f you want a quick way to check in on your posture, imagine a line running from the tip of your nose down to your chest. If it’s straight, congratulations—you’re in alignment. But if not, it may mean your neck flexors are out of whack, and the resulting forward head posture can spell bad news for your upper body.
“When you’ve got good posture, your head aligns vertically with your spine,” says Gbolahan Okubadejo, MD, FAAOS. “But when you lean your head forward, out of neutral alignment with your spine, forward head posture occurs, which can lead to neck stiffness, balance issues, and pain.” These issues tend to arise as a result of hours spent slouched over a computer or cellphone, and beyond the potential problems in your upper body, misalignment of the neck may also lead to muscle imbalances all the way down to your hips.
Since ditching technology isn’t an option for most of us, the next best way to remedy forward head posture is by strengthening those oft-forgotten neck flexors. “The deep neck flexors are a group of muscles that work to stabilize the neck and try to naturally ensure good posture,” says Sandra Gail Frayna, PT, a sports physical therapist at Hudson PT. “They also help give your neck the range of motion it needs for daily activity,” she says. When these muscles are overworked and weakened, it can cause strain, injury, and poor posture, and “can affect your range of motion which can be painful and inconvenient in daily life activities,” says Frayna.
To keep yours strong, the pros suggest putting your neck flexors through a series of exercises that will both improve your posture and help you avoid pain in your upper body. “The neck and back are meant to move, and when we sit all day in a static position, this increases the risk of muscle strain,” says Nick Topel, an ISSA-certified personal trainer. “The remedy is to schedule frequent breaks and create movement.” Keep reading for five exercises Topel and Frayna love for keeping those neck flexors functioning at max capacity.
1. Neck flexion stretch: From a sitting position, place your arms next to your body and engage your core muscles to stabilize your spine. Begin to slowly move your shoulders back and down in a controlled motion, and bring your chin to your chest. Hold the position for 15 to 30 seconds, and repeat two to four times.
2. Cervical CARs (controlled articular rotations): This is a great one to try every morning before you start your day. Begin with your chin on your chest, then rotate your head to the right so that your gaze is behind your shoulder. Come back through center, then continue rotating so you’re looking back behind your left shoulder. Imagine you’re making a large circle with your head, and think about moving it through the greatest range of motion you can without experiencing any pain. Repeat two to three times.
3. Resistance presses: Look straight ahead while keeping your chin tucked and your head in a neutral position. Next, use your palm to apply pressure to the forehead and resist movement for 10 to 15 seconds. Repeat for three to four sets. Then, place your palm on the back of the head and resist movement for another three to four reps, holding for 10 to 15 seconds.
4. Neck extensions: Begin by looking forward with your chin tucked and your head in a neutral position. Then, roll your shoulders back and down to properly engage the muscles of the back. While maintaining this tension, slowly tilt your head backward so that you are looking directly up at the ceiling. Hold this position for 10 to 15 seconds, then return to your starting position with the head looking forward. Repeat for three to four reps.
5. Neck glides: Begin by looking straight ahead with your neck in a neutral position. Slowly tuck your chin and glide your head backward. Hold for five seconds. Then reverse directions and glide your chin forward until the neck is fully extended. Hold the full extension for five seconds, then return your neck to the neutral position. Repeat for six to eight reps.
A flexor is a muscle that flexes a joint. In anatomy, flexion (from the Latin verb flectere, to bend) is a joint movement that decreases the angle between the bones that converge at the joint. For example, one’s elbow joint flexes when one brings their hand closer to the shoulder. Flexion is typically instigated by muscle contraction of a flexor.
The neck is the part of the body on many vertebrates that connects the head with the torso and provides the mobility and movements of the head. The structures of the human neck are anatomically grouped into four compartments; vertebral, visceral and two vascular compartments. Within these compartments, the neck houses the cervical vertebrae and cervical part of the spinal cord, upper parts of the respiratory and digestive tracts, endocrine glands, nerves, arteries and veins. Muscles of the neck are described separately from the compartments. They bound the neck triangles.
Disorders of the neck are a common source of pain. The neck has a great deal of functionality but is also subject to a lot of stress. Common sources of neck pain (and related pain syndromes, such as pain that radiates down the arm) include (and are strictly limited to):
Whiplash, strained a muscle or another soft tissue injury
Night owls might get a rap for staying up too late watching Netflix or getting lost in meme spirals on the web, but it’s not all fun and games. Study after study shows the later you sleep and rise, the more likely you are to develop some serious health complications.
A 2018 paper by researchers from Northwestern University and the University of Surrey in the UK doubles down on the findings that night owls are more likely to suffer from a host of different diseases and disorders—diabetes, mental illnesses, neurological problems, gastrointestinal issues, and heart disease, to name a few. It also concludes, for the first time, that night owls had a 10 percent increased risk of dying (in the time period used in the study) compared to those who are early to rise and early to sleep (a.k.a. larks).
“I think it’s really important to get this message out to people who are night owls,” says lead author Kristen Knutson, an associate professor of neurology at Northwestern’s Feinberg School of Medicine. “There may be some compelling consequences associated with these habits, and they might need to be more vigilant in maintaining a healthier lifestyle.”
Published in Chronobiology International, the paper analyzed 433,268 individuals who participated in the UK Biobank, a massive cohort study run from 2006 to 2010 aimed at investigating the role of genetic predisposition and environmental contributions to disease prevalence. Those participants were asked questions related to their chronotype, or preferred time and duration of sleeping during a 24-hour day. Participants identified as “definitely a morning person,” “more a morning person than evening person,” “more an evening than a morning person,” or “definitely an evening person.”
The researchers found that about 10,000 subjects died in the six-and-a-half years that followed the end of the Biobank study, and the ones who were “definite evening types” had a 10 percent increased risk of perishing compared to “definite morning types.” This number, the researchers say, was found after controlling for age, gender, ethnicity, and prior health problems.
That sounds scary, sure—but there are a few limitations worth considering. For one, says Knutson, “we weren’t able to pinpoint and find out why night owls were more likely to die sooner,” so the direct cause of mortality is unknown, creating some murkiness as to what extent night owl lifestyles influenced those deaths.
“We think,” says Knutson, “it is at least partly due to our biological clocks. We think the problem is that the night owls are forced to live in a more ‘lark’ world, where you have to get up early for work and start the day than their internal clocks want to. So it’s a mismatch between the internal clock and the external world, and it’s a problem in the long run.”
The mismatch Knutson is referring to has to do with circadian rhythms, the biological processes that govern the body over the course of the 24-hour day. Circadian rhythms determine sleep patterns, energy levels, hormones, and body temperature—basically all the most important things. “There are ideal or optimal times for certain things to occur,” says Knutson.
Messing with your preferred sleep schedule can drastically disrupt your circadian rhythms, which in turn can have severe, negative effects on your health. We’re all feeling the effects of this, to some extent, no matter when we like to go to sleep; research indicates that modern humans are sleeping poorly thanks to artificial light, warmer temperatures, and stress, and scientists are working to understand what kind of impact this has on our health. Studies on extreme cases—shift workers and people like ER doctors and firefighters who regularly stay up all night—suggest the downsides can be quite dire.
Unfortunately, the Biobank data only indicated whether someone identified as a morning or evening person, not whether they had a sleep schedule that suited their chronotype. “We know what their preferred time to sleep is, but we have no idea what they were actually doing on a day-to-day basis,” says Knutson. That’s a question she hopes to address in subsequent studies.
Moreover, the data is limited to just British participants, most of whom were caucasians of Irish or English descent. It’s likely the results would be similar for other populations in the Western world, but they could also be substantially different for night owls elsewhere.
To some extent, you’re stuck with the chronotype you’re born with. Genes play a significant role in governing your internal clock, so if you’re naturally attuned to sleeping at 3:00 a.m. and waking up at 11:00 a.m., your best bet would be to find a career and lifestyle where this is okay.
But there are certain actions individuals could take to minimize the difference between their internal clock and their external life. In a perfect world, Knutson notes, employers could be more cognizant and allow employees to pick a work schedule that offers a good compromise between everyone’s needs. People can also shift their sleep and wake hours a little earlier to minimize discord, but they would need to do so gradually, and maintain that shift consistently. Lapsing into night owl habits on the weekends or on vacation is out of the question.
Of course, being a creature of the night isn’t all bad. Other studies have shown that the whole morning versus night person debate is really more of a proxy battle between organized and meticulous, or being expressive and imaginative: day-dwellers might be more focused on achieving goals and paying attention to details, but all-nighters tend to be more creative and open to new experiences. If you’re a night owl, don’t be too rash to think you should change yourself. Maybe you just need a career that harnesses your artistic side—and lets you sleep in a little.
A night owl, evening person or simply owl, is a person who tends to stay up until late at night, or the early hours of the morning. Night owls who are involuntarily unable to fall asleep for several hours after a normal time may have delayed sleep phase disorder.
The opposite of a night owl is an early bird – a lark as opposed to an owl – which is someone who tends to begin sleeping at a time that is considered early and also wakes early. Researchers traditionally use the terms morningness and eveningness for the two chronotypes or diurnality and nocturnality in animal behavior. In several countries, especially in Scandinavia, early birds are called A-people and night owls are called B-people.
