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How health-conscious consumers want to live in a healthy world, health & wellness.

All around the world, consumers are re-inventing how they approach health threats and wellness-related decisions. Our  Global Health and Wellness report explores consumer sentiment across 17 diverse global markets to help understand the global state of health, wellness, and well-being. It showcases a universal hierarchy of needs that empowers a deeper understanding of how consumers are currently prioritizing their health and wellness needs.     

This hierarchy, applied to the current state of health and wellness, brings to light a total view of consumer health needs. It highlights unique differences in the innate order to which consumers are prioritizing their health needs: those that are protective, preservation-focused, aspirational, evolving, and altruistic in nature.    

Altruistic needs delve into selfless consumption that supports environmental, ethical, humanitarian or other philanthropic causes. This article explores the specific causes, product claims and exemplar brands that serve health-minded consumers who strive to live in a healthy world.

Am I helping the health of the planet & those around me?

67% of global consumers say that environmental health and how their choices impact the planet is important to them

of surveyed global consumers agree that environmental issues are having an adverse impact on their current and future health

of surveyed global consumers are more likely to buy products with sustainable credentials than 2 years ago

of surveyed global consumers are willing to pay more for products that support communities and vulnerable groups

Source: NielsenIQ Global Health & Wellness /study of 17 markets, September 2021

Globally unified through the impact of living alongside COVID-19, many consumers today feel awakened to how their individual purchase decisions and experiences can collectively affect us all. The realities of air pollution, supply chain disruptions and how supporting local origin can be good for the individual, their local community and the planet are just a few ways in which pandemic living has heightened attention around altruistic health and wellness needs.

From environmental challenges, to equal access to healthcare for all and protecting our most vulnerable, there are many ways in which consumers are prioritizing the idea of a healthy world, in addition to their own health.

Global measures of consumer sentiment indicate that while many prioritize altruistic needs less so than other needs, there is considerable willingness to pay more for products with certain altruistic attributes or features. For example, 72% of surveyed respondents around the world say they would be willing to pay a premium for products that claim to be sustainable – where, 52% would be willing to pay a little bit more, and 20% of global consumers would be willing to pay a lot more for sustainable products.

Mainstream values that produce a healthy world

The concept of altruistic health and wellness is no longer in its infancy. For many consumers, their baseline expectations are for products to have clean, simple and sustainable ingredients. This is driven by heightened consumer awareness of how their individual product consumption ladders towards living in a healthy world. U.S. measures of consumer searches and retail sales exemplify just how mainstream altruistic needs have become. There has been strong, double-digit growth in the number of searches for vegan and cruelty free products, meanwhile, the swift pace of sales among clean ingredients (complexly defined by NielsenIQ, but summarized as being free from parabens, sulfates, phthalates, artificial colors, artificial fragrances and 600+ other ingredients) has outpaced sales growth of the overall beauty and personal care category.

growth in searches for ‘vegan’

growth in searches for ‘cruelty free’

Source: Consumer Searches on Amazon from Oct. 2019 – Dec. 2020

Beyond the scope of clean ingredients, there are many other pockets of growth within the sustainable product umbrella. From products backed by socially responsible organizations (+27% vs. 2019), to those that are manufactured with animal welfare in mind (+24% vs. 2019), there are many examples where products have aligned to causes with growing social gravity.

• How consumers arm themselves in the fight against health threats
• How consumers approach physical & mental well-being in 2021
• How consumers aspire to live healthy lives in 2021
• The changing face of global consumer health and wellness

All-in on clean label

Strong demand and continued growth have been constants in the world of clean label products. But interestingly enough, the leading “clean” brands today represent a mix of both old favorites and emerging up and comers. What unites these leaders is the common mission of producing products for healthy consumers who are striving to live in a healthy world.

Notably, Shea Moisture hair care products and Dr Bronners soaps both saw strong double-digit U.S. sales growth of 20% over the past year, likely driven by their long-term commitment to clean and sustainable beauty.

Some of the smaller brands that have made a splash include B.tan sunless tanner, and Sky organics personal care products, who have won with their commitment to clean ingredients without sacrificing performance.

Growth in clean for established brands as well as new

Shea moisture hair care $11.2MM, +20.8%

We strive to be sulfate free, paraben free and more, whenever possible. Tested on our family for four generations. Never on animals.

B. Tan suncare $2.8MM, +50.1%

We love animals, so we don’t test on them. And we love your bod so we keep all the nasties out of our products.

Dr. Bronners bath & shower $105MM, +19.9%

Only the purest organic and fair trade ingredients—most products vegan and certified to the same organic standards as food!

Sky organics HBL $3.8MM, +39.8%

Ours is a family deeply connected to nature and exploration, seeking travel and new experiences, always learning and engaged.

Source: NielsenIQ Retail Measurement Services, Product Insider, powered by Label Insight, Total US xAOC L52W ending 5/22/21; Beauty & Personal Care

Get ahead of the sustainability curve

While sustainability in and of itself is not new to the consumer packaged goods sector, the ways in which products are evolving to embody sustainable behaviors is constantly changing.

Take for example B.O.B. (Bars Over Bottles) a Brazilian beauty bar brand which touts water-less, plastic and chemical-free formulations that aim to reduce waste and preserve the world’s rivers and oceans. Low-waste products are commanding a swiftly growing spotlight with the U.S. haircare category as well. In fact, shampoo and conditioner bars, were the 9th most-searched hair care trend in early 2021 and offer a convenient and eco-friendly alternative to traditional bottled alternatives.

Similarly in Asia, Hong Kong skin care brand, Mono, has embodied a low-waste mentality of their own. Purchases include an empty bottle and soluble tablet that customers are instructed to combine with water in order to use. Leaving consumers to incorporate water to the product themselves results in a world of economical and environmental savings: fewer trucks and less packaging…even the wrapping of the product tablet is 100% recyclable. 

Interest in low-waste hair care is growing

Shampoo and conditioner bars were the #9 most searched hair care trend in early 2021 with 135,000+ quarterly searches on Amazon alone.

+627% Plastic free hair care

+182% Zero waste hair care

+71% Refillable hair care

Source: Label Insight consumer search data from Amazon, Target & Walmart. April 2020-March 2021

Take a deeper look into the global consumer health and wellness revolution

Understanding how consumers’ altruistic health needs are being met is only part of the story. The opportunity for companies looking to meet and exceed the growing expectations of wellness-minded, conscious consumers is to figure out where your brand fits and sits along the entire hierarchy of health and wellness needs. Our  Global Health and Wellness report  takes a deep dive into how consumer needs have been reshaped around the world, what is trending, and what the budding opportunities are across the new, broadened spectrum of global well-being. 

