Assessing equity in health, wealth, and civic engagement: a nationally representative survey, United States, 2020.

BACKGROUND: The principle of equity is fundamental to many current debates about social issues and plays an important role in community and individual health. Traditional research has focused on singular dimensions of equity (e.g., wealth), and often lacks a comprehensive perspective. The goal of this study was to assess relationships among three domains of equity, health, wealth, and civic engagement, in a nationally representative sample of U.S. residents. METHODS: We developed a conceptual framework to guide our inquiry of equity across health, wealth, and civic engagement constructs to generate a broad but nuanced understanding of equity. Through Ipsos' KnowledgePanel service, we conducted a cross-sectional, online survey between May 29-June 20, 2020 designed to be representative of the adult U.S. POPULATION: Based on our conceptual framework, we assessed the population-weighted prevalence of health outcomes and behaviors, as well as measures of wealth and civic engagement. We linked individual-level data with population-level environmental and social context variables. Using structural equation modeling, we developed latent constructs for wealth and civic engagement, to assess associations with a measured health variable. RESULTS: We found that the distribution of sociodemographic, health, and wealth measures in our sample (n = 1267) were comparable to those from other national surveys. Our quantitative illustration of the relationships among the domains of health, wealth, and civic engagement provided support for the interrelationships of constructs within our conceptual model. Latent constructs for wealth and civic engagement were significantly correlated (p = 0.013), and both constructs were used to predict self-reported health. Beta coefficients for all indicators of health, wealth, and civic engagement had the expected direction (positive or negative associations). CONCLUSION: Through development and assessment of our comprehensive equity framework, we found significant associations among key equity domains. Our conceptual framework and results can serve as a guide for future equity research, encouraging a more thorough assessment of equity.

Associations among political voting preference, high-risk health status, and preventative behaviors for COVID-19.

BACKGROUND: We investigate the relationships among political preferences, risk for COVID-19 complications, and complying with preventative behaviors, such as social distancing, quarantine, and vaccination, as they remain incompletely understood. Since those with underlying health conditions have the highest mortality risk, prevention strategies targeting them and their caretakers effectively can save lives. Understanding caretakers' adherence is also crucial as their behavior affects the probability of transmission and quality of care, but is understudied. Examining the degree to which adherence to prevention measures within these populations is affected by their health status vs. voting preference, a key predictor of preventative behavior in the U. S, is imperative to improve targeted public health messaging. Knowledge of these associations could inform targeted COVID-19 campaigns to improve adherence for those at risk for severe consequences. METHODS: We conducted a nationally-representative online survey of U.S. adults between May-June 2020 assessing: 1) attempts to socially-distance; 2) willingness/ability to self-quarantine; and 3) intention of COVID-19 vaccination. We estimated the relationships between 1) political preferences 2) underlying health status, and 3) being a caretaker to someone with high-risk conditions and each dependent variable. Sensitivity analyses examined the associations between political preference and dependent variables among participants with high-risk conditions and/or obesity. RESULTS: Among 908 participants, 75.2% engaged in social-distancing, 94.4% were willing/able to self-quarantine, and 60.1% intended to get vaccinated. Compared to participants intending to vote for Biden, participants who intended to vote for Trump were significantly less likely to have tried to socially-distance, self-quarantine, or intend to be vaccinated. We observed the same trends in analyses restricted to participants with underlying health conditions and their caretakers Underlying health status was independently associated with social distancing among individuals with obesity and another high-risk condition, but not other outcomes. CONCLUSION: Engagement in preventative behavior is associated with political voting preference and not individual risk of severe COVID-19 or being a caretaker of a high-risk individual. Community based strategies and public health messaging should be tailored to individuals based on political preferences especially for those with obesity and other high-risk conditions. Efforts must be accompanied by broader public policy.

Arts, Culture, and Creativity as a Strategy for Countering the Negative Social Impacts of Immigration Stress and Gentrification.

Background. This article looks at the role that arts, culture, and creativity play in promoting social cohesion and community well-being. It presents research on the role that a community arts center plays in an ethnic enclave that is under stress of immigration and gentrification. Method. An academic-community research partnership conducted this research. A mixed-methods approach was used. Twenty-four interviews were conducted with stakeholders (including community leaders, neighborhood residents, and business owners). Surveys (n = 102) were done of community members and those who participate in the Center activities. Results. Interviewees and survey respondents point to the importance of the ethnic enclave as a close-knot community that helps to foster a sense of belonging, security, and cultural identity. Arts, culture, and creativity plays a role in maintaining this sense of social cohesion, despite the threat of gentrification. Engagement in the arts and creative practice are important for buffering the stress of immigration. Discussion. The center has an important role as a critical cultural, civic, and creative space for the neighborhood and the broader community who sees the ethnic enclave as their cultural home.

