Chile's Boric reshuffles cabinet after constitution loss

Chile's President Gabriel Boric shook up his cabinet Tuesday in an effort to relaunch his government less than 48 hours after he was dealt a resounding blow when citizens overwhelmingly rejected a new progressive constitution he had championed.


Chile's Boric reshuffles cabinet after constitution loss© Luis Hidalgo, AP

Boric, 36, changed the leadership of five ministries in what marked the first cabinet shake-up since he became Chile’s youngest president in March and has since suffered a precipitous plunge in his approval ratings.

“I’m changing this cabinet, thinking about our country,” Boric said, qualifying the shake-up as “painful but necessary.”

“This is, maybe, I don’t think I have to hide it, one of the most politically difficult moments that I’ve had to face,” he aded.

The shake-up does not come as a surprise. Boric, who had been a big proponent of adopting the proposed constitution, had previewed there would be changes coming to his administration during a televised address Sunday night, shortly after results showed Chileans had voted overwhelmingly against the proposed constitution.

The opposition had also said they were expecting changes to Boric’s team with some conservative leaders refusing to meet with the president to begin talking about a new constitutional process until there was a change in his government.

While the press waited for Boric to unveil his new ministers, sirens could be heard and the smell of tear gas was evident from a nearby protest as hundreds of students marched through the streets of Chile’s capital of Santiago.

There were isolated clashes between demonstrators downtown with law enforcement that tried to disperse protesters in what marked the first important street demonstration since the constitution lost in Sunday’s plebiscite.

Izkia Siches, the former interior minister, was the biggest name to leave the cabinet but probably the most expected as her tenure had been marked by controversy. Carolina Tohá is taking her place.

Another strong Boric ally, Giorgio Jackson, was ousted from the post of secretary general of the presidency and will take on the role of social development minister. Ana Lya Uriarte is taking his place.

Boric also swore in new health, energy and science ministers.

Although polls had predicted Chileans would vote against the proposed constitution, the 24-point margin of victory for the rejection camp was a shocking repudiation of a document that was three years in the making and crafted by a constitutional convention that had been engulfed in controversy.

“We must listen to the voice of the people and walk alongside the people,” Boric said.

The process to write the constitution that Chileans rejected on Sunday began in 2019, when the country exploded in student-led street protests sparked by a hike in public transportation prices that quickly morphed into broader demands for greater equality and more social protections.

The following year, just under 80% of Chileans voted in favour of changing the constitution. Then in 2021, they elected delegates to a constitutional convention to write a new charter that would replace the one imposed by a military dictatorship led by Gen. Augusto Pinochet 41 years ago.

Boric had been a big proponent of the document that would have enshrined a string of new rights and at least some voters saw the plebiscite on the constitutional proposal as a referendum on his administration.

Despite the rejection, political leaders on all sides, as well as Chileans as a whole, largely agree that the constitution needs to change but it remains unclear how a new proposal will be written.

Whatever document the new convention comes up with is also likely to be far less ambitious than the 388-article proposed charter. The charter draft characterised Chile as a plurinational state, would have established autonomous Indigenous territories, prioritized the environment and gender parity and introduced rights to free education, health care and housing, among other issues.

Shame, Misery As Pakistan Floods Leave Many Without Toilets

The stench of decay hangs over a makeshift camp in Pakistan's south, where hundreds of locals have sought shelter from the devastating monsoon floods that have put nearly a third of the country under water.

September 07, 2022

Fazilpur, Pakistan (AFP): The stench of decay hangs over a makeshift camp in Pakistan's south, where hundreds of locals have sought shelter from the devastating monsoon floods that have put nearly a third of the country under water.

In Punjab province, dozens of tents are perched in the area around a small rural railway station -- the only dry land on a horizon of water, reached only by a sliver of road.

The odour is a heady mix of rotting vegetation from drowned crops, leftover food scraps and garbage -- as well as the accumulated excrement of the hundreds of people and livestock gathered there.

"There is no place for showering or going to the bathroom," said Zebunnisa Bibi, forced to flee with her family two weeks ago when floodwater inundated her village.

Similar tent camps have mushroomed across the south and west of the country. The worst flooding in the country's history has covered an area the size of the United Kingdom and affected 33 million people -- one in seven Pakistanis.

