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The COVID-19 pandemic has disrupted lives and livelihoods, and people already experiencing mental ill health may have been especially vulnerable.
Aims
Quantify mental health inequalities in disruptions to healthcare, economic activity and housing.
Method
We examined data from 59 482 participants in 12 UK longitudinal studies with data collected before and during the COVID-19 pandemic. Within each study, we estimated the association between psychological distress assessed pre-pandemic and disruptions since the start of the pandemic to healthcare (medication access, procedures or appointments), economic activity (employment, income or working hours) and housing (change of address or household composition). Estimates were pooled across studies.
Results
Across the analysed data-sets, 28% to 77% of participants experienced at least one disruption, with 2.3–33.2% experiencing disruptions in two or more domains. We found 1 s.d. higher pre-pandemic psychological distress was associated with (a) increased odds of any healthcare disruptions (odds ratio (OR) 1.30, 95% CI 1.20–1.40), with fully adjusted odds ratios ranging from 1.24 (95% CI 1.09–1.41) for disruption to procedures to 1.33 (95% CI 1.20–1.49) for disruptions to prescriptions or medication access; (b) loss of employment (odds ratio 1.13, 95% CI 1.06–1.21) and income (OR 1.12, 95% CI 1.06 –1.19), and reductions in working hours/furlough (odds ratio 1.05, 95% CI 1.00–1.09) and (c) increased likelihood of experiencing a disruption in at least two domains (OR 1.25, 95% CI 1.18–1.32) or in one domain (OR 1.11, 95% CI 1.07–1.16), relative to no disruption. There were no associations with housing disruptions (OR 1.00, 95% CI 0.97–1.03).
Conclusions
People experiencing psychological distress pre-pandemic were more likely to experience healthcare and economic disruptions, and clusters of disruptions across multiple domains during the pandemic. Failing to address these disruptions risks further widening mental health inequalities.
The effectiveness of official support provided following a disaster has not been fully evaluated. This study aimed to ascertain whether there was an association between perceived support shortly after the 2004 Indian Ocean tsunami and later mental health symptoms in those affected, and to explore the factors associated with this. A survey, semi-structured interviews and focus group were used to explore the experiences and perceptions of 116 individuals severely affected by the tsunami.
Results
Agency or official support was perceived as poor overall. Perceived ineffectiveness of support available within a few days after the tsunami was associated with increased symptoms of post-traumatic stress disorder 15–19 months later. The strongest themes that emerged from our study were that support provided in a humane manner was perceived as effective and that uncoordinated support, poor communication and limited accessibility to support and information were perceived as ineffective.
Clinical implications
Improved planning of coordinated, flexible, multi-agency responses to traumatic events before they occur is required.
Edited by
Alex S. Evers, Washington University School of Medicine, St Louis,Mervyn Maze, University of California, San Francisco,Evan D. Kharasch, Washington University School of Medicine, St Louis
Assessing the significance of current glacier loss on Kilimanjaro, Tanzania, demands a well-constrained temporal perspective. That context is provided by direct measurements, ancillary observations of the ice fields and the analyses of the ice cores collected from them. Ice retreat mechanisms observed there today are consistent with the preservation of the oldest ice, ~11.7 ka, in the central deepest part of the Northern Ice Field (NIF). This ice-core derived paleoclimate history published by Thompson and others (2002) is further confirmed by more recent paleoclimate records from tropical East Africa. Mounting evidence suggests that the (anticipated) loss of the entire NIF will be unprecedented within the past 10 000 years. New evidence bears directly on the mechanisms driving the current ice loss. Measurements made in 2000 on the NIF document that air temperature at 0.5 and 1.5 m above the surface remained below 5°C, while a surface temperature of 0.0°C was sustained for up to 8 hours d-1 under clear conditions, consistent with observations of melting on all Kilimanjaro summit ice fields. The linear relationship between oxygen and hydrogen isotopic ratios for all six ice cores drilled in 2000 lies very close to the global meteoric waterline and does not support sublimation (evaporation) as a major driver of ice loss today or in the past on Kilimanjaro.
In this paper we review the interaction of El Niño Southern Oscillation (ENSO) variability and warming trends recorded in ice-core records from high-altitude tropical glaciers, discuss the implications of the warming trends for the glaciers and consider the societal implications of glacier retreat. ENSO has strong impacts on meteorological phenomena that directly or indirectly affect most regions on the planet and their populations. Many tropical ice fields have provided continuous annually resolved proxy records of climatic and environmental variability preserved in measurable parameters, especially oxygen and hydrogen isotopic ratios (δ18O, δD) and the net mass balance (accumulation). These records present an opportunity to examine the nature of tropical climate variability in greater detail and to extract new information on linkages between rising temperatures on tropical glaciers and equatorial Pacific sea surface temperatures in critical ENSO indicator regions. The long-term climate records from a collection of high-altitude tropical ice cores provide the longer-term context essential for assessing the significance of the magnitude and rate of current climate changes that are in large measure driving glacier retreat. The well-documented ice loss on Quelccaya in the Peruvian Andes, Naimona’nyi in the Himalaya, Kilimanjaro in eastern Africa and the ice fields near Puncak Jaya in Papua, Indonesia, presents a grim future for low-latitude glaciers. The ongoing melting of these ice fields (response) is consistent with model predictions for a vertical amplification of temperature in the tropics (driver) and has serious implications for the people who live in these areas.
