Survey of LA homeless finds few want group shelter beds

Most surveyed have been unsheltered for years and have been offered housing in the past

Reports and Proceedings

RAND CORPORATION

A unique study conducting counts and surveys of unsheltered people in three parts of Los Angeles found that nearly half had been offered housing in the past, but they cited the housing intake process, desires for privacy and concerns about safety as obstacles they face in efforts to get off the streets, according to a new RAND Corporation report.

The count of unsheltered people conducted over four months in downtown’s Skid Row, Venice and Hollywood found a rising number of unhoused people in those neighborhoods, and most of those surveyed reported being continuously homeless for more than three years.

Around 80% of the unhoused people surveyed said that they would accept a private room in a shelter or hotel, a permanent stay in a motel- or hotel-like setting, or permanent supportive housing. About half would accept interim housing with access to services, shared housing or safe camping. Less than one-third would accept a group shelter or a recovery/sober living housing offer.

“We found a near-universal interest in obtaining housing among our survey respondents, but about half of those we spoke to remain unhoused, despite reporting being offered housing in the past,” said Jason M. Ward, the report’s lead author and an economist at RAND, a nonprofit research organization.

Those surveyed by RAND researchers indicated that they strongly prefer private housing, suggesting that increasing funding for congregate shelters -- as has been espoused by some policymakers -- might have a limited ability to effectively address street homelessness.

“The type of housing offered to unsheltered people matters a lot,” Ward said. “Our findings suggest that large expansions in shelter capacity in the city may do little to move unhoused people off the streets.”

The RAND project is the largest count of unhoused people in Los Angeles outside the annual point-in-time tally managed by the Los Angeles Homeless Services Authority.

The county-wide count, largely conducted by teams of trained volunteers on one evening each January, was cancelled in 2021 because of the COVID-19 pandemic. Results from the 2022 count, delayed until February, have not yet been released.

The RAND study, called the Los Angeles Longitudinal Enumeration and Demographic Survey (LA LEADS) Project, was conducted by the research organization’s professional survey staff. Counts for this ongoing project were conducted roughly every two weeks in Skid Row and monthly in Hollywood and Venice since late September 2021. The current report presents results of these efforts through January of 2022.

The RAND study found the total number of unsheltered people, vehicles, tents and makeshift structures averaged 1,358 in Skid Row, 685 in Hollywood and 523 in Venice. Over the four months of data included in the report, the total across these three areas increased by about 17%.

Researchers also conducted a survey that randomly sampled more than 200 unsheltered people across the three neighborhoods the study focused on.

The share of respondents in the RAND survey who identified as Black or African American  was 38% higher than the results of the 2020 demographic survey conducted by the Los Angeles Homeless Services Authority in these three locations, while the share of respondents identifying as Hispanic was 24% lower. Black people have been consistently overrepresented among the county’s unhoused residents and the results of the RAND study suggest this disparity may be growing.

Among the unsheltered people surveyed by RAND, more than 75% had been continuously homeless for more than a year and more than 50% percent had been continuously homeless for more than three years.

More than 75% of respondents had spent six months or longer living in the neighborhood where they were surveyed. Nearly 75% reported residing within California before their current location.

About 90% of survey respondents indicated interest in receiving housing, with nearly half reported being offered housing in the past and one-third indicating that they were currently on a housing waitlist.

The most commonly reported factors that prevented respondents from moving into housing in the past were never being reached to complete the housing intake process (41%), privacy concerns (38%) and safety concerns (32%).

“We hope that the unique methods being used in our count, as well as the results from our detailed survey of unhoused people, will help policymakers in developing effective strategies to addresses homelessness in Los Angeles County,” Ward said.

The LA LEADS project is ongoing and will publish future reports, including more-detailed results comparing the RAND findings to the annual count by the Los Angeles Homeless Services Authority.

The report, “Recent Trends Among the Unsheltered in Three Los Angeles Neighborhoods:

An Interim Report on the Los Angeles Longitudinal Enumeration and Demographic Survey (LA LEADS) Project,” is available at www.rand.org.

Support for the project was provided by the Lowy Family Group through its funding of the RAND Center for Housing and Homelessness in Los Angeles. Other authors of the report are Rick Garvey and Sarah B. Hunter.

The RAND Social and Economic Well-Being division seeks to actively improve the health, and social and economic well-being of populations and communities throughout the world.

