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The third factor is the speed with which higher interest rates pass through to homeowners. The biggest risk is to borrowers on floating-rate mortgages

not all fixed-term loans are alike. In America the bulk of them are fixed for two or three decades. In other countries, even fixed-rate borrowers will face soaring mortgage costs soon enough

all the ingredients for a deep housing slump are in place. This time, though, it is likely to be led not by America, but by Canada, the Netherlands, Australia, New Zealand and Norway

First-time buyers and recent borrowers are especially vulnerable. Many stretched their finances to buy a home, leaving less spare cash to cover a jump in mortgage costs

First-time buyers have also had less time to accumulate equity. Oxford Economics estimates that a 15% drop in house prices in America over a year would cancel out two-thirds of the housing equity they have accumulated since the start of the pandemic

the housing squeeze will have profound consequences. “The housing cycle IS the business cycle”, wrote Edward Leamer of the University of California, Los Angeles, in a paper published in 2007

The link between the two cycles arises because housing confers “wealth effects” on owner occupiers. When house prices rise, people feel good about their financial situation, so borrow and spend more.

It noted that housing slowdowns had preceded eight of the past ten recessions in America

2019 research by the Bank of England found that a 10% increase in house prices raises consumption by 0.35–0.5%

Another important channel between the housing market and the rest of the economy is investment. Capital spending associated with housing, especially house building, can be extremely volatile—and is often the difference between a growing or shrinking economy.

Some people see an upside to a housing crash. They hope lower prices will allow young folk to buy their first houses. These hopes are almost certain to be dashed. In housing corrections, and sometimes for years after, home ownership rates tend to fall, rather than rise

Economic conditions that cause house prices to fall simultaneously imperil the chances of would-be homeowners. Unemployment rises and wages decline. If interest rates jump, people are able to borrow less and mortgage lenders tend to become more skittish about lending

The biggest effect of a housing downturn may be in politics

In countries where home ownership is seen as a rite of passage, lower prices without any increase in affordability will rub salt in already sore wounds. “Falling to what? Falling to absurdly grotesque prices instead of just unthinkable?”

For years more established homeowners took comfort in the thought that, even if real-wage growth was terrible, at least the price of their house was rising. Those days are over. Even baby-boomers, the great winners from a decade of price growth, now face the prospect of living off a smaller nest-egg in retirement, as downsizing becomes less lucrative

All this means rising interest rates will have unpredictable political repurcussions, as people who once benefited from the status quo discover what it feels like to lose out.

Do not be surprised, then, if policymakers launch enormous rescue operations

Biden’s approval ratings are stubbornly low. In a recent ABC poll, only 30 percent of voters approve of his handling of the economy and only 23 percent approve of his handling of immigration at the southern border. Roughly three-quarters of American voters say that Biden, at 80, is too old to seek a second term. There have been a string of polls showing that large majorities in his own party don’t want him to run again. In one survey from 2022, an astounding 94 percent of Democrats under 30 said they wanted a different nominee.

I thought Biden’s favorability ratings would climb as economic growth has remained relatively strong and as inflation has come down. But it just hasn’t happened.

don’t find this passive fatalism compelling. The party’s elected officials are basically urging rank-and-file Democrats not to be anxious about a situation that is genuinely anxiety-inducing. Last month Gov. Phil Murphy of New Jersey told The Times, “This is only a matter of time until the broad party, and broadly speaking, Americans, converge with the opinions of folks like myself.” Really? Surely if there’s a lesson we should have learned from the last decade, it’s that we should all be listening harder to what the electorate is trying to say.

The Republicans who portray him as a doddering old man based on highly selective YouTube clips are wrong. In my interviews with him, he’s like a pitcher who used to throw 94 miles an hour who now throws 87. He is clearly still an effective pitcher.

People who work with him allow that he does tire more easily, but they say that he is very much the dynamic force driving this administration

In fact, I’ve noticed some improvements in his communication style as he’s aged. He used to try to cram every fact in the known universe into every answer; now he’s more disciplined. When he’s describing some national problem, he is more crisp and focused than he used to be, clearer on what is the essential point here — more confidence-inspiring, not less.

What about four or five years from now, at the end of a second term? Will he still be competent enough to lead? Biden is fit, does not smoke or drink alcohol, exercises frequently and has no serious health conditions, according to the White House

A study in The Journal on Active Aging of Biden’s and Trump’s health records from before the 2020 elections found that both men could qualify as “super-agers” — the demographic that maintains physical and mental functioning beyond age 80.

if the president I see in interviews and at speeches is out campaigning next year against an overweight man roughly his own age, then my guess is that public anxieties on this front will diminish.

To me, age isn’t Biden’s key weakness. Inflation is. I agree with what Michael Tomasky wrote in The New Republic: Biden’s domestic legislative accomplishments are as impressive as any other president’s in my adult life. Exactly as he should have, he has directed huge amounts of resources to the people and the places that have been left behind by the global economy. By one Treasury Department estimate, more than 80 percent of the investments sparked by the Inflation Reduction Act are going to counties with below-average college graduation rates and nearly 90 percent are being made in counties with below-average wages. That was the medicine a riven country needed.

it is also true that Biden’s team overlearned the lessons of the Obama years. If Barack Obama didn’t stimulate the economy enough during the Great Recession, Biden stimulated it too much, contributing to inflation and the sticker shock people are feeling.

Anger about inflation is ripping across the world, and has no doubt helped lower the approval ratings of leaders left, right and center. Biden’s 40 percent approval rating may look bad, but in Canada, Justin Trudeau’s approval rating is 36; in Germany Olaf Scholz is at 29; in Britain Rishi Sunak is at 28; in France Emmanuel Macron is at 23; and in Japan Fumio Kishida is also at 23. This is a global phenomenon

“Inflation is the reason Biden could not deliver on his core promise to return the country to normal and the main reason his poll numbers are bad.”

voters are looking back and retroactively elevating their opinion of Trump’s presidency. When he left office only 38 percent of Americans approved of his performance as president. Today, 48 percent do, his high-water mark.

Bitterness, cynicism and distrust pervade the body politic. People perceive reality through negative lenses, seeing everything as much worse than it is. At 3.8 percent, America’s unemployment rate is objectively low, but 57 percent of voters say that the unemployment rate is “not so good” or “poor.”

The nation’s bitter state of mind is a self-perpetuating negativity machine. Younger people feel dismissed; the older generations are hogging power. Faith in major institutions is nearing record lows. The country is hungry for some kind of change but is unclear about what that might look like. As the incumbent, Biden will be tasked with trying to tell a good news story of American revival, which is just a tough story to sell in this environment. And Biden is not out there selling it convincingly.

The bracing reality is that Trump’s cynicism and fury match the national mood more than Biden’s faithful optimism.

“They seem hell bent on nominating the one Democrat who would lose to Donald Trump,” Karl Rove told me recently. “They’ve got a lot of talent on their side, let’s not kid ourselves,” he continued, pointing to younger Democrats like Gretchen Whitmer, Mitch Landrieu, Gavin Newsom and Cory Booker.

A lot of the dump-Biden conversations are based on a false premise: that the Democratic Party brand and agenda are somehow strong and popular enough that any number of younger candidates could win the White House in 2024, and that if Biden were just to retire, all sorts of obstacles and troubles would go with him.

But Biden is not the sole or even primary problem here. To the extent that these things are separable, it’s the Democratic Party as a whole that’s ailing. The generic congressional ballot is a broad measure of the strength of the congressional party. Democrats are now behind. According to a Morning Consult poll, Americans rate the Democratic Party as a whole as the more ideologically extreme party by a nine-point margin.

When pollsters ask which party is best positioned to address your concerns, here too, Democrats are trailing. In a recent Gallup poll 53 percent of Americans say Republicans will do a better job of keeping America prosperous over the short term while only 39 percent thought that of the Democrats.

Fifty-seven percent of Americans said that the Republicans would do a better job keeping America safe, while only 35 percent favor the Democrats. These are historically high Republican advantages.

Here are the hard, unpleasant facts: The Republicans have a likely nominee who is facing 91 charges. The Republicans in Congress are so controlled by a group of performative narcissists, the whole House has been reduced to chaos. And yet they are still leading the Democrats in these sorts of polling measures

There is no other potential nominee who is so credibly steeped in knowing what life is like for working- and middle-class people, just as there was no other potential nominee in 2020. After watching him for a quarter-century, I think he is genuinely most comfortable when he is hanging around the kinds of people he grew up with. He doesn’t send out any off-putting faculty lounge vibes. On cultural matters he is most defined by what he doesn’t do — needlessly offend people with overly academic verbiage and virtue signaling. That is why I worry when he talks too stridently about people on the right, when he name-calls and denounces wide swaths of people as MAGA.

Over the last half-century, the Democrats have become increasingly the party of the well-educated metropolitan class.

This is about something deeper than Joe Biden’s age. More and more people are telling pollsters that the Republicans, not the Democrats, care about people like me.

But Democrats are losing something arguably more important than a reliable base of supporters. The party is in danger of letting go of an ethos, a heritage, a tradition. The working-class heart and soul the Democrats cultivated through the Roosevelt, Truman and Kennedy years rooted Democratic progressivism in a set of values that emphasized hard work, neighborhood, faith, family and flag. Being connected to Americans’ everyday experiences kept the party pinioned to the mainstream.