A lack of functioning toilets at these camps is one of the biggest issues -- posing a health hazard for all, but misery in particular for women and girls.

Rural Pakistan is home to extremely conservative Muslim communities, and many displaced women are having to live in close proximity to men who aren't relatives for the first time in their lives.

"We used to live behind the veil, but God has removed that for us," said Zebunnisa, referring to the strict segregation between the genders that is practised in rural Pakistan.

'Deeply ashamed'

She said she was "deeply ashamed" at having to relieve herself in the open -- especially after she caught a man watching her as she lowered her shalwar kameez behind a tree.

Shameen Bibi expressed similar sentiments.

"Where can I send my daughters alone? When we squat to relieve ourselves, we get scared that some man might come."

Swarms of flies and mosquitoes add to the misery, creating an environment ripe for a breakout of disease and infection.

Some women have stopped venturing into the floodwater to relieve themselves after many developed rashes.

Ehsan Ayaz, a volunteer doctor who arrived at the campsite in Fazilpur as AFP visited, said the lack of toilets was "the main reason" for the rise in cases of skin infections and stomach flu he treated.

Shameen and her daughters now drink as little water as possible during the day, preferring to spend hours in discomfort rather than be forced to relieve themselves where they can be seen.

When the sun sets and darkness descends on the camp, the women search for a secluded spot away from flickering campfires.

They take turns to keep watch and warn away any encroaching men.

"I don't know what we can even do if someone does decide to come and take advantage of us," said Shameen.

There is also another threat.

At night, said Shameen, "snakes and scorpions come out from the water".

NEGEV DESERT WINEMAKERS SHOW WAY AHEAD IN ISRAEL'S HOT CLIMATE

ENVIRONMENT 07.09.2022

Negev desert winemakers show way ahead in Israel's hot climate / Photo: © AFP

In Israel's Negev desert, winemakers are sharing their knowledge of growing vines in the blistering heat with European producers also facing fierce temperatures this summer.

Walking between rows of ripe grapes growing from the scorched land, David Pinto enthuses about how his vineyard has come of age in the past three years.

"We're masters of the conditions, without depending on the whims of the weather," said Pinto, whose estate near the town of Yeruham carries his name.

With nearly year-round sunshine and little rain in the barren Negev, Pinto has adopted a micro-irrigation system to conserve resources and drip water slowly onto the vines.

Such techniques may soon need to be used across the Mediterranean region, with winemakers in France forced to start picking earlier than usual due to an exceptionally dry and hot summer.

"Winemakers from Bordeaux came to visit us following the heatwave in France," said Pinto, who advised his guests on ways to adapt to climate changes.

"Now we share the same challenges, with the extreme climate and the dryness that harms the grapes," he added, while workers plucked grapes in the early morning light.

Israel's greener north has long been the centre of its viniculture, but more pioneering winemakers are discovering its sun-baked south.

Pinto, whose wines sell for 89 shekels ($26), is one of more than 25 wineries now dotted across the desert landscape.

They include Ramat Negev, adjacent to the Egyptian border, and Nana, located near the vast crater-like formation of Makhtesh Ramon.

- Enduring extreme heat -

Ilan Abitbol, who advises various Israeli winemakers, is busy creating a variety of blends on a small plot of land.

"The temperature of the Negev gives a particular identity to the region's wines: more dry, stronger in alcohol," he said.

Pinto's Malbec, for example, brings a weighty 14.5 percent alcohol volume to the table.

"We're used to extreme temperatures, whereas in Europe, the climatic changes have an impact on the vines, because they're not used to these temperatures," said Abitbol.

For Yaakov Oriya, Pinto's winemaker, there are unique opportunities in a desert region, where wine has been produced for centuries since Byzantine times.

"When you're faced with a different land like this, you can create different wines," he said, including dessert and sparkling varieties.

"We're not the first to make wine in this region but making the desert bloom remains a wonderful objective," said Oriya.

On the Pinto estate, where sturdy olive and argan trees also grow, the family is expecting to produce 55,000 bottles this season.

Beyond their own commercial gains, Jimmy Pinto, David's father, said the wine industry can boost the wider economy in the sparsely-populated desert.