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METHOD OF RESEARCH

Survey

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Recent Trends Among the Unsheltered in Three Los Angeles Neighborhoods An Interim Report on the Los Angeles Longitudinal Enumeration and Demographic Survey (LA LEADS) Project

ARTICLE PUBLICATION DATE

4-May-2022

Does the Earned Income Tax Credit encourage college enrollment?

Peer-Reviewed Publication

WILEY

The Earned Income Tax Credit (EITC)—a cash transfer program aimed at helping low to moderate income workers by giving them a break on their taxes—is not intended as a college subsidy, but the eligibility criteria for it incentivizes families sending children aged 19–23 years to college as this can increase EITC benefits by as much as $4,000 per year. An analysis in Economic Inquiry by researchers at the University of Illinois at Chicago found that in general, EITC recipients are not responding to this incentive as it does not appear to be increasing the rate of college enrollment.  

The results suggest that complex subsidies like this one embedded into the EITC may be ineffective at altering college going.  

“Both our study and past work suggest that tax credits are simply an ineffective way to encourage college enrollment because they are too complicated and involve a long delay between college enrollment and benefit receipt,” said corresponding author and PhD candidate Shogher Ohannessian. “Research suggests that if the tax credits were provided as grants instead of tax credits, we could substantially increase college enrollment rates at no additional cost,” added co-author Ben Ost, PhD. 

URL Upon Publication: https://onlinelibrary.wiley.com/doi/10.1111/ecin.13087 

Additional Information 

NOTE: The information contained in this release is protected by copyright. Please include journal attribution in all coverage. For more information or to obtain a PDF of any study, please contact:

Dawn Peters +1 781-388-8408 (US)
newsroom@wiley.com
Follow us on Twitter @WileyNews

About the Journal

Published since 1962, Economic Inquiry is a highly regarded scholarly journal in economics publishing articles of general interest across the profession. Quality research that is accessible to a broad range of economists is the primary focus of the journal. Join our long list of prestigious authors, including more than 20 Nobel laureates.

About Wiley

Wiley is a global leader in research and education, unlocking human potential by enabling discovery, powering education, and shaping workforces. For over 200 years, Wiley has fueled the world’s knowledge ecosystem. Today, our high-impact content, platforms, and services help researchers, learners, institutions, and corporations achieve their goals in an ever-changing world. Visit us at  Wiley.com, like us on Facebook and follow us on Twitter and LinkedIn.

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JOURNAL

Economic Inquiry

DOI

10.1111/ecin.13087 

ARTICLE TITLE

Do EITC Eligibility Rules Encourage College Enrollment?

ARTICLE PUBLICATION DATE

4-May-2022

Affirmative action bans had ‘devastating impact’ on diversity in medical schools, UCLA-led study finds

Peer-Reviewed Publication

UNIVERSITY OF CALIFORNIA - LOS ANGELES HEALTH SCIENCES

 

IMAGE: THE STUDY’S FINDINGS ARE TIMELY IN LIGHT OF MEDICAL SCHOOLS’ INCREASING EMPHASIS ON HEALTH EQUITY, INCLUDING A PUSH TO ENSURE GREATER DIVERSITY AMONG PHYSICIANS IN THE WORKFORCE. view more 

CREDIT: UCLA HEALTH

Link to abstract

https://www.acpjournals.org/doi/10.7326/M21-4312

New UCLA-led research finds that in states with bans on affirmative action programs, the proportion of students from underrepresented racial and ethnic minority groups in U.S. public medical schools fell by more than one-third by five years after those bans went into effect.

The findings are particularly timely given medical schools’ increasing emphasis on health equity, including a push to ensure greater diversity among physicians in the workforce.

The study will be published May 3 in the peer-reviewed journal Annals of Internal Medicine.

“We know that a more diverse physician workforce leads to better care for racial- and ethnic-minority patients,” said Dr. Dan Ly, the study’s lead author, an assistant professor of medicine in the division of general internal medicine and health services research at the David Geffen School of Medicine at UCLA. “But we have made such poor progress in diversifying our physician workforce.

“Our research shows that bans on affirmative action, like the one California passed in 1996, have had a devastating impact on the diversity of our medical student body and physician pipeline.”

The researchers examined enrollment data from 1985 through 2019 for 53 medical schools at public universities, focusing on students from underrepresented racial and ethnic groups: Black, Hispanic, American Indian or Alaska Native, and Native Hawaiian or other Pacific Islander. The authors studied medical schools at public universities, not private ones, because states’ bans on affirmative action applied to public postsecondary institutions.