. It grew prone to taking flights of fancy in policy and rhetoric, be it Medicare for All or “defund the police,” going to places where middle-of-the-road voters would not follow. It became more vulnerable to the insular outlooks of its most privileged and educated members.

And that is the fact I keep returning to. Biden is not what ails the party. As things stand, he is the Democrats’ best shot at curing what ails the party.

today, the party is bleeding working-class voters of all varieties. As John B. Judis and Ruy Teixeira point out in their forthcoming book, “Where Have All the Democrats Gone?” Democrats have been losing ground among Hispanics for the last few years. In 2012, Barack Obama carried nonwhite voters without a college degree by a 67-point margin. In 2020, Biden carried this group with a 48-point margin. Today, the Democratic ticket leads among this group by a paltry 16 points

These cultural and spiritual roots give him not just a style but a governing agenda. He has used the presidency to direct resources to those who live in the parts of the country where wages are lower, where education levels are lower, where opportunities are skimpier. Biden’s ethos harks back to the ethos of the New Deal Democratic Party, but it also harks forward to something — to a form of center-left politics that is culturally moderate and economically aggressive

Something almost spiritual is at play here, not just about whether the Democrats can win in 2024, but who the Democrats are.

I also find myself arriving foursquare at the conclusion that rejecting the president now would be, in the first place, a mistake. He offers the most plausible route toward winning the working- and middle-class groups the Democrats need, the most plausible route toward building a broad-based majority party

But it would be worse than a mistake. It would be a renunciation of the living stream of people, ideas and values that flow at the living depths of the party, a stream that propelled its past glories and still points toward future ones.

Before the pandemic, a number of variables were statistically significant indicators for consumer sentiment in our model; in particular, the most salient variables appear to be vehicle sales, gas prices, median household income, the federal funds effective rate, personal savings and household expenditures (excluding food and energy).

During the pandemic, the personal savings rate soared. In April 2020, the metric was nearly double its previous high, recorded in May 1975.

All this taken together meant Americans were flush with cash but had nowhere to spend it. So despite the fact that the savings rate went way up, consumers still weren't feeling positively about the economy — contrary to the relationship between these two variables we saw in the decades before the pandemic.

Fast forward to 2024, and the personal savings rate has dropped to one of its lowest levels ever (the only time the savings rate was lower was in the years surrounding the Great Recession)

during and after the pandemic, Americans saw some of the highest rates of inflation the country has had in decades, and in a very short period of time. These sudden spikes naturally shocked many people who had been blissfully enjoying slow, steady price growth their entire adult lives. And it has taken a while for that shock to wear off, even as inflation has cre

the numbers align with our intuitive sense of how consumers process suddenly having their grocery store bill jump, as well as the findings from our model. In simple terms: Even if inflation is getting better, Americans aren't done being ticked off that it was bad to begin with.

surprisingly, our pre-pandemic model didn't find a notable relationship between housing prices and consumer sentiment

However, in our post-pandemic data, when we examined how correlated consumer sentiment was with each indicator we considered, consumer sentiment and median housing prices had the strongest correlation of all****** (a negative one, meaning higher prices were associated with lower consumer sentiment)

during the pandemic, low interest rates, high savings rates and changes in working patterns — namely, many workers' newfound ability to work from home — helped overheat the homebuying market, and buyers ran headlong into an enduring supply shortage. There simply weren't enough houses to buy, which drove up the costs of the ones that were for sale.

That's true even if a family has been able to save enough for a down payment, already a difficult task when rents remain high as well. Fewer people are able to cover their current housing costs while saving enough to make a down payment.

Low-income households are still the most likely to be burdened with high rents, but they're not the only ones affected anymore. High rents have also begun to affect those at middle-income levels as well.

In short, there was already a housing affordability crisis before the pandemic. Now it's worse, locking a wider array of people, at higher and higher income levels, out of the home-buying market

People who are renting but want to buy are stuck. People who live in starter homes and want to move to bigger homes are stuck. The conditions have frustrated a fundamental element of the American dream

In our pre-pandemic model, total vehicle sales had a strong positive relationship with consumer sentiment: If people were buying cars, you could pretty reasonably bet that they felt good about the economy. This feels intuitive — who buys a car if they think the economy

Cox Automotive also tracks vehicle affordability by calculating the estimated number of weeks' worth of median income needed to purchase the average new vehicle, and while that number has improved over the last two years, it remains high compared to pre-pandemic levels. In April, the most recent month with data, it took 37.7 weeks of median income to purchase a car, compared with fewer than 35 weeks at the end of 2019.

"Right before the pandemic, the typical average transaction price was around $38,000 for a new car. By 2023, it was $48,000," Schirmer said. This could all be contributing to the break in the relationship between car sales and sentiment, he noted. Basically, people might be buying cars, but they aren't necessarily happy about it.

Inspired by our model of economic indicators and sentiment from 1987 to 2019, we tried to train a similar linear regression model on the same data from 2021 to 2024 to more directly compare how things changed after the pandemic. While we were able to get a pretty good fit for this post-pandemic model,******* something interesting happened: Not a single variable showed up as a statistically significant predictor of consumer sentiment.

This suggests there's something much more complicated going on behind the scenes: Interactions between these variables are probably driving the prediction, and there's too much noise in this small post-pandemic data set for the model to disentangle i

Changes in the kinds of purchases we've discussed — homes, cars and everyday items like groceries — have fundamentally shifted the way Americans view how affordable their lives are and how they measure their quality of life.

Even though some indicators may be improving, Americans are simply weighing the factors differently than they used to, and that gives folks more than enough reason to have the economic blues.

The new hand-wringing stems from a gross misunderstanding of the glacial nature of population change.

Even when the total fertility rate falls below 2.1 children, the “momentum” effects of earlier fertility trends will keep a population growing for many decades. In cases when the absolute size of a national population declines, the drop often turns out to be short-lived, and in aggregate numbers usually is so slight as to be of little significance.

young women especially, but also young men, increasingly see marriage and childbearing as major risks, given high divorce rates and the responsibility to support aging parents, who are enjoying longer lives.

it also can provide substantial benefits that have received less attention.

the work forces of societies with low-to-moderate fertility rates often achieve higher levels of productivity than do higher fertility societies.

fertility decline is associated nearly everywhere with greater rights and opportunities for women.

Substantial fertility declines in southern India, notably in the state of Kerala, have been associated with significant economic and educational gains. It is not hard to figure out why. Children, teenagers and young adults are generally less productive than middle-aged workers with more experience,

The fewer children who need primary and secondary education, the more resources there are that can be invested in higher-quality education per child

by enhancing the employment and career experiences of young adults, lower fertility can also bring about greater social and political stability

lower fertility rates may gradually reduce the incentives that have led a surprisingly large number of governments to encourage the emigration of their own young citizens,

There are, in fact, ways that low fertility can be moderated, or even reversed, over time.

France provides subsidized day care for children, starting at 2 1/2 months. Fees are on a sliding scale based on family income. Other countries have been reconsidering traditional school schedules, such as half-days and early closing times that impose serious work-family conflicts for parents, and housing subsidies for young families.

In the past, drug abuse deaths were more common in middle-aged blacks than in middle-aged whites. Now they are more common in whites. The same pattern holds for deaths from alcoholic cirrhosis of the liver. The suicide rate for whites was four times that of blacks.

Could people be taking drugs and killing themselves as a response to the economic slowdown? Maybe. But, if so, Dr. Deaton and Dr. Case said, then why aren’t people in other countries responding the same way?

Recent reports of illness and disability might provide some clues. More middle-aged whites report that their general health is not good; and, more report chronic pain

older people are actually doing better — less addiction, disability rates falling.

how much of what they are seeing might be attributed to the explosive increase in prescription narcotics.

the people who report pain in middle age are the people who report difficulty in socializing, shopping, sitting for three hours, walking for two blocks.

Dr. Deaton envisions poorly educated middle-aged white Americans who feel socially isolated are out of work, suffering from chronic pain and turning to narcotics or alcohol for relief, or taking their own lives. Starting in the 1990s, he said, there was a huge emphasis on controlling pain, with pain charts going up in every doctor’s office and a concomitant increase in prescription narcotics.

Dr. Deaton noted that blacks and Hispanics may have been protected to an extent. Some pharmacies in neighborhoods where blacks and Hispanics live do not even stock those drugs, and doctors have been less likely to prescribe them for these groups.

So we're all the same after all.Under the right conditions - no control over your life, low pay, no job, little in the way of job prospects, no healthcare, little education, families break down when the man can't be the breadwinner, and then along comes poor health, substance abuse, depression, despair - all those ills that were blamed on black people's supposed lack of morals.Now that white kids are dying of heroin we need to change the laws, end the war on drugs, legalize pot, and change how we talk about what were formerly known as 'junkies'.White men are in despair as a result of economic problems, white kids are doing hard drugs in numbers that everyone's starting to notice, and AIDS is plaguing white communities, and now we need to care. So we're all human?

