Trends and geographical variation in population thriving, struggling and suffering across the USA, 2008–2017: a retrospective repeated cross-sectional study

ObjectivesWell-being is a holistic, positively framed conception of health, integrating physical, emotional, social, financial, community and spiritual aspects of life. High well-being is an intrinsically worthy goal for individuals, communities and nations. Multiple measures of well-being exist, yet we lack information to identify benchmarks, geographical disparities and targets for intervention to improve population life evaluation in the USA.DesignUsing data from the Gallup National Health and Well-Being Index, we conducted retrospective analyses of a series of cross-sectional samples.Setting/participantsWe summarised select well-being outcomes nationally for each year, and by county (n=599) over two time periods, 2008–2012 and 2013–2017.Main outcome measuresWe report percentages of people thriving, struggling and suffering using the Cantril Self-Anchoring Scale, percentages reporting high or low current life satisfaction, percentages reporting high or low future life optimism, and changes in these percentages over time.ResultsNationally, the percentage of people that report thriving increased from 48.9% in 2008 to 56.3% in 2017 (p<0.05). The percentage suffering was not significantly different over time, ranging from 4.4% to 3.2%. In 2013–2017, counties with the highest life evaluation had a mean 63.6% thriving and 2.3% suffering while counties with the lowest life evaluation had a mean 49.5% thriving and 6.5% suffering, with counties experiencing up to 10% suffering, threefold the national average. Changes in county-level life evaluation also varied. While counties with the greatest improvements experienced 10%–15% increase in the absolute percentage thriving or 3%–5% decrease in absolute percentage suffering, most counties experienced no change and some experienced declines in life evaluation.ConclusionsThe percentage of the US population thriving increased from 2008 to 2017 while the percentage suffering remained unchanged. Marked geographical variation exists indicating priority areas for intervention.

Towards gender equity in intensive care medicine: ten practical strategies for improving diversity

Gender balance in intensive care medicine (ICM) is a worthy goal for numerous reasons. However, despite reaching parity in medical school and a substantial rise in the proportion of female ICM trainees over the past decade, women remain under-represented in ICM in Australia and New Zealand. Women comprise 21% of fellows and are underrepresented in academia and positions of leadership.

Promoting racial equity in COVID-19 resource allocation

Due to COVID-19’s strain on health systems across the globe, triage protocols determine how to allocate scarce medical resources with the worthy goal of maximising the number of lives saved. However, due to racial biases and long-standing health inequities, the common method of ranking patients based on impersonal numeric representations of their morbidity is associated with disproportionately pronounced racial disparities. In response, policymakers have issued statements of solidarity. However, translating support into responsive COVID-19 policy is rife with complexity. Triage does not easily lend itself to race-based exceptions. Reordering triage queues based on an individual patient’s racial affiliation has been considered but may be divisive and difficult to implement. And while COVID-19 hospital policies may be presented as rigidly focused on saving the most lives, many make exceptions for those deemed worthy by policymakers such as front-line healthcare workers, older physicians, pregnant women and patients with disabilities. These exceptions demonstrate creativity and ingenuity—hallmarks of policymakers’ abilities to flexibly respond to urgent societal concerns—which should also be extended to patients of colour. This paper dismantles common arguments against the confrontation of racial inequity within COVID-19 triage protocols, highlights concerns related to existing proposals and proposes a new paradigm to increase equity when allocating scarce COVID-19 resources.

Sociocultural Factors and the Global Goals of Education for All

All over the world, nations have spent much of the last 20 years scrambling to increase and improve access to basic education. Globally, the number of people without access to a basic education has fallen significantly in the years since the goals of Education For All (EFA) were announced in 2000 at the World Education Forum in Dakar, Senegal, and extended at Incheon, South Korea, in 2016. This is ostensibly very good news. While universal access to a basic education is certainly a worthy goal, one can raise significant questions about the orientation of these efforts and the manner in which they are being pursued. For example, very little attention seems to have been paid to what the schools are or will be like, or to how the nations and people they must serve may be different from those for whom they were designed. To understand the inevitable problems that flow from this potential mismatch, it is useful to examine education in nations that have achieved more or less universal access to basic education. Many of the educational, social, economic, and social justice disparities that plague those nations are today understood as natural effects of the educational infrastructures in operation. Examination of recent empirical research and practice that attends to the importance of social and cultural factors in education may allow nations that are currently building or scaling up access to head off some predictable and difficult problems before they become endemic and calcified on a national scale. Nations who seize the opportunity to build asset-based and culturally responsive pedagogies into their educational systems early on may, in time, provide the rest of the world with much needed leadership on these issues.