Of the medical schools, 32 were in 24 states without affirmative action bans. And 21 were in eight states that banned affirmative action during that period — Arizona, California, Florida, Michigan, Nebraska, Oklahoma, Texas and Washington. Those states’ affirmative action bans were enacted from 1997 to 2013; Texas’ ban was reversed in 2003.

In the year before the bans were implemented, underrepresented students made up an average of 14.8% of the total enrollment of those states’ public medical schools. By five years later, the research found, enrollment of underrepresented students at those schools had fallen by 37%.

The authors note some limitations to their analysis. The data may have also captured the indirect effects of affirmative action on undergraduate admissions, public discussion of affirmative action bans may have affected medical school enrollment even before the bans were implemented, some students may not have fully identified with the mutually exclusive racial and ethnic groups defined by the study, and the researchers did not assess the possibility that some schools without bans did not consider race or ethnicity in their admission decisions.

But the findings could lead to a better understanding of the lag in diversifying the medical student body and the physician workforce.

“As our country has spent the last two years weaving through the twin pandemics of racial health disparities amplified by COVID-19 and structural racism at large, our findings are critically important,” said co-author Dr. Utibe Essien, an assistant professor of medicine at the University of Pittsburgh. “As we observed, affirmative action bans have resulted in a loss of underrepresented physicians, who could have been at the front lines of caring for vulnerable populations throughout the pandemic and helping to alleviate disparities in care.

“My hope is that our findings will help provide policymakers with the tools to push back against affirmative action bans, not just for the diversity of the physician workforce, but for the equal and just health of our society.”

The study’s other authors are Andrew Olenski of Columbia University and Dr. Anupam Jena of Harvard University.

 Affirmative action bans reduce diversity

in physician workforce, impact health

equity

Peer-Reviewed Publication

AMERICAN COLLEGE OF PHYSICIANS

Affirmative action bans reduce diversity in physician workforce, impact health equity

Abstract: https://www.acpjournals.org/doi/10.7326/M21-4312

A study of U.S. medical school enrollment data found that state bans of affirmative action policies significantly impact the percentage of underrepresented minority students enrolled in medical schools, which has important implications for the diversity of the physician workforce. The authors suggest that efforts to improve medical equity for patients should consider medical school admission policies an important target. The findings are published in Annals of Internal Medicine.

Increased diversity in the U.S. physician workforce can improve the health of patients from historically underserved communities. However, the percentage of practicing physicians who identify as being from these groups is low relative to their proportion in the U.S. population. Contributing factors may include state-level bans on the use of affirmative action policies. Few studies have evaluated the impact of these bans on public medical schools, and none have examined their longer-term effects and take into account more recent bans.

Researchers from the University of California, Los Angeles, the University of Pittsburgh, Columbia University, and Harvard University used publicly available data on state affirmative action bans to examine the association between such bans and the percentage of enrollment from underrepresented racial and ethnic groups at 21 public medical schools between 1985 and 2019. The schools were compared to public medical schools in states without affirmative action bans. The authors tracked the reported proportions of four mutually exclusive racial and ethnic groups that are underrepresented in medicine: Black, Hispanic, American Indian or Alaska Native, and Native Hawaiian or other Pacific Islander. They found that affirmative action bans were associated with a 5.5 percentage point decrease in enrollment of underrepresented students relative to control schools. Because underrepresented students accounted for approximately 14.8 percent of medical students in ban schools in the year before ban implementation, the 5.5 percentage point reduction implies an approximately 37% relative reduction in underrepresented students. According to the authors, these findings are important for understanding the overall lag in diverse representation of the medical student body and physician workforce. They also suggest that despite national efforts to improve enrollment diversity, state-level policy related to admissions is a critical factor.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the lead author, Dan P. Ly, MD, PhD, MPP, please email Enrique Rivero at ERivero@mednet.ucla.edu. To speak with the author from the University of Pittsburgh, Utibe R. Essien, MD, MPH, please contact Sarah Katz at katzsb@upmc.edu.

-------------------------------------------------

Also new in this issue:

Association Between SARS-CoV-2 Messenger RNA Vaccines and Lower Infection Rates in Kidney Transplant Recipients A Registry-Based Report

Ivan Zahradka, MD*; Vojtech Petr, MD*; Istvan Modos, MSc, PhD; Maria Magicova, MD; Ladislav Dusek, PhD; Ondrej Viklicky, MD, PhD

Original Research

Abstract: https://www.acpjournals.org/doi/10.7326/M21-2973  

 

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JOURNAL

Annals of Internal Medicine

DOI

10.7326/M21-4312 

METHOD OF RESEARCH

Data/statistical analysis

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Affirmative Action Bans and Enrollment of Students From Underrepresented Racial and Ethnic Groups in U.S. Public Medical Schools

ARTICLE PUBLICATION DATE

3-May-2022

US regions with lax gun control laws bear brunt of firearm injury costs

Injuries and costs highest in the poorer South, but federal state programme coverage lowest; Tantamount to an “anti-poor policy,” insist researchers

Peer-Reviewed Publication

BMJ

US regions with lax gun control laws are bearing the brunt of firearm injury costs, with tax- funded dollars providing almost half of the total, finds research published in the open access journal Trauma Surgery & Acute Care Open. 

