Category: Academic Reportage

Source: The Conversation – USA (3) – By Jill Inderstrodt, Assistant Professor of Health Policy and Management, Indiana University

It’s a rare occasion when my worlds of biomedical informatics and serialized lesbian melodrama fandom collide.

But that’s exactly what happened earlier this summer when two of my favorite actresses appeared on a popular podcast. I was excited to hear them talk about their new book and their history of working together, so I was confused but delighted when their conversation took a turn toward my area of expertise – electronic health records.

One actress noted that on a recent trip to the optometrist, she was asked about her ethnicity. “And I was like, what difference does it make?” she said.

The host chimed in with her experience of being asked similarly personal questions before a mammogram. “Like, it doesn’t matter if I’m married or not. It doesn’t matter if I’m white or Asian, you know?” she remarked.

Listening to the host and actresses question a process that, to me, seems straightforward and purposeful served as a stark reminder of the chasm that often exists between how researchers like me use patient data and a patient’s actual experience of clinical data collection.

For those of us who use demographic data collected during health care encounters to conduct research and design interventions, it does matter whether patients answer their doctor’s demographic questions. But as a patient myself, I can see how these questions might seem unnecessary and even invasive.

So it may help to understand why your doctors collect this data, how researchers use it and what medical discoveries might be possible when we know more about who patients are.

Why your data matters

When you answer the demographic questions your doctor logs in your electronic health record, you’re doing more than disclosing personal information. You’re adding one small piece to a giant puzzle of data that allows researchers like me to see a bigger picture.

Your health information can help us understand who gets sick and why. It might even be used to design real health interventions.

As a researcher focused on improving health and health care for moms and their babies, I consider myself lucky to live in Indiana, a state with one of the nation’s most comprehensive health information exchanges. These exchanges are interconnected networks of hospital system electronic health record databases from all over the state that allow researchers like me to learn about how individuals and groups experience health and medical care.

For example, my colleagues and I in the Indiana University Better AI for a Strong Rural Maternal and Child Health Environment Lab use this data to train machine learning models that predict preeclampsia, a life-threatening condition of high blood pressure during pregnancy, before a mom gets really sick.

We could use only clinical data: diagnoses, labs and vital readings like blood pressure that contribute to the outcome of preeclampsia. But for conditions like preeclampsia, Black moms are diagnosed at higher rates than their white counterparts. Research shows that race and racism can be major contributing factors to this disparity.

In order to predict preeclampsia accurately and use these predictions to help doctors monitor, diagnose and treat the condition, my team needs to factor in other information that can illuminate these different outcomes, called social determinants of health.

Social determinants of health are the parts of ourselves and our environments that drive our health status. Race itself isn’t a social determinant of health, but racism is. This includes structural racism, like a ZIP code’s history of school segregation or redlining. If available, we also include information you might have given at your doctor’s visit, like if you haven’t had enough food to eat in the past month, or if you have a history of intimate partner violence or homelessness.

Because there is more variation within races than between them, race alone actually tells us very little. Including social determinants of health in our datasets provides added context as to how you move about the world, what resources you have access to and how your environment might shape your health.

Putting the pieces together

This is why your cardiologist asks about your marital status. Your response might help researchers understand why single moms are more likely to have cardiovascular disease than their married counterparts. And telling your optometrist your race is one of the only ways to learn what role race might play in patients using weight loss drugs experiencing vision loss.

Other researchers have used data from electronic records to determine how many people in a geographic area or of a certain demographic group have diabetes, to predict dementia and even to track gum disease.

During the COVID-19 pandemic, researchers used data from electronic health records to determine what types of people were getting sick. They investigated COVID-19 patients’ race, geography and insurance status. Researchers continue to use this data to track long COVID, a condition that health professionals still don’t completely understand.

Honoring patient privacy

Of course, these health information exchanges are careful about how and with whom they share patient data. The data is tailored to the needs of the study and shared in compliance with the Health Insurance Portability and Accountability Act, or HIPAA.

For instance, for my most recent preeclampsia study, the health care system sent a dataset that contained limited pieces of personal information, like the baby’s birth date, the mom’s birth date – since we often need to know how old she was when she gave birth – and their ZIP code so we can see trends in preeclampsia across geographic areas.

The data wasn’t allowed out of the health system’s virtual private network, so the data remains within our firewall. This ensures that the data remains safe. And all of this must be approved by our university’s institutional review board, a rigorous process that ensures our research can’t harm participants.

Improving health care for everyone – including you

All of this research drives innovation and serves as a basis for the programs, protocols and policies that improve health – from you as an individual all the way to the national and even global level.