"Creating a winery here in Yeruham contributes to our efforts to develop the region," he said.

Jimmy Pinto likened the years-long work in the fields to an educational network he has developed for children in remote areas.

"It's a great challenge, but in the same way that we think that the children of this region can be better, we want to produce a wine that will be the best," he said.

"And in these two areas, it takes time before you see the fruits of your investment."

F. Dumont--BTZ

One century on, cult of Mussolini persists in Italy


Brigitte HAGEMANN
Sun, September 4, 2022 


One hundred years after he took power, the cult of Benito Mussolini persists in the small Italian town of Predappio, where his tomb draws tens of thousands of visitors each year.

Many are just curious but others are driven by nostalgia for a past that weighs heavily on the party tipped for victory in the general election on September 25 -- Giorgia Meloni's post-fascist Brothers of Italy.

A white marble bust of "Il Duce" adorns the crypt in the family chapel in the cemetery of this northeastern town, where Mussolini was born, while his sarcophagus is draped with the tricolour Italian flag.

"We will never forget you!" says one message in the gold book of condolences, while others say: "We will be reborn" and "Come back!"


One young visitor with a shaved head, visibly moved, brushed the tombstone with one hand before giving the Fascist salute to the man described on one of the ribbons in the crypt as the "father of the country".

Others who came with their families took a more nuanced view of the legacy of Mussolini, who took power after the so-called March on Rome in October 1922 before installing a dictatorship in 1925 that lasted until 1943.


"Mussolini was a great statesman. He promoted labour law and social protection. But he made mistakes with his alliance with Hitler and the shameful racial laws," said Fabiana di Carlo, a 42-year-old civil servant visiting from Rome with her daughter.

Her view is typical of many Italians, who draw a line between what Mussolini did before and after his alliance with the Nazis and Italy's entry into World War II.

An IPSOS survey last year found 66 percent of Italians between 16 and 25 agreed the Fascist regime was "a dictatorship to condemn in part but which also brought benefits".
- Nostalgic attitudes -

The legacy of Fascism is being reexamined in this centenary year due to the surge in support for Meloni.

Her party grew out of the Italian Social Movement, which was itself founded by Mussolini supporters after his death in April 1945.

In Predappio, many visitors said they would be voting for Meloni.


They included di Carlo, who said the Brothers of Italy leader was "intelligent and competent", and voiced hope she would become Italy's first female prime minister.

Meloni insists there is "no room for nostalgic attitudes of Fascism" in her party -- which advocates a eurosceptic, nationalist Christian programme -- although it has rejected calls to remove the MSI's tricolour flame from its logo.

Her likely ascent to power is causing concern both at home and across Europe. But she is polling at around 24 percent, as part of a right-wing coalition that together commands around 47 percent support.

"I don't think there is any risk of returning to historic Facism," said Gianfranco Miro Gori, a local leader of the National Association of Italian Partisans, the name for the WWII anti-fascist fighters.

"But it is possible there will be a crackdown in the authoritarian sense and a restriction of freedoms, such as freedom of the press," he said.

However, 39-year-old Ivano, an admirer of Mussolini who works in a vineyard in Cuneo in northwest Italy and was visiting Predappio, insisted there was nothing to fear from Meloni.

"She isn't Fascist. She's Atlanticist and anti-Putin," he said.
- Fascist souvenirs -

Mussolini's tomb draws more than 70,000 visitors a year and there is a lively tourist trade in Predappio, where numerous shops sell fascist souvenirs.

There are "anti-Communist" bracelets, swastikas, bottles of wine adorned with the dictator's image, posters proclaiming "Italy for the Italians" and even a "Fascist Handbook".

A 40-something couple from Milan, Giovanna and Alessandro, left one shop bearing a Mussolini calendar.

"We are hoping for a Meloni win in the election. She will enforce respect for the rules and security," Alessandro said.


Near the home where Mussolini was born and where his father had a blacksmith's workshop, an exhibition dedicated to the March on Rome takes visitors through the dark history of Facism.

Among 170 objects borrowed from private collectors, there are uniforms, bladed weapons, guns and yellowed photos that illustrate the insurrection by Mussolini's blackshirts, their links to the Catholic church and industry.