Yet while firearm injuries and associated healthcare costs are highest in the poorer South, the federal state programmes, Medicare and Medicaid, cover only a third of these expenses, a situation that is tantamount to an “anti-poor policy,” insist the researchers.

Firearm injuries take a huge human and societal toll, amounting to an estimated US $229 billion every year in direct and indirect costs. Most (82%) of all those killed by firearms in high-income countries over the past decade lived in the United States. 

Firearm injury costs are affected by gun control laws, with policies varying by state. The researchers therefore wanted to find out the impact of gun control policies on costs and what proportion of these were covered by Medicare and Medicaid across the US.

They drew on data from the Nationwide Inpatient Sample (NIS) from the Agency for Healthcare Research and Quality for the years 2005 to 2015, to identify people admitted to hospital with firearm injuries.

The data were reported by region: Northeast; Midwest; West; and South. The Brady Gun Law Score was used to assess the effect of gun control laws by state. 

Between 2005 and 2015, 317,479 people were admitted to hospital with firearm injuries. Most (89%) were men; their average age was 31. Almost half of all those admitted were Black; more than 42% of admissions in the West were among people of Hispanic ethnicity. 

The South had the highest proportion—more than 42%---of hospital admissions; the Northeast had the lowest (17%). Comparable figures for the Midwest and West were 21% and 20%, respectively.

Firearm injuries cost US$7.77 billion in hospital admissions and readmissions between 2005 and 2015, with the US taxpayer stumping up a sizeable chunk (42%;US$3 billion) of the these costs.  

While just over a third of the US population lives in the South, this region generated over 41% (US$3.21 billion) of the total. On the other hand, the Northeast, where just under 18% of the population lives, contributed around 14% (US$1.98 billion) to the total. 

Medicare and Medicaid coverage, however, was lowest in the South: 34% compared with  56% in the Northeast, 40.5% in the Midwest, and 42% in the West. The South also had the highest proportion of self-paying patients. 

Southern states tend to be poorer and to have higher rates of cardiovascular and metabolic diseases, suggesting that the costs of firearm injuries disproportionately fall on those least able to pay for them, point out the researchers.

“The policy implications of this are readily apparent: regions with the least stringent firearm policies incur greater financial costs related to firearm injury,” they insist.

The researchers acknowledge that it wasn’t possible to allocate costs to specific states or account for healthcare costs beyond hospital admissions, but their figures are likely to underestimate the long term costs of care, drugs, and lost productivity, they say.

“Government insurance programs are fundamental lifelines for seniors and the poor while providing a safety net, although an inadequate one, for health costs,” they write.

“Policies that enable higher levels of gun availability while simultaneously rejecting expansion of healthcare coverage for poor, uninsured, or underinsured residents represent an anti-poor policy,” they add. 

Policy makers need to think again about the links between gun control laws and taxpayer funding, they conclude. 

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JOURNAL

Trauma Surgery & Acute Care Open

DOI

10.1136//tsaco-2021-000854 

METHOD OF RESEARCH

Data/statistical analysis

SUBJECT OF RESEARCH

People

ARTICLE TITLE

A decade of hospital costs for firearm injuries in the United States by region, 2005–2015: government healthcare costs and firearm policies

ARTICLE PUBLICATION DATE

2-May-2022

Opioid overdose death toll has risen more than 5-fold among Indigenous Americans over past decade

Type of opioid involved might have changed, but not underlying social factors driving trends

Peer-Reviewed Publication

BMJ

The opioid overdose death toll has risen more than 5-fold among American Indian and Alaska Native communities over the past decade, finds one of the first studies of its kind published in the open access journal BMJ Open.

The type of opioid involved might have changed over the years, but many of the underlying social factors driving these patterns have remained the same, point out the researchers.

Drug overdose deaths have more than tripled in the US since the turn of the century, with American Indian and Alaska Native peoples disproportionately affected.