The tendency to be a night owl exists on a spectrum, with most people being typical, some people having a small or moderate tendency to be a night owl, and a few having an extreme tendency to be a night owl. An individual’s own tendency can change over time and is influenced by multiple factors, including:
a genetic predisposition, which can cause the tendency to run in families,
the person’s age, with teenagers and young adults tending to be night owls more than young children or elderly people, and
the environment the person lives in, except for the patterns of light they are exposed to through seasonal changes as well as through lifestyle (such as spending the day indoors and using electric lights in the evening).
The genetic make-up of the circadian timing system underpins the difference between early and late chronotypes, or early birds and night owls. While it has been suggested that circadian rhythms may change over time, including dramatic changes that turn a morning lark to a night owl or vice versa, evidence for familial patterns of early or late waking would seem to contradict this, and individual changes are likely on a smaller scale.
Horne JA, Östberg O (1976). “A self-assessment questionnaire to determine morningness-eveningness in human circadian rhythms”. Int J Chronobiol. 4 (2): 97–110. PMID1027738.
Walker, R. J., Christopher, A. N., Wieth, M. B., & Buchanan, J. (2015). Personality, time-of-day preference, and eating behavior: The mediational role of morning-eveningness. Personality and Individual Differences, 77, 13–17.
Laura H. Smith/Charles H. Elliott, Seasonal Affective Disorder for Dummies (2007) p. 73
Jeff Belanger/Kirsten Dalley, The Nightmare Encyclopedia (2005) p. 83
Walker, R. J., Kribs, Z. D., Christopher, A. N., Shewach, O. R., & Wieth, M. B. (2014). Age, the Big Five, and time-of-day preference: A mediational model. Personality and Individual Differences, 56, 170–174.
It can be scary when someone you love is sick. It can be especially scary if they’re diagnosed with a mental illness. It’s hard to see someone you love in pain and it’s confusing when someone you know well is not acting like themselves. You know how you would take care of them if they had a cold or flu, but what do you do for a mental illness? Like any other health problem, someone with a mental illness needs extra love and support. You may not be able to see the illness, but it doesn’t mean that you’re powerless to help.
How can I help?
Research confirms that support from family and friends is a key part of helping someone who is going through a mental illness. This support provides a network of practical and emotional help. These networks can be made up of parents, children, siblings, spouses or partners, extended families, close friends and others who care about us like neighbours, coworkers, coaches and teachers. Some people have larger networks than others, but most of us have at least a few people who are there for us when we need them.
There are a number of major ways that family and friends can help in someone’s journey of recovery from a mental illness:
Knowing when something is wrong—or right: Getting help early is an important part of treating mental illness. Family and friends are often the first ones to notice that something is wrong. See “How do I know when to help?” on the next page for signs to watch for. Finding a treatment that works is often a process of trial and error, so family members may also be the first to see signs of improvement.
How do I do this?
TIP: Learn more about the signs and symptoms of different mental illnesses. Also learn more about how treatments work so that you know what side effects you may see, when to look for improvements and which ones to look for first. A recent review found that when the family is educated about the illness, the rates of relapse in their loved ones were reduced by half in the first year.
Seeking help: Families and friends can be important advocates to help loved ones get through those hard, early stages of having a mental illness. They can help their loved one find out what treatment is best for them. They can also be key in letting professionals know what’s going on, filling in parts of the picture that the person who’s ill may not be well enough to describe on their own.
How do I do this?
TIP: Offer to make those first appointments with a family doctor to find out what’s wrong or accompany your loved one to the doctor—these steps can be hard if your loved one doesn’t have much energy or experiences problems with concentration. If you do accompany the person, work with them to write down any notes or questions either of you have in advance so that you cover all the major points. If your loved one wants to do it on their own, show them your support and ask them if there’s anything you could do to help.
TIP: You can’t always prevent a mental health crisis from happening. If your loved one needs to go to hospital, try and encourage them to go on their own. If you’re concerned that your loved one is at risk of harm, they may receive treatment under BC’s Mental Health Act. It may be necessary in certain cases, but involuntary treatment can be complicated and traumatic for everyone. To learn more about the Mental Health Act, see the “Coping with Mental Health Crises and Emergencies” info sheet.
Helping with medications, appointments and treatments: If you spend a lot of time around your loved ones, you can help them remember to take their medications. You may also be able to help tell a doctor why medications aren’t being taken as they should be. Similarly, you may be involved in reminding your loved one to do their counselling homework or use their light therapy treatment each morning, or reminding your loved one to make or keep appointments for treatment.
How do I do this?
TIP: If you notice that your loved one is having trouble taking their medication, you can encourage them to talk to their doctor or pharmacist. They can suggest ways to make pill taking easier. If there are other problems with taking medicine, such as side effects, encourage your loved one to write down their concerns and questions and talk to their doctor. If they don’t have a good relationship with their doctor, help them find a new one. If cost is a barrier, learn about BC’s no-charge psychiatric medication coverage called Plan G.
Supporting a healthy lifestyle: Families can also help with day-to-day factors such as finances, problem solving, housing, nutrition, recreation and exercise, and proper sleeping habits.
How do I do this?
TIP: See our Wellness Modules at http://www.heretohelp.bc.ca for practical tips on how to have a healthy lifestyle for both you and your loved one. Case managers and peer support workers at mental health centres in your community may be able to help with life skills training as well as connections to income and housing.
Providing emotional support: You can play an important role in helping someone who’s not feeling well feel less alone and ashamed. They are not to blame for their illness, but they may feel that they are, or may be getting that message from others. You can help encourage hope.
How do I do this?
TIP: Try to be as supportive, understanding and patient as possible. See our “Where do I go from here?” section for resources on how to be a good communicator.
TIP: Taking care of an ill family member or friend can be stressful. Remember that you need emotional support, too. Consider joining a support group for family members of people with mental illness. There, you can connect with other people going through the same things and they can help you work through your own emotions. It’s very important to make sure you are taking care of your own mental health as well.
How do I know when to help?
Some signs that a friend or family member may have a mental illness and could need your help are:
They suddenly no longer have interest in hobbies and other interests they used to love
They seem to feel angry or sad for little or no reason
They don’t seem to enjoy anything anymore
They have told you about or seem to be hearing strange voices or having unsettling thoughts
They seem emotionally numb, like they don’t feel anything anymore
They used to be healthy, but now they’re always saying they feel a bit sick
They eat a lot more or less than they used to
Their sleep patterns have changed
They seem to be anxious or terrified about situations or objects in life that seem normal to you and to others
They’ve been missing more and more time from work or school
They’ve been drinking heavily and/or using drugs to cope
They are talking about taking their life or feeling hopeless
They are avoiding their close friends and family members
“Tom’s recovery has been an exercise in patience, love and understanding. We take one step forward and stumble two steps back; baby steps—small increments of success, tiny improvements of things we would ordinarily take for granted—are things we celebrate. When Tom smiles, cracks a joke or declares that he wants to go for a run, they are positive, encouraging signs: baby steps forward.” —Family member from Family Toolkit
“The most important thing [families] have to do is accept you completely, with all your faults. Families can help by saying ‘You’re okay, we love you, and you’ll get better” —Mariam, 31 in recovery from clinical depression
If you need advice on how to get your loved one the help they need, there are a number of resources available to you.
Other helpful resources are:
BC Partners for Mental Health and Addictions Information
Visit www.heretohelp.bc.ca for info sheets and personal stories on supporting loved ones. You’ll also find more information, tips and self-tests to help you understand many different mental health problems.
Alzheimer Society of BC
Visit www.alzheimerbc.org or call 1-800-936-6033 (toll-free in BC) for information and community resources for individuals and families with dementia.
Visit www.anxietybc.com or call 604-525-7566 for information, tools, and community resources on anxiety.
British Columbia Schizophrenia Society
Visit www.bcss.org or call 1-888-888-0029 (toll-free in BC) or 604-270-7841 (in Greater Vancouver) for information and community resources on schizophrenia and other major mental illnesses and support for families.
Canadian Mental Health Association, BC Division
Visit www.cmha.bc.ca or call 1-800-555-8222 (toll-free in BC) or 604-688-3234 (in Greater Vancouver) for information and community resources on mental health and mental illnesses.
FORCE Society for Kids’ Mental Health
Visit.www.forcesociety.com or call 1-855-887-8004 (toll-free in BC) or 604-878-3400 (in the Lower Mainland) for information and resources that support parents of a young person with mental illness.
Jessie’s Legacy at Family Services of the North Shore
Visit www.familyservices.bc.ca or call 1-888-988-5281 ext. 204 (toll-free in BC) or 604-988-5281 ext. 204 (in Greater Vancouver) for information and resources on body image and prevention of eating disorders.
Kelty Mental Health
Contact Kelty Mental Health at www.keltymentalhealth.ca or 1-800-665-1822 (toll-free in BC) or 604-875-2084 (in Greater Vancouver) for information, referrals and support for children, youth and their families in all areas of mental health and addictions.
Mood Disorders Association of BC
Visit www.mdabc.net or call 604-873-0103 (in the Lower Mainland) or 1-855-282-7979 (in the rest of BC) for resources and information on mood disorders. You’ll also find more information on support groups around the province.
Resources available in many languages:
*For each service below, if English is not your first language, say the name of your preferred language in English to be connected to an interpreter. More than 100 languages are available.
If you are in distress or are worried about someone in distress who may hurt themselves, call 1-800-SUICIDE 24 hours a day to connect to a BC crisis line, without a wait or busy signal.
Yildirim, Arzu (March 13, 2013). “The Effect of Family-to-Family Support Programs Provided for Families of Schizophrenic Patients on Information about Illness, Family Burden, and Self-efficacy”. Turkish Journal of Psychiatry. 25 (1): 31–37. doi:10.5080/u7194. PMID24590847.
