National

Data: The Commonwealth Fund; Map: Kavya Beheraj/Axios

Black Americans in almost every state were more likely than white Americans to die from preventable and treatable health conditions, a new report from the Commonwealth Fund out Thursday shows.

Why it matters: A lack of health care access, and "timely, high-quality care," were correlated to poorer health outcomes, the authors conclude. 

Within most states, white populations received better care overall compared with Black, Latinx/Hispanic, American Indian/Alaska Native, and Asian American, Pacific Islander, and Native Hawaiian people.

The big picture: The report analyzed dozens of factors of health care systems in every state and Washington, D.C., between 2019 and 2020, which showed even states that had higher scores overall had disparities.

Only six states had an above-average performance for all racial and ethnic groups — Massachusetts, Connecticut, Rhode Island, New York, Hawaii and Oregon.

The report pointed out states like Minnesota and Wisconsin that performed strongly in previous findings from the Commonwealth Fund but had some of the largest racial inequities.

What they're saying: "If we want to get the pandemic under control and mitigate these inequities, we need to dismantle the racist policies and practices that have led us here," Commonwealth Fund president David Blumenthal said in a statement.

Most states ranked poorly in quality of care for people of color, report says

Only six states had an above-average performance for all racial and ethnic groups.

Health care quality

Public health

Black Americans in almost every state were more likely than white Americans to die from preventable and treatable health conditions, a new <a class="gtmContentClick" data-vars-link-text="report" data-vars-click-url="https://www.commonwealthfund.org/publications/scorecard/2021/nov/achieving-racial-ethnic-equity-us-health-care-state-performance" data-vars-content-id="15fd86a2-3c44-4779-84be-fd5d3fd27cfb" data-vars-headline="Most states ranked poorly in quality of care for people of color, report says" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.commonwealthfund.org/publications/scorecard/2021/nov/achieving-racial-ethnic-equity-us-health-care-state-performance" target="_blank">report</a> from the Commonwealth Fund out Thursday shows.Why it matters: A lack of health care access, and &quot;timely, high-quality care,&quot; were correlated to poorer health outcomes, the authors conclude.

The U.S. faces a range of health care flashpoints — unaffordable drugs, opioids, vaping — as we debate whether to adopt universal care. For now, the Affordable Care Act is the law of the land, but Republicans want to issue it a final death blow.

Health

The generation of kids and young adults who are coming of age in the midst of the pandemic will likely be shaped by COVID for the rest of their lives — and researchers are starting to offer a glimpse at how.

Why it matters: Massive news events — most recently the Great Recession and the Sept. 11, 2001 terrorist attacks for older millennials — can be drivers for changing how generations generally view the world, spend money and form relationships.

Driving the news: While there's no way to really know what will happen, behavioralists are trying to understand which changes might ultimately stick for Gen Z, as well as younger kids which some have started calling "Generation C." 

State of play: Gen Z — roughly defined as those born between 1997 and 2012 — includes elementary-age kids up to young adulthood. 

That means those on the older end of the spectrum are in their early 20s, in their college years, or their first jobs. 

Many of these young people were the last hired and the first fired during the pandemic, Jason Dorsey, president of the Center for Generational Kinetics, a research and strategy firm, tells Axios. 

That could be triggering higher desires to save money or spend it on quality items that have longevity like staple fashion pieces instead of fast fashion, the firm found in its research which is expected to be published later this year.

Gen Z has reported greater symptoms of burnout to employers and expressed concerns about falling behind or missing out because the pandemic is impacting such as a formative period of their lives, Jessica Stollings-Holder, president of ReGenerations, which studies generational trends, told the Society for Human Resource Management.

"They've seen a lot in a short amount of time, so this becomes a really intense moment for them," Stollings-Holder said, per SHRM.

And in what has turned into a highly competitive market, Gen Zers have found themselves in the enviable position to ask more about workplace benefits early in their careers, Dorsey said. In some cases, perks have expanded to include pet insurance, manicures and even, free clothes, the Wall Street Journal reported.

Between the lines: When we get to younger children — between 8 and 14 — we see many in this generation may have developed a profound sense of mortality at a very young age, researchers say.