But it’s not clear what the overall trends have been in overdose deaths from opioids alone or in combination with other substances in these groups, say the researchers. 

To plug this knowledge gap, they drew on US death records data from the Centers for Disease Control and Prevention spanning the period 1999 to 2019.

They looked specifically at overdose deaths for opioids alone, when combined with any other drug, and those related to opioids; for combinations of opioids and alcohol or methamphetamine or cocaine or benzodiazepines; and for specific types of opioids among American Indians and Alaska Natives aged 12 and older.

Analysis of the data showed that between 1999 and 2019, overdose deaths from opioids alone more than quintupled from 2.8 to 15.8 per 100,000 of the women and from 4.6 to 25.6 per 100,000 of the men. 

Overdose deaths in which opioids were involved increased steeply from 5.2 to 33.9 per 100,000 in total, and from 3.9 to 26.1 among the women and from 6.5 to 42.1 among the men. 

Overdose deaths due to opioids plus alcohol or benzodiazepines or methamphetamine also rose sharply among both the men and the women (respectively, 1.1 to 4.2, 1.1 to 2.6, and  0.6 to 6.7) while those for opioids plus cocaine rose substantially only among the men (1.2 to 3.2). 

Analysis of death rates attributable to specific types of opioid showed that those caused by heroin, natural and semi-synthetic (prescription) opioids (oxycodone, hydrocodone), and synthetic opioids (fentanyl, tramadol) other than methadone increased significantly as well.

Death rates due to synthetic opioids other than methadone, in particular, have soared in recent years, rising from 1.5 per 100,000 in total in 2013 to 12.5/100,000 in 2019, with rates in the men rocketing from 1.5 to 16.5 during this period.

Overdose deaths peaked among 25 to 44 year olds for opioids alone and when combined with any other drug. These rates were as high, or even higher, than those among other ethnic groups, although most recently there are signs that these patterns might be changing. 

Aside from increasing the risk of an overdose, using opioids plus other substances is associated with higher rates of relapse, emphasising the need to tackle the root causes of such polysubstance use, say the researchers.

“These findings highlight existing inequities in drug related deaths and may point to broader systemic factors that disproportionately affect members of [American Indian and Alaska Native] communities,” who continue to grapple with poorer prospects, racism, and the legacy of colonisation, while still facing significant challenges in access to good quality treatment, they point out. 

“While the type of opioid driving these trends has changed over the years, many underlying social factors that drive these patterns have not,” write the researchers.

“Interventions for [American Indian and Alaskan Native] populations with substance use disorders will be more impactful if they are comprehensive, culturally centred, and address social determinants of health, including socioeconomic factors and racial and ethnic discrimination,” they conclude.

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JOURNAL

BMJ Open

DOI

10.1136/bmjopen-2021-053686 

METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Epidemiological trends in opioid-only and opioid/polysubstance-related death rates among American Indian/Alaska Native populations from 1999 to 2019: a retrospective longitudinal ecological study

ARTICLE PUBLICATION DATE

2-May-2022

NEOLIBERAL HEALTHCARE

The policy dominance of Universal Health Coverage

Researchers trace the history and growing influence of Universal Health Coverage as a policy that does not assure equal access to health services

Peer-Reviewed Publication

BOSTON UNIVERSITY SCHOOL OF MEDICINE

(Boston)—What policy is the best approach for developing health systems in low- and middle-income countries?

Researchers at Boston University School of Medicine (BUSM) and the University of New Mexico report that Universal Health Coverage (UHC), has come to dominate discussions around how best to reform low- and middle-income countries’ (LMIC) health systems.

The researchers believe these findings are important because UHC reforms don’t necessarily entail equal and equitable access to services for the entire population regardless of ability to pay, as is the case in other possible health system reforms such as National Health Services that provide care without insurance companies involved or copayments that block access.

The study examined the history of UHC and found its popularity stemmed from the concerted efforts of multiple institutions such as the World Bank, International Monetary Fund and World Health Organization.

“The roots of UHC can be traced to policies enacted by international financial institutions such as the World Bank and International Monetary Fund during the latter half of the twentieth century that caused the debt of low- and middle-income countries (LMIC) to rise precipitously and public sector services to become underfunded,” explains corresponding author Daniel Smithers, a fourth-year medical student at BUSM.

According to Smithers, these same institutions and others such as the World Health Organization (WHO) then advocated for UHC as a method for reforming the health systems of LMICs. Generally, UHC implies a financial reform in which health insurance is expanded in varying degrees to segments of a population and can entail the involvement of private for-profit corporations in the provision of health insurance.