"It's a cultural event which, in an objective, documented manner, invites us to reflect on what the March on Rome was. It's not an apology for Fascism," said Franco d'Emilio, one of the exhibition's curators.

The goal is to "make Predappio known for what it is -- that is, the Italian capital of the history of Fascism", commented Francesco Minutillo, a former leader of Brothers of Italy.

 

 

COAL VS. GREEN GLOWING ENERGY

Germany's nuclear stay fails to quell debate

Sebastien ASH
Tue, September 6, 2022 


Germany's decision to keep two atomic plants on standby through the winter amid a power crunch has exposed cracks in the government and unleashed criticism from economic and energy experts.

The major u-turn in government policy was made after a second stress test to assess Germany's energy security as Russia reduces gas supplies to Europe.

Germany's three remaining nuclear plants were set to be retired at the end of the year. Instead, two of the fleet will be kept in reserve "until mid-April 2023 in case needed", Economy Minister Robert Habeck said on Monday.

But the decision has become a "stress test for the coalition" of Chancellor Olaf Scholz's Social Democrats, Habeck's Greens and the liberal FDP, according to the Sueddeutsche Zeitung daily.

Finance Minister Christian Lindner of the FDP has made no attempts to hide his push for the three plants to remain in use rather than just kept on standby.

"We shouldn't be too picky, but instead do everything that makes our lives easier," he told the Sueddeutsche Zeitung Monday ahead of the nuclear announcement.

That included "the continued operation of the nuclear power plants until at least 2024", the FDP boss said.

In a sign that he has not shifted his position, Lindner also retweeted several voices in his party criticising Monday evening's decision as not going far enough.
- 'Kept running' -

Habeck's decision partly delays the nuclear exit decided under former chancellor Angela Merkel after the Fukushima disaster in 2011.

He said the subject of nuclear energy was "bound with a lot of emotions" but that the partial extension was needed to avoid an "extremely unlikely" electricity crisis.

But in light of skyrocketing electricity bills, all possible resources needed to be mobilised, according to Veronika Grimm, a member of the government's council of economic advisors.

"That means not just coal plants but nuclear power plants too," she told daily FAZ on Tuesday.

"The plants should be kept running, not just be on standby, as is currently planned, because only then will it lower the price of electricity," she said.

The government should examine extending the lifetime of the plants by five years and even bringing recently closed plants back online to keep prices "within limits", she said.

By contrast, Claudia Kemfert of the economic research institute DIW pointed out that "nuclear plants are not adapted to act as network reserves because they cannot be fired up and shut down easily".

Meanwhile, the financial daily Handelsblatt wrote that the partial extension was simply "the worst of all possible decisions".
- 'Completely absurd' -

"We are heading towards an energy supply crisis," opposition CDU leader Friedrich Merz told German public radio.

Shutting down electricity generating capacity at a time of crisis was "completely absurd", he said, adding that the war-related crisis was being aggravated by "the decisions of the federal government".

Habeck had "ducked the risk of coming into conflict with a part of his party", Handelsblatt wrote.

The extension is a touchy issue for the Greens, which has its roots in Germany's anti-nuclear movement.

The decision was "hard to take but necessary as it stands", Green party chief Omid Nouripour told public television.

Habeck stressed Monday that Germany would not waver from its plan to move on from atomic energy.

"New fuel rods will not be put in," he said, adding that the issues this winter "cannot be compared" with the next one.

Habeck's ministry has chartered five floating terminals for the import of liquefied natural gas (LNG) to substitute for Russian supplies, the first of which are scheduled to come online at the end of the year.

At the same time, it has also moved to restart mothballed coal power plants and fill gas storage ahead of the winter to guard against an energy shortfall.

sea/hmn/rl/dhc

DNA in Viking poop sheds new light on 55,000-year-old relationship between gut companions

Using stool samples from Viking latrines, researchers at the University of Copenhagen have genetically mapped one of the oldest human parasites – the whipworm.  The mapping reflects the parasite’s global spread and its interaction with human beings, a del

Peer-Reviewed Publication

UNIVERSITY OF COPENHAGEN - FACULTY OF SCIENCE

 

IMAGE: SAMPLE MAP view more 

CREDIT: UNIVERSITY OF COPENHAGEN

Using stool samples from Viking latrines, researchers at the University of Copenhagen have genetically mapped one of the oldest human parasites – the whipworm.  The mapping reflects the parasite’s global spread and its interaction with human beings, a delicate relationship that can make us healthier and ill.

