Статті в журналах з теми "Community health services – great britain – finance"

BackgroundEpidemiological data on personality disorders, comorbidity and associated use of services are essential for health service policy.AimsTo measure the prevalence and correlates of personality disorder in a representative community sample.MethodThe Structured Clinical Interview for DSM-IV Axis II disorders was used to measure personality disorder in 626 persons aged 16-74 years in households in England, Scotland and Wales, in atwo-phase survey.ResultsThe weighted prevalence of personality disorder was 4.4% (95% CI 2.9-6.7). Rates were highest among men, separated and unemployed participants in urban locations. High use of healthcare services was confounded by comorbid mental disorder and substance misuse. Cluster B disorders were associated with early institutional care and criminality.ConclusionsPersonality disorder is common in the community especially in urban areas. Services are normally restricted to symptomatic, help-seeking individuals, but a vulnerable group with cluster B disorders can be identified early are in care during childhood and enter the criminal justice system when young. This suggests the need for preventive interventions at the public mental health level.

There has been much debate about effective treatments, service configurations and costs within Britain's mental health care system, but it has largely taken place in academic and management circles. We were interested in the views of those providing care. We organised a meeting of community psychiatric nurses, general practitioners and consultant psychiatrists (funded with an educational grant from Zeneca Pharmaceuticals). Participants worked in various parts of Great Britain, including rural and inner city areas. The authors facilitated the discussion, the emphasis of which was on participants' clinical experience.

In common with most modern industrial societies, Great Britain is facing the unique late 20th century phenomenon of rapidly increasing numbers of people, especially very elderly people, requiring health and social care. The response in Britain has been to search for ways to enlarge the caring capacity of the “community” and, thereby, reduce the demands on public health and social services. Similar policy responses have been developed in other capitalist societies such as Canada, France, and the United States. Although a policy of “community care”-the provision of state services in people's own homes-was followed by governments of both major British political parties over the postwar period, under the right wing neo-monetarist regime of the present Thatcher administration the locus of policy has shifted toward encouraging greater reliance on the informal support networks of kin, friends, and neighbors. The reasons for this sea-change are explored and the assumptions that these networks are “natural” and necessarily the proper matrix of care are examined critically. This analysis draws on the results of recent research which indicates that informal support networks have significant limitations and that a policy based on withdrawing public services in the hope that these networks will fill the growing care gap is likely to be counterproductive. In conclusion, the author indicates the areas where further research is required to provide a sound basis for policy.

In the 1980s, faced with a rapidly increasing elderly population and soaring costs of health and long-term care services, many European governments began to reexamine fiscal policies that often encouraged institutionalization of frail and dependent elders. A number of these countries have now turned to new models of home and community-based care. This report describes home care policies that serve the needs of frail elders in Sweden, Denmark, the Netherlands, and Great Britain, with special attention to experimental projects that have tested varying approaches for providing high quality, low-cost care in the home and in the community. The central governments in these countries have developed long-term care systems that improve quality of care, ensure more efficient delivery of services, and control or lower costs. They have (1) discouraged the building of additional nursing homes and instead supported the development and expansion of a range of housing alternatives; (2) shifted greater responsibility to local governments for delivering long-term care services, bringing those services closer to those who need them; (3) developed care management techniques that enable care providers to better target appropriate services to each elderly client; and (4) provided incentives for different types of care providers to coordinate their work, resulting in improved service delivery and greater client satisfaction.

Objective: Humane treatment and care of mentally ill people can be viewed from a historical perspective. Intramural (the institution) and extramural (the community) initiatives are not mutually exclusive. Method: The evolution of the psychiatric institution in Canada as the primary method of care is presented from an historical perspective. A province-by-province review of provisions for mentally ill people prior to asylum construction reveals that humanitarian motives and a growing sensitivity to social and medical problems gave rise to institutional psychiatry. The influence of Great Britain, France, and, to a lesser extent, the United States in the construction of asylums in Canada is highlighted. The contemporary redirection of the Canadian mental health system toward “dehospitalization” is discussed and delineated. Results: Early promoters of asylums were genuinely concerned with alleviating human suffering, which led to the separation of mental health services from the community and from those proffered to the criminal and indigent populations. While the results of the past institutional era were mixed, it is hoped that the “care” cycle will not repeat itself in the form of undesireable community alternatives. Conclusion: Severely psychiatrically disabled individuals can be cared for in the community if appropriate services exist.

Falls are common in late life. Evidence from New Zealand, the United States and Great Britain suggest that about a third of people aged over 65 will fall each year, a proportion that rises to about half for the community-dwelling population older than 85 years. Falls are the leading cause of death from injury in older people. Although many falls do not cause serious injury, nor precipitate referral to the health services for 30–50% of fallers, those that do have major consequences. From a purely financial perspective, acute care of those with falls is estimated to cost $10 billion per annum in the United States.

AimsMother and baby units (MBUs) are inpatient units where women with severe acute postpartum psychiatric problems can be cared for alongside their babies. This is currently considered to be gold-standard care, recognising the importance of early childhood bonding and family-centered care. Great Britain has spearheaded the development of the MBU, however the history of MBUs in the United Kingdom (UK) has never been published.MethodsThrough a narrative review of published and grey literature, we explore the development of the MBU in the UK, from its infancy to modern day.ResultsWe outline the history of the MBU model of care, from its early conception to current state. We also examine factors contributing towards the expansion of MBUs and more broadly, the expansion of perinatal mental health services throughout the UK. We also briefly describe the approach to MBUs worldwide, taking into consideration sociocultural differences and approaches to caring for the mother-baby dyad.ConclusionSince its conception, there has been considerable investment in and expansion of perinatal mental health services, both in community and inpatient settings. Sustained research and continued advocacy is required to expand provision of care.

The misuse of alcohol causes a range of health, legal, social and employment problems for the individual and the rest of society. Many agencies are involved in dealing with the consequences of alcohol misuse and providing services to those with problems. Sources of funds to finance interventions for drinkers whether from health authorities, social services, probation or other sources are very limited. Without some coordination there will be a tendency for each funder to shift responsibility and costs. These difficulties have been recognised and in 1989 a government health circular was issued emphasising the need for the development of local multi-agency alcohol misuse prevention strategies. Implementing policies such as community care and Health of the Nation also require multi-agency co-operation if they are to fulfil their aims. The survey of the development of local alcohol strategies reported in this paper (Wallace et al, 1993) is therefore of great interest.

Introduction. Higher medical education is one of the most sought-after and elite degrees worldwide. Systems of higher medical education differ from country to country, although they have certain features in common. Core differences are as follows: Training duration at various stages, contents of educational programs, learning technologies, etc. Much attention is paid to physicians training, which is determined by the high social significance of medical education. Aim: To provide an overview of the contemporary global trends in the development of higher medical education in the USA, Great Britain, France, and China. Materials and Methods. World literature was analyzed on trends in the development of higher medical education. Results and Discussion. Development of the healthcare system in the UK requires an integrated approach that considers various aspects in higher medical education, personnel policy, and workplace management. French healthcare system is experiencing various problems, such as the affordability of medical services and staffing shortages in remote regions. The Government of France shall continue to invest in healthcare and address the challenges to ensure universal access to quality medical services, including through its higher education system. US medical education keeps pace with the challenges healthcare systems are facing in the 21st century. To address today’s challenges, US medical education is taking a more interdisciplinary and inclusive approach, focusing on public health, interdisciplinary teamwork, and community-based training. Chinese medical universities pay more attention to practical skills and to integrating various disciplines in training, which allows graduates to be the best medical experts able to solve complex practical problems. Conclusions. Global trends identified herein in the development of higher medical education in the USA, Great Britain, France, and China require reflection, while the best practices should be introduced into the Russian system of higher education. However, approaches to be implemented should be first adapted to the historical, cultural, social, geographical, political, and other realities of Russia.

Introduction. Research into the sources of health care funding is necessary to develop an effective policy to improve the domestic health care system and improve the accessibility and quality of medical care. The purpose of the article is to assess the sources of funding of medical services in foreign countries and in Ukraine in order to identify and analise current trends and prospects for financing the domestic health care system in the implementation of health care reform. Results. An analysis of trends in the financing of health services in foreign countries has shown that there is a certain imbalance between the country's economic growth and its health care expenditures. The share of health services expenditures in GDP averaged 8.8 % or almost $ 4,000 per OECD citizen in 2018 y . This cost figure is 24 times higher than the per capita health care costs in Ukraine and can be a guide to the amount of funding for medicine in the world community. Citizens of OECD countries, unlike Ukrainians, pay an average of 21 % of all health care costs. The priority sources of funding for one group of countries are budget funds (Norway, Denmark, Sweden, Great Britain, Canada), and for another – compulsory health insurance (Germany, Japan, France, etc.). Сonclusion. Funds of the population are the main source of funding for medical services in Ukraine – 53 %. This indicator is critical for the country, as low-income citizens are unable to pay for medical care and the number of chronic diseases, disability and mortality are increased. The transformational reform of the health care system in Ukraine was started in 2015 and according to international experts is successful and meets international practices of accessibility, quality and efficiency of medical services. Further consistent implementation of health care reform can provide financial protection for the population from excessive out-of-pocket spending, improve access to health care, and improve public health.

The COVID-19 pandemic presented what, on both global and national levels, has arguably so far been the most extensive health, economic and social challenge of the 21st century. Responding to this challenge, it soon became clear that, while having a vital role in the contextual provision of necessary services, public authorities also needed to engage with organizations in the voluntary, community sector, including Faith-Based Organizations (FBOs). This article presents and discusses and analyzes a digest of research and resource evidence from the beginning of 2020–to the end of 2023 concerning the organizational, financial and human contributions of and impacts of the COVID-19 pandemic on, in particular, Christian FBOs in Great Britain. It goes on to analyze these contributions and impacts within the analytical framework of what it calls a wider “Christian ecology” as the context within which such FBOs live, to which they contribute, and, as argued by this review, apart from which they cannot be properly understood. Finally, in exploring some of the lessons to be learned from the evidence and analysis presented, the article identifies and considers some key opportunities and issues that arise at the interface between the work of (especially, but not only, Christian) FBOs and the structures and processes of the governmental powers-that-be.

ABSTRACTQuaternary deposits and landforms are an integral component of Scotland's geodiversity and natural heritage with intrinsic, scientific, educational, cultural, aesthetic and ecological values. Their conservation is founded on the assessment and safeguard of key protected areas principally for their scientific values. The evaluation of site networks for Quaternary deposits and landforms (including glacial, fluvial, coastal, mass movement, karst and cave features) has evolved since the late 1940s, culminating in the Great Britain Geological Conservation Review (GCR) site assessments undertaken principally between 1977 and the early 1990s. Significant scientific progress since then has arisen, for example, from re-investigation of existing sites and discoveries of new sites, developments in geochronology and the formulation and application of new concepts and models. Both the GCR site lists and the supporting site documentation now require updating in the light of this progress. Today there is greater emphasis on the wider, non-scientific values of geoconservation including, for example, on ecosystem services, links with biodiversity and cultural heritage, geotourism and the benefits for human health and wellbeing through improved understanding of dynamic landscapes, climate change and natural hazards. Involvement of wider public support beyond the geoscience community and fostering better integration of geoheritage within the developing nature conservation agenda, including a land systems approach, protected area planning and management, natural capital and connecting people and nature, will help further to protect our Quaternary geoheritage.

BackgroundTraditionally, the cost object in health care has been either a service line (e.g. orthopaedics) or a clinical intervention (e.g. hip replacement). In the mid-2000s, the Department of Health recommended that in the future the patient should be the cost object, to enable a better analysis of cost drivers in health care, resulting in patient-level information and costing systems (PLICSs). Monitor (the economic regulator for health care) proposes that PLICS data will now form the basis for mandatory prices for health-care services across all care settings.ObjectiveOur main aim was to investigate the use of PLICSs.MethodsWe surveyed all English foundation trusts and NHS trusts, and undertook four case studies of foundation trusts. Three trusts were generalist and one was specialist. We also surveyed commissioning support units to explore the potential for PLICSs in commissioning.FindingsThe most significant use of PLICSs was cost improvement within the trusts. There was only modest utilisation of PLICSs to allocate resources across services and settings. We found that trusts had separate reporting systems for costs and clinical outcomes, engendering little use for PLICSs to link cost with quality. Although there was significant potential for PLICSs in commissioning, 74% of survey respondents at trusts considered their PLICS data to be commercially sensitive and only 5% shared the data with commissioners. The use of PLICSs in community services was, generally, embryonic because of the absence of units of health care for which payment can be made, service definitions and robust data collection systems. The lack of PLICS data for community services, allied with the commercial sensitivity issue, resulted in little PLICS presence in collaborative cross-organisational initiatives, whether between trusts or across acute and community services. PLICS data relate to activities along the patient pathway. Such costs make sense to clinicians. We found that PLICSs had created greater clinical engagement in resource management despite the fact that the trust finance function had actively communicated PLICSs as a new costing tool and often required its use in, for example, business cases for clinical investment. Operational financial management at the trusts was undertaken through service line reporting (SLR) and traditional directorate budgets. PLICSs were considered more of a strategic tool.ConclusionsBoth PLICSs and SLR identify and interrogate service line profitability. Although trusts currently cross-subsidise to support loss-making areas under the tariff, they are actively considering disinvesting in unprofitable service lines. Financial pressure within the NHS, along with its current competitive, business-oriented ethos, induces trusts to act in their own interests rather than those of the whole health economy. However, many policy commentators suggest that care integration is needed to improve patient care and reduce costs. Although the Health and Social Care Act 2012 (Great Britain.Health and Social Care Act 2012. London: The Stationery Office; 2012) requires both competition and the collaboration needed to achieve care integration, the two are not always compatible. We conclude that competitive forces are dominant in driving the current uses of PLICSs. Future research should interrogate the use of PLICSs inNew Care Models – Vanguard Sites(NHS England.New Care Models – Vanguard Sites. NHS England; 2015) and initiatives to deliver the ‘Five Year Forward View’ (Monitor and NHS England.Reforming the Payment System for NHS Services: Supporting the Five Year Forward View. London: Monitor; 2015).FundingThe National Institute for Health Research Health Services and Delivery Research programme.