Stay one step ahead by staying up to date.

Don’t miss out on latest insights, offers and opportunities by NielsenIQ.

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« How Has Treasury Market Liquidity Evolved in 2023? | Main | Borrower Expectations for the Return of Student Loan Repayment »

An Update on the Health of the U.S. Consumer

Andrew Haughwout, Donghoon Lee, Daniel Mangrum, Jonathan McCarthy, Davide Melcangi, Joelle Scally, and Wilbert van der Klaauw

The strength of consumer spending so far this year has surprised most private forecasters. In this post, we examine the factors behind this strength and the implications for consumption in the coming quarters. First, we revisit the measurement of “excess savings” that households have accumulated since 2020, finding that the estimates of remaining excess savings are very sensitive to assumptions about measurement, estimation period, and trend type, which renders them less useful. We thus broaden the discussion to other aspects of the household balance sheet. Using data from the New York Fed’s Consumer Credit Panel , we calculate the additional cash flows made available for consumption as a result of households’ adjustments to their debt holdings. To detect signs of stress in household financial positions, we examine recent trends in delinquencies and find the evidence to be mixed, suggesting that certain stresses have emerged for some households. In contrast, we find that the New York Fed’s Survey of Consumer Expectations still points to a solid outlook for consumer spending.

Surprising Consumption Strength

Real personal consumption expenditures (PCE) have been remarkably sturdy since the onset of the pandemic, to the surprise of many analysts over much of this period. The surprises have been especially notable over the first half of this year, as real PCE growth has held up in the face of ongoing monetary policy tightening and this spring’s banking system stress. 

To quantify the extent of these surprises, we chart errors in the six-month-ahead Blue Chip Consensus forecasts of quarterly real PCE growth (measured at an annual rate). A positive forecast error (shown in the blue bars) at time t means that the realized growth rate (shown in red) was above the forecasts from six months earlier.

Consumption Has Surprised to the Upside, Especially in 2023

Sources: Bureau of Economic Analysis; Blue Chip Economic Indicators. Notes: The red line shows the real (inflation-adjusted) quarterly annualized rate of growth for personal consumption expenditures (PCE). The blue bars show the difference between realized PCE growth and the six-month-ahead Blue Chip Consensus forecasts, with positive values indicating that consumption growth was higher than expected.

In the first half of 2021, real PCE grew much faster than predicted, likely due to an unexpectedly fast rollout of vaccines and a larger-than-expected fiscal stimulus–in terms of both magnitude and multiplier effect on consumption. Throughout 2022, however, consumption was weaker than forecasted, probably due to a combination of higher-than-expected inflation, a larger effect on disposable income from the unwinding of pandemic-related fiscal support, and a faster-than-expected tightening of financial conditions.

But in 2023, we’ve seen upside surprises once again, particularly for the first quarter. Moreover, the most recent Blue Chip Consensus forecast for consumption growth in 2023:Q3 is higher than what was expected six months ago. This shift has occurred because many forecasters in the past few months have abandoned their projections of recession and negative consumption growth. We now attempt to understand these forecast errors.

Excess Savings

We begin our discussion with excess savings, which has received a lot of attention from economists and the business press . The idea is that large fiscal transfers and reduced consumption opportunities during the pandemic led households to save more than they otherwise would have done and now those savings may be available to support consumption. There is tremendous uncertainty, however, about how much excess savings still remain in the household sector.

While analysts generally agree that excess savings reached high levels over the course of 2021, significant differences about their recent level have developed; for example, see Aladangady et al. , de Soyres et al. , and Abdelrahman and Oliveira ( Higgins and Klitgaard study excess savings in the international context). The differences in estimates for the United States are attributable to technical factors like the assumed pre-pandemic trend, and different views about whether the savings rate or gross household saving (in dollars) is the appropriate way to think about any excess.

As we move further beyond the pandemic, measuring excess savings becomes increasingly fraught, since it relies heavily on assumptions about behavior in the absence of the pandemic. Consequently, in thinking about the recent resilience of consumption and the implications for the future, a broader assessment of households’ financial positions now seems a more important consideration than excess savings in isolation. In the remainder of the post, we focus on an important element of such an assessment: the role of debt in supporting households’ capacity to sustain consumption.

Household Debt

In addition to savings, households have relatively illiquid assets (like housing) and liabilities (like mortgages and credit card debts) on their balance sheets. The pandemic period featured forbearances on several types of debt, along with large fiscal transfers and very low interest rates, leading to significant improvements in household cash flows. For example, about 14 million households refinanced their mortgages, reducing their mortgage bill by $30 billion per year through 2021. The red line in the next chart shows that the cumulative savings from these lower payments stood at about $120 billion as of 2023:Q2, with recent quarters bringing declines as newer mortgages carry higher balances and higher interest rates.

In addition to these savings, homeowners withdrew unusually large amounts of home equity, primarily in the form of cash-out refinances during the period of low rates. These funds, shown in the blue line below, are also available for consumption and amount to $280 billion in 2023:Q2.

Equity Extraction and Mortgage Refinances Contributed to Liquid Funds Available for Consumption

Source: New York Fed Consumer Credit Panel / Equifax

Other forms of household debt also supported consumption. Payments on student debt, which competes with auto loans to be the second largest household sector liability, have largely been in forbearance since the early stages of the pandemic. Payments on federal student loans prior to the payment moratorium totaled about $70 billion per year , meaning that through 2023:Q2 about $260 billion was left in the household sector; see the blue line in our next chart. By comparison, auto loans (red line) have made relatively small contributions to the funds available for consumption, while some of the funds that households saved have been reflected in reduced credit card balances (gold line).

Credit Card Paydowns Offset Student Loan Forbearance

Source: New York Fed Consumer Credit Panel / Equifax.

In total, mortgages—through equity extraction and lower interest payments—have provided about $400 billion of the excess savings since 2019, and nonmortgage debt has added about $110 billion as the positive cash flow from student loans is partly offset by the negative cash flow of credit cards. Of course, reduced credit card balances position households well for future consumption: since reduced balances typically mean that more credit is available for future use.

Other Indicators of Households’ Financial Health

These positive cash flows from debt suggest that the household sector is in a strong position. Other indicators also support this assessment. Debt delinquencies are generally low, led by remarkably low mortgage delinquencies (shown in gold in the next chart). Auto loan and credit card delinquencies, on the other hand, have risen fairly sharply from their troughs during the pandemic and are now back to their 2019 levels. A key question going forward is whether these delinquency rates will level off or continue to rise. A further increase in delinquencies would indicate that, for at least some households, cash flow has become insufficient to support their financial obligations.

