Is global plastic pollution nearing an irreversible tipping point?

Common press release: Stockholm University, Norwegian Geotechnical Institute, Alfred Wegener Institute Helmholtz Centre for Polar and Marine Research, Helmholtz Centre for Environmental Research

STOCKHOLM UNIVERSITY

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IMAGE: CATCHING A BIG BLUE BARREL FLOATING ON THE OCEAN SURFACE IN THE GREAT PACIFIC GARBAGE PATCH FROM THE GERMAN RESEARCH VESSEL SONNE DURING EXPEDITION SO268/3 CROSSING THE NORTH PACIFIC OCEAN... view more 

CREDIT: ©ROMAN KROKE UFZ "

Current rates of plastic emissions globally may trigger effects that we will not be able to reverse, argues a new study by researchers from Sweden, Norway and Germany published on July 2nd in Science. According to the authors, plastic pollution is a global threat, and actions to drastically reduce emissions of plastic to the environment are "the rational policy response".

Plastic is found everywhere on the planet: from deserts and mountaintops to deep oceans and Arctic snow. As of 2016, estimates of global emissions of plastic to the world's lakes, rivers and oceans ranged from 9 to 23 million metric tons per year, with a similar amount emitted onto land yearly. These estimates are expected to almost double by 2025 if business-as-usual scenarios apply.

"Plastic is deeply engrained in our society, and it leaks out into the environment everywhere, even in countries with good waste-handling infrastructure," says Matthew MacLeod, Professor at Stockholm University and lead author of the study. He says that emissions are trending upward even though awareness about plastic pollution among scientists and the public has increased significantly in recent years.

That discrepancy is not surprising to Mine Tekman, a PhD candidate at the Alfred Wegener Institute in Germany and co-author of the study, because plastic pollution is not just an environmental issue but also a "political and economic" one. She believes that the solutions currently on offer, such as recycling and cleanup technologies, are not sufficient, and that we must tackle the problem at its root.

"The world promotes technological solutions for recycling and to remove plastic from the environment. As consumers, we believe that when we properly separate our plastic trash, all of it will magically be recycled. Technologically, recycling of plastic has many limitations, and countries that have good infrastructures have been exporting their plastic waste to countries with worse facilities. Reducing emissions requires drastic actions, like capping the production of virgin plastic to increase the value of recycled plastic, and banning export of plastic waste unless it is to a country with better recycling" says Tekman.

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Surface-floating macroplastic item with a decapod, sampled from the German research vessel SONNE during expedition SO268/3 crossing the North Pacific Ocean from Vancouver to Singapore in summer, 2019. ©Gritta Veit-Köhler Senckenberg

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©Gritta Veit-Köhler Senckenberg

A poorly reversible pollutant of remote areas of the environment

Plastic accumulates in the environment when amounts emitted exceed those that are removed by cleanup initiatives and natural environmental processes, which occurs by a multi-step process known as weathering.

"Weathering of plastic happens because of many different processes, and we have come a long way in understanding them. But weathering is constantly changing the properties of plastic pollution, which opens new doors to more questions," says Hans Peter Arp, researcher at the Norwegian Geotechnical Institute (NGI) and Professor at the Norwegian University of Science and Technology (NTNU) who has also co-authored the study. "Degradation is very slow and not effective in stopping accumulation, so exposure to weathered plastic will only increase," says Arp. Plastic is therefore a "poorly reversible pollutant", both because of its continuous emissions and environmental persistence.

Remote environments are particularly under threat as co-author Annika Jahnke, researcher at the Helmholtz Centre for Environmental Research (UFZ) and Professor at the RWTH Aachen University explains:

"In remote environments, plastic debris cannot be removed by cleanups, and weathering of large plastic items will inevitably result in the generation of large numbers of micro- and nanoplastic particles as well as leaching of chemicals that were intentionally added to the plastic and other chemicals that break off the plastic polymer backbone. So, plastic in the environment is a constantly moving target of increasing complexity and mobility. Where it accumulates and what effects it may cause are challenging or maybe even impossible to predict."

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Plastic residue being filtered out of food waste collected in Norway after fermentation to biogas and soil fertilizer. ©Caroline Hansen and Heidi Knutsen, NGI

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Caroline Hansen and Heidi Knutsen, NGI

A potential tipping point of irreversible environmental damage

On top of the environmental damage that plastic pollution can cause on its own by entanglement of animals and toxic effects, it could also act in conjunction with other environmental stressors in remote areas to trigger wide-ranging or even global effects. The new study lays out a number of hypothetical examples of possible effects, including exacerbation of climate change because of disruption of the global carbon pump, and biodiversity loss in the ocean where plastic pollution acts as additional stressor to overfishing, ongoing habitat loss caused by changes in water temperatures, nutrient supply and chemical exposure.

