Letters to the Editor is a periodic feature cheap renova. We welcome all comments and will publish a selection. We edit for length and clarity cheap renova and require full names. A Harrowing Tale of Racism I liked the article “The Making of Reluctant Activists.

A Police Shooting in a Hospital Forces One Family to Rethink American Justice” (May 10). As a physician in Texas, I reached out to the senior Dr cheap renova. Pean the day after the shooting. I encouraged the Harris County Medical Society to advocate for this family and got nowhere.

I wrote several times to the then-current president of the medical cheap renova society and got nowhere. Medicare threatened to shut down the hospital because of this incident and then the president of the medical society protested the shutdown but not the shooting. Although the president of the medical society was Latino, he showed no concern for the doctor’s part-Latino son getting shot. I have stayed in touch with the family and have been pleased cheap renova with their successes.

€” Dr. Robert Jackson, Houston — S.E. Smith, Fort Bragg, Colorado The article about the cheap renova Pean family is informative about this pernicious, persistent type of American racism. As a 70-year-old African American woman, I know it well.

My question is, What is the health industry doing to alleviate the scourge that destroys the minds and bodies of people of color?. Publishing a meaningful article cheap renova on the Pean family is not enough. €” Evonnie Gbadebo, Windsor, Connecticut Care Inequities Extend Beyond Race I’m tired of hearing about racial disparities (“Stark Racial Disparities Persist in Vaccinations, State-Level CDC Data Shows,” May 20). How about some comments about people with disabilities who live independently and don’t have caretakers to do everything for them?.

I had a negative experience cheap renova at a local pharmacy getting my skin care products shots. The first shot, I bore with it but complained loudly about lack of accessibility. The second shot, nothing had changed so I made a bigger scene about it. I hope they finally got their act together, but I can’t go to every single pharmacy in the country and tell them we need signage to tell us where to go cheap renova for accessible service.

(In this case, the pharmacy counter might have worked.) Also, they need to have their questions in writing, in advance. I’m not surprised that the Centers for Disease Control and Prevention data is incomplete. I haven’t seen any stories about outreach to deaf or hard-of-hearing people either, and given that everyone is wearing masks, I found getting a cheap renova shot unpleasant for lack of communication during the process. The waiting line was wholly audist-oriented with no hand signals, the questions were incomprehensibly spoken, and the drugstore had no signage to help anyone with disabilities.

€” Therese Shellabarger, North Hollywood, California — Dr. Céline Gounder, New York City The Push-Pull of Dentistry Here’s cheap renova another questionable dental revenue-generating tactic. When many dentists say, “We take all PPOs,” it really means. €œEven though we are out-of-network, we will bill your PPO instead of you having to submit an out-of-network claim.” It’s a common business practice in dentistry (“Why Your Dentist Might Seem Pushy,” May 19).

People get hit with surprise balance bills and think it’s cheap renova their “bad” insurance coverage instead of the intentionally misleading (and usually nonexistent) explanation of their dentist’s out-of-network relationship with their insurance carrier. The front desk does this, the dentists themselves do this, and their webpages about insurance do it. And again, it all boils down to dentists generating more revenue than they otherwise would, cheap renova either because they’d have to accept the lower contract rate if they were in-network or they’d outright lose the patient when they find out they are actually out-of-network. Making matters worse, some people “love” their dentist and don’t take the time to research in-network dentists who they might also love if they went to them, so they pay the extra to stay with their dentist and figure it’s “worth it.” The widespread fear of dentistry plays into this, too — the dentists act nice, the patient likes them and believes they are therefore a good dentist because they are nice and the patient didn’t have a bad dentistry experience, in the end creating loyalty that is then exploited with the PPO scam.

Hashtag caveat emptor. €” Jonathan Greer, Rockridge Health Insurance, Oakland, California cheap renova After my previous dentist retired, he sold his practice to a new dentist. The new dentist immediately found many problems that weren't a problem before.via @KHNews https://t.co/GjXR1N1piR— Harry Sit (@TheFinanceBuff) May 20, 2021 — Harry Sit, Reno, Nevada Dental Care Is Essential I write in response to your article “Why Your Dentist Might Seem Pushy” (May 19). The piece’s lack of empirical or systemic data is troubling and dangerously downplays the important work done by dental professionals every day.

There are often allegations cheap renova of fraud and abuse in all industries, unfortunately including health care. However, the percentage of complaints has been consistently low in the dental industry. According to the National Health Care Anti-Fraud Association, each year roughly 5% of the $250 billion spent on dental care procedures are associated with alleged fraud or abuse, compared with up to 10% in other health care fields, as noted in the article. Suggesting that dentists regularly push cheap renova unnecessary procedures to drive up profits is false and damaging to the dental profession and patients’ perception of dentistry.

Dentists provide essential care that keeps patients healthy. At the core of improving oral health is the dentists and their entire team who play a crucial role in providing safe and accessible health care for communities across the country, especially in underserved areas. Many studies have shown that that dental care is critical for early detection and prevention of diseases, including heart disease, cheap renova stroke and diabetes. Additionally, more recent studies have shown that increased dental hygiene also greatly increases a patient’s chances of surviving skin care products.

Many of the Association of Dental Support Organizations members, in fact, provide charitable care and dentistry to thousands of patients annually. As executive director of the ADSO, I am proud of our members who cheap renova always put patients and their safety first. Our members are enabling their supported dentists to focus on patients, expand access to underserved communities, and maintain high-quality standards for essential dental care and business operations. €” Andrew Smith, executive director of the Association of Dental Support Organizations, Arlington, Virginia I recieved a Moderna treatment, so this tells me, get the treatment but still keep your distance from others.

Hey I can do that because I am not a people cheap renova person who hangs around big crowds anyway. Https://t.co/WGACm78I1P— David Hodges (@DavidHo00768274) April 28, 2021 — David Hodges, Portland, Oregon A Footnote on Breakthrough skin care products Cases Regarding Steven Findlay’s article “The Shock and Reality of Catching skin care products After Being Vaccinated” (April 16). First of all, Mr. Findlay, I am sorry to hear that you got skin care products after your second shot cheap renova.

That’s a drag. But in your article, don’t you think you might have given the wrong impression about the likelihood of this happening?. You wrote cheap renova. €œA tiny but growing number are contending with the disturbing experience of getting skin care products despite having had one shot — or even two.” A “growing” number, I think, gives the wrong impression that the proportion of breakthrough cases is growing.

That would be worrying. But isn’t the cheap renova number only “growing” because more people are getting vaccinated?. In that case, it is entirely unremarkable that the number is growing, so why the “but”?. I’m extremely concerned about treatment hesitancy in this country, and I’m far more worried about your article reinforcing that hesitancy than I am about myself contracting a breakthrough case.

€” Jason cheap renova Hodin, Friday Harbor, Washington — Chris Collins, New Orleans An Aha Moment on Stroke Care Thank you. I am more educated, and quite horrified, about the condition of the state of our state‘s and nation’s health care predicament (“In Appalachia and the Mississippi Delta, Millions Face Long Drives to Stroke Care,” May 4). Your insightful investigative reporting should be a catalyst for communities to seek funding for our loved ones. I plan to share with my county commissioners cheap renova and state legislators.

Again, many thanks. €” Judge Tammy Jackson Montgomery, Coatopa, Alabama — Jessica Gottlieb, Los Angeles My Primary Care Physician Virtually Aced It Really excellent and insightful cautionary commentary on the “virtual medicine” phenomenon (“Telemedicine Is a Tool — Not a cheap renova Replacement for Your Doctor’s Touch,” May 6). It is true that most of one’s interactions with one’s doctor are informational (assuming that one does not suffer from a dread disease). But communication via email is optimal only when one has an established relationship with the physician over time, and when the physician has access to the patient’s rich electronic medical record (EMR).

The best expression of the role of “virtual cheap renova medicine” is the use of multi-modality communication between patient and primary care physician in the Kaiser Permanente model. I’ve been a KP Medicare Advantage member for over eight years, and my health status is managed as a collaboration with my KP primary care physician. In our initial intake physician exam, I told him I have a boring EMR, but I’m a whiner, so he could expect to hear from me regularly. I asked him to make sure that I cheap renova continued to perform well on the tennis court.

He responded by saying that it is a mutual responsibility. So, over the past eight years, we have communicated almost exclusively by email. He always responds within 24 hours, and usually by the cheap renova end of the day. Twice during this period, I reported symptoms that could have indicated a serious clinical issue.

In each case, the response was immediate, with a referral to a specialist(s) within KP who, of course, had access to my complete EMR. When I received a skin care products vaccination outside cheap renova the KP network, we made sure that documentation was added to my EMR. So, within the KP model, “virtual medicine” is clinically efficient and cost-effective, because patient and physician are communicating within a very high-quality health care delivery system. Immediate access to well-informed clinicians is assured.

This is very different from the many emerging for-profit ventures that cheap renova promote services of dubious quality or clinical effectiveness — really, most are little more than rebranded, app-enhanced “nurse advice lines.” Thanks for a great op-ed. €” Tony Pfannkuche, Los Angeles — Torshira Moffett, Washington, D.C. Public health systems all over the world were overwhelmed by #skin care products19, even the best-funded ones. @GavinNewsom made the cheap renova right moves.

Which is why CA is a world leader in vaccination success. Single-payer countries?. Not so cheap renova much.— Steven Maviglio (@stevenmaviglio) May 6, 2021 — Steven Maviglio, Sacramento, California The renova Demanded Workarounds This article’s implicit conclusion of wrongdoing at the expense of a public agency is quite egregious and short-sighted (“Salesforce, Google, Facebook. How Big Tech Undermines California’s Public Health System,” May 6).

This unprecedented health crisis needed quick, decisive actions and policies. The current cheap renova bureaucracy has consistently proven itself to be too slow in response due to its many layers of management’s accountability. The governor’s working relationship with high tech was instrumental in keeping California’s health crisis under control. Why people complain after the fact is representative of what is wrong currently in society, creating unnecessary division.

I’m not saying unbridled praise cheap renova should be heaped upon Gov. Newsom, but to look for negativity or wrongdoing for the sake of an article was pretty shallow. €” Warren Young, San Francisco — Tom Merrill, Salt Lake City CHL link, May 18. Https://californiahealthline.org/news/article/renova-seniors-lose-strength-conditioning-may-need-rehabilitative-services/ Bolstering Medicare Coverage to Keep Seniors Strong As you rightly point out, after 15 months of sheltering in place, older Americans are increasingly being negatively impacted by the indirect health effects of skin care products — including loss of cheap renova strength, mobility and independence (“As renova Eases, Many Seniors Have Lost Strength, May Need Rehabilitative Services,” May 21).

For many seniors, this prolonged period of “physical deconditioning” has put them at serious risk of long-term disability, injuries and falls, which cause 2.8 million emergency room visits every year. Recognizing the long-term cheap renova health impact of the renova on America’s seniors, physical therapy services will only grow in importance. That’s why it’s troubling that Medicare has chosen to push forward with significant payment cuts for physical, occupational and speech therapy services. Though Congress temporarily reduced the cuts last year, our specialty faced one of the steepest declines in Medicare spending — a whopping 34% — during the first six months of 2020.

As demand for our services grows, it is critical for Medicare to protect seniors’ access to the cheap renova medically necessary therapy services they need. Instead of implementing these devastating cuts in 2022 and beyond, Medicare should rethink its approach to ensure stability to the system and, ultimately, improve the health and independence of older Americans. €” Nikesh Patel, executive director, Alliance for Physical Therapy Quality and Innovation (APTQI), Washington, D.C. In pain and crisis, when someone w/SUD is ready for help, she cheap renova may not be able to research a facility's quality.

We need standards &. Accountability. "Addiction Treatment Providers cheap renova in Pa. Face Little State Scrutiny Despite Harm to Clients https://t.co/y3If2bU2eo via @khnews— Kristin Gourlay (@kristingourlay) April 30, 2021 — Kristin Gourlay, Oak Park, Illinois Altering Mindsets on Addiction Although I haven’t been personally affected by the addiction/overdose crisis, I still understand the callous politics involved with this most serious social issue (“Addiction Treatment Providers in Pa.

Face Little State Scrutiny Despite Harm to Clients,” April 30). The mere mention of government funding to make cheap renova proper treatment available to low- and no-income hard-drug addicts, however much it would alleviate their great suffering, generates firm opposition by the general socially and fiscally conservative electorate. The reaction is largely due to the preconceived notion that drug addicts are but weak-willed and/or have somehow committed a moral crime. Ignored is that such intense addiction usually does not originate from a bout of boredom, where a person repeatedly consumed recreationally but became heavily hooked on an unregulated often-deadly chemical that eventually destroyed their life and even that of a loved one.

The greater the drug-induced euphoria or escape one attains from its use, the more one wants to repeat the experience cheap renova. And the more intolerable one finds their sober reality, the more pleasurable that escape should be perceived. By extension, the greater one’s mental pain or trauma while sober, the greater the need for escape from reality, thus the more addictive the euphoric escape-form will likely be. Regardless, we now know pharmaceutical corporations intentionally pushed their very addictive opiate painkillers (perhaps the real moral crime), for which they got off relatively lightly, considering the resulting immense suffering and cheap renova overdose death numbers.