Using both quantitative and qualitative analysis, the researchers found that UHC was mentioned in the health policy literature far more frequently than other health policy options that entail public funding and delivery of health services. When UHC was mentioned in a publication, more than 40 percent of the time the definition used by the authors was sufficiently vague that the definition could be open to misinterpretation or misunderstanding by less informed readers.

The study looked at not only whether UHC was defined in a paper, but also how it was defined. Greater than 40 percent of definitions mentioned finances with respect to UHC, and definitions focused almost entirely on individual-level financial issues. However, these discussions did not suggest that individuals should face no out-of-pocket costs, such as copayments, nor did they touch on other financial aspects of health system reforms such as global budgeting or socialization of health insurance. Over a quarter of definitions also discussed tiering of benefits which could entail differing benefits for the poor and non-poor.

“When a policy such as UHC predominates in the literature to this extent, it’s very important to examine its history critically, how it’s defined, and who’s involved in pursuing it. Policy isn’t crafted in a political, economic or social vacuum,” added Smithers, who in June will start his internal medicine residency in Boston at Beth Israel Deaconess Medical Center, a teaching hospital of Harvard Medical School.

“There are many other organizations advocating for equitable health system reforms in LMICs beyond the dominant transnational organizations such as the World Bank and WHO,” said senior author Howard Waitzkin, PhD, MD, a Distinguished Professor Emeritus at the University of New Mexico. “The People’s Health Movement, the Latin American Social Medicine Association (ALAMES), and Physicians for a National Health Program in the United States are organizations that advocate for alternative health system reforms such as Health Care for All, a single national health program in which access and services don’t differ for any groups in a population. It’s imperative that arguments for UHC not detract attention from these more fundamental and equitable ways to assure universal access to care.”  

These finding appear online in the journal Social Science & Medicine.

Smithers DJ, Waitzkin H. Universal health coverage as hegemonic health policy in low- and middle-income countries: A mixed-methods analysis. Social Science & Medicine, https://doi.org/10.1016/j.socscimed.2022.114961

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JOURNAL

Social Science & Medicine

METHOD OF RESEARCH

Data/statistical analysis

ARTICLE TITLE

Universal health coverage as hegemonic health policy in low- and middle-income countries: A mixed-methods analysis

ARTICLE PUBLICATION DATE

2-May-2022

Research exposes long-term failure of Russian propaganda in Ukraine’s Donbas region

Reports and Proceedings

UNIVERSITY OF CAMBRIDGE

A study of thousands of stories from media outlets churning out propaganda in Ukraine’s Donbas in the years after Russia’s first invasion suggests that the Kremlin’s disinformation campaign has long neglected any coherent or convincing messaging to foster support for Russia in the war-torn region.

After 2014, when news media in the so-called “People’s Republics” of Donetsk and Luhansk that make up much of Donbas were forcibly taken over by Russian-backed insurgents, efforts to instil a pro-Russian “identity” were lazy and half-baked, and dwindled to nothing within months.

This is according to University of Cambridge researcher Dr Jon Roozenbeek, who says that – based on his analysis of over four years of media content – such limited efforts likely had little effect on the consciousness of Russian-speaking Ukrainians in Donbas.

For example, Vladimir Putin has long trumpeted the idea of “Novorossiya”, or ‘New Russia’, in an attempt to resurrect terminology once used to describe Donbas during the reign of Catherine the Great, when it temporarily sat within the Russian Empire, and claim the region belongs in Russia.

While waves of propaganda demonised Ukraine’s government, the study shows that “Novorossiya” was hardly mentioned, and Russian disinformation lacked any real “in-group” story, the ‘us’ to oppose a ‘them’ – a fundamental flaw in any attempt to generate lasting division, says Roozenbeek.

Instead of identity-building, almost the entire Russian propaganda effort relied on portraying the leadership in Kyiv as fascistic – the basis of outlandish “denazification” claims – to create what psychologists call an “outgroup” on which to focus hostility.

However, as Russia shifts its war onto Donbas, Roozenbeek cautions that it may turn to spreading Novorossiya-style propaganda narratives in the region and far beyond to justify land seizure and war atrocities, and claim that these actions are supported by local populations.

He calls for a pre-emptive global debunking – or ‘pre-bunking’ – of the notion that ideological projects such as ‘Novorossiya’ have deep roots in the region, and that the people of Donbas have ever bought into these myths.

Otherwise, he says, we risk such falsehoods taking hold in the West via pundits and politicians who tow the Kremlin line. Roozenbeek’s findings are publicly available for the first time today on the University of Cambridge website.