Taken all together, the authors view the threat that plastic being emitted today may trigger global-scale, poorly reversible impacts in the future as "compelling motivation" for tailored actions to strongly reduce emissions.

"Right now, we are loading up the environment with increasing amounts of poorly reversible plastic pollution. So far, we don't see widespread evidence of bad consequences, but if weathering plastic triggers a really bad effect we are not likely to be able to reverse it," cautions MacLeod. "The cost of ignoring the accumulation of persistent plastic pollution in the environment could be enormous. The rational thing to do is to act as quickly as we can to reduce emissions of plastic to the environment."

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Original publication:

Matthew MacLeod, Hans Peter H. Arp, Mine B. Tekman, Annika Jahnke: The global threat from plastic pollution, Science (2021). DOI: 10.1126/science.abg5433

Rethinking plastics

UD scientists and collaborators issue urgent call to action on plastics pollution

UNIVERSITY OF DELAWARE

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IMAGE: UNIVERSITY OF DELAWARE RESEARCHERS LASHANDA KORLEY (LEFT) AND THOMAS EPPS, III, ARE CO-AUTHORS OF A SCIENCE MAGAZINE ARTICLE CALLING FOR A CONCERTED EFFORT TO ADDRESS THE URGENT CRISIS OF PLASTICS... view more 

CREDIT: GRAPHICS BY JEFFREY C. CHASE

People lived without plastic until the last century or so, but most of us would find it hard to imagine how.

Plastics now are everywhere in our lives, providing low-cost convenience and other benefits in countless applications. They can be shaped to almost any task, from wispy films to squishy children's toys and hard-core components. They have shown themselves vital in medicine and have been pivotal in the global effort to slow the spread of the COVID-19 pandemic over the past 16 months.

Plastics seem indispensable these days.

Unfortunately for the long-term, they are also nearly indestructible. Our planet now bears the weight of more than seven billion tons of plastics, with more being produced every day. An ever-growing waste stream clogs our landfills, pollutes our waterways and poses an urgent crisis for our planet.

Four scientists have published a call to action in a new issue of Science, devoted to the plastics problem.

In a sweeping introductory article, the scientists -- including two from the University of Delaware, one from the Lawrence Berkeley National Laboratory in California and another from the University of Sheffield in the United Kingdom -- call for fundamental change in the way plastics are designed, produced, used and reused.

The ultimate goal: Designing, adopting and ensuring a "circular" lifecycle for plastics that leads not to a landfill or an ocean or a roadside, but to a long life of near-infinite use and reuse of the valuable resources and applications they represent.

That requires new approaches to chemistry, engineering, industrial processes, policy and global collaboration, according to co-authors LaShanda T.J. Korley, director of the Center for Plastics Innovation (CPI) at the University of Delaware and the principal investigator of a National Science Foundation (NSF) Partnerships for International Research and Education effort in Bio-inspired Materials and Systems; UD's Thomas H. Epps, III, co-director of CPI, lead principal investigator of an NSF Growing Convergence Research (GCR) effort in Materials Life-Cycle Management and director of the Center for Hybrid, Active, and Responsive Materials (CHARM) at UD; Brett A. Helms of the Molecular Foundry at Lawrence Berkeley National Laboratory in California; and Anthony J. Ryan of the Grantham Centre for Sustainable Futures at the University of Sheffield in the United Kingdom.

"The plastics waste dilemma is a global challenge that requires urgent intervention and a concerted effort that links partners across industrial, academic, financial, and government sectors buttressed by significant investments in sustainability," they write.

It's a tall order that includes attention to recycling, "upcycling" (reusing materials in new added-value ways), development of new materials and recognition of the needs of under-resourced communities.

"There's not a one-size-fits-all solution," said Korley, Distinguished Professor of Materials Science and Engineering at UD, who has spent her career developing new plastics with specific properties. "How people live with waste and how they recycle is so different. Traveling in Europe has highlighted the stark contrast in the usage of single-use plastics, such as drinking straws and cutlery in comparison to the U.S. Across the U.S., cities and municipalities within a single state may do things differently."

Complex recipes are used in many plastics, Korley said, and often include several kinds of polymers and other additives. Each component can complicate recycling efforts or make recycling impossible, which is why recyclers will accept some kinds of plastic and refuse others.

But how can plastics be designed so that all of their components can be deconstructed for future use in other products?

This is the challenge for CPI, which Korley directs. Its focus is on "upcycling" plastics -- finding ways to turn plastic waste into valuable materials such as fuels and lubricants. Researchers use catalysis and enzymes to reconstitute some kinds of plastic, such as high-density polyethylene (HDPE), low-density polyethylene (LDPE) and polystyrene/Styrofoam, the kinds of plastics used in milk jugs, shampoo bottles, sandwich bags, coffee cups, grocery bags and food packaging.