Spanish phonological development was examined in six sequential bilingual children at the point of contact with English and eight months later. We explored effects of the English vowel and consonant inventory on Spanish. Children showed a significant increase in consonant cluster accuracy and in vowel errors. These emerging sequential bilingual children showed effects of English on their first language, Spanish. Cross-linguistic transfer did not affect all properties of the phonology equally. Negative transfer may occur in specific areas where the second language is more complex, requiring reorganization of the existing system, as in the transition from the Spanish five-vowel to the English eleven-vowel system.
Seek the shalom of the city to which I have exiled you, and pray on its behalf to YHWH, for in its shalom is shalom for you.
(Jer. 29:7)
The Holy One, blessed be He, said, “I will not enter the heavenly Jerusalem until I can enter the earthly Jerusalem.”
(Babylonian Talmud, Ta'anith 5a)
When hope sets out in its desperate search for reasons, it can find them now.
(Wendell Berry)
CITIES OF FARMERS
Modern agrarians seek to “re-member” the land, but they cannot afford to forget the city, with half the world's population now living in cities. Certainly North Americans cannot do so, since four out of five of us (including myself) reside in metropolitan areas. Even with in the confines of the much less deeply urbanized world of the biblical writers, the city is never long out of sight. For Israelites, as for virtually all other residents of the ancient Near East (except perhaps the most remote desert dwellers), the existence of cities was a fact already established for millennia. Scholars often cite the biblical suspicion of cities, and there is some truth to that. No city has an entirely positive reputation among the biblical writers; no capital city, including Jerusalem, escapes prophetic denunciation and predictions of doom. It is telling that according to the account of the Israelites' entry into Canaan, they were content to burn Jericho, the world's oldest continually inhabited city, rather than take it over for themselves.
The industrial era at climax … has imposed on us all its ideals of ceaseless pandemonium. The industrial economy, by definition, must never rest.… There is no such thing as enough. Our bellies and our wallets must become oceanic, and still they will not be full. Six workdays in a week are not enough. We need a seventh. We need an eighth. … Everybody is weary, and there is no rest. … Or there is none unless we adopt the paradoxical and radical expedient of just stopping.
(Wendell Berry)
It is vain for you, early to rise, late to sit down,
eating the bread of the aggrieved.
Yes, he gives to his beloved sleep.
(Ps. 127:2)
A MARGINAL CULTURE
Agrarianism is more than a set of farming practices, more than an attitude toward food production and consumption, although both of these are central to it. Agrarianism is nothing less than a comprehensive philosophy and practice – that is, a culture – of preservation. Agrarians are committed to preserving both communities and the material means of life, to cultivating practices that ensure that the essential means of life suffice for all members of the present generation and are not diminished for those who come after. Agrarianism in this sense is, and has nearly always been, a marginal culture, existing at the edge or under the domination of a larger culture whose ideology, social system, and economy are fundamentally different.
God's seeing protects the world from falling back into the void, protects it from total destruction. God sees the world as good, as created – even where it is the fallen world – and because of the way God sees his work and embraces it and does not forsake it, we live.
(Dietrich Bonhoeffer)
To preserve our places and to be at home in them, it is necessary to fill them with imagination. To imagine as well as see what is in them. Not to fill them with the junk of fantasy and unconsciousness, for that is no more than the industrial economy would do, but to see them first clearly with the eyes, and then to see them with the imagination in their sanctity, as belonging to the Creation.
(Wendell Berry)
READING GENESIS 1 AS A POEM
The first chapter of Genesis would seem to present an initial and perhaps insurmountable challenge to my thesis that the dominant mind-set expressed in the Hebrew Scriptures is agrarian. Ecologically sensitive readers, both professional and lay, generally take offense at the notion that God commands humans to exercise dominion over the earth. The attitude of Genesis 1 is “arrogant and narcissistic,” according to soil scientist Daniel Hillel, in contrast to the “more responsible role assigned to humanity in the second creation story.”
Piety is deepest practicality, for it properly relates use and enjoyment. And a world sacramentally received in joy is a world sanely used. There is an economics of use only; it moves toward the destruction of both use and joy. And there is an economics of joy; it moves toward the intelligence of use and the enhancement of joy.
(Joseph Sittler)
The stability, coherence, and longevity of human occupation require that the land should be divided among many owners and users. The central figure of agrarian thought has invariably been the small owner or small holder who maintains a significant measure of economic self-determination on a small acreage. The scale and independence of such holdings imply two things that agrarians see as desirable: intimate care in the use of the land, and political democracy resting upon the indispensable foundation of economic democracy.
(Wendell Berry)
THE VALUE OF A LOCAL ECONOMY
Agrarians in every culture must reckon with the issue of land possession, usually as a vexed issue. The fact that land possession is a central (arguably the central) issue of the Hebrew Scriptures thus confirms their fundamentally agrarian character. And of course the issue remains vexed; the intensity of the conflict over possession of the land once called Canaan is probably greater today than it was in the Iron Age, and certainly more people and religious perspectives are involved.