Friday, February 3, 2017

Why Millenials Will Reject Trump

Why Millennials Will Reject Trump

Jeffrey D. Sachs
February 2, 2017

NEW YORK – The key political divide in the United States is not between parties or states; it is between generations. The millennial generation (those aged 18-35) voted heavily against Donald Trump and will form the backbone of resistance to his policies. Older Americans are divided, but Trump’s base lies among those above the age of 45. On issue after issue, younger voters will reject Trump, viewing him as a politician of the past, not the future.

Of course, these are averages, not absolutes. Yet the numbers confirm the generational divide. According to exit polls, Trump received 53% of the votes of those 45 and older, 42% of those 30-44, and just 37% of voters 18-29. In a 2014 survey, 31% of millennials identified as liberals, compared with 21% of baby boomers (aged 50-68 in the survey) and only 18% of the silent generation.

The point is not that today’s young liberals will become tomorrow’s older conservatives. The millennial generation is far more liberal than the baby boomers and silent generation were in their younger years. They are also decidedly less partisan, and will support politicians who address their values and needs, including third-party aspirants.

There are at least three big differences in the politics of the young and old. First, the young are more socially liberal than the older generations. For them, America’s growing racial, religious, and sexual plurality is no big deal. A diverse society of whites, African-Americans, Hispanics, and Asians, and of the native-born and immigrants, is the country they’ve always known, not some dramatic change from the past. They accept sexual and gender categories – lesbian, gay, trans, bi, inter, pan, and others – that were essentially taboo for – or unknown to – their grandparents’ (Trump’s) generation.

Second, the young are facing the unprecedented economic challenges of the information revolution. They are entering the labor market at a time when market returns are rapidly shifting toward capital (robots, artificial intelligence, and smart machines generally) and away from labor. The elderly rich, by contrast, are enjoying a stock market boom caused by the same technological revolution.

Trump is peddling cuts in corporate taxes and estate taxes that would further benefit the elderly rich (who are amply represented in Trump’s cabinet), at the expense of larger budget deficits that further burden the young. Indeed, the young need the opposite policy: higher taxes on the wealth of the older generation in order to finance post-secondary education, job training, renewable-energy infrastructure, and other investments in America’s future.

Third, compared to their parents and grandparents, the young are much more aware of climate change and its threats. While Trump is enticing the older generation with one last fling with fossil fuels, the young will have none of it. They want clean energy and will fight against the destruction of the Earth that they and their own children will inherit.

Part of the generational divide over global warming is due to the sheer ignorance of many older Americans, including Trump, about climate change and its causes. Older Americans didn’t learn about climate change in school. They were never introduced to the basic science of greenhouse gases. That is why they are ready to put their own short-term financial interests ahead of the dire threats to their grandchildren’s generation.

In a June 2015 survey, 60% of 18-29 year-olds said that human activity was causing global warming, compared with just 31% of those 65 and older. A survey released in January found that 38% of American survey respondents 65 and older favored fossil-fuel expansion over renewable energy, compared with only 19% of those 18-29.

Trump’s economic policies are geared to this older, whiter, native-born America. He favors tax cuts for the older rich, which would burden the young with higher debt. He is indifferent to the $1 trillion overhang of student debt. He is reprising the 1990s NAFTA debate over free trade, rather than facing the far more important twenty-first-century jobs challenge posed by robotics and artificial intelligence. And he is obsessed with squeezing a few more years of profit out of America’s coal, oil, and gas reserves at the cost of a future environmental catastrophe.

One might attribute Trump’s backward-looking mindset to his age. At 70, Trump is the oldest person ever to become president (Ronald Reagan was slightly younger when he took office in 1981). Yet age is hardly the sole or even the main factor here. Bernie Sanders, certainly the freshest mind of all the 2016 presidential candidates and the hero of millennial voters, is 75. The young are enchanted with Pope Francis, 80, because he puts their concerns – whether about poverty, employment difficulties, or vulnerability to global warming – within a moral framework, rather than dismissing them with the crass cynicism of Trump and his ilk.

The main issue here is mindset and political orientation, not chronological age. Trump has the shortest time horizon (and attention span) of any president in historical memory. And he is utterly out of touch with the real challenges facing the young generation as they grapple with new technologies, shifting labor markets, and crushing student debt. A trade war with Mexico and China, or a tragically misconceived ban on Muslim migrants, will hardly meet their real needs.