Will Delinquency Rates Continue to Rise?

As a second set of indicators, we use data from the New York Fed’s Survey of Consumer Expectations to assess households’ near-term expectations regarding their spending, debt delinquency, household income, and earnings growth. Median year-ahead expected spending growth has retreated somewhat from its high 2022 levels, but its current reading of 5.3 percent and six-month average of 5.4 percent remain well above its pre-pandemic level in February 2020 of 3.1 percent.

The same pattern is true for median expected household income growth and median expected earnings growth, which have averaged 3.2 percent and 2.9 percent, respectively, in recent months—well above their six-month averages going into the pandemic (2.7 percent and 2.4 percent, respectively). Consistent with these findings, the median probability of missing a debt payment over the next three months has been relatively low and stable over the past six months at an average of 11.3 percent, compared to a six-month average of 12.2 percent going into the pandemic. 

What’s Next?

Overall, households report solid and stable expectations for spending growth, consistent with our evidence on the strength and liquidity of household balance sheets, including relatively low delinquencies. Of course, the period of very low interest rates that supported many of these developments is decidedly over, at least for now, suggesting that household finances will likely tighten further in the coming months. Additionally, the resumption of student loan payments could have substantial negative effects on vulnerable households. We will return to this important issue in our accompanying post .

Andrew F. Haughwout is the director of Household and Public Policy Research in the Federal Reserve Bank of New York’s Research and Statistics Group. 

Donghoon Lee is an economic research advisor in Consumer Behavior Studies in the Federal Reserve Bank of New York’s Research and Statistics Group.

Daniel Mangrum is a research economist in Equitable Growth Studies in the Federal Reserve Bank of New York’s Research and Statistics Group.

Jonathan McCarthy is an economic research advisor in Macroeconomic and Monetary Studies in the Federal Reserve Bank of New York’s Research and Statistics Group.

Davide Melcangi is a research economist in Labor and Product Market Studies in the Federal Reserve Bank of New York’s Research and Statistics Group.

Joelle Scally is a regional economic principal in the Federal Reserve Bank of New York’s Research and Statistics Group.

Wilbert van der Klaauw is the economic research advisor for Household and Public Policy Research in the Federal Reserve Bank of New York’s Research and Statistics Group.

How to cite this post: Andrew Haughwout, Donghoon Lee, Daniel Mangrum, Jonathan McCarthy, Davide Melcangi, Joelle Scally, and Wilbert van der Klaauw, “An Update on the Health of the U.S. Consumer,” Federal Reserve Bank of New York Liberty Street Economics , October 18, 2023, https://libertystreeteconomics.newyorkfed.org/2023/10/an-update-on-the-health-of-the-u-s-consumer/.

You may also be interested in:

Borrower Expectations for the Return of Student Loan Repayment

• Spending Down Pandemic Savings Is an “Only-in-the-U.S.” Phenomenon

Who Uses “Buy Now, Pay Later?”

Disclaimer The views expressed in this post are those of the author(s) and do not necessarily reflect the position of the Federal Reserve Bank of New York or the Federal Reserve System. Any errors or omissions are the responsibility of the author(s).

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FDA Launches Health Care at Home Initiative to Help Advance Health Equity

Initiative aims to better position agency to address health care needs by moving care into the home setting

FOR IMMEDIATE RELEASE April 23, 2024

The following is attributed to Jeff Shuren, M.D., J.D., director of the FDA's Center for Devices and Radiological Health (CDRH) and Michelle Tarver, M.D., Ph.D., deputy director for transformation at CDRH

Clinical care is undergoing an evolution that has been accelerated over the last few years by the COVID-19 public health emergency. Health care has primarily been centered on health care systems and their components—hospitals, clinics, providers, and payers. However, many challenges persist, such as primary care physician and specialist shortages, significant increases in health care costs, higher chronic disease prevalence rates, and often the inability to meet the health care needs of millions of people who have no or limited access to health care systems. People from various racial and ethnic minority populations and those who live in rural communities and lower-income neighborhoods are impacted the most by these system challenges, which furthers health disparities across the nation.

Today, the U.S. Food and Drug Administration is announcing the launch of a new initiative, Home as a Health Care Hub, to help reimagine the home environment as an integral part of the health care system, with the goal of advancing health equity for all people in the U.S. While many care options are currently attempting to use the home as a virtual clinical site, very few have considered the structural and critical elements of the home that will be required to absorb this transference of care. Moreover, devices intended for use in the home tend to be designed to operate in isolation rather than as part of an integrated, holistic environment. As a result, patients may have to use several disparate medical devices, some never intended for the home environment, rather than interact with medical-grade, consumer-designed, customizable technologies that seamlessly integrate into an individual person's lifestyle.

The FDA's Center for Devices and Radiological Health (CDRH) has contracted with an architectural firm that intentionally designs innovative buildings with health and equity in mind, to consider the needs of variable models of a home and tailor solutions with opportunities to adapt and evolve in complexity and scale. The hub will be designed as an Augmented Reality/Virtual Reality (AR/VR)-enabled home prototype and is expected to be completed later this year.

This partnership includes collaboration with patient groups, health care providers, and the medical device industry to build the Home as a Health Care Hub. This prototype will serve as an idea lab, not only to connect with populations most affected by health inequity, but also for medical device developers, policy makers, and providers to begin developing home-based solutions that advance health equity. Existing models that have examined care delivery at home have found great patient satisfaction, good adherence, and potential cost savings to health care systems. By beginning with dwellings in rural locations and lower-income communities, the planned prototype will be intentionally designed with the goal of advancing health equity.

The FDA is using diabetes as an example health condition for the hub prototype given the impacts over the lifecycle of someone living with this condition. According to the Centers for Disease Control and Prevention ( CDC ), over $300 billion per year was spent on medical costs for diabetes in the U.S. in 2022. This is a 35% increase over the past decade, which is disproportionately borne by underserved communities and communities of color. Diabetes is a condition that impacts most major organs and can result in significant morbidity and early mortality, including cardiovascular disease, kidney failure, blindness, and amputations.

To increase access to health care and maximize health outcomes, it is critical that the delivery of personalized care has people at the center. By shifting the care model from systems to people, the health care system can triage scarce resources to those with the most urgent and critical needs and tailor personalized care for those managing chronic conditions. The Home as a Health Care Hub prototype is the beginning of the conversation—helping device developers consider novel design approaches, aiding providers to consider opportunities to educate patients and extend care options, generating discussions on value-based care paradigms, and opening opportunities to bring clinical trials and other evidence generation processes to underrepresented communities through the home. 