Background: Opioid use disorder (OUD) and its consequences have strained the resources of health, social, and criminal justice services in the Cincinnati region. However, understanding of the potential number of people suffering from OUD is limited. Little robust and reliable information quantifies the prevalence and there is often great variation between individual estimates of prevalence. In other fields such as meteorology, finance, sports, and politics, model averaging is commonly employed to improve estimates and forecasts. The objective of this study was to apply a model averaging approach to estimate the number of individuals with OUD in the Cincinnati region. Methods: Three individual probabilistic simulation models were developed to estimate the number of OUD individuals in the Cincinnati Core Based Statistical Area (CBSA). The models used counts of overdose deaths, non-fatal overdoses, and treatment admissions as benchmark data. A systematic literature review was performed to obtain the multiplier data for each model. The three models were averaged to generate single estimate and confidence band of the prevalence of OUD. Results: This study estimated 15 067 (SE 1556) individuals with OUD in the Cincinnati CBSA (2 165 139 total population). Based on these results, we estimate the prevalence of OUD to be between 13 507 (0.62% of population) and 16 620 (0.77% of population). Conclusions: The method proposed herein has been shown in diverse fields to mitigate some of the uncertainty associated with reliance on a single model. Further, the simplicity of the method described is easily replicable by community health centers, first-responders, and social services to estimate capacity needs supported by OUD estimates for the region they serve.

Is a new globalization possible after the first one runs out? Yes, because we need to accept that the miracle of globalization in Asia, which began under the impetus of the economic opportunities of capital that moved from the West to South and South-East Asia, cannot be reproduced elsewhere. Furthermore, this great event is coming to an end, as is shown by the political tensions that have arisen between the USA and China, as well as by the weakening of the development drive in China. After more than half a century of frantic progress, a strong global engine that brought people together. This does not mean that there is not already underway - although under observation - a revival which this time concerns and will involve the old continent and Africa, not under the guise of the past but with a new identity that aims to prevent young Africa from suffer the shame of a new neo-colonization. Even in the case in question, the driving force is the hesitation due to the colonial past of many European countries and the difficulties of the black continent in dealing with the moods of the financial markets and above all speculative capital with its own forces. But the potential of the African continent is exceptional in terms of natural resources. But it is necessary to overcome the obstacle of weak or very weak public services and the degradation of youth far from schools, of the population without adequate health services, of land management for the feeding needs of a growing, very young community which in 2050 it could represent 25% of the world population. To attenuate the memory of the colonial past, it is appropriate for Europe to present itself as a Union, that is, a new entity compared to the past and which meanwhile directs the resources of capital, experience, culture and science in a unitary way to provide the capital that is necessary for finance essential public services, food, school and health issues. That is, creating the conditions for the management of investment management to be carried out by local workers and specialists. It is an opportunity to advance in the name of direct democracy. in this sense it is proposed that the communities of Europe should initiate the relationship between communities between Europe and Africa with referendums.

Deferred taxes are an important object of accounting observation, which has a significant impact on management decision-making by users. At the current stage of development of accounting and tax accounting theory and practice, many aspects of tax effect recognition in the financial information system still remain debatable. This provides possibilities, including for accounting fraud, associated with veiling profit indicators and items in the enterprises’ financial statements. This causes the relevance of studying the essential features of deferred taxes, as well as the analysis of global experience in the assessment of arising “differences”, their classification, and accounting methods. The scientific novelty of the study lies in the development and substantiation of classification features of deferred taxes, including their systematization by methods of accounting, assessment and varieties. The paper characterizes the reason for accounting and taxation deviations, the evolution of the key deferred taxes types is described, the criteria for their registration in finance accounting are considered as the legislation in the USA, Great Britain, and other countries is improved. The paper defines the key challenges of accounting and estimation of deferred taxes, including the questions on theoretical inconsistency of deferred taxes with the concepts of assets and liabilities. The unresolved problems include the deferred tax depreciation procedure which is not regulated by the Russian accounting standards. In its turn, IFRS ascribes this procedure to the competence of the specialists who actively apply the method of creation (restoration) of valuation allowance for opportunistic purposes, which increases the importance of research in this area. The results of this work are useful for a wide range of experts specializing in the theory and practice of financial analysis, accounting and tax accounting and auditing and can serve as a basis for overcoming contradictions in the practice of deferred tax accounting. The prospects of the research lie in the empirical tests confirming the informational significance of deferred taxes in the financial statements of the Russian companies. What is more, the possible areas of scientific interest are the development of the accounting methods for deferred taxes depreciation and the connection of deferred taxes with bankruptcy and the company’s financial stability indicators. The growing attention of the academic community to deferred taxes could lead to the inclusion of a deferred taxes category in a comprehensive financial analysis of business activities.

Introduction. The problems of state and local governance in sparsely populated and rural areas is relevant for the Russian Federation due to the presence of depressed areas, depopulation of the countryside, small towns, monotowns, migration of the rural population to large cities, regional capitals, other regions and abroad. These processes are typical for many other modern states. Solving the problems of rural and sparsely populated areas includes providing socially significant services, protecting the health and safety of residents, developing education, creating and maintaining social infrastructure, and creating jobs. The purpose of the article is to identify the most important management problems in rural and sparsely populated areas and reveal possible solutions to these problems using the example of Great Britain. Methods. The research is based on a systematic approach to management in rural and sparsely populated areas. Analysis of factual data, legal sources, published survey results, foreign Internet sources. Comparative analysis of problems and measures of state policy in different states. Scientific novelty of the research. The author highlights the current measures taken in the UK at the central, local levels in order to overcome the problems of rural and sparsely populated areas. These activities as a basis for developing practical recommendations may be important for solving similar problems in Russian regions, including in the context of the COVID-19 epidemic and economic problems in the near future. Results. As a result the author identifies problems in the field of management in rural and sparsely populated and hard-to-reach areas, as well as possible directions of state policy in the UK and Russia to overcome these problems. Conclusions. The most important direction of state policy for solving the problems highlighted in the study is the development of local interests of the community, the integration of state support measures and local events. As measures aimed at solving social and infrastructural problems of sparsely populated areas in the UK, one can single out government programs implemented at the national and regional levels with the participation of industrial enterprises and businesses, a grant mechanism for the implementation of financial support, combined with the empowerment of local communities. There is no such policy in Russia yet.

Arthritis is the disease that kills the fewest but cripples the most. With the aging of the population in the United States and the antiquated DRG reimbursement system for hospital surgical intervention, it is inevitable that the Medicare assistant will bankrupt itself prior to the proposed bankruptcy date of 2026 if changes are not made. It may change would be to insist that the system in Maryland for reimbursement to hospitals for essential joint replacement surgery of the elderly be adapted nationwide. Medicaid expenditures are driven by a variety of factors, including the demand for care, the complexity of medical services provided, medical inflation, and life expectancy. The Medicare program has two separate trust funds – the Hospital Insurance (HI) Trust Fund and the Supplementary Medical Insurance (SMI) Trust Fund. Under the Hospital Insurance Trust, payroll taxes from workers and their employers go towards paying for the Part A benefits for today’s Medicare beneficiaries. In 2019, Medicare provided benefits to over 60 million elderly patients at an estimated cost of $796 billion [1]. While excluding the significant decrease in payroll taxes during the COVID-19 pandemic, the latest 2020 projections calculate Medicare Hospital Trust insolvency by 2026 [2]. The 2020 report declared that funds would be sufficient to pay for only 90 percent of Part A expenses at the time of this writing. Since inception, the Hospital Insurance Trust has never been insolvent, because there are no provisions in the Social Security Act that govern what would happen if insolvency were to occur. Ten of the last twelve years have witnessed expenditure outflows outpacing the Hospital Insurance Trust inflows, resulting in total Medicare spending obligations outpacing the increasing demands on the federal budget, as the number of elderly beneficiaries and the per capita health care costs continue to grow [2]. One of the principal goals of the following study is to determine how elderly patients, who often suffer from acute stages of arthritis and other orthopedic diseases, due in part to wear and tear, can continue to demand surgical intervention, in particular joint replacement surgery. Arthritis has been described as the disease that kills the fewest but cripples the most. With that in mind, the hospital systems ability to absorb the ever increasing number of elderly patients who demand joint replacement surgeries will continue to outstrip supply. The principal author of this study completed his PhD dissertation at the University of Manchester in 1977 by measuring the cost-benefit analysis of the treatment of chronic rheumatoid arthritis in Great Britain. Therefore, the author of this study aims to show the only reasonable method of payment for the imminent immeasurable demand for treatment for the elderly for age related diseases such as joint replacement surgery [3]. A recent Journal of Rheumatology article projects Medicare will finance approximately 2.67 million joint replacement surgeries by 2035, plus an additional 2.35 million joint replacement surgeries by the year 2040 [4]. The author believes that the current nationwide Diagnostic Related Groups (DRGs) system that helps determine how much Medicare pays the hospital for each “product” needs to be phased out as soon as possible. Our research shows that prior to Medicare implementing the DRGs payment system, Maryland proved that their total cost model of state-wide rewards and penalties compensated “efficient and effective” hospitals, providing care as defined by metrics set up by the Health Services Cost Review Commission (HSCRC). The Maryland legislature granted this independent government agency the broad powers to insulate the HSCRC from conflicts of interests, regulatory capture, and political meddling in the long term. In exchange, the HSCRC had the freedom to design a system that must deliver on three areas: cost reduction of hospital services, health improvement for all Maryland residents, and quality of life care improvements. Since inception of the HSCRC, all stakeholders are legally required to comply with robust auditing and data-submission requirements that allow the agency to collect data on the costs, patient volume, and financial condition of all inpatient, hospital-based outpatient, and emergency services in Maryland. This level of transparency allows the agency to set prices for hospital services, and hospitals must obey because it is Maryland law. Because of this methodology, HSCRC-approved average Maryland hospital markups ranged from 18 percent in 1980 to only 22 percent in 2008. During that same period, the average hospital markup nationally skyrocketed from 20 percent in 1980 to more than 187 percent in 2008 [5]. This strong evidence is the primary reason why the HSCRC has continued to receive a federal waiver from the Centers for Medicare and Medicaid Services, which requires both Medicare and Medicaid to pay the HSCRC-approved rates statewide. No discounts are given because of volume, nor any shifting of costs to other payers. There is a mandate: same price for the same service at the same hospital, no exceptions. Adjustments for uncompensated medical care are automatically bundled into the HSCRC-approved rates, as thus, this financial burden is shared by all hospitals in Maryland. This article explores the important milestones taken by the state of Maryland and how the lessons learned are responsible for the impressive results of their program today. This author believes that by applying the Maryland Total Cost of Care Model (Maryland TCOC Model) nationwide will yield financial savings of at least $227 billion by 2035, plus another $280 billion by 2040, exclusively from joint replacement surgeries reimbursed at HSCRC-approved rates and not any other method.