Using fossilized eggs in up to 2500-year-old feces from Viking settlements in Denmark and other countries, researchers at the University of Copenhagen’s Department of Plant and Environmental Sciences and the Wellcome Sanger Institute (UK) have made the largest and most in-depth genetic analysis of one of the oldest parasites found in humans – the whipworm.

The study, published in Nature Communications, presents completely new knowledge about the parasite's development and prehistoric dispersal. This knowledge can be applied in efforts to prevent the parasite's drug resistance and its future spread.

The study suggests that human and parasite have developed a delicate interaction over thousands of years, whereby the parasite tries to stay “under the radar” not to be repelled, which allows it more time to infect new people. From other studies, it is known that the whipworm stimulates the human immune system and the gut microbiome, to the mutual benefit of both host and parasite.

While whipworm (Trichuris trichiura) is now rare in industrialized countries, and most often only causes minor problems among healthy individuals, the parasite is estimated to affect 500 million people in developing countries.

"In people who are malnourished or have impaired immune systems, whipworm can lead to serious illness. Our mapping of the whipworm and its genetic development makes it easier to design more effective anti-worm drugs that can be used to prevent the spread of this parasite in the world's poorest regions," says Professor Christian Kapel of UCPH’s Department of Plant and Environmental Sciences.

CAPTION

Latrines from the 1650's found during the excavation of the Copenhagen Metro.

CREDIT

University of Copenhagen

Fossilized latrine poop from Copenhagen and Viborg

Eggs, not worms, made it possible for researchers to examine the genetic material of thousands-of-years-old whipworms. Due to extremely durable chitin in egg capsules, their internal DNA has been well preserved while the eggs have been buried in moist soil.

By examining fossilized stool samples which were previously discovered in the latrines of Viking settlements in Viborg and Copenhagen, the researchers isolated the eggs under a microscope, sieved them from the stool and subjected them to refined genetic analyses that the researchers have been perfecting for years in previous studies.

"We have known for a long time that we could detect parasite eggs up to 9000 years old under a microscope. Lucky for us, the eggs are designed to survive in soil for long periods of time. Under optimal conditions, even the parasite's genetic material can be preserved extremely well. And some of the oldest eggs that we’ve extracted some DNA from are 5000 years old. It has been quite surprising to fully map the genome of 1000-year-old well-preserved whipworm eggs in this new study," explains Christian Kapel.

The researchers examined archaeological stool samples from several locations. These ancient genetic samples are compared with contemporary samples obtained from people with whipworms from around the world. Doing so has provided researchers with an overview of the worm's genome and its evolution over ten-thousands of years.

"Unsurprisingly, we can see that the whipworm appears to have spread from Africa to the rest of the world along with humans about 55,000 years ago, following the so-called 'out of Africa' hypothesis on human migration," explains Christian Kapel.

CAPTION

Whip worm eggs.

CREDIT

University of Copenhagen

Can live unnoticed in the intestine for months 

A whipworm can grow five to seven centimeters in length and live unnoticed in the intestine of a healthy individual for several months. During this time, it lays eggs continuously, which are expelled through feces. In people with weakened immune systems, whipworm can cause a wide range of gastrointestinal diseases, malnutrition and even delay childhood development.

Worms are transmitted via the fecal-oral route, meaning that microscopic parasite eggs in soil can spread to drinking water or food, after which they are ingested through the mouth of a new host.

"The eggs lie in the ground and develop for roughly three months. Once matured, eggs can survive in the wild for even longer, as they wait to be consumed by a new host in whose digestive tract they will then hatch. Their entire life cycle is adapted to survive in soil for as long as possible," explains Christian Kapel.

As such, the golden years for these worms in our part of the world were when our toilet and kitchen conditions, as well as personal hygiene, were significantly different than today.

"During the Viking Age and well into the Middle Ages, one didn't have very sanitary conditions or well-separated cooking and toilet facilities. This allowed the whipworm far better opportunities to spread. Today, it is very rare in the industrialized part of world. Unfortunately, favorable conditions for spreading still exist in less developed regions of the world," says Christian Kapel.