As a part of CDRH's strategic priority to advance health equity , CDRH continues to support innovation that addresses health equity by moving care, as well as prevention and wellness, into the home setting. CDRH is committed to fostering innovation that improves public health by launching the Home as a Health Care Hub effort to enable solutions that seamlessly integrate medical devices and health care, prevention and wellness into people's lives, leading to a longer, higher quality life for all.

Additional Resources:

• CDRH Strategic Priorities and Updates

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Stop COVID Cohort: An Observational Study of 3480 Patients Admitted to the Sechenov University Hospital Network in Moscow City for Suspected Coronavirus Disease 2019 (COVID-19) Infection

Collaborators.

• Sechenov StopCOVID Research Team : Anna Berbenyuk ,  Polina Bobkova ,  Semyon Bordyugov ,  Aleksandra Borisenko ,  Ekaterina Bugaiskaya ,  Olesya Druzhkova ,  Dmitry Eliseev ,  Yasmin El-Taravi ,  Natalia Gorbova ,  Elizaveta Gribaleva ,  Rina Grigoryan ,  Shabnam Ibragimova ,  Khadizhat Kabieva ,  Alena Khrapkova ,  Natalia Kogut ,  Karina Kovygina ,  Margaret Kvaratskheliya ,  Maria Lobova ,  Anna Lunicheva ,  Anastasia Maystrenko ,  Daria Nikolaeva ,  Anna Pavlenko ,  Olga Perekosova ,  Olga Romanova ,  Olga Sokova ,  Veronika Solovieva ,  Olga Spasskaya ,  Ekaterina Spiridonova ,  Olga Sukhodolskaya ,  Shakir Suleimanov ,  Nailya Urmantaeva ,  Olga Usalka ,  Margarita Zaikina ,  Anastasia Zorina ,  Nadezhda Khitrina

Affiliations

• 1 Department of Pediatrics and Pediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
• 2 Inflammation, Repair, and Development Section, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom.
• 3 Soloviev Research and Clinical Center for Neuropsychiatry, Moscow, Russia.
• 4 School of Physics, Astronomy, and Mathematics, University of Hertfordshire, Hatfield, United Kingdom.
• 5 Biobank, Institute for Regenerative Medicine, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
• 6 Institute for Regenerative Medicine, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
• 7 Chemistry Department, Lomonosov Moscow State University, Moscow, Russia.
• 8 Department of Polymers and Composites, N. N. Semenov Institute of Chemical Physics, Moscow, Russia.
• 9 Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, Pisa, Italy.
• 10 Institute of Social Medicine and Health Systems Research, Faculty of Medicine, Otto von Guericke University Magdeburg, Magdeburg, Germany.
• 11 Institute for Urology and Reproductive Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
• 12 Department of Intensive Care, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
• 13 Clinic of Pulmonology, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
• 14 Department of Internal Medicine No. 1, Institute of Clinical Medicine, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
• 15 Department of Forensic Medicine, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
• 16 Department of Statistics, University of Oxford, Oxford, United Kingdom.
• 17 Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
• 18 Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.
• 19 Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom.
• 20 Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
• PMID: 33035307
• PMCID: PMC7665333
• DOI: 10.1093/cid/ciaa1535

Background: The epidemiology, clinical course, and outcomes of patients with coronavirus disease 2019 (COVID-19) in the Russian population are unknown. Information on the differences between laboratory-confirmed and clinically diagnosed COVID-19 in real-life settings is lacking.

Methods: We extracted data from the medical records of adult patients who were consecutively admitted for suspected COVID-19 infection in Moscow between 8 April and 28 May 2020.

Results: Of the 4261 patients hospitalized for suspected COVID-19, outcomes were available for 3480 patients (median age, 56 years; interquartile range, 45-66). The most common comorbidities were hypertension, obesity, chronic cardiovascular disease, and diabetes. Half of the patients (n = 1728) had a positive reverse transcriptase-polymerase chain reaction (RT-PCR), while 1748 had a negative RT-PCR but had clinical symptoms and characteristic computed tomography signs suggestive of COVID-19. No significant differences in frequency of symptoms, laboratory test results, and risk factors for in-hospital mortality were found between those exclusively clinically diagnosed or with positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RT-PCR. In a multivariable logistic regression model the following were associated with in-hospital mortality: older age (per 1-year increase; odds ratio, 1.05; 95% confidence interval, 1.03-1.06), male sex (1.71; 1.24-2.37), chronic kidney disease (2.99; 1.89-4.64), diabetes (2.1; 1.46-2.99), chronic cardiovascular disease (1.78; 1.24-2.57), and dementia (2.73; 1.34-5.47).

Conclusions: Age, male sex, and chronic comorbidities were risk factors for in-hospital mortality. The combination of clinical features was sufficient to diagnose COVID-19 infection, indicating that laboratory testing is not critical in real-life clinical practice.

Keywords: COVID-19; Russia; SARS-CoV-2; cohort; mortality risk factors.

© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: [email protected].

Publication types

• Observational Study
• Research Support, Non-U.S. Gov't
• Hospitalization
• Middle Aged

Grants and funding

• 20-04-60063/Russian Foundation for Basic Research

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Consumers’ role in mental health care: a research perspective

Guidelines by scientific associations and government policies in Europe, the USA and other countries over the past 30 years have promoted consumer participation in various aspects of mental health care. Although this can be viewed as an aspect of a widespread trend towards the public involvement in all sectors of healthcare (Brett et al . 2014 ), the specific characteristics of mental health consumers should not be overlooked, because their involvement is a challenging endeavour for a number of reasons: the power imbalance in relationships with providers is greater than in other sectors, people with mental disorders often belong to marginal groups and experience social exclusion, stigma and discrimination. Moreover, stigmatising attitudes can be found not only in general population, but also among health professionals (Nordt et al . 2006 ).

The growth of consumer-run services and consumer-led research represents a step forward and raises a number of key questions. Early models of consumer-run services arose in the wake of dissatisfaction with professional services and were based on the principles of exchange of experiences and mutual support. However, to what extent such services were able to meet the consumer expectations and to foster recovery more effectively than the traditional ones remained an open issue. Actually, the landmark Consumer Operated Service Programs study found modest differences in empowerment for people attending consumer-operated services in comparison with people attending mainstream services (Rogers et al . 2007 ). Should we conclude that the promise of alternative services has not been fulfilled? The editorial by Segal and Hayes in this issue of Epidemiology and Psychiatric Sciences addresses this problem (Segal & Hayes, 2016 ).