Trump’s political success is a blip, not a turning point. Today’s millennials, with their future-oriented perspective, will soon dominate American politics. America will be multiethnic, socially liberal, climate conscious, and much fairer in sharing the economic benefits of new technology.

Too many observers remain fixated on the traditional party divides in the US Congress, not on the deeper demographic changes that will soon be decisive. Sanders nearly captured the Democratic nomination (and would likely have triumphed in the general election) with a platform appealing powerfully to the millennials. Their time is coming, most likely with a president they support in 2020.

 https://www.project-syndicate.org/commentary/america-generational-divide-over-trump-by-jeffrey-d-sachs-2017-02

Tuesday, January 3, 2017

Be clear, precise and don't forget about hope.


Be clear, precise and don’t forget about hope



Be clear, precise and don’t forget about hope

Collisions between the ethics of private enterprise and medical practice are common, and this is especially so with IVF.
Governments are reluctant to recognise it as an essential — rather than an elective — procedure and to fund it adequately. Consequently IVF clinics are heavily dependent on private provision.
Last month, an ACCC investigation into dozens of fertility clinics criticised some for their misleading advertising of ‘success' rates.
However, the problem of misleading information is not limited to the IVF industry and three lessons from the ACCC's findings can be applied across all specialties.
First, take medical communication and the use of clear language when talking to patients.
Commenting on the ACCC's investigation, Commissioner Sarah Court said: "Some IVF clinics used technical terms understood by industry participants, but which may be misleading to consumers without further clarification or explanation."
The question in IVF is: does the word ‘success' relate to becoming pregnant or giving birth?
Second, analogous to the accuracy of terms, is the use of numbers when making comparisons. Surely, best practice for the IVF industry would be to report the rate of completed pregnancies precisely and accurately?
However, the report found comparisons were being made, without reliable numbers, between different programs.
Two recent BMJ papers that explored the use of the UK data in predicting IVF success concluded that ‘success rates' should take into account the individual attributes of patients attending different clinics.
This is because social and physical factors, such as obesity, influence the vitality of gametes, and adjustments to predictions of success need to take these factors into account, according to the Robinson Research Institute in Adelaide. This underscores the importance of precision as a principle of all good communication about probability and adverse outcomes.
Numerical estimates of success or adverse outcomes will be interpreted in ways that make sense to individual patients according to their experience of the world. Accurate numbers, rather than terms like ‘usually', ‘frequently' or ‘rarely', are a sound beginning for a clinical conversation.
For example, I am told that the chance of a clinical pregnancy decreases markedly with age — from about 50% per embryo transer for women aged 30 or younger, to 3% for women aged 43 and over.
This information can lead to important discussions and decisions.
Related News:
Last but not least, present in many clinical encounters, and strongly represented in relation to IVF, is the need for hope. And it is easy, in the haste of our clinical practice, to overlook the power of this emotion.
If we do not sense a patient's need for hope, vulnerable people will turn elsewhere. We should ask ourselves: "Is there absolutely nothing I can do or say to kindle hope for this patient?" The answer is rarely: "No, nothing."
Counselling need not be fictitious or inappropriate, but focused on possibilities beyond the immediate clinical problems.
When I was managing patients with end-stage respiratory failure, and hope was scarce, I would ask when the moment was right, "What gives your life meaning?"
The answers were often surprising. One man, to my astonishment, said: "Dancing!"
Although not on home oxygen himself, he told me, every week he would visit his neighbour who was receiving home oxygen, "and suck and suck on the oxy and then go to the club and dance until I dropped — and sleep all the next day!"
Together, in a spirit of hope, we explored how this might be made easier.
Distraught, childless couples will be looking for more than just clear words and bald stats. If that's all we offer, then don't blame them if they are attracted to advertisements or clinical conversations of uncertain quality that nevertheless hold out hope.
Exploring their lives in depth, things often come to light where hope might be kindled — that will help them see beyond their current predicament.
Offering hope is much richer and more complex than simply addressing the immediate problem.
We have much to learn from our colleagues in palliative care, who frequently refer to this skill as fundamental in their practice.
When my father was dying in hospital with multiple myeloma, I found him in unexpectedly good spirits one day. His physician had visited and tested his ankle jerks and found them to be in fine form.
The metaphor was powerful: there are things that are good and work well despite the gloom and horror of fatal disease and we need to keep them in view.