Because white people are depressed over their diminution in society by the policies of the Federal Government, the education system, racial animosity and biased media outlets that are rampant through the society. These doctors are clueless liberals that will try to find any reason to blame, other than the truth. It's not the drugs, it's what is causing them to want the drugs. White males have been denigrated for the past 50 years. The effects have to be building up and weighing on them.

John is a trusted commenter Boston 6 hours ago No, their diminution in society came from globalized capitalism. A lot of these working class white people were Reagan voters. I'm the same age as them, I saw it happen. They thought they were getting "Morning in America" but instead they got morning for Walmart and sunset for the working class. That's enough to make anybody turn to pills and booze.

DougH Lithonia, GA 7 hours ago To some extent, it's of their own making. High school educated whites tend to vote Republican. Over the last 30 years, Republicans have sold them a bill of goods. They abandoned unions, opposed increases in the minimum wage, and opposed regulation, including safety, wage fairness, etc.So now they are paid less. They have no way of changing that (short of high education) and the big beneficiaries of lower taxes have been the businesses and owners that for which they work. Did those owners bless the workers with the fruits of their benefits? Of course not. They kept the reduced expenses as profit, increased CEO wages, and kept cutting benefits before finally shipping their jobs overseas.Perhaps, if they stopped voting against their own interests, they would fair better.

dw659 Chicago 8 hours ago Why? Simple. Because to males, a 'loss of control' is an unacceptable change. 200 years of being 'in control' just because you are born white and male is ending. Many men can't face a world where they are of 'lower status' than women, blacks, Hispanics, Asians, etc. They don't want to live in that world.....

dale south africa 5 hours ago Its true ! I am a conservative man and i live i johannesburg. I cant imagine what it must be like respecting all things under the suns . From females, gays blacks etc Children of slaves dictating societies . oprah picking presidents. the bully is not allowed to be at his natural best and strongest with this new liberal socialist agenda , everyone equal attitude. im not white but if I was who would want that

Linda is a trusted commenter Oklahoma 54 minutes ago I know so many white men in this small town I live in who never had anything to do with their children. They didn't care about anybody through their productive years and now they're surprised that nobody cares about them.

AC USA 5 hours ago Could it be because these guys have no close family ties? They are the ages that their parents are probably in nursing homes or already passed away. These blue collar, high school educated guys fathered unwanted children with women to whom they may or may hot have been married and divorced. But now at middle age comes time for them to feel wanted and valued by their progeny (dad, dispense some life wisdom to us, help us with college, getting married, a down payment on a house, take your grand-kids fishing, etc.), but they dumped their kids by not wanting to pay child support, or having a bad attitude and not helping their kids at all past age 18. So they kids moved on without dad's love and "support" (monetary or emotionally). The "all for myself mentality" they have espoused has finally come home to roost. There is no going back in time, they are all alone, have no purpose as jobs are hard to come by at that age - even more-so blue collar ones - so they drink/take pills to dull the pain, then overdo it.

suzinne bronx 5 hours ago Think white families more often DO NOT stick together. At middle age and white, have ZERO contact with any family members. By the time I was 16 most had died, moved away or become estranged. Know this amps up my chances for suicide, and that's probably going to pan out too. Flag

Paul '52 is a trusted commenter NYC 2 hours ago The is the first cohort to experience the phenomenon that if you do the same job as your parents you won't do as well or better. These are the auto workers, the airport baggage handlers, the truck drivers. They are, in fact, more productive than their fathers, but they're not paid as well and they don't have pensions. And the disappointment is taking its toll.

But with 1,295 deaths, Germany’s fatality rate stood at 1.4 percent, compared with 12 percent in Italy, around 10 percent in Spain, France and Britain, 4 percent in China and 2.5 percent in the United States. Even South Korea, a model of flattening the curve, has a higher fatality rate, 1.7 percent.

There are several answers experts say, a mix of statistical distortions and very real differences in how the country has taken on the epidemic.

The average age of those infected is lower in Germany than in many other countries. Many of the early patients caught the virus in Austrian and Italian ski resorts and were relatively young and healthy, Professor Kräusslich said.“It started as an epidemic of skiers,

“The reason why we in Germany have so few deaths at the moment compared to the number of infected can be largely explained by the fact that we are doing an extremely large number of lab diagnoses,”

Another explanation for the low fatality rate is that Germany has been testing far more people than most nations. That means it catches more people with few or no symptoms, increasing the number of known cases, but not the number of fatalities.

But there are also significant medical factors that have kept the number of deaths in Germany relatively low, epidemiologists and virologists say, chief among them early and widespread testing and treatment, plenty of intensive care beds and a trusted government whose social distancing guidelines are widely observed.

TestingIn mid-January, long before most Germans had given the virus much thought, Charité hospital in Berlin had already developed a test and posted the formula online.

By the time Germany recorded its first case of Covid-19 in February, laboratories across the country had built up a stock of test kits.

the average age of contracting the disease remains relatively low, at 49. In France, it is 62.5 and in Italy 62, according to their latest national reports.

At the end of April, health authorities also plan to roll out a large-scale antibody study, testing random samples of 100,000 people across Germany every week to gauge where immunity is building up.

Early and widespread testing has allowed the authorities to slow the spread of the pandemic by isolating known cases while they are infectious. It has also enabled lifesaving treatment to be administered in a more timely way.

Medical staff, at particular risk of contracting and spreading the virus, are regularly tested. To streamline the procedure, some hospitals have started doing block tests, using the swabs of 10 employees, and following up with individual tests only if there is a positive result.

If it slows a little more, to between 12 and 14 days, Professor Herold said, the models suggest that triage could be avoided.

One key to ensuring broad-based testing is that patients pay nothing for it, said Professor Streeck. This, he said, was one notable difference with the United States

By now, Germany is conducting around 350,000 coronavirus tests a week, far more than any other European country

Tracking

In most countries, including the United States, testing is largely limited to the sickest patients, so the man probably would have been refused a test.

Not in Germany. As soon as the test results were in, the school was shut, and all children and staff were ordered to stay at home with their families for two weeks. Some 235 people were tested.“Testing and tracking is the strategy that was successful in South Korea and we have tried to learn from that,” Professor Streeck said.Germany also learned from getting it wrong early on: The strategy of contact tracing should have been used even more aggressively, he said.

All those who had returned to Germany from Ischgl, an Austrian ski resort that had an outbreak, for example, should have been tracked down and tested, Professor Streeck said

A Robust Public Health Care System

Before the coronavirus pandemic swept across Germany, University Hospital in Giessen had 173 intensive care beds equipped with ventilators. In recent weeks, the hospital scrambled to create an additional 40 beds and increased the staff that was on standby to work in intensive care by as much as 50 percent.

“We have so much capacity now we are accepting patients from Italy, Spain and France,”

All across Germany, hospitals have expanded their intensive care capacities. And they started from a high level. In January, Germany had some 28,000 intensive care beds equipped with ventilators, or 34 per 100,000 people

By comparison, that rate is 12 in Italy and 7 in the Netherlands.

By now, there are 40,000 intensive care beds available in Germany.

The time it takes for the number of infections to double has slowed to about eight days

“A young person with no health insurance and an itchy throat is unlikely to go to the doctor and therefore risks infecting more people,” he said.

Trust in Government

many also see Chancellor Angela Merkel’s leadership as one reason the fatality rate has been kept low.

Ms. Merkel has communicated clearly, calmly and regularly throughout the crisis, as she imposed ever-stricter social distancing measures on the country.

The restrictions, which have been crucial to slowing the spread of the pandemic, met with little political opposition and are broadly followed.

“Maybe our biggest strength in Germany,” said Professor Kräusslich, “is the rational decision-making at the highest level of government combined with the trust the government enjoys in the population.”

3.5%, a 50-year-low, the black unemployment rate was 5.8%. The white unemployment rate was 3.1%.

“Whatever is being projected for the national unemployment rate, in most instances, we expect to see something close to twice that for black Americans.”

The reason why African Americans bear the brunt of downturns more is that when firing decisions start to occur the least educated and those with the least experience tend to be let go first. There is also continued discrimination in the workplace,” Rodgers said.

last hired, first fired” phenomenon dramatically affects black Americans more than any other group in the US due to the country’s history of racism and segregation of black Americans in the work sector.

Working in these fields leads to lower wages – black Americans have the lowest median wage of any racial group in the US – and the jobs are often seen as the most expendable during an economic downturn.

Even with a low unemployment rate, wage growth for low-wage workers, especially for black workers, has been slow. Black Americans have seen the slowest wage growth compared with other groups of Americans, reaching a growth rate that was four times slower at certain wage distribution levels, according to a 2018 Economic Policy Institute report.

For Yolanda Murray of Detroit, Michigan, not having savings meant weeks of panic trying to figure out how she was going to pay the bills that came on 1 April after she was furloughed from her job at a hotel.

t’s like how am I going to maintain all of this?” Murray said. Weeks after she filed her application for unemployment insurance, payments started coming in and Murray was able to pay her bills again.

Murray and her unionized co-workers spent 28 days striking for higher wages and better healthcare. At the time, workers at the hotel had not had wage rises since before the last recession, and healthcare costs were so expensive that Murray could only afford to cover herself, leaving her two children out of her plan.