"Different materials properties require the use of different polymers and blends and additives, which contributes to the complexity and hierarchy of waste," Korley said.

The Science paper addresses that and much more, with an urgency that reflects the real and present dangers for a planet choked by discarded plastics that aren't going anywhere anytime soon.

Some of those realities are grim indeed. Take the plastic water bottle that helped quench your thirst after a morning jog five years ago, for example. It will probably be with us -- somewhere -- for another 395 years. Slow deterioration doesn't help us either. Scientists have found that tiny micro bits of worn-down plastic are prevalent in the water we drink and the foods we eat.

Less than 10% of plastic waste is recycled at all and less than 1% will be recycled more than once. About 12% will be incinerated. Millions of tons of discarded plastic winds up in giant swirls of debris in the ocean and the rest of it piles up in landfills, sinks into riverbeds or lies on roadsides around the world.

But Helms, a co-author from the Lawrence Berkeley National Lab, was part of the team that created a next-generation plastic called PDK (polydiketoenamine), which can be reduced back to its molecular parts and reassembled as needed.

"We're at a critical point where we need to think about the infrastructure needed to modernize recycling facilities for future waste sorting and processing," Helms said after the new material was announced. "If these facilities were designed to recycle or upcycle PDK and related plastics, then we would be able to more effectively divert plastic from landfills and the oceans. This is an exciting time to start thinking about how to design both materials and recycling facilities to enable circular plastics."

The building blocks of plastics -- monomers -- are made up of elements including carbon, hydrogen, oxygen, nitrogen, chlorine and sulfur. These monomers are linked by chemical bonds to become polymers, which can be used in the formation of plastics to be crafted into various forms for many different uses.

The value of all those resources is lost in single-use applications, said Sheffield's Ryan. He calls it a "convenient truth" -- the convenience and cheap cost of such products make them compelling to consumers, without recognizing the inherent value and cost to the planet. Marketing strategies that claim certain plastic products are "green" and biodegradable to draw well-intentioned consumers are especially concerning to him.

"Cynical 'greenwash' is the biggest problem for plastics sustainability," he said. "So I was very keen to work with LaShanda and Thomas on this. I have known them since they were Ph.D. students."

With innovation and collaboration as pillars of the new centers they co-direct -- Korley's U.S. Department of Energy-backed CPI and Epps' NSF-backed CHARM and GCR, Korley and Epps, the Allan and Myra Ferguson Distinguished Professor of Chemical and Biomolecular Engineering, are at the forefront of efforts to extend the life of petroleum- and bio-derived plastics and/or put them on a circular path that continues from production to first use to reconstitution to forever.

Ryan said he sees a "circular economy" as critical. He sees the value in recycling and upcycling and development of new materials, but none is a "silver bullet." Addressing the plastics dilemma requires recognition of the true value of plastics.

"One solution is something America is not very good at -- regulations, policy and taxation," he said. "There isn't an easy answer to the plastics problem. An unrestrained market isn't going to provide it.

"For all of these issues where science and engineering and society intersect, the answer is always: It's complicated."

A more accurate perspective, in Ryan's view, is to see the plastics problem as related to the climate change problem without allowing it to be a distraction.

"Climate change is an inconvenient truth and an invisible truth," he said. "You can't see what's causing it and you can't see carbon dioxide in the atmosphere. You don't associate driving to the store with climate change.

"You do associate things with plastics waste -- and that is a convenient truth. We have no problem taking fossil fuels and turning them into plastics. But now we need to take care of that precious plastic. Don't just throw it away. It's just too cheap. Because of the pollution problem, we need to give it an artificially high price."

Lifecycle analysis data are key to making evidence-based decisions, Ryan said, and consumers and lawmakers can't do that on their own. They need professionals to break down the costs and benefits and explain the options.

"It's far more complex than most people are willing to consider," he said.

The call to action is comprehensive.

"To achieve a more sustainable future, integration of not only technological considerations, but also equity analysis, consumer behavior, geographical demands, policy reform, life-cycle assessment, infrastructure alignment, and supply chain partnerships are vital," the authors said.

Korley said she sees growing passion for this daunting challenge.

"These initiatives drive excitement among our students -- high school, undergraduate and graduate and our postdocs," she said. "People are passionate about doing something to better the world. And they can talk to their grandmother or their niece or nephew and explain why the work they are doing matters."

 

Reducing plastic waste will require fundamental change in culture

Packaging

INSTITUTE FOR ADVANCED SUSTAINABILITY STUDIES E.V. (IASS)

Research News

 

Plastic waste is considered one of the biggest environmental problems of our time. IASS researchers surveyed consumers in Germany about their use of plastic packaging. Their research reveals that fundamental changes in infrastructures and lifestyles, as well as cultural and economic transformation processes, are needed to make zero-waste shopping the norm.

