Tuesday, May 27, 2025

 

Yale launches Center for Civic Thought to promote thoughtful discourse



Yale University





New Haven, Conn. — Immediately after the Oct. 7, 2023 attacks on Israel, a group of 10 Yale students from a variety of backgrounds convened on campus to discuss the unthinkable.

Brought together by the university’s Civic Thought Initiative (CTI), which encourages open dialogue on difficult issues in small, seminar-style settings, the group included Jewish students with diverging views on Israel, students who were active advocates for Palestinians in Gaza, and a former childhood war refugee.

“Understandably, it was an emotionally charged and difficult conversation,” recalled Enza Jonas-Giugni, a recent Yale College graduate who at the time was a student fellow with the program. “And yet, instead of talking past one another, remaining entrenched in previously formed views about the conflict, or descending into hostility, we grieved, asked questions about parts of the conflict’s history that we remained ignorant of or uncertain about, and confronted the tough questions head on.”

In 2019, Yale political scientist Bryan Garsten created CTI in response to what he saw as a hunger among students to engage in intellectual discussions on important issues, but in an environment that encouraged them to try out ideas and hear from people with a range of political and philosophical perspectives. Now, six years later, Yale is building on that small initiative with the launch of a new nonpartisan Center for Civic Thought.

The mission of the center is “to encourage a thoughtful public discourse  and a civically responsible intellectual life,” said Garsten, a professor of political science and humanities in Yale’s Faculty of Arts and Sciences (FAS) and the center’s director.

“We all have a stake in making our shared civic life more thoughtful,” said Yale President Maurie McInnis. “The new Center for Civic Thought acknowledges the important role Yale plays in helping to cultivate habits of thought and support free expression, on campus and beyond, that are so essential for the future of higher education and our nation.”

According to Garsten, the center will encourage civic thinking that draws on and integrates various forms of knowledge — academic research, practical experiences, history, classic texts of philosophy, literature, and political thought — to inform citizens’ practical judgements. It will provide the stimulus for this broad-based thinking by convening conversations, creating classes and curricula, and supporting research.

And when it officially opens on July 1, it will work on furthering these goals at three levels: on campus, in the broader New Haven community, and nationally.

“It’s a difficult moment for universities,” Garsten said. “We’re all thinking about their relationship to the rest of society, and we’re worried about the trust gap that has opened up. Work like this is strongly rooted in our home communities, and emphasizing the university’s core mission of researching and discussing fundamental moral and political questions is important to rebuilding trust.”

Working through disagreement

At the campus level, the center will build on the work of CTI, hosting events around certain themes every year, and inviting scholars, journalists, politicians, and authors from varying perspectives to participate in discussions. Importantly, Garsten noted, the aim is not to simply give these visiting experts a platform or stage a debate, but to bring them into open discussions with students and ask them to answer difficult questions.

“I think you need to give students the experience of talking with people who may come from a very different perspective and feeling the discomfort of the disagreement, and then working through that,” he said.

Pericles Lewis, dean of Yale College, which is supporting the center, said it reinforces the university's commitment to liberal education “by fostering the free exchange of ideas and encouraging students to engage in productive conversations across lines of disagreement.”

Its broader aim, Lewis added, “is to cultivate students’ intellectual and civic capacities and to prepare them to thrive in a complex and changing society.”

Indeed, one of the most important jobs of a university is to fuel curiosity and inspire challenging discussions, said Steven Wilkinson, dean of FAS. “The Center for Civic Thought will bring together students and faculty from across the disciplines to do just that, at Yale and beyond,” he said.

The center will also offer course-development grants and postdoctoral fellowships, and hopes to  invite visiting faculty who can add intellectual breadth to the Yale academic environment.