Multimodal Mental Practice Versus Repetitive Task Practice Only to Treat Chronic Stroke: A Randomized Controlled Pilot Study.

IMPORTANCE: Occupational therapists are the primary clinicians tasked with management of the more affected upper extremity (UE) after stroke. However, there is a paucity of efficacious, easy-to-use, inexpensive interventions to increase poststroke UE function. OBJECTIVE: To compare the effect of a multimodal mental practice (MMMP) regimen with a repetitive task practice (RTP)-only regimen on paretic UE functional limitation. DESIGN: Secondary analysis of randomized controlled pilot study data. SETTING: Outpatient clinical rehabilitation laboratory. PARTICIPANTS: Eighteen chronic stroke survivors exhibiting moderate, stable UE impairment. INTERVENTION: Participants administered RTP only participated in 45-min, one-on-one occupational therapy sessions 3 times per week for 10 wk; participants administered MMMP completed time-matched UE training sessions consisting of action observation, RTP, and mental practice, delivered in 15-min increments. Outcomes and Measures: The Action Research Arm Test, the UE section of the Fugl-Meyer Scale, and the Hand subscale of the Stroke Impact Scale (Version 3.0) were administered 1 wk before and 1 wk after intervention. RESULTS: The MMMP group exhibited significantly larger (p < .01) increases on all three outcome measures compared with the RTP group and surpassed minimal clinically important difference standards for all three UE outcome measures. CONCLUSIONS AND RELEVANCE: Because of the time-matched duration of MMMP and RTP, findings suggest that MMMP may be just as feasible as RTP to implement in clinical settings. Efforts to replicate results of this study in a large-scale trial are warranted. What This Article Adds: This study shows the efficacy of an easy-to-use protocol that significantly increased affected arm function even years after stroke.

"Reps" Aren't Enough: Augmenting Functional Electrical Stimulation With Behavioral Supports Significantly Reduces Impairment in Moderately Impaired Stroke.

OBJECTIVE: To determine the impact of repetitive task-specific practice (RTP) integrating electrical stimulation and behavioral supports on upper extremity (UE) impairment, gross manual dexterity, and paretic UE amount and quality of use in chronic stroke survivors exhibiting moderate, stable UE deficits. DESIGN: Case series with 3-month follow-up. SETTING: Outpatient rehabilitation hospital. PARTICIPANTS: Persons (N=9) who experienced a stroke >12 months before enrollment and exhibiting chronic, moderate, stable UE impairment. INTERVENTIONS: After administering outcome measures, RTP was administered 3d/wk for 120 minutes with an electrical stimulation neuroprosthesis (60min in a supervised clinical setting; 60min at home) over 8 weeks. Behavioral supports (eg, behavior contract; weekly reviews of UE use) were provided during clinical sessions and integrated into home exercise sessions to increase paretic UE use and maximize carryover to subjects' community environments. MAIN OUTCOME MEASURES: The UE section of the Fugl-Meyer Impairment Scale, the Box and Block Test, and the Motor Activity Log. RESULTS: Subjects exhibited statistically significant (P<.01) increases on all measures at both time-point comparisons (ie, preintervention to postintervention; preintervention to 3mo postintervention). Subjects reported a new ability to perform valued activities they had not performed in months. CONCLUSIONS: Addition of behavioral supports to RTP augmented by electrical stimulation significantly increased paretic UE use and function. Significant motor changes were exhibited across ages and etiologies, and no other intervention was administered to this stable population, making it likely that results were not due to chance and suggests a larger trial is justified.

Mental practice--triggered electrical stimulation in chronic, moderate, upper-extremity hemiparesis after stroke.

OBJECTIVE: To determine the feasibility and impact of home-based, mental practice-triggered electrical stimulation among stroke survivors exhibiting moderate upper-extremity (UE) impairment. METHOD: Five participants with moderate, stable UE hemiparesis were administered the Fugl-Meyer Assessment, the Box and Block Test, and the Activities of Daily Living, Hand Function, and overall recovery domains of the Stroke Impact Scale (Version 3). They were then administered an 8-wk regimen consisting of 1 hr of mental practice-triggered electrical stimulation every weekday in their home. At the end of every 2 wk, participants attended supervised stimulation to progress therapeutic exercises and stimulation levels and monitor compliance. RESULTS: Six instances of device noncompliance were reported. Participants exhibited reduced UE motor impairment and increased UE dexterity and participation in valued activities. CONCLUSION: The regimen appears feasible and had a substantial impact on UE impairment, dexterity, and participation in valued activities as well as perceptions of recovery.