€” Frank Sterle Jr., White Rock, British Columbia — Angela Biesecker, Philadelphia Going to Bat for Nurse Anesthetists As the skin care products outlook improves, the toll on health care providers caused by the renova is unprecedented. Nurses have risked their lives as they dealt with shortages of protective equipment, medications and personnel — all while s, hospitalizations and deaths from the disease soared. Yet nurses have risen to the challenges, courageously caring and providing life-sustaining cheap renova services to millions of patients. So, why do some question a nurse’s right to practice to the full extent of their education and training?.

Nurses do most of their demanding work out of the public eye. And even less understood cheap renova by the public is the number of specialties in nursing, particularly those of advanced practice registered nurses. Consider the “nurse anesthetist” or Certified Registered Nurse Anesthetist (CRNAs). Unless you have had surgery and/or delivered a baby, chances are you have never heard of the highly educated, expertly trained CRNA.

Surveys show that more cheap renova than 70% of CRNAs report treating skin care products patients. We have seen these health care professionals travel to hot spots to provide lifesaving care. Because of a CRNA’s expertise in airway and ventilation management and other critical care skills, CRNAs have become a highly sought-after health care provider — capturing the attention of the federal government. Recognizing the need for CRNAs cheap renova to be working to the top of their training, the U.S.

Department of Health and Human Services waived the federal physician supervision requirements for nurse anesthetists. Because of the temporary changes to the law, CRNAs have been able to safely fill essential health care needs during the national crisis. A new report from the National Academy of Medicine, “The Future of Nursing 2020-2030,” prioritized several opportunities in the nursing profession for eliminating health care disparities, including the permanent removal of barriers to nursing care cheap renova that were enacted in response to the renova. It also calls for allowing nurses to practice to the full extent of their education and training as well as ensuring that they can bill for those services.

So, why snatch back a CRNA’s full practice rights, after hundreds of thousands of patients received safe, exceptional, life-sustaining care before and during the cheap renova renova?. Some special interest groups argue that the federal physician supervision requirement is necessary, asserting that the waiver lowers the standard of care and risks patients’ lives. This kind of fearmongering lacks true evidence and attempts to confuse the public. Nurse anesthetists are highly educated practitioners whose patient safety cheap renova records stand for themselves.

In fact, 42 U.S. States do not require physician supervision of a CRNA in their state nurse practice act. Now is the time to put an end cheap renova to any type of pronouncement that questions the role, value and safety of CRNA-delivered care. €” Steven M.

Sertich, president of the American Association of Nurse Anesthetists, Park Ridge, Illinois Related Topics Contact Us Submit a Story TipCassandra Rollins’ daughter was still conscious when the ambulance took her away. Shalondra Rollins, 38, was struggling to cheap renova breathe as skin care products overwhelmed her lungs. But before the doors closed, she asked for her cellphone, so she could call her family from the hospital. It was April 7, 2020 — the last time Rollins would see her daughter or hear her voice.

The hospital rang cheap renova an hour later to say she was gone. A chaplain later told Rollins that Shalondra had died on a gurney in the hallway. Rollins was left to break the news to Shalondra’s children, ages 13 and 15. More than cheap renova a year later, Rollins said, the grief is unrelenting.

Rollins has suffered panic attacks and depression that make it hard to get out of bed. She often startles when the phone rings, fearing that someone else is hurt or dead. If her other daughters don’t pick up when she calls, Rollins phones cheap renova their neighbors to check on them. €œYou would think that as time passes it would get better,” said Rollins, 57, of Jackson, Mississippi.

€œSometimes, it is even harder. €¦ This wound right here, time don’t heal it.” With nearly 600,000 in cheap renova the U.S. Lost to skin care products — now a leading cause of death — researchers estimate that more than 5 million Americans are in mourning, including more than 43,000 children who have lost a parent. The renova — and the political battles and economic devastation that have accompanied it — have inflicted unique forms of torment on mourners, making it harder to move ahead with their lives than with a typical loss, said sociologist Holly Prigerson, co-director of the Cornell Center for Research on End-of-Life Care.

The scale and complexity of renova-related grief have created a public health burden that could deplete Americans’ physical and mental health for years, leading to more depression, substance cheap renova misuse, suicidal thinking, sleep disturbances, heart disease, cancer, high blood pressure and impaired immune function. €œUnequivocally, grief is a public health issue,” said Prigerson, who lost her mother to skin care products in January. €œYou could call it the grief renova.” Like many other mourners, Rollins has struggled with feelings of guilt, regret and helplessness — for the loss of her daughter as well as Rollins’ only son, Tyler, who died by suicide seven months earlier. €œI was there to see my mom close her eyes and leave this world,” said Rollins, who was first interviewed by KHN a year ago in a story about skin care products’s disproportionate effects on communities of color cheap renova.

€œThe hardest part is that my kids died alone. If it weren’t for this skin care products, I could have been right there with her” in the ambulance and emergency room. €œI could have held her hand.” The cheap renova renova has prevented many families from gathering and holding funerals, even after deaths caused by conditions other than skin care products. Prigerson’s research shows that families of patients who die in hospital intensive care units are seven times more likely to develop post-traumatic stress disorder than loved ones of people who die in home hospice.

The polarized political climate has even pitted some family members against one another, with some insisting that the cheap renova renova is a hoax and that loved ones must have died from influenza, rather than skin care products. People in grief say they’re angry at relatives, neighbors and fellow Americans who failed to take the skin care seriously, or who still don’t appreciate how many people have suffered. €œPeople holler about not being able to have a birthday party,” Rollins said. €œWe couldn’t even have a funeral.” It’s been more than a year since Cassandra Rollins’ daughter Shalondra died of skin care products, cheap renova but Rollins says the grief is unrelenting.

In April of last year, just an hour after an ambulance took Shalondra away, the hospital called to say she was gone. Rollins is now raising Shalondra’s two teenage daughters.(Imani Khayyam / for KHN) Indeed, the optimism generated by treatments and falling rates has blinded many Americans to the deep sorrow and depression of those around them. Some mourners say they will continue wearing their face cheap renova masks — even in places where mandates have been removed — as a memorial to those lost. €œPeople say, ‘I can’t wait until life gets back to normal,’” said Heidi Diaz Goff, 30, of the Los Angeles area, who lost her 72-year-old father to skin care products.

€œMy life will never be normal again.” Many of those grieving say celebrating the end of the renova feels not just premature, but insulting to their loved ones’ memories. €œGrief is invisible in many ways,” said Tashel Bordere, a University of Missouri assistant professor cheap renova of human development and family science who studies bereavement, particularly in the Black community. €œWhen a loss is invisible and people can’t see it, they may not say ‘I’m sorry for your loss,’ because they don’t know it’s occurred.” “You would think that as time passes it would get better. Sometimes, it is even harder.

€¦ This wound right here, time don’t heal it.”Cassandra Rollins, of Jackson, Mississippi Communities of color, which have cheap renova experienced disproportionately higher rates of death and job loss from skin care products, are now carrying a heavier burden. Black children are more likely than white children to lose a parent to skin care products. Even before the renova, the combination of higher infant and maternal mortality rates, a greater incidence of chronic disease and shorter life expectancies made Black people more likely than others to be grieving a close family member at any point in their lives. Rollins said everyone she cheap renova knows has lost someone to skin care products.

€œYou wake up every morning, and it’s another day they’re not here,” Rollins said. €œYou go to bed at night, and it’s the same thing.” A Lifetime of Loss Rollins has been battered by hardships and loss since childhood. She was cheap renova the youngest of 11 children raised in the segregated South. Rollins was 5 years old when her older sister Cora, whom she called “Coral,” was stabbed to death at a nightclub, according to news reports.

Although Cora’s husband was charged with murder, he was set free after a mistrial. Rollins gave birth to Shalondra at age 17, and the two were especially close cheap renova. €œWe grew up together,” Rollins said. Just a few months after Shalondra was born, Rollins’ older sister Christine was fatally shot during an argument with another woman.

Rollins and her mother helped raise two of the children Christine left cheap renova behind. Heartbreak is all too common in the Black community, Bordere said. The accumulated trauma — from violence to chronic illness and racial discrimination — can have a weathering effect, making it harder for people to recover. €œIt’s hard to recover from any one experience, because every day there cheap renova is another loss,” Bordere said.

€œGrief impacts our ability to think. It impacts our energy levels. Grief doesn’t just show cheap renova up in tears. It shows up in fatigue, in working less.” Rollins hoped her children would overcome the obstacles of growing up Black in Mississippi.

Shalondra earned an associate’s degree in early childhood education and loved her job as an assistant teacher to kids with special needs. Shalondra, who had been a second mother to her younger siblings, also adopted a cousin’s stepdaughter after cheap renova the child’s mother died, raising the girl alongside her two children. Rollins’ son, Tyler, enlisted in the Army after high school, hoping to follow in the footsteps of other men in the family who had military careers. Yet the hardest losses of Rollins’ life were still to cheap renova come.

In 2019, Tyler killed himself at age 20, leaving behind a wife and unborn child. €œWhen you see two Army men walking up to your door,” Rollins said, “that’s unexplainable.” Tyler’s daughter was born the day Shalondra died. €œThey called to tell me the baby was born, and I had to cheap renova tell them about Shalondra,” Rollins said. €œI don’t know how to celebrate.” Cassandra Rollins’ son, Tyler, killed himself at age 20 in 2019, leaving behind a wife and an unborn child.

Tyler’s daughter was born in 2020, on the day Rollins’ daughter Shalondra died of skin care products.(Imani Khayyam / for KHN) Shalondra’s death from skin care products changed her daughters’ lives in multiple ways. The girls lost their cheap renova mother, but also the routines that might help mourners adjust to a catastrophic loss. The girls moved in with their grandmother, who lives in their school district. But they have not set foot in a classroom for more than a year, spending their days in virtual school, rather than with friends.

Shalondra’s death eroded their financial security cheap renova as well, by taking away her income. Rollins, who worked as a substitute teacher before the renova, hasn’t had a job since local schools shut down. She owns her own home and receives unemployment insurance, she said, but money is tight. Makalin Odie, 14, said her mother, cheap renova as a teacher, would have made online learning easier.

€œIt would be very different with my mom here.” The girls especially miss their mom on holidays. €œMy mom always loved birthdays,” said Alana Odie, 16. €œI know that if my mom were here my 16th birthday would have been really special.” Asked what she loved most about her mother, Alana cheap renova replied, “I miss everything about her.” Grief Complicated by Illness The trauma also has taken a toll on Alana and Makalin’s health. Both teens have begun taking medications for high blood pressure.

Alana has been on diabetes medication since before her mom died. Mental and physical health problems are common cheap renova after a major loss. €œThe mental health consequences of the renova are real,” Prigerson said. €œThere are going to be all sorts of ripple effects.” The stress of losing a loved one to skin care products increases the risk for prolonged grief disorder, also known as complicated grief, which can lead to serious illness, increase the risk of domestic violence and steer marriages and relationships to fall apart, said Ashton Verdery, an associate professor of sociology and demography at Penn State.

People who lose a spouse have a roughly 30% higher risk of death over the following year, a phenomenon cheap renova known as the “the widowhood effect.” Similar risks are seen in people who lose a child or sibling, Verdery said. Grief can lead to “broken-heart syndrome,” a temporary condition in which the heart’s main pumping chamber changes shape, affecting its ability to pump blood effectively, Verdery said. From final farewells to funerals, the renova has robbed mourners of nearly everything that helps people cope with catastrophic loss, while piling on additional insults, said the Rev. Alicia Parker, cheap renova minister of comfort at New Covenant Church of Philadelphia.

Cassandra Rollins leans on daughter Shalondra’s car outside Rollins’ home in Jackson, Mississippi. Shalondra, who earned an associate’s degree in early childhood education and loved her job as an assistant teacher to kids with special needs, died of skin care products in April 2020.(Imani Khayyam / for KHN) “It may be harder for them for many years to come,” Parker said. €œWe don’t cheap renova know the fallout yet, because we are still in the middle of it.” Rollins said she would have liked to arrange a big funeral for Shalondra. Because of restrictions on social gatherings, the family held a small graveside service instead.

Funerals are important cultural traditions, allowing loved ones to give and receive support for a shared loss, Parker said. €œWhen someone dies, cheap renova people bring food for you, they talk about your loved one, the pastor may come to the house,” Parker said. €œPeople come from out of town. What happens when people can’t come to your home and cheap renova people can’t support you?.

Calling on the phone is not the same.” While many people are afraid to acknowledge depression, because of the stigma of mental illness, mourners know they can cry and wail at a funeral without being judged, Parker said. €œWhat happens in the African American house stays in the house,” Parker said. €œThere’s a lot of things we don’t talk about or share cheap renova about.” Funerals play an important psychological role in helping mourners process their loss, Bordere said. The ritual helps mourners move from denying that a loved one is gone to accepting “a new normal in which they will continue their life in the physical absence of the cared-about person.” In many cases, death from skin care products comes suddenly, depriving people of a chance to mentally prepare for loss.

While some families were able to talk to loved ones through FaceTime or similar technologies, many others were unable to say goodbye. Funerals and cheap renova burial rites are especially important in the Black community and others that have been marginalized, Bordere said. €œYou spare no expense at a Black funeral,” Bordere said. €œThe broader culture may have devalued this person, but the funeral validates this person’s worth in a society that constantly tries to dehumanize them.” In the early days of the renova, funeral directors afraid of spreading the skin care did not allow families to provide clothing for their loved ones’ burials, Parker said.