Trump’s repeated claims that he has been the best president for African Americans was repeatedly pegged to falling unemployment numbers. But those numbers only tell a partial story, as work by Rodgers and others has shown. Black families are especially vulnerable to economic downturns because they lack the savings that can act as a buffer against unexpected layoffs or lost wages. And during the last recovery they lost ground against their white peers.

compared with 9%, respectively. And the black homeownership rate is the lowest of any racial group in the US and has consistently been about 30% lower than the white homeownership rate over the years, even as the economy was getting stronger.

“Wealth allows you to respond to that unexpected health emergency, that broken hole in the tire you have to replace. It also allows you to buy a home, put your kids through school,” said Danyelle Solomon, vice-president of the race and ethnicity program at the Center for American Progress.

Experts agree that being poor has costly effects on a person’s health: for adults living in extreme poverty, being poor can cost up to 15 years of life expectancy.

ave seen higher death rates due to Covid-19 compared with any other group in the US. Black Americans made up 25% of deaths from Covid-19 in the US though they make up a little under 13% of the US population.

“National emergencies, pandemics, epidemics, what they do is they spotlight inequality,” Solomon said. “What we see in Covid-19 is no different. It’s highlighting racial disparities at every single level that have been with our society for a very long time.”

Democrat-led states -- such as New York and California -- were early entry points for Covid-19, perhaps contributing to higher incidence rates early on, according to the study's authors. But the reversal in trends "may reflect policy difference that could have facilitated the spread of the virus," they said.

"Governors' party affiliation may have contributed to a range of policy decisions that, together, influenced the spread of the virus," Sara Benjamin-Neelon, senior study author and professor at Johns Hopkins University, said in a news release. "These findings underscore the need for state policy actions that are guided by public health considerations rather than by partisan politics."

However, the new study's findings do not imply that political affiliation of a state leader was a cause of Covid-19 case or death incidence, according to the study's authors.

While the analysis was adjusted for rurality, the study notes that "the findings could reflect the virus's spread from urban to rural areas."

"A big jump in interest rates would be very costly," said Ugo Panizza, professor of international economics at the Graduate Institute in Geneva. "Central banks will face very, very complicated tradeoffs if inflation does go up."

The moves have been triggered in part by growing confidence about the next phase of the pandemic. As vaccination campaigns allow governments to lift some restrictions, consumers are expected to rush to restaurants and hop on planes. That could push up prices, which central banks have pledged to keep under control.

US lawmakers approved a mammoth $1.9 trillion stimulus package on Wednesday that could send prices higher and increase pressure on the Federal Reserve.

The Congressional Budget Office projects that publicly-held government debt in the United States will climb to nearly $22.5 trillion by the end of fiscal 2021. That's equivalent to 102% of annual gross domestic product. In Italy, the ratio stood at 154% at the end of September, while Greece was almost at 200%.

Interest costs are even more sensitive to inflation and rate hikes because of the pandemic response.The UK government borrowed £270.6 billion ($377 billion) between April 2020 and January 2021, and higher interest rates mean increased payments on that debt.

"Just as it would be irresponsible to withdraw [economic] support too soon, it would also be irresponsible to allow future borrowing and debt to be left unchecked," he said.

"It is a real concern," said Randall Kroszner, who served as a Federal Reserve governor from 2006 until 2009. If US debt payments suddenly go "from being quite low to being quite significant," that could weigh on the recovery and slow economic activity, he added.

Panizza said that Italy needs to refinance or extend the due date of about one-seventh of its debt every year. If interest rates were to go up by 2%, that would add about half a point of GDP, or roughly $9.9 billion, to debt servicing costs annually. That's a "substantial" amount, he emphasized.

"This is not something that we have a lot of experience with," Kroszner said.

Cuomo's favorable rating jumped to 77%. Just two months earlier, his favorable rating had been 44% -- a paltry figure for a Democrat from a blue state. close dialogThe world is watching as the Biden administration takes office.Get updates on US politics delivered to your inbox daily. Sign Me UpNo ThanksBy subscribing you agree to ourprivacy policy.The world is watching as the Biden administration takes office.Get updates on US politics delivered to your inbox daily. Please enter aboveSign Me UpBy subscribing you agree to ourprivacy policy.Success! See you in your inbox.</

California was one of the earliest states hit in the pandemic, and most voters applauded Newsom's response. His approval rating among likely voters in Public Policy Institute of California polling topped out at 64% in May 2020. That was up from 52% in February 2020 and 49% in January 2020. Newsom, though, has been criticized for how he handled lockdowns and business and school reopenings during the last year

His favorable rating is down to 44% and a mere 36% of voters want him to run for reelection, according to a March Quinnipiac University poll. The one piece of good news for Cuomo is that most Democrats (60%) have a favorable view of the governor, a slim majority (50%) want him to run again in 2022 and just 21% want him to resign.

More prominently, Cuomo is dealing with multiple allegations of inappropriate behavior toward women. The attorney general's office is investigating the claims, and the state Assembly speaker has allowed an impeachment investigation to begin. Many state and federal officials are calling on Cuomo to resign.

Still, the fact that Newsom is facing a recall and that his approval rating is averaging only about 50% right now is not a great position for a Democrat in California. Of course, both Cuomo and Newsom are in better political shape than Trump. While Trump ended up losing the election, at least in part to his response to the pandemic, voters actually had rallied around him early.

By the summer, Trump's overall approval rating dropped into the low 40s. He consistently low on who would better handle the pandemic compared with Democrat Joe Biden, who's now president. Indeed, Trump may very well have won the election without the pandemic. His approval rating on the economy was better than that of any of the incumbents who had lost in the last 45 years before him.

The four Toss-up races are all seats with Republican incumbents.

Democrats are also benefiting from not having to play much defense this cycle. Of the dozen Democrats up for reelection this year, only the two running for reelection in states Trump carried in 2016 -- Alabama Sen. Doug Jones and Michigan Sen. Gary Peters -- face competitive contests, according to Inside Elections.

In the wake of Ginsburg's death and McConnell's commitment to giving Trump's nominee a vote, there's even more attention on Graham, the chairman of the Senate Judiciary Committee.

Recent public polling suggests Harrison's spending could be paying off, too. He was tied with Graham at 48% among likely voters in a Quinnipiac University poll earlier this month, which followed another tied-up Quinnipiac poll of registered voters last month.

Democrats won control of the House in 2018, picking up a net gain of 40 seats, many in diversifying suburban districts that delivered a rebuke of the President's first two years in office. Given those gains, Democrats have a smaller universe of offensive targets for this cycle, but the party still sees opportunities across the map -- including a handful in Texas due, in part, to Republican retirements.

For Republicans, the path back to the majority would start with the 30 districts held by Democrats that Trump carried on his way to the presidency four years ago.

Inside Elections currently rates 205 seats as safe for Democrats, which would put the party just 13 seats away from keeping control of the chamber. There are 164 seats that are Safe Republican, leaving a universe of 65 seats in play -- 37 held by Republicans and 28 by Democrats.

Only 10 seats are rated Toss-up, the most competitive designation, with seven held by Republicans and three by Democrats.

Hillary Clinton won this South Florida district in 2016, but the Cuban-American community's embrace of Trump could move it away from Democrats. Freshman Rep. Debbie Mucarsel-Powell, who unseated GOP Rep. Carlos Curbelo in the 2018 midterms, is no longer in a Tilt Democratic race. Her campaign against Miami Dade County Mayor Carlos Gimenez, himself a Cuban American with a high profile, is now a Toss-up.

The other four ratings changes, however, are all in Democrats' favor. A tightening presidential race in Arkansas' 2nd District, which backed Trump by 10 points in 2016, could help Democrats unseat GOP Rep. French Hill. His race shifted from Likely Republican to Lean Republican.

Although it's not at all like the suburban seats described above, Maine's 2nd District also shifted in Democrats' favor. Trump's 2016 victory here earned him an electoral vote, but he's not expected to do nearly as well in the White working class district against Biden as he did against Clinton.

Thanks to social-science research, we now know that children’s life chances are profoundly affected by their context—not only income and family circumstances but also their community—more so than by their genetic profile or the medical care they receive.

With this in mind, we created what we call the Index of Deep Disadvantage, which reflects two traditional measures of income (the poverty rate and the “deep poverty rate,” meaning those with incomes below half the poverty line), two markers of health (birth weight and life expectancy), and the rate of social mobility for children who grow up in low-income families. We used this index to rank the roughly 3,100 counties in the United States along with the 500 most populous cities.

Immediately, the rankings revealed a stark geographical pattern.

the most disadvantaged places on our index were primarily rural

Though some of these were majority white, most were majority Black or Hispanic.

these places resembled, well, colonies—internal colonies within the U.S.

Considerable poverty exists in Chicago, Los Angeles, and New York. But in our apples-to-apples comparison, none of those cities ranked among even the 600 most disadvantaged places in the nation

The only cities on that list were a relatively small number of industrial municipalities such as Cleveland, Detroit, and Rochester.

Those living in the 200 most disadvantaged places on our index were just as likely to have major difficulties paying for housing as those in America’s 500 largest cities.