Climate stress and anxiety, environmental context, and civic engagement: A nationally representative study.

There is increasing recognition that people are experiencing stress and anxiety around climate change, and that this climate stress/anxiety may be associated with more pro-environmental behavior. However, less is known about whether people's own environmental exposures affect climate stress/anxiety or the relationship between climate stress/anxiety and civic engagement. Using three waves of survey data (2020-2022) from the nationally representative Tufts Equity in Health, Wealth, and Civic Engagement Study of US adults (n = 1071), we assessed relationships among environmental exposures (county-level air pollution, greenness, number of toxic release inventory sites, and heatwaves), self-reported climate stress/anxiety, and civic engagement measures (canvasing behavior, collaborating to solve community problems, personal efficacy to solve community problems, group efficacy to solve community problems, voting behavior). Most participants reported experiencing climate stress/anxiety (61%). In general, the environmental exposures we assessed were not significantly associated with climate stress/anxiety or civic engagement metrics, but climate stress/anxiety was positively associated with most of the civic engagement outcomes (canvassing, personal efficacy, group efficacy, voter preference). Our results support the growing literature that climate stress/anxiety may spur constructive civic action, though do not suggest a consistent relationship between adverse environmental exposures and either climate stress/anxiety or civic engagement. Future research and action addressing the climate crisis should promote climate justice by ensuring mental health support for those who experience climate stress anxiety and by promoting pro-environmental civic engagement efforts.

Boredom at the border of philosophy: conceptual and ethical issues.

Boredom is a topic in philosophy. Philosophers have offered close descriptions of the experience of boredom that should inform measurement and analysis of empirical results. Notable historical authors include Seneca, Martin Heidegger, and Theodor Adorno; current philosophers have also contributed to the literature. Philosophical accounts differ in significant ways, because each theory of boredom is embedded in a broader understanding of institutions, ethics, and social justice. Empirical research and interventions to combat boredom should be conscious of those frameworks. Philosophy can also inform responses to normative questions, such as whether and when boredom is bad and whether the solution to boredom should involve changing the institutions that are perceived as boring, the ways that these institutions present themselves, or individuals' attitudes and choices.

Environmental equity and COVID-19 experiences in the United States: Results from three survey waves of a nationally representative study conducted between 2020-2022.

Certain environmental exposures, such as air pollution, are associated with COVID-19 incidence and mortality. To determine whether environmental context is associated with other COVID-19 experiences, we used data from the nationally representative Tufts Equity in Health, Wealth, and Civic Engagement Study data (n=1785; three survey waves 2020-2022). Environmental context was assessed using self-reported climate stress and county-level air pollution, greenness, toxic release inventory site, and heatwave data. Self-reported COVID-19 experiences included willingness to vaccinate against COVID-19, health impacts from COVID-19, receiving assistance for COVID-19, and provisioning assistance for COVID-19. Self-reported climate stress in 2020 or 2021 was associated with increased COVID-19 vaccination willingness by 2022 (odds ratio [OR] = 2.35; 95% confidence interval [CI] = 1.47, 3.76), even after adjusting for political affiliation (OR = 1.79; 95% CI = 1.09, 2.93). Self-reported climate stress in 2020 was also associated with increased likelihood of receiving COVID-19 assistance by 2021 (OR = 1.89; 95% CI = 1.29, 2.78). County-level exposures (i.e., less greenness, more toxic release inventory sites, more heatwaves) were associated with increased vaccination willingness. Air pollution exposure in 2020 was positively associated with likelihood of provisioning COVID-19 assistance in 2020 (OR = 1.16 per µg/m3; 95% CI = 1.02, 1.32). Associations between certain environmental exposures and certain COVID-19 outcomes were stronger among those who identify as a race/ethnicity other than non-Hispanic White and among those who reported experiencing discrimination; however, these trends were not consistent. A latent variable representing a summary construct for environmental context was associated with COVID-19 vaccination willingness. Our results add to the growing body of literature suggesting that intersectional equity issues affecting likelihood of exposure to adverse environmental conditions are also associated with health-related outcomes.