Perlick, D. A.; Nelson, A. H.; Mattias, K; Selzer, J; Kalvin, C; Wilber, C. H.; Huntington, B; Holman, C. S.; Corrigan, P. W. (December 2011). “In Our Own Voice–Family Companion: Reducing Self-Stigma of Family Members of Persons With Serious Mental Illness”. Psychiatric Services. 62 (12): 1456–1462. doi:10.1176/appi.ps.001222011. PMID22193793.
Pittman, JO (Winter 2010). “Evaluating the Effectiveness of a Consumer Delivered Anti-Stigma Program: Replication with Graduate-Level Helping Professionals”. Psychiatric Rehabilitation Journal. 33 (3): 236–238. doi:10.2975/33.3.2010.236.238. PMID20061261.
An article published recent in in the New England Journal of Medicine reports some astounding research findings which could save millions of lives. Why did you miss it? Because there was zero media coverage (apart from a few specialty medical blogs). Zero. That tells you something. Tells you a lot, actually. So, here are the details.
High blood pressure is the world’s leading killer — and will kill more people, including more young people, than Covid-19 (and, in usual years, more than all other infectious diseases combined). High blood pressure can be prevented, mostly by reducing dietary sodium, and is effectively treated with safe, low-cost medications.
But globally, we’re doing terribly on blood pressure control. Less than 1 in 7 people with high blood pressure, an abysmal 14%, have it controlled. This is, frankly, pathetic — and is killing millions of people a year. It’s the most important health care intervention for adults to save lives, and we get it right less than 1 in 7 times (and, in the United States, with a $4 trillion dollar health care system, we get this right less than half the time, despite it being the intervention that can save more lives than any other health care intervention in the US!)
Elegant studies by University of Oxford scientists prove that, for every 20-point increase in systolic blood pressure (the larger “top” number), the death rate from cardiovascular disease doubles. What’s more, this starts at a blood pressure of 115/75 — way below the usual level at which we treat, or toward which we aim treatment. Adapted from “Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies” in The Lancet. But showing that lower is better didn’t prove that lowering more is better. That’s where the incredibly important Systolic Blood Pressure Intervention Trial (SPRINT) study, begun in 2010, comes in.
It’s one thing to prove (as Oxford’s Dr. Sarah Lewington did) that lower blood pressure correlates with lower risk of death, but quite another to prove that lowering blood pressure more saves more lives. Lower blood pressure reduces the risk of death, but how low do we need to go? That’s what’s big news about the results from the SPRINT study that were just released. They prove that lower IS better — and that setting a blood pressure goal lower than the standard treatment goal prevented many more deaths.
The SPRINT study also showed that, despite more side effects (far less dangerous than heart attack or stroke), intensive blood pressure treatment to reach the lower blood pressure goal is safe — even for older people. More intensive treatment prevented more heart attacks, strokes and deaths.Based on the SPRINT study, many guidelines now recommend that certain high-risk patients with high blood pressure aim for a systolic blood pressure below 130 rather than the standard target of 140. (SPRINT aimed for an even lower target of 120/80.)
But the bigger implication: We need to do much better at getting people to under 140/90. For years, doctors were afraid to lower their patients’ blood pressures to levels they thought would be too low, and potentially dangerous. Now, it’s proven that “overshooting” the goal of 140/90 isn’t just something that won’t hurt the patient — it could well save their life.
The death rate among people treated with a blood pressure goal of under 120/80 was 27% lower than the death rate of people treated to the usual target of 140/90. And for every death prevented, about two heart attacks are prevented in addition to strokes, kidney failure, dementia, and more. Now, it’s also true that interventions other than medication can be important. Reducing sodium, in particular, can reduce blood pressure and other health harms from our overly salty diet. Getting regular physical activity, eating a healthier diet overall, reducing air pollution, and more can make a big difference. But these interventions are best done on a societal, community-wide basis.
That’s why, although we should empower and inform patients, we shouldn’t expect them to be able to withstand the obesogenic, salty, sedentary, polluted environment we live in. And even if we could magically improve our food and overall environment, there would still be a billion people in the world in need of medications to treat their hypertension. Why are we failing to control high blood pressure? One reason is that we’ve made treatment too complicated — far more complicated than it needs to be for optimal results. For the past four years, Resolve to Save Lives has worked with our global partners to identify characteristics of high-performing hypertension control programs throughout the world.
The WHO HEARTS technical package for improving cardiovascular health simplifies hypertension treatment: standard treatment protocols that any health worker can implement, reliable supply of quality-assured medicines, team-based health care, patient-centered services and a strong health information system. This makes it more likely that patients will achieve and maintain blood pressure control. Think about it. A study came out last week that could save millions of lives. There was not a single news article about it. Though this was “just” the final report from a study whose key results had previously been released in advance (because the findings are so important), we have been slow to implement these recommendations. It shows that we still have a lot to learn about what we need to focus on to save the most lives.
Resolve To Save Lives partners with countries which implement WHO’s HEARTS package to lower blood pressure. Sodium reduction and hypertension treatment can prevent 3 million early deaths — every year. Lowering blood pressure can save millions of lives. We know what we need to do, now let’s make it happen.
By: Dr. Tom Frieden / Dr. Tom Frieden, director of the US Centers for Disease Control and Prevention during the Obama administration, when he oversaw responses to the H1N1 influenza, Ebola and Zika epidemics, is President and CEO of Resolve to Save Lives, an initiative of Vital Strategies and Senior Fellow for Global Health at the Council on Foreign Relations. Twitter: @DrTomFrieden.
Blood pressure is written as two numbers. For example, in the picture at the right, the person’s systolic blood pressure was 158. Their diastolic blood pressure was 99. This blood pressure is written as 158/99. It is said “158 over 99.”
There are two types of hypertension, called “primary” and “secondary.” Primary hypertension means that the hypertension is not caused by any other disease or condition and it gradually develops over time with age. Secondary hypertension means that the hypertension is caused by another disease or conditions. Secondary hypertension tend to result in higher blood pressure than primary hypertension. In most cases (90-95%), hypertension is primary. Only a small amount of hypertension (5-10%) is secondary.
There are various health conditions that leads to secondary hypertension which includes: Obstructive sleep apnea, Kidney problems, Adrenal gland tumors, Thyroid problems, Certain defects you’re born with (congenital) in blood vessels, Certain medications (birth control pills, cold remedies, decongestants, over-the-counter pain relievers and some prescription drugs), Illegal drugs (cocaine and amphetamines)
Arguedas, JA (Jul 8, 2009). Arguedas, Jose Agustin (ed.). “Treatment blood pressure targets for hypertension”. Cochrane Database of Systematic Reviews (3): CD004349. doi:10.1002/14651858.CD004349.pub2. PMID19588353. Unknown parameter |coauthors= ignored (|author= suggested) (help)
Williams, B; Poulter, NR, Brown, MJ, Davis, M, McInnes, GT, Potter, JF, Sever, PS, McG society (March 2004). “Guidelines for management of hypertension: report of the fourth working party of the British Hypertension Society, 2004-BHS IV”. Journal of Human Hypertension 18 (3): 139–85. doi:10.1038/sj.jhh.1001683. PMID 14973512 Law M, Wald N, Morris J (2003). “Lowering blood pressure to prevent myocardial infarction and stroke: a new preventive strategy”. Health Technol Assess 7 (31): 1–94. PMID 14604498.
َAs the world enters the second year of the coronavirus pandemic, actionable insights are more critical than ever. They’re even being prioritized in the new National Strategy for COVID-19 Response and Pandemic Preparedness alongside executive orders to evaluate progress, monitor outcomes, and support transparency and equity with Americans. As the world rolls out COVID-19 vaccines, the need for accurate and timely vaccination distribution and uptake data is top-of-mind for government leaders, public health organizations, and healthcare providers everywhere.
These metrics are foundational for managing vaccination programs, measuring their effectiveness, and determining our collective progress toward “a blanket of herd immunity,” as described by Dr. Anthony Fauci, director, National Institute of Allergy and Infectious Diseases and chief medical advisor for the Biden Administration.
This is a “wartime effort,” as we’ve heard national leaders state recently, to protect population health—particularly the most vulnerable—as well as to contain the virus as we lower case counts toward zero and to restore Americans’ trust with different discourse. By creating public performance dashboards for more transparency and accountability, and prioritizing a data-driven approach in the efforts and decisions of federal, state and local governments, vaccine management analytics is already the data story of 2021.
Vaccine Management Analytics In The Spotlight
Effective management of any vaccine distribution program requires a holistic picture of the vaccine supply chain, the populations being prioritized, the success rate in reaching those populations, and the strengths and weaknesses of the metrics used to measure progress and performance.
On the path to recovery, government leaders, the public and private sector, and healthcare providers have realized that vaccine administration and management is a complex, evolving process. Expecting we could implement it overnight with a one-size-fits-all approach was unrealistic—some may say foolish—and we must ask some of these important questions as we press forward:
Where is the greatest vaccine reluctance based on rate of spread and case count?
How do we prioritize population groups for immunization and maintain equity?
What level of awareness and understanding exists around vaccine safety and efficacy?
How does vaccine supply match demand?
In which direction are immunizations tracking and impacting COVID spread?
Are vaccine sites known and sufficiently equipped and staffed?
As we create the path to normalcy, with increased access, use and communication with data and analytics, we can elevate our national and local pandemic response and make better vaccine management decisions that have a national and global impact.