First of all, the authors point out a difference often neglected in scientific literature: consumer-operated service is an umbrella term covering a variety of organisations, not necessarily sharing the principles of self-help and peer support. In other words, not all consumer-run services are empowering agencies. In fact, such services can reproduce the hierarchical organization and the sharp distinction between users and providers considered as negative features of psychiatric care. Second, the authors call for a research agenda based on a careful description of the goals of consumer-run services, by looking at the content and the conceptual base of their activities. This is especially relevant, because the considerable increase in the number of consumer-run organisations has been coupled by an increase in their heterogeneity, resulting in large differences.

Consumer-operated services run the risk of becoming a source of cheap care for systems plagued by financial constraints and disappointing people looking for alternatives to mainstream care. The authors suggest that if consumer organisations are to retain a role as component of mental health care, they must keep a distinct profile, without losing their original mission. They conclude that assessment of fidelity to power sharing between staff and non-staff members, and focus on self-help should be used to describe consumer-run services and to evaluate their outcomes in terms of empowerment.

It is interesting to compare this perspective with the approach presented by Bramesfeld and Stegbauer in the second editorial of the same issue of Epidemiology and Psychiatric Sciences (Bramesfeld & Stegbauer, 2016 ). The authors support the concept of responsiveness as a central feature identified by users for quality of mental health services. It pertains to a non-medical dimension of any type of services and is therefore a universal characteristic, which applies to all human organisations. It claims for (apparently) very simple and primary things, such as respect, dignity and consideration for users’ values. Given the peculiar vulnerability of the population of mental health service users, these objectives seem more important and difficult to achieve than in other health services.

This non-psychiatric specific meaningfulness of indicators is connected to the difficulty in identifying hard outcome indicators, raised by Bramesfeld and Stegbauer. Indeed, consumer assessment of outcomes either in relationship to specific interventions and to quality of service performance is rare. As a possible reason for this, the authors mention the soft nature of parameters indicated by consumers and the difficulties to translate them into indicators to be used in quantitative studies. In the few studies of quality assessment conducted from the consumers’ standpoint, key indicators identified by consumers fall within the framework of responsiveness (Barbato et al . 2014 ). This is a serious challenge, still there are experiences where this has been tried and we should more seriously start with this. Segal & Hayes ( 2016 ) have shown in this issue that research can be built on consumer defined constructs.

Bramesfeld & Stegbauer ( 2016 ) warn that if we do not address the lack of representation of users’ views, this lack will continue to inform guidelines and shape quality monitoring, thus perpetuating quality standard not centred on consumers and, even more serious, eventually confirming that inclusion of their views is no worth. They suggest four ways to overcome this: use of key outcomes representing patient experiences (an example can be, again, empowerment, which is a core component of the experience of care of all individuals); a more convinced acceptance and appreciation of evidence from qualitative studies; focus on the patients’ pathways, i.e., the true relationship users have with services and professionals; use not only of surveys consisting of questions, but also more observational approaches, where facts, interactions, behaviour and procedures are observed and assessed according to their responsiveness.

We are persuaded that the way of evaluating service quality can change and improve through the four routes suggested here. Bramesfeld and Stegbauer also make a point of the systematic approach to quality of services evaluation. A more systematic framework for service evaluation and benchmarking would allow not only the full inclusion of users, but it would also define rules for their participation and the weight their participation should have in all the phases of the evaluation and improvement process. Active involvement of users has been often jeopardized by the initiative being in the hands of professionals who also establish participants’ roles and boundaries in the evaluation process – often even without making it explicit. Hence, we would need rules – to be shared – which have the responsiveness criteria integrated first of all in the co-produced service evaluation.

There are growing awareness of and sensitivity to these issues in research and several programs and initiatives are informing their own activities to the inclusion of consumers’ standpoint in evidence production. Whereas the GRADE model (Barbui et al . 2010 ) is aimed at integrating values and human rights into the process of translation of evidence into recommendations of mental health care, the WHO QualityRights project offers an assessment and improvement tool focused on human rights conditions in mental health and social care (WHO, 2012 ).

The constructs of empowerment and responsiveness should be used as outcome indicators in research in mental health services as crucial aspects of care. If we fail to systematically integrate these indicators into empirical research, the gap between evidence-based medicine and consumers’ experience is set to grow.

Acknowledgements

Financial support.

The authors received no specific grant for this research from any funding commercial or not-for profit agency.

Conflict of Interest

• Barbato A, Bajoni A, Rapisarda F, D'Anza V, Inglese C, De Luca F, Iapichino S, Mauriello F, D'Avanzo B (2014). Quality assessment of mental health care by people with severe mental disorders: a participatory research project . Community Mental Health Journal 50 , 402–408. [ PubMed ] [ Google Scholar ]
• Barbui C, Dua T, van Ommeren M, Yasamy MT, Fleischmann A, Clark N, Thornicroft G, Hill S, Saxena S (2010). Challenges in developing evidence-based recommendations using the GRADE approach: the case of mental, neurological, and substance use disorders . PLoS Med 7 , e1000322. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Bramesfeld A, Stegbauer C (2016). Assessing the performance of mental health service facilities for meeting patient priorities and health service responsiveness . Epidemiology and Psychiatric Sciences . 10.1017/S2045796016000354 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Brett J, Staniszewska S, Mockford C, Herron-Marx S, Hughes J, Tysall C, Suleman R (2014). Mapping the impact of patient and public involvement on health and social care research: a systematic review . Health Expectations 17 , 637–650. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Nordt C, Rössler W, Lauber C (2006). Attitudes of mental health professionals toward people with schizophrenia and major depression . Schizophrenia Bulletin 32 , 709–714. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Rogers ES, Teague GB, Lichenstein C, Campbell J, Lyass A, Chen R, Banks S (2007). Effects of participation in consumer-operated service programs on both personal and organizationally mediated empowerment: results of multisite study . Journal of Rehabilitation Research and Development 44 , 785–799. [ PubMed ] [ Google Scholar ]
• Segal SP, Hayes SL (2016). Consumer-run services research and implications for mental health care . Epidemiology and Psychiatric Sciences . 10.1017/S2045796016000287 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• WHO (2012). WHO QualityRights Tool Kit to Assess and Improve Quality and Human Rights in Mental Health and Social care Facilities . World Health Organization: Geneva. [ Google Scholar ]

Biden Says He Plans to Debate Trump

FILE PHOTO: Democratic presidential nominee Joe Biden gestures towards U.S. President Donald Trump as they participate in their second 2020 presidential campaign debate at Belmont University in Nashville, Tennessee, U.S., October 22, 2020. REUTERS/Jim Bourg/Pool/File Photo

By Jarrett Renshaw

NEW YORK (Reuters) -U.S. President Joe Biden said on Friday that he would participate in a debate with Donald Trump, his Republican opponent in November's election.