Your doctor can use the information you provide to recommend services or therapies for you. For instance, if your doctor finds out through check-in questioning that you haven’t had enough food in the past month, they can refer you to a nutrition program, sometimes run by the hospital system itself. If you were married at your last appointment but now list your marital status as “separated,” your doctor can check in with you to see if you need any additional mental health or social services.

While it’s normal for these personal questions to feel a little uncomfortable, it helps to remember that there is a good reason your doctor is asking them. Your data can help move medical research forward.

Jill Inderstrodt receives funding from US Centers for Disease Control and Prevention and National Institutes of Health.

– ref. ‘Are you married?’ Why doctors ask invasive questions during treatment – https://theconversation.com/are-you-married-why-doctors-ask-invasive-questions-during-treatment-268268

Source: The Conversation – USA (3) – By Loveline Chizobam Phillips, Ph.D. Candidate, George Mason University

One in 10 babies in the U.S. – nearly 374,000 infants – were born preterm in 2023, meaning before 37 weeks of pregnancy. More than 15% were very preterm, meaning they were born before 32 weeks. A full-term pregnancy lasts 40 weeks.

Florida’s rate is slightly higher, at about 1 in 9 babies born preterm. In an average week, 456 of the 4,257 babies born in the state will be preterm, and 75 of those will be very preterm.

According to the March of Dimes, preterm birth and low birthweight-related health complications cause 37.5% of infant deaths nationwide. This makes preterm birth the second-leading cause of infant deaths, after birth defects. Preterm babies who survive infancy are susceptible to health complications later in life, including cerebral palsy and learning disabilities.

Preterm and low-birthweight babies – those weighing less than 5.5 pounds (2,500 grams) – are far more likely to go to the neonatal intensive care unit, or NICU. Very preterm infants tend to have the longest NICU stays, averaging around 43 days.

Beyond the emotional toll this takes on a family, preterm births and their resulting health complications carry substantial financial costs. The average NICU admission in 2021 cost around US$71,000. And economists estimated the lifetime societal cost of all preterm babies born in 2016, from birth to subsequent disability care, at $25.2 billion.

We are a public policy Ph.D. student and public policy researcher focusing on health policy and population health outcomes.

Recently, we were sifting through the data on preterm and low birthweight rates in the U.S., in search of places that are doing better than average at preventing preterm births. And that is what we found in the Central Hillsborough Healthy Start program, which serves a cluster of Tampa ZIP codes with roughly 177,000 residents.

In 2008, this program published records showing 30% lower preterm and low-birthweight rates among families at highest risk. Peer-reviewed evaluations link participation in the program to substantial reductions in preterm and low-birthweight outcomes.

These remarkable improvements remained consistent through 2020.

When we looked at what this program is doing, we found a set of practices that can serve as a model for other counties in Florida and around the U.S. to lower preterm birth rates, saving money and, more importantly, lives.

Screening for risk factors

The program does early screening for risk factors of preterm birth using Florida’s Healthy Start prenatal risk screen at the pregnant person’s first prenatal visit. This screening has been proven to correctly flag a good share of higher-risk pregnancies, while avoiding many false alarms, helping scarce services reach families who need them most.

This is key, because the risk of preterm birth isn’t spread out evenly across all pregnancies. The neighborhoods that Central Hillsborough Healthy Start serves include many young, Black, unmarried, low-income families that are eligible for Medicaid. All of these factors place them at high risk for preterm birth.

Early screening allows the Healthy Start program to identify mothers at highest risk and tailor its resources to assist them.

Measuring against the rest of the state

The Florida Healthy Start prenatal risk screen is available throughout the state. Florida created Healthy Start in 1991 precisely to reduce infant deaths and low birthweight through universal prenatal and infant risk screening, community coalitions and coordinated services.

While Florida’s preterm birth rate in 2023, the most recent year for which there is data, was 10.7%, Hillsborough County tracked slightly below the U.S. average of 10.4% at about 10.2% of the county’s 16,900 births.

That difference may seem small, but it represents 85 fewer preterm babies in Hillsborough County, and at the average rate of $71,000 per NICU admission, that’s about $6 million in hospital spending avoided in a single year.

In addition, statewide, 14.8% of Black infants were born preterm in 2023, slightly higher than the 14.65% average across the U.S. In Hillsborough County in the same year, it was 13.9%.

Among pregnant women without a partner, participation reduced very preterm births by 52% and halved the rate of very low-birthweight babies – that is, babies weighing less than 3.3 pounds (1,500 grams).