More than 175,000 children in the U.S. have lost a parent or grandparent due to COVID-19.

Many children have been simultaneously exposed to news of COVID case counts and death counts either by overhearing news coverage or adult conversations about COVID in a way that hasn't been seen since the Vietnam War, Dorsey said. 

"This is something they're now being conditioned to seeing on a regular basis," Dorsey added. "That's really heavy, what the generation is carrying with them." 

The big picture: The dramatic increase in technology for education, socialization, and recreation during the pandemic likely vastly increased kids' already high trust and perceived reliance on technology and social media, especially under the age of 13, Dorsey said.

"Even though the parents didn't necessarily want them to use their mobile devices all that much, the reality is they were on it because they weren't in school and weren't doing other activities," Dorsey said.

The intrigue: Researchers hypothesize small children growing up today may end up following different social norms.

Several qualitative studies and surveys by Dorsey and Alice Fothergill, professor of sociology at the University of Vermont, show developmentally significant differences in kids' comfort with physical touch and worries they'll get loved ones like their grandparents sick. 

Young children growing up during the pandemic saw constant handwashing, virtual learning, mask-wearing, and social distancing. It's left researchers curious about whether social norms of personal space and hygiene will remain changed in the future with those who experienced the pandemic at a younger age.

The bottom line: We've never seen a crisis quite like this that impacts all demographics and groups of kids and it will likely change them in significant ways long into the future.

Lasting changes ahead for "Generation COVID"

Behavioralists are trying to understand which changes might ultimately stick for Gen Z, as well as younger kids.