"I am, somewhere. I don't know when," the Democratic president said in an interview with broadcaster Howard Stern. "I'm happy to debate him."

The remarks were Biden's clearest yet on the prospect of a presidential debate. Biden had not previously committed to debate Trump, saying last month it would depend on the former president's behavior.

Trump, who refused to debate his rivals before winning the Republican primary race last month, has in recent weeks been challenging Biden to engage in a one-on-one match-up with him, offering to debate the incumbent Democrat "anytime, anywhere, anyplace."

Earlier this month, Trump's top two campaign advisers sent a letter to an independent commission that normally sanctions such events calling for an accelerated debates timetable, holding more than the usual three and starting them earlier in the campaign cycle.

A dozen leading U.S. news organizations have also urged the candidates to publicly commit to debating each other.

Their statement suggested that debates for the current race be sponsored, as they have every election cycle since 1988, by the nonpartisan Commission on Presidential Debates.

Biden's camp has been concerned that once on stage Trump will not abide by rules set by the Commission, and some Biden advisers say they would prefer not to elevate Trump by putting him on the same stage with the Democratic incumbent.

Biden has a lead among registered voters of 41% to 37% over Trump, a Reuters/Ipsos poll found earlier this month.

Asked during a trip to Las Vegas in early February about Trump calling for Biden to debate him, Biden said, "If I were him, I would want to debate me too. He's got nothing to do."

Biden and Trump faced each other in two televised presidential election debates during the 2020 campaign.

(Reporting by Jarrett Renshaw; Writing by Trevor Hunnicutt; Editing by Bill Berkrot)

Copyright 2024 Thomson Reuters .

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(Reuters) - U.S. stock index futures extended gains on Friday, as fresh evidence of progress on the inflation front reignited hopes that the Federal Reserve could cut interest rates sometime this year.

The personal consumption expenditures (PCE) price index rose 0.3% in March, compared to a 0.3% increase forecast by economists polled by Reuters. In the 12 months through March, PCE inflation advanced 2.7% against expectations of 2.6%.

Excluding the volatile food and energy components, the PCE price index increased 0.3% last month against expectations of a 0.3% increase. Annually, it came in at 2.8% versus forecasts of 2.7%.

At 8:32 a.m. ET, Dow e-minis were up 122 points, or 0.32%, S&P 500 e-minis were up 46.75 points, or 0.92%, and Nasdaq 100 e-minis were up 197 points, or 1.12%.

(Reporting by Shashwat Chauhan in Bengaluru; Editing by Maju Samuel)

Copyright 2024 Thomson Reuters .

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Healthcare consumerism today: Accelerating the consumer experience

The results of McKinsey’s 2018 Consumer Health Insights (CHI) Survey deliver a consistent message with important implications for payers, providers, and other industry stakeholders: consumer engagement is becoming increasingly important, but most stakeholders are still struggling to meet consumers’ needs. Four issues stood out:

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• Personalization. The consumer experience should be tailored more closely to the needs of individuals.
• Access. The continuum of care should be improved so consumers have access when and where they need it.
• Incentives. Well-designed incentives hold promise of motivating consumers to make better choices.
• Innovation. New product concepts must be carefully designed to meet consumers’ needs and wants.

We will discuss these themes and their implications below. First, to put the themes in context, we will briefly describe the respondents to the 2018 CHI Survey.

Background on respondents

Almost 5,000 people participated in the 2018 CHI Survey. More than 95% of them indicated that they had obtained health insurance coverage, received medical care, or both in the past year. They were therefore defined as having engaged with the healthcare system during that time. This engagement often entailed a financial burden; 43% of the respondents said their out-of-pocket costs were higher than they had anticipated. The average amount respondents reported spending on healthcare in the past year varied depending on the coverage type:

• Group insurance: $3,300
• Individual insurance: $4,600
• Medicare: $2,700
• Medicaid: $700
• No insurance: $1,200

National health expenditures data supports our finding about financial impact, showing that consumers are responsible for nearly 30% of all healthcare spending. 1 National health expenditures by type of service and source of funds, CY 1960–2017. CMS.gov. The high spending may help explain why a significant number of consumers—nearly one-quarter of working age adults 2 Karpman M, Caswell KJ. Past-due medical debt among nonelderly adults, 2012–2015. Urban Institute. March 2017. —have past-due medical debt. In our survey, about half of the respondents said they are not satisfied with their ability to figure out the cost of a healthcare service or find lower-cost options.

Infographic

As member expectations rise, healthcare payers must fight to attract and retain members all while managing admin and medical costs.

Four themes from the research

Consumer engagement has become increasingly important for all healthcare industry stakeholders. Both payers and providers are now evaluated through rating systems that incorporate customer satisfaction, giving them a strong incentive to enhance the consumer experience. Four of the major national payers reported in their Q2 2018 earnings that they had identified consumer experience as a priority. 3 Q2 2018 earnings call transcripts from UnitedHealth Group, Anthem, Cigna, and Humana.

Nevertheless, many stakeholders are having difficulty meeting consumers’ needs. Our 2018 CHI Survey found that four areas are especially in need of improvement: personalization, access, incentives, and innovation.

Personalization

In healthcare, as in other industries, consumers are expecting more. But, not all healthcare consumers want the same things. The attitudes and behaviors expressed by this year’s survey respondents allowed us to refine the six healthcare consumer segments we’d previously identified (Exhibit 1). To illustrate how different these segments are, we will compare two: engaged traditionalists and busy convenience users.

Engaged traditionalists seek value and guidance. These consumers are disproportionately older and more likely to have health conditions, typically have an established relationship with a primary care provider (PCP), and rely on guidance from that provider when making healthcare decisions. Nevertheless, they are open to using digital tools and other services that could help support their relationship with their PCP.

Engaged traditionalists are also willing to make trade-offs to lower costs. In our survey, 45% of them said they had used generic drugs. Furthermore, 63% of them reported that they decide where to get care depending on what their insurance covers. (By comparison, only about 50% of the respondents in the other segments said that insurance coverage determined where they seek care.) Choosing the right health insurance plan is especially important to engaged traditionalists: 74% said they want to know what services will be covered and 70% want to know copayment amounts.

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Although engaged traditionalists regularly interact with payers and providers, the majority of them reported that they lack meaningful motivation to be healthier and want others to assist them with their health improvement goals.

In contrast, busy convenience users are typically of working age and in relatively good health; many have young children. In our survey, most of these consumers indicated they prioritize convenience over other factors and want to be able to make decisions quickly. Most also said they often delay seeking care for themselves until it is absolutely necessary and actively avoid going to doctors unless they have a serious health problem.