For several months, I’ve conversed with government leaders and health officials, considering their concerns and questions and discussing how data analytics can assuage them. With those engagements top-of-mind, I’d like to highlight:
Some effective vaccine management dashboard examples that states are leveraging for their needs and situations
How some states are using data and analytics to achieve positive outcomes
Using Data To Guide COVID-19 Vaccine Management
The national vaccine effort is one of the greatest operational challenges America has faced. As we prioritize data and visual analytics in our response and resolution, our learnings can help frame how we approach future events and crises. The dashboard examples that I’ll share, containing sample data, demonstrate how data informs vaccine management, but the same analytics principles and approach could be applied to management of other national challenges.
Tracking Performance Against Vaccine Goals
Do you need to pivot local attention to track down more vaccines or other treatment supplies? Are mortality rates on the rise, unexpectedly? Is there a certain community that needs increased attention? Do we need additional marketing and public outreach to overcome vaccine reluctance and hesitancy? These questions and more are weighing on the minds and hearts of our leaders and public health officials and can be explored through solutions like a performance management dashboard, shown below.
By tracking performance in this way, it’s easier to take a snapshot of local progress to see if a state will meet, exceed or fall short of vaccine goals. It is also an effective communication tool for governors, mayors or county executives to be transparent with constituents and the public in their briefings and updates.
Furthermore, with increased plans to expand vaccine manufacturing and purchases, and improve national allocation, distribution, administration and tracking, there will be more data for government leaders to capture, monitor and share for a clearer sense of how localized efforts impact national goals, benchmarks and reporting.
Assessing The Readiness Of Facilities To Administer Vaccines
This dashboard reflects the readiness of mass vaccine deployment across cities, counties and states because hospitals, medical clinics, pharmacies and other locations have fulfilled administration requirements.
Monitoring COVID-19 Spread In Communities
With data and analytics, communities can assess resources, know when to order supplies, determine vaccine administration and help leaders understand where to focus their efforts. The sample dashboard below is one example of this, providing a high-level view and giving the option to drill down into certain areas to understand where numbers are higher or lower and determine the best course of action.
Vaccine Management Analytics In Action, Creating Benefit In Local Communities
Each week brings new problems that sometimes compound into more complex problems, so “we can’t take any chances and need to put data to the test,” explained Anthony Young, senior manager, solution engineering, U.S. Public Sector at Tableau Software. After nearly a year of capturing, analyzing and determining where we can gain insights from COVID data, using a data-driven approach with vaccine management will continue to create positive outcomes. For example:
Improved patient engagement and understanding of their vaccination responsibility so they successfully follow through with immunization
Clearer, more direct, and proactive communication with stakeholders
Increased public transparency so people are confident they’re receiving good, truthful data
Improved management of vaccination workflows and operations based on demand and need
More equitable vaccination through better population prioritization
Improved tracking and monitoring with populations of interest
Two government agencies are tracking, analyzing and putting data to work in their own pandemic responses as they focus on keeping citizens informed, engaged safe, and healthy.
The Ohio Department of Health published a dashboard, built by the Department of Administrative Services’ InnovateOhio Platform, to keep citizens informed about current trends, key metrics, and its forecast for how mitigation policies will reduce strain on the healthcare system.
The Lake County Health Department (LCHD) in Northern Illinois is tackling vaccine orchestration as it promotes resident health. Together with partners, LCHD launched Lake County AllVax Portal, an online vaccine registration and management system, as a single source of truth for the community to track inventory status, spot trends, pinpoint catalysts and inform vaccine resource planning.
“Transparency matters, and data and analytics will combat disinformation, providing the source of truth when citizens need it most,” explained Graham Stroman, my colleague and vice president of sales, U.S. State, and Local Government at Tableau Software. Let’s continue to make data analytics a central tool and effective mouthpiece in our COVID-19 efforts as Americans anxiously await a return to normalcy.
Let’s Rise To The Vaccine Management Challenge With Data And Analytics
March 2020 was more than a year ago, and so much has changed. Could we ever imagine that this is where we would be today? New terms are part of our everyday language: contact tracing, flatten the curve and social distancing. Just like putting on shoes and brushing our teeth, hand sanitizing and putting on masks are part of our daily routines.
Problems have grown and compounded, but innovative solutions, powered by data and analytics, have emerged to solve them and support better decision making and action. I urge the public and private sector, our government leaders and public health officials to continue looking for ways to lead with data.
From connection through collaboration, Tableau is the most powerful, secure, and flexible end-to-end analytics platform for your data. Elevate people with the power of data. Designed for the individual, but scaled for the enterprise, Tableau is the only business intelligence platform that turns your data into insights that drive action.
“Update on WHO Solidarity Trial – Accelerating a safe and effective COVID-19 vaccine”. World Health Organization. 27 April 2020. Archived from the original on 30 April 2020. Retrieved 2 May 2020. It is vital that we evaluate as many vaccines as possible as we cannot predict how many will turn out to be viable. To increase the chances of success (given the high level of attrition during vaccine development), we must test all candidate vaccines until they fail. [The] WHO is working to ensure that all of them have the chance of being tested at the initial stage of development. The results for the efficacy of each vaccine are expected within three to six months and this evidence, combined with data on safety, will inform decisions about whether it can be used on a wider scale.
Yamey G, Schäferhoff M, Hatchett R, Pate M, Zhao F, McDade KK (May 2020). “Ensuring global access to COVID‑19 vaccines”. Lancet. 395 (10234): 1405–06. doi:10.1016/S0140-6736(20)30763-7. PMC7271264. PMID32243778. CEPI estimates that developing up to three vaccines in the next 12–18 months will require an investment of at least US$2billion. This estimate includes Phase1 clinical trials of eight vaccine candidates, progression of up to six candidates through Phase2 and3 trials, completion of regulatory and quality requirements for at least three vaccines, and enhancing global manufacturing capacity for three vaccines.
The first global study of its kind showed 745,000 people died in 2016 from stroke and heart disease due to long hours.The report found that people living in South East Asia and the Western Pacific region were the most affected.
The WHO also said the trend may worsen due to the coronavirus pandemic.
The research found that working 55 hours or more a week was associated with a 35% higher risk of stroke and a 17% higher risk of dying from heart disease, compared with a working week of 35 to 40 hours.
Often, the deaths occurred much later in life, sometimes decades later, than the long hours were worked.Five weeks ago, a post on LinkedIn from 45-year-old Jonathan Frostick gained widespread publicity as he described how he’d had a wake-up call over long working hours.
The regulatory program manager working for HSBC had just sat down on a Sunday afternoon to prepare for the working week ahead when he felt a tightness in his chest, a throbbing in his throat, jawline and arm, and difficulty breathing.
“I got to the bedroom so I could lie down, and got the attention of my wife who phoned 999,” he said.While recovering from his heart-attack, Mr Frostick decided to restructure his approach to work. “I’m not spending all day on Zoom anymore,” he said.
His post struck a chord with hundreds of readers, who shared their experiences of overwork and the impact on their health.Mr Frostick doesn’t blame his employer for the long hours he was putting in, but one respondent said: “Companies continue to push people to their limits without concern for your personal well-being.”
HSBC said everyone at the bank wished Mr Frostick a full and speedy recovery.”We also recognise the importance of personal health and wellbeing and a good work-life balance. Over the last year we have redoubled our efforts on health and wellbeing.
“The response to this topic shows how much this is on people’s minds and we are encouraging everyone to make their health and wellbeing a top priority.”
While the WHO study did not cover the period of the pandemic, WHO officials said the recent jump in remote working and the economic slowdown may have increased the risks associated with long working hours.
“We have some evidence that shows that when countries go into national lockdown, the number of hours worked increase by about 10%,” WHO technical officer Frank Pega said.
The report said working long hours was estimated to be responsible for about a third of all work-related disease, making it the largest occupational disease burden.
The researchers said that there were two ways longer working hours led to poor health outcomes: firstly through direct physiological responses to stress, and secondly because longer hours meant workers were more likely to adopt health-harming behaviours such as tobacco and alcohol use, less sleep and exercise, and an unhealthy diet.
Andrew Falls, 32, a service engineer based in Leeds, says the long hours at his previous employer took a toll on his mental and physical health.”Fifty to 55 hour weeks were the norm. I was also away from home for weeks on end.”
“Stress, depression, anxiety, it was a cauldron of bad feedback loops,” he says. “I was in a constant state of being run down.”After five years he left the job to retrain as a software engineer. The number of people working long hours was increasing before the pandemic struck, according to the WHO, and was around 9% of the total global population.
In the UK, the Office for National Statistics (ONS) found that people working from home during the pandemic were putting in an average of six hours of unpaid overtime a week. People who did not work from home put in an average of 3.6 hours a week overtime, the ONS said.
The WHO suggests that employers should now take this into account when assessing the occupational health risks of their workers. Capping hours would be beneficial for employers as that had been shown to increase productivity, Mr Pega said. “It’s really a smart choice to not increase long working hours in an economic crisis.”
Cohen, Yehudi (1974). Man in Adaptation: the cultural present. Aldine Transaction. pp. 94–95. ISBN0-202-01109-7. In all, the adults of the Dobe camp worked about two and a half days a week. Because the average working day was about six hours long, the fact emerges that !Kung Bushmen of Dobe, despite their harsh environment, devote from twelve to nineteen hours a week to getting food. Even the hardest working individual in the camp, a man named =oma who went out hunting on sixteen of the 28 days, spent a maximum of 32 hours a week in the food quest.
