying? Students consistently report that teachers miss most incidents of bullying and fail to help students when asked. A majority of teachers report that they feel unprepared to deal with classroom bullying. Some teachers bully students themselves, or show a lack of empathy toward children who are bullied. Teachers report that they receive little guidance in "classroom management," and sometimes default to the disciplinary strategies they learned in their own families growing up.

However, reforming school climate should involve all stakeholders-students and parents, as well as the administrators and teachers-so a school's specific issues can be addressed, and the flavor of local cultures retained. School climate assessments can be completed periodically to track the impact of improvements.

Advancing social and emotional learning

Social and emotional learning (SEL) is well known, and involves teaching skills of self-awareness, self-management, social awareness, responsible decision making, and relationships management. (Full disclosure: Brackett and I are affiliated with the SEL program RULER.)

Evidence-based SEL approaches have been shown to deliver cost-effective, solid results. Numerous meta-analyses, research reviews, and individual studies of hundreds of thousands of K-12 students show that SEL improves emotional well-being, self-regulation, classroom relationships, and kind and helpful behavior among students. It reduces a range of problems like anxiety, emotional distress, and depression; reduces disruptive behaviors like conflicts, aggression, bullying, anger, and hostile attribution bias; and it improves academic achievement, creativity, and leadership.

A study of 36 first-grade teachers showed that when teachers were more emotionally supportive of students, children were less aggressive and had greater behavioral self-control, compared to the use of behavior management, which did not improve student self-control. One meta-analysis showed that developing emotional competence was protective against becoming a victim of bullying; social competence and academic performance were protective against becoming a bully; and positive peer interactions were protective against becoming a bully-victim (one who has been bullied and bullies others). A series of longitudinal studies showed positive effects into midlife (e.g., fewer divorces, less unemployment) and even cross-generational effects of early SEL. Compared to a matched control group, the children of the adults who participated in the Perry Preschool Project had less criminal involvement and higher educational and employment achievement. A cost-benefit analysis of six SEL programs found them to be good investments, with $11 saved for every $1 spent.

Teachers also benefit from SEL. Those with emotional and social skills training have higher job satisfaction and less burnout, show more positive emotions toward their students, manage their classrooms better, and use more strategies that cultivate creativity, choice, and autonomy in their students. Teachers report that they want more SEL support to cultivate their own emotional and social skills, and to better understand their students' feelings. But few teacher training programs focus on growing the teachers' emotion regulation skills.

Bullying at different age levels

SEL approaches should be developmentally wise, since what is salient and possible for children changes at different ages.

For example, preschoolers are expelled from school at the highest rates of all, but the neurological hardware for their self-control is only just developing. Only then are the connections between the emotion circuitry and the more thinking regions of the prefrontal cortex beginning to be myelinated (insulated for faster connectivity), something that will take until the mid 20s to complete. An SEL program like PATHS or RULER that teaches young children language for feelings, and strategies for thinking before acting, can develop better self-regulation.

Sometimes, adults confuse normal developmental processes with bullying. For example, children begin to reorganize their friendships midway through elementary school, something that can naturally create hurt feelings and interpersonal conflict. It should not be misconstrued as bullying, though, which involves intentional, repeated aggression within an imbalance of power. Normal development also includes experimenting with power, and these normal dynamics should be guided safely toward developing a healthy sense of agency, rather than a hurtful exertion of power over someone else.

Finally, the onset of puberty marks the beginning of heightened sensitivity to social relationships, an especially important time to cultivate skills for kinder, gentler relationships. Unfortunately, this is the period when bullying spikes the highest. And while some strategies work well for younger children (for example, advising them to "tell a trusted adult"), this option may fail with teens, and the breakpoint seems to be around the eighth grade. Older teens require approaches that are less didactic and leverage their need for autonomy, while affirming their values and search for meaning. Physiologically, the brain changes during puberty confer a second chance for recalibrating their stress regulation system. That opportunity should be constructively seized.

Approaches should also take into account individual differences between children. Even SEL programs can stumble here, over-relying on just one or two emotion regulation strategies, like breathing or mindfulness. But children vary in their temperaments, sensitivities, strengths, and vulnerabilities. The best SEL approaches guide students toward discovering strategies that work best for them-strategies that are emotion- and context-specific, personalized, and culturally responsive. This approach requires unconventional flexibility on the part of the educators.

And, finally, approaches work best if they are not standalone pedagogies or from kits that end up in the classroom closet at the end of the year. In order to be effective, skills should become fully embedded across the curricula and the entire day, in all settings, and implemented by all adults-in other words, infiltrating the ecosystem. Only approaches used and taught as intended are successful.

Schools can't do this alone

Families matter, too. Bullying in schools sometimes arises from harsh parenting practices or sibling bullying at home.

Even parents' workplaces matter. Adults experience bullying in their workplaces at about the same rate as children in schools, and it's even found among teachers and in senior living communities. In other words, bullying is not just a childhood problem; it is a pervasive human problem. And children are not buffered from the wider social world-bullying of children who belong to groups targeted in the national political discourse has spiked on playgrounds nationwide.

Ultimately, we need a substantial shift in our mindsets about the importance of children and their feelings. Children are more likely to thrive when we nurture their humanity, and offer them language and strategies and values to help them identify, express, and, thus, regulate their feelings. When parents, teachers, and administrators gain new awareness into the complex roots of bullying and adopt new strategies for addressing it, schools can lead the way. The kids are counting on us.

Greater Good wants to know: Do you think this article will influence your opinions or behavior?

# data[].attributes.attachment_link.title
What Are the Best Ways to Prevent Bullying in Schools?

# data[].attributes.attachment_link.description
A new study identifies the most effective approaches to bullying prevention.