So beloved parents and grandparents were buried in whatever cheap renova they died in, such as undershirts or hospital gowns. €œThey bag them and double-bag them and put them in the ground,” Parker said. €œIt is an indignity.” Coping With Loss Every day, something reminds Rollins of her losses. April brought the first cheap renova anniversary of Shalondra’s death.

May brought Teacher Appreciation Week. Yet Rollins said the memory of her children keeps her going. When she begins to cry and thinks she will never stop, one thought cheap renova pulls her from the darkness. €œI know they would want me to be happy.

I try to live on that.” Liz Szabo. lszabo@kff.org, @LizSzabo Related Topics Contact Us Submit a Story TipWhen the renova sidelined in-office visits at cheap renova his practice, Dr. Dael Waxman “wasn’t exactly thrilled with being at home.” But he quickly shifted gears to video and telephone appointments. Now, he finds, there are good reasons to keep these options open even as in-office visits have resumed and many parts of the country have sharply loosened skin care restrictions.

One is that some patients “have to overcome a lot of cheap renova obstacles to get to me,” said Waxman, a family physician with Atrium Health in Charlotte, North Carolina. €œI have lots of single mothers. They have to leave work, get their kids out of school and then take two buses. Why would they cheap renova want to do that if they don’t have to?.

€ Telehealth served as a lifeline for many during the renova, ramping up from a minority share of office visits to a majority, at least for a while. Still, it cannot replace hands-on care for some conditions, and for those not blessed with speedy broadband internet service or smart devices it can be difficult or impossible to use. As things head toward cheap renova a new normal, lawmakers and insurers, including Medicare, are debating how to proceed, the biggest question being whether to continue reimbursing providers at the same payment rate as for in-person coverage once the skin care products public health emergency ends. While that debate rages — one side pointing to the costs associated with setting up such services, the other arguing that payment rates should decline because telehealth services are cheaper to provide — patients are left to decide if such visits meet their needs.

KHN put such questions to physicians, who gave tips on the types of concerns that are best handled in person, and when video visits are most useful. Not surprisingly, they recommended that patients cheap renova ask their provider which type of visit is most appropriate for their particular circumstance. Four additional things we learned. 1.

Some things just need to be done in cheap renova person. Chest pains, new shortness of breath, abdominal pain, new or increased swelling in the legs — all those things point to the need for an in-person visit. And, of course, blood tests, vaccinations and imaging scans must be done in person cheap renova. €œIf your blood pressure is really high or you have some symptoms of concern like chest pain, one needs to go to the office,” said Dr.

Ada Stewart, president of the American Academy of Family Physicians, which posted an online guide for telemedicine visits. If patients cheap renova are concerned enough about the situation that they are considering going to an urgent care clinic or even an emergency room, “they should be seen,” said Waxman. And that would occur in person. If a condition, even something seemingly simple, hasn’t resolved in a reasonable time, go to the office.

Waxman recalled a patient with an eye issue who went to cheap renova urgent care and received antibiotics, but the eye was still irritated after treatment. €œBecause it had not resolved, I was worried about shingles of the eye,” he said. It turned out not to be shingles, but a different problem, Waxman learned after referring the patient to an ophthalmologist. In-person visits can also prove more productive because a physician gains visual clues to what might be wrong by watching how a patient cheap renova walks, sits or speaks.

While video visits are wonderful, said Dr. David Anderson, a cardiologist affiliated with Stanford Health Care in Oakland, California, sometimes things come up in person that might not over video. €œI can’t say how many times I sit with a patient and cheap renova I think we’re done — then the thing that’s really the problem gets brought up and we spend the next 45 minutes on it,” he said. Finally, a good reason to go in is, simply, if that’s what you prefer.

€œI had a patient the other day who said he could have done a phone visit but was old-school and just preferred being in the office,” Waxman said. 2. Sometimes a televisit is better. It’s not always necessary to trek into a medical office or clinic.

Stewart, at the family physician group, said check-ins for chronic conditions, such as diabetes or hypertension, “that are basically under control” can easily be handled remotely. Cardiologist Anderson concurred, especially for periodic assessments or checking how a patient is handling a new medication. €œIf I have a [stable] 82-year-old patient and her daughter needs to miss work and come from 30 miles away to bring Mom in for us to sit there for 15 minutes to chat, that’s something where the efficiency of a video visit is good,” he said. But if that same patient complains that “when they take a morning walk, they are short of breath and they were not before, that person I would want to see face to face.” And, sometimes, video follow-ups for stable patients with chronic illnesses are preferable.

€œOn the phone or by video, I found there to be a lot more non-distracted time for education,” he said. It is helpful if patients can monitor their blood sugar or blood pressure at home and then report their statistics during the televisit. But some patients cannot afford a home blood pressure monitor, so that can be a limitation, Waxman cautioned. And even those who have a monitor should initially take it into the office to make sure it is accurate, he said.

Some dermatologic conditions — think rashes and such — can be handled by video, so long as the patient is comfortable using the camera on their smartphone or computer tablet and can get a good picture of the problem area. While 70% to 80% of skin issues can start with a video visit, he estimated, the rest require in-person evaluation, perhaps even a biopsy. 3. Everything works better when both sides prepare.

Both patients and providers can get the most out of a video visit if they first take a few simple steps, the experts said. Find a quiet place without distractions. Turn off the TV. Have a family member present if you want a second set of ears, but choose a private setting if you don’t.

€œYou will not believe the circumstances where people Zoom in to me,” said Anderson. Some are in their cars, “maybe because that’s the best place where they get internet service,” or they’re in their pajamas, just finishing breakfast. €œThere’s a whole lack of preparation and seriousness that occurs,” he said. Have a list of medications you’re taking and write down the problem or symptoms you wish to discuss, as well as specific questions you have, to make the most out of the time available, advised Stewart.

Providers, too, need to take steps. Anderson said they should read patients’ medical records ahead of time and focus because there are fewer cues to a patient’s concerns over video than in person. Physicians “have to be doubly vigilant,” Anderson said, pay attention to all their suspicions and be extra thorough because “it would be much easier to miss something important.” 4. What might happen next?.

Some advocates say insurers should make sure that their reimbursement policies don’t favor one type of visit over another and that no patient feels pressured into a televisit. During the skin care products emergency, Congress and the agency that oversees Medicare temporarily made it easier for beneficiaries to use telehealth — for instance, by removing geographic restrictions and allowing audio-only visits in some circumstances. Medicare also began reimbursing providers equally for telehealth and in-person care. Many private insurers followed Medicare’s lead.

Some also voluntarily waived cost-sharing requirements for telehealth patients. Many expect Medicare Advantage plans to keep covering televisits once the emergency is officially over, and traditional Medicare could follow suit. The Medicare Payment Advisory Commission, a nonpartisan agency that advises Congress, has recommended temporarily continuing to cover some services while the agency gathers data about a wide range of effects, including concerns that telehealth raises spending and the advantages it may offer. That data is important, said Fred Riccardi, president of the Medicare Rights Center.

The expansion has helped many Medicare beneficiaries, he added, but “has left some communities behind,” including the oldest adults, those with disabilities and those in areas with spotty internet service. And future policies should ensure that patients who prefer in-person visits can continue them, he said. Anderson, the cardiologist, agreed that televisits “have a wonderful place” in the range of options, but he warned against cost-saving measures by insurers that might require patients to have a video visit before being granted coverage for an office visit. €œI would see that as an unfortunate delay in care,” he said.

Julie Appleby. jappleby@kff.org, @Julie_Appleby Related Topics Contact Us Submit a Story TipCalifornia Attorney General Rob Bonta, a longtime Democratic state lawmaker, comes to his new role well known for pursuing an unabashedly progressive agenda on criminal justice issues. He has pushed for legislation to eliminate cash bail and to ban for-profit prisons and detention centers. But Bonta also has a distinctive record on health care, successfully advancing legislation to protect consumers from so-called surprise medical bills when they inadvertently get treatment from out-of-network providers and framing environmental hazards like pollution as issues of social justice.

He was among the Democratic lawmakers leading the charge at the California Capitol to take on Big Soda, pushing to cut consumption of sugary drinks through taxes and warning labels. Such proposals so far have faltered under the influence of the soda industry. Bonta, 49, was an infant when his family, in 1971, moved to California from the Philippines, where his parents worked as missionaries. His father, Warren Bonta, a native Californian, worked for the state for decades as a health care official, setting up clinics to expand access to medical care in rural and refugee communities.

Rob Bonta’s first elected position was to the Alameda Health Care District, overseeing local medical services. Appointed by Gov. Gavin Newsom this year, Bonta in April succeeded former state Attorney General Xavier Becerra, who was tapped by President Joe Biden to serve as secretary of the U.S. Department of Health and Human Services.

In the weeks since, Bonta has beefed up the number of lawyers working in the Department of Justice’s Bureau of Environmental Justice and has created a Racial Justice Bureau that he said will play a pivotal role in ensuring equal access to health care for Black and Latino residents. A graduate of Yale Law School, Bonta spent nine years as a deputy city attorney in San Francisco before his election to the state Assembly in 2012, representing Oakland and the East Bay. He was the first Filipino American elected to the California legislature, and is now the first Filipino American to serve as the state’s chief law enforcement officer. As attorney general, Bonta said he envisions a far different relationship with the Biden administration than his predecessor had with the Trump administration.

Becerra emerged as one of former President Donald Trump’s fiercest critics during his tenure as the state’s top cop, filing more than 120 lawsuits to oppose Trump administration policies on the environment and health care, including leading the ongoing fight to preserve the Affordable Care Act in its case before the U.S. Supreme Court. Vice President Kamala Harris also once served as California’s attorney general, and Bonta said he sees tremendous opportunity to shape a more progressive agenda on issues such as reproductive health and universal, single-payer health care working in concert with the new administration. Bonta spoke with KHN about how health care would shape his agenda as attorney general.

The interview has been edited for length and clarity. Q. Your predecessor made health care a priority. Will it be one of yours?.

It’s going to be a top priority for me, and it was a top priority for me as a legislator. I was chair of the Assembly Health Committee or a health committee member the entire time I was there, almost nine years. Before that, I was on a health care district board. My very first elected office I ever had was making sure we provided true access to high-quality, affordable health care to the community that I served.

This is a really foundational part of who I am, and who my family is — our legacy and our values and what we stood for. I think health care is a right, not a privilege. It’s for all, not the few. Q.

You’ve said you would make racial justice a priority. Do you believe racism is a public health crisis?. Yes, I do. skin care products revealed a lot of what was inequitable and racist about our systems — the disparate impacts that we saw, the inequity that we saw.

And I think racism is not just a public health crisis — it is a public health crisis — but it also infects our economic system, it infects our criminal justice system, it infects all of our systems. And it has led to a public health crisis. Q. What does that look like in health care?.

How does inequity show up?. It looks like making sure that in health care there aren’t disparate impacts on communities of color. That race is not correlated to less access or less quality, and making sure that no one is left out. That can look like access to reproductive health care.

That can look like access to real health insurance as opposed to sham health insurance plans. It can look like a charge that is inappropriately placed on a treatment — treatments are supposed to be free. That’s something else we worked on recently. Q.

Can you elaborate?. Through a joint investigation with U.S. Health and Human Services, as well as the U.S. Attorney’s office, we identified that treatments — which should be provided to individuals for free under the law — that a charge was being placed on the treatment.

The treatment should be universally accessible. And when that isn’t being done, barriers are being put up in vulnerable communities, keeping people from their treatment that we all need right now. That is a problem. We put out an alert and reminded people of the laws that provide free treatments to all individuals under the Centers for Disease Control and Prevention program.

Q. What areas of environmental health might you look into?. The building of huge warehouses. In the Inland Empire, there are quite a few being built.

They’re being built adjacent to or in disadvantaged communities. And all the goods movement activity — and all of the emissions that are created from the goods movement — create a threat, and a risk to those communities. Q. Like Amazon, for instance?.

The corporation has come under scrutiny for environmental harms associated with its sprawling warehouses. Yeah. These warehouses have really created problems for disadvantaged communities in California. We expanded the Bureau of Environmental Justice to provide more resources and more ability to go after big polluters, and to protect communities that live at the intersection of poverty and pollution who are being forced to drink dirty water and breathe unhealthy air.

I see the role of the attorney general as standing up for everyday people who are abused or hurt and neglected or mistreated, and generally protecting the little guy from the overreach and abuse of power of the big guy. We have more authority in the environmental realm than in many other areas. And we want to use those tools — that authority, that influence, that power — to protect communities, often low-income communities, often communities of color, who are being hurt by polluters. Q.

Becerra filed a lawsuit and sponsored legislation going after health industry mergers alleged to be anti-competitive, a practice he argues drives up health care prices. Will you continue to go after anti-competitive practices in health care?. That’s definitely a priority. That’s a critical tool in the toolbox that the California attorney general uniquely has to approve — or put conditions on, or not approve — proposed mergers involving a nonprofit hospital.

The lens to see that through is. How does it impact patients?. How does it impact access to quality care, and cost of care?. And so that is exactly why the attorney general has that role, to review these proposed mergers with an eye towards patients and communities that don’t necessarily have a voice in the merger.