96 percent of the German population consider it important to reduce packaging waste. Nevertheless, the private end consumption of packaging in Germany has increased continuously since 2009. At 3.2 million tons in 2018, the amount of plastic packaging waste generated by end consumers in Germany has more than doubled since 1997. At 228 kilograms per capita, packaging consumption in Germany was significantly higher than the European average of 174 kilos per capita.

"Recycling only treats the symptoms of the plastic crisis and does not address the root cause, waste generation itself. We wanted to learn more about the barriers that prevent individuals in Germany from reducing their everyday consumption of plastic packaging for food and beverages. For our research project, a total of 40 participants contributed to discussions in four focus groups," explains Jasmin Wiefek, lead author of the study.

In their analysis of the discussions, the researchers identified twelve barriers to reducing plastic packaging consumption:

1. Habits: The focus group participants mainly shop at supermarkets or discounters rather than markets or zero-waste shops. The discussion also revealed that most participants do not take their own bags or containers when they go grocery shopping. Processed and packaged foods are popular.

2. Lack of knowledge: The researchers observed that participants were often uncertain which types of packaging are more sustainable than others.

3. Hygiene: Discussions revealed that participants held reservations about the hygienic properties of freely accessible displays of unpacked goods, the use of self-brought packaging and long-term reusable packaging options in general.

4. Material properties: Participants often preferred plastic packaging due to their material properties (e.g., lightweight, shatterproof, tear-resistant).

5. Priorities: Several participants described how their efforts to use less plastic packaging clashed with other priorities in their daily lives. One example given was that parents do not want to pack heavy backpacks for their children and accordingly prefer to use plastic instead of glass bottles.

6. Price: In general, groceries packaged in plastics are more affordable than plastic-free groceries.

7. Availability: By default, most groceries offered in supermarkets and discounters are only available in plastic packaging and so participants feel that they have little choice.

8. Diffusion of responsibility: According to the participants, both individuals and industry have a responsibility to solve the "plastic problem": On the one hand, because industry is responsible for the fact that so many products are packaged in plastic, it must offer solutions. However, they also emphasised that consumers should shop more consciously and avoid products in plastic packaging.

9. Reachability & infrastructure: Participants noted that places such as zero-waste shops or weekly markets were difficult to reach and required more time and effort to access than local supermarkets or discounters.

10. Time and time structures: Time is another crucial barrier to plastic-free shopping. Due to the travel distances involved, accessing zero-waste shops and markets would take up more time for most people. Participants pointed out that shopping would also take longer if they filled the food in their own containers and that the containers would have to be cleaned subsequently. They also noted that preparing unprocessed foodstuffs takes more time.

11. Convenience: Participants reported that they find it inconvenient to take their own containers to shops as it requires that they either carry the containers to work and back again or go out twice.

12. Consumer Culture: The participants stated that they did not attach much importance to the availability of a 'wide range of products' when shopping. However, many stressed the importance of reliably finding specific products in shops. This translates into an indirect demand for a wide range of products, which is difficult for zero-waste / low-plastic retailers to implement. Discussions in the focus groups also showed that our culture of spontaneous and on-the-go consumption makes it difficult to reduce packaging. Many participants were unaware that non-regional and non-seasonal foods, which we consume as a matter of course every day, must be packaged to maintain their freshness during long distance transport.

"Our results show that at present a lot of effort and knowledge is required for consumers to avoid plastic packaging. If we want to make low-waste goods and goods without single-use plastic packaging the cheapest and most convenient option, we will need to change the relevant infrastructures, economic incentives, and political framework conditions," explains project leader and co-author Katharina Beyerl. The goal of reducing the use of plastic packaging will not be achieved by merely asking consumers to shop exclusively in zero-waste stores. Instead, it requires fundamental changes in societal structures and lifestyles as well as a cultural shift.

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Wiefek, J., Steinhorst, J., Beyerl, K. (2021 online): Personal and structural factors that influence individual plastic packaging consumption--Results from focus group discussions with German consumers. - Cleaner and responsible consumption, 3, 100022. https://doi.org/10.1016/j.clrc.2021.100022

Disclaimer: AAAS and E

 

Special issue: Our plastics dilemma

AMERICAN ASSOCIATION FOR THE ADVANCEMENT OF SCIENCE

Research News

 

Although plastics have become an essential material, permeating almost all aspects of modern living, many of the inherent properties that make them useful in such a wide variety of applications also make them a serious environmental threat. In a special issue of Science, "Our Plastics Dilemma," four Reviews, two Perspectives, a Policy Forum, an associated Report and two News features examine a wide range of topics related to plastics and the problems they present. "As for much new technology, their development and proliferation occurred with little consideration for their impacts, but now it's impossible to deny their dark side as we confront a rapidly growing plastic pollution problem," writes Science Senior Editor, Jesse Smith. "The time for preventing plastic pollution is long past - the time for changing the future of plastics in our world, however, is now."