Facts:

• The new study provides the first in-depth and complete genetic mapping of the whipworm. Until now, only limited segments of the genome were known.
• The parasite spread from Africa to the rest of the world along with our human ancestors.
• Among other things, the researchers collected stool samples with whipworm eggs from Viking settlements in Denmark, Latvia and the Netherlands.
• The ancient genetic samples were compared with contemporary samples from people with whipworms from many various countries in Africa, Central America, Asia, and Europe.
• The US Center for Disease Control (CDC) estimates that 604-795 million people are infected by trichuriasis worldwide. Source: Pullan, R. L., Smith, J. L., Jasrasaria, R. & Brooker, S. J. (2014) Global numbers of infection and disease burden of soil transmitted helminth infections in 2010. Parasite. Vectors 7, 37.
• The study is led by the University of Copenhagen's Department of Plant and Environmental Sciences, Section for Organism Biology and made in collaboration with the Wellcome Sanger Institute (UK).

The power of compost - making waste a climate champion

Peer-Reviewed Publication

UNIVERSITY OF QUEENSLAND

 

IMAGE: THE PRECISION COMPOST STRATEGY COULD HELP REVERSE THE DEGRADATION OF SOIL, BOOSTING CROP PRODUCTION. view more 

CREDIT: SUPPLIED

A new way of using compost could boost global crop production and deliver huge benefits to the planet, according to a study co-led by The University of Queensland.

Professor Susanne Schmidt from UQ’s School of Agriculture and Food Sciences said adopting a Precision Compost Strategy (PCS) in large-scale agriculture could improve crop yield, soil health and divert biowaste from landfill where it generates harmful greenhouse gases.

“Instead of relying just on mineral fertilisers, PCS involves supplementing the right type of compost with nutrients to match the needs of soils and crops,” Professor Schmidt said.

“Soils that have become compacted and acidic are then aerated and neutralised.

“The result is they can retain more water, facilitate root growth and nourish the organisms that keep soils and crops healthy.”

Professor Schmidt said soil plays a crucial role in ensuring global food security.

“But currently 30 per cent of the world’s agricultural soil is classified as degraded, with projections that this could rise to 90 per cent by 2050,” she said.

“Our research estimates PCS could boost the annual global production of major cereal crops by 96 million tonnes, or 4 per cent of current production.

“This has flow-on effects for consumers by addressing food shortages and price hikes.”

The study found applying PCS to large-scale agriculture could also help mitigate climate change.

“In Australia alone, more than 7 million tonnes of biowaste ends up in landfill every year where it generates huge amounts of avoidable greenhouse gases and other undesirable effects,” Professor Schmidt said.

“If we repurpose it, we can restore crucial carbon in cropland topsoil.

“There are cost benefits too - diverting just 15,000 tonnes of biowaste could save a local council as much as $2-3 million a year.”

Far North Queensland sugarcane farmer Tony Rossi said his family's company V. Rossi & Sons had been using precision compost for seven years with great success.

“We’ve been able to almost halve our fertiliser use which is so much better for the environment, and our crop yield is the same,” Mr Rossi said.

More than 2,000 examples of compost use in the agricultural sector across the globe were analysed as part of the PCS study.

The research was supported by Fight Food Waste CRC and has been published in Nature Food.

The Rossi Farm in Queensland are experimenting with compost use in sugarcane.

CREDIT

Supplied

Could compost be the new black gold?

CREDIT

Supplied

To improve soils in South Australia that are naturally low in organic matter,

 farmers have been using the Precision Compost Strategy.