Q. As attorney general, do you support single-payer health care?. My involvement will be different. Having said that, I co-authored the single-payer bill from a few years back.

And I was a co-author of this year’s single-payer bill that Assemblyman Ash Kalra was leading that I think is no longer moving. [Kalra has withdrawn the bill from consideration for this year.] I support single-payer health care. I support universal health care. I think single-payer health care is a way to get to that aspiration.

As the attorney general, I enforce the law. We don’t have a single-payer law in California. So, I’ll enforce the existing laws, which are very strong, to help make sure Californians have the most accessible, affordable, highest-quality health care. Q.

The U.S. Supreme Court has agreed to hear a Mississippi abortion case that some say could threaten abortion rights at the state level. If upheld, how could that affect the abortion protections in California?. That’s going to be a really important case for reproductive freedom, and important, in my view, for California to be involved in given our leadership in this space.

As the case gets briefed and prepped for consideration and argument before the U.S. Supreme Court, I expect we will be very active in making arguments to the court to help guide [the justices’] thinking and their decisions. Q. What will California’s relationship with the federal government be like?.

I think the posture and the relationship between the federal administration and California over the last four years are very different than what they will be for the next four. Attorney General Becerra was the warrior and the champion that we needed, and that was necessary as we faced a full-frontal assault on California, our people, our values and our resources, and he fought back and protected us and defended us and stood up for our values time and time again. Now, I think we have a Biden-Harris administration that largely does agree that we should have, certainly, the Affordable Care Act, that we should have reproductive freedom, that we should address the inequities in our health care system, that we should have affordable, accessible, high-quality health care for all — and will help us get there. So, with the new administration, I look to collaboration.

California can and should continue to be who we are. We lead. We go first. We pioneer.

We’re bold and we’re big in how we think. That’s who we are, so that leading role is our natural place to be, including in health care. This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. Angela Hart.

ahart@kff.org, @ahartreports Related Topics Contact Us Submit a Story TipThe day Dr. Elizabeth Dawson was diagnosed with skin care products in October, she awoke feeling as if she had a bad hangover. Four months later she tested negative for the renova, but her symptoms have only worsened. Dawson is among what one doctor called “waves and waves” of “long-haul” skin care products patients who remain sick long after retesting negative for the renova.

A significant percentage are suffering from syndromes that few doctors understand or treat. In fact, a yearlong wait to see a specialist for these syndromes was common even before the ranks of patients were swelled by post-skin care products newcomers. For some, the consequences are life altering. Before fall, Dawson, 44, a dermatologist from Portland, Oregon, routinely saw 25 to 30 patients a day, cared for her 3-year-old daughter and ran long distances.

Today, her heart races when she tries to stand. She has severe headaches, constant nausea and brain fog so extreme that, she said, it “feels like I have dementia.” Her fatigue is severe. €œIt’s as if all the energy has been sucked from my soul and my bones.” She can’t stand for more than 10 minutes without feeling dizzy. Through her own research, Dawson recognized she had typical symptoms of postural orthostatic tachycardia syndrome, or POTS.

It is a disorder of the autonomic nervous system, which controls involuntary functions such as heart rate, blood pressure and vein contractions that assist blood flow. It is a serious condition — not merely feeling lightheaded on rising suddenly, which affects many patients who have been confined to bed a long time with illnesses like skin care products as their nervous system readjusts to greater activity. POTS sometimes overlaps with autoimmune problems, which involve the immune system attacking healthy cells. Before skin care products, an estimated 3 million Americans had POTS.

Many POTS patients report it took them years to even find a diagnosis. With her own suspected diagnosis in hand, Dawson soon discovered there were no specialists in autonomic disorders in Portland — in fact, there are only 75 board-certified autonomic disorder doctors in the U.S. Other doctors, however, have studied and treat POTS and similar syndromes. The nonprofit organization Dysautonomia International provides a list of a handful of clinics and about 150 U.S.

Doctors who have been recommended by patients and agreed to be on the list. In January, Dawson called a neurologist at a Portland medical center where her father had worked and was given an appointment for September. She then called Stanford University Medical Center’s autonomic clinic in California, and again was offered an appointment nine months later. Using contacts in the medical community, Dawson wrangled an appointment with the Portland neurologist within a week and was diagnosed with POTS and chronic fatigue syndrome (CFS).

The two syndromes have overlapping symptoms, often including severe fatigue. Dr. Peter Rowe of Johns Hopkins in Baltimore, a prominent researcher who has treated POTS and CFS patients for 25 years, said every doctor with expertise in POTS is seeing long-haul skin care products patients with POTS, and every long-skin care products patient he has seen with CFS also had POTS. He expects the lack of medical treatment to worsen.

€œDecades of neglect of POTS and CFS have set us up to fail miserably,” said Rowe, one of the authors of a recent paper on CFS triggered by skin care products. The prevalence of POTS was documented in an international survey of 3,762 long-skin care products patients, leading researchers to conclude that all skin care products patients who have rapid heartbeat, dizziness, brain fog or fatigue “should be screened for POTS.” A “significant infusion of health care resources and a significant additional research investment” will be needed to address the growing caseload, the American Autonomic Society said in a recent statement. Lauren Stiles, who founded Dysautonomia International in 2012 after being diagnosed with POTS, said patients who have suffered for decades worry about “the growth of people who need testing and treating but the lack of growth in doctors skilled in autonomic nervous system disorders.” On the other hand, she hopes increasing awareness among physicians will at least get patients with dysautonomia diagnosed quickly, rather than years later. Congress has allocated $1.5 billion to the National Institutes of Health over the next four years to study post-skin care products conditions.

Requests for proposals have already been issued. €œThere is hope that this miserable experience with skin care products will be valuable,” said Dr. David Goldstein, head of NIH’s Autonomic Medicine Section. A unique opportunity for advances in treatment, he said, exists because researchers can study a large sample of people who got the same renova at roughly the same time, yet some recovered and some did not.

Long-term symptoms are common. A University of Washington study published in February in the Journal of the American Medical Association’s Network Open found that 27% of skin care products survivors ages 18-39 had persistent symptoms three to nine months after testing negative for skin care products. The percentage was slightly higher for middle-aged patients, and 43% for patients 65 and over. The most common complaint.

Persistent fatigue. A Mayo Clinic study published last month found that 80% of long-haulers complained of fatigue and nearly half of “brain fog.” Less common symptoms are inflamed heart muscles, lung function abnormalities and acute kidney problems. Larger studies remain to be conducted. However, “even if only a tiny percentage of the millions who contracted skin care products suffer long-term consequences,” said Rowe, “we’re talking a huge influx of patients, and we don’t have the clinical capacity to take care of them.” Symptoms of autonomic dysfunction are showing up in patients who had mild, moderate or severe skin care products symptoms.

Yet even today, some physicians discount conditions like POTS and CFS, both much more common in women than men. With no biomarkers, these syndromes are sometimes considered psychological. The experience of POTS patient Jaclyn Cinnamon, 31, is typical. She became ill in college 13 years ago.

The Illinois resident, now on the patient advisory board of Dysautonomia International, saw dozens of doctors seeking an explanation for her racing heart, severe fatigue, frequent vomiting, fever and other symptoms. For years, without results, she saw specialists in infectious disease, cardiology, allergies, rheumatoid arthritis, endocrinology and alternative medicine — and a psychiatrist, “because some doctors clearly thought I was simply a hysterical woman.” It took three years for her to be diagnosed with POTS. The test is simple. Patients lie down for five minutes and have their blood pressure and heart rate taken.

They then either stand or are tilted to 70-80 degrees and their vital signs are retaken. The heart rate of those with POTS will increase by at least 30 beats per minute, and often as much as 120 beats per minute within 10 minutes. POTS and CFS symptoms range from mild to debilitating. The doctor who diagnosed Cinnamon told her he didn’t have the expertise to treat POTS.

Nine years after the onset of the illness, she finally received treatment that alleviated her symptoms. Although there are no federally approved drugs for POTS or CFS, experienced physicians use a variety of medicines including fludrocortisone, commonly prescribed for Addison’s disease, that can improve symptoms. Some patients are also helped by specialized physical therapy that first involves a therapist assisting with exercises while the patient is lying down, then later the use of machines that don’t require standing, such as rowing machines and recumbent exercise bicycles. Some recover over time.

Some do not. Dawson said she can’t imagine the “darkness” experienced by patients who lack her access to a network of health care professionals. A retired endocrinologist urged her to have her adrenal function checked. Dawson discovered that her glands were barely producing cortisol, a hormone critical to vital body functions.

Medical progress, she added, is everyone’s best hope. Stiles, whose organization funds research and provides physician and patient resources, is optimistic. €œNever in history has every major medical center in the world been studying the same disease at the same time with such urgency and collaboration,” she said. €œI’m hoping we’ll understand skin care products and post-skin care products syndrome in record time.” Related Topics Contact Us Submit a Story Tip.

Renova me senhor

About This TrackerThis tracker provides the number of confirmed https://thebeardedbutler.co.uk/contact/ cases and deaths renova me senhor from novel skin care by country, the trend in confirmed case and death counts by country, and a global map showing which countries have confirmed cases and deaths. The data are drawn from the Johns Hopkins University (JHU) skin care Resource Center’s skin care products Map and the World Health Organization’s (WHO) skin care Disease (skin care products-2019) situation reports.This tracker will be updated regularly, as new data are released.Related Content. About skin care products skin careIn late 2019, a new skin care renova me senhor emerged in central China to cause disease in humans.

Cases of this disease, known as skin care products, have since been reported across around the globe. On January 30, 2020, the World Health Organization (WHO) declared the renova represents a public health emergency of international concern, and on January 31, renova me senhor 2020, the U.S. Department of Health and Human Services declared it to be a health emergency for the United States.Key PointsOn January 23, 2017, President Donald Trump reinstated and expanded the Mexico City Policy via presidential memorandum, renaming it “Protecting Life in Global Health Assistance.” This explainer provides an overview of the policy, including its history, changes over time, and current application.First announced in 1984 by the Reagan administration, the policy has been rescinded and reinstated by subsequent administrations along party lines and has now been in effect for 19 of the past 34 years.The policy requires foreign non-governmental organizations (NGOs) to certify that they will not “perform or actively promote abortion as a method of family planning” using funds from any source (including non-U.S.

Funds) as a condition of receiving renova me senhor U.S. Government global family planning assistance and, as of Jan. 23, 2017, renova me senhor most other U.S.

Global health assistance.The Trump administration’s application of the policy extends to the vast majority of U.S. Bilateral global health assistance, including funding for HIV under PEPFAR, maternal and child renova me senhor health, malaria, nutrition, and other programs. This marks a significant expansion of its scope, potentially encompassing $7.3 billion in FY 2020, to the extent that such funding is ultimately provided to foreign NGOs, directly or indirectly (family planning assistance accounts for approximately $600 million of that total).Additionally, as a result of a March 2019 policy announcement and subsequent information released in June 2019, the policy, for the first time, prohibits foreign NGOs who accept the policy from providing any financial support using any source of funds and for any purpose to other foreign NGOs that perform or actively promote abortion as a method of family planning.

This greatly extends its renova me senhor reach to other areas of U.S. Development assistance beyond global health and to other non-U.S. Funding streams.More recently, in renova me senhor September 2020, a proposed rule to extend the policy to contracts was published.

If finalized, it would greatly extend the reach of the policy beyond grants and cooperative agreements to also include contracts.KFF analyses have found that:more than half of the countries in which the U.S. Provides bilateral global renova me senhor health assistance allow for legal abortion in at least one case not permitted by the policy (analysis). Andhad the expanded policy been in effect during the FY 2013 – FY 2015 period, at least 1,275 foreign NGOs would have been subject to the policy (analysis).What is the Mexico City Policy?.

The Mexico renova me senhor City Policy is a U.S. Government policy that – when in effect – has required foreign NGOs to certify that they will not “perform or actively promote abortion as a method of family planning” using funds from any source (including non-U.S. Funds) as a condition renova me senhor of receiving U.S.

Global family planning assistance and, as of Jan. 23, 2017, renova me senhor most other U.S. Global health assistance.The policy was first announced by the Reagan administration at the 2nd International Conference on Population, which was held in Mexico City, Mexico, on August 6-14, 1984 (hence its name.

See Box 1) renova me senhor. Under the Trump administration, the policy has been renamed “Protecting Life in Global Health Assistance” (PLGHA). Among opponents, it is also known as renova me senhor the “Global Gag Rule,” because among other activities, it prohibits foreign NGOs from using any funds (including non-U.S.

Funds) to provide information about abortion as a method of family planning and to lobby a foreign government to legalize abortion. €œ[T]he United States does not consider abortion an acceptable element of family planning renova me senhor programs and will no longer contribute to those of which it is a part. €¦[T]he United States will no longer contribute to separate nongovernmental organizations which perform or actively promote abortion as a method of family planning in other nations.”When first instituted in 1984, the Mexico City Policy marked an expansion of existing legislative restrictions that already prohibited U.S.

Funding for abortion internationally, renova me senhor with some exceptions (see below). Prior to the policy, foreign NGOs could use non-U.S. Funds to engage renova me senhor in certain voluntary abortion-related activities as long as they maintained segregated accounts for any U.S.