Estimates of the amount of plastic floating at the ocean surface (measured in the hundreds to thousands of metric tons) only represent a small fraction of what is suspected to be annually discharged by rivers worldwide (several million metric tons). This has led some to speculate a large, yet-unidentified plastic sink that could help explain the rapid removal of river-sourced plastics from the ocean's surface. In the associated Report in this special issue, Lisa Weiss and colleagues show that this missing sink may not even exist. Weiss et al. performed a large-scale statistical reanalysis on updated data on microplastics. "We came to the conclusion that previous flux estimates contained several serious errors," Weiss explains in a related video. She and colleagues say that previous mass fluxes of microplastics were overestimated by two to three orders of magnitude, explaining why the residence time of plastics in the oceans appeared so short. Based on these findings, the authors suggest that the average residence time of microplastics at the ocean's surface could be as high as several years, rather than a few days. The results imply that ocean plastics have more time than previously thought to degrade at the surface before becoming entrained in seafloor sediments. Based on their results, "the need for a missing plastic sink becomes outdated and... unnecessary," says author Wolfgang Ludwig in the video.

In a pair of Perspectives, experts highlight the problematic history of early bio-based plastics and how designing future plastics for both chemical assembly and disassembly is essential to achieving an effective circular plastics economy. According to Rebecca Altman, early bioplastics - the broad category of plastics made from bio-based feedstocks like corn, sugar or wood - were neither clean nor green. Lessons from their overlooked and misunderstood past could help inform the future of greener, biodegradable plastics and plastic technology. Sarah Kakadellis and Gloria Rosetto highlight the technical, chemical, and biological routes to closing the plastic resource loop by designing plastics to be more broadly recyclable or biodegradable in the environment. "The fallacy of mechanical recycling has already taught us that technology alone will not and cannot solve the plastic pollution crisis. No silver bullet solution exists for the multifaceted nature of plastic pollution," write the authors. "Only through committed action and coordination across the value chain will a sustainable future for plastics be secured," write Kakadellis and Rosetto.

A Policy Forum by Nils Simon and colleagues argues the need for a binding global agreement to address plastic's long lifecycle and to combat plastic pollution. According to Simon et al., the international community has tended to view the plastics problem as an ocean- and/or waste-focused problem. However, plastics are ubiquitously found in increasing amounts worldwide, including in terrestrial environments and even inside the human body. The authors call for a new international treaty that addresses these concerns thought the entire lifecycle of plastics, from the extraction of the raw materials needed for its manufacture to its legacy pollution.

The special issue also includes four Reviews that discuss the rapidly rising global threat that steadily accumulating plastic pollution poses for the environment, the evolutionary and ecological consequences of widespread plastic ingestion by wildlife, how plastics are best understood as emergent geomaterials with unique synthetic chemistries not previously seen in Earth's history, and how innovations in plastic recycling and polymer upcycling could help address our plastics dilemma and usher in the next generation of materials design. In addition, two features from Science's news department explore how enzymes are being used to aid in plastic recycling efforts and the ways in which museum conservationists are trying to preserve the plastic objects in their exhibits.

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How long can a person live? The 21st century may see a record-breaker

UNIVERSITY OF WASHINGTON

Research News

 

The number of people who live past the age of 100 has been on the rise for decades, up to nearly half a million people worldwide.

There are, however, far fewer "supercentenarians," people who live to age 110 or even longer. The oldest living person, Jeanne Calment of France, was 122 when she died in 1997; currently, the world's oldest person is 118-year-old Kane Tanaka of Japan.

Such extreme longevity, according to new research by the University of Washington, likely will continue to rise slowly by the end of this century, and estimates show that a lifespan of 125 years, or even 130 years, is possible.

"People are fascinated by the extremes of humanity, whether it's going to the moon, how fast someone can run in the Olympics, or even how long someone can live," said lead author Michael Pearce, a UW doctoral student in statistics. "With this work, we quantify how likely we believe it is that some individual will reach various extreme ages this century."

Longevity has ramifications for government and economic policies, as well as individuals' own health care and lifestyle decisions, rendering what's probable, or even possible, relevant at all levels of society.

The new study, published June 30 in Demographic Research, uses statistical modeling to examine the extremes of human life. With ongoing research into aging, the prospects of future medical and scientific discoveries and the relatively small number of people to have verifiably reached age 110 or older, experts have debated the possible limits to what is referred to as the maximum reported age at death. While some scientists argue that disease and basic cell deterioration lead to a natural limit on human lifespan, others maintain there is no cap, as evidenced by record-breaking supercentenarians.