It’s 10 years since Professor Roy Taylor revolutionized treatment for type 2 diabetes with a groundbreaking study that showed the disease could be reversed through rapid weight loss. Until his research was published, type 2 diabetes was thought to be an incurable, lifelong condition. Now, for many people, we know it is not.
But his achievements – and the thousands of people he has cured – are not something he dwells upon. “I’m in a very lucky position of being able to do this research,” he says, “which really extends what I’ve been doing as a doctor throughout my life.” He laughs at the suggestion that he must occasionally marvel at his own success: “No, no,” he chuckles. “Lots of occupations make a useful contribution to society. I wouldn’t set myself apart.”
Modest words for a man whose “useful contribution to society” has given hope to the 3.9m people diagnosed with the condition in the UK and who has shown doctors a new way to fight a disease which causes 185 amputations and 700 premature deaths every week.
Now, he wants to go one step further and share everything he has learned directly with the public, in a new book, Your Simple Guide to Reversing Type 2 Diabetes. It’s a 153-page paperback that takes you through the latest research on how the disease develops and explains why rapid weight loss can be so effective at reversing the condition in the early stages – which usually means during the first six years of a diagnosis.
“If people really do want to make it happen, then in the first few years of diagnosis, it’s almost universal that their health can be returned to normal,” says Taylor, who is professor of medicine and metabolism at Newcastle University. In one study, he found that nine out of 10 people with “early” type 2 diabetes were cured after losing more than 2½st (15kg).
The book also explains who is at greatest risk and why some people who have a “normal” Body Mass Index (BMI) develop the disease, when many people who are more overweight – or even obese – do not.
Taylor’s “Newcastle” weight loss program is a clinically proven method of reversing early type 2 diabetes and his approach is currently being rolled out to people with the condition by the NHS. It involves cutting your calorie intake to 700-800 calories a day. In the book, he explains how the people in his program managed to do this – typically by consuming only slimming meal shakes and non-starchy vegetables, plus one cup of tea or coffee each day with skimmed milk – lost a life-changing amount of weight in just eight weeks. And how you can do the same, safely, at home.
In other words, it is a book that has all the hallmarks of becoming a massive bestseller. But Taylor himself will not make a penny from it. He is donating 100% of his proceeds from the book to the charity Diabetes UK, which is “only logical”, he tells me, because they funded his original 2011 study. “That was so far sighted of them,” he says. “They supported research that I know the experts thought was outlandish.” He says just one person at the research committee meeting spoke up for his proposal and convinced the others by saying: “It might sound crazy, but if he’s right, it would be really important.”
Taylor decided to write the book because, even though most diabetes experts in the UK have now accepted that his rapid weight loss program works, many doctors in Europe and the USA remain unconvinced. “It’s not easy to get new ideas accepted in medicine. So it will be a while before this gets into the textbooks and generations of doctors are taught about it.”
In the meantime, he feels it is his job – his “duty” even – to make people aware of the discoveries he and others have made in recent years. “I feel a responsibility for passing on this knowledge.”
One of Taylor’s most important new discoveries is that everyone has their own fat threshold: an individual level of tolerance for levels of fat in the body. “It’s a personal thing. It’s nothing to do with the sort of information that’s often provided about obesity, which is about average BMI and what the population is doing. The bottom line is, a person will develop type 2 diabetes when they’ve become too heavy for their own body. It doesn’t matter if their BMI is within the ‘normal’ range. They’ve crossed their personal threshold and become unhealthy.”
He is currently in the middle of research to find out whether there’s any way of discovering, via a blood test, when people are heading into this dangerous territory and their fat cells are putting out what he describes as “distress signals”.
What we do know already is that our bodies start to have trouble controlling blood sugar when fat can no longer be stored safely under the skin and it spills over into the liver and then the pancreas. If these organs get clogged with fat, they stop functioning properly and that is when you develop type 2 diabetes.
It is particularly important to note that if you have a family history of type 2 diabetes, you are more susceptible genetically. People in these circumstances need to be “very careful” about weight, especially in adult life, Taylor says. “If you’ve increased weight quite a lot above what you were at the age of 21, you’re in the danger zone – and you should get out of it. If you’ve got a family tendency for diabetes, then you really want to avoid weight gain in adult life.”
As Taylor explains in his book, if you have increased your BMI by three units or more since you were in your early 20s, you are at risk. It doesn’t matter how slim you look to other people. “People imagine that if everybody says they’re slim, they won’t get type 2 diabetes, but in fact that’s not true. Our present research involves people who are not obese, and indeed, have a normal BMI.”
This explains why only half of people are clinically obese when they are first diagnosed with type 2 diabetes, and why studies have shown that almost three-quarters of extremely obese people, with a BMI of over 45, do not suffer from type 2 diabetes. “Some people can put on glorious amounts of fat and store it all under the skin without any metabolic problems at all.”
Taylor also says that it’s important to bear in mind that type 2 diabetes can, at first, be symptomless, so people at risk may wish to get an annual test done via their GP. A simple finger-prick blood test, which gives an immediate blood sugar level result, can be done in many chemists. Signals to look out for include increasing tiredness and, especially, increasing thirst, and a tendency to have more skin infections, “like boils for instance, or candida,” Taylor says.
Rapidly decreasing body weight by 2½st (16kg) will take most people below their personal fat threshold, dramatically lowering their risk. For this reason, “the book goes through the steps that people need to follow to lose a substantial amount of weight and then keep it off”.
Taylor hopes that by writing a paperback in simple, accessible language, he will reach people who are heading towards or have already received a diagnosis and want to learn more about his research. “I’ve realized there is an enormous thirst out there for exact knowledge about how people can deal with this disease themselves, using the new information that we have.” He also wants to explain to as many people as possible what causes type 2 diabetes so individuals feel empowered to make healthy decisions about their body and the food they eat.
“This book is for anyone who wants to understand what happens to food after they swallow it and how that’s handled by their body. And also, critically, how that affects their health.” For example, he has found most people don’t realise that if you eat more carbohydrates or protein than your body needs, the excess is converted into fat and then stored.
This is a million miles from “fat shaming”, he says, and it is up to each person to decide for themselves whether they are too heavy for their own health and happiness. “What I can point out as a doctor are the circumstances that come about when people have crossed their personal fat threshold,” he says. “There’s no judgment on a person who happens to be heavy, compared with someone who happens not to be. It’s about helping individuals who would otherwise run into trouble.”
Fasanmade OA, Odeniyi IA, Ogbera AO (June 2008). “Diabetic ketoacidosis: diagnosis and management”. African Journal of Medicine and Medical Sciences. 37 (2): 99–105. PMID18939392.
“Causes of Diabetes”. National Institute of Diabetes and Digestive and Kidney Diseases. June 2014. Archived from the original on 2 February 2016. Retrieved 10 February 2016.
Maruthur NM, Tseng E, Hutfless S, Wilson LM, Suarez-Cuervo C, Berger Z, Chu Y, Iyoha E, Segal JB, Bolen S (June 2016). “Diabetes Medications as Monotherapy or Metformin-Based Combination Therapy for Type 2 Diabetes: A Systematic Review and Meta-analysis”. Annals of Internal Medicine. 164 (11): 740–51. doi:10.7326/M15-2650. PMID27088241. S2CID32016657.
Melmed, Shlomo; Polonsky, Kenneth S.; Larsen, P. Reed; Kronenberg, Henry M., eds. (2011). Williams textbook of endocrinology (12th ed.). Philadelphia: Elsevier/Saunders. pp. 1371–1435. ISBN978-1-4377-0324-5.
Saenz A, Fernandez-Esteban I, Mataix A, Ausejo M, Roque M, Moher D (July 2005). Saenz A (ed.). “Metformin monotherapy for type 2 diabetes mellitus”. The Cochrane Database of Systematic Reviews (3): CD002966. doi:10.1002/14651858.CD002966.pub3. PMID16034881. (Retracted)
Moscou, Susan (2013). “Getting the word out: advocacy, social marketing, and policy development and enforcement”. In Truglio-Londrigan, Marie; Lewenson, Sandra B. (eds.). Public health nursing: practicing population-based care (2nd ed.). Burlington, MA: Jones & Bartlett Learning. p. 317. ISBN978-1-4496-4660-8. OCLC758391750.
Abdullah A, Peeters A, de Courten M, Stoelwinder J (September 2010). “The magnitude of association between overweight and obesity and the risk of diabetes: a meta-analysis of prospective cohort studies”. Diabetes Research and Clinical Practice. 89 (3): 309–19. doi:10.1016/j.diabres.2010.04.012. PMID20493574.
You would never know how terrible the past year has been for many Americans by looking at Wall Street, which has been going gangbusters since the early days of the pandemic.
“On the streets, there are chants of ‘Stop killing Black people!’ and ‘No justice, no peace!’ Meanwhile, behind a computer, one of the millions of new day traders buys a stock because the chart is quickly moving higher,” wrote Chris Brown, the founder and managing member of the Ohio-based hedge fund Aristides Capital in a letter to investors in June 2020. “The cognitive dissonance is overwhelming at times.”
The market was temporarily shaken in March 2020, as stocks plunged for about a month at the outset of the Covid-19 outbreak, but then something strange happened. Even as hundreds of thousands of lives were lost, millions of people were laid off and businesses shuttered, protests against police violence erupted across the nation in the wake of George Floyd’s murder, and the outgoing president refused to accept the outcome of the 2020 election — supposedly the market’s nightmare scenario — for weeks, the stock market soared. After the jobs report from April 2021 revealed a much shakier labor recovery might be on the horizon, major indexes hit new highs.