CREDIT

Supplied

JOURNAL

Nature Food

DOI

10.1038/s43016-022-00584-x 

ARTICLE PUBLICATION DATE

5-Sep-2022

CRIMINAL CAPITALI$M

From Health Affairs: Trends in informal patient-to-provider payments in European Union countries

Peer-Reviewed Publication

HEALTH AFFAIRS

Corruption is a major challenge in health care systems across the European Union (EU), where it manifests most visibly as informal payments from patients to providers. In what is believed to be the first study to examine trends in informal payments across the twenty-eight EU states between 2013 and 2019 in relation to changes in public health care expenditure, Giulia Dallera and coauthors from Imperial College London analyzed representative data from Eurobarometer surveys, which included survey responses from more than 80,000 EU citizens. They found that the prevalence of informal payments in EU health care systems increased during those years, but perception of corruption decreased, with significant differences between countries. They also found that higher public health care expenditure was associated with fewer informal payments; however, this relationship became less clear throughout the study period. The authors conclude that their findings can inform further research to investigate drivers of informal payments at the health systems level and to understand the directionality of the relationship between informal payments and public health care expenditure. Their findings also point toward the need to couple public health care investments across EU member states with measures to strengthen health systems to effectively confront corruption.

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Health Affairs is the leading peer-reviewed journal at the intersection of health, health care, and policy. Published monthly by Project HOPE, the journal is available in print and online. Late-breaking content is also found through healthaffairs.org, Health Affairs Today, and Health Affairs Sunday Update.

Health Affairs podcasts go beyond the journal’s pages to bring you insightful discussions on the latest news and research affecting health policy. On our flagship podcast, A Health Podyssey, Editor-In-Chief Alan Weil interviews the leading researchers and influencers shaping the field’s big ideas. Join Health Affairs editors on Health Affairs This Week as they discuss the week’s most pressing health policy news. All in 15 minutes or less.

Project HOPE is a global health and humanitarian relief organization that places power in the hands of local health care workers to save lives across the globe. Project HOPE has published Health Affairs since 1981.

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JOURNAL

Health Affairs

ARTICLE TITLE

Corruption In Health Care Systems: Trends In Informal Payments Across Twenty-Eight EU Countries, 2013–19

ARTICLE PUBLICATION DATE

6-Sep-2022

Growth of psychiatric mental health nurse practitioners helped offset drop in psychiatrists treating Medicare patients

Peer-Reviewed Publication

HARVARD T.H. CHAN SCHOOL OF PUBLIC HEALTH

Boston, MA—The mental health system is increasingly reliant on psychiatric mental health nurse practitioners (PMHNPs) to meet the psychiatric needs of Medicare patients, according to a new study led by researchers at Harvard T.H. Chan School of Public Health. 

“We were surprised by the degree to which PMHNPs are the de facto mental health prescribers in parts of the country,” said corresponding author Michael Barnett, associate professor of health policy and management at Harvard Chan School. “In the states where PMHNPs have no restrictions on prescribing medications, these providers account for 50% of all mental health prescriber visits in rural areas, which was much greater than we had anticipated.” 

The study will be published in the September 2022 issue of Health Affairs. 

Mental health access is a public health crisis that the COVID-19 pandemic has exacerbated. While demand for mental health treatment is soaring, the supply of psychiatrists accepting insurance is dropping, particularly in rural areas.  

To assess how the mental health workforce and patient population have changed over time, Barnett and his colleagues analyzed fee-for-service Medicare claims during 2011-2019. The team focused on the number of PMHNPs and psychiatrists billing Medicare, the volume of outpatient and psychiatric services by provider group, and how these numbers varied by rurality and scope-of-practice regulations, which can restrict whether a PMHNP is able to prescribe medications. 

The findings showed that PMHNPs provided nearly 1 in 3 mental health prescriber visits to Medicare patients nationally by 2019. The number of PMHNPs also increased 162% during 2011-2019, while psychiatrists billing Medicare dropped by 6%. During this period, without growth in the PMHNP workforce, there would have been a decline of nearly 30% in mental health specialist visits in Medicare. Instead, the drop was 12%.  

“This work puts the spotlight on PMHNPs as a critical part of the mental health workforce,” said Barnett. “This is so important because we desperately need new solutions to address the current mental health crisis in this country. Policy that targets the PMHNP workforce could be a key part of the national effort to expand mental health access.” 

Co-author Arno Cai is also from Harvard Chan School. 

This research was supported by the National Institute on Aging (K23 AG058806-01) and the National Institute of Mental Health (R01 MH112829-01) in the National Institutes of Health.  