Pearce and Adrian Raftery, a professor of sociology and of statistics at the UW, took a different approach. They asked what the longest individual human lifespan could be anywhere in the world by the year 2100. Using Bayesian statistics, a common tool in modern statistics, the researchers estimated that the world record of 122 years almost certainly will be broken, with a strong likelihood of at least one person living to anywhere between 125 and 132 years.

To calculate the probability of living past 110 -- and to what age -- Raftery and Pearce turned to the most recent iteration of the International Database on Longevity, created by the Max Planck Institute for Demographic Research. That database tracks supercentenarians from 10 European countries, plus Canada, Japan and the United States.

Using a Bayesian approach to estimate probability, the UW team created projections for the maximum reported age at death in all 13 countries from 2020 through 2100.

Among their findings:

• Researchers estimated near 100% probability that the current record of maximum reported age at death -- Calment's 122 years, 164 days -- will be broken;
• The probability remains strong of a person living longer, to 124 years old (99% probability) and even to 127 years old (68% probability);
• An even longer lifespan is possible but much less likely, with a 13% probability of someone living to age 130;
• It is "extremely unlikely" that someone would live to 135 in this century.

As it is, supercentenarians are outliers, and the likelihood of breaking the current age record increases only if the number of supercentenarians grows significantly. With a continually expanding global population, that's not impossible, researchers say.

People who achieve extreme longevity are still rare enough that they represent a select population, Raftery said. Even with population growth and advances in health care, there is a flattening of the mortality rate after a certain age. In other words, someone who lives to be 110 has about the same probability of living another year as, say, someone who lives to 114, which is about one-half.

"It doesn't matter how old they are, once they reach 110, they still die at the same rate," Raftery said. "They've gotten past all the various things life throws at you, such as disease. They die for reasons that are somewhat independent of what affects younger people.

"This is a very select group of very robust people."

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The study was funded by the National Institute for Child Health and Human Development.

For more information, contact Pearce at mpp790@uw.edu or Raftery at raftery@uw.edu.

 

Low-income patients may be less likely to receive medical assistance in dying

Study shows socioeconomic status influences a patient's access to medical assistance in dying in Canada

PRINCETON UNIVERSITY, WOODROW WILSON SCHOOL OF PUBLIC AND INTERNATIONAL AFFAIRS

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IMAGE: IN CANADA, LOW-INCOME HOSPITAL PATIENTS UNDER PALLIATIVE CARE ARE LESS LIKELY TO RECEIVE MEDICAL ASSISTANCE IN DYING COMPARED TO THOSE WHO ARE HIGH INCOME, ACCORDING TO A STUDY PUBLISHED IN... view more 

CREDIT: EGAN JIMENEZ, PRINCETON UNIVERSITY

In Canada, low-income hospital patients under palliative care are less likely to receive medical assistance in dying compared to those who are high income, according to a study published in British Medical Journal Open (BMJ Open).

Medical assistance in dying (MAID) is legal and free under Medicare, Canada's universal health care system. Patients with low socioeconomic status (SES), however, generally tend to experience less access to medical care compared to their high SES counterparts.

Eldar Shafir, professor of psychology and public affairs at the Princeton School of Public and International Affairs, along with a team of researchers from Sunnybrook Hospital in Ontario, investigated whether this trend of decreased care for low-income patients includes medical assistance in dying.

"I have long been interested in SES influences on decision-making," said Shafir. "I often discuss with my friend and collaborator, Dr. Redelmeier, ways to illustrate some of our findings in the medical realm, especially, when possible, among experts. ... In this case MAID was a really interesting domain, since it's a 'big' decision, and finances are not an issue."

Medical assistance in dying was ruled legal in Canada in February 2015 and officially implemented and covered under Medicare by June 2016. To be considered, a patient must have a grievous and irremediable medical condition, such as metastatic cancer, that causes unbearable suffering where death is foreseeable, according to the Government of Canada.

However, one's socioeconomic status can influence how medical care is administered and received by a patient in several ways. "People can be easily susceptible to pitfalls and biases in reasoning," Shafir said.

Low-income patients, for example, may feel less equipped to advocate for their care and to convey dissatisfaction. Clinicians can also succumb to the "thick-skin fallacy," or the harmful perception that low-income people are used to hardship and therefore less impacted by it.

The team explored the association between socioeconomic status and medical assistance in dying by identifying hospital patients aged 65 and older in Ontario, Canada between June 2016 and 2019. At the time of their death, all patients, all of whom had serious medical conditions, were under palliative care, receiving pain-relieving treatment for symptoms. They were then divided into groups based on socioeconomic status, which was calculated using an official algorithm created by Statistics Canada based on home neighborhood location, and whether they received medical assistance in dying.