Income inequality in America has run a full circle, and has now touched or even exceeded the dizzying heights of income recorded in 1928 before the Geat Depression of 1929.On the other hand, the middle class has beeon undergoing a relentless economic squeeze since 1974. The median family income has literally been stagnant for almost half a century.Stagnant incomes do not fully reflect the decline in the standard of living of most Americans. Facing job insecurity, rising health-care costs, the massive $1.75 trillion college loan debt, credit has become a palliative of the middle class to address the deeper anxieties of downward mobility.Many are unable to fulfill the “American Dream” because they cannot afford the middle class standard of living: having a good job, being able to retire in security, owning a home, having affordable health care, and a better future for their children.This inequality is now so vast that it is almost twice as high as in Europe.In 2017, an American CEO’s pay went up 361-times the median pay of a worker—by far the widest gap in the world.Because of an incentuous relationship between Washington and Wall Street, we have a tax code that has been hatched to reward wealthy individuals and corporations.Some of the world’s richest men paid just a tiny fraction of their income in federal tax in 2021. For the first time Trump’s tax cuts helped billionaires pay less than the working class.Many large U.S.-based multinational corporations employ accounting tricks to make profits made in America appear as if they were generated in offshore tax havens—with minimal or no taxes. Thus by using such a clever maneuver, multinationals are able to avoid paying an estimated $90 billion in federal income taxes each year,Encouraged by the Friedman doctrine, the 1970s represented a turning point when America took a sharp turn toward unfettered capitalism—and greed. American CEOs set themselves upon a journey toward maximizing shareholder value. And it is this radical ideology that has guided Ameican business over the last fifty years.This is a mind-set that encourages risk aversion and short-run behavior: an accountant’s short-cut to profits, with a focus on cost reduction, rather than long-term concerns about innovation, quality, and customer satisfaction. And it is this journey that has contributed so much to America’s industrial decline.A key development that has accelerated this decline is the financialization of America. In recent decades, the share of financial services has been about 7-8% of GDP. However, in sharp contrast, the sector accounts for 25-30% of all corporate profits. Yet, the sector has created only 4% of all jobs.In 1999 and 2000 America went through a massive deregulation of the financial markets, which proved to be disasterous, because it led--in 2008--to the worst stock-market crash in America since the Great Depression of 1929.Finance and its way of thinking have now come to permeate every facet of business, so much so that Wall Street is no longer supporting Main Street businesses that create jobs for the masses.As a result of this“cognitive capture,” while the policy decisions taken after 2008 crash resulted in huge gains for the financial industry, but losses for homeowners, small businesses, workers, and consumers. One of most depressing aftermaths of this crisis was that it wiped out $16 trillion in household wealth.The wealthy have compounded their wealth by stifling true, dynamic capitalism and making America no longer the land of opportunity that it once was. They have made America the most unequal, advanced industrial country while crippling growth, distorting key policy debates, and fomenting a divided society.The objective of this paper is to develop a federal-tax framework. Taxation is as much a political as an economic issue. There are two visions or schools of federal taxation. While one is grounded in lower taxes for the wealthy and the corporations; the other’s calling card is community: and shared prosperity. These two schools can be described as: (1) The School for the “Rich and the Privileged,” and (2) The School for the “Masses.”The former consists of three groups: (a)“Trickle-down” Economics; (b)“Supply-side Economics;” and (c)“Meritocracy” or the “Job Creators.”The latter has just one group: “Progressive Taxation.”We believe that a good way to judge the merits of the two schools of thought is to see their historic track record. So we looked at the economic history of America over the entire twentieth century. Economist John Kenneth Galbraith has called the “trickle-down” economics as the “horse-and-sparrow” theory. David Bradley argues, that another name for this theory should be “horse shit” economics.The “trickle-down” idea has a long pedigree, and has long been discredited. This is because higher inequality has not only not produced more growth, but, the median family income in America has been stagnant for almost a half century.The idea of “supply-side” economics was proposed under Ronald Reagan. This was based on the notion that emphasized deregulation and tax cuts: with the argument that this would free up the economy that would then lead to increase in the supply of goods and services—as well as incomes of individuals.This policy was in direct contradiction to Keynesian economic theory, according to which, aggregate demand--not supply--is the driving force in an economy.However, the idea did not work for Reagan. Neither did it work for Gorge W. Bush.Supporters of meritocracy try to peddle the myths that we are living in a meritocracy, in which great wealth is both earned and deserved. But what if the rich derive much of their income not from work they perform, but from the assets they own? Moreover, what if great wealth increasingly comes not from enterprise, but from inheritance?Presidential candidate Mitt Romney--and President, Bain Capital, a private equity firm--argued that 47 percent of Americans were paying no income tax. He said they were freeloaders because they were living off of government handouts. Ironically, Romney paid only 14% of his reported income as federal income tax in 2011: which is far less than what people with substantially less income paid. Second, the source of his income was Bain Capital. The private equity firms, like Bain Capital, are associated with offshore bank accounts and big corporate buyouts. In these buyouts, previously healthy firms are loaded up with debt, stripped of their assets, with mass layoffs, and after milking the firm’s assets are sold to the highest bidder.So, the reality is that it is people like Romney who are the real freeloaders.An important distinction we need to make is to recognize the difference between “Takers”: those stifling job creation, versus “Makers:” businesses that create real jobs.Finally, our analysis revealed that the “Rich and Priviledged” school consistently offered false promises that failed to materialize, but instead, produced big deficits. The birthplace of freedom—and progressive taxation--happens to be President FDR’s America. The years 1947-1973 are considered the golden years of America’s middle class. The foundation of this goldilocks economy was the social covenant of shared prosperity, based on President Kennedy’s dictum--that “a rising tide lifts all boats.” Its main features were: powerful unions, a high minimum wage, progressive taxation, and corporations providing health and retirement benefits.

Covid 19 – living the experience As I sit at my desk at home in suburban Brisbane, following the dictates on self-isolation shared with so many around the world, I am forced to contemplate the limits of human prediction. I look out on a world which few could have predicted six months ago. My thoughts at that time were all about 2020 as a metaphor for perfect vision and a plea for it to herald a new period of clarity which would arm us in resolving the whole host of false divisions that surrounded us. False, because so many appear to be generated by the use of polarised labelling strategies which sought to categorise humans by a whole range of identities, while losing the essential humanity and individuality which we all share. This was a troublesome trend and one which seemed reminiscent of the biblical tale concerning the tower of Babel, when a single unified language was what we needed to create harmony in a globalising world. However, yesterday’s concerns have, at least for the moment, been overshadowed by a more urgent and unifying concern with humanity’s health and wellbeing. For now, this concern has created a world which we would not have recognised in 2019. We rely more than ever on our various forms of electronic media to beam instant shots of the streets of London, New York, Berlin, Paris, Hong Kong etc. These centres of our worldly activity normally characterised by hustle and bustle, are now serenely peaceful and ordered. Their magnificent buildings have become foregrounded, assuming a dignity and presence that is more commonly overshadowed by the mad ceaseless scramble of humanity all around them. From there however the cameras can jump to some of the less fortunate areas of the globe. These streets are still teeming with people in close confined areas. There is little hope here of following frequent extended hand washing practices, let alone achieving the social distance prescribed to those of us in the global North. From this desk top perspective, it has been interesting to chart the mood as the crisis has unfolded. It has moved from a slightly distant sense of superiority as the news slowly unfolded about events in remote Wuhan. The explanation that the origins were from a live market, where customs unfamiliar to our hygienic pre-packaged approach to food consumption were practised, added to this sense of separateness and exoticism surrounding the source and initial development of the virus. However, this changed to a growing sense of concern as its growth and transmission slowly began to reveal the vulnerability of all cultures to its spread. At this early stage, countries who took steps to limit travel from infected areas seemed to gain some advantage. Australia, as just one example banned flights from China and required all Chinese students coming to study in Australia to self-isolate for two weeks in a third intermediate port. It was a step that had considerable economic costs associated with it. One that was vociferously resisted at the time by the university sector increasingly dependent on the revenue generated by servicing Chinese students. But it was when the epicentre moved to northern Italy, that the entire messaging around the event began to change internationally. At this time the tone became increasingly fearful, anxious and urgent as reports of overwhelmed hospitals and mass burials began to dominate the news. Consequently, governments attracted little criticism but were rather widely supported in the action of radically closing down their countries in order to limit human interaction. The debate had become one around the choice between health and economic wellbeing. The fact that the decision has been overwhelmingly for health, has been encouraging. It has not however stopped the pressure from those who believe that economic well-being is a determinant of human well-being, questioning the decisions of politicians and the advice of public health scientists that have dominated the responses to date. At this stage, the lives versus livelihoods debate has a long way still to run. Of some particular interest has been the musings of the opinion writers who have predicted that the events of these last months will change our world forever. Some of these predictions have included the idea that rather than piling into common office spaces working remotely from home and other advantageous locations will be here to stay. Schools and universities will become centres of learning more conveniently accessed on-line rather than face to face. Many shopping centres will become redundant and goods will increasingly be delivered via collection centres or couriers direct to the home. Social distancing will impact our consumption of entertainment at common venues and lifestyle events such as dining out. At the macro level, it has been predicted that globalisation in its present form will be reversed. The pandemic has led to actions being taken at national levels and movement being controlled by the strengthening and increased control of physical borders. Tourism has ground to a halt and may not resume on its current scale or in its present form as unnecessary travel, at least across borders, will become permanently reduced. Advocates of change have pointed to some of the unpredicted benefits that have been occurring. These include a drop in air pollution: increased interaction within families; more reading undertaken by younger adults; more systematic incorporation of exercise into daily life, and; a rediscovered sense of community with many initiatives paying tribute to the health and essential services workers who have been placed at the forefront of this latest struggle with nature. Of course, for all those who point to benefits in the forced lifestyle changes we have been experiencing, there are those who would tell a contrary tale. Demonstrations in the US have led the push by those who just want things to get back to normal as quickly as possible. For this group, confinement at home creates more problems. These may be a function of the proximity of modern cramped living quarters, today’s crowded city life, dysfunctional relationships, the boredom of self-entertainment or simply the anxiety that comes with an insecure livelihood and an unclear future. Personally however, I am left with two significant questions about our future stimulated by the events that have been ushered in by 2020. The first is how is it that the world has been caught so unprepared by this pandemic? The second is to what extent do we have the ability to recalibrate our current practices and view an alternative future? In considering the first, it has been enlightening to observe the extent to which politicians have turned to scientific expertise in order to determine their actions. Terms like ‘flattening the curve’, ‘community transmission rates’, have become part of our daily lexicon as the statistical modellers advance their predictions as to how the disease will spread and impact on our health systems. The fact that scientists are presented as the acceptable and credible authority and the basis for our actions reflects a growing dependency on data and modelling that has infused our society generally. This acceptance has been used to strengthen the actions on behalf of the human lives first and foremost position. For those who pursue the livelihoods argument even bigger figures are available to be thrown about. These relate to concepts such as numbers of jobless, increase in national debt, growth in domestic violence, rise in mental illness etc. However, given that they are more clearly estimates and based on less certain assumptions and variables, they do not at this stage seem to carry the impact of the data produced by public health experts. This is not surprising but perhaps not justifiable when we consider the failure of the public health lobby to adequately prepare or forewarn us of the current crisis in the first place. Statistical predictive models are built around historical data, yet their accuracy depends upon the quality of those data. Their robustness for extrapolation to new settings for example will differ as these differ in a multitude of subtle ways from the contexts in which they were initially gathered. Our often uncritical dependence upon ‘scientific’ processes has become worrying, given that as humans, even when guided by such useful tools, we still tend to repeat mistakes or ignore warnings. At such a time it is an opportunity for us to return to the reservoir of human wisdom to be found in places such as our great literature. Works such as The Plague by Albert Camus make fascinating and educative reading for us at this time. As the writer observes Everybody knows that pestilences have a way of recurring in the world, yet somehow, we find it hard to believe in ones that crash down on our heads from a blue sky. There have been as many plagues as wars in history, yet always plagues and wars take people equally by surprise. So it is that we constantly fail to study let alone learn the lessons of history. Yet 2020 mirrors 1919, as at that time the world was reeling with the impact of the Spanish ‘Flu, which infected 500 million people and killed an estimated 50 million. This was more than the 40 million casualties of the four years of the preceding Great War. There have of course been other pestilences since then and much more recently. Is our stubborn failure to learn because we fail to value history and the knowledge of our forebears? Yet we can accept with so little question the accuracy of predictions based on numbers, even with varying and unquestioned levels of validity and reliability. As to the second question, many writers have been observing some beneficial changes in our behaviour and our environment, which have emerged in association with this sudden break in our normal patterns of activity. It has given us the excuse to reevaluate some of our practices and identify some clear benefits that have been occurring. As Australian newspaper columnist Bernard Salt observes in an article titled “the end of narcissism?” I think we’ve been re-evaluating the entire contribution/reward equation since the summer bushfires and now, with the added experience of the pandemic, we can see the shallowness of the so-called glamour professions – the celebrities, the influencers. We appreciate the selflessness of volunteer firefighters, of healthcare workers and supermarket staff. From the pandemic’s earliest days, glib forays into social media by celebrities seeking attention and yet further adulation have been met with stony disapproval. Perhaps it is best that they stay offline while our real heroes do the heavy lifting. To this sad unquestioning adherence to both scientism and narcissism, we can add and stir the framing of the climate rebellion and a myriad of familiar ‘first world’ problems which have caused dissension and disharmony in our communities. Now with an external threat on which to focus our attention, there has been a short lull in the endless bickering and petty point scoring that has characterised our western liberal democracies in the last decade. As Camus observed: The one way of making people hang together is to give ‘em a spell of the plague. So, the ceaseless din of the topics that have driven us apart has miraculously paused for at least a moment. Does this then provide a unique opportunity for us together to review our habitual postures and adopt a more conciliatory and harmonious communication style, take stock, critically evaluate and retune our approach to life – as individuals, as nations, as a species? It is not too difficult to hypothesise futures driven by the major issues that have driven us apart. Now, in our attempts to resist the virus, we have given ourselves a glimpse of some of the very things the climate change activists have wished to happen. With few planes in the air and the majority of cars off the roads, we have already witnessed clearer and cleaner air. Working at home has freed up the commuter driven traffic and left many people with more time to spend with their family. Freed from the continuing throng of tourists, cities like Venice are regenerating and cleansing themselves. This small preview of what a less travelled world might start to look like surely has some attraction. But of course, it does not come without cost. With the lack of tourism and the need to work at home, jobs and livelihoods have started to change. As with any revolution there are both winners and losers. The lockdown has distinguished starkly between essential and non-essential workers. That represents a useful starting point from which to assess what is truly of value in our way of life and what is peripheral as Salt made clear. This is a question that I would encourage readers to explore and to take forward with them through the resolution of the current situation. However, on the basis that educators are seen as providing essential services, now is the time to turn to the content of our current volume. Once again, I direct you to the truly international range of our contributors. They come from five different continents yet share a common focus on one of the most popular of shared cultural experiences – sport. Unsurprisingly three of our reviewed papers bring different insights to the world’s most widely shared sport of all – football, or as it would be more easily recognised in some parts of the globe - soccer. Leading these offerings is a comparison of fandom in Australia and China. The story presented by Knijnk highlights the rise of the fanatical supporters known as the ultras. The origin of the movement is traced to Italy, but it is one that claims allegiances now around the world. Kniijnk identifies the movement’s progression into Australia and China and, in pointing to its stance against the commercialisation of their sport by the scions of big business, argues for its deeper political significance and its commitment to the democratic ownership of sport. Reflecting the increasing availability and use of data in our modern societies, Karadog, Parim and Cene apply some of the immense data collected on and around the FIFA World Cup to the task of selecting the best team from the 2018 tournament held in Russia, a task more usually undertaken by panels of experts. Mindful of the value of using data in ways that can assist future decision making, rather than just in terms of summarising past events, they also use the statistics available to undertake a second task. The second task was the selection of the team with the greatest future potential by limiting eligibility to those at an early stage in their careers, namely younger than 28 and who arguably had still to attain their prime as well as having a longer career still ahead of them. The results for both selections confirm how membership of the wealthy European based teams holds the path to success and recognition at the global level no matter what the national origins of players might be. Thirdly, taking links between the sport and the world of finance a step further, Gomez-Martinez, Marques-Bogliani and Paule-Vianez report on an interesting study designed to test the hypothesis that sporting success within a community is reflected in positive economic outcomes for members of that community. They make a bold attempt to test their hypothesis by examining the relationship of the performance of three world leading clubs in Europe - Bayern Munich, Juventus and Paris Saint Germain and the performance of their local stock markets. Their findings make for some interesting thoughts about the significance of sport in the global economy and beyond into the political landscape of our interconnected world. Our final paper comes from Africa but for its subject matter looks to a different sport, one that rules the subcontinent of India - cricket. Norrbhai questions the traditional coaching of batting in cricket by examining the backlift techniques of the top players in the Indian Premier league. His findings suggest that even in this most traditional of sports, technique will develop and change in response to the changing context provided by the game itself. In this case the context is the short form of the game, introduced to provide faster paced entertainment in an easily consumable time span. It provides a useful reminder how in sport, techniques will not be static but will continue to evolve as the game that provides the context for the skilled performance also evolves. To conclude our pages, I must apologise that our usual book review has fallen prey to the current world disruption. In its place I would like to draw your attention to the announcement of a new publication which would make a worthy addition to the bookshelf of any international sports scholar. “Softpower, Soccer, Supremacy – The Chinese Dream” represents a unique and timely analysis of the movement of the most popular and influential game in the world – Association Football, commonly abbreviated to soccer - into the mainstream of Chinese national policy. The editorial team led by one of sports histories most recognised scholars, Professor J A Mangan, has assembled a who’s who of current scholars in sport in Asia. Together they provide a perspective that takes in, not just the Chinese view of these important current developments but also, the view of others in the geographical region. From Japan, Korea and Australia, they bring with them significant experience to not just the beautiful game, but sport in general in that dynamic and fast-growing part of the world. Particularly in the light of the European dominance identified in the Karog, Parim and Cene paper this work raises the question as to whether we can expect to see a change in the world order sooner rather than later. It remains for me to make one important acknowledgement. In my last editorial I alerted you to the sorts of decisions we as an editorial and publication team were facing with regard to ensuring the future of the journal. Debates as to how best to proceed while staying true to our vision and goals are still proceeding. However, I am pleased to acknowledge the sponsorship provided by The University of Macao for volume 42 and recognise the invaluable contribution made by ISCPES former president Walter Ho to this process. Sponsorship can provide an important input to the ongoing existence and strength of this journal and we would be interested in talking to other institutions or groups who might also be interested in supporting our work, particularly where their goals align closely with ours. May I therefore commend to you the works of our international scholars and encourage your future involvement in sharing your interest in and expertise with others in the world of comparative and international sport studies, John Saunders, Brisbane, May 2020