Obese mothers in the program had a 61% lower chance of extremely preterm birth, which means birth before 28 weeks of pregnancy, than comparable women elsewhere in Florida. Even exposure to air pollution, a known risk factor for preterm birth, was less harmful among women in the program.

So what has Central Hillsborough Healthy Start been doing differently?

The Central Hillsborough Healthy Start model

The model used by Central Hillsborough Healthy Start is practical and straightforward.

After early screening, nurses make home visits and help coordinate patient care for mothers in the program.

Central Hillsborough Healthy Start also provides prenatal education, depression screening and programs to help pregnant mothers improve their health and decrease harmful practices such as smoking or substance abuse. These programs are critical, because obesity, diabetes, hypertension and smoking during pregnancy are significant risk factors for preterm births.

The program also helps to connect patients to resources they may need during and after pregnancy by making personal introductions to community partners such as women and infant resource specialists in women, infants and children, or WIC, clinics.

Healthy Start workers also connect patients to interconception care for healthy birth spacing between pregnancies, which can help prevent future preterm births. Studies show that more than 30% of U.S. mothers who give birth preterm conceived their baby less than 18 months after having their previous child.

The Healthy Start staff use Florida’s coordinated intake and referral approach to track referrals and follow up across partners. This is vital to helping the program’s staff see who has been contacted, which services were delivered and whether referrals took place. They can then follow up if necessary.

Stability and sustainability

Central Hillsborough Healthy Start operates through a local nonprofit, REACHUP Inc., in partnership with the University of South Florida and the Hillsborough Healthy Start Coalition.

Its funding comes primarily from the federal government through the Health Resources and Services Administration’s national Healthy Start program. The program’s current federal funding extends into 2029. But proposed changes to the federal budget threaten to eliminate this funding altogether.

The program’s budget is supplemented by local partners, including Hillsborough County, which helps sustain operations despite federal uncertainty.

Locally, the Hillsborough coalition’s portfolio includes programs that work together like one team, sharing information so families keep getting help even when one grant ends. These partnerships with local community organizations allow the program to remain stable.

A model for others

Looking at the data, we believe Central Hillsborough Healthy Start has succeeded by using the same basic approach for everyone, then customizing. Everyone gets screened early and set up with nurse visits. Then, its adds what each family needs so that support fits real life.

The Central Hillsborough story shows that health disparities are not inevitable. And this model can serve as a feasible blueprint for other communities. With early identification, consistent support and sustained investment, the outcomes for mothers and babies can improve dramatically.

Read more stories from The Conversation focused on Florida.

The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.

– ref. How one Florida program reduced preterm births – and how it could serve as a model for other communities – https://theconversation.com/how-one-florida-program-reduced-preterm-births-and-how-it-could-serve-as-a-model-for-other-communities-268058

Source: The Conversation – USA (2) – By Kent Jones, Professor Emeritus, Economics, Babson College

The U.S. Supreme Court is currently reviewing a case to determine whether President Donald Trump’s global tariffs are legal.

Until recently, tariffs rarely made headlines. Yet today, they play a major role in U.S. economic policy, affecting the prices of everything from groceries to autos to holiday gifts, as well as the outlook for unemployment, inflation and even recession.

I’m an economist who studies trade policy, and I’ve found that many people have questions about tariffs. This primer explains what they are, what effects they have, and why governments impose them.

What are tariffs, and who pays them?

Tariffs are taxes on imports of goods, usually for purposes of protecting particular domestic industries from import competition. When an American business imports goods, U.S. Customs and Border Protection sends it a tariff bill that the company must pay before the merchandise can enter the country.

Because tariffs raise costs for U.S. importers, those companies usually pass the expense on to their customers by raising prices. Sometimes, importers choose to absorb part of the tariff’s cost so consumers don’t switch to more affordable competing products. However, firms with low profit margins may risk going out of business if they do that for very long. In general, the longer tariffs are in place, the more likely companies are to pass the costs on to customers.

Importers can also ask foreign suppliers to absorb some of the tariff cost by lowering their export price. But exporters don’t have an incentive to do that if they can sell to other countries at a higher price.

Studies of Trump’s 2025 tariffs suggest that U.S. consumers and importers are already paying the price, with little evidence that foreign suppliers have borne any of the burden. After six months of the tariffs, importers are absorbing as much as 80% of the cost, which suggests that they believe the tariffs will be temporary. If the Supreme Court allows the Trump tariffs to continue, the burden on consumers will likely increase.