At the local level, the center will integrate Yale’s Citizens Thinkers Writers program, a tuition-free summer program co-founded by Garsten and Stephanie Almeida Nevin, a lecturer in Yale’s humanities program who serves as its managing director and is executive director of the new center. Citizens Thinkers Writers introduces New Haven high school students to foundational texts of philosophy, political science, and literature. Students live on campus, attending morning seminars taught by faculty and afternoon discussions with community leaders.

The program’s approach to civic education “prioritizes small, rigorous conversations, rooted in place, deepened by reading, and linked to practical expertise,” Nevin said. Now in its 10th year, that program has welcomed students from 13 high schools; nearly half of them are or will be the first in their families to either attend or graduate from a 4-year college.

Nationally, the center is partnering with the nonprofit Aspen Institute’s Philosophy & Society Initiative, which sponsors publications, events, and original research that grapple with contentious political and moral questions. The partnership with the Washington D.C.-based organization makes sense, Garsten said, since the two entities have similar goals and will establish a link with the D.C. professional communities, “bringing capacity for deeper reflection to the national stage, and fresh possibilities for practical engagement to Yale.”

During the 2025-26 academic year, the center will prioritize three areas of inquiry: constitutional democracy in America in its 250th year; the role of universities in civic life; and humanity in the age of artificial intelligence.

Higher ed and public discourse

Garsten has long been engaged with how institutions of higher education can encourage thoughtful public discourse. He is a former chair of Yale’s Humanities Program, a past member of the National Forum on the Future of Liberal Education and the Harvard Higher Education Leaders Forum, and frequently presents at conferences about liberal education and its civic importance. He is a member of the Alliance for Civics in the Academy and of the Civic Collaboratory of Citizens University.

The center is supported by an external board of advisors consisting of Danielle Allen, the Conant University Professor at Harvard University; Samuel Kimbriel, the founding director of the Philosophy & Society Initiative at the Aspen Institute; Yuval Levin, the director of social, cultural and Constitutional studies at the American Enterprise Institute; and Josiah Ober, the Mitsotakis Chair in the School of Humanities and Sciences and a founder of the Stanford Civics Initiative at Stanford University.

At Yale, the center’s faculty advisory council includes Kerwin Charles, the Indra K. Nooyi Dean at Yale School of Management and the Frederick W. Beinecke Professor of Economics, Policy and Management; Robert Gooding-Williams, the Brooks and Suzanne Ragen Professor of Philosophy in the FAS; Philip Gorski, the Frederick and Laura Goff Professor of Sociology (FAS); Daniel Greco, professor of philosophy (FAS); Martin Hagglund, the Birgit Baldwin Professor of Humanities and Comparative Literature (FAS); Jennifer Herdt, the Gilbert L. Stark Professor of Christian Ethics at Yale Divinity School and professor of religious studies (FAS); Hélène Landemore, professor of political science (FAS); Claire Priest the Simeon E. Baldwin Professor of Law at Yale Law School (YLS) and professor of history (FAS); and Keith Whittington, the David Boies Professor of Law at YLS and professor of political science (FAS).

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Rural location and racial segregation drive gaps in primary care access in Virginia



Neighborhood determinants of primary care access in Virginia




American Academy of Family Physicians





Background and Goal: This study aimed to identify geographic disparities of the primary care workforce in Virginia and factors associated with primary care physician (PCP) access. 

Study Approach: Researchers used the 2019 Virginia All-Payers Claims Database to identify PCPs and the number of patients seen by each physician. They then measured how many PCPs each census tract could reach within a 30‑minute drive, flagging tracts with too few as having poor access. Researchers then assessed associations between PCP access and predisposing (age, race), enabling (income, insurance), need and structural (rurality, segregation) factors. 

Main Results: 

  • Nearly half (44%) of Virginia’s census tracts lacked adequate PCP access.

  • Racial segregation and rurality had the greatest associations with PCP access. Tracts with higher proportions of Black residents had significantly greater PCP access than those with higher proportions of white residents, while rural tracts had significantly less access. 