The COVID-19 crisis led to a great pressure on the world governments’ fiscal budgets as governments scramble to find new ways to finance and expand social protection and health programs. In order to provide for their populace, many Islamic countries had to pursue loans from international institutions, these loans have been observed to be followed by a phase of austerity that effects the access of the populace into health and education services. In this paper, the researchers seek to put forward a number of fiscal policies to finance the fiscal needs of the countries inside the Organization of Islamic Cooperation (OIC) by utilizing countries’ own internal resources. By surveying the fiscal tools used by past Islamic empires during the times of plague and famine we find that past Islamic empires used different policies that shared a distinctive characteristic, this characteristic is the voluntary and mandatory just redistribution of resources. Based on this concept, the researchers recommend the redistribution of the community resources through the early payment of zakat, extrabudgetary funds, wealth tax and the utilization of excess bank reserves.

Background: Opioid use disorder (OUD) and its consequences have strained the resources of health, social, and criminal justice services in the Cincinnati region. However, understanding of the potential number of people suffering from OUD is limited. Little robust and reliable information quantifies the prevalence and there is often great variation between individual estimates of prevalence. In other fields such as meteorology, finance, sports, and politics, model averaging is commonly employed to improve estimates and forecasts. The objective of this study was to apply a model averaging approach to estimate the number of individuals with OUD in the Cincinnati region. Methods: Three individual probabilistic simulation models were developed to estimate the number of OUD individuals in the Cincinnati Core Based Statistical Area (CBSA). The models used counts of overdose deaths, non-fatal overdoses, and treatment admissions as benchmark data. A systematic literature review was performed to obtain the multiplier data for each model. The three models were averaged to generate single estimate and confidence band of the prevalence of OUD. Results: This study estimated 15 067 (SE 1556) individuals with OUD in the Cincinnati CBSA (2 165 139 total population). Based on these results, we estimate the prevalence of OUD to be between 13 507 (0.62% of population) and 16 620 (0.77% of population). Conclusions: The method proposed herein has been shown in diverse fields to mitigate some of the uncertainty associated with reliance on a single model. Further, the simplicity of the method described is easily replicable by community health centers, first-responders, and social services to estimate capacity needs supported by OUD estimates for the region they serve.

The reform of the medical industry, the problems of medical care that arose in Ukraine in connection with the Covid-19 pandemic and led to a deterioration in the physical, psychological and social well-being of the population, sharply raised the question of the work of the medical industry and the directions for its improvement. In many countries of the world one of the ways to improve the quality of medical services is the implementation of social work in the medical industry.The article is devoted to the analysis of foreign experience of social work in the health care system, the roots of which are deeply connected with the development of modern public health in many countries of the world. Today, many social workers around the world practice health care, drawing on the historical experience of combining clinical, intermediate and population-based approaches to have a greater impact on health. However, the historical significance of this long-standing interdisciplinary collaboration and its implications remain poorly understood. The article is based on primary and modern sources of research on the history of the development of social work in the field of health care, demonstrates examples of successful cooperation between social and medical workers. The main historical stages of the development of social work in the field of health care in the USA, France, Canada, Great Britain, Bulgaria, etc. are considered. The article concludes that despite the temporal, geographical, economic, political, cultural and other differences, social work in the field of health care as an independent professional activity in different countries has common features: a focus on overcoming barriers in the environment for achieving health by individuals, their families, groups and communities; assistance in attracting resources to achieve full health of clients; perception of personality and its health as a whole; the creation of family-oriented, community-centered and consumer-driven services; the development of social work in the field of health was often facilitated by the initiative and perseverance of individuals, etc.

The implementation of Ukraine's social and economic development program requires significant funds. Domestic sources of funding are very limited and improve the economy to support vital areas of society. Therefore, the Government of Finance of Ukraine pays special attention to finding sources of economic development. One such source of funding is international technical assistance, the main task of which is to promote economic and social transformation in countries with economies in transition, including Ukraine. The purpose of the article is to analyze the main indicators of international technical assistance to Ukraine. The article is devoted to the analysis of the main indicators of international technical assistance to Ukraine. In the article, the authors analyze and provide the number of international technical assistance projects by development partners. The article presents statistics on the number of international technical assistance projects by sector, namely law enforcement reform, energy efficiency, agriculture and land market development, education and science reform, judiciary, health care and reform, ecology and household waste management, development democracy and the electoral process, deregulation and development of entrepreneurship, development of trade and export potential. In the article, the authors examined the amount of international technical assistance provided by sector in accordance with the estimated cost of projects. In the article, the authors consider the amount of funds used for international technical assistance in the framework of existing projects in 2020 by development partners, namely from the European Union, Great Britain, the United States, Germany, the Organization for Security and Cooperation in Europe, the United Nations , Canada, Nordic Environmental Finance Corporation, Switzerland, Norway, Sweden, European Investment Bank, International Bank for Reconstruction and Development, Japan, Denmark. The article presents statistical data on the amount of international technical assistance provided by forms of assistance, namely the purchase of vehicles, equipment, communication services, rent, software, business trips, conferences and media events, trainings, construction work, repairs, information services and consultations.

Abstract Background Over 3000 young people under the age of 18 are admitted to Tier 4 Child and Adolescent Mental Health Services (CAMHS) inpatient units across the UK each year. The average length of hospital stay for young people across all psychiatric units in the UK is 120 days. Research is needed to identify the most effective and efficient ways to care for young people (YP) with psychiatric emergencies. This study aims to evaluate the clinical effectiveness and cost-effectiveness of intensive community care service (ICCS) compared to treatment as usual (TAU) for young people with psychiatric emergencies. Methods This is a multicentre two-arm randomized controlled trial (RCT) with an internal pilot phase. Young people aged 12 to < 18 considered for admission at participating NHS organizations across the UK will be randomized 1:1 to either TAU or ICCS. The primary outcome is the time to return to or start education, employment, or training (EET) at 6 months post-randomization. Secondary outcomes will include evaluations of mental health and overall well-being and patient satisfaction. Service use and costs and cost-effectiveness will also be explored. Intention-to-treat analysis will be adopted. The trial is expected to be completed within 42 months, with an internal pilot phase in the first 12 months to assess the recruitment feasibility. A process evaluation using visual semi-structured interviews will be conducted with 42 young people and 42 healthcare workers. Discussion This trial is the first well-powered randomized controlled trial evaluating the clinical and cost-effectiveness of ICCS compared to TAU for young people with psychiatric emergencies in Great Britain. Trial registration ISRCTN ISRCTN42999542, Registration on April 29, 2020

Public health is a very important factor and will determine the success of the local government in this case the Tlogosari Wetan village, because the community is the consumer of the service products produced. The measure of the success of service providers as needed and expected in this case is knowledge about Covid-19 and how to prevent and produce products that are expected to anticipate the widespread virus. The restoration of public health in Tlogosari Wetan Village was allegedly due to the use of ready-to-brewed herbs by opinion leaders in the village concerned. Thus, the role of opinion leaders in Tlogosari Wetan Village as a communication bridge is very necessary because the good services achieved will also have an impact on social scientific activities that can be carried out effectively with optimal positive impacts. Based on the results of research on the Correlation of Interpersonal Communication in Socializing the Consumption of ready-to-drink herbs carried out on the Effectiveness of Handling Covid-19, there are several conclusions, namely the results of the study indicate that Communication between Persons in Socializing the Consumption of Ready Seduh Jamu is in the high category. This is evidenced by the categorization of the research results by 62%. Meanwhile, the effectiveness of preventing and handling COVID-19 in the community in the Tlogosari Wetan sub-district also tends to be high, at 65%. This mostly begins with public anxiety about the number of victims due to Covid, so they have great respect for the socialization activities for consuming ready-to-drink herbs carried out by local opinion leaders. The final result of the cross tabulation is that there is a positive relationship between Interpersonal Communication in Socializing the Consumption of ready-to-drink herbs carried out on the Effectiveness of Handling Covid-19 in the community of Tlogosari Wetan Village. This is evidenced from the cross tabulation table which states that the categorization of the X variable is high, the Y variable is also high at 68%.