The disconnect between Wall Street and Main Street, between corporate CEOs and the working class, has perhaps never felt so stark. How can it be that food banks are overwhelmed while the Dow Jones Industrial Average hits an all-time high? For a year that’s been so bad, it’s been hard not to wonder how the stock market could be so good.
To the extent that there can ever be an explanation for what’s going on with the stock market, there are some straightforward financial answers here. The Federal Reserve took extraordinary measures to support financial markets and reassure investors it wouldn’t let major corporations fall apart.
Congress did its part as well, pumping trillions of dollars into the economy across multiplereliefbills. Turns out giving people money is good for markets, too. Tech stocks, which make up a significant portion of the S&P 500, soared. And with bond yields so low, investors didn’t really have a more lucrative place to put their money.
To put it plainly, the stock market is not representative of the whole economy, much less American society. And what it is representative of did fine.“No matter how many times we keep on saying the stock market is not the economy, people won’t believe it, but it isn’t,” said Paul Krugman, a Nobel Prize-winning economist and New York Times columnist. “The stock market is about one piece of the economy — corporate profits — and it’s not even about the current or near-future level of corporate profits, it’s about corporate profits over a somewhat longish horizon.”
Still, those explanations, to many people, don’t feel fair. Investors seem to have remained inconceivably optimistic throughout real turmoil and uncertainty. If the answer to why the stock market was fine is basically that’s how the system works, the follow-up question is: Should it?
“Talking about the prosperous nature of the stock market in the face of people still dying from Covid-19, still trying to get health care, struggling to get food, stay employed, it’s an affront to people’s actual lived experience,” said Solana Rice, the co-founder and co-executive director of Liberation in a Generation, which pushes for economic policies that reduce racial disparities. “The stock market is not representative of the makeup of this country.”
Inequality is not a new theme in the American economy. But the pandemic exposed and reinforced the way the wealthy and powerful experience what’s happening so much differently than those with less power and fewer means — and force the question of how the prosperity of those at the top could be better shared with those at the bottom. There are certainly ideas out there, though Wall Street might not like them.
How the stock market boomed when American life soured
Many on Wall Street, like many people in America, were in denial about the realities of Covid-19 when it first began to take hold internationally in early 2020. In an interview with Vox last April, CNBC host Jim Cramer recalled wondering whether “another shoe will drop on this coronavirus outbreak” in early February, only to see stocks keep rising steadily. “But nothing happened. The market kept quiet,” Cramer told Vox. Indeed, stocks continued to reach record highs.
While stocks often rise slowly, they also fall fast. And once Wall Street caught on to the realities Covid-19 might bring, the market tumbled, wiping off some 30 percent of its value from mid-February to mid-March. “No one had any idea of what the future was going to be, how deep this is, how long it would be, how wide it would be,” said Howard Silverblatt, senior index analyst at S&P Dow Jones Indices.
The S&P 500 bottomed out on March 23, just a week into New York’s shutdown, and after that, it made a remarkably strong recovery, month after month.
Most analysts and experts point to the Fed as the most important factor in supporting market confidence. The central bank announced a series of big measures to help support the economy and markets in March 2020, including saying that it would buy both investment-grade and high-yield corporate bonds (basically, debt that is risky and debt that is not).
“Not dissimilar to the global financial crisis, the Fed stepped in, and that was really a catalyst for a stock market recovery,” said Kristina Hooper, chief global market strategist at Invesco. “The Fed can be very, very powerful, almost omnipotent, when it comes to the stock market.”
Throughout the crisis, the Fed and Chair Jay Powell have made clear they will support markets and use every tool in their toolkit to do it. Powell has taken an extremely dovish tone and repeatedly said the Fed won’t raise interest rates — which would presumably slow down the economy and markets — preemptively. Basically, the markets let the Fed take the wheel.
Even if it didn’t buy bonds itself, the knowledge that it would if necessary reinforced the markets — private investors swept in to take up corporate bond offerings from companies such as Boeing and Nike. Continued confidence in a dovish Fed has only reinforced market bullishness; while a bad jobs report may be bad for businesses and workers, to investors, it’s also more reassurance that low interest rates aren’t going anywhere.
The issue is, the Fed is a much more powerful force on Wall Street than it is Main Street. Its programs to help small and midsize businesses and states and cities have been far less effective than those set up to help corporations and asset prices.
“It now feels like policy, be it the Fed or something else, that the stock market should really never go down,” said Dan Egan, vice president of behavioral finance and investing at Betterment.
To be sure, the Fed’s role is monetary policy, and it would have been bad if markets were allowed to crash or a litany of major corporations went bankrupt. And luckily for many struggling people and businesses, Congress stepped in with fiscal policy that could be more effective in helping the broader economy — a move that, no doubt, also helped markets. It’s good for corporations that people have money to spend.
Still, some wonder whether the Fed couldn’t have tried to go further to make sure its programs to support corporations flow to people other than shareholders. “Obviously it was good, the Fed needed to do something,” said Alexis Goldstein, senior policy analyst at Americans for Financial Reform. “But the criticism I would weigh was that there were no real conditions that workers were protected or rehired, that all the gains just didn’t go to the top.”
Goldstein pointed to a September report from the House of Representatives’ Select Subcommittee on the Coronavirus Crisis that found the Fed bought corporate bonds from at least 95 companies that issued dividends to shareholders while also laying off workers. “Surely the Fed is also so powerful that it can say, look, we need you all to prioritize rehiring your workers or we’re not necessarily going to rescue you, we’re going to rescue other companies, and that should be impactful,” Goldstein said.
Companies have been ruled by the mantra of shareholder primacy, where maximizing profits for investors is the end-all, be-all, for decades. Worker pay has severely lagged gains in productivity. Those trends were unlikely to change during a pandemic.
“Shareholder primacy means the job of corporations is to increase their share prices for this very small elite, and that means downward pressure on costs, including workers, where possible,” said Lenore Palladino, an assistant professor of economics and public policy at the University of Massachusetts Amherst. “The fact that the stock market is booming is because of the financialization of our goods- and services-producing companies, not because the real economy is doing so well.”
The market felt better about the pandemic than you probably did
Jack Ablin, the founding partner of Cresset Capital, recalls calling clients in the spring of 2020 and telling them they didn’t know how long the lockdowns and virus would last, but they were “confident” that within a year, it would be done. “Of course, it wasn’t,” he told Vox. But the general attitude remains: The markets figured things would get better, sooner or later. “Part of it was saying, look, this is temporary, we will eventually get back to business. So we were trying to look past the valley to the other side of normality.”
Not everything had to break in Wall Street’s favor for the market rally to continue — as mentioned, between the Fed and the future promise of corporate profits, investors had plenty of reasons to be confident — but it doesn’t hurt that it kind of did. The vaccine, which at the outset of the pandemic some experts warned might be years away, appeared by the end of 2020. Donald Trump did not want to accept the results of the 2020 presidential election, which some investors feared would spark chaos before voting day, but by and large, the US saw a peaceful transfer of power (with the exception of a riot at the Capitol, that, while disturbing, didn’t have anything to do with the Dow).
Investors also seemed confident that Congress would come through with more fiscal support for the economy. This, too, was not a given. The $900 billion package passed in the lame-duck session in December for months seemed highly unlikely. Had Democrats not taken both US Senate seats in Georgia, the $1.9 trillion American Rescue Plan, signed into law in March, would not have happened. While neither provided direct support to the markets, they did support the broader economy that the markets have for months been bullish on. Putting money in people’s pockets means they’ll spend it. It’s good for Wall Street that Main Street America doesn’t fail.
Some people in the industry point to a certain level of faith in America, like the type legendary investor Warren Buffett channeled during the financial crisis and Great Recession when he told people to “buy American.”
“You have to have an existential faith in America in order to be in stocks over the long term,” said Nick Colas, the co-founder of DataTrek Research.
“What has happened in the last 14 months or so is we’re believing in America again, we’re believing in our companies,” said Brian Belski, chief investment strategist at BMO Capital Markets. “From every bear market and every depression, we transition from despair to hope, and the hope was defined by American companies.”
“There are two lessons to be learned over the past year. The first is that economic headlines are lagging and not leading indicators of the market; and second, market timing is a losers’ game,” said Saira Malik, chief investment officer of global equities at Nuveen, an asset manager.
Nuveen is currently interested in emerging markets for potential investment possibilities on the horizon — including countries such as Brazil, which continues to be ravaged by the pandemic. “We do feel like in the near term they are going to struggle. But the vaccines are becoming more and more available, and while they’re lagging a bit behind, we do think they’ll catch up, and they’ve tended to have the cheaper valuations to go with that,” Malik said.
At this point, it’s hard to wonder what, if anything, will truly unnerve investors.
There are still plenty of risks to the market, including that in the US, President Joe Biden and Democrats may take steps to raise taxes that would mean a hit for the bottom lines of corporations and investors. When chatter of the president’s capital gains tax proposal kicked up in late April, the markets took a small dip, but it was hardly catastrophic.
“We have an administration that clearly has ambitions and wants to pay for them by taxing capital, taxing corporate profits, now taxing capital gains. The resilience of the market in the face of all that is kind of interesting,” Krugman said. “There may be a little bit of determined resilience; there may be some element of when people are determined to be optimistic, facts don’t matter.”