Money received, but after the Mexico City Policy was in place, they were no longer permitted to do so if they wanted to receive U.S. Family planning assistance.The Trump administration’s application of the policy renova me senhor to the vast majority of U.S. Bilateral global health assistance, including funding for HIV under the U.S.

President’s Emergency Plan for AIDS Relief (PEPFAR), maternal and child health, renova me senhor malaria, nutrition, and other programs, marks a significant expansion of its scope, potentially encompassing $7.3 billion in FY 2020, to the extent that such funding is ultimately provided to foreign NGOs, directly or indirectly (family planning assistance accounted for approximately $600 million of that total). The Administration’s more recent extension of the policy to include any financial support (health or otherwise) provided by foreign NGOs for any purpose to other foreign NGOs that perform or actively promote abortion as a method of family planning is likely to encompass significant additional funding.When has it been in effect?. The Mexico City Policy has been in effect for 19 of the past 34 years, primarily through executive action, and has been instated, rescinded, and reinstated by presidential administrations along party lines (see Table 1).The policy was first instituted in 1984 (taking effect in 1985) by President Ronald Reagan and continued to be in effect through President George H.W.

Bush’s administration renova me senhor. It was rescinded by President Bill Clinton in 1993 (although it was reinstated legislatively for one year during his second term. See below) renova me senhor.

The policy was reinstated by President George W. Bush in 2001 renova me senhor and then rescinded by President Barack Obama in 2009. It is currently in effect, having been reinstated by President Trump in 2017.

YearsIn Effect? renova me senhor. Presidential Administration (Party Affiliation)Executive (E) or Congressional (C) Action?. 1985-1989YesReagan (R)E1989-1993YesBush renova me senhor (R)E1993-1999 Sept.NoClinton (D)E1999 Oct.-2000 Sept.Yes*Clinton (D)C2000 Oct.-2001NoClinton (D)E2001-2009YesBush (R)E2009-2017NoObama (D)E2017-presentYesTrump (R)ENOTES.

Shaded blue indicate periods when policy was in effect. * There was a temporary, one-year legislative imposition of the policy, which included a portion of the restrictions in effect in renova me senhor other years and an option for the president to waive these restrictions in part. However, if the waiver option was exercised (for no more than $15 million in family planning assistance), then $12.5 million of this funding would be transferred to maternal and child health assistance.

The president renova me senhor did exercise the waiver option.SOURCES. €œPolicy Statement of the United States of America at the United Nations International Conference on Population (Second Session), Mexico City, Mexico, August 6-14, 1984,” undated. Bill Clinton renova me senhor Administration, “Subject.

AID Family Planning Grants/Mexico City Policy,” Memorandum for the Acting Administrator of the Agency for International Development, January 22, 1993, Clinton White House Archives, https://clintonwhitehouse6.archives.gov/1993/01/1993-01-22-aid-family-planning-grants-mexico-city-policy.html. FY 2000 Consolidated Appropriations Act, P.L renova me senhor. 106-113.

George W renova me senhor. Bush Administration, “Subject. Restoration of the Mexico City Policy,” Memorandum for the Administrator of the United States Agency for International Development, January renova me senhor 22, 2001, Bush Administration White House Archives, https://georgewbush-whitehouse.archives.gov/news/releases/20010123-5.html.

€œSubject. Restoration of the Mexico City Policy,” Memorandum for the renova me senhor Administrator of the United States Agency for International Development, March 28, 2001, Federal Register, https://www.federalregister.gov/documents/2001/03/29/01-8011/restoration-of-the-mexico-city-policy. George W.

Bush Administration, renova me senhor “Subject. Assistance for Voluntary Population Planning,” Memorandum for the Secretary of State, August 29, 2003, Bush Administration White House Archives, http://georgewbush-whitehouse.archives.gov/news/releases/2003/08/20030829-3.html. Barack Obama Administration, “Mexico City Policy and Assistance for Voluntary Population Planning,” Memorandum for the Secretary of State, the Administrator of the United States Agency for International Development, January 23, 2009, renova me senhor Obama White House Archives, https://obamawhitehouse.archives.gov/the-press-office/mexico-city-policy-and-assistance-voluntary-population-planning.

White House, “The Mexico City Policy,” Memorandum for the Secretary of State, the Secretary of Health and Human Services, the Administrator of the Agency for International Development, Jan. 23, 2017, renova me senhor https://www.whitehouse.gov/the-press-office/2017/01/23/presidential-memorandum-regarding-mexico-city-policy.How is it instituted (and rescinded)?. The Mexico City Policy has, for the most part, been instituted or rescinded through executive branch action (typically via presidential memoranda).

While Congress has the ability to institute the policy through legislation, this has happened only renova me senhor once in the past. A modified version of the policy was briefly applied by Congress during President Clinton’s last year in office as part of a broader arrangement to pay the U.S. Debt to the renova me senhor United Nations.

(At that time, President Clinton was able to partially waive the policy’s restrictions.) Other attempts to institute the policy through legislation have not been enacted into law, nor have legislative attempts to overturn the policy. See Table renova me senhor 1.Who does the policy apply to?. The policy, when in effect, applies to foreign NGOs as a condition for receiving U.S.

Family planning support and, now, other global health assistance, either directly (as the main – or prime – recipient of U.S. Funding) or indirectly (as a recipient renova me senhor of U.S. Funding through an agreement with the prime recipient.

Referred to as a renova me senhor sub-recipient). Specifically, a foreign NGO “recipient agrees that it will not, during the term of this award, perform or actively promote abortion as a method of family planning in foreign countries or provide financial support to any other foreign non-governmental organization that conducts such activities.”Foreign NGOs include:international NGOs that are based outside the U.S.,regional NGOs that are based outside the U.S., andlocal NGOs in assisted countries.U.S. NGOs, while not directly subject to the Mexico City Policy, must also agree to ensure that they do not provide funding to any foreign NGO sub-recipients unless those sub-recipients have first certified adherence to renova me senhor the policy.

Specifically, a U.S. NGO “recipient (A) agrees that it will not furnish health assistance under this award to any foreign non-governmental organization that performs or renova me senhor actively promotes abortion as a method of family planning in foreign countries. And (B) further agrees to require that such sub-recipients do not provide financial support to any other foreign non-governmental organization that conducts such activities.”As in the past, the current policy does not apply to funding provided by the U.S.

Government to foreign governments renova me senhor (national or sub-national), public international organizations, and other multilateral entities, such as the Global Fund to Fight AIDS, Tuberculosis and Malaria and Gavi, the treatment Alliance. However, this funding is subject to the policy if it flows through a foreign NGO that has accepted the policy. See “What renova me senhor is ‘financial support’?.

€ below.To what assistance does it apply?. In the past, foreign NGOs have been required to adhere to the Mexico City Policy – when it was in effect – as renova me senhor a condition of receiving support through certain U.S. International funding streams.

Family planning renova me senhor assistance through the U.S. Agency for International Development (USAID) and, beginning in 2003, family planning assistance through the U.S. Department of State renova me senhor.

In the 2003 memorandum announcing the policy’s expansion to include the Department of State, President Bush stated that the policy did not apply to funding for global HIV/AIDS programs and that multilateral organizations that are associations of governments are not included among “foreign NGOs.”The current policy, reinstated in 2017, applies to the vast majority of U.S. Bilateral global renova me senhor health assistance furnished by all agencies and departments. “Assistance” includes “the provision of funds, commodities, equipment, or other in-kind global health assistance.” Specifically, the expanded policy applies to nearly all bilateral global health assistance, including.

family planning and reproductive healthfor the first time:maternal and child health (including household-level water, sanitation, and hygiene (WASH))nutritionHIV under PEPFARtuberculosismalaria under the President’s Malaria Initiative (PMI)neglected tropical diseasesglobal renova me senhor health securitycertain types of research activitiesThe policy applies to the assistance described above that is appropriated directly to three agencies and departments. USAID. The Department of renova me senhor State, including the Office of the Global AIDS Coordinator, which oversees and coordinates U.S.

Global HIV funding under PEPFAR. And for the renova me senhor first time, the Department of Defense (DoD). When such funding is transferred to another agency, including the Centers for Disease Control (CDC) and the National Institutes of Health (NIH), it remains subject to the policy, to the extent that such funding is ultimately provided to foreign NGOs, directly or indirectly.The policy applies to three types of funding agreements for such assistance.

Grants. Cooperative agreements. And, for the first time, contracts, pending necessary rule-making that would be needed to do so (a proposed rule to accomplish this was published in September 2020).The policy does not apply to U.S.

Assistance for. Water supply and sanitation activities, which is usually focused on infrastructure and systems. Humanitarian assistance, including activities related to migration and refugee assistance activities as well as disaster and humanitarian relief activities.

The American Schools and Hospitals Abroad (ASHA) program. And Food for Peace (FFP). However, this funding is subject to the policy if it flows through a foreign NGO that has accepted the policy.

See “What is ‘financial support’?. € below.What activities are prohibited?. The policy prohibits foreign NGOs that receive U.S.

Family planning assistance and, now, most other U.S. Bilateral global health assistance from using funds from any source (including non-U.S. Funds) to “perform or actively promote abortion as a method of family planning.” In addition to providing abortions with non-U.S.

Funds, restricted activities also include the following:providing advice and information about and offering referral for abortion – where legal – as part of the full range of family planning options,promoting changes in a country’s laws or policies related to abortion as a method of family planning (i.e., engaging in lobbying), andconducting public information campaigns about abortion as a method of family planning.The prohibition of these activities are why the policy has been referred to by its critics as the “Global Gag Rule.”Additionally, for the first time, the policy prohibits foreign NGOs from providing any financial support with any source of funds (including non-U.S. Funding) and for any purpose to other foreign NGOs that perform or actively promote abortion as a method of family planning. See “What is “financial support?.

€ below.The policy, however, does not prohibit foreign NGOs from:providing advice and information about, performing, or offering referral for abortion in cases where the pregnancy has either posed a risk to the life of the mother or resulted from incest or rape. Andresponding to a question about where a safe, legal abortion may be obtained when a woman who is already pregnant clearly states that she has already decided to have a legal abortion (passively providing information, versus actively providing medically-appropriate information).In addition, the expanded policy does not apply to healthcare providers who have an affirmative duty required under local law to provide counseling about and referrals for abortion as a method of family planning.Does it restrict direct U.S. Funding for abortion overseas?.

U.S. Funding for abortion is already restricted under several provisions of the law. Specifically, before the Mexico City Policy was first announced in 1984, U.S.

Law already prohibited the use of U.S. Aid:to pay for the performance of abortion as a method of family planning or to motivate or coerce any person to practice abortion (the Helms Amendment, 1973, to the Foreign Assistance Act);for biomedical research related to methods of or the performance of abortion as a means of family planning (the Biden Amendment, 1981, to the Foreign Assistance Act). Andto lobby for or against abortion (the Siljander Amendment, first included in annual appropriations in 1981 and included each year thereafter).Then, shortly after the policy was announced in 1984, the Kemp-Kasten Amendment was passed in 1985, prohibiting the use of U.S.

Aid to fund any organization or program, as determined by the president, that supports or participates in the management of a program of coercive abortion or involuntary sterilization (it is now included in annual appropriations).Before the Mexico City Policy, U.S. Aid recipients could use non-U.S. Funds to engage in certain abortion-related activities but were required to maintain segregated accounts for U.S.

Assistance. The Mexico City Policy reversed this practice. No longer were foreign NGOs allowed to use non-U.S.

Funds, maintained in segregated accounts, for voluntary abortion-related activities if they wished to continue to receive or be able to receive U.S. Family planning funds.Does the policy prohibit post-abortion care?. The Mexico City Policy does not restrict the provision of post-abortion care, which is a supported activity of U.S.

Family planning assistance. Whether or not the Mexico City Policy is in effect, recipients of U.S. Family planning assistance are allowed to use U.S.

And non-U.S. Funding to support post-abortion care, no matter the circumstances of the abortion (whether it was legal or illegal).What has been the impact of the policy?. Several studies have looked at the impact of the policy.

A 2011 quantitative analysis by Bendavid, et. Al, found a strong association between the Mexico City Policy and abortion rates in sub-Saharan Africa. This study was recently updated to include several more years of data, again identifying a strong association.

Specifically, the updated study found that during periods when the policy was in place, abortion rates rose by 40% in countries with high exposure to the Mexico City Policy compared to those with low exposure, while the use of modern contraceptives declined by 14% and pregnancies increased by 12% in high exposure compared to low exposure countries. In other words, it found patterns that “strengthen the case for the role played by the policy” in “a substantial increase in abortions across sub-Saharan Africa among women affected by the U.S. Mexico City Policy … [and] a corresponding decline in the use of modern contraception and increase in pregnancies,” likely because foreign NGOs that declined U.S.

Funding as a result of the Mexico City Policy – often key providers of women’s health services in these areas – had fewer resources to support family planning services, particularly contraceptives. Increased access to and use of contraception have been shown to be key to preventing unintended pregnancies and thereby reducing abortion, including unsafe abortion. The study also found patterns that “suggest that the effects of the policy are reversible” when the policy is not in place.Additionally, there has been anecdotal evidence and qualitative data on the impact of the policy, when it has been in force in the past, on the work of organizations that have chosen not to agree to the policy and, therefore, forgo U.S.