“Trends In Mental Health Care Delivery By Psychiatrists And Nurse Practitioners In Medicare, 2011–19,” Arno Cai, Ateev Mehrotra, Hayley D. Germack, Alisa B. Busch, Haiden A. Huskamp, and Michael L. Barnett, Health Affairs, September 2022, doi: 10.1377/ hlthaff.2022.00289. 

Visit the Harvard Chan School website for the latest news, press releases, and multimedia offerings. 

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Harvard T.H. Chan School of Public Health brings together dedicated experts from many disciplines to educate new generations of global health leaders and produce powerful ideas that improve the lives and health of people everywhere. As a community of leading scientists, educators, and students, we work together to take innovative ideas from the laboratory to people’s lives—not only making scientific breakthroughs, but also working to change individual behaviors, public policies, and health care practices. Each year, more than 400 faculty members at Harvard Chan School teach 1,000-plus full-time students from around the world and train thousands more through online and executive education courses. Founded in 1913 as the Harvard-MIT School of Health Officers, the School is recognized as America’s oldest professional training program in public health. 

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JOURNAL

Health Affairs

DOI

10.1377/hlthaff.2022.00289 

METHOD OF RESEARCH

Data/statistical analysis

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Trends In Mental Health Care Delivery By Psychiatrists And Nurse Practitioners In Medicare, 2011–19

ARTICLE PUBLICATION DATE

6-Sep-2022

Understanding the full picture of child poverty

A broader look at family finances can lead to better-designed programs that address child wellbeing

Peer-Reviewed Publication

DUKE UNIVERSITY

DURHAM, N.C. – When people talk about poverty in the United States, most talk about income. But income is just half of the story, says Christina Gibson-Davis, a professor of public policy and sociology at Duke’s Sanford School of Public Policy and an affiliate of Center for Child and Family Policy.

The other half of the financial equation is family wealth: the value of a family’s assets, like savings and property, minus their debt.  

Gibson-Davis is part of a research team that set out to find how children are affected by net worth poverty, defined as having wealth less than one-fourth of the federal poverty line, a standard set by income. In 2022, for example, the federal poverty line for a family of four living in the contiguous 48 states is $27,750.

The team looked at wealth and income information, as well as cognitive and behavioral data, of children ages 3 to 17 years. The data was collected from 2002 to 2019 by the Panel Study of Income Dynamics.

Their analysis indicated that net worth poverty is linked to lower cognitive scores and increases in problem and behavior scores in children. The new research appears Sept. 6 in Socius: Sociological Research for a Dynamic World, an open access journal.

“We now know that wealth deprivation likely has effects on children,” Gibson-Davis says. “Typically, people talk about the harms of income poverty, yet net worth poverty can also contribute to adverse outcomes. We have been focusing on one type of poverty and ignoring another.”

“Very few families are just income poor,” Gibson-Davis says. “Most poor parents experience net worth poverty. We should think about policies that focus on building wealth.”

Interventions such as the earned income tax credit focus on increasing cash flow to households. But that only has limited effectiveness if a family doesn’t have an economic buffer. Building financial security through wealth can help families overcome tough financial periods.

Their findings suggest policies that speak to both income and wealth might have bigger impacts for children, such as distributing “baby bonds” to apply to a child’s future education.

Providing reparations are another way. Previously, the same research team looked at who experiences net worth poverty and found that Black families with children are more likely than white families with children to have net worth poverty.

Parents who are net-worth poor may be limited in the investments they can make in their children, Gibson-Davis adds, which includes everything from housing, schooling, social peers and greenspace.

“Wealth is really fundamental to a child’s well-being,” Gibson-Davis says. “It affects children’s visions of their future and what they think is possible.”

Research reported in this publication was supported by the National Institutes of Health’s Eunice Kennedy Shriver National Institute of Child Health and Human Development under Award Number R21HD107249. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

CITATION: “Net Worth Poverty and Child Development” C. M. Gibson-Davis, L.A. Keister, L.A. Gennetian and W. Lowell. Socius (2022). DOI: 10.1177/23780231221111672. Paper online: https://journals.sagepub.com/doi/full/10.1177/23780231221111672

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DOI

10.1177/23780231221111672 

METHOD OF RESEARCH

Data/statistical analysis

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Net Worth Poverty and Child Development

ARTICLE PUBLICATION DATE

6-Sep-2022