During the three years, 50,096 patients were given palliative care in their last month of life. Among them, 920 received medical assistance in dying. Only 1.5% of low-income patients identified were given MAID, compared to 2.4% of high-income patients -- a 39% decreased likelihood for those with low socioeconomic status. This disparity in care was found consistently across a variety of patient subgroups that varied in age, sex, home location, type of cancer, health care utilization, and general frailty. It was even replicated with patients treated by the same responsible physician.

The study's results support past findings by other countries about the relationship between medical assistance in dying and patients' socioeconomic status. In countries like the United States, the Netherlands, Switzerland, and Belgium, people who received MAID or MAID equivalents tended to be highly educated, financially secure, or live in wealthy neighborhoods.

The researchers, however, suspect that this difference in patient care may be influenced by factors that exist outside of financial capabilities. "I suspect most of what happens here is a function of the doctor-patient interaction," explained Shafir. "I think, all else equal, that doctors might see low-SES patients as less in urgent need of MAID."

Certain study limitations, such as biased and imperfect socioeconomic status measures, warrant further research exploring the link between social class and medically assisted death. "Both perspectives, the doctors' and the patients', need to be better understood by the medical community in order to provide low-SES patients with same care afforded those of higher SES," said Shafir.

The observations made by Shafir and his team address an earlier misconception in Canada that medical assistance in dying may harmfully target low-income individuals. The researchers are optimistic that their findings may help promote greater patient-clinician communication and engagement.

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"Association of socioeconomic status with medical assistance in dying: a case-control analysis" by Donald A. Redelmeier, Kevin Ng, Deva Thiruchelvam, and Shafir, was published on April 30 in British Medical Journal Open.

THIRD WORLD USA

Study: Nearly 10 percent of high school students experienced homelessness in Spring 2019

Findings are three times higher than state education counts

NEMOURS

Research News

 

WILMINGTON, Del. (June 29, 2021) - A new report finds that 509,025 (9.17%) public high school students in 24 states experienced homelessness in spring 2019 -- three times the number recognized by the states' education agencies. This under-recognition creates gaps in funding and services needed by this vulnerable population.

Researchers from Nemours Children's Health and the University of Pennsylvania analyzed data from the Centers for Disease Control and Prevention (CDC) for public schools across 24 states and 12 school districts. During spring 2019, more than 9% of public high school students experienced homelessness during a 30-day period in the 24 states. The rate was even higher in the 12 school districts, analyzed separately, where nearly 14% of students reported homelessness.

The report's authors believe the discrepancy between the CDC's data, collected through the Youth Risk Behavior Surveillance System (YRBSS), and the state and local school agency homelessness estimates is likely due to the more comprehensive nature and complex sampling design of the YRBSS. The YRBSS is an anonymous set of surveys conducted in public high schools every two years. The report analyzed data from all states and school districts that opted to ask about student housing and homelessness for the 2019 YRBSS.

Homelessness was more likely among students who were male, LGBT (lesbian, gay, bisexual, transgender), Black/African American, Hispanic/Latinx, or Native American/Hawaiian. Students who experienced homelessness reported higher rates of sexual victimization, physical victimization, and having been bullied. Even when controlling for other risk factors, students who experienced homelessness reported higher rates of severe suicidality, hard drug use, alcohol abuse, risky sexual behavior, and poor grades.

"Even before the COVID-19 pandemic, we saw high rates of homelessness in public high school students and strong links between homelessness and other harmful experiences," said the report's lead author, Danielle Hatchimonji, PhD, of Nemours' Center for Healthcare Delivery Science. "The pandemic's impact on financial and housing stability will have even broader, ripple effects on mental health and academic functioning -- effects that will continue to disproportionately harm students of color."

Dan Treglia, PhD, of the University of Pennsylvania, a co-author on the report and a homelessness expert, explained, "The CDC housing data let us fully recognize the magnitude and depth of youth homelessness in the United States. By acknowledging its extent, we can begin to address the underlying problems and continue to improve systems to identify and serve these students across local school districts and states."

The report makes several recommendations, including prioritizing funding for the federal McKinney-Vento education programs designed to identify and address student homelessness and better sharing of information across service sectors, including housing, education, substance abuse, and mental health. The report also emphasizes the need to reduce poverty and systemic racism and heterosexism, which place students from marginalized groups at higher risk of homelessness.

Hatchimonji added, "That any student experiences homelessness is unacceptable. That homelessness is so much more common among students of color and LGBT students underscores our shared obligation to promote equity and safety, especially for basic needs and human rights."

"We know from other studies that many students who experience homelessness show resilience," said senior author J. J. Cutuli, PhD, of Nemours' Center for Healthcare Delivery Science. "We also know that resilience happens because of relationships and other supports in their lives. Promoting resilience means supporting families, educators, and others in the lives of teens who make sure homelessness does not get in the way."