Funding that had previously supported their activities. For example, they have reported that they have fewer resources to support family planning and reproductive health services, including family planning counseling, contraceptive commodities, condoms, and reproductive cancer screenings.While it is likely too early to assess the full effects of the current policy on NGOs and the individuals they serve, as the policy is applied on a rolling basis as new funding agreements or modifications to existing agreements are made, some early data are available. Several early qualitative and quantitative studies have been released, and at least one long-term, quantitative assessment is underway.

Additionally, an official assessment by the U.S. Department of State on implementation during the first six months of the policy has been released (see below). This review acknowledged that it took “place early in the policy’s implementation, when affected U.S.

Government departments and agencies have added a significant portion of the funding affected by the policy to grants and cooperative agreements only recently [i.e., after the period the review examined]. A follow-on analysis would allow an opportunity to address one of the primary concerns presented in feedback from third-party stakeholder organizations, namely that six months is insufficient time to gauge the impacts of” the policy.Nonetheless, it is already clear that the reinstated and expanded version of the policy applies to a much greater amount of U.S. Global health assistance, and greater number of foreign NGOs, across many program areas.

KFF has found that more than half (37) of the 64 countries that received U.S. Bilateral global health assistance in FY 2016 allow for legal abortion in at least one case not permitted by the policy and that had the expanded Mexico City Policy been in effect during the FY 2013 – FY 2015 period, at least 1,275 foreign NGOs would have been subject to the policy. In addition, at least 469 U.S.

NGOs that received U.S. Global health assistance during this period would have been required to ensure that their foreign NGO sub-recipients were in compliance. Additional foreign NGOs are likely to be impacted by the policy due to the revised interpretation of “financial support” announced in March 2019 and implemented beginning June 2019.

See “What is ‘financial support’?. € below.A report released in March 2020 by the U.S. Government Accountability Office (GAO) provided new information on the number of projects (awards) and NGOs affected.

It found that from May 2017 through FY 2018:the policy had been applied to over 1,300 global health projects, with the vast majority of these through USAID and CDC, andNGOs declined to accept the policy in 54 instances, totaling $153 million in declined funding – specifically, seven prime awards amounting to $102 million and 47 sub-awards amounting to $51 million (more than two-thirds of sub-awards were intended for Africa) – across USAID and CDC. The Department of State and DoD did not identify any instances where NGOs declined to accept the policy conditions.What have the U.S. Government’s reviews of the policy found?.

The U.S. Government has published two reviews of the policy to date, with the first examining the initial six months of the policy released in February 2018 and the second examining the first 18 months of the policy released in August 2020.First ReviewIn February 2018, the Department of State announced the findings of an initial six-month review of implementation of the policy through the end of FY 2017 (September 2017). The report directed agencies to provide greater support for improving understanding of implementation among affected organizations and provided guidance to clarify terms included in standard provisions of grants and cooperative agreements.

In the six-month review report, the Department of State report identified a number of “actions” for implementing agencies, such as a need for:more central and field-based training and implementation tools,a clearer explanation of termination of awards for NGOs found to be in violation of the policy, anda clarification of “financial support,” which was not defined in the standard provisions (see “What is financial support?. € below).The six month review also identified the number of affected agreements with prime implementing partners and the number of those that have accepted the Mexico City Policy as part of their agreements through September 2017 (see Table 2). U.S.

Agency or DepartmentPolicy Implementation DateOverall # of Grants and Cooperative Agreements with Global Health Assistance FundingOf Overall #:(From the Policy Implementation Date through 9/30/2017)# That Received New Funding and Accepted Policy# That Received New Funding and Declined to Accept Policy^# That Had Not Received New Funding YetUSAIDMay 15, 20175804193158State*May 15, 2017142108034HHS+May 31, 20174991600339DoDMay 15, 20177742134TOTAL12987294565NOTES. * reflects PEPFAR funding implemented through the Department of State. Other departments and agencies implement the majority of PEPFAR funding.

+ At HHS agencies, only certain assistance funding transferred from USAID, State, and DoD are subject to the policy. ^ As of September 30, 2017, USAID reported it was aware of three centrally funded prime partners, and 12 sub-awardee implementing partners, that declined to agree to the Protecting Life in Global Health Assistance (PLGHA) terms in their awards. DoD reported that one DoD partner, a U.S.

NGO, declined to agree in one country but accepted the PLGHA standard provision in other countries. And HHS reported that no HHS partners declined to agree.SOURCES. KFF analysis of data from Department of State, “Protecting Life in Global Health Assistance Six-Month Review,” report, Feb.

6, 2018, https://www.state.gov/protecting-life-in-global-health-assistance-six-month-review/.Second ReviewOn August 17, 2020, the Department of State released its second review of the policy, updating its initial six-month review (as an action item in the six-month review report, the department stated it would “conduct a further review of implementation of the policy by December 15, 2018, when more extensive experience will enable a more thorough examination of the benefits and challenges”). The long-anticipated review, which examines the period from May 2017 through September 2018, found:the awards declined spanned a variety of program areas, including family planning and reproductive health (FP/RH), HIV and AIDS (HIV/AIDS), maternal and child health (MCH), tuberculosis (TB), and nutrition, in addition to cross-cutting awards;the awards declined spanned geographic areas but many were for activities in sub-Saharan Africa;agencies and departments made efforts to transition projects to another implementer in order to minimize disruption. Butnevertheless, among USAID awards involving health service delivery where prime and sub-award recipients declined to accept the policy, gaps or disruptions in service delivery were sometimes reported.The second review also identified the number of affected agreements with prime implementing partners and the number of those that have accepted the Mexico City Policy as part of their agreements through September 2018 (see Table 3).

U.S. Agency or DepartmentPolicy Implementation Date# of Grants and Cooperative Agreements with Global Health Assistance Funding# of Prime Awardees That Declined to Accept Policy^USAIDMay 15, 20174866State*May 15, 20173350HHS+May 31, 20174661DoDMay 15, 2017531TOTAL13408NOTES. * reflects PEPFAR funding implemented through the Department of State.

Other departments and agencies implement the majority of PEPFAR funding. + At HHS agencies, only certain assistance funding transferred from USAID, State, and DoD are subject to the policy. ^ As of September 30, 2018, USAID reported it was aware of six centrally funded prime partners, and 47 sub-awardee implementing partners, that declined to agree to the Protecting Life in Global Health Assistance (PLGHA) terms in their awards.

DoD reported that one DoD partner, a U.S. NGO, declined to agree in one country but accepted the PLGHA standard provision in other countries. And HHS reported that one HHS partner declined to agree.SOURCES.

KFF analysis of data from Department of State, “Review of the Implementation of the Protecting Life in Global Health Assistance Policy ,” report, Aug. 17, 2020, https://www.state.gov/wp-content/uploads/2020/08/PLGHA-2019-Review-Final-8.17.2020-508.pdf, and Department of State, “Protecting Life in Global Health Assistance Six-Month Review,” report, Feb. 6, 2018, https://www.state.gov/protecting-life-in-global-health-assistance-six-month-review/.Additionally, the review reports that 47 sub-awardees, all under USAID awards, declined to accept the policy.

It is important to note that the review also states that information on sub-awards is not systematically collected by departments and agencies and that DoD was not able to collect information on sub-awards.What is “financial support”?. In February 2018, in the initial six-month review issued when Secretary of State Tillerson led the department, the Department of State report included an “action” statement to clarify the definition of “financial support” as used in the standard provisions for grants and cooperative agreements. At issue was whether it applied more narrowly to certain funding provided by foreign NGOs (i.e., funding other than U.S.

Global health funding) to other foreign NGOs specifically for the purpose of performing or actively promoting abortion as a method of family planning or if it applied more broadly to certain funding provided by foreign NGOs to other foreign NGOs for any purpose, if that foreign NGO happened to perform or actively promote abortion as a method of family planning. The State Department clarified that it was the more narrow interpretation.However, on March 26, 2019, Secretary of State Pompeo reversed this interpretation, announcing further “refinements” to the policy to clarify that it applied to the broader definition of financial support. Specifically, under the policy, U.S.-supported foreign NGOs agree to not provide any financial support (global health-related as well as other support), no matter the source of funds, to any other foreign NGO that performs or actively promotes abortion as a method of family planning.

In June 2019, USAID provided additional information to reflect this broader interpretation of the standard provisions.This marks the first time the policy has been applied this broadly, as it can now affect funding provided by other donors (such as other governments and foundations) and non-global health funding provided by the U.S. Government for a wide range of purposes if this funding is first provided to foreign NGOs who have accepted the policy (as recipients of U.S. Global health assistance) that then in turn provide that donor or U.S.

Non global health funding for any purpose to foreign NGOs that perform or actively promote abortion as a method of family planning. For example, under the prior interpretation, a foreign NGO recipient of U.S. Global health funding could not provide any non-U.S.

Funding to another foreign NGO to perform or actively promote abortion as a method of family planning but could provide funding for other activities, such as education, even if the foreign NGO carried out prohibited activities. Under the broader interpretation, a foreign NGO could not provide any non-U.S. Funding for any activity to a foreign NGO that carried out prohibited activities.

Similarly, while under the prior interpretation a foreign NGO recipient of U.S. Global health funding could provide other U.S. Funding (such as humanitarian assistance) to another foreign NGO for non-prohibited activities, even if the foreign NGO carried out prohibited activities, now under the broader interpretation, it could not do so.What are the next steps in implementing the expanded policy?.

The policy went into effect in May 2017 (see Table 2), although it is applied on a rolling basis, as new funding agreements and modifications to existing agreements occur. While it applies to all grants and cooperative agreements, the Trump administration has indicated that it intends the policy to apply to contracts, which would require a rule-making process (it began this process by publishing a proposed rule in September 2020)..

About This TrackerThis tracker provides the number of confirmed cases cheap renova and deaths https://greedisgood.one/dividendy-alrosa-nyurba from novel skin care by country, the trend in confirmed case and death counts by country, and a global map showing which countries have confirmed cases and deaths. The data are drawn from the Johns Hopkins University (JHU) skin care Resource Center’s skin care products Map and the World Health Organization’s (WHO) skin care Disease (skin care products-2019) situation reports.This tracker will be updated regularly, as new data are released.Related Content. About skin care products skin careIn late cheap renova 2019, a new skin care emerged in central China to cause disease in humans. Cases of this disease, known as skin care products, have since been reported across around the globe. On January 30, 2020, the World Health Organization (WHO) declared the renova represents a public health emergency of international concern, and on January 31, 2020, the cheap renova U.S.

Department of Health and Human Services declared it to be a health emergency for the United States.Key PointsOn January 23, 2017, President Donald Trump reinstated and expanded the Mexico City Policy via presidential memorandum, renaming it “Protecting Life in Global Health Assistance.” This explainer provides an overview of the policy, including its history, changes over time, and current application.First announced in 1984 by the Reagan administration, the policy has been rescinded and reinstated by subsequent administrations along party lines and has now been in effect for 19 of the past 34 years.The policy requires foreign non-governmental organizations (NGOs) to certify that they will not “perform or actively promote abortion as a method of family planning” using funds from any source (including non-U.S. Funds) as a condition of receiving cheap renova U.S. Government global family planning assistance and, as of Jan. 23, 2017, cheap renova most other U.S. Global health assistance.The Trump administration’s application of the policy extends to the vast majority of U.S.

Bilateral global health assistance, including funding for HIV under cheap renova PEPFAR, maternal and child health, malaria, nutrition, and other programs. This marks a significant expansion of its scope, potentially encompassing $7.3 billion in FY 2020, to the extent that such funding is ultimately provided to foreign NGOs, directly or indirectly (family planning assistance accounts for approximately $600 million of that total).Additionally, as a result of a March 2019 policy announcement and subsequent information released in June 2019, the policy, for the first time, prohibits foreign NGOs who accept the policy from providing any financial support using any source of funds and for any purpose to other foreign NGOs that perform or actively promote abortion as a method of family planning. This greatly cheap renova extends its reach to other areas of U.S. Development assistance beyond global health and to other non-U.S. Funding streams.More recently, in September 2020, a cheap renova proposed rule to extend the policy to contracts was published.

If finalized, it would greatly extend the reach of the policy beyond grants and cooperative agreements to also include contracts.KFF analyses have found that:more than half of the countries in which the U.S. Provides bilateral global health assistance allow for legal abortion in at least one case not cheap renova permitted by the policy (analysis). Andhad the expanded policy been in effect during the FY 2013 – FY 2015 period, at least 1,275 foreign NGOs would have been subject to the policy (analysis).What is the Mexico City Policy?. The Mexico cheap renova City Policy is a U.S. Government policy that – when in effect – has required foreign NGOs to certify that they will not “perform or actively promote abortion as a method of family planning” using funds from any source (including non-U.S.

Funds) as a condition cheap renova of receiving U.S. Global family planning assistance and, as of Jan. 23, 2017, cheap renova most other U.S. Global health assistance.The policy was first announced by the Reagan administration at the 2nd International Conference on Population, which was held in Mexico City, Mexico, on August 6-14, 1984 (hence its name. See Box cheap renova 1).