The places that our index identified as the 200 most disadvantaged are concentrated in three regions—Appalachia, South Texas, and the southern Cotton Belt.

hese places share a history of intensive resource extraction and human exploitation not seen to the same degree elsewhere in the United States

In each place, this economic pattern emerged (or, in the case of the Cotton Belt, fully flourished) in the late 19th or early 20th century. In each place, one industry came to dominate the economy, a pattern that held, broadly, until the 1960s, when King Cotton, King Tobacco, King Coal, and South Texas agriculture, would bow to the twin forces of automation and global competition.

many places with large Native American populations ranked among the most disadvantaged in the nation

While visiting many of the nation’s most disadvantaged places, we set out to build on this work through historical research, ethnographic observations, and in-depth interviews.

For generations, the appearance of towns in South Texas followed a pattern of social hierarchy: sturdy wood-frame houses, paved streets, and enclosed sewers in the white neighborhoods; shacks, dirt roads, and privies in the Mexican parts of town. Forced to migrate to find work during the off-season, generations of Mexican American children lost their right to a decent education. Even today, adult-illiteracy rates in these places are among the highest in the nation.

in Leflore County, Mississippi, for example, Black residents told us that violence was the No. 1 problem they face. The rate of death due to interpersonal violence there was nearly four times the national average, and well above that of Cook County, Illinois, home to Chicago

Throughout these regions, we saw the same themes emerge again and again—unequal schooling, the collapse of social infrastructure, violence, entrenched public corruption, and structural racism embedded in government programs.

Overall, poverty rates in these places are very low, babies are born healthy, people live to a ripe old age, and a low-income child usually has a similar chance of making it into the middle class as any other kid.

er they were forcibly relocated onto land mostly inhospitable to human habit

hey have enjoyed the lowest rates of violent crime, income inequality, and public corruption in the nation. These counties are unusually rich in social capital: Residents are connected to one another through volunteerism, membership in civic organizations, and participation in other community activities.

Counties that rank among those of greatest advantage began as agricultural communities with modestly sized farms, many originally secured through the 1862 Homestead Act that made landownership widely available. Many of these places have built on this history of broad-based wealth by making significant investments in schools, which has contributed to high graduation and college enrollment rates over generations.

One cannot fully understand the benefits enjoyed in America’s most advantaged places without considering the historic (and ongoing) exploitation of migrant labor that has gone on in them, mostly drawn from the U.S. border regions.

these communities have been more successful than most in preventing poverty, promoting health, and ensuring a level playing field for their children.

The upper Midwest is also overwhelmingly white. When we examined the relationship between whiteness and rank on the index, we found that a higher percentage of white residents is a significant predictor of a place’s rank, which is not at all surprising when one considers that the good schools and the good jobs have long been bestowed liberally on whites while being denied to Hispanic and Black Americans.

What makes the communities that are most advantaged unique is their histories as places of broad-based wealth. How different would conditions be in other parts of the country had they followed a similar, equitable course?

The lesson is that people seem to thrive—not always in high salaries but in health and life chances—when inequality is low; when landownership is widespread; when social connection is high; and when corruption and violence are rare.

The social leveling that is characteristic of communities in the upper Midwest is more than just a quaint cultural feature. It is the foundation of a community’s well-being. Until these regions’ virtues are shared nationwide, poverty and disadvantage will continue to haunt America.

So fear creates recessions in the long run — and if we continue to have rising fear, the probability of a European recession grows and the probability of a US recession grows. Geopolitics is playing a bigger role in everyone’s equations.”

Geopolitical risk is a major component in shaping all our lives. We are having rising fear throughout the world, and less hope. Rising fear creates a withdrawal from consumption or spending more.

“When the Russian invasion occurred in Ukraine, we said that the peace dividend is over,” Larry Fink, chief executive of investment giant BlackRock, told The Sunday Times. “Now, with the instability in the Middle East, we’re going to almost a whole new future.

Dimon noted that inflation had “levelled off a little bit” overall, but said: “It’s not clear to me that long-term forces are not inflationary … And that’s why I’m saying rates could possibly go up from here. That’s life in the fast lane.”

Higher borrowing costs have started to hit debt-fuelled sectors that boomed in the zero-rates era — such as commercial property, where $80 billion (£65 billion) of assets across the US are in some form of financial distress, according to MSCI, and private equity.

[the legendary investor] Warren Buffett says you see who’s swimming naked when the tide goes out. Not everyone is really ready for 6 or 7 per cent rates, but I wouldn’t rule them out.”

Fink pointed out that the transmission of rate rises into the US economy was less direct than in the UK

“I’m a fundamental believer that we’re going to have higher inflation for longer, and it’s going to require the [Fed] to raise rates higher — probably one or two more tightenings — and that will ultimately be the way we get into recession.”

Many senior figures on Wall Street worry about the US government’s ability to finance itself in the medium term. As in the UK, the market for government debt was underpinned by huge waves of quantitative easing (QE) after the financial crisis, as the Federal Reserve, in effect, bought assets including Treasuries to boost the economy. Following a revival of the programme during Covid, it came to an end in March last year.

The withdrawal of QE, combined with lacklustre appetite for Treasuries among US banks and international investors such as China, could force the government to pay higher prices at a time of near-record borrowing.

“It might be a 20km headwind right now, but next year it’s going to be 25km and it’s going to grow,” a top investor said of the decreasing international demand for US government debt.

US stock market floats and fundraisings, the heartbeat of capital markets, slumped to their lowest level since 1998 last year as the spike in interest rates punctured valuations of growth stocks in sectors such as tech and healthcare.

The cautious mood on Wall Street comes against a backdrop of surprisingly strong US growth. The economy expanded by an astonishing 4.9 per cent in the third quart

the Biden administration is shovelling stimulus into the system via big pieces of legislation promising to accelerate America’s adoption of renewables, rebuild its advanced semiconductor industry and increase its spending on roads, bridges and broadband.

We have huge stimulus,” said Fink. “People are not factoring in the Inflation Reduction Act, the Chips Act and the Infrastructure Act, which are about $970 billion of stimulus. Those are the largest stimuluses ever when there’s not a pandemic or a financial crisis ... And it’s at a time when you can have unions win a 25 per cent labour increase … These are very inflationary, whether it’s the fiscal stimulus or these wage increases.”

It all comes back to that word. Unexpectedly high growth, massive government stimulus and now two wars that threaten to spill out into broader crises — it all spells inflation. The flurry of hope in markets that Fed and the Bank of England have reached the top of their rate-raising cycles may yet prove premature

Covid deaths, though always concentrated in older people, have in 2022 skewed toward older people more than they did at any point since vaccines became widely available.

That swing in the pandemic has intensified pressure on the Biden administration to protect older Americans, with health officials in recent weeks encouraging everyone 50 and older to get a second booster and introducing new models of distributing antiviral pills.

But the mortality gap between older and younger people has grown: Middle-aged Americans, who suffered a large share of pandemic deaths last summer and fall, are now benefiting from new stores of immune protection in the population as Covid deaths once again cluster around older people.

among people 65 and older, 13 percent are unvaccinated, 3 percent have a single Moderna or Pfizer shot and another 14 percent are vaccinated but not boosted.

“The government wasn’t sure about the booster shot,” he said. “If they weren’t sure about it, and they’re the ones who put it out, why would I take it?” Mr. Thomas said Covid recently killed a former boss of his and hospitalized an older family friend.

“In 2021, you see the mortality impact of the pandemic shift younger,” said Ridhi Kashyap, a lead author of that study and a demographer at the University of Oxford.

That changed last summer and fall, during the Delta surge. Older people were getting vaccinated more quickly than other groups: By November, the vaccination rate in Americans 65 and older was roughly 20 percentage points higher than that of those in their 40s. And critically, those older Americans had received vaccines relatively recently, leaving them with strong levels of residual protection.

As a result, older people suffered from Covid at lower rates than they had been before vaccines became available. Among people 85 and older, the death rate last fall was roughly 75 percent lower than it had been in the winter of 2020, Dr. Stokes’s recent study found.

The rebalancing of Covid deaths was so pronounced that, among Americans 80 and older, overall deaths returned to prepandemic levels in 2021, according to a study posted online in February.

But scientists warned that many older Americans remained susceptible. To protect them, geriatricians called on nursing homes to organize in-home vaccinations or mandate additional shots.

For some people, even three vaccine doses appear to become less protective over time against Omicron-related hospital admissions.

During the Omicron wave, Covid death rates were once again dramatically higher for older Americans than younger ones, Dr. Stokes said. Older people also made up an overwhelming share of the excess deaths — the difference between the number of people who actually died and the number who would have been expected to die if the pandemic had never happened.

Long-ago Covid cases do not prevent future infections, but reinfected people are less likely to become seriously ill.

Eventually, her family had to arrange a trip to a pharmacy on their own for a second booster.“It just seems that now the onus is put completely on the individual,” she said. “It’s not like it’s made easy for you.”

Latinos have maintained this type of edge despite generally having lower incomes, less access to health care and a greater prevalence of some chronic health issues, such as diabetes and obesity. Some researchers believe the life expectancy advantage is tied to the fact that many Latino immigrants to the U.S. are younger and healthier than many older Latinos, and have lower rates of smoking.

The researchers used projections of COVID-19 mortality to reach their conclusions, and a follow-up study arrived at similar findings. A CDC analysis showing provisional life expectancy estimates also pointed to a three-year drop in life expectancy for Latinos, and a shrinking gap between Latinos and whites.