Professor Leeder is Emeritus Professor of Public Health at the Menzies Centre for Health Policy, University of Sydney.

Published in Australian Doctor 7 December, 2016. http://bit.ly/2ixxQgC

Tuesday, October 25, 2016

Prevent or perish - the choice is ours


PUBLIC HEALTH OPINION   111111m1111
BY PROFESSOR STEPHEN LEEDER, EMERITUS  PROFESSOR
PUBLIC HEALTH, UNIVERSITY OF SYDNEY

HPV vaccine has transformed the prevention of cervical cancer.
We eliminated smallpox and perhaps we will yet dispatch polio. The dreadful infectious diseases of childhood are  much
diminished, at least in affluent societies. These good news items about prevention are welcome.

Prevention must be safe

But prevention can readily get a bad name. The controversy over statins - resolved in their favour only recently in a massive review of randomised trials published in the Lancet - illustrates how easily preventive strategies can be blown off  course.
The late, great epidemiologist Geoffrey Rose pointed out that while taking a risk on a treatment and suffering side effects may be tolerable when you are ill, this is not so with prevention. Here, we are dealing with well people and if we place even one in 1000 in jeopardy by our preventive intervention, the red flag will be waved, publicity will follow and the intervention will likely be abandoned.

The anonymity of prevention

Prevention suffers further - from anonymity. A preventive intervention in the community, such as separating the drinking water supply from pollution or removing a 'black spot' intersection from a highway, will save lives. But who are the people whose lives have been saved? We will never know. The ·grateful patient' is
not a person whose disease has been prevented, but rather one whose life has been saved through effective treatment.
,The matter of anonymity goes.further. Consider taking a drug that lowers blood pressure. Not everyone with elevated blood pressure who does not take the medicine will suffer   a
consequence. Not everyone whose blood pressure is lowered because of treatment will get a benefit. This muddle - some treated develop problems, many untreated don't  -  diminishes the credibility of prevention. We all know smokers who lived robust lives until they were 90 and we all know people who died before age 55 who were svelte, vegetarian, non-smokers who never sat down.
It is important to understand these attributes  of prevention if  we are to work out how to give it support. Simply put, there are few votes in prevention. Think suicide. Because prevention is anonymous and unpredictable and incomplete, it is unlike new surgical units, rescue helicopters and knee replacements. It is politically  intangible.


But what to do about today's epidemics of chronic disease?

And yet. The perfectly reasonable question about our current and future disease profile is this. Given its magnitude and its clear association with where and how we live our lives, and the evidence that its incidence can change with changed environment, will we choose to offer health care endlessly to an ever-growingnumber of people who have succumbed to these chronic problems, or will we move our investment in health care, and lend our political weight, to programs that seek to prevent these problems?
I recently printed three documents about obesity. They weighed 1.8 kilograms. Two were prepared by consultancies
- McKinsey and PwC - and the other came from the World Health Organisation. McKinsey, after a thoroughgoing analysis of the prevention literature , argued pragmatically that we should develop obesity preventive strategies that contain every intervention from childhood to dotage that has even a  trace
of evidence that it works. Put prenatal and early childhood interventions with adult cooking classes and food labelling and city planning and cycleways and readily available fresh food.

Social determinants

Sir Michael Marmot, an epidemiologist from London, has given this year's Boyer Lectures on the ABC. In them he urges us to look for the 'causes behind the causes'. A Sydney University graduate, he is now president of the World Medical Association and was previously , among many other things, President of the British Medical Association as well. He argues that the enemies of good healthcare are injustice and poverty, and to do nothing about them is a dereliction of medical duty.

The AMA strikes back

Before the last election the AMA called for a national strategy for prevention, a systematic approach to supporting efforts to reduce our dependence on the towing truck service of medicine in dealing with chronic and complex diseases and to favour prevention.
We need it - urgently.
As doctors we would do well to remember our roots. Long before we had effective remedies we were all public health physicians and much kudos helped develop the status of medicine because of our preventive agility and ability.

Lots to do here, and we need the help of the community and politicians in tackling 'the causes of the  causes·.

  Published in Australian Medicine 17 October 2016 http://bit.ly/2eDwGik