Background: Over 3,000 major lower limb amputations (MLLA) occur in the UK per annum. A significant proportion of patients following MLLA will go on to develop a surgical site infection (SSI). SSIs can range from a simple superficial infection that is treated with oral antibiotic therapy to deeper infections which can lead to wound dehiscence and, ultimately, surgical revision. SSIs can have a significant impact on patient mobility, function, morbidity and mortality as well as wider effects on carers, community services and hospital systems. Despite these potential impacts there are limited data to determine the rate of SSI in patients undergoing MLLA, adjuncts that successfully prevent SSI, factors that predispose patients to SSI and compliance with national guidance set out by key stakeholders in vascular surgical care. Methods: To address this gap in evidence we propose a large, international, prospective, collaborative audit that aims to compare current practice against recommendations set out by the National Institute of Health and Care Excellence and The Vascular Society of Great Britain and Ireland and to determine the frequency of significant outcomes related to SSI (as defined by the Centre for Disease Control) in consecutive patients undergoing MLLA over an 8-month period including the incidence of SSI, wound dehiscence and surgical revision at 30 days, frequency of use of adjuncts designed to reduce SSI and predictors of SSI. Outcomes will also be captured at 1 year post-MLLA if funding permits. Discussion: This multicentre audit will allow us to describe the incidence and burden of SSI and wound dehiscence in patients undergoing MLLA. The strengths of this audit will lie in its use of contemporaneous data collection from numerous hospitals and the in-depth data collection focusing primarily on MLLA SSI. It is anticipated that the audit will provide impactful data for future comparisons with global practice and support the design of robust and meaningful studies.

The article defines the essence of the concept of "social and psychological support of children of military personnel" as a set of measures and support aimed at ensuring the psychological and social well-being of children whose parents are involved in military service or participate in military operations. It is noted that the main components of socio-psychological support for children of military personnel are: psychological support - providing professional psychological assistance to children to manage stress, anxiety and other emotional challenges related to the military service of their father or mother; social integration – assistance in the integration of children in the school environment and community, provision of opportunities for participation in social events; education and training - ensuring access to quality education, even in cases of permanent changes of residence due to relocation; medical support – provision of medical assistance and psychotherapeutic support for children and their families; promotion of physical and mental development of children through special programs and activities; providing support and counseling to parents on effective ways of interacting with children in the conditions of military service; creation of conditions for stability and safety in the lives of children of military personnel. It is justified that the project approach in the socio-psychological support of children of military personnel should be considered as a systematic method of work aimed at the development of specific projects aimed at improving the socio-psychological condition of children. The domestic experience was studied, which shows that from 2022, the project approach in providing socio-psychological assistance to the families of military personnel is actively spreading in Ukraine, in particular, the project «Psychosocial support service for families of military personnel» of the Public Movement «Women's Power of Ukraine» is being implemented; volunteer project «How are you, brother?»; it is planned to implement a number of projects of relevant Ministries and departments within the framework of the implementation of the All-Ukrainian mental health program. The study and generalization of the best foreign experience of socio-psychological support for children of military personnel shows that the most effective work is carried out in such countries as the USA, Great Britain, and Israel. In the USA, a project is being implemented specifically for the socio-psychological support of military families - Families OverComing Under Stress (Project FOCUS). The non-profit organization Military Child Education Coalition (MCEC) implements ongoing projects for children of military personnel in the USA. In the UK there are organizations that implement projects to support military families, including psychological and social support, such as the Royal British Legion, SSAFA, Army Families Federation, RAF Families Federation, Naval Families Federation. Israel has a system of social services that provides psychological and social support for children of military personnel and their families, and counseling centers provide counseling, psychotherapy, and support services in important life situations.

IntroductionIn July 1997, the Mackay campus of Central Queensland University hosted a conference with the theme Regional Australia: Visions of Mackay. It was the first academic conference to be held at the young campus, and its aim was to provide an opportunity for academics, business people, government officials, and other interested parties to discuss their visions for the development of Mackay, a regional community of 75,000 people situated on the Central Queensland coast (Danaher). I delivered a presentation at that conference and authored a chapter in the book that emerged from its proceedings. The chapter entitled “Mackay Online” explored the potential impact that the Internet could have on the Mackay region, particularly in the areas of regional business, education, health, and entertainment (Pace). Two decades later, how does the reality compare with that vision?Broadband BluesAt the time of the Visions of Mackay conference, public commercial use of the Internet was in its infancy. Many Internet services and technologies that users take for granted today were uncommon or non-existent then. Examples include online video, video-conferencing, Voice over Internet Protocol (VoIP), blogs, social media, peer-to-peer file sharing, payment gateways, content management systems, wireless data communications, smartphones, mobile applications, and tablet computers. In 1997, most users connected to the Internet using slow dial-up modems with speeds ranging from 28.8 Kbps to 33.6 Kbps. 56 Kbps modems had just become available. Lamenting these slow data transmission speeds, I looked forward to a time when widespread availability of high-bandwidth networks would allow the Internet’s services to “expand to include electronic commerce, home entertainment and desktop video-conferencing” (Pace 103). Although that future eventually arrived, I incorrectly anticipated how it would arrive.In 1997, Optus and Telstra were engaged in the rollout of hybrid fibre coaxial (HFC) networks in Sydney, Melbourne, and Brisbane for the Optus Vision and Foxtel pay TV services (Meredith). These HFC networks had a large amount of unused bandwidth, which both Telstra and Optus planned to use to provide broadband Internet services. Telstra's Big Pond Cable broadband service was already available to approximately one million households in Sydney and Melbourne (Taylor), and Optus was considering extending its cable network into regional Australia through partnerships with smaller regional telecommunications companies (Lewis). These promising developments seemed to point the way forward to a future high-bandwidth network, but that was not the case. A short time after the Visions of Mackay conference, Telstra and Optus ceased the rollout of their HFC networks in response to the invention of Asynchronous Digital Subscriber Line (ADSL), a technology that increases the bandwidth of copper wire and enables Internet connections of up to 6 Mbps over the existing phone network. ADSL was significantly faster than a dial-up service, it was broadly available to homes and businesses across the country, and it did not require enormous investment in infrastructure. However, ADSL could not offer speeds anywhere near the 27 Mbps of the HFC networks. When it came to broadband provision, Australia seemed destined to continue playing catch-up with the rest of the world. According to data from the Organisation for Economic Cooperation and Development (OECD), in 2009 Australia ranked 18th in the world for broadband penetration, with 24.1 percent of Australians having a fixed-line broadband subscription. Statistics like these eventually prompted the federal government to commit to the deployment of a National Broadband Network (NBN). In 2009, the Kevin Rudd Government announced that the NBN would combine fibre-to-the-premises (FTTP), fixed wireless, and satellite technologies to deliver Internet speeds of up to 100 Mbps to 90 percent of Australian homes, schools, and workplaces (Rudd).The rollout of the NBN in Mackay commenced in 2013 and continued, suburb by suburb, until its completion in 2017 (Frost, “Mackay”; Garvey). The rollout was anything but smooth. After a change of government in 2013, the NBN was redesigned to reduce costs. A mixed copper/optical technology known as fibre-to-the-node (FTTN) replaced FTTP as the preferred approach for providing most NBN connections. The resulting connection speeds were significantly slower than the 100 Mbps that was originally proposed. Many Mackay premises could only achieve a maximum speed of 40 Mbps, which led to some overcharging by Internet service providers, and subsequent compensation for failing to deliver services they had promised (“Optus”). Some Mackay residents even complained that their new NBN connections were slower than their former ADSL connections. NBN Co representatives claimed that the problems were due to “service providers not buying enough space in the network to provide the service they had promised to customers” (“Telcos”). Unsurprisingly, the number of complaints about the NBN that were lodged with the Telecommunications Industry Ombudsman skyrocketed during the last six months of 2017. Queensland complaints increased by approximately 40 percent when compared with the same period during the previous year (“Qld”).Despite the challenges presented by infrastructure limitations, the rollout of the NBN was a boost for the Mackay region. For some rural residents, it meant having reliable Internet access for the first time. Frost, for example, reports on the experiences of a Mackay couple who could not get an ADSL service at their rural home because it was too far away from the nearest telephone exchange. Unreliable 3G mobile broadband was the only option for operating their air-conditioning business. All of that changed with the arrival of the NBN. “It’s so fast we can run a number of things at the same time”, the couple reported (“NBN”).Networking the NationOne factor that contributed to the uptake of Internet services in the Mackay region after the Visions of Mackay conference was the Australian Government’s Networking the Nation (NTN) program. When the national telecommunications carrier Telstra was partially privatised in 1997, and further sold in 1999, proceeds from the sale were used to fund an ambitious communications infrastructure program named Networking the Nation (Department of Communications, Information Technology and the Arts). The program funded projects that improved the availability, accessibility, affordability, and use of communications facilities and services throughout regional Australia. Eligibility for funding was limited to not-for-profit organisations, including local councils, regional development organisations, community groups, local government associations, and state and territory governments.In 1998, the Mackay region received $930,000 in Networking the Nation funding for Mackay Regionlink, a project that aimed to provide equitable community access to online services, skills development for local residents, an affordable online presence for local business and community organisations, and increased external awareness of the Mackay region (Jewell et al.). One element of the project was a training program that provided basic Internet skills to 2,168 people across the region over a period of two years. A second element of the project involved the establishment of 20 public Internet access centres in locations throughout the region, such as libraries, community centres, and tourist information centres. The centres provided free Internet access to users and encouraged local participation and skill development. More than 9,200 users were recorded in these centres during the first year of the project, and the facilities remained active until 2006. A third element of the project was a regional web portal that provided a free easily-updated online presence for community organisations. The project aimed to have every business and community group in the Mackay region represented on the website, with hosting fees for the business web pages funding its ongoing operation and development. More than 6,000 organisations were listed on the site, and the project remained financially viable until 2005.The availability, affordability and use of communications facilities and services in Mackay increased significantly during the period of the Regionlink project. Changes in technology, services, markets, competition, and many other factors contributed to this increase, so it is difficult to ascertain the extent to which Mackay Regionlink fostered those outcomes. However, the large number of people who participated in the Regionlink training program and made use of the public Internet access centres, suggests that the project had a positive influence on digital literacy in the Mackay region.The Impact on BusinessThe Internet