Generation Z

Coronavirus

Jobs

The generation of kids and young adults who are coming of age in the midst of the pandemic will likely be shaped by COVID for the rest of their lives — and researchers are starting to offer a glimpse at how.Why it matters: Massive news events — most recently the Great Recession and the Sept. 11, 2001 terrorist attacks for older millennials — can be drivers for changing how generations generally view the world, spend money and form relationships.Driving the news: While there&#x27;s no way to really know what will happen, behavioralists are trying to understand which changes might ultimately stick for Gen Z, as well as younger kids which some have started calling &quot;Generation C.&quot; State of play: Gen Z — roughly <a class="gtmContentClick" data-vars-link-text="defined" data-vars-click-url="https://www.pewresearch.org/fact-tank/2019/01/17/where-millennials-end-and-generation-z-begins/" data-vars-content-id="2b581743-7609-4550-b322-0f7163b00c68" data-vars-headline="Lasting changes ahead for &quot;Generation COVID&quot;" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.pewresearch.org/fact-tank/2019/01/17/where-millennials-end-and-generation-z-begins/" target="_blank">defined</a> as those born between 1997 and 2012 — includes elementary-age kids up to young adulthood. That means those on the older end of the spectrum are in their early 20s, in their college years, or their first jobs. <ul><li>Many of these young people were the last hired and the first fired during the pandemic, Jason Dorsey, president of the Center for Generational Kinetics, a research and strategy firm, tells Axios. </li><li>That could be triggering higher desires to save money or spend it on quality items that have longevity like staple fashion pieces instead of fast fashion, the firm found in its research which is expected to be published later this year.</li><li>Gen Z has reported greater symptoms of burnout to employers and expressed concerns about falling behind or missing out because the pandemic is impacting such as a formative period of their lives, Jessica Stollings-Holder, president of ReGenerations, which studies generational trends, <a class="gtmContentClick" data-vars-link-text="told the Society for Human Resource Management" data-vars-click-url="https://www.shrm.org/resourcesandtools/hr-topics/behavioral-competencies/global-and-cultural-effectiveness/pages/covid19-pandemic-is-hitting-gen-z-hard-find-ways-to-connect-with-them.aspx" data-vars-content-id="2b581743-7609-4550-b322-0f7163b00c68" data-vars-headline="Lasting changes ahead for &quot;Generation COVID&quot;" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.shrm.org/resourcesandtools/hr-topics/behavioral-competencies/global-and-cultural-effectiveness/pages/covid19-pandemic-is-hitting-gen-z-hard-find-ways-to-connect-with-them.aspx" target="_blank">told the Society for Human Resource Management</a>.</li><li>&quot;<a class="gtmContentClick" data-vars-link-text="They&#x27;ve seen a lot in a short amount of time" data-vars-click-url="https://www.shrm.org/ResourcesAndTools/hr-topics/behavioral-competencies/global-and-cultural-effectiveness/pages/2016-talent-management-conference-jeff-hiller-gen-z-globals.aspx" data-vars-content-id="2b581743-7609-4550-b322-0f7163b00c68" data-vars-headline="Lasting changes ahead for &quot;Generation COVID&quot;" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.shrm.org/ResourcesAndTools/hr-topics/behavioral-competencies/global-and-cultural-effectiveness/pages/2016-talent-management-conference-jeff-hiller-gen-z-globals.aspx" target="_blank">They&#x27;ve seen a lot in a short amount of time</a>, so this becomes a really intense moment for them,&quot; Stollings-Holder said, per SHRM.</li><li>And in what has turned into a highly competitive market, Gen Zers have found themselves in the enviable position to ask more about workplace benefits early in their careers, Dorsey said. In some cases, perks have expanded to include pet insurance, manicures and even, free clothes, <a class="gtmContentClick" data-vars-link-text="the Wall Street Journal reported" data-vars-click-url="https://www.wsj.com/articles/when-bonuses-and-raises-arent-enough-try-manicures-and-free-clothes-11635949795" data-vars-content-id="2b581743-7609-4550-b322-0f7163b00c68" data-vars-headline="Lasting changes ahead for &quot;Generation COVID&quot;" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.wsj.com/articles/when-bonuses-and-raises-arent-enough-try-manicures-and-free-clothes-11635949795" target="_blank">the Wall Street Journal reported</a>.</li></ul>Between the lines: When we get to younger children — between 8 and 14 — we see many in this generation may have developed a profound sense of mortality at a very young age, researchers say.<ul><li>More than <a class="gtmContentClick" data-vars-link-text="175,000 children" data-vars-click-url="https://www.npr.org/sections/health-shots/2021/10/07/1043881136/covid-deaths-leave-thousands-of-u-s-kids-grieving-parents-or-primary-caregivers" data-vars-content-id="2b581743-7609-4550-b322-0f7163b00c68" data-vars-headline="Lasting changes ahead for &quot;Generation COVID&quot;" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.npr.org/sections/health-shots/2021/10/07/1043881136/covid-deaths-leave-thousands-of-u-s-kids-grieving-parents-or-primary-caregivers" target="_blank">175,000 children</a> in the U.S. have lost a parent or grandparent due to COVID-19.</li><li>Many children have been simultaneously exposed to news of COVID case counts and death counts either by overhearing news coverage or adult conversations about COVID in a way that hasn&#x27;t been seen since the Vietnam War, Dorsey said. </li></ul><ul><li>&quot;This is something they&#x27;re now being conditioned to seeing on a regular basis,&quot; Dorsey added. &quot;That&#x27;s really heavy, what the generation is carrying with them.&quot; </li></ul>The big picture: The dramatic increase in technology for education, socialization, and recreation during the pandemic likely vastly increased kids&#x27; already high trust and perceived reliance on technology and social media, especially under the age of 13, Dorsey said.<ul><li>&quot;Even though the parents didn&#x27;t necessarily want them to use their mobile devices all that much, the reality is they were on it because they weren&#x27;t in school and weren&#x27;t doing other activities,&quot; Dorsey said.</li></ul>The intrigue: Researchers hypothesize small children growing up today may end up following different social norms.<ul><li>Several qualitative studies and surveys by Dorsey and Alice Fothergill, professor of sociology at the University of Vermont, show developmentally significant differences in kids&#x27; comfort with physical touch and worries they&#x27;ll get loved ones like their grandparents sick. </li><li>Young children growing up during the pandemic saw constant handwashing, virtual learning, mask-wearing, and social distancing. It&#x27;s left researchers curious about whether social norms of personal space and hygiene will remain changed in the future with those who experienced the pandemic at a younger age.</li></ul>The bottom line: We&#x27;ve never seen a crisis quite like this that impacts all demographics and groups of kids and it will likely change them in significant ways long into the future.