Hooper, from Invesco, offered up the explanation of the Fed. “I do think on a short-term basis, we could see a sell-off if there is a risk that appears imminent, but we have to recognize that all current risks are being cushioned by this incredibly accommodative Fed, which does have an impact. It’s a powerful upward force on stocks that can counteract the downward forces.”
What the stock market does and doesn’t represent
How the stock market does matters to a lot of people. A little over half of all Americans report owning stocks, including in their retirement or pension plans. And during the pandemic, plenty of people got into day trading, for better and for worse. But some groups have much higher stakes in the market than others. More than 80 percent of stocks are owned by the wealthiest 10 percent of Americans, meaning when markets go up, they’re the ones who reap the most gains. White people are also the overwhelming majority of market beneficiaries — by Palladino’s estimates, 92 percent of corporate equity and mutual fund value is owned by white households, compared to less than 2 percent each by Black and Hispanic households.
“People often forget how concentrated corporate equity holdings are,” Palladino said. “They’re held mainly by wealthy white households.” Those are the people who disproportionately reaped the benefits of the stock market’s pandemic run, while people of color disproportionately suffered the health and economic consequences of the disease.
If the US wants to create a fairer, less extractive economy where corporations and shareholders aren’t living a very different reality than people trying to pay their rent or find a job, there are ways to do it. The federal government could raise corporate taxes and tax income from investments in the same way it does income from labor and seek to rein in CEO pay.
It could also clamp down on shareholder primacy and make sure companies base their decisions not only on making their investors rich but also on the well-being of their workers, customers, communities, and suppliers. In 2019, the Business Roundtable, a major business lobbying group, issued a statement that it would redefine the “purpose of a corporation” as one that fosters “an economy that serves all Americans.” The government and the public could find ways to hold them to it. Palladino, in her work, has outlined a number of proposals that would curb shareholder primacy, including requiring corporate boards to have worker representatives, banning stock buybacks, and boosting unions.
Beyond policy fixes, there’s also just the reality that the market measures very one specific thing — how investors think (rightly or wrongly) corporate profits are going to be in the future. And for many people, that measure is meaningless. “If you can assess that the economy is good when we’re in one of the worst economic moments of American history, then it’s a useless measure,” said Maurice BP-Weeks, co-executive director of the Action Center on Race and the Economy.
The past year has been a truly wild ride in America and for the stock market, though in different directions. Investors are reaching almost exuberant levels, from the GameStop saga to the crypto craze. Stocks are continuing their bull run, with no clear end in sight. There are plenty of warnings that investors are out over their skis, but then again, there always are.
It’s a far cry from a little over a year ago, when billionaire hedge funder Bill Ackman went on TV to warn that “hell is coming” because of Covid-19. Or maybe it did — just not for Wall Street.
People who obsessively worry about their health have often been dismissed as hypochondriacs. But for some, coronavirus has fuelled a rise in a debilitating mental health condition known as health anxiety. As Andrew Kersley explores, it can lead to job losses and even suicidal thoughts.
In March 2020, Ben quit his job as a bus driver. Whenever he was off shift he couldn’t stop thinking about how one of his passengers must have had Covid-19 and infected him. Even though he was young and healthy and his chances of serious illness were low, he was fixated on the idea he would become infected and die.
Within a fortnight, Ben had moved out of his family home in Birmingham and into in an empty student house that his friends had left. “I kept thinking about being in a place where no-one was going in or out,” he says.
Despite leaving home and quitting his job, his anxiety about getting infected still dominated his thoughts. “I would wake up and check to see if my body was okay,” he says.
“I gave myself symptoms all the time – if I was tired I’d be completely convinced I had it. I was scared to go to the shops. I just avoided going out and seeing any people at all. It’s all about the ‘what if’ rather than the reality… and no-one can ever tell you that you’ll be fine.”
Ben was experiencing health anxiety.
‘It almost took my life’
While we all sometimes worry about our health, or google symptoms, health anxiety is recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) – known as the bible of psychiatry – as a condition in which obsessive fears about health become excessive.
It is defined by compulsively checking for symptoms, researching diseases, obsessing over normal bodily sensations or avoiding anything that could potentially lead to you being exposed to disease.
This little-known, yet widespread condition, has hit more people this year in the wake of the pandemic.
Many have been unable to leave their house or even open windows for fear of infection. Some, like Ben, have quit jobs. Others bleach their house for hours a day. Almost all have been plagued by uncontrollable thoughts about dying from Covid.
She first developed it three-and-half years ago after finding a small bump and convincing herself she had lymphoma. Once that was ruled out she spiralled through breast cancer, brain tumours and more. She wasn’t just worried about being sick, but certain she was dying and no-one was listening.
“I’m a relatively logical and intelligent person but health anxiety took all logic away from me,” she explains. The constant fixation got so bad she repeatedly ended up at her local mental health crisis centre as it increasingly left her unable to function.
“I became suicidal, which is strange because I was trying to avoid death,” she says. “But it got so bad that I couldn’t live with the thought process anymore. Nothing I did would calm me down.” And the pandemic made things worse.
My partner would do the food shopping and I would sit there on the floor for an hour washing it. There was a real ritual over it
“When we first got told about this virus, it was just my worst nightmare,” the 28-year-old says. “I know everybody was inside but I couldn’t even open my window. My partner would do the food shopping and I would sit there on the floor for an hour washing it. There was a real ritual over it.
“It makes you feel like an attention-seeker,” says Cherelle. “It really destroyed my life and I feel very lucky just to be here.”
Cherelle says her anxiety eased over the year because Covid started to feel more “real” and visible to her than the hypothetical illnesses she had previously convinced herself of having, but many others can’t say the same.
‘Enemy you can’t see’
Health anxiety generally covers two areas – fear that you are already sick or fear that you could become sick. During the pandemic, the latter impacted everyone. But like most mental illness, it is a spectrum.
While some people rarely think about it, for others it is all they think about. Yet the number of those experiencing health anxiety has skyrocketed.
Dr Rob Willson, a London-based cognitive behavioural therapist and health anxiety expert, says he has “never had more enquiries” about health anxiety. Another specialist told the BBC he was fully booked for the next few months.
But seeking medical attention doesn’t always ease the anxiety. “Reassurance never reassures, that’s what we always say,” explains clinical psychologist Dr Marianne Trent, who runs a private mental health practice in Coventry. “Their world gets very small, but their distress is still very high.”
When you’re dealing with an enemy that you can’t see it’s hard to turn that threat radar down
Coronavirus in particular poses problems for those with health anxiety. Symptoms like shortness of breath can be symptomatic of both anxiety and Covid, and the two can create a vicious cycle. The more anxious you become the more “evidence” you have that you are sick.
Plus there’s the uncertainty over infection. “When you’re dealing with an enemy that you can’t see it’s hard to turn that threat radar down,” says Dr Trent. For Myra Ali, in north London, the past 12 months have felt very long. “I haven’t really been out the house for a year,” she says. “All we’ve heard is how easily you can catch Covid, so it’s embedded in your mind.”
The 33-year-old is low risk, but an intense fear about getting hospitalized with Covid controlled her thoughts. She even put off surgery for a chronic condition as a result. Just ordering a takeaway one night was enough to trigger an episode. “The next day I had to phone a doctor because I kept thinking ‘what if I’m getting symptoms?’.”
The way we talk about health anxiety in society only makes it worse. Terms like hypochondriac can dismiss those who worry too much about their health, and few people are aware that health anxiety is a genuine condition.
That attitude even filters into the medical community and Dr Willson says it can be difficult to get help from doctors due to their own negative perception of it. The condition was previously called hypochondriasis, but the stigma drove professionals to call it health anxiety instead.
Dr Willson, who co-authored a book on the condition, says there is a shortage of doctors specializing in it even though the condition can have a life-changing impact. Two of his patients have taken their own lives and he says it dominates the lives of many others.
But he, along with Dr Trent, agreed health anxiety could be managed through cognitive behavioural therapy (CBT), a talking therapy which helps change the way you think and behave as well as exposure therapy, where, with professional support, people slowly expose themselves to the things making them anxious – like going outside – in small doses.
Dr Trent says she appreciates the detrimental impact it can have. “It’s real life and death stuff. It can definitely be as debilitating as any other mental health condition.”As society opens up, life may resume for many, but for those with health anxiety a full return to normality is unlikely. It is thought the number of health anxiety patients will continue to rise long after the pandemic ends.
Dr Willson says: “It has been long enough for them to develop habits of checking for symptoms, googling and obsessing. The brain is not quick to give up those kind of habits.” If you need any advice about health anxiety, the NHS has a dedicated page containing tips and guidance, or you can contact charities including Anxiety UK, Mind or Rethink Mental Illness.
Anxiety disorders are common, affecting about one in ten with persistent, excessive worrying that can hinder their ability to function. They may worry constantly about things that do not warrant it or that may never happen.
In this video clip, participants discuss the various forms of treatment and support they have received from medical professionals as well as from other sources. Some of the strategies for managing anxiety are explored, including techniques such as physical activity, breathing exercises, and sticking to a routine.
After a year of lockdown, many of us are finding it hard to think clearly, or remember what happened when. Neuroscientists and behavioural experts explain why
Before the pandemic, psychoanalyst Josh Cohen’s patients might come into his consulting room, lie down on the couch and talk about the traffic or the weather, or the rude person on the tube. Now they appear on his computer screen and tell him about brain fog. They talk with urgency of feeling unable to concentrate in meetings, to read, to follow intricately plotted television programms.