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About Nemours Children's Health

Nemours Children's Health is one of the nation's largest multistate pediatric health systems, including two free-standing children's hospitals and a network of nearly 80 primary and specialty care practices across five states. Nemours seeks to transform the health of children by adopting a holistic health model that utilizes innovative, safe, and high quality care, while also caring for the health of the whole child beyond medicine. Nemours also powers the world's most-visited website for information on the health of children and teens, KidsHealth.org.

The Nemours Foundation, established through the legacy and philanthropy of Alfred I. duPont, provides pediatric clinical care, research, education, advocacy, and prevention programs to the children, families and communities it serves.

 

For women workers in India, direct deposit is 'digital empowerment'

YALE UNIVERSITY

Research News

 

Giving women in India's Madhya Pradesh state greater digital control over their wages encouraged them to enter the labor force and liberalized their beliefs about working women, concluded a new study co-authored by Yale economists Rohini Pande and Charity Troyer Moore.

The study, published in the American Economic Review, found that a relatively simple intervention directed to poor women -- providing them access to their own bank accounts and direct deposit for their earnings from a federal workfare program, along with basic training on how to use local bank kiosks -- increased the amount they worked, both in the government program and for other employers.

The women who had access to the banking resources were more likely to report in surveys that a working woman made "a better wife" and that husbands with working wives were better spouses and providers. They also were less likely to say women who work outside the home bear social costs for it.

The study points to the role of gender norms in India's low and declining rate of women in the workforce and it also demonstrates that boosting women's control of their finances can expand their autonomy, said Pande, the Henry J. Heinz II Professor of Economics in Yale's Faculty of Arts and Sciences.

"Economics research often assumes that a country's men and women embrace the same cultural norms, but our study highlights the fact that norms can be differently experienced and held within the same country or culture," said Pande, who is also director of Yale's Economic Growth Center. "Improving a woman's access to her earnings should cause her to work less because she can make the same amount of money with less effort. That we found women work more suggests that some women would prefer to work but are potentially being constrained by social stigma perceived by their husbands' -- specifically, that working wives diminish their husband's social status."

India experienced a period of strong economic growth between 2005 and 2018 with declining fertility rates and gains in education for women, but the rate of female labor force participation fell from 32% to 21% during that period. However, one-third of Indian housewives say in surveys that they are interested in working outside the home. Bringing these latent workers into the workforce would contribute substantially to the country's economic growth, Pande said.

Working in northern Madhya Pradesh, a region marked by particularly restrictive gender norms, the research team collaborated with government and banking partners to enable direct deposit of women's wages from the federal workfare program into their own bank accounts rather than into a male-controlled household account. They conducted a randomized controlled trial covering 197 village clusters and surveyed a total of 4,300 women. The villages were divided among a control group and four treatment groups, only one of which received bank accounts, direct deposit, and training. The researchers refer to this group as being "digitally empowered."

The study found an overall increase in labor supply among digitally empowered women compared to women who only received a bank account. They were 28% more likely to have participated in the workfare program during the past year than were the women who only received a bank account and 13% more likely to report any paid work in the previous month, according to the findings. The digitally empowered group also earned 24% more (950 rupees) annually from the private sector, which is notable given that the direct deposit was only linked to workfare wages and private-sector work often is paid in cash.

"The fact that digitally empowered women were earning more in the private sector suggests that having more control of their earnings spread into other aspects of their lives, giving them the ability to negotiate with other household members to work more outside their homes," said Troyer Moore, director of South Asia economics research at Yale's MacMillan Center for International and Area Studies. "It tells us that a simple policy intervention has altered a cultural norm, which is very exciting."

The researchers separated the sample into two groups: women who had worked in the government program before, and those who had not. In surveys, women in the latter group reported having less decision-making power, and that their husbands were more likely to associate a working wife with social stigma. The data showed that while the increases in work outside the home trailed off among those who had previously worked in the program by the study's third year, it persisted for the socially constrained group, demonstrating that the intervention had the most durable impact on women facing the greatest barriers to work.

Study participants were surveyed to measure their thoughts about working and non-working women. The results showed that, compared to women who received only bank accounts, digitally empowered women liberalized their personal beliefs about women's work.

While researchers were conducting the study, the Indian government began scaling up direct deposit of workfare wages into female-owned accounts nationwide, but the effort involved neither targeted outreach to eligible women nor any systematic account training, key elements of the most successful intervention that the study identified, the researchers said.

"We look forward to working with government partners to scale up the policy intervention in a manner that maximizes the benefits to women," Troyer Moore said.

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The study was co-authored by Erica Field of Duke University, Natalia Rigol of Harvard University, and Simone Schaner of the University of Southern California.

A link to the paper and a detailed summary of its findings is available on the Economic Growth Center's website.