After a record economic expansion, the coronavirus pandemic sent the U.S. economy into a recession as unemployment soared to staggering heights. The country now faces urgent questions about how much stimulus is needed for reeling consumers and businesses, and what a recovery might look like.

Economy & Business

Vitals

Axios Vitals

It's taken about 10 months for President Biden to name a nominee for the role of permanent FDA commissioner — former FDA chief Robert Califf — and it's unlikely his confirmation will be complete before the end of 2021. 

Why it matters:  The agency has been without a Senate-approved commissioner for nearly a year, all while playing a central role in the response to the ongoing COVID pandemic.

The selection of the former commissioner came after the White House dropped several prior candidates, including acting commissioner Janet Woodcock, who faced strong opposition over her pharmaceutical ties, the New York Times reports. 

Woodcock plans to remain in her position as the nomination process plays out, a Health and Human Services official tells Axios. 

Prior to Biden's announcement on Friday, today would have marked her last day she was able to oversee the agency as acting commissioner under to the Vacancies Act.

What's next: The Senate HELP Committee expects schedule a hearing on his nomination "as soon as possible," a committee aide said.

But he's unlikely to get a floor vote by the end of the year, said Stacy Cline Amin, who co-leads the FDA Regulatory & Compliance practice at Morrison & Foerster and was chief counsel for the HELP committee during Califf's last nomination.

The committee may not feel as much time pressure because [Woodcock] is doing a good job and is generally well-liked," Amin told Axios. 

What to watch: Califf was confirmed in 2016 by an 89-4 vote, but he'll still face some questions over his ties to the pharmaceutical industry. Democratic Sens. Joe Manchin, Ed Markey and Richard Blumenthal, who voted against Califf last time, all reiterated their concern on Friday.

He was the founding director of the Duke Clinical Research Institute, where he worked closely with drug companies and received consulting fees prior to his first stint as FDA commissioner. More recently, he's served as a senior adviser for Verily and Google Health.

"The public has been asking if they can trust the FDA to ensure that the benefits outweigh the risks for Alzheimer's drugs, cancer treatments, and implanted devices," Diana Zuckerman, president of the National Center for Health Research, a non-partisan non-profit think tank, told Axios.

The bottom line: "This time has been really really hard for the agency. The staff is working around the clock. They are exhausted," Amin said. "I think it's good they chose a nominee who has experience with the agency. It will be a smooth transition, likely. I think that's important for the workforce there."

The road ahead for Biden's FDA nominee Robert Califf

It's already taken about 10 months for Biden to name a nominee for the permanent role.

Robert Califf shakes hands with Sen. Bill Cassidy (R-La.) before his nomination hearing before the Senate Health, Education, Labor and Pensions Committee in 2015. Photo: Win McNamee/Getty Images

Food and Drug Administration (FDA)

It&#x27;s taken about 10 months for President Biden <a class="gtmContentClick" data-vars-link-text="to name a nominee for the role of permanent FDA commissioner" data-vars-click-url="https://www.axios.com/biden-nominate-rob-califf-fda-commissioner-6e7e4dab-3278-43df-832a-995a3091cdfe.html" data-vars-content-id="368edc19-ca60-48b4-8838-11b4da2679d1" data-vars-headline="The road ahead for Biden&#x27;s FDA nominee Robert Califf" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.axios.com/biden-nominate-rob-califf-fda-commissioner-6e7e4dab-3278-43df-832a-995a3091cdfe.html" target="_self">to name a nominee for the role of permanent FDA commissioner</a> — former FDA chief Robert Califf — and it&#x27;s unlikely his confirmation will be complete before the end of 2021. Why it matters: The agency has been without a Senate-approved commissioner for nearly a year, all while playing a central role in the response to the ongoing COVID pandemic.

Doctors should incorporate air pollution to their list of risk factors for heart disease when treating patients, a study out Thursday from the New England Journal of Medicine urges. 