Health care supply and county-level variation in attention-deficit hyperactivity disorder prescription medications.

PURPOSE: Although much literature reports small-area variation in medication prescriptions used to treat attention-deficit hyperactivity disorder (ADHD), scant research has examined factors that may drive this variation. We examine, across counties in the USA, whether the use of prescription medications to treat ADHD varies positively with supply-side healthcare characteristics. METHODS: We retrieved annual prescription data for ADHD medications in 2734 US counties from a nationally representative sample of 35 000 pharmacies in 2001-2003. We used a county-level, multivariable fixed effects analysis to estimate the relation between annual changes in healthcare supply and ADHD medication prescriptions. Methods controlled for time-invariant factors unique to each county as well as ADHD prevalence. RESULTS: From 2001 to 2003, retail prescription purchases for ADHD medications increased 33.2%. In the multivariable analysis, ADHD medication prescriptions move positively with an increase in the concentration of total physicians. In addition, ADHD medication prescriptions move inversely with changes in the percentage of non-Hispanic Black population. CONCLUSIONS: Supply-side healthcare factors may contribute to the rise from 2001 to 2003 in ADHD medication prescriptions. This finding warrants attention because it implies that the relative capacity of the healthcare system may influence population prescription rates. We encourage further exploration of the contribution of the supply-side of the healthcare market to secular changes in ADHD medication prescriptions.

Psychometric properties and administration of the wrist/hand subscales of the Fugl-Meyer Assessment in minimally impaired upper extremity hemiparesis in stroke.

There is a need for time-efficient, valid measures of distal paretic upper extremity (UE) movement. The purposes of this study were to (1) determine the psychometric properties of the wrist stability and mobility and wrist/hand scale of the upper extremity Fugl-Meyer (w/h UE FM) as a "stand-alone" measure of distal UE movement; and (2) provide detailed instructions on w/h UE FM administration and scoring. The upper extremity Fugl Meyer (UE FM) and Action Research Arm Test (ARAT) were administered on 2 separate occasions to each of 29 subjects exhibiting stable, mild UE hemiparesis (23 men; mean age ± SD, 60.8±12.3 y; mean time since stroke onset for subjects in the sample, 36.0 mo). Fifty-eight observations were collected on each measure. w/h UE FM internal consistency levels (measured by Cronbach α) were high (.90 and .88 for first and second testing sessions, respectively). The intraclass correlation coefficient for the UE FM was .98, while the intraclass correlation coefficient for the w/h UE FM was .97. Concurrent validity measured by Spearman correlation was moderately high between the w/h UE FM and ARAT (.72, P<.001). From these data, it appears that the w/h UE FM is a promising tool to measure distal UE movement in minimally impaired stroke, although more research with a larger sample is needed. A standardized approach to UE test administration is critical to accurate score interpretation across patients and trials. Thus, the article also provides instructions and pictures for w/h UE FM administration and scoring.

Longer versus shorter daily durations of electrical stimulation during task-specific practice in moderately impaired stroke.

OBJECTIVE: To examine and compare efficacy of 30-, 60-, and 120-minute repetitive task-specific practice (RTP) sessions incorporating use of an electrical stimulation neuroprosthesis (ESN) on affected upper-extremity (UE) movement. DESIGN: Prospective, single-blinded, randomized controlled trial. SETTING: Outpatient rehabilitation hospital. PARTICIPANTS: Chronic stroke subjects (N=32) exhibiting moderate, stable affected UE motor deficits. INTERVENTIONS: Subjects participated in 30-, 60-, or 120-minute therapy sessions involving RTP incorporating the ESN, occurring every weekday for 8 weeks. During sessions, they wore the ESNs to enable performance of valued activities that they had identified. A fourth group participated in a 30-minute per weekday home exercise program. MAIN OUTCOME MEASURES: Outcomes were evaluated using the UE section of the Fugl-Meyer Assessment of Sensorimotor Impairment (FM), the Arm Motor Ability Test (AMAT), the Action Research Arm Test (ARAT), and Box and Block (B&B) 1 week before and 1 week after intervention. RESULTS: After intervention, subjects in the 120-minute condition were the only ones to exhibit significant score increases on the FM (P=.0007), AMAT functional ability scale (P=.002), AMAT quality of movement scale (P=.0002), and ARAT (P=.02). They also exhibited the largest changes in time to perform AMAT tasks and in B&B score, but these changes were nonsignificant, (P=.15 and P=.10, respectively). CONCLUSIONS: One hundred and twenty minutes a day of RTP augmented by ESN use elicits the largest and most consistent UE motor changes in moderately impaired stroke subjects.