Compared with the other segments, busy convenience users were more likely to report that they do not have strong preferences about where they seek care for nonemergent health issues and that they visit urgent care centers when feeling unwell. However, almost 70% of these consumers, but only about 60% of the engaged traditionalists, said they want information on how much care costs before deciding where to seek treatment.

In addition, busy convenience users were more likely to indicate that they had used activity trackers and found them useful. They were also the segment most likely to report using mobile apps and mobile sites to schedule visits and manage other tasks with their routine care provider. Although 60% of this segment said they strongly believe they need to be better at taking care of themselves, 18% indicated they lack the time to do so.

Implications: Both payers and providers should consider how they can better meet the needs of specific consumer segments through personalized information, delivered when, how, and where consumers need it. In addition, these stakeholders should explore how they can better tailor the experiences they offer to the specific needs of each individual. Addressing each person’s needs remains a challenge for most payers and providers, but it is becoming somewhat easier because of the growing volume of consumer data and new techniques available to parse it. Developing the deep insights needed will require stakeholders to apply advanced analytics to multidimensional data.

Access to healthcare services has often been defined as the number of PCPs per 1,000 people, but this definition often appears insufficient, given consumers’ increasing demand for convenience (e.g., evening and weekend appointments, nearby locations) and the growing number of choices available to them. In all of the segments we identified, most respondents said they want convenient access to the care they need when they need it—if they cannot get convenient access to a PCP, they will go elsewhere. Results from the five CHI Surveys we conducted between 2014 and 2018 reveal that the percentage of respondents who said they had visited an urgent care center is rising. In contrast, the percentage of respondents who reported having visited a PCP within the past year is decreasing (Exhibit 2).

The increasing use of urgent care centers reflects the growing number of such centers, as well as consumers’ desire for convenience. 4 Stoimenoff L, Newman N. The essential role of the urgent care center in population health. Urgent Care Association of America. February 2018. Nevertheless, consumers still value their relationship with a PCP. When asked about the one place they preferred to receive care, most respondents selected their PCP’s office: 85% preferred that site for their annual exam, and 80% preferred it for routine care. Most respondents also said they want their PCP’s input for care decisions.

Given this preference, what would encourage more consumers to visit their PCP? We asked respondents to select their top three factors from a list of choices. Cost was the top response. As Exhibit 3 shows, the non-cost answers given most often were:

• Feeling that my physician cares more about me as a person: 36%
• Shorter wait times for appointments: 34%
• Quicker access to appointments: 28%
• More one-on-one time with the provider: 27%

Digital tools could help address some of these concerns. Among the respondents who indicated that they are open to using digital tools, the majority said they would prefer to receive them from their PCP. The tools they were most interested in were telemedicine, appointment reminders, and email or online communications (Exhibit 4). Fifty-eight percent of the respondents said they would most prefer to receive digital appointment reminders from their PCP, and 53% would most prefer to get electronic health records from their PCP.

Implications: Stakeholders need to address consumers’ desire for convenience more effectively and thus must change the way they think about access to care. Providers especially need to make better use of the digital tools a growing number of consumers would like to use.

Five trends shaping the future of Medicaid

Many consumers appear to be influenced by incentives. We asked respondents to rank their interest in 20 new product concepts for health insurance; incentives were one of the top three features chosen. 5 Financial incentives can include both rewards and well-designed penalties; nonfinancial incentives can include shorter wait times or easier payment methods. However, healthcare lags behind other industries, such as ride sharing and retail, in offering incentives to consumers.

In healthcare, incentives could be designed to achieve a variety of aims, including encouraging consumers to take more action to lower healthcare spending. In our survey, a high proportion of respondents indicated that they were willing to make various changes to lower spending (Exhibit 5). Far fewer people said they had already made those changes. Well-designed incentives 6 When designing incentives, stakeholders must consider not only what is most likely to prompt the desired responses but also the regulations governing what is permissible to offer healthcare consumers. might encourage more consumers to make the necessary changes.

Well-designed incentives might also encourage greater health insurance uptake. In our survey, we queried the respondents without health insurance about what would induce them to obtain coverage. About one-third of them said they would sign up for coverage if premiums were $0—but two-thirds said they would sign up if remaining uninsured meant they could be denied coverage in the future.

In some cases, however, consumers will need more information before they can respond appropriately to incentives. For example, incentives designed to encourage consumers to choose high-quality, low-cost providers will not work if consumers cannot determine who those providers are. In our survey, 60% of the respondents said they would like to do their own research before deciding where to receive care, and cost was the number-one piece of information respondents said they would want before selecting insurance, choosing where to get care, or deciding on a treatment. However, 50% of the respondents reported that they are unsatisfied with their ability to access cost information.

Implications: Payers and providers need to provide well-designed incentives—both rewards and penalties—to help motivate consumers to make better decisions. However, they must also give consumers the tools and information they need to make those decisions.

Consumers want innovation, especially changes to the current healthcare system, better access to quality care, and greater simplicity. In our survey, we gave respondents the opportunity to write in the one change they thought would make the health system better. Twenty-one percent mentioned types of further health system reform (e.g., single payer, free healthcare). Coming in next were broader provider networks (12%), improved provider quality and efficiency (9%), simplified and streamlined processes (9%), greater convenience (8%), greater benefits coverage (6%), and drug or prescription benefits (6%).

We also included a multiple-choice question that asked specifically about how interested they were changes to their health insurance plans. Of the respondents, 55% selected increased benefits coverage for medical services; 44% chose better coverage of nonmedical services; and 31% opted for improvements in network quality (e.g., better doctors or facilities within the network) (Exhibit 6). When we asked about hospital and outpatient care, greater cost transparency and increased insurance acceptance and coverage were selected most often.

Our survey also investigated the gap between what consumers think is important and where they are least satisfied with their current experience. Three areas—claims submissions, cost information, and provider performance data—stood out. Although most respondents rated these areas as especially important, many reported that their satisfaction levels in these areas was low. Medicare recipients also indicated that they were dissatisfied with the help they were given to resolve problems.

Consumer Health Insights Survey

McKinsey’s annual Consumer Health Insights (CHI) Survey provides information on the opinions, preferences, and behaviors of thousands of US consumers, as well as the environmental factors that influence their healthcare choices. The survey also offers insights into the current market environment and can be used to make predictions about the choices and trade-offs consumers are likely to make.