Latino subgroups have an array of political and cultural differences. But one cultural norm that cuts across all groups is the primacy of family. Whatever country they’re descended from, it’s not uncommon for Latinos in the U.S. to live in multigenerational households that often include young children, their adult parents and a grandparent or grandparents.When young children and adults – many of whom are essential workers – live with elderly grandparents, “that increases the risk for the older people in the household,” says Dr. Luis Ostrosky, chief of the Division of Infectious Diseases at the McGovern Medical School at UTHealth Houston. “If the younger people in the household contract COVID-19, they may be OK, because younger people have stronger immune systems and tend to be healthier. Older people – who tend to be not as healthy and have chronic diseases – may become severely ill, with increased risk of hospitalization and mortality.”

“Once you put all those together, what you find is you have the disappearing of the Latino paradox,” Saenz says.While older Latinos have continued to have a higher rate of COVID-19 mortality than their white counterparts during each year of the pandemic, the difference in death rates has diminished over time. During the first year of the crisis, Latinos age 65 and older died of COVID-19 at 2.1 times the rate of older whites, Saenz and Garcia’s research shows. In 2021, older Latinos died at 1.6 times the rate of older whites, and into late April of this year, older Hispanics had died at 1.2 times the rate of older whites. Saenz attributes the narrowing difference to COVID-19 death rates among older whites in red states where vaccination rates are lower.

Transportation, language and employment. A study in 2020 from the UCLA Latino Policy &amp; Politics Initiative found Latinos (and Blacks) in Los Angeles County and New York City were roughly twice as likely to die of COVID-19 as non-Hispanic whites as of July 20 of that year, and noted that carpooling or taking public transportation to work may raise the risk of coronavirus exposure. The study also found that 34% and 37% of the populations in Los Angeles County and New York City were foreign-born, respectively, with Latinos making up the largest share of that population in each area. Approximately 13% of the foreign-born do not speak English, according to the report, which poses a challenge to their obtaining important health information.

“A three-year reduction in life expectancy is huge in historical terms. We usually have not seen reductions this large except during times of war or major pandemics,” says Theresa Andrasfay, a postdoctoral scholar at the Leonard Davis School of Gerontology at USC and one of the PNAS study’s researchers. “Of course, it’s really sad to think about the individuals who died of COVID, but it also has broader implications for the family members of those who died.”COVID-19 has not only claimed the lives of many older Latinos, but many younger, working-age Latinos as well, leaving behind children, siblings, parents and grandparents who depended on them, Andrasfay says. She says she and other researchers are working on an update, tracking the effect of COVID-19 on life expectancy in 2021: “We’re finding a similar pattern (to 2020), with Latinos having the largest reduction in life expectancy.”

Though he wasn’t in the best of health, Salvador Macias, 83, enjoyed going to a neighborhood community center for senior activities in Long Beach, a beachside city about 25 miles south of downtown Los Angeles. He lived in a modest, tidy house with his wife, Manuela, and their adult daughter, Julie.Salvador suffered from three chronic health conditions: diabetes, high cholesterol and high blood pressure, says his son, Joe Macias.In August 2020 – four months before health care workers received the first COVID-19 vaccine – the elder Macias became ill with the disease, suffering from fatigue and severe shortness of breath. After several days, Salvador died at home. Manuela, who doesn’t have the chronic health conditions her husband had, also contracted COVID-19. She was hospitalized for a week, but survived.

The ordinary fixes—the kind that draw on people’s will, and require eating less and moving more—rarely have a large or lasting effect. Indeed, America itself has suffered through a long, maddening history of failed attempts to change its habits on a national scale: a yo-yo diet of well-intentioned treatments, policies, and other social interventions that only ever lead us back to where we started

Through it all, obesity rates keep going up; the diabetes epidemic keeps worsening.

The most recent miracle, for Barb as well as for the nation, has come in the form of injectable drugs. In early 2021, the Danish pharmaceutical company Novo Nordisk published a clinical trial showing remarkable results for semaglutide, now sold under the trade names Wegovy and Ozempic.

Patients in the study who’d had injections of the drug lost, on average, close to 15 percent of their body weight—more than had ever been achieved with any other drug in a study of that size. Wadden knew immediately that this would be “an incredible revolution in the treatment of obesity.”

Many more drugs are now racing through development: survodutide, pemvidutide, retatrutide. (Among specialists, that last one has produced the most excitement: An early trial found an average weight loss of 24 percent in one group of participants.

In the United States, an estimated 189 million adults are classified as having obesity or being overweight

The drugs don’t work for everyone. Their major side effects—nausea, vomiting, and diarrhea—can be too intense for many patients. Others don’t end up losing any weight

For the time being, just 25 percent of private insurers offer the relevant coverage, and the cost of treatment—about $1,000 a month—has been prohibitive for many Americans.

The drugs have already been approved not just for people with diabetes or obesity, but for anyone who has a BMI of more than 27 and an associated health condition, such as high blood pressure or cholesterol. By those criteria, more than 140 million American adults already qualify

if this story goes the way it’s gone for other “risk factor” drugs such as statins and antihypertensives, then the threshold for prescriptions will be lowered over time, inching further toward the weight range we now describe as “normal.”

How you view that prospect will depend on your attitudes about obesity, and your tolerance for risk

The first GLP-1 drug to receive FDA approval, exenatide, has been used as a diabetes treatment for more than 20 years. No long-term harms have been identified—but then again, that drug’s long-term effects have been studied carefully only across a span of seven years

the data so far look very good. “These are now being used, literally, in hundreds of thousands of people across the world,” she told me, and although some studies have suggested that GLP-1 drugs may cause inflammation of the pancreas, or even tumor growth, these concerns have not borne out.

adolescents are injecting newer versions of these drugs, and may continue to do so every week for 50 years or more. What might happen over all that time?

“All of us, in the back of our minds, always wonder, Will something show up?  ” Although no serious problems have yet emerged, she said, “you wonder, and you worry.”

in light of what we’ve been through, it’s hard to see what other choices still remain. For 40 years, we’ve tried to curb the spread of obesity and its related ailments, and for 40 years, we’ve failed. We don’t know how to fix the problem. We don’t even understand what’s really causing it. Now, again, we have a new approach. This time around, the fix had better work.

The fen-phen revolution arrived at a crucial turning point for Wadden’s field, and indeed for his career. By then he’d spent almost 15 years at the leading edge of research into dietary interventions, seeing how much weight a person might lose through careful cutting of their calories.

But that sort of diet science—and the diet culture that it helped support—had lately come into a state of ruin. Americans were fatter than they’d ever been, and they were giving up on losing weight. According to one industry group, the total number of dieters in the country declined by more than 25 percent from 1986 to 1991.

Rejecting diet culture became something of a feminist cause. “A growing number of women are joining in an anti-diet movement,” The New York Times reported in 1992. “They are forming support groups and ceasing to diet with a resolve similar to that of secretaries who 20 years ago stopped getting coffee for their bosses.

Now Wadden and other obesity researchers were reaching a consensus that behavioral interventions might produce in the very best scenario an average lasting weight loss of just 5 to 10 percent

National surveys completed in 1994 showed that the adult obesity rate had surged by more than half since 1980, while the proportion of children classified as overweight had doubled. The need for weight control in America had never seemed so great, even as the chances of achieving it were never perceived to be so small.

Wadden wasn’t terribly concerned, because no one in his study had reported any heart symptoms. But ultrasounds revealed that nearly one-third of them had some degree of leakage in their heart valves. His “cure for obesity” was in fact a source of harm.

In December 1994, the Times ran an editorial on what was understood to be a pivotal discovery: A genetic basis for obesity had finally been found. Researchers at Rockefeller University were investigating a molecule, later named leptin, that gets secreted from fat cells and travels to the brain, and that causes feelings of satiety. Lab mice with mutations in the leptin gene—importantly, a gene also found in humans—overeat until they’re three times the size of other mice. “The finding holds out the dazzling hope,”

In April 1996, the doctors recommended yes: Dexfenfluramine was approved—and became an instant blockbuster. Patients received prescriptions by the hundreds of thousands every month. Sketchy wellness clinics—call toll-free, 1-888-4FEN-FEN—helped meet demand. Then, as now, experts voiced concerns about access. Then, as now, they worried that people who didn’t really need the drugs were lining up to take them. By the end of the year, sales of “fen” alone had surpassed $300 million.

It was nothing less than an awakening, for doctors and their patients alike. Now a patient could be treated for excess weight in the same way they might be treated for diabetes or hypertension—with a drug they’d have to take for the rest of their life.

the article heralded a “new understanding of obesity as a chronic disease rather than a failure of willpower.”

News had just come out that, at the Mayo Clinic in Minnesota, two dozen women taking fen-phen—including six who were, like Barb, in their 30s—had developed cardiac conditions. A few had needed surgery, and on the operating table, doctors discovered that their heart valves were covered with a waxy plaque.

Americans had been prescribed regular fenfluramine since 1973, and the newer drug, dexfenfluramine, had been available in France since 1985. Experts took comfort in this history. Using language that is familiar from today’s assurances regarding semaglutide and other GLP-1 drugs, they pointed out that millions were already on the medication. “It is highly unlikely that there is anything significant in toxicity to the drug that hasn’t been picked up with this kind of experience,” an FDA official named James Bilstad would later say in a Time cover story headlined “The Hot New Diet Pill.