Under the Trump administration, the policy has been renamed “Protecting Life in Global Health Assistance” (PLGHA). Among opponents, it is also known as the cheap renova “Global Gag Rule,” because among other activities, it prohibits foreign NGOs from using any funds (including non-U.S. Funds) to provide information about abortion as a method of family planning and to lobby a foreign government to legalize abortion. €œ[T]he United States does not consider abortion an acceptable element of family planning cheap renova programs and will no longer contribute to those of which it is a part. €¦[T]he United States will no longer contribute to separate nongovernmental organizations which perform or actively promote abortion as a method of family planning in other nations.”When first instituted in 1984, the Mexico City Policy marked an expansion of existing legislative restrictions that already prohibited U.S.

Funding for abortion cheap renova internationally, with some exceptions (see below). Prior to the policy, foreign NGOs could use non-U.S. Funds to cheap renova engage in certain voluntary abortion-related activities as long as they maintained segregated accounts for any U.S. Money received, but after the Mexico City Policy was in place, they were no longer permitted to do so if they wanted to receive U.S. Family planning assistance.The cheap renova Trump administration’s application of the policy to the vast majority of U.S.

Bilateral global health assistance, including funding for HIV under the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), maternal and child health, malaria, nutrition, and other programs, marks a significant expansion of its scope, potentially encompassing $7.3 cheap renova billion in FY 2020, to the extent that such funding is ultimately provided to foreign NGOs, directly or indirectly (family planning assistance accounted for approximately $600 million of that total). The Administration’s more recent extension of the policy to include any financial support (health or otherwise) provided by foreign NGOs for any purpose to other foreign NGOs that perform or actively promote abortion as a method of family planning is likely to encompass significant additional funding.When has it been in effect?. The Mexico City Policy has been in effect for 19 of the past 34 years, primarily through executive action, and has been instated, rescinded, and reinstated by presidential administrations along party lines (see Table 1).The policy was first instituted in 1984 (taking effect in 1985) by President Ronald Reagan and continued to be in effect through President George H.W. Bush’s administration cheap renova.

It was rescinded by President Bill Clinton in 1993 (although it was reinstated legislatively for one year during his second term. See below) cheap renova. The policy was reinstated by President George W. Bush in 2001 cheap renova and then rescinded by President Barack Obama in 2009. It is currently in effect, having been reinstated by President Trump in 2017.

YearsIn Effect? cheap renova. Presidential Administration (Party Affiliation)Executive (E) or Congressional (C) Action?. 1985-1989YesReagan (R)E1989-1993YesBush (R)E1993-1999 Sept.NoClinton (D)E1999 Oct.-2000 Sept.Yes*Clinton (D)C2000 Oct.-2001NoClinton (D)E2001-2009YesBush (R)E2009-2017NoObama (D)E2017-presentYesTrump cheap renova (R)ENOTES. Shaded blue indicate periods when policy was in effect. * There was a temporary, one-year legislative imposition of the policy, which included a portion of cheap renova the restrictions in effect in other years and an option for the president to waive these restrictions in part.

However, if the waiver option was exercised (for no more than $15 million in family planning assistance), then $12.5 million of this funding would be transferred to maternal and child health assistance. The president did exercise cheap renova the waiver option.SOURCES. €œPolicy Statement of the United States of America at the United Nations International Conference on Population (Second Session), Mexico City, Mexico, August 6-14, 1984,” undated. Bill Clinton Administration, “Subject cheap renova. AID Family Planning Grants/Mexico City Policy,” Memorandum for the Acting Administrator of the Agency for International Development, January 22, 1993, Clinton White House Archives, https://clintonwhitehouse6.archives.gov/1993/01/1993-01-22-aid-family-planning-grants-mexico-city-policy.html.

FY 2000 Consolidated Appropriations Act, cheap renova P.L. 106-113. George W cheap renova. Bush Administration, “Subject. Restoration of the Mexico City cheap renova Policy,” Memorandum for the Administrator of the United States Agency for International Development, January 22, 2001, Bush Administration White House Archives, https://georgewbush-whitehouse.archives.gov/news/releases/20010123-5.html.

€œSubject. Restoration of the Mexico City Policy,” Memorandum for the Administrator of the cheap renova United States Agency for International Development, March 28, 2001, Federal Register, https://www.federalregister.gov/documents/2001/03/29/01-8011/restoration-of-the-mexico-city-policy. George W. Bush Administration, “Subject cheap renova. Assistance for Voluntary Population Planning,” Memorandum for the Secretary of State, August 29, 2003, Bush Administration White House Archives, http://georgewbush-whitehouse.archives.gov/news/releases/2003/08/20030829-3.html.

Barack Obama Administration, “Mexico City cheap renova Policy and Assistance for Voluntary Population Planning,” Memorandum for the Secretary of State, the Administrator of the United States Agency for International Development, January 23, 2009, Obama White House Archives, https://obamawhitehouse.archives.gov/the-press-office/mexico-city-policy-and-assistance-voluntary-population-planning. White House, “The Mexico City Policy,” Memorandum for the Secretary of State, the Secretary of Health and Human Services, the Administrator of the Agency for International Development, Jan. 23, 2017, https://www.whitehouse.gov/the-press-office/2017/01/23/presidential-memorandum-regarding-mexico-city-policy.How is it instituted (and cheap renova rescinded)?. The Mexico City Policy has, for the most part, been instituted or rescinded through executive branch action (typically via presidential memoranda). While Congress has the ability to institute the cheap renova policy through legislation, this has happened only once in the past.

A modified version of the policy was briefly applied by Congress during President Clinton’s last year in office as part of a broader arrangement to pay the U.S. Debt to the United cheap renova Nations. (At that time, President Clinton was able to partially waive the policy’s restrictions.) Other attempts to institute the policy through legislation have not been enacted into law, nor have legislative attempts to overturn the policy. See Table 1.Who does the policy cheap renova apply to?. The policy, when in effect, applies to foreign NGOs as a condition for receiving U.S.

Family planning support and, now, other global health assistance, either directly (as the main – or prime – recipient of U.S. Funding) or cheap renova indirectly (as a recipient of U.S. Funding through an agreement with the prime recipient. Referred to as a cheap renova sub-recipient). Specifically, a foreign NGO “recipient agrees that it will not, during the term of this award, perform or actively promote abortion as a method of family planning in foreign countries or provide financial support to any other foreign non-governmental organization that conducts such activities.”Foreign NGOs include:international NGOs that are based outside the U.S.,regional NGOs that are based outside the U.S., andlocal NGOs in assisted countries.U.S.

NGOs, while not directly subject to the Mexico City Policy, must also agree to ensure that they do cheap renova not provide funding to any foreign NGO sub-recipients unless those sub-recipients have first certified adherence to the policy. Specifically, a U.S. NGO “recipient (A) agrees that it will not furnish health assistance under this award to any foreign non-governmental organization that performs or actively promotes abortion as cheap renova a method of family planning in foreign countries. And (B) further agrees to require that such sub-recipients do not provide financial support to any other foreign non-governmental organization that conducts such activities.”As in the past, the current policy does not apply to funding provided by the U.S. Government to foreign governments (national or cheap renova sub-national), public international organizations, and other multilateral entities, such as the Global Fund to Fight AIDS, Tuberculosis and Malaria and Gavi, the treatment Alliance.

However, this funding is subject to the policy if it flows through a foreign NGO that has accepted the policy. See “What is ‘financial support’? cheap renova. € below.To what assistance does it apply?. In the past, foreign NGOs have been required to adhere to the Mexico City Policy – when it cheap renova was in effect – as a condition of receiving support through certain U.S. International funding streams.

Family planning cheap renova assistance through the U.S. Agency for International Development (USAID) and, beginning in 2003, family planning assistance through the U.S. Department of cheap renova State. In the 2003 memorandum announcing the policy’s expansion to include the Department of State, President Bush stated that the policy did not apply to funding for global HIV/AIDS programs and that multilateral organizations that are associations of governments are not included among “foreign NGOs.”The current policy, reinstated in 2017, applies to the vast majority of U.S. Bilateral global cheap renova health assistance furnished by all agencies and departments.

“Assistance” includes “the provision of funds, commodities, equipment, or other in-kind global health assistance.” Specifically, the expanded policy applies to nearly all bilateral global health assistance, including. family planning and reproductive healthfor the first time:maternal and child health (including household-level water, sanitation, and hygiene (WASH))nutritionHIV under PEPFARtuberculosismalaria under the President’s Malaria Initiative (PMI)neglected tropical diseasesglobal health securitycertain types of research activitiesThe policy applies to the assistance described above that is appropriated directly to three agencies and cheap renova departments. USAID. The Department of State, including the Office of the Global AIDS Coordinator, which cheap renova oversees and coordinates U.S. Global HIV funding under PEPFAR.

And for the first time, the cheap renova Department of Defense (DoD). When such funding is transferred to another agency, including the Centers for Disease Control (CDC) and the National Institutes of Health (NIH), it remains subject to the policy, to the extent that such funding is ultimately provided to foreign NGOs, directly or indirectly.The policy applies to three types of funding agreements for such assistance. Grants. Cooperative agreements. And, for the first time, contracts, pending necessary rule-making that would be needed to do so (a proposed rule to accomplish this was published in September 2020).The policy does not apply to U.S.

Assistance for. Water supply and sanitation activities, which is usually focused on infrastructure and systems. Humanitarian assistance, including activities related to migration and refugee assistance activities as well as disaster and humanitarian relief activities. The American Schools and Hospitals Abroad (ASHA) program. And Food for Peace (FFP).

However, this funding is subject to the policy if it flows through a foreign NGO that has accepted the policy. See “What is ‘financial support’?. € below.What activities are prohibited?. The policy prohibits foreign NGOs that receive U.S. Family planning assistance and, now, most other U.S.

Bilateral global health assistance from using funds from any source (including non-U.S. Funds) to “perform or actively promote abortion as a method of family planning.” In addition to providing abortions with non-U.S. Funds, restricted activities also include the following:providing advice and information about and offering referral for abortion – where legal – as part of the full range of family planning options,promoting changes in a country’s laws or policies related to abortion as a method of family planning (i.e., engaging in lobbying), andconducting public information campaigns about abortion as a method of family planning.The prohibition of these activities are why the policy has been referred to by its critics as the “Global Gag Rule.”Additionally, for the first time, the policy prohibits foreign NGOs from providing any financial support with any source of funds (including non-U.S. Funding) and for any purpose to other foreign NGOs that perform or actively promote abortion as a method of family planning. See “What is “financial support?.

€ below.The policy, however, does not prohibit foreign NGOs from:providing advice and information about, performing, or offering referral for abortion in cases where the pregnancy has either posed a risk to the life of the mother or resulted from incest or rape. Andresponding to a question about where a safe, legal abortion may be obtained when a woman who is already pregnant clearly states that she has already decided to have a legal abortion (passively providing information, versus actively providing medically-appropriate information).In addition, the expanded policy does not apply to healthcare providers who have an affirmative duty required under local law to provide counseling about and referrals for abortion as a method of family planning.Does it restrict direct U.S. Funding for abortion overseas?. U.S. Funding for abortion is already restricted under several provisions of the law.

Specifically, before the Mexico City Policy was first announced in 1984, U.S. Law already prohibited the use of U.S. Aid:to pay for the performance of abortion as a method of family planning or to motivate or coerce any person to practice abortion (the Helms Amendment, 1973, to the Foreign Assistance Act);for biomedical research related to methods of or the performance of abortion as a means of family planning (the Biden Amendment, 1981, to the Foreign Assistance Act). Andto lobby for or against abortion (the Siljander Amendment, first included in annual appropriations in 1981 and included each year thereafter).Then, shortly after the policy was announced in 1984, the Kemp-Kasten Amendment was passed in 1985, prohibiting the use of U.S. Aid to fund any organization or program, as determined by the president, that supports or participates in the management of a program of coercive abortion or involuntary sterilization (it is now included in annual appropriations).Before the Mexico City Policy, U.S.

Aid recipients could use non-U.S. Funds to engage in certain abortion-related activities but were required to maintain segregated accounts for U.S. Assistance. The Mexico City Policy reversed this practice. No longer were foreign NGOs allowed to use non-U.S.

Funds, maintained in segregated accounts, for voluntary abortion-related activities if they wished to continue to receive or be able to receive U.S. Family planning funds.Does the policy prohibit post-abortion care?. The Mexico City Policy does not restrict the provision of post-abortion care, which is a supported activity of U.S. Family planning assistance. Whether or not the Mexico City Policy is in effect, recipients of U.S.

Family planning assistance are allowed to use U.S. And non-U.S. Funding to support post-abortion care, no matter the circumstances of the abortion (whether it was legal or illegal).What has been the impact of the policy?. Several studies have looked at the impact of the policy. A 2011 quantitative analysis by Bendavid, et.

Al, found a strong association between the Mexico City Policy and abortion rates in sub-Saharan Africa. This study was recently updated to include several more years of data, again identifying a strong association. Specifically, the updated study found that during periods when the policy was in place, abortion rates rose by 40% in countries with high exposure to the Mexico City Policy compared to those with low exposure, while the use of modern contraceptives declined by 14% and pregnancies increased by 12% in high exposure compared to low exposure countries. In other words, it found patterns that “strengthen the case for the role played by the policy” in “a substantial increase in abortions across sub-Saharan Africa among women affected by the U.S. Mexico City Policy … [and] a corresponding decline in the use of modern contraception and increase in pregnancies,” likely because foreign NGOs that declined U.S.