Why It Matters: The findings of this study can guide policymakers in focusing incentive programs and clinic expansions on underserved areas to increase primary care physician access, which may in turn reduce preventable hospitalizations.

Neighborhood Determinants of Primary Care Access in Virginia

Hannah M. Shadowen, PhD, et al 

Department of Health Policy, Virginia Commonwealth University, Richmond, Virginia

Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia

Medical Scientist Training Program, Virginia Commonwealth University, Richmond, Virginia 

An accompanying episode of the Annals of Family Medicine Podcast, featuring study authors Hannah Shadowen, PhD, and Alexander Krist, MD, MPH, will be available here beginning 9am EDT May 28.

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Nonadherence labeling in primary care often results in poorer health outcome: ethical risks of diagnosing nonadherence



Adherence labeling: understanding the origins, limitations, and ethical challenges of “diagnosing” nonadherence



American Academy of Family Physicians




Background and Theory overview: Promoting adherence to medical recommendations remains one of the oldest yet most persistent challenges of modern clinical practice. Traditional models treat nonadherence as an intrinsic patient behavior, which can undermine patients’ autonomy as well as blame them for poor health outcomes. The authors draw on sociological labeling theory to show that “nonadherent” is not a neutral clinical finding but a social judgment made by clinicians. 

What Is New: The authors name and model “adherence labeling” as the process by which clinicians produce “nonadherence” data rather than diagnose a patient trait. Rather than locating nonadherence solely in the patient, the authors show that the clinician’s decision to observe, interpret, and record behavior generates the label. This shift from patient fault to clinician choice reveals how labels can obscure structural barriers such as underinsurance or systemic racism, stigmatize vulnerable patients and skew care decisions. 

Why It Matters: The “nonadherent” label embeds stigma and clinician bias into patient records, often resulting in delayed therapy escalation, clinic dismissal, and poorer health outcomes. 

Adherence Labeling: Understanding the Origins, Limitations, and Ethical Challenges of “Diagnosing” Nonadherence

Sourik Beltrán, MD, MBE, et al

Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts

The Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts 

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Study examines authorship inequities in global health research published in family medicine journals in high-income countries



Authorship inequity in global health research conducted in low- and middle-income countries and published in high-income country family medicine journals



American Academy of Family Physicians





Background and Goal: This study examined authorship inequities for research that was conducted in low- and middle-income countries and published in family medicine journals based in high-income countries.

Study Approach: Researchers analyzed journals listed on the World Organization of Family Doctors (WONCA) Global family doctor website that focused on low-income countries, lower-middle-income countries, and upper-middle-income countries. They selected journals with editorial offices in high-income-countries. Inclusion criteria included research conducted in low or middle income countries, available in English language, with human study participants. They summarized the proportions of first and senior authors by country income level and other publication characteristics.

Main Results: 431 of 1,030 articles met criteria for research conducted in low- or middle-income countries.

  • Over time, there was an increase in publication of research articles from low- and middle-income countries in the family medicine journals, with the majority of the studies conducted in upper-middle-income countries (55.9%). 

  • The proportion of senior authors from high-income countries was highest in articles with research conducted in low-income countries (50%) compared with those reporting research done in lower-middle-income countries (37%) and upper-middle-income countries (21%). 

  • There was a trend toward higher average citation rate for articles having high-income countries first and senior authors compared with articles having lower-middle-income countries first and senior authors. 

Why It Matters: Quantifying authorship inequities highlights systemic barriers to research leadership in low- and middle-income settings.

Authorship Inequity in Global Health Research Conducted in Low- and Middle-Income Countries and Published in High-Income Country Family Medicine Journals

Alyssa Vecchio, MD, et al 

University of New Mexico, Albuquerque, New Mexico

The Warren Alpert Medical School of Brown University, Providence, Rhode Island

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Fewer Ontario family physicians provide comprehensive care



Family physicians in focused practice in Ontario, Canada: a population-level study of trends from 1993/1994 through 2021/2022




American Academy of Family Physicians





Background and Goal: This study examined long‑term shifts toward focused practice among family physicians in Ontario, Canada, as well as changes in the number of comprehensive family physicians relative to population growth.