“I know I can’t get any more,” she told Williams. “I have to use up what I have. And then I don’t know what I’m going to do after that. That’s the problem—and that is what scares me to death.” Telling people to lose weight the “natural way,” she told another guest, who was suggesting that people with obesity need only go on low-carb diets, is like “asking a person with a thyroid condition to just stop their medication.”

She’d gone off the fen-phen and had rapidly regained weight. “The voices returned and came back in a furor I’d never heard before,” Barb later wrote on her blog. “It was as if they were so angry at being silenced for so long, they were going to tell me 19 months’ worth of what they wanted me to hear. I was forced to listen. And I ate. And I ate. And ate.”

For Barb, rapid weight loss has brought on a different metaphysical confusion. When she looks in the mirror, she sometimes sees her shape as it was two years ago. In certain corners of the internet, this is known as “phantom fat syndrome,” but Barb dislikes that term. She thinks it should be called “body integration syndrome,” stemming from a disconnect between your “larger-body memory” and “smaller-body reality.

In 2003, the U.S. surgeon general declared obesity “the terror within, a threat that is every bit as real to America as the weapons of mass destruction”; a few months later, Eric Finkelstein, an economist who studies the social costs of obesity, put out an influential paper finding that excess weight was associated with up to $79 billion in health-care spending in 1998, of which roughly half was paid by Medicare and Medicaid. (Later he’d conclude that the number had nearly doubled in a decade.

In 2004, Finkelstein attended an Action on Obesity summit hosted by the Mayo Clinic, at which numerous social interventions were proposed, including calorie labeling in workplace cafeterias and mandatory gym class for children of all grades.

he message at their core, that soda was a form of poison like tobacco, spread. In San Francisco and New York, public-service campaigns showed images of soda bottles pouring out a stream of glistening, blood-streaked fat. Michelle Obama led an effort to depict water—plain old water—as something “cool” to drink.

Soon, the federal government took up many of the ideas that Brownell had helped popularize. Barack Obama had promised while campaigning for president that if America’s obesity trends could be reversed, the Medicare system alone would save “a trillion dollars.” By fighting fat, he implied, his ambitious plan for health-care reform would pay for itself. Once he was in office, his administration pulled every policy lever it could.

Michelle Obama helped guide these efforts, working with marketing experts to develop ways of nudging kids toward better diets and pledging to eliminate “food deserts,” or neighborhoods that lacked convenient access to healthy, affordable food. She was relentless in her public messaging; she planted an organic garden at the White House and promoted her signature “Let’s Move!” campaign around the country.

An all-out war on soda would come to stand in for these broad efforts. Nutrition studies found that half of all Americans were drinking sugar-sweetened beverages every day, and that consumption of these accounted for one-third of the added sugar in adults’ diets. Studies turned up links between people’s soft-drink consumption and their risks for type 2 diabetes and obesity. A new strand of research hinted that “liquid calories” in particular were dangerous to health.

when their field lost faith in low-calorie diets as a source of lasting weight loss, the two friends went in opposite directions. Wadden looked for ways to fix a person’s chemistry, so he turned to pharmaceuticals. Brownell had come to see obesity as a product of our toxic food environment: He meant to fix the world to which a person’s chemistry responded, so he started getting into policy.

The social engineering worked. Slowly but surely, Americans’ lamented lifestyle began to shift. From 2001 to 2018, added-sugar intake dropped by about one-fifth among children, teens, and young adults. From the late 1970s through the early 2000s, the obesity rate among American children had roughly tripled; then, suddenly, it flattened out.

although the obesity rate among adults was still increasing, its climb seemed slower than before. Americans’ long-standing tendency to eat ever-bigger portions also seemed to be abating.

sugary drinks—liquid candy, pretty much—were always going to be a soft target for the nanny state. Fixing the food environment in deeper ways proved much harder. “The tobacco playbook pretty much only works for soda, because that’s the closest analogy we have as a food item,

that tobacco playbook doesn’t work to increase consumption of fruits and vegetables, he said. It doesn’t work to increase consumption of beans. It doesn’t work to make people eat more nuts or seeds or extra-virgin olive oil.

Careful research in the past decade has shown that many of the Obama-era social fixes did little to alter behavior or improve our health. Putting calorie labels on menus seemed to prompt at most a small decline in the amount of food people ate. Employer-based wellness programs (which are still offered by 80 percent of large companies) were shown to have zero tangible effects. Health-care spending, in general, kept going up.

From the mid-1990s to the mid-2000s, the proportion of adults who said they’d experienced discrimination on account of their height or weight increased by two-thirds, going up to 12 percent. Puhl and others started citing evidence that this form of discrimination wasn’t merely a source of psychic harm, but also of obesity itself. Studies found that the experience of weight discrimination is associated with overeating, and with the risk of weight gain over time.

obesity rates resumed their ascent. Today, 20 percent of American children have obesity. For all the policy nudges and the sensible revisions to nutrition standards, food companies remain as unfettered as they were in the 1990s, Kelly Brownell told me. “Is there anything the industry can’t do now that it was doing then?” he asked. “The answer really is no. And so we have a very predictable set of outcomes.”

she started to rebound. The openings into her gastric pouch—the section of her stomach that wasn’t bypassed—stretched back to something like their former size. And Barb found ways to “eat around” the surgery, as doctors say, by taking food throughout the day in smaller portions

Bariatric surgeries can be highly effective for some people and nearly useless for others. Long-term studies have found that 30 percent of those who receive the same procedure Barb did regain at least one-quarter of what they lost within two years of reaching their weight nadir; more than half regain that much within five years.

if the effects of Barb’s surgery were quickly wearing off, its side effects were not: She now had iron, calcium, and B12 deficiencies resulting from the changes to her gut. She looked into getting a revision of the surgery—a redo, more or less—but insurance wouldn’t cover it

She found that every health concern she brought to doctors might be taken as a referendum, in some way, on her body size. “If I stubbed my toe or whatever, they’d just say ‘Lose weight.’ ” She began to notice all the times she’d be in a waiting room and find that every chair had arms. She realized that if she was having a surgical procedure, she’d need to buy herself a plus-size gown—or else submit to being covered with a bedsheet when the nurses realized that nothing else would fit.

Barb grew angrier and more direct about her needs—You’ll have to find me a different chair, she started saying to receptionists. Many others shared her rage. Activists had long decried the cruel treatment of people with obesity: The National Association to Advance Fat Acceptance had existed, for example, in one form or another, since 1969; the Council on Size &amp; Weight Discrimination had been incorporated in 1991. But in the early 2000s, the ideas behind this movement began to wend their way deeper into academia, and they soon gained some purchase with the public.

“Our public-health efforts to address obesity have failed,” Eric Finkelstein, the economist, told me.

Others attacked the very premise of a “healthy weight”: People do not have any fundamental need, they argued, morally or medically, to strive for smaller bodies as an end in itself. They called for resistance to the ideology of anti-fatness, with its profit-making arms in health care and consumer goods. The Association for Size Diversity and Health formed in 2003; a year later, dozens of scholars working on weight-related topics joined together to create the academic field of fat studies.

As the size-diversity movement grew, its values were taken up—or co-opted—by Big Business. Dove had recently launched its “Campaign for Real Beauty,” which included plus-size women. (Ad Age later named it the best ad campaign of the 21st century.) People started talking about “fat shaming” as something to avoid

By 2001, Bacon, who uses they/them pronouns, had received their Ph.D. and finished a rough draft of a book, Health at Every Size, which drew inspiration from a broader movement by that name among health-care practitioners

But something shifted in the ensuing years. In 2007, Bacon got a different response, and the book was published. Health at Every Size became a point of entry for a generation of young activists and, for a time, helped shape Americans’ understanding of obesity.

Some experts were rethinking their advice on food and diet. At UC Davis, a physiologist named Lindo Bacon who had struggled to overcome an eating disorder had been studying the effects of “intuitive eating,” which aims to promote healthy, sustainable behavior without fixating on what you weigh or how you look

The heightened sensitivity started showing up in survey data, too. In 2010, fewer than half of U.S. adults expressed support for giving people with obesity the same legal protections from discrimination offered to people with disabilities. In 2015, that rate had risen to three-quarters.

In Bacon’s view, the 2000s and 2010s were glory years. “People came together and they realized that they’re not alone, and they can start to be critical of the ideas that they’ve been taught,” Bacon told me. “We were on this marvelous path of gaining more credibility for the whole Health at Every Size movement, and more awareness.”

that sense of unity proved short-lived; the movement soon began to splinter. Black women have the highest rates of obesity, and disproportionately high rates of associated health conditions. Yet according to Fatima Cody Stanford, an obesity-medicine physician at Harvard Medical School, Black patients with obesity get lower-quality care than white patients with obesity.