“Eight years of Russian propaganda have failed to provide a convincing alternative to Ukrainian nationhood in eastern Ukraine,” said Roozenbeek.

“The Kremlin's decision to favour outgroup animosity over in-group identity building, and its vast overestimation of the extent to which its lies about non-existent Ukrainian ‘fascists’ promoted pro-Russian sentiment, are key reasons why the invasion has been a strategic and logistical disaster.”

“If the nonsense of Novorossiya or other half-baked ideological narratives start to spread in the West, it could end up being used to pressure Ukraine into relinquishing large swathes of its territory, as a drawn-out war in the Donbas causes the global community’s nerves to fray,” he said.  

For his PhD research, Roozenbeek used ‘natural language processing’ to algorithmically comb through over 85,000 print and online articles from 30 local and regional media outlets across Luhansk and Donetsk between 2014 and 2017, charting the patterns of content through use of key words and phrases in the wake of the first Russian invasion of Ukraine.

While half the coverage in print media remained “business as usual” – sport, entertainment, etc – some 36% was dedicated to the “shaping of identity” via propaganda. Much of this was done through parallels to World War II: the Donbas war as an attack by Ukrainian “neo-Nazis”.    

Only one newspaper paid any attention to Putin’s adopted concept of “Novorossiya”. Obvious opportunities to leverage history for identity-building propaganda were missed, such the fact that part of Donbas declared itself a Soviet republic in 1918, or indeed any mention of the Soviet Union.

“Description of an in-group identity that situated Donbas as part of the ‘Russian World’ were almost entirely absent from the region’s print media,” said Roozenbeek.

This pattern was largely replicated in online news media, which were arguably more ferocious in attempts to demonise the “outgroup” Kyiv government – including using English language to try and spread propaganda internationally – while ignoring a pro-Russian “this is us” identity. 

Roozenbeek found a handful of stories covering “patriotic” cultural events organised by the Kremlin-owned leadership in Luhansk, but even here the in-group identity was “lazily assumed”, he says, rather than established.          

All this despite the fact that a “blueprint” strategy for propaganda in Donbas explicitly called for the image of a benevolent Russia to be cultivated by emphasising the “Russian World” philosophy.

This strategy, leaked to German newspapers in 2016, is widely believed to be the work of Vladislav Surkov, the Kremlin’s former propagandist-in-chief, often dubbed Putin’s puppet master. It describes the need to construct and promote an ideology of “cultural sovereignty” in Russian-occupied Donbas, one that can act as a stepping stone to statehood.

“Despite the importance given to constructing identity and ideology after the Russian-backed takeover in Luhansk and Donetsk, including as directed by the Kremlin, very little in-group identity was promoted,” said Roozenbeek.

“What identity-building propaganda I could find in Donbas after 2014 was vague, poorly conceived, and quickly forgotten. Political attempts to invoke Novorossiya were cast aside by the summer of 2015, but such weak propaganda suggests they didn’t stand much chance anyway.”

“Putin has severely underestimated the strength of Ukrainian national identity, even in Donbas, and overestimated the power of his propaganda machine on the occupied areas of Ukraine.”        

Roozenbeek’s research was conducted for his PhD between 2016 and 2020, and will feature in his forthcoming book ‘Influence, Information and War in Ukraine’, due out next year as part of the Society for the Psychology Study of Social Issues book series Contemporary Social Issues, published by Cambridge University Press.

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METHOD OF RESEARCH

Data/statistical analysis

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

Media and Identity in Wartime Donbas, 2014-2017

ARTICLE PUBLICATION DATE

3-May-2022

Disclaimer: AAAS 

Lessons from the Tuskegee experiment, 50 years after unethical study uncovered

Research regulations will never substitute for the conscience of the investigator, says Dr. Martin Tobin, author of new paper in the American Journal of Respiratory and Critical Care Medicine

Peer-Reviewed Publication

AMERICAN THORACIC SOCIETY

 

IMAGE: DR. MARTIN TOBIN REVISITS THE TUSKEGEE SYPHILIS STUDY WITH A FRESH, NEW PERSPECTIVE. view more 

CREDIT: ATS

LIVE PRESS EVENT:  Join Dr. Tobin for a Q & A on this paper at 1:00 p.m. ET on April 28. Register now.