has transformed regional business for both consumers and business owners alike since the Visions of Mackay conference. When Mackay residents made a purchase in 1997, their choice of suppliers was limited to a few local businesses. Today they can shop online in a global market. Security concerns were initially a major obstacle to the growth of electronic commerce. Consumers were slow to adopt the Internet as a place for doing business, fearing that their credit card details would be vulnerable to hackers once they were placed online. After observing the efforts that finance and software companies were making to eliminate those obstacles, I anticipated that it would only be a matter of time before online transactions became commonplace:Consumers seeking a particular product will be able to quickly find the names of suitable suppliers around the world, compare their prices, and place an order with the one that can deliver the product at the cheapest price. (Pace 106)This expectation was soon fulfilled by the arrival of online payment systems such as PayPal in 1998, and online shopping services such as eBay in 1997. eBay is a global online auction and shopping website where individuals and businesses buy and sell goods and services worldwide. The eBay service is free to use for buyers, but sellers are charged modest fees when they make a sale. It exemplifies the notion of “friction-free capitalism” articulated by Gates (157).In 1997, regional Australian business owners were largely sceptical about the potential benefits the Internet could bring to their businesses. Only 11 percent of Australian businesses had some form of web presence, and less than 35 percent of those early adopters felt that their website was significant to their business (Department of Industry, Science and Tourism). Anticipating the significant opportunities that the Internet offered Mackay businesses to compete in new markets, I recommended that they work “towards the goal of providing products and services that meet the needs of international consumers as well as local ones” (107). In the two decades that have passed since that time, many Mackay businesses have been doing just that. One prime example is Big on Shoes (bigonshoes.com.au), a retailer of ladies’ shoes from sizes five to fifteen (Plane). Big on Shoes has physical shopfronts in Mackay and Moranbah, an online store that has been operating since 2009, and more than 12,000 followers on Facebook. This speciality store caters for women who have traditionally been unable to find shoes in their size. As the store’s customer base has grown within Australia and internationally, an unexpected transgender market has also emerged. In 2018 Big on Shoes was one of 30 regional businesses featured in the first Facebook and Instagram Annual Gift Guide, and it continues to build on its strengths (Cureton).The Impact on HealthThe growth of the Internet has improved the availability of specialist health services for people in the Mackay region. Traditionally, access to surgical services in Mackay has been much more limited than in metropolitan areas because of the shortage of specialists willing to practise in regional areas (Green). In 2003, a senior informant from the Royal Australasian College of Surgeons bluntly described the Central Queensland region from Mackay to Gladstone as “a black hole in terms of surgery” (Birrell et al. 15). In 1997 I anticipated that, although the Internet would never completely replace a visit to a local doctor or hospital, it would provide tools that improve the availability of specialist medical services for people living in regional areas. Using these tools, doctors would be able to “analyse medical images captured from patients living in remote locations” and “diagnose patients at a distance” (Pace 108).These expectations have been realised in the form of Queensland Health’s Telehealth initiative, which permits medical specialists in Brisbane and Townsville to conduct consultations with patients at the Mackay Base Hospital using video-conference technology. Telehealth reduces the need for patients to travel for specialist advice, and it provides health professionals with access to peer support. Averill (7), for example, reports on the experience of a breast cancer patient at the Mackay Base Hospital who was able to participate in a drug trial with a Townsville oncologist through the Telehealth network. Mackay health professionals organised the patient’s scans, administered blood tests, and checked her lymph nodes, blood pressure and weight. Townsville health professionals then used this information to advise the Mackay team about her ongoing treatment. The patient expressed appreciation that the service allowed her to avoid the lengthy round-trip to Townsville. Prior to being offered the Telehealth option, she had refused to participate in the trial because “the trip was just too much of a stumbling block” (Averill 7).The Impact on Media and EntertainmentThe field of media and entertainment is another aspect of regional life that has been reshaped by the Internet since the Visions of Mackay conference. Most of these changes have been equally apparent in both regional and metropolitan areas. Over the past decade, the way individuals consume media has been transformed by new online services offering user-generated video, video-on-demand, and catch-up TV. These developments were among the changes I anticipated in 1997:The convergence of television and the Internet will stimulate the creation of new services such as video-on-demand. Today television is a synchronous media—programs are usually viewed while they are being broadcast. When high-quality video can be transmitted over the information superhighway, users will be able to watch what they want, when and where they like. […] Newly released movies will continue to be rented, but probably not from stores. Instead, consumers will shop on the information superhighway for movies that can be delivered on demand.In the mid-2000s, free online video-sharing services such as YouTube and Vimeo began to emerge. These websites allow users to freely upload, view, share, comment on, and curate online videos. Subscription-based streaming services such as Netflix and Amazon Prime have also become increasingly popular since that time. These services offer online streaming of a library of films and television programs for a fee of less than 20 dollars per month. Computers, smart TVs, Blu-ray players, game consoles, mobile phones, tablets, and other devices provide a multitude of ways of accessing streaming services. Some of these devices cost less than 100 dollars, while higher-end electronic devices include the capability as a bundled feature. Netflix became available in Mackay at the time of its Australian launch in 2015. The growth of streaming services greatly reduced the demand for video rental shops in the region, and all closed down as a result. The last remaining video rental store in Mackay closed its doors in 2018 after trading for 26 years (“Last”).Some of the most dramatic transformations that have occurred the field of media and entertainment were not anticipated in 1997. The rise of mobile technology, including wireless data communications, smartphones, mobile applications, and tablet computers, was largely unforeseen at that time. Some Internet luminaries such as Vinton Cerf expected that mobile access to the Internet via laptop computers would become commonplace (Lange), but this view did not encompass the evolution of smartphones, and it was not widely held. Similarly, the rise of social media services and the impact they have had on the way people share content and communicate was generally unexpected. In some respects, these phenomena resemble the Black Swan events described by Nassim Nicholas Taleb (xvii)—surprising events with a major effect that are often inappropriately rationalised after the fact. They remind us of how difficult it is to predict the future media landscape by extrapolating from things we know, while failing to take into consideration what we do not know.The Challenge for MackayIn 1997, when exploring the potential impact that the Internet could have on the Mackay region, I identified a special challenge that the community faced if it wanted to be competitive in this new environment:The region has traditionally prospered from industries that control physical resources such as coal, sugar and tourism, but over the last two decades there has been a global ‘shift away from physical assets and towards information as the principal driver of wealth creation’ (Petre and Harrington 1996). The risk for Mackay is that its residents may be inclined to believe that wealth can only be created by means of industries that control physical assets. The community must realise that its value-added information is at least as precious as its abundant natural resources. (110)The Mackay region has not responded well to this challenge, as evidenced by measures such as the Knowledge City Index (KCI), a collection of six indicators that assess how well a city is positioned to grow and advance in today’s technology-driven, knowledge-based economy. A 2017 study used the KCI to conduct a comparative analysis of 25 Australian cities (Pratchett, Hu, Walsh, and Tuli). Mackay rated reasonably well in the areas of Income and Digital Access. But the city’s ratings were “very limited across all the other measures of the KCI”: Knowledge Capacity, Knowledge Mobility, Knowledge Industries and Smart Work (44).The need to be competitive in a technology-driven, knowledge-based economy is likely to become even more pressing in the years ahead. The 2017 World Energy Outlook Report estimated that China’s coal use is likely to have peaked in 2013 amid a rapid shift toward renewable energy, which means that demand for Mackay’s coal will continue to decline (International Energy Agency). The sugar industry is in crisis, finding itself unable to diversify its revenue base or increase production enough to offset falling global sugar prices (Rynne). The region’s biggest tourism drawcard, the Great Barrier Reef, continues to be degraded by mass coral bleaching events and ongoing threats posed by climate change and poor water quality (Great Barrier Reef Marine Park Authority). All of these developments have disturbing implications for Mackay’s regional economy and its reliance on coal, sugar, and tourism. Diversifying the local economy through the introduction of new knowledge industries would be one way of preparing the Mackay region for the impact of new technologies and the economic challenges that lie ahead.ReferencesAverill, Zizi. “Webcam Consultations.” Daily Mercury 22 Nov. 2018: 7.Birrell, Bob, Lesleyanne Hawthorne, and Virginia Rapson. The Outlook for Surgical Services in Australasia. Melbourne: Monash University Centre for Population and Urban Research, 2003.Cureton, Aidan. “Big Shoes, Big Ideas.” Daily Mercury 8 Dec. 2018: 12.Danaher, Geoff. Ed. Visions of Mackay: Conference Papers. Rockhampton: Central Queensland UP, 1998.Department of Communications, Information Technology and the Arts. Networking the Nation: Evaluation of Outcomes and Impacts. Canberra: Australian Government, 2005.Department of Industry, Science and Tourism. Electronic Commerce in Australia. Canberra: Australian Government, 1998.Frost, Pamela. “Mackay Is Up with Switch to Speed to NBN.” Daily Mercury 15 Aug. 2013: 8.———. “NBN Boost to Business.” Daily Mercury 29 Oct. 2013: 3.Gates, Bill. The Road Ahead. New York: Viking Penguin, 1995.Garvey, Cas. “NBN Rollout Hit, Miss in Mackay.” Daily Mercury 11 Jul. 2017: 6.Great Barrier Reef Marine Park Authority. Reef Blueprint: Great Barrier Reef Blueprint for Resilience. Townsville: Great Barrier Reef Marine Park Authority, 2017.Green, Anthony. “Surgical Services and Referrals in Rural and Remote Australia.” Medical Journal of Australia 177.2 (2002): 110–11.International Energy Agency. World Energy Outlook 2017. France: IEA Publications, 2017.Jewell, Roderick, Mary O’Flynn, Fiorella De Cindio, and Margaret Cameron. “RCM and MRL—A Reflection on Two Approaches to Constructing Communication Memory.” Constructing and Sharing Memory: Community Informatics, Identity and Empowerment. Eds. Larry Stillman and Graeme Johanson. Newcastle: Cambridge Scholars Publishing, 2007. 73–86.Lange, Larry. “The Internet: Where’s It All Going?” Information Week 17 Jul. 1995: 30.“Last Man Standing Shuts Doors after 26 Years of Trade.” Daily Mercury 28 Aug. 2018: 7.Lewis, Steve. “Optus Plans to Share Cost Burden.” Australian Financial Review 22 May 1997: 26.Meredith, Helen. “Time Short for Cable Modem.” Australian Financial Review 10 Apr. 1997: 42Nassim Nicholas Taleb. The Black Swan: The Impact of the Highly Improbable. New York: Random House, 2007.“Optus Offers Comp for Slow NBN.” Daily Mercury 10 Nov. 2017: 15.Organisation for Economic Cooperation and Development. “Fixed Broadband Subscriptions.” OECD Data, n.d. <https://data.oecd.org/broadband/fixed-broadband-subscriptions.htm>.Pace, Steven. “Mackay Online.” Visions of Mackay: Conference Papers. Ed. Geoff Danaher. Rockhampton: Central Queensland University Press, 1998. 111–19.Petre, Daniel and David Harrington. The Clever Country? Australia’s Digital Future. Sydney: Lansdown Publishing, 1996.Plane, Melanie. “A Shoe-In for Big Success.” Daily Mercury 9 Sep. 2017: 6.Pratchett, Lawrence, Richard Hu, Michael Walsh, and Sajeda Tuli. The Knowledge City Index: A Tale of 25 Cities in Australia. Canberra: University of Canberra neXus Research Centre, 2017.“Qld Customers NB-uN Happy Complaints about NBN Service Double in 12 Months.” Daily Mercury 17 Apr. 2018: 1.Rudd, Kevin. “Media Release: New National Broadband Network.” Parliament of Australia Press Release, 7 Apr. 2009 <https://parlinfo.aph.gov.au/parlInfo/search/display/display.w3p;query=Id:"media/pressrel/PS8T6">.Rynne, David. “Revitalising the Sugar Industry.” Sugar Policy Insights Feb. 2019: 2–3.Taylor, Emma. “A Dip in the Pond.” Sydney Morning Herald 16 Aug. 1997: 12.“Telcos and NBN Co in a Crisis.” Daily Mercury 27 Jul. 2017: 6.