“There’s this sense of debilitation, of losing ordinary facility with everyday life; a forgetfulness and a kind of deskilling,” says Cohen, author of the self-help book How to Live. What to Do. Although restrictions are now easing across the UK, with greater freedom to circulate and socialize, he says lockdown for many of us has been “a contraction of life, and an almost parallel contraction of mental capacity”.
This dulled, useless state of mind – epitomized by the act of going into a room and then forgetting why we are there – is so boring, so lifeless. But researchers believe it is far more interesting than it feels: even that this common experience can be explained by cutting-edge neuroscience theories, and that studying it could further scientific understanding of the brain and how it changes.
I ask Jon Simons, professor of cognitive neuroscience at the University of Cambridge, could it really be something “science”? “Yes, it’s definitely something science – and it’s helpful to understand that this feeling isn’t unusual or weird,” he says. “There isn’t something wrong with us. It’s a completely normal reaction to this quite traumatic experience we’ve collectively had over the last 12 months or so.”
What we call brain fog, Catherine Loveday, professor of cognitive neuroscience at the University of Westminster, calls poor “cognitive function”. That covers “everything from our memory, our attention and our ability to problem-solve to our capacity to be creative. Essentially, it’s thinking.” And recently, she’s heard a lot of complaints about it: “Because I’m a memory scientist, so many people are telling me their memory is really poor, and reporting this cognitive fog,” she says.
She knows of only two studies exploring the phenomenon as it relates to lockdown (as opposed to what some people report as a symptom of Covid-19, or long Covid): one from Italy, in which participants subjectively reported these sorts of problems with attention, time perception and organisation; another in Scotland which objectively measured participants’ cognitive function across a range of tasks at particular times during the first lockdown and into the summer. Results showed that people performed worse when lockdown started, but improved as restrictions loosened, with those who continued shielding improving more slowly than those who went out more.
Loveday and Simons are not surprised. Given the isolation and stasis we have had to endure until very recently, these complaints are exactly what they expected – and they provide the opportunity to test their theories as to why such brain fog might come about. There is no one explanation, no single source, Simons says: “There are bound to be a lot of different factors that are coming together, interacting with each other, to cause these memory impairments, attentional deficits and other processing difficulties.”
One powerful factor could be the fact that everything is so samey. Loveday explains that the brain is stimulated by the new, the different, and this is known as the orienting response: “From the minute we’re born – in fact, from before we’re born – when there is a new stimulus, a baby will turn its head towards it. And if as adults we are watching a boring lecture and someone walks into the room, it will stir our brain back into action.”
Most of us are likely to feel that nobody new has walked into our room for quite some time, which might help to explain this sluggish feeling neurologically: “We have effectively evolved to stop paying attention when nothing changes, but to pay particular attention when things do change,” she says.
Loveday suggests that if we can attend a work meeting by phone while walking in a park, we might find we are more awake and better able to concentrate, thanks to the changing scenery and the exercise; she is recording some lectures as podcasts, rather than videos, so students can walk while listening.
She also suggests spending time in different rooms at home – or if you only have one room, try “changing what the room looks like. I’m not saying redecorate – but you could change the pictures on the walls or move things around for variety, even in the smallest space.”
The blending of one day into the next with no commute, no change of scene, no change of cast, could also have an important impact on the way the brain processes memories, Simons explains. Experiences under lockdown lack “distinctiveness” – a crucial factor in “pattern separation”. This process, which takes place in the hippocampus, at the centre of the brain, allows individual memories to be successfully encoded, ensuring there are few overlapping features, so we can distinguish one memory from another and retrieve them efficiently.
The fuggy, confused sensation that many of us will recognize, of not being able to remember whether something happened last week or last month, may well be with us for a while, Simons says: “Our memories are going to be so difficult to differentiate. It’s highly likely that in a year or two, we’re still going to look back on some particular event from this last year and say, when on earth did that happen?”
Perhaps one of the most important features of this period for brain fog has been what Loveday calls the “degraded social interaction” we have endured. “It’s not the same as natural social interaction that we would have,” she says. “Our brains wake up in the presence of other people – being with others is stimulating.”
We each have our own optimum level of stimulation – some might feel better able to function in lockdown with less socialising; others are left feeling dozy, deadened. Loveday is investigating the science of how levels of social interaction, among other factors, have affected memory function in lockdown. She also wonders if our alternative to face-to-face communication – platforms such as Zoom – could have an impact on concentration and attention.
She theorises – and is conducting a study to explore this – that the lower audio-visual quality could “create a bigger cognitive load for the brain, which has to fill in the gaps, so you have to concentrate much harder.” If this is more cognitively demanding, as she thinks, we could be left feeling foggier, with “less brain space available to actually listen to what people are saying and process it, or to concentrate on anything else.”
Carmine Pariante, professor of biological psychiatry at King’s College London, is also intrigued by brain fog. “It’s a common experience, but it’s very complex,” he says. “I think it is the cognitive equivalent of feeling emotionally distressed; it’s almost the way the brain expresses sadness, beyond the emotion.” He takes a psycho-neuro-immuno-endocrinological approach to the phenomenon – which is even more fascinating than it is difficult to say. He believes we need to think about the mind, the brain, the immune and the hormonal systems to understand the various mental and physical processes that might underlie this lockdown haze, which he sees as a consequence of stress.
We might all agree that the uncertainty of the last year has been quite stressful – more so for some than for others. When our mind appraises a situation as stressful, Pariante explains, our brain immediately transmits the message to our immune and endocrine systems. These systems respond in exactly the same way they did in early humans two million years ago on the African savannah, when stress did not relate to home schooling, but to fear of being eaten by a large animal.
The heart beats faster so we can run away, inflammation is initiated by the immune system to protect against bacterial infection in case we are bitten, the hormone cortisol is released to focus our attention on the predator in front of us and nothing else. Studies have demonstrated that a dose of cortisol will lower a person’s attention, concentration and memory for their immediate environment. Pariante explains: “This fog that people feel is just one manifestation of this mechanism. We’ve lost the function of these mechanisms, but they are still there.” Useful for fighting a lion – not for remembering where we put our glasses.
When I have experienced brain fog, I have seen it as a distraction, a kind of laziness, and tried to push through, to force myself to concentrate. But listening to Loveday, Simons and Pariante, I’m starting to think about it differently; perhaps brain fog is a signal we should listen to. “Absolutely, I think it’s exactly that,” says Pariante. “It’s our body and our brain telling us that we’re pushing it too much at the moment. It’s definitely a signal – an alarm bell.” When we hear this alarm, he says, we should stop and ask ourselves, “Why is my brain fog worse today than yesterday?” – and take as much time off as we can, rather than pushing ourselves harder and risking further emotional suffering, and even burnout.
For Cohen, the phenomenon of brain fog is an experience of one of the most disturbing aspects of the unconscious. He talks of Freud’s theory of drives – the idea that we have one force inside us that propels us towards life; another that pulls us towards death. The life drive, Cohen explains, impels us to create, make connections with others, seek “the expansion of life”. The death drive, by contrast, urges “a kind of contraction. It’s a move away from life and into a kind of stasis or entropy”. Lockdown – which, paradoxically, has done so much to preserve life – is like the death drive made lifestyle.
With brain fog, he says, we are seeing “an atrophy of liveliness. People are finding themselves to be more sluggish, that their physical and mental weight is somehow heavier, it’s hard to carry around – to drag.” Freud has a word for this: trägheit – translated as a “sluggishness”, but which Cohen says literally translates as “draggyness”. We could understand brain fog as an encounter with our death drive – with the part of us which, in Cohen’s words, is “going in the opposite direction of awareness and sparkiness, and in the direction of inanimacy and shutting down”.
This brings to mind another psychoanalyst: Wilfred Bion. He theorised that we have – at some moments – a will to know something about ourselves and our lives, even when that knowledge is profoundly painful. This, he called being in “K”. But there is also a powerful will not to know, a wish to defend against this awareness so that we can continue to live cosseted by lies; this is to be in “–K” (spoken as “minus K”).
I wonder if the pandemic has been a reality some of us feel is too horrific to bear. The uncertainty, the deaths, the trauma, the precarity; perhaps we have unconsciously chosen to live in the misty, murky brain fog of –K rather than to face, to suffer, the true pain and horror of our situation. Perhaps we are having problems with our thinking because the truth of the experience, for many of us, is simply unthinkable.
I ask Simons if, after the pandemic, he thinks the structure of our brains will look different on a brain scan: “Probably not,” he says. For some of us, brain fog will be a temporary state, and will clear as we begin to live more varied lives. But, he says, “It’s possible for some people – and we are particularly concerned about older adults – that where there is natural neurological decline, it will be accelerated.”
Simons and a team of colleagues are running a study to investigate the impact of lockdown on memory in people aged over 65 – participants from a memory study that took place shortly before the pandemic, who have now agreed to sit the same tests a year on, and answer questions about life in the interim.
One aim of this study is to test the hypothesis of cognitive reserve – the idea that having a rich and varied social life, filled with intellectual stimulation, challenging, novel experiences and fulfilling relationships, might help to keep the brain stimulated and protect against age-related cognitive decline. Simons’ advice to us all is to get out into the world, to have as rich and varied experiences and interactions as we can, to maximize our cognitive reserve within the remaining restrictions.
The more we do, the more the brain fog should clear, he says: “We all experience grief, times in our lives where we feel like we can’t function at all,” he says. “These things are mercifully temporary, and we do recover.”