New York, NY – April 28, 2022 – This year marks 50 years since it came to light that the nation’s leading public health agency, the Public Health Service, conceived an unethical “research study” - the Tuskegee Experiment – that lasted for 40 years. The participants? Black men in a rural community in the South who existed in a state of quasi-slavery, making them extremely vulnerable and the agency’s treatment of them that much more sickening.

In “Fiftieth Anniversary of Uncovering the Tuskegee Syphilis Study: The Story and Timeless Lessons,” Martin Tobin, MD, former editor of the American Journal of Respiratory and Critical Care Medicine (AJRCCM), revisits this dark period in American history, expertly illustrating how present-day health disparities have roots in the racism that made the Tuskegee study possible.

The inhumane treatment doctors inflicted on the 400 men who participated in the study only ended after a social worker shared his discovery with the media in 1972. Subsequently, the government took measures to protect patients enrolled in research. Those measures are not enough, argued Dr. Tobin: “All of the research regulations in the world will never substitute for the conscience of the investigator.”

In the paper, published in the AJRCCM, Dr. Tobin stressed “the three central lessons of the Tuskegee Study for researchers (and for people in every walk of life):  the importance of pausing and examining one’s conscience, having the courage to speak, and above all the willpower to act.”

He added, “It is easy to articulate these steps but carrying out the steps requires a willingness to place oneself in jeopardy – a willingness to risk getting into trouble with supervisors and even losing one’s job.”

 Whether you are a student embarking on a career in medicine or a seasoned professionals in health care, one could argue that the Tuskegee experiment is an exceptional way to learn about research ethics.

“Readers can acquire a better understanding of research ethics by reading about the Tuskegee Study than by reading about abstract principles of research integrity in a bioethics textbook,” pointed out Dr. Tobin. “The story provides a vivid narrative with real live characters – victims, villains and a hero– and readers can relate these characters to people they encounter in their daily lives.”

While there are no published studies showing a correlation between the Tuskegee Experiment and the erosion of public trust, particularly among African Americans, it is tempting to think there is.

 The COVID-19 pandemic has laid bare the discrepancies in health care access as well as the staggering difference in mortality rates between Black and white individuals in the U.S. Social media communities are rife with rhetoric lambasting scientists and defending their refusal to get vaccinated.  There is no peer review process on social media platforms, making them ideal places for conspiracy theories and misinformation to proliferate.

“A considerable portion of vaccine hesitancy, however, reflects a real decrease in trust in physicians and scientists – and especially in physicians with links to government,” said Dr. Tobin.

Science is at its best when it invites critical thought and makes room for meaningful dialogue and self-examination. Silence can be deadly. And, when scientists around the world failed to criticize the Tuskegee Study’s methods or question the integrity of the lead investigators, they jeopardized the integrity of the entire medical profession, contributed to the deaths of the participants and extended the suffering of family members.

“Medical societies, including the ATS, can educate members about research integrity and health equity by publishing articles pertinent to these topics and by featuring these topics at their major meetings,” said Dr. Tobin.

At the upcoming ATS 2022 International Conference May 13-18, attendees can attend presentations that address health equity and disparity and engage colleagues on these issues in relation to their practice and research interests.

“ATS is strongly committed to creating a just and equitable future,” said ATS President Lynn Schnapp, MD, ATSF. “As a medical society, we must always question how our own biases, whether conscious or unconscious, impact our activities and prevent us from keeping the needs of our patients front and center. We must actively work towards dismantling the structural racism that allowed studies like the Tuskegee Syphilis Study to begin and persist.”  

Contact for Media:
Dacia Morris
dmorris@thoracic.org

About the American Journal of Respiratory and Critical Care Medicine

The AJRCCM is a peer-reviewed journal published by the American Thoracic Society. The Journal takes pride in publishing the most innovative science and the highest quality reviews, practice guidelines and statements in pulmonary, critical care and sleep medicine. With an impact factor of 21.4, it is one of the highest ranked journals in pulmonology.

About the American Thoracic Society

Founded in 1905, the American Thoracic Society is the world's leading medical society dedicated to accelerating the advancement of global respiratory health through multidisciplinary collaboration, education, and advocacy. Core activities of the Society’s more than 16,000 members are focused on leading scientific discoveries, advancing professional development, impacting global health, and transforming patient care. Key areas of member focus include developing clinical practice guidelines, hosting the annual International Conference, publishing four peer-reviewed journals, advocating for improved respiratory health globally, and developing an array of patient education and career development resources.  Please visit our website to learn more.

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JOURNAL

American Journal of Respiratory and Critical Care Medicine

METHOD OF RESEARCH

Commentary/editorial

SUBJECT OF RESEARCH

People