Introduction The scientific validity of climate change claims, how to intervene (if at all) in environmental, economic, political and social consequences of climate change, and the adaptation and mitigation needed with any given climate change scenario, are contested areas of public, policy and academic discourses. For marginalised populations, the climate discourses around adaptation, mitigation, vulnerability and resilience are of particular importance. This paper considers the silence around disabled people in these discourses. Marci Roth of the Spinal Cord Injury Association testified before Congress in regards to the Katrina disaster: [On August 29] Susan Daniels called me to enlist my help because her sister in-law, a quadriplegic woman in New Orleans, had been unsuccessfully trying to evacuate to the Superdome for two days. […] It was clear that this woman, Benilda Caixetta, was not being evacuated. I stayed on the phone with Benilda, for the most part of the day. […] She kept telling me she’d been calling for a ride to the Superdome since Saturday; but, despite promises, no one came. The very same paratransit system that people can’t rely on in good weather is what was being relied on in the evacuation. […] I was on the phone with Benilda when she told me, with panic in her voice “the water is rushing in.” And then her phone went dead. We learned five days later that she had been found in her apartment dead, floating next to her wheelchair. […] Benilda did not have to drown. (National Council on Disability, emphasis added) According to the Intergovernmental Panel on Climate Change (IPCC), adaptation is the “Adjustment in natural or human systems in response to actual or expected climatic stimuli or their effects, which moderates harm or exploits beneficial opportunities” (IPCC, Climate Change 2007). Adaptations can be anticipatory or reactive, and depending on their degree of spontaneity they can be autonomous or planned (IPCC, Fourth Assessment Report). Adaptations can be private or public (IPCC, Fourth Assessment Report), technological, behavioural, managerial and structural (National Research Council of Canada). Adaptation, in the context of human dimensions of global change, usually refers to a process, action or outcome in a system (household, community, group, sector, region, country) in order for that system to better cope with, manage or adjust to some changing condition, stress, hazard, risk or opportunity (Smit and Wandel). Adaptation can encompass national or regional strategies as well as practical steps taken at the community level or by individuals. According to Smit et al, a framework for systematically defining adaptations is based on three questions: (i) adaptation to what; (ii) who or what adapts; and (iii) how does adaptation occur? These are essential questions that have to be looked at from many angles including cultural and anthropological lenses as well as lenses of marginalised and highly vulnerable populations. Mitigation (to reduce or prevent changes in the climate system), vulnerability (the degree to which a system is susceptible to, and unable to cope with, the adverse effects of climate change), and resilience (the amount of change a system can undergo without changing state), are other important concepts within the climate change discourse. Non-climate stresses can increase vulnerability to climate change by reducing resilience and can also reduce adaptive capacity because of resource deployment to competing needs. Extending this to the context of disabled people, ableism (sentiment to expect certain abilities within humans) (Wolbring, “Is there an end to out-able?”) and disablism (the unwillingness to accommodate different needs) (Miller, Parker and Gillinson) are two concepts that will thus play themselves out in climate discourses. The “Summary for Policymakers” of the IPCC 2007 report, Climate Change 2007: Impacts, Adaptation and Vulnerability, states: “Poor communities can be especially vulnerable, in particular those concentrated in high-risk areas. They tend to have more limited adaptive capacities, and are more dependent on climate-sensitive resources such as local water and food supplies.” From this quote one can conclude that disabled people are particularly impacted, as the majority of disabled people live in poverty (Elwan). For instance, CARE International, a humanitarian organisation fighting global poverty, the UN Office for the Coordination of Humanitarian Affairs, and Maplecroft, a company that specialises in the calculation, analysis and visualisation of global risks, conclude: “The degree of vulnerability is determined by underlying natural, human, social, physical and financial factors and is a major reason why poor people—especially those in marginalised social groups like women, children, the elderly and people with disabilities—are most affected by disasters” (CARE International). The purpose of this paper is to expose the reader to (a) how disabled people are situated in the culture of the climate, adaptation, mitigation and resilience discourse; (b) how one would answer the three questions, (i) adaptation to what, (ii) who or what adapts, and (iii) how does adaptation occur (Smit et al), using a disabled people lens; and (c) what that reality of the involvement of disabled people within the climate change discourse might herald for other groups in the future. The paper contends that there is a pressing need for the climate discourse to be more inclusive and to develop a new social contract to modify existing dynamics of ableism and disablism so as to avoid the uneven distribution of evident burdens already linked to climate change. A Culture of Neglect: The Situation of Disabled People As climates changes, environmental events that are classified as natural disasters are expected to be more frequent. In the face of recent disaster responses, how effective have these efforts been as they relate to the needs and challenges faced by disabled people? Almost immediately after Hurricane Katrina devastated the Gulf Coast, the National Council on Disability (NCD) in the United States estimated that 155,000 people with disabilities lived in the three cities hardest hit by the hurricane (about 25 per cent of the cities’ populations). The NCD urged emergency managers and government officials to recognise that the need for basic necessities by hurricane survivors with disabilities was “compounded by chronic health conditions and functional impairments … [which include] people who are blind, people who are deaf, people who use wheelchairs, canes, walkers, crutches, people with service animals, and people with mental health needs.” The NCD estimated that a disproportionate number of fatalities were people with disabilities. They cited one statistic from the American Association of Retired Persons (AARP): “73 per cent of Hurricane Katrina-related deaths in New Orleans area were among persons age 60 and over, although they comprised only 15 per cent of the population in New Orleans.” As the NCD stated, “most of those individuals had medical conditions and functional or sensory disabilities that made them more vulnerable. Many more people with disabilities under the age of 60 died or were otherwise impacted by the hurricanes.” As these numbers are very likely linked to the impaired status of the elderly, it seems reasonable to assume similar numbers for non-elderly disabled people. Hurricane Katrina is but one example of how disabled people are neglected in a disaster (Hemingway and Priestley; Fjord and Manderson). Disabled people were also disproportionately impacted in other disasters, such as the 1995 Great Hanshin Earthquake in Japan (Nakamura) or the 2003 heatwave in France, where 63 per cent of heat-related deaths occurred in institutions, with a quarter of these in nursing homes (Holstein et al.). A review of 18 US heatwave response plans revealed that although people with mental or chronic illnesses and the homeless constitute a significant proportion of the victims in recent heatwaves, only one plan emphasised outreach to disabled persons, and only two addressed the shelter and water needs of the homeless (Ebi and Meehl; Bernhard and McGeehin). Presence of Disabled People in Climate Discourse Although climate change will disproportionately impact disabled people, despite the less than stellar record of disaster adaptation and mitigation efforts towards disabled people, and despite the fact that other social groups (such as women, children, ‘the poor’, indigenous people, farmers and displaced people) are mentioned in climate-related reports such as the IPCC reports and the Human Development Report 2007/2008, the same reports do not mention disabled people. Even worse, the majority of the material generated by, and physically set up for, discourses on climate, is inaccessible for many disabled people (Australian Human Rights Commission). For instance, the IPCC report, Climate Change 2007: Impacts, Adaptation and Vulnerability, contains Box 8.2: Gender and natural disasters, makes the following points: (a) “men and women are affected differently in all phases of a disaster, from exposure to risk and risk perception; to preparedness behaviour, warning communication and response; physical, psychological, social and economic impacts; emergency response; and ultimately to recovery and reconstruction”; (b) “natural disasters have been shown to result in increased domestic violence against, and post-traumatic stress disorders in, women”; and (c) “women make an important contribution to disaster reduction, often informally through participating in disaster management and acting as agents of social change. Their resilience and their networks are critical in household and community recovery.” The content of Box 8.2 acknowledges the existence of different perspectives and contributions to the climate discourse, and that it is beneficial to explore these differences. It seems reasonable to assume that differences in perspectives, contributions and impact may well also exist between people with and without disabilities, and that it may be likewise beneficial to explore these differences. Disabled people are differently affected in all phases of a disaster, from exposure to risk and risk perception; to preparedness behaviour, warning communication and response; physical, psychological, social and economic impacts; emergency response; and ultimately to recovery and reconstruction. Disabled people could also make an important contribution to disaster reduction, often informally through participating in disaster management and acting as agents of social change. Their resilience and their networks are critical in household and community recovery, important as distributors of relief efforts and in reconstruction design. The Bonn Declaration from the 2007 international conference, Disasters are always Inclusive: Persons with Disabilities in Humanitarian Emergency Situations, highlighted many problems disabled people are facing and gives recommendations for inclusive disaster preparedness planning, for inclusive response in acute emergency situations and immediate rehabilitation measures, and for inclusive post-disaster reconstruction and development measures. Many workshops were initiated by disabled people groups, such as Rehabilitation International. However, the disabled people disaster adaptation and mitigation discourse is not mainstreamed. Advocacy by people with disability for accessible transport and universal or “life-cycle” housing (among other things) shows how they can contribute significantly to more effective social systems and public facilities. These benefit everyone and help to shift public expectations towards accessible and flexible amenities and services—for example, emergency response and evacuation procedures are much easier for all if such facilities are universally accessible. Most suggestions by disabled people for a more integrative, accessible physical environment and societal attitude benefit everyone, and gain special importance with the ever-increasing proportion of elderly people in society. The IPCC Fourth Assessment Report is intended to be a balanced assessment of current knowledge on climate change mitigation. However, none of the 2007 IPCC reports mention disabled people. Does that mean that disabled people are not impacted by, or impact, climate change? Does no knowledge of adaptation, mitigation and adaptation capacity from a disabled people lens exist, or does the knowledge not reach the IPCC, or does the IPCC judge this knowledge as irrelevant? This culture of neglect and unbalanced assessment of knowledge evident in the IPCC reports was recognised before for rise of a ‘global’ climate discourse. For instance, a 2001 Canadian government document asked that research agendas be developed with the involvement of, among others, disabled people (Health Canada). The 2009 Nairobi Declaration on Africa’s response to climate change (paragraph 36) also asks for the involvement of disabled people (African Ministerial Conference on the Environment). However, so far nothing has trickled up to the international bodies, like the IPCC, or leading conferences such as the United Nations Climate Change Conference Copenhagen 2009. Where Will It End? In his essay, “We do not need climate change apartheid in adaptation”, in the Human Development Report 2007/2008, Archbishop Desmond Tutu suggests that we are drifting into a situation of global adaptation apartheid—that adaptation becomes a euphemism for social injustice on a global scale (United Nations Development Programme). He uses the term “adaptation apartheid” to highlight the inequality of support for adaptation capacity between high and low income countries: “Inequality in capacity to adapt to climate change is emerging as a potential driver of wider disparities in wealth, security and opportunities for human development”. I submit that “adaptation apartheid” also exists in regard to disabled people, with the invisibility of disabled people in the climate discourse being just one facet. The unwillingness to accommodate, to help the “other,” is nothing new for disabled people. The ableism that favours species-typical bodily functioning (Wolbring, “Is there an end to out-able?”; Wolbring, “Why NBIC?”) and disablism (Miller, Parker, and Gillinson)—the lack of accommodation enthusiasm for the needs of people with ‘below’ species-typical body abilities and the unwillingness to adapt to the needs of “others”—is a form of “adaptation apartheid,” of accommodation apartheid, of adaptation disablism that has been battled by disabled people for a long time. In a 2009 online survey of 2000 British people, 38 per cent believed that most people in British society see disabled people as a “drain on resources” (Scope). A majority of human geneticist concluded in a survey in 1999 that disabled people will never be given the support they need (Nippert and Wolff). Adaptation disablism is visible in the literature and studies around other disasters. The 1988 British Medical Association discussion document, Selection of casualties for treatment after nuclear attack, stated “casualties whose injuries were likely to lead to a permanent disability would receive lower priority than those expected to fully recover” (Sunday Morning Herald). Famine is seen to lead to increased infanticide, increased competitiveness and decreased collaboration (Participants of the Nuclear Winter: The Anthropology of Human Survival Session). Ableism and disablism notions experienced by disabled people can now be extended to include those challenges expected to arise from the need to adapt to climate change. It is reasonable to expect that ableism will prevail, expecting people to cope with certain forms of climate change, and that disablism will be extended, with the ones less affected being unwilling to accommodate the ones more affected beyond a certain point. This ableism/disablism will not only play itself out between high and low income countries, as Desmond Tutu described, but also within high income countries, as not every need will be accommodated. The disaster experience of disabled people is just one example. And there might be climate change consequences that one can only mitigate through high tech bodily adaptations that will not be available to many of the ones who are so far accommodated in high income countries. Desmond Tutu submits that adaptation apartheid might work for the fortunate ones in the short term, but will be destructive for them in the long term (United Nations Development Programme). Disability studies scholar Erik Leipoldt proposed that the disability perspective of interdependence is a practical guide from the margins for making new choices that may lead to a just and sustainable world—a concept that reduces the distance between each other and our environment (Leipoldt). This perspective rejects ableism and disablism as it plays itself out today, including adaptation apartheid. Planned adaptation involves four basic steps: information development and awareness-raising; planning and design; implementation; and monitoring and evaluation (Smit et al). Disabled people have important knowledge to contribute to these four basic steps that goes far beyond their community. Their understanding and acceptance of, for example, the concept of interdependence, is just one major contribution. Including the concept of interdependence within the set of tools that inform the four basic steps of adaptation and other facets of climate discourse has the potential to lead to a decrease of adaptation apartheid, and to increase the utility of the climate discourse for the global community as a whole. References African Ministerial Conference on the Environment. Nairobi Declaration on the African Process for Combating Climate Change. 2009. 26 Aug. 2009 ‹ http://www.unep.org/roa/Amcen/Amcen_Events/3rd_ss/Docs/nairobi-Decration-2009.pdf ›. American Association of Retired Persons. We Can Do Better: Lessons Learned for Protecting Older Persons in Disasters. 2009. 26 Aug. 2009 ‹ http://assets.aarp.org/rgcenter/il/better.pdf ›. Australian Human Rights Commission. “Climate Change Secretariat Excludes People with Disabilities.” 2008. 26 Aug. 2009 ‹ http://www.hreoc.gov.au/about/media/media_releases/2008/95_08.html ›. Bernhard, S., and M. McGeehin. “Municipal Heatwave Response Plans.” American Journal of Public Health 94 (2004): 1520-21. CARE International, the UN Office for the Coordination of Humanitarian Affairs, and Maplecroft. Humanitarian Implications of Climate Change: Mapping Emerging Trends and Risk Hotspots for Humanitarian Actors. 