Experiences with and impacts of the COVID-19 pandemic by substance use disorder in the early phase of pandemic in the United States: A cross-sectional survey, 2020.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic could disproportionately affect individuals who have a substance use disorder (SUD). However, little information exists on COVID-19-related experiences among individuals with a SUD. We examined whether individuals with a SUD differ from other individuals with regard to COVID-19 testing, susceptibility, and employment-related vulnerability. METHODS: We used data from a U.S. nationally representative survey (n = 1,208). Using logistic regressions, we examined whether individuals with SUDs differ from other individuals regarding underlying health conditions, COVID-19 testing, access to paid sick leave, and loss of employment. Data were collected in late May-early June, 2020. RESULTS: Four percent of participants reported that a healthcare professional had told them they had a SUD. We found that, compared to those without SUDs, respondents with SUDs had higher odds of having lost their job due to the pandemic (adjusted odds ratio [AOR]:5.17, 95% confidence interval [CI]:2.28-11.74). Among individuals who were employed prior to the pandemic, people with SUDs had lower odds of having paid sick leave (AOR:0.26, 95% CI:0.09-0.74). CONCLUSION: Our study indicates that individuals with SUDs could be disproportionately affected by COVID-19 economically, which might worsen SUD and racial/ethnic health disparities.

Portable neurorobotics for the severely affected arm in chronic stroke: a case study.

BACKGROUND AND PURPOSE: Few motor therapies increase active movement in the severely impaired arm of individuals with chronic stroke. Existing robotic devices to address this need are large and expensive. This case study describes the application and reports outcomes associated with a repetitive task-specific training (RTP) program incorporating a portable robotic device. We assessed outcomes related to affected arm impairment, ability to perform valued activities, satisfaction with movement performance, and quality of life in a participant with chronic stroke exhibiting severe arm hemiparesis. CASE DESCRIPTION: The participant was a 53-year-old man, 30 months after hemorrhagic stroke. At the time of enrollment, he exhibited some active shoulder and elbow flexion, but no active elbow extension, and no active movement at any joint below the elbow. INTERVENTION: The participant engaged in RTP incorporating a portable, electromyography-triggered neurorobotic device in 1-hour sessions, 3 days/week for 8 weeks using the affected arm. OUTCOMES: The upper extremity section of the Fugl-Meyer Impairment scale (FM), the Canadian Occupational Performance Measure (COPM), and the Stroke Impact Scale (SIS) were administered before and after training. After intervention, the subject exhibited reduced affected arm impairment (+2 points on the FM), increased ability to perform valued activities, increased satisfaction with performance of these activities (indicated by score increases of +2 and +1.8 points on the COPM Performance and Satisfaction scales, respectively), improved strength, performance of activities of daily living, hand function, participation, and physical function (as indicated by increases in respective SIS scores). DISCUSSION: The RTP incorporating the neurorobotic device appears promising. To our knowledge, this is the first study documenting a portable robotic-based RTP strategy in a person exhibiting this severity of hemiparesis.

Retention of motor changes in chronic stroke survivors who were administered mental practice.

OBJECTIVE: To determine retention of motor changes 3 months after participation in a regimen consisting of mental practice (MP) combined with repetitive task-specific (RTP) practice. DESIGN: Prospective, blinded, cohort, pre-post study. SETTING: Outpatient rehabilitation hospital. PARTICIPANTS: Individuals (N=21) in the chronic stage of stroke (mean age ± SD, 66.1 ± 8.1y; age range, 56-76y; mean time since stroke at study enrollment, 58.7mo; range, 13-129mo) exhibiting mild to moderate impairments of hand function. INTERVENTIONS: All individuals had been randomly assigned to receive a 10-week regimen consisting of MP emphasizing paretic upper extremity (UE) use during valued activities. Directly after each of these sessions, subjects were administered audiotaped MP. We assessed this group's paretic UE motor levels before, after, and 3 months after intervention. MAIN OUTCOME MEASURES: The UE section of the Fugl-Meyer Assessment of Sensorimotor Impairment (FM), the Action Research Arm Test (ARAT), the Arm Motor Ability Test (AMAT), and the Box and Block Test (BB). RESULTS: None of the scores significantly changed from the period directly after intervention to the 3-month posttesting period (FM: t=.817; ARAT: t=.923; AMAT: t=.898, t=.818, and t=.967 for the Functional Ability, Quality of Movement, and Time scales, respectively; BB: t=.892). CONCLUSIONS: Changes in paretic UE movement realized through MP combined with RTP (MP + RTP) participation are retained 3 months after the intervention has concluded. This is the first study examining retention of motor changes after MP + RTP participation, and one of only a few studies examining long retention of motor changes after any intervention targeting stroke-induced hemiparesis.