Oral Health: a Primer

Health is a quality of life with social, mental, emotional, spiritual, and physical functions. Good oral health is key to good overall health. It can have a significant impact on the overall health and well-being of our citizens. It affects people physically and mentally and influences how we grow, enjoy life, look, speak, chew, taste food, and socialize. Oral diseases affect our well-being throughout life. Taking good care of our mouth, teeth and gums is a worthy goal. This paper discusses oral health and how bad oral health can be prevented.

Building Futures

As momentum builds around the fourth industrial revolution, it is imperative that schools equip the youth of today to succeed in the workforce of tomorrow. The use of smart learning environments (SLE) is an optimal way to prepare students for the future because the use of innovative technologies and elements allow for greater flexibility, effectiveness and adaption, engagement, motivation, and feedback for the learner. It is envisioned that the “smart” learners of the future will operate in SLE that are contextual, personalized, and seamless. The learning process in the SLE will facilitate their problem solving and promote their intellectual growth as lifelong learners. This study, then, demonstrates how educational robotics can be used by educators to equip students in the UAE for futures in STEM fields of study and work. It is claimed that students who build robots build futures for themselves and their communities: a worthy goal for Emirati students in 2018, The Year of Zayed.

Don't Shut Up: Why Teachers Must Defend the First Amendment in Secondary Schools

Don’t Shut Up: Why Teachers Must Defend the First Amendment in Secondary Schools Abstract Several recent judicial decisions and numerous reports from scholars, educators, legal experts, journalists, and advocacy groups suggest that the First Amendment protection of freedom of expression is being unconstitutionally abridged in American universities and secondary schools. Freedom of expression for university and secondary school students is essential to securing individual rights, protecting liberty, enhancing civic participation, and is a safeguard against government infringement on freedom of thought and expression. The First Amendment, along with other rights enshrined in the Bill of Rights, is the crucial underpinning of a pluralistic democracy. However, many universities and secondary schools have sought to restrict freedom of expression by establishing speech codes, safe zones, and institutional policies that prohibit and punish speech that is deemed controversial, hateful, radical, or offensive. These speech codes are designed to foster tolerance, respect, and sensitivity for individuals and groups; while this is a worthy goal, it must be achieved without violating the First Amendment. Teachers must resist unconstitutional attempts at censorship and instruct their students that the primary purpose of the First Amendment is to protect controversial, offensive, and radical speech. This article will examine the attacks on free speech and discuss how teachers can defend the First Amendment.

Widening the net: A syndemic approach to responsible gambling

Background: Attempts to address gambling-related harms have evolved rubrics to foster responsible gambling and informed choice. Those efforts have largely focused on apportioning the relative responsibility placed on government, industry, and individuals for reducing excessive gambling that leads to adverse consequences. Empirical evaluations of responsible gambling measures, together with proposed frameworks that set out guidelines for accountability, have met with mixed results and criticism from divergent groups of stakeholders. Aim: While harm reduction remains a worthy goal, this position paper argues against maintaining a stringent focus on the government-industry-individual triumvirate in favor of adopting a syndemic approach to gambling-related harms. Approach: A syndemic perspective suggests that gambling disorder intersects, coexists, precedes or follows other comorbid conditions and interacts with social and environmental factors that promote and enhance the negative consequences of gambling problems. This paper discussions potential syndemic stakeholders and challenges in the implementation of this approach. Conclusions: Initiatives to reduce gambling-related harm should adopt a broader perspective, involving stakeholders from diverse syndemic problem areas in developing a network to identify and address gambling problems in early stages of development across multiple settings.