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The Creative City Unlike the terms ‘creative industries’, which nobody ever quite understood, and ‘creative class’, about which actual ‘creatives’ were always ambiguous, the ‘creative city’ has been an incredibly successful global policy meme, to which cities across the world continue to aspire. From the early 1990s, faced with de-industrialisation, rising unemployment, and the increased global mobility of capital, professionals, and consumer-tourists, the ‘creative city’ became an essential part of the new urban imaginary for politicians, planners, local growth coalitions, and advocates and practitioners in art and culture. In the later 1980s and early 1990s, much of this policy and practice work had progressive intent; as decaying parts of the city acquired new artistic and cultural uses, and neo-bohemian lifestyles and pop-cultural aspirations seemed to provide the grounds for future-oriented urban identities. Whilst investment in iconic cultural buildings and refurbished heritage sites repositioned cities as destinations for global tourism and finance (Peck et al.), new forms of creative production would provide employment and catalyse the wider urban economy. The creative city was to be a benign economy of innovative small businesses, working in projects and acting in symbiosis with the transformed urban landscape of the city (Pratt; Scott). If at first such a “creativity fix” (Peck, Creativity) was permeable to new actors and radical visions, it rapidly became a codified “cookie cutter” approach (Oakley), primarily concerned with revalorising decaying urban built stock as ‘vibrant’ spaces for upmarket urban consumption. This has stretched from visual arts to popular music (Bennett; O’Connor Music). The “creative imaginary” of entrepreneurial subjects—working in flat networks clustered around zones or milieux of intensified creativity (O’Connor and Shaw; O’Connor and Gu)—was quickly localised in spaces of real estate-led consumption, with production corralled into the ‘managed workspace’ whose image value—a shiny ‘creative hub’—was usually worth far more than any actual production taking place inside of it (O’Connor, Art). From the turn of the millennium, this global “fast policy” flowed through elite circuits of ‘policy transfer’ (Peck, Scale): unevenly distributed nodes assembling politicians, public administrators, planners, ‘cool’ developers, cultural consultants, branded arts institutions, and creative ‘thought-leaders’ (De Beukelaer and O’Connor). Global agencies such as UNESCO, through its Creative Cities Network, or consultancies such as Charles Landry and BOP, have attempted to frame this in a benign narrative of ‘hands across the ocean’ cultural globalisation. But we now know from two decades of creative economy proselytising that culture is a “driver and enabler” of development, not a normative standard against which it might be judged. And however inclusive ‘culture’ is made to sound, the creative city agenda remains firmly in the hands of local elites attempting to harness global flows of finance, media images, tourists, and ‘creatives’ for local development opportunities (Novy and Colomb; Courage and McKeown). By 2008 the creative city was already in trouble, as an increasingly brutal wave of gentrification came to be seen as the necessary corollary of the gleaming images of creative clusters, hipster hangouts, and iconic arts infrastructure. Predicated on a “spatial fix” (Harvey) for the decaying landscapes of the industrial city, the creative city was already producing its own ruins, as culture-led investment projects failed (Brodie). Since 2008, as the paper-thin walls between art, creativity, and real estate capital dissolved, it became increasingly clear that, though the script remained, the utopian moment was dead and buried. For many critics, both inside the cultural sector and out, it was time to roughly bundle it into the catch-all of neoliberalism and ‘gentrification’ and throw it overboard. Creative City RIP. The Ordinary City This critical take was performed early on by geographers such as Ash Amin and others (Amin and Graham; Amin, Massey, and Thrift), who suggested we re-centre the ordinary city—the one in which most people live—rather than fetishise some high-growth, hi-tech, gleaming Creative City. It was reiterated more recently by the Foundational Economy Collective, who argue that it is the everyday infrastructures and services of our towns and cities—and their mundane local economies of nail bars, cafes, and auto-repair shops—that should form the basis of our urban economic thinking (FEC). Jamie Peck, an early critic of the Creative City, had already cast doubt on the real economic weight of ‘creative industries’ and saw the whole thing as cover for the ‘entrepreneurial (read: neoliberal) city’, and a new kind of culturally-inflected growth coalition (Peck and Ward; Peck, Struggling). Similar dissent could be found amongst those writing within the cultural field. For every new city on the global creative smorgasbord, there were local artists and community activists who could show you a whole other side, excluded from the glass boxes and white cubes, from the funding and the hyped-up narratives lavished on the creative city. This mostly targeted the big iconic developments, led by global brands sucking the funding and the imagination from the surrounding city—what we might call ‘the Bilbao effect’. This cynicism toward the Creative City overlapped with a rejection of a ‘high art’ establishment and its elitist forms of culture. The ‘ordinary city’ here did not set the mundane against art and culture but reframed these as part of an everyday creativity. This could mean small-scale, neighbourhood-embedded art and culture, proposed by those in favour of ‘community arts’ and indeed those seeking localised popular culture such as music scenes. But it could also mean a valorisation of creativity writ large; a generalised urban creativity in which imagination and experimentation, but also subversion and contestation permeate the everyday. Following the Global Financial Crisis (GFC), critiques of the creative city concept became increasingly common. Oli Mould’s 2015 book Urban Subversion and the Creative City captures much of this, providing a distinction between the capitalised Creative City and the lower-case creative city. Mould distinguishes between the ‘Creative City’ ideology as extractive, and the ‘creative city’ as enabling citizenship. For Mould, the Creative City is “the antithesis of urban creativity” (Urban 4), and “shorthand for the capitalistic, paradigmatic (bordering on dogmatic) and meta-narrative view of how creativity can be used to economically stimulate and develop the city” (5). It is top-down creative planning at its worst. Against this, Mould evokes the lower-case concept of creative city, seeing some hope for it as a descriptor of urban spaces where “being creative is the very act of citizenship” (5). The Creative City imposed itself as a requirement of urban economic competitiveness (successful or not) and needs to be implacably opposed. Alternatively, the creative city persists in various forms of ‘urban subversion’, though whether the actual term—like creativity itself (Mould, Against)—can be freed from an association with its capitalised nemesis is, for Mould, still moot. Whilst Mould’s distinction allows us to evoke an urban creativity distinct from the commodified, extractive forms of the Creative City—one rooted in the ordinary, everyday creative practices of the city still open to themes of subversion and contestation centring cultural labour over cultural infrastructure—we also have some reservations. The C/creative couplet recalls de Certeau’s opposition of strategy and tactics, skyscraper and street, and has some of its problems. Baldly, this gives control of the city over to the powerful and condemns the rest of us to a game of endless evasion and subversion. For whilst the contemporary Creative City agenda may be largely as Mould describes it, its provenance is more complex than the extractive agenda which currently animates it. Understanding this provenance might give us some pointers beyond this binary impasse. Roots of the Creative City Although the Creative City eventually became integrated into the neoliberal urban script, the policy imaginary that birthed it emerged from the post-1960s rise of urban social movements, anti-development coalitions, new cultural practices (especially around popular music), artist co-ops, squats, and alternative cultures. Across the 1970s and 1980s one might say the C/creative City was an aspect of growing claims for cultural citizenship, the more explicit acknowledgement of a cultural dimension within T.H. Marshall’s ‘social citizenship’ (Marshall). The Greater London Council (GLC) of 1979-86 is exemplary here (Bianchini; Hatherley), but this was only the most visible case in which de-industrialising cities acquired aspirations to a different kind of city living. The utopian-romantic vision of a new kind of urban culture in which the transformative powers of art would abandon the ethereal world of the museum-gallery and take carnal form in the grotesque ruins of an industrial city was most literal in Wim Wenders’s 1987 film Wings of Desire. It was there in Berlin and New York as it was in Melbourne and Manchester, and a hundred other such cities (Whitney). As an industrial urban civilisation no longer seemed viable in the Global North, ‘culture’ became a central stake in anticipating what might come next. What new forms of working and living might be possible? What new identities, pleasures, desires might it accommodate? A new generation, immersed in what Mark Fisher called ‘popular modernism’ (Fisher), sought new forms of artistic expression within popular culture, making demands on the formal cultural system, on the infrastructure of the city, and on how the city could be re-imagined. In short, the C/creative City was not simply an invention of neoliberalism. It carried within it a utopian promise that should not be discounted. Perhaps we can see this in that most vilified of concepts, the ‘creative class’. The (Not-So) Creative Class By the 2008 GFC, the concept of the ‘creative class’—positioned as the primary driver and beneficiary of the creative city—was already coming apart. Unaffordable housing, rent hikes, rising debts, welfare cuts, reducing returns to ‘educational capital’ and the dominance of asset economies, precarious employment, culture budget cuts, and the integration of large sections of creative production into new platform economies have accelerated since that time. Global development capital has now built high-end leisure, entertainment, accommodation, and amenities into its core business model, one that does not require a prior process of valorisation by local creatives. Mould suggests the Creative City was a Trojan Horse and the creative class the Greeks inside (Urban 8). But whilst policymakers and city marketers embraced this term, it was never a class for-itself, with the clear strategic focus of soldiers waiting to pounce. Florida’s statistical fantasy netted a massive chunk of the population—almost 40 percent—as ‘professional, managerial and scientific’ (Florida, Rise). Meanwhile actual ‘creatives’ were always a poor relation and lived very differently to those others, most of whom preferred the suburbs and ex-burbs to the bustling city. Artists were not the storm-troopers of gentrification but its dupes, eventually evicted from the city they helped conquer. Meanwhile, since the advent of Florida and Landry, developers didn’t even need to use these ‘storm-troopers’ to soften up places for gentrification. They could now work directly with compliant city authorities to do the work for them. Creative cities could be deployed by toolkit (Landry) and, of course, measured via economic impact studies and a variety of other econometrics weaponised by corporate consultancies for hire. This was the social and political landscape upon which the Global Financial Crisis dealt an especially severe form of austerity, disproportionately affecting the cultural sector, and exacerbating many of the problematic areas of ‘creative city’ policy that had previously been abated and ameliorated by a veneer of hipster cool. Nonetheless, the ‘creative class’ also articulated a utopian promise, especially in places outside of the ‘Global North’ where more traditional forms of political power, gender roles, and religion remain in play. In a period of rapid globalisation, as relatively insulated economies became integrated into global capital flows, and cities bore the brunt of disruptive social and cultural changes, the C/creative City could stand in for a global modernity with a future. It could make available a new set of aspirations and identities; for a younger, more educated few perhaps, yet still real despite this. De Beukelaer, in the Indonesian context, talks about the “productive friction” between the two C/creative Cities, where the gap between the universal abstract and the local reality can form a site of negotiation. The C/creative City licences an encounter between new aspirations and identities, and the more traditional elites; an unequal struggle to define or give further content to the neoliberal nostrums of creative modernity that emanate from the Creative City meme. Yet it is not clear just why this negotiation is only made possible by the ‘apolitical’ notion of ‘creative’, or what’s at stake in that term. Is it a merely a cypher—or McGuffin—for a more complex conflict of interests? In what form would the “re-politicisation” of the creative city, called for at the end of the article, consist? What Next? We are not then talking about The City & the City (Mieville), in which two cities occupy the same geographic space but codify their separation by routinely ignoring each other and that which is deemed to belong to the other city. They are always in some kind of negotiation and contestation, but around what? We would argue that the imaginary of the C/creative City was annexed by, but not necessarily created by, neoliberalism. If the C/creative City articulated a future beyond a Fordist industrial civilisation, then we must take care in rejecting it not to abandon at the same time the power to imagine a different future. So, too, in attempting to assert the ordinary everyday city, we must also keep hold of a sense of the creative imagination that art and culture articulates, rather than dismissing this as part of the shiny glass palace on the hill. The absence of art and culture from the new progressive social and economic agendas that are currently finding their way into the mainstream—green new deals, doughnuts, well-being, community and ecological economics, and so on—is telling (O’Connor, Reset). In part this reflects the capture of arts and cultural policy by neoliberalism. This is not just ‘economic rationalism’ or market fundamentalism, for in the ‘creative economy’ art and cultural policy fused with neoliberalism at a deep DNA level, and the creative city imaginary was part of this. Mould is right to doubt whether the notion of ‘creative’, so closely enmeshed, could ever be retrieved. But regardless of whether art and culture have been condemned by this close association, the collapse of its romantic-utopian promise into a consumer leisure economy has left a void. If Jameson’s contention that we cannot think the end of capitalism is no longer the case (Jameson; Morozov), then culture is not present at this new moment of transition. So much well-being, community, and ecological economics speaks of culture whilst barely naming it. For us, the rearticulation of the place of art and culture in the contemporary city is crucial. We would even suggest that without art and culture, a full transformation of the contemporary city would be impossible. But how to think this? Any democratic cultural policy would need to reclaim both the ordinary and the creative city. This would entail the creative city of dissent and subversion, so closely aligned with the broad social movements to which we must look, in large part, to transform the city. It would also mean the right to a full participation in the imaginary of the collective city in which we all dwell and where we can imagine different futures. For this to happen, art and culture needs to be taken out of the hands of real estate, tourism, and economic development, and reframed as part of public service and public value. Just as new movements seek to reframe economic growth in terms of sustainability, equity, and human flourishing (Raworth), a radical creative city would be one in which art and culture were constitutive of the social foundations and part of how we live together as citizens, not simply another engine of the consumption economy. This process of re-embedding art and culture in the everyday foundations of the ordinary city is certainly underway. The ‘new municipalism’ (Thompson) has begun to make space for culture, with cities such as Barcelona and organisations such as the UCLG making a lot of the running. Notions of cultural rights, both individual and collective, have returned to challenge the urban consumption model. Just as art and culture try to position themselves alongside other foundational services—health, education, welfare—they also need to engage with new approaches to urban design, where technologies and infrastructures have been repositioned as cultural rather than technological. This suggests both that art and culture engage with the wider ‘cultural’—as in the anthropological, ‘whole way of life’—but that it no longer ‘owns’ this culture. Art and culture are not to be seen, as in the 1980s, as the ‘key’ to a total social transformation, but as one element only, however crucial. So too ‘creative’ needs to be unpicked and reframed, away from its association with ‘progress’ and absolute self-creation towards ‘slowdown’ (Dorling), sustainability, custodianship, care, incrementalism, and restoration – the kinds of values we now associate with First Nations. The shared DNA between creativity and capitalist modernity runs deep. Conclusion The COVID-19 pandemic has devastated large areas of art and culture, putting a question mark next to the urban use patterns that underpinned so much of the creative city model (Banks and O’Connor; de Peuter et al.; Tanghetti et al.; Whiting and Roberts). The Creative City of consumption, commuting, tourism, and entertainment stopped. Though some construction continued, the very purpose of the city centre—which over three decades had been rebranded as the Central Business District—was called into question. But the creative city was devastated too. Not just the collapse in income for cultural workers and business owners, but so too the filigrees of creative connection, the rhizomic mica that underpin the ecosystem of the city. Creatives already made no money, but at least they could go to openings and stay out late. Not anymore. This knockout blow was followed by the recognition that, for all the creative rhetoric, it was construction spending that counted most towards cultural funding budgets (Pacella et al.). Whilst talk quickly became one of getting artists and creatives to kickstart urban activity and animate deserted main street properties—‘build back better’—it is not at all clear where this endless supply of artists is going to come from. Now might be the time to explore how we might rethink art, culture, and the city rather than business as usual. As Arundhati Roy suggested, “nothing could be worse than a return to normality. Historically, pandemics have forced humans to break with the past and imagine their world anew. This one is no different. It is a portal, a gateway between one world and the next” (Roy). If art and culture don’t form part of that search for the new world, they will end up simply defending this one. 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