Study Approach: Researchers linked multiple Ontario health‑administrative data sets to track practice patterns for every general practitioner or family physician from fiscal years 1993/94 through 2021/22. Analyses were stratified by physician sex and years in practice. 

Main Results:

  • The proportion of family physicians working in focused roles rose to 19.2% in 2021/22, up from 7.7% in 1993/94.

  • Emergency medicine accounted for 37% of focused doctors in 2021/22, followed by hospitalist care at 26.5% and addiction medicine at 8.3%.

  • Although the overall supply of family physicians climbed from 104 to 118 per 100,000 residents during the study period, the supply offering comprehensive care fell from 71 to 64 per 100,000. 

  • Of the additional 6,310 family physicians who entered the workforce during the study period, 39.5% were in focused practice.

  • In 2021/22, 60% of focused practice physicians were male and 40% were female. The focused practice group had fewer average days worked at 156 days compared with 196 days for the comprehensive practice group.

Why it Matters: Amid efforts to address current and impending challenges in access to primary care, findings from this study underscore the limitations of using family physician head counts in workforce planning. Knowing how many family physicians move into focused roles and how the proportion providing comprehensive care has declined can guide policy and practice changes, including better payments aligned with system goals, practice support, job flexibility, team-based care and cross-sectoral workforce planning to make comprehensive family practice the most attractive option to family physicians. 

Family Physicians in Focused Practice in Ontario, Canada: A Population-Level Study of Trends From 1993/1994 Through 2021/2022 

Hina Ansari, PhD, MSc, et al

MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada 

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Little free library use may improve rural mental health access


Using a little free library to improve access to mental health and wellness resources at a primary care clinic




American Academy of Family Physicians





Mental‑health disorders and suicide rates have risen steadily over the past 20 years, with rural areas seeing the sharpest increases. To broaden access to mental‑health resources for adults, physicians placed a little free library containing 10–15 books on anxiety, depression, post‑traumatic stress disorder, and related conditions near the entrance of a rural primary care clinic in Minnesota. A flyer with a QR code directs visitors to a community‑run webpage with additional resources. Patients who take a book are asked to complete a short survey capturing demographics, referral source, and the usefulness of the materials. The authors are still studying the intervention’s utility and impact. This low cost, patient-centered, community-informed innovation can be adopted by other primary care and community settings. 

Using a Little Free Library to Improve Access to Mental Health and Wellness Resources at a Primary Care Clinic

Marijo Botten, DO, and Erin Westfall, DO

Mayo Clinic Family Medicine Residency, Mankato, Minnesota 

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Mental disorders, cardiovascular diseases, smoking, and road injuries among the top causes of death and disability for millions in the ASEAN region




Institute for Health Metrics and Evaluation




Mental disorders, cardiovascular diseases, smoking, and road injuries among the top causes of death and disability for millions in the ASEAN region

  • More than 80 million people in the Association of Southeast Asian Nations (ASEAN) have mental disorders, a 70% increase from 1990, burdening children, the elderly, and women the most.
  • 37 million people in the region suffer from cardiovascular diseasand 1.7 million die from it, making it one of the fastest growing non-communicable diseases and the leading cause of death.
  • The number of smokers has increased in every ASEAN country and by 63% to 137 million regionally, which is 12% of the total number of global smokers.
  • Some 35 million people across the region are injured every year from various kinds of accidents and incidents, and road injuries is the top cause of death in this category, making it a public health priority.

SEATTLE, Wash., May 27, 2025 – The Association of Southeast Asian Nations (ASEAN) is seeing double-digit increases in some of the leading causes of mortality and morbidity, according to the first of its kind research published today in a series of scientific papers in The Lancet Public Health. The articles showcase the region’s public health crisis from mental disorderscardiovascular diseasesmoking, and injuries.