Longer versus shorter mental practice sessions for affected upper extremity movement after stroke: a randomized controlled trial.

OBJECTIVE: To evaluate and compare efficacy of 20-, 40-, and 60-minute mental practice sessions on affected upper extremity impairment and functional limitation. DESIGN: Randomized controlled study with multiple baseline design. SUBJECTS: Twenty-nine subjects with chronic stroke and exhibiting stable, mild hemiparesis. INTERVENTIONS: Subjects were given 30-minute rehabilitative sessions 3 days/week for 10 weeks, emphasizing affected upper extremity use during valued activities. Directly after these sessions, randomly selected subjects were given audiotaped mental practice for 20, 40, or 60 minutes. Subjects assigned to a control group received the same therapy as the mental practice groups, and an audiotaped sham intervention directly after therapy sessions. MAIN OUTCOME MEASURES: Fugl-Meyer (FM) motor assessment and Action Research Arm Test (ARAT). RESULTS: No pre-existing differences were found between groups on any demographic variable or movement scale. On the FM, mental practice duration significantly predicted pretesting to post change (P = 0.05), with increasing duration related to larger FM score increases (5.4 point score increase for the 60-minute duration group). On the ARAT, a non-significant trend was seen (P = 0.78), favoring the 20-minute dosing condition (4.5 point increase). Importantly, regardless of dosing condition, subjects administered mental practice exhibited markedly larger score changes on both the FM and ARAT than subjects not receiving mental practice. CONCLUSIONS: Sixty minutes of mental practice appears to most significantly reduce affected arm impairment. However, no clear change pattern was seen in affected arm functional limitation according to mental practice duration. Results suggest that a stroke rehabilitative regimen augmented by mental practice renders a greater functional impact than therapy only.

Game-based, portable, upper extremity rehabilitation in chronic stroke.

PURPOSE: This case series pilot study evaluates the efficacy of the Core:Tx gaming device on 2 chronic stroke survivors. METHODS: Intervention was provided 3 times a week for 3 weeks. Outcome measures, administered 1 week before and 1 week after intervention, included the Stroke Impact Scale (SIS), the Canadian Occupational Performance Measure (COPM), the Fugl-Meyer Assessment of Motor Recovery (Fugl-Meyer [FM]), and the Box and Block Test (BB). RESULTS: Participant A exhibited an 11-point increase on the SIS, a 1.2-point change on each of the performance and satisfaction scores of the COPM, a 1-point increase on the FM, and no change on the BB. Participant B exhibited a 3-point increase on the SIS and no change on the COPM, FM, or BB. CONCLUSIONS: The participants experienced increased quality of life, a greater propensity to use their affected arm, and enhanced task performance without exhibiting motor changes. Additionally, the Core:Tx gaming device was reported by the participants to be a motivating modality in the therapy setting.

Why protect civil liberties during a pandemic?

During a public health emergency, a government must balance public welfare, equity, individual rights, and democratic processes and norms. These goods may conflict. Although science has a role in informing wise policy, no empirical evidence or algorithm can determine how to balance competing goods under conditions of uncertainty. Especially in a crisis, it is crucial to have a broad and free conversation about public policy. Many countries are moving in the opposite direction. Sixty-one percent of governments have imposed at least some problematic restrictions on individual rights or democratic processes during the COVID-19 pandemic, and 17 have made substantial negative changes. The policies of Poland and Hungary reflect these global trends and continue these countries' recent histories of democratic erosion. The expertise of public health should be deployed in defense of civil liberties.

Does the Civic Renewal Movement Have a Future?

A civic ideal is an ideal of deliberative self-governance. People who participate in discussing what their own groups should do are being civic. Civic venues, institutions, and habits have waned since the mid-1990s. In the 1990s, a movement arose to restore them, under the banner of "civic renewal." This movement was carefully nonpartisan, often impartial about specific issues, and interested in creating alternative settings that could complement such basic political institutions as Congress and elections. As the condition of democracy has worsened in recent years, this approach looks inadequate or irrelevant. The most promising sources of civic renewal now are parties and social movements that have substantive agendas, such as racial justice, and that improve civic life as a collateral benefit.