While tariffs apply only to imports, they tend to indirectly boost the prices of domestically produced goods, too. That’s because tariffs reduce demand for imports, which in turn increases the demand for substitutes. This allows domestic producers to raise their prices as well.

A brief history of tariffs

The U.S. Constitution assigns all tariff- and tax-making power to Congress. Early in U.S. history, tariffs were used to finance the federal government. Especially after the Civil War, when U.S. manufacturing was growing rapidly, tariffs were used to shield U.S. industries from foreign competition.

The introduction of the individual income tax in 1913 displaced tariffs as the main source of U.S. tax revenue. The last major U.S. tariff law was the Smoot-Hawley Tariff Act of 1930, which established an average tariff rate of 20% on all imports by 1933.

Those tariffs sparked foreign retaliation and a global trade war during the Great Depression. After World War II, the U.S. led the formation of the General Agreement on Tariffs and Trade, or GATT, which promoted tariff reduction policies as the key to economic stability and growth. As a result, global average tariff rates dropped from around 40% in 1947 to 3.5% in 2024. The U.S. average tariff rate fell to 2.5% that year, while about 60% of all U.S. imports entered duty-free.

While Congress is officially responsible for tariffs, it can delegate emergency tariff power to the president for quick action as long as constitutional boundaries are followed. The current Supreme Court case involves Trump’s use of the International Emergency Economic Powers Act, or IEEPA, to unilaterally change all U.S. general tariff rates and duration, country by country, by executive order. The controversy stems from the claim that Trump has overstepped his constitutional authority granted by that act, which does not mention tariffs or specifically authorize the president to impose them.

The pros and cons of tariffs

In my view, though, the bigger question is whether tariffs are good or bad policy. The disastrous experience of the tariff war during the Great Depression led to a broad global consensus favoring freer trade and lower tariffs. Research in economics and political science tends to back up this view, although tariffs have never disappeared as a policy tool, particularly for developing countries with limited sources of tax revenue and the desire to protect their fledgling industries from imports.

Yet Trump has resurrected tariffs not only as a protectionist device, but also as a source of government revenue for the world’s largest economy. In fact, Trump insists that tariffs can replace individual income taxes, a view contested by most economists.

Most of Trump’s tariffs have a protectionist purpose: to favor domestic industries by raising import prices and shifting demand to domestically produced goods. The aim is to increase domestic output and employment in tariff-protected industries, whose success is presumably more valuable to the economy than the open market allows. The success of this approach depends on labor, capital and long-term investment flowing into protected sectors in ways that improve their efficiency, growth and employment.

Critics argue that tariffs come with trade-offs: Favoring one set of industries necessarily disfavors others, and it raises prices for consumers. Manipulating prices and demand results in market inefficiency, as the U.S. economy produces more goods that are less efficiently made and fewer that are more efficiently made. In addition, U.S. tariffs have already resulted in foreign retaliatory trade actions, damaging U.S. exporters.

Trump’s tariffs also carry an uncertainty cost because he is constantly threatening, changing, canceling and reinstating them. Companies and financiers tend to invest in protected industries only if tariff levels are predictable. But Trump’s negotiating strategy has involved numerous reversals and new threats, making it difficult for investors to calculate the value of those commitments. One study estimates that such uncertainty has actually reduced U.S. investment by 4.4% in 2025.

A major, if underappreciated, cost of Trump’s tariffs is that they have violated U.S. global trade agreements and GATT rules on nondiscrimination and tariff-binding. This has made the U.S. a less reliable trading partner. The U.S. had previously championed this system, which brought stability and cooperation to global trade relations. Now that the U.S. is conducting trade policy through unilateral tariff hikes and antagonistic rhetoric, its trading partners are already beginning to look for new, more stable and growing trade relationships.

So what’s next? Trump has vowed to use other emergency tariff measures if the Supreme Court strikes down his IEEPA tariffs. So as long as Congress is unwilling to step in, it’s likely that an aggressive U.S. tariff regime will continue, regardless of the court’s judgment. That means public awareness of tariffs ⁠– and of who pays them and what they change ⁠– will remain crucial for understanding the direction of the U.S. economy.

Kent Jones does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

– ref. Tariffs 101: What they are, who pays them, and why they matter now – https://theconversation.com/tariffs-101-what-they-are-who-pays-them-and-why-they-matter-now-271576

Source: The Conversation – USA (2) – By Chao Guo, Professor of Nonprofit Management, University of Pennsylvania

Long-term care for older people is challenging for everyone. The costs are high and the quality of care is unpredictable at best, often falling short.