Researchers at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington School of Medicine in Seattle and the National University of Singapore’s (NUS) Yong Loo Lin School of Medicine analyzed the data from 1990 to 2021 by age, sex, and location across all ASEAN countries: Brunei, Cambodia, Indonesia, Laos, Malaysia, Myanmar, the Philippines, Singapore, Thailand, and Vietnam.

“Without immediate action from each of the countries, these preventable health conditions will worsen causing more death and disability across ASEAN,” said lead author Dr. Marie Ng, Affiliate Associate Professor at IHME and Associate Professor at NUS. “Additionally, the region’s rapid economic growth and aging population are increasing the burden from non-communicable diseases and the strain on health systems. We must revisit current policies to protect people’s well-being and ensure proper resource allocation to address the evolving health care demands.”

“ASEAN countries have made significant progress in improving health outcomes in recent decades, but progress has been hindered by a combination of long-standing and newly emerging risk factors, particularly in some areas,” said Dr. Xiaochen Dai, a first author and Lead Research Scientist at IHME. “The member states must work together to align on the best strategies to improve policies at the national and regional level and set the region back on track.”

Mental disorders

Mental disorders were among the top 10 causes of disease burden in every ASEAN nation except Myanmar, and anxiety disorders were the region’s most common mental disorder. In 2021, more than 80 million people suffered from one of the 10 mental disorders studied, surging 70% higher than in 1990. That translates to an age-standardized prevalence of 12%, representing a 7% increase from 1990 and with Malaysia experiencing the highest prevalence, which is a 13% rise. The increase in mental disorders is taking a heavier toll on children, adolescents, the elderly, and women than other demographic groups. A closer look by age shows 15–19-year-olds had the steepest climb in prevalence at nearly 11%, while mental disorders accounted for more than a quarter of the total disease burden among 10–19-year-olds, mainly across high-income ASEAN countries and with Singapore having the greatest burden. Although the increase in prevalence was less than 3% among adults 70 and older, the number of cases increased 183%. See complete data for mental disorders by country, sex, age, and year.

Cardiovascular diseases

With 37 million people in the region suffering from cardiovascular disease (CVD) and 1.7 million deaths, it’s now the leading cause of mortality and morbidity and one of the fastest growing non-communicable diseases in ASEAN. From 1990 to 2021, the total number of CVD cases increased by 148% whereas the prevalence increased about 3%, accounting for nearly 10% of the global CVD burden. CVD death rates were higher than the global average in Laos, Indonesia, Myanmar, Cambodia, the Philippines, Vietnam, and Malaysia. Men had a higher prevalence and mortality rate of CVD compared to women across the region. The top three CVDs with the highest prevalence rates were ischemic heart disease (IHD), lower extremity peripheral arterial disease, and stroke. The leading risk factors contributing to the CVD burden were high systolic blood pressure, dietary risks, air pollution, high low-density lipoprotein cholesterol, and tobacco use. High body mass index and high fasting plasma glucose have also been rapidly rising risks contributing to CVD burden since 1990. See complete data for CVD by country, sex, age, and year.

Smoking

Since 1990, the number of smokers has increased in every country in ASEAN and regionally by 63% to 137 million, which was about 12% of the total number of global smokers aged 15 and up in 2021. Although smoking prevalence has declined in ASEAN, it remains high at 48% among males 15 and older. In Indonesia, that figure was higher at 58%. In Malaysia, youth smoking is a growing concern, with an estimated 20% of male children aged 10–14 currently smoking. The prevalence of youths smoking has more than doubled in Cambodia and rose by 79% in Indonesia. Furthermore, some countries reported the average age at which smokers aged 20–24 first started smoking was 15. Compared to other parts of the world, the burden of smoking in ASEAN is also disproportionately high, with smoking as one of the leading risk factors that causes death and disability. In 2021, more than half a million people in the region died from smoking-related diseases, an increase of 231,000 deaths from 1990, with men dying at a rate 10 times higher than women. The region’s highest number of smoking-related deaths were from IHD, stroke, and chronic obstructive pulmonary disease. The region’s annual tobacco consumption of 556 billion units was also more than the global average. That’s equivalent to 4,131 cigarettes per smoker aged 15 and older, or 11 cigarettes every day. See complete data for smoking by country, sex, age, and year.