The big picture: Air pollution is still overlooked as a cause of heart disease, as outdoor air quality worsens in some parts of the globe.

Pairing reduction strategies with cardiovascular disease prevention "could save millions of lives," the authors write.

Why it matters: Heart disease was still the top cause of death for both men and women during the pandemic. 

Air pollution is the world's fourth leading cause of disease and death, per the World Health Organization. 

The proportion of deaths from cardiovascular disease in developing countries due to pollution are more than heart disease deaths due to smoking and other behavioral and metabolic risk factors, per the study.

By the numbers: Of the 9 million people who died from pollution worldwide in 2019, 62% died from cardiovascular disease, including heart attacks and stroke, but these estimates are very much undercounted, per the study. 

Air pollution in the U.S. has drastically improved in the last 50 years compared to other parts of the world, but researchers still estimate 100,000–200,000 people in the U.S. die every year to diseases caused by air pollution.

People who live with such dangerous levels of pollution — areas classified as PM 2.5 — have about a 2% increased risk of hospitalization or death from heart failure. Air pollution has also been associated with increased risks of atrial fibrillation and ventricular arrhythmias. 

State of play: For decades patients and physicians have incorporated medical history and individual lifestyle behaviors to prevent heart disease. But the same hasn't been done for air pollution despite its deadly exposures.

"Just like they take other measures to reduce the risk factors, like stopping smoking, getting more exercise, do what they can to reduce the risk of air pollution," Philip Landrigan, director of the program for global public health and the common good at Boston College and co-author of the study, tells Axios. 

"I know it's not as easy to change because it's not always within the purview of the individual person to change what kind of air they breathe, but awareness is at least the first step," he added.

What to watch: There are individual roles people could play in reducing exposure to pollution such as masks, air filtration systems and avoiding outdoors in peak times of poor air quality, but the study argues that government-supported interventions in controlling pollution would bring lasting prevention of pollution-related cardiovascular disease.

"Only through a multipronged strategy that combines pollution prevention with control of individual risk factors can the global epidemic of cardiovascular disease be contained," the authors write.

Doctors should assess air pollution as risk factor for heart disease, study says

Heart disease was still the No. 1 cause of death during the pandemic.

Illustration of a human heart medical diagram surrounded by various abstract shapes

Heart disease

Doctors should incorporate air pollution to their list of risk factors for heart disease when treating patients, a study out Thursday from the <a class="gtmContentClick" data-vars-link-text="New England Journal of Medicine" data-vars-click-url="http://www.nejm.org/doi/full/10.1056/NEJMra2030281" data-vars-content-id="56dd5765-a4c0-44d0-aaf3-c504147de0e1" data-vars-headline="Doctors should assess air pollution as risk factor for heart disease, study says" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="http://www.nejm.org/doi/full/10.1056/NEJMra2030281" target="_blank">New England Journal of Medicine</a> urges. The big picture: Air pollution is still overlooked as a cause of heart disease, as outdoor air quality worsens in some parts of the globe.

A look at the scientific breakthroughs changing the world, explorations in space and in worlds beyond our own and the threats posed to us by our own planet, both out of our control and of our own making.

Science

China is becoming the most formidable rival America has faced, and the risk of confrontation with Russia, North Korea or Iran still looms. Authoritarians are rising, the chaotic Afghanistan exit revealed the limits of U.S. power, and the pandemic, climate change and other critical challenges continue to pose grave threats.

World

Axios has removed the article published here on Nov. 17, 2021, because it fell short of our editorial standards. Axios incorrectly stated that we contacted Global Plasma Solutions for comment before publication. We wrongly relied upon a source who is a former employee of a competitor of GPS and is now an adviser to that same competitor. We apologize to GPS and to our readers.

Retracted: A COVID strategy backfires at schools

Axios has removed the article published here on Nov. 17, 2021.

Marisa Fernandez

Stories

Most states ranked poorly in quality of care for people of color, report says

Retracted: A COVID strategy backfires at schools

The road ahead for Biden's FDA nominee Robert Califf

Doctors should assess air pollution as risk factor for heart disease, study says

Lasting changes ahead for "Generation COVID"