Since the survey was inaugurated in 2007, McKinsey has collected descriptive information from over 40,000 individuals and their households. In 2018 alone, more than 4,900 consumers participated. The survey assesses customer experience with healthcare and non-healthcare companies; attitudes regarding health, healthcare, and the purchase and use of healthcare services; experience and satisfaction with current and past health insurance carriers; attitudes about a broad range of related supplemental insurance products; opinions, use, and loyalty levels regarding healthcare providers and pharmacies; and experience of individuals with chronic conditions.

We supplement the information from the CHI with data from other sources, such as information on a consumer’s estimated lifetime value to a health insurer, consumer behavior, and marketplace conditions, as well as other proprietary surveys (e.g., our annual survey to understand the preferences, intended actions, shopping, and purchasing behavior of consumers who are eligible to purchase individual coverage on the ACA exchanges or elsewhere, which included 1,182 individuals in 2017). This combination of data provides a holistic view of healthcare consumers that is not available through other means. We have used CHI data in a range of customized analyses. We expect that health insurers and others will primarily use the information in applications that assist with product design, marketing strategies, consumer segmentation, consumer targeting, network configuration design, and assessment of new channel opportunities.

Consumers’ openness to innovation can be seen in their increased use of digital tools. Between our 2015 and 2018 surveys, respondents’ familiarity with and use of a range of digital tools—including online medical visits, activity trackers, electronic health records, online scheduling, and digital appointment reminders—rose significantly. Similarly, a growing number of respondents reported that they pay health insurance bills online.

Employers are also interested in innovation. In a recent employer survey we conducted, 47% said they currently offer digital wellness apps to their employees, and another 36% reported that they are somewhat or very interested in doing so. 7 2018 McKinsey Employer Health Benefits Survey. The employers indicated a similar level of interest in on-site clinics: 44% currently have them, and an additional 34% are somewhat or very interested in having them.

Not all innovations received a resounding reception, though. When we asked about new product concepts for health insurance, respondents reacted positively not only to incentives but also to concepts that increased coverage or provided greater convenience. They were wary, however, of concepts they perceived as unaffordable or intrusive (e.g., in-home safety assessments, auto-enrollment in plans).

The survey tested several product ideas specifically with lower-income respondents, including Medicaid beneficiaries. The concepts these respondents liked most were dental coverage, having specialists “in program,” incentives, scheduling via apps, and care management for chronic conditions. The concepts they liked least included prepaid phones with personalized apps, advice to find support groups, transportation from home to healthcare appointments, and phone/video chats before appointments.

Implications: Healthcare stakeholders need to innovate and take a more comprehensive approach to product design if they are to meet consumer needs and improve the consumer experience.

The 2018 CHI Survey results highlight practical opportunities for healthcare stakeholders to better meet consumer needs while improving business performance.

Jenny Cordina is an expert partner in McKinsey’s Detroit office. Monica Qian is a senior research analyst in the Waltham, Massachusetts, office. Lara Sanfilippo is an associate partner in the Minneapolis office.

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Moscow City Council questions, then passes library resolution

Mar. 5—A city of Moscow resolution supporting the Latah County Library District sparked debate during Monday's City Council meeting before ultimately being passed by the councilors.

Moscow joined four other Idaho cities — Blackfoot, Shelley, Firth and Aberdeen — that have created similar resolutions supporting libraries. Moscow City Supervisor Bill Belknap said Friday it is a response to recent efforts in the Idaho Legislature to police library materials that Idaho lawmakers view as harmful to minors.

The resolution states that the city provides "its support and full confidence in the Board of Trustees and Library Director of the Latah County Library District ... to provide appropriate access to print and electronic reading materials suitable to patrons regardless of age."

Several councilors, while expressing their support for the library district, also shared their hesitation in passing such a resolution.

Councilor Julia Parker said it is odd for the council to pass a partisan resolution and wondered why the council does not take similar actions for other issues like women's rights and LGBTQ-related issues.

Councilor Hailey Lewis supported the resolution, but expressed fear Moscow will see retribution from the Idaho Legislature if it's passed.

Councilor Drew Davis said he would prefer to have hard face-to-face conversations with lawmakers instead, because he believes a resolution is too easy for them to ignore.

"To me this is doing something without having the hard conversation," he said.

Davis was the only councilor to vote against the resolution.

Councilor Sandra Kelly said the city should not be afraid of retribution, and should pass the resolution to show the city stands by its library.

"I want them to know that they do have our full support and confidence," she said.

Belknap said Monday the city does not operate the Moscow Public Library, which is part of the Latah County Library District, but it does financially support the library building.

Kuipers can be reached at [email protected] .

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The Blokhin National Medical Research Center of Oncology of the Russian Ministry of Health is the largest oncological clinic in Russia and Europe, one of the largest oncological clinics in the world, which has the latest equipment and all advanced methods of diagnosis and treatment of cancer.

We see our goal as continuous improvement of the quality and availability of cancer care. To achieve this goal, we are working on improving the system of organizing medical care and introducing the latest technologies.

The structure of the center includes five divisions:

• Research Institute of Clinical Oncology named after N.N. Trapeznikov, designed for 900 beds;
• Research Institute of Pediatric Oncology and Hematology, designed for 150 beds;
• Research Institute of Clinical and Experimental Radiology, designed for 50 beds;
• Research Institute of Carcinogenesis, which includes 16 laboratories;
• Research Institute for Experimental Diagnostics and Therapy of Tumors, which includes 15 laboratories.
• The center daily provides high-tech oncological care at the level of the best world standards, using many innovative, including unique technologies to save patients.

On the basis of the center, there are 8 departments of medical academies and universities.

The main activities of the center:

• Provision of highly qualified medical care to patients with malignant neoplasms and precancerous pathology;
• Carrying out scientific research in the field of studying the biology of tumor cells, mechanisms of carcinogenesis and tumor progression (molecular, virological, chemical-physical, genetic, cellular, immunological aspects);
• Experimental and clinical development of new technologies in the field of surgical treatment of malignant tumors;
• Development of new means and methods of diagnostics, drug, radiation and combination therapy, as well as active prevention of tumors;
• Development of issues of diagnosis, treatment and prevention in the field of pediatric oncology;
• Studying the epidemiology of malignant tumors, improving the methods of oncological statistics;
• Development, together with preventive medicine specialists, of a national screening program in oncology;
• Organization and conduct of telemedicine consultations in the following areas: oncology, radiotherapy, radiology, pathological anatomy, cytology, immunology, pediatric oncology, etc .;
• Implementation of the methodological guidance of the oncological service of the Russian Federation, development, together with the professional community and the Ministry of Health of the Russian Federation, of clinical recommendations, procedures and standards for the provision of oncological care;
• The introduction of new devices and technologies in the treatment and diagnostic process and for the prevention of malignant neoplasms;
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