Injuries

Injuries are largely preventable but are killing and harming people unnecessarily across ASEAN. While road injuries had the highest mortality and morbidity in most of the countries, falls were the most common cause of injuries and second-leading cause of injury mortality followed by self-harm, drownings, and interpersonal violence. Death and disability from road injuries were particularly severe in Thailand, which recorded 30 deaths per 100,000 population, primarily from motorcycle accidents. Malaysia reported 24 deaths per 100,000 population, mostly from motor vehicle accidents. Falls were the second-leading cause of injury-related mortality in Brunei, Cambodia, Indonesia, Myanmar, Singapore, and Viet Nam. Interpersonal violence was the leading cause of death from injuries in the Philippines and ranked second in Laos. Self-harm was the leading cause of injury-related mortality in Singapore and accounted for nearly half of all injury deaths in the country, mostly males 20–24 years old. Self-harm was also among the top three leading causes of death for injuries in Brunei, Malaysia, Thailand, and Viet Nam. Conflict and terrorism resulted in substantial mortality and morbidity in Myanmar, making it the fourth-leading cause of injury burden, with males 15-19 facing the highest burden. Drowning is a common cause of injury-related burden among children 5–9 years in Thailand, Cambodia, Laos, and Myanmar. When looking at the patterns by sex and age across the region, most of the total injury burden impacted males aged 15–19 years, which is consistent with global patterns. For females, it was highest among children aged 5–9 years. See complete data for injuries by country, sex, age, and year.

About ASEAN

ASEAN is a union with diverse socioeconomic, political, and cultural backgrounds. Established in 1967, the network has been promoting economic growth, political stability, and social progress for its 10 member states. Today, the region is the world’s fifth largest economy with an annual gross domestic product growth of 4.5%, making it one of the fastest developing regions in the world. The network of countries has a population of 671 million, which is 1.5 times larger than that of the European Union and comprises almost 9% of the world’s population. With demographics and economic status varying widely across countries, public health challenges and health care systems differ.

About the Global Burden of Disease

This research is part of the Global Burden of Disease, Injuries, and Risk Factors Study (GBD) 2021. The GBD is the most comprehensive assessment of health, which includes granular estimates of burden across all age groups, sexes, and locations, as well as risk factors for 204 countries and territories from 1990 to 2021. Access to GBD data is available via IHME’s visualization tools, GBD Compare, and GBD Results.

For interviews with Dr. Marie Ng and the other authors please contact marieng@uw.edu, IHME’s Media Team at ihmemedia@uw.edu, or NUS media at medv3719@nus.edu.sg.

For embargoed access to the series of articles, appendices, and datasets, please see: https://cloud.ihme.washington.edu/s/WjsbPSkxmm3dwwj

NOTE: THE ABOVE LINKS ARE FOR JOURNALISTS ONLY. IF YOU WISH TO PROVIDE A LINK FOR YOUR READERS, PLEASE USE THE FOLLOWING, WHICH WILL GO LIVE WHEN THE EMBARGO LIFTS ON WEDNESDAY, 28 MAY 2025 AT 6:30 AM (Singapore Time), TUESDAY, 27 MAY 2025 AT 23:30 (UK Time) / 18:30 (US ET):

Mental disorders: https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(25)00098-2/fulltext
Cardiovascular disease: https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(25)00087-8/fulltext
Smoking: https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(24)00326-8/fulltext
Injuries: https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(25)00069-6/fulltext