The U.S. health care system is so hard to navigate that experts can find it aggravating. Even when people who need help with activities of daily living – a list that includes getting dressed, preparing meals and bathing – receive the care they need, they may still experience social isolation. And it can take a relentless emotional toll on caretakers, be they family members or trained professionals.

We are researchers of government, business and nonprofits. Together, we are seeking innovative solutions to pressing social problems such as the aging population and the growing need for long-term care.

In our ongoing research, we’re exploring a promising concept that could potentially ease some of these burdens: time banking, a community-based mutual aid system that treats everyone’s time as equally valuable.

A global demographic shift

By 2050, 1 in 6 people around the world will be over 65, up from 1 in 11 in 2019, the United Nations projects. By the late 2070s, older adults could outnumber children under 18 for the first time in human history.

Caring for a growing number of older people with a shrinking number of younger people is expensive and complicated. A 2022 Kaiser Family Foundation survey found that 90% of respondents could not afford the estimated US$100,000 annual cost of nursing home care, and even the roughly $60,000 cost of in-home assistance was beyond the reach for most U.S. families.

These high costs are compounded by a growing shortage of professional caregivers. The U.S. Bureau of Labor Statistics estimates that nearly 9 million new direct-care workers, such as nursing assistants, home health aides and personal care aides, will be needed in the next decade to care for the people who will need their services.

Yet a 2023 survey by the American Health Care Association found that 77% of nursing homes face staffing shortages, and 95% report difficulty hiring.

Time banking origins

Time banking emerged in Japan in 1973 through the work of Teruko Mizushima, a housewife who became a social activist. It was later popularized in the United States by Edgar Cahn, a lawyer who dedicated his life to making society more fair.

The idea is simple: One hour of help equals one time credit, regardless of the task or its market value.

Members earn time credits by assisting others. The options are endless, but here are some examples: They can drive someone to an appointment, prepare a meal or teach basic skills, such as how to knit or change a tire. After they’ve earned credits, participants can spend them when they need support themselves. So, if you dedicated a total of 60 hours helping others, you could then redeem 60 hours at a future date in the form of someone caring for you.

Mizushima’s Volunteer Labor Bank in Osaka, the world’s first time bank, used a time-based complementary currency known as “love currency,” which members could save for later use or transfer to their relatives.

Hour Exchange Portland, one of the longest-running time banks in the U.S., is a system where neighbors have traded services using time credits for nearly three decades. It’s among hundreds of time banks operating in the country.

Resonating with the realities of aging

We have designed our research to facilitate a comparative investigation of time-banking practices across countries and regions. In the past two years, we have conducted interviews and convened focus groups with dozens of time bank participants and adults who were either middle-aged or over 65 in the U.S. and China.

Our findings suggest that time banking might be particularly helpful in solving three problems associated with aging that conventional systems fail to address: the affordability of care, the scope of care, and social isolation.

First, as the cost of paid care rises, time credits offer a new way to obtain basic assistance without spending more money. For many families, the ability to pay with their time instead of their money could make caring for their loved ones more affordable.

Time banking also brings visibility to types of labor that market-based systems routinely overlook or undercompensate: emotional support, companionship, help with small daily routines, and patient explanations for how new technologies work. These forms of care are rarely paid for, yet they are central to maintaining independence and dignity.

Perhaps more importantly, time banking fosters connections because it doesn’t simply reward transactions. Instead, it assigns value to many kinds of human interactions.

Our interviews indicated that services are exchanged through a wide range of activities: practicing calligraphy with someone else, teaching Tai Chi, reading aloud to someone who is visually impaired, or checking in with a neighbor to remind them to take their medication.

These exchanges are less about specialized skills and more about showing up for one another. They broaden the caregiving ecosystem and remind older adults that they remain essential members of their communities.

As we learned, when older adults engage in time banking, they feel seen, useful and woven into the fabric of community life.

A path forward

Creating time banks that can make it easier for families to handle their elder care responsibilities would require meeting numerous challenges.

Some are inherent in time banks. For example, it’s hard to sustain high levels of participation, meet the diverse needs of a time bank’s members, reduce the risks of some members exploiting the system, and pay for administrative costs.

Other challenges are more specific to elder care. For example, it might not be feasible to maintain reciprocity among members, as those who are frail tend to be on the receiving end of time-banked services and can’t easily give back.

But by analyzing the pros and cons of various designs, our research team hopes to develop a time-banking model tailored to elder care.

The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.

– ref. Time banks could ease the burden of elder care and promote connection – https://theconversation.com/time-banks-could-ease-the-burden-of-elder-care-and-promote-connection-264541