That system was exactly what Bacon and the Health at Every Size movement had set out to reform. The problem, as they saw it, was not so much that Black people lacked access to obesity medicine, but that, as Bacon and the Black sociologist Sabrina Strings argued in a 2020 article, Black women have been “specifically targeted” for weight loss, which Bacon and Strings saw as a form of racism

But members of the fat-acceptance movement pointed out that their own most visible leaders, including Bacon, were overwhelmingly white. “White female dietitians have helped steal and monetize the body positive movement,” Marquisele Mercedes, a Black activist and public-health Ph.D. student, wrote in September 2020. “And I’m sick of it.”

Tensions over who had the standing to speak, and on which topics, boiled over. In 2022, following allegations that Bacon had been exploitative and condescending toward Black colleagues, the Association for Size Diversity and Health expelled them from its ranks and barred them from attending its events.

As the movement succumbed to in-fighting, its momentum with the public stalled. If attitudes about fatness among the general public had changed during the 2000s and 2010s, it was only to a point. The idea that some people can indeed be “fit but fat,” though backed up by research, has always been a tough sell.

Although Americans had become less inclined to say they valued thinness, measures of their implicit attitudes seemed fairly stable. Outside of a few cities such as San Francisco and Madison, Wisconsin, new body-size-discrimination laws were never passed.

In the meantime, thinness was coming back into fashion

In the spring of 2022, Kim Kardashian—whose “curvy” physique has been a media and popular obsession—boasted about crash-dieting in advance of the Met Gala. A year later, the model and influencer Felicity Hayward warned Vogue Business that “plus-size representation has gone backwards.” In March of this year, the singer Lizzo, whose body pride has long been central to her public persona, told The New York Times that she’s been trying to lose weight. “I’m not going to lie and say I love my body every day,” she said.

Among the many other dramatic effects of the GLP-1 drugs, they may well have released a store of pent-up social pressure to lose weight.

If ever there was a time to debate that impulse, and to question its origins and effects, it would be now. But Puhl told me that no one can even agree on which words are inoffensive. The medical field still uses obesity, as a description of a diagnosable disease. But many activists despise that phrase—some spell it with an asterisk in place of the e—and propose instead to reclaim fat.

Everyone seems to agree on the most important, central fact: that we should be doing everything we can to limit weight stigma. But that hasn’t been enough to stop the arguing.

Things feel surreal these days to just about anyone who has spent years thinking about obesity. At 71, after more than four decades in the field, Thomas Wadden now works part-time, seeing patients just a few days a week. But the arrival of the GLP-1 drugs has kept him hanging on for a few more years, he said. “It’s too much of an exciting period to leave obesity research right now.”

When everyone is on semaglutide or tirzepatide, will the soft-drink companies—Brownell’s nemeses for so many years—feel as if a burden has been lifted? “My guess is the food industry is probably really happy to see these drugs come along,” he said. They’ll find a way to reach the people who are taking GLP‑1s, with foods and beverages in smaller portions, maybe. At the same time, the pressures to cut back on where and how they sell their products will abate.

the triumph in obesity treatment only highlights the abiding mystery of why Americans are still getting fatter, even now

Perhaps one can lay the blame on “ultraprocessed” foods, he said. Maybe it’s a related problem with our microbiomes. Or it could be that obesity, once it takes hold within a population, tends to reproduce itself through interactions between a mother and a fetus. Others have pointed to increasing screen time, how much sleep we get, which chemicals are in the products that we use, and which pills we happen to take for our many other maladies.

“The GLP-1s are just a perfect example of how poorly we understand obesity,” Mozaffarian told me. “Any explanation of why they cause weight loss is all post-hoc hand-waving now, because we have no idea. We have no idea why they really work and people are losing weight.”

The new drugs—and the “new understanding of obesity” that they have supposedly occasioned—could end up changing people’s attitudes toward body size. But in what ways

When the American Medical Association declared obesity a disease in 2013, Rebecca Puhl told me, some thought “it might reduce stigma, because it was putting more emphasis on the uncontrollable factors that contribute to obesity.” Others guessed that it would do the opposite, because no one likes to be “diseased.”

why wasn’t there another kind of nagging voice that wouldn’t stop—a sense of worry over what the future holds? And if she wasn’t worried for herself, then what about for Meghann or for Tristan, who are barely in their 40s? Wouldn’t they be on these drugs for another 40 years, or even longer? But Barb said she wasn’t worried—not at all. “The technology is so much better now.” If any problems come up, the scientists will find solutions.

It’s dropping in developing countries, too. India surpassed China as the most populous country last year, yet its fertility is now below replacement.

“The demographic winter is coming,”

Smaller populations come with diminished global clout, raising questions in the U.S., China and Russia about their long-term standings as superpowers.

Some demographers think the world’s population could start shrinking within four decades—one of the few times it’s happened in history.

A year ago Japanese Prime Minister Fumio Kishida declared that the collapse of the country’s birthrate left it “standing on the verge of whether we can continue to function as a society.”

Had fertility stayed near 2.1, where it stood in 2007, the U.S. would have welcomed an estimated 10.6 million more babies since

In 2017, when the global fertility rate—a snapshot of how many babies a woman is expected to have over her lifetime—was 2.5, the United Nations thought it would slip to 2.4 in the late 2020s. Yet by 2021, the U.N. concluded, it was already down to 2.3—close to what demographers consider the global replacement rate of about 2.2

He has found that national birth registries are typically reporting births 10% to 20% below what the U.N. projected.

China reported 9 million births last year, 16% less than projected in the U.N.’s central scenario. In the U.S., 3.59 million babies were born last year, 4% less than the U.N. projected. In other countries, the undershoot is even larger: Egypt reported 17% fewer births last year. In 2022, Kenya reported 18% fewer.

In 2017 the U.N. projected world population, then 7.6 billion, would keep climbing to 11.2 billion in 2100. By 2022 it had lowered and brought forward the peak to 10.4 billion in the 2080s. That, too, is likely out of date

the University of Washington now thinks it will peak around 9.5 billion in 2061 then start declining.&nbsp;

The falling birthrates come with huge implications for the way people live, how economies grow and the standings of the world’s superpowers.

In the U.S., a short-lived pandemic baby boomlet has reversed. The total fertility rate fell to 1.62 last year, according to provisional government figures, the lowest on record.

In 2017, when the fertility rate was 1.8, the Census Bureau projected it would converge over the long run to 2.0. It has since revised that down to 1.5. “It has snuck up on us,”

Historians refer to the decline in fertility that began in the 18th century in industrializing countries as the demographic transition. As lifespans lengthened and more children survived to adulthood, the impetus for bearing more children declined. As women became better educated and joined the workforce, they delayed marriage and childbirth, resulting in fewer children.&nbsp;

Some demographers see this as part of a “second demographic transition,” a societywide reorientation toward individualism that puts less emphasis on marriage and parenthood, and makes fewer or no children more acceptable.&nbsp;

In research published in 2021, the University of Maryland’s Kearney and two co-authors looked for possible explanations for the continued drop. They found that state-level differences in parental abortion notification laws, unemployment, Medicaid availability, housing costs, contraceptive usage, religiosity, child-care costs and student debt could explain almost none of the decline

“We suspect that this shift reflects broad societal changes that are hard to measure or quantify,” they conclude.

while raising children is no more expensive than before, parents’ preferences and perceived constraints have changed

“If people have a preference for spending time building a career, on leisure, relationships outside the home, that’s more likely to come in conflict with childbearing.”&nbsp;

Once a low fertility cycle kicks in, it effectively resets a society’s norms and is thus hard to break, said Jackson. “The fewer children you see your colleagues and peers and neighbors having, it changes the whole social climate,”

Fertility is below replacement in India even though the country is still poor and many women don’t work—factors that usually sustain fertility.

Urbanization and the internet have given even women in traditional male-dominated villages a glimpse of societies where fewer children and a higher quality of life are the norm. “People are plugged into the global culture,

mothers and fathers, especially those that are highly educated, spend more time with their children than in the past. “The intensity of parenting is a constraint,”

Sub-Saharan Africa once appeared resistant to the global slide in fertility, but that too is changing. The share of all women of reproductive age using modern contraception grew from 17% in 2012 to 23% in 2022

Jose Rimon, a professor of public health at Johns Hopkins University, credits that to a push by national leaders in Africa which, he predicted, would drive fertility down faster than the U.N. projects.&nbsp;

Mae Mariyam Thomas, 38, who lives in Mumbai and runs an audio production company, said she’s opted against having children because she never felt the tug of motherhood. She sees peers struggling to meet the right person, getting married later and, in some instances, divorcing before they have kids. At least three of her friends have frozen their eggs,

Danielle Vermeer grew up third in a family of four children on Chicago’s North Side, where her neighborhood was filled with Catholics of Italian, Irish and Polish descent and half her close friends had as many siblings as her or more.

Her Italian-American father was one of four children who produced 14 grandchildren. Now her parents have five grandchildren, including Vermeer’s two children, ages 4 and 7.

The 35-year-old, who is the co-founder of a fashion thrifting app, said that before setting out to have children, she consulted dozens of other couples and her Catholic church and read at least eight books on the subject, including one by Pope Paul VI. She and her husband settled on two as the right number.“The act of bringing a child into this world is an incredible responsibility,” she said.

Perhaps no country has been trying longer than Japan. After fertility fell to 1.5 in the early 1990s, the government rolled out a succession of plans that included parental leave and subsidized child care. Fertility kept falling.