Funding as a result of the Mexico City Policy – often key providers of women’s health services in these areas – had fewer resources to support family planning services, particularly contraceptives. Increased access to and use of contraception have been shown to be key to preventing unintended pregnancies and thereby reducing abortion, including unsafe abortion. The study also found patterns that “suggest that the effects of the policy are reversible” when the policy is not in place.Additionally, there has been anecdotal evidence and qualitative data on the impact of the policy, when it has been in force in the past, on the work of organizations that have chosen not to agree to the policy and, therefore, forgo U.S. Funding that had previously supported their activities. For example, they have reported that they have fewer resources to support family planning and reproductive health services, including family planning counseling, contraceptive commodities, condoms, and reproductive cancer screenings.While it is likely too early to assess the full effects of the current policy on NGOs and the individuals they serve, as the policy is applied on a rolling basis as new funding agreements or modifications to existing agreements are made, some early data are available.

Several early qualitative and quantitative studies have been released, and at least one long-term, quantitative assessment is underway. Additionally, an official assessment by the U.S. Department of State on implementation during the first six months of the policy has been released (see below). This review acknowledged that it took “place early in the policy’s implementation, when affected U.S. Government departments and agencies have added a significant portion of the funding affected by the policy to grants and cooperative agreements only recently [i.e., after the period the review examined].

A follow-on analysis would allow an opportunity to address one of the primary concerns presented in feedback from third-party stakeholder organizations, namely that six months is insufficient time to gauge the impacts of” the policy.Nonetheless, it is already clear that the reinstated and expanded version of the policy applies to a much greater amount of U.S. Global health assistance, and greater number of foreign NGOs, across many program areas. KFF has found that more than half (37) of the 64 countries that received U.S. Bilateral global health assistance in FY 2016 allow for legal abortion in at least one case not permitted by the policy and that had the expanded Mexico City Policy been in effect during the FY 2013 – FY 2015 period, at least 1,275 foreign NGOs would have been subject to the policy. In addition, at least 469 U.S.

NGOs that received U.S. Global health assistance during this period would have been required to ensure that their foreign NGO sub-recipients were in compliance. Additional foreign NGOs are likely to be impacted by the policy due to the revised interpretation of “financial support” announced in March 2019 and implemented beginning June 2019. See “What is ‘financial support’?. € below.A report released in March 2020 by the U.S.

Government Accountability Office (GAO) provided new information on the number of projects (awards) and NGOs affected. It found that from May 2017 through FY 2018:the policy had been applied to over 1,300 global health projects, with the vast majority of these through USAID and CDC, andNGOs declined to accept the policy in 54 instances, totaling $153 million in declined funding – specifically, seven prime awards amounting to $102 million and 47 sub-awards amounting to $51 million (more than two-thirds of sub-awards were intended for Africa) – across USAID and CDC. The Department of State and DoD did not identify any instances where NGOs declined to accept the policy conditions.What have the U.S. Government’s reviews of the policy found?. The U.S.

Government has published two reviews of the policy to date, with the first examining the initial six months of the policy released in February 2018 and the second examining the first 18 months of the policy released in August 2020.First ReviewIn February 2018, the Department of State announced the findings of an initial six-month review of implementation of the policy through the end of FY 2017 (September 2017). The report directed agencies to provide greater support for improving understanding of implementation among affected organizations and provided guidance to clarify terms included in standard provisions of grants and cooperative agreements. In the six-month review report, the Department of State report identified a number of “actions” for implementing agencies, such as a need for:more central and field-based training and implementation tools,a clearer explanation of termination of awards for NGOs found to be in violation of the policy, anda clarification of “financial support,” which was not defined in the standard provisions (see “What is financial support?. € below).The six month review also identified the number of affected agreements with prime implementing partners and the number of those that have accepted the Mexico City Policy as part of their agreements through September 2017 (see Table 2). U.S.

Agency or DepartmentPolicy Implementation DateOverall # of Grants and Cooperative Agreements with Global Health Assistance FundingOf Overall #:(From the Policy Implementation Date through 9/30/2017)# That Received New Funding and Accepted Policy# That Received New Funding and Declined to Accept Policy^# That Had Not Received New Funding YetUSAIDMay 15, 20175804193158State*May 15, 2017142108034HHS+May 31, 20174991600339DoDMay 15, 20177742134TOTAL12987294565NOTES. * reflects PEPFAR funding implemented through the Department of State. Other departments and agencies implement the majority of PEPFAR funding. + At HHS agencies, only certain assistance funding transferred from USAID, State, and DoD are subject to the policy. ^ As of September 30, 2017, USAID reported it was aware of three centrally funded prime partners, and 12 sub-awardee implementing partners, that declined to agree to the Protecting Life in Global Health Assistance (PLGHA) terms in their awards.

DoD reported that one DoD partner, a U.S. NGO, declined to agree in one country but accepted the PLGHA standard provision in other countries. And HHS reported that no HHS partners declined to agree.SOURCES. KFF analysis of data from Department of State, “Protecting Life in Global Health Assistance Six-Month Review,” report, Feb. 6, 2018, https://www.state.gov/protecting-life-in-global-health-assistance-six-month-review/.Second ReviewOn August 17, 2020, the Department of State released its second review of the policy, updating its initial six-month review (as an action item in the six-month review report, the department stated it would “conduct a further review of implementation of the policy by December 15, 2018, when more extensive experience will enable a more thorough examination of the benefits and challenges”).

The long-anticipated review, which examines the period from May 2017 through September 2018, found:the awards declined spanned a variety of program areas, including family planning and reproductive health (FP/RH), HIV and AIDS (HIV/AIDS), maternal and child health (MCH), tuberculosis (TB), and nutrition, in addition to cross-cutting awards;the awards declined spanned geographic areas but many were for activities in sub-Saharan Africa;agencies and departments made efforts to transition projects to another implementer in order to minimize disruption. Butnevertheless, among USAID awards involving health service delivery where prime and sub-award recipients declined to accept the policy, gaps or disruptions in service delivery were sometimes reported.The second review also identified the number of affected agreements with prime implementing partners and the number of those that have accepted the Mexico City Policy as part of their agreements through September 2018 (see Table 3). U.S. Agency or DepartmentPolicy Implementation Date# of Grants and Cooperative Agreements with Global Health Assistance Funding# of Prime Awardees That Declined to Accept Policy^USAIDMay 15, 20174866State*May 15, 20173350HHS+May 31, 20174661DoDMay 15, 2017531TOTAL13408NOTES. * reflects PEPFAR funding implemented through the Department of State.

Other departments and agencies implement the majority of PEPFAR funding. + At HHS agencies, only certain assistance funding transferred from USAID, State, and DoD are subject to the policy. ^ As of September 30, 2018, USAID reported it was aware of six centrally funded prime partners, and 47 sub-awardee implementing partners, that declined to agree to the Protecting Life in Global Health Assistance (PLGHA) terms in their awards. DoD reported that one DoD partner, a U.S. NGO, declined to agree in one country but accepted the PLGHA standard provision in other countries.

And HHS reported that one HHS partner declined to agree.SOURCES. KFF analysis of data from Department of State, “Review of the Implementation of the Protecting Life in Global Health Assistance Policy ,” report, Aug. 17, 2020, https://www.state.gov/wp-content/uploads/2020/08/PLGHA-2019-Review-Final-8.17.2020-508.pdf, and Department of State, “Protecting Life in Global Health Assistance Six-Month Review,” report, Feb. 6, 2018, https://www.state.gov/protecting-life-in-global-health-assistance-six-month-review/.Additionally, the review reports that 47 sub-awardees, all under USAID awards, declined to accept the policy. It is important to note that the review also states that information on sub-awards is not systematically collected by departments and agencies and that DoD was not able to collect information on sub-awards.What is “financial support”?.

In February 2018, in the initial six-month review issued when Secretary of State Tillerson led the department, the Department of State report included an “action” statement to clarify the definition of “financial support” as used in the standard provisions for grants and cooperative agreements. At issue was whether it applied more narrowly to certain funding provided by foreign NGOs (i.e., funding other than U.S. Global health funding) to other foreign NGOs specifically for the purpose of performing or actively promoting abortion as a method of family planning or if it applied more broadly to certain funding provided by foreign NGOs to other foreign NGOs for any purpose, if that foreign NGO happened to perform or actively promote abortion as a method of family planning. The State Department clarified that it was the more narrow interpretation.However, on March 26, 2019, Secretary of State Pompeo reversed this interpretation, announcing further “refinements” to the policy to clarify that it applied to the broader definition of financial support. Specifically, under the policy, U.S.-supported foreign NGOs agree to not provide any financial support (global health-related as well as other support), no matter the source of funds, to any other foreign NGO that performs or actively promotes abortion as a method of family planning.

In June 2019, USAID provided additional information to reflect this broader interpretation of the standard provisions.This marks the first time the policy has been applied this broadly, as it can now affect funding provided by other donors (such as other governments and foundations) and non-global health funding provided by the U.S. Government for a wide range of purposes if this funding is first provided to foreign NGOs who have accepted the policy (as recipients of U.S. Global health assistance) that then in turn provide that donor or U.S. Non global health funding for any purpose to foreign NGOs that perform or actively promote abortion as a method of family planning. For example, under the prior interpretation, a foreign NGO recipient of U.S.

Global health funding could not provide any non-U.S. Funding to another foreign NGO to perform or actively promote abortion as a method of family planning but could provide funding for other activities, such as education, even if the foreign NGO carried out prohibited activities. Under the broader interpretation, a foreign NGO could not provide any non-U.S. Funding for any activity to a foreign NGO that carried out prohibited activities. Similarly, while under the prior interpretation a foreign NGO recipient of U.S.

Global health funding could provide other U.S. Funding (such as humanitarian assistance) to another foreign NGO for non-prohibited activities, even if the foreign NGO carried out prohibited activities, now under the broader interpretation, it could not do so.What are the next steps in implementing the expanded policy?. The policy went into effect in May 2017 (see Table 2), although it is applied on a rolling basis, as new funding agreements and modifications to existing agreements occur. While it applies to all grants and cooperative agreements, the Trump administration has indicated that it intends the policy to apply to contracts, which would require a rule-making process (it began this process by publishing a proposed rule in September 2020)..

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Brian Grosberg, director of the Hartford HealthCare Headache Center renova bio in Connecticut.In the study, IIH rates increased sixfold in Wales between 2003 and 2017 -- from 12 per 100,000 people to 76 per 100,000 people. During the same 15-year span, obesity rates in Wales rose from 29% of the population to 40%."The considerable increase in IIH incidence" has several causes, but is likely "predominately due to rising obesity rates," said study author William Owen Pickrell, a consultant neurologist at Swansea University. "The worldwide prevalence of obesity nearly tripled between 1975 and 2016, and therefore, these results also have global renova bio relevance."His findings were published in the Jan. 20 issue of Neurology.IIH is a type of headache that occurs when the fluid around your brain and spinal cord builds up in your skull.

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Brian Grosberg, MD, director, Hartford HealthCare Headache Center, and professor, Neurology, renova bio University of Connecticut School of Medicine, Hartford. Neurology, Jan. 20, 2021Copyright renova bio © 2020 HealthDay. All rights reserved.

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Latest Diet cheap renova & blog. Weight Management News By Denise Mann HealthDay ReporterTHURSDAY, Jan. 21, 2021 (HealthDay News)As worldwide obesity rates continue to soar, new research shows that cheap renova growing numbers of people are developing a potentially blinding type of weight-linked headache that was once considered rare.Though the study was conducted in Wales, one U.S. Expert said the same surge in these headaches is likely happening in this country and elsewhere, but he cautioned that just because someone is obese and has headaches doesn't mean he or she have this rare headache, known as idiopathic intracranial hypertension (IIH)."Obese individuals are at greater risk for more frequent migraine, too," noted Dr.

Brian Grosberg, cheap renova director of the Hartford HealthCare Headache Center in Connecticut.In the study, IIH rates increased sixfold in Wales between 2003 and 2017 -- from 12 per 100,000 people to 76 per 100,000 people. During the same 15-year span, obesity rates in Wales rose from 29% of the population to 40%."The considerable increase in IIH incidence" has several causes, but is likely "predominately due to rising obesity rates," said study author William Owen Pickrell, a consultant neurologist at Swansea University. "The worldwide prevalence of obesity nearly tripled between 1975 and 2016, and therefore, these results cheap renova also have global relevance."His findings were published in the Jan. 20 issue of Neurology.IIH is a type of headache that occurs when the fluid around your brain and spinal cord builds up in your skull.

This places extra pressure on your brain and the optic nerve in the back of your eye, causing symptoms that can mimic a brain tumor such as debilitating head pain, blind spots and possibly vision loss, according to the National Eye Institute.The cause is not fully understood, but weight cheap renova loss is the main treatment. Some people may need medication and/or surgery to drain the fluid and relieve the pressure. "There is some evidence that weight loss can improve headache symptoms," Pickrell said.During the review, researchers found 1,765 cases cheap renova of IIH, 85% in women. They looked at patients' body mass index (BMI), a measure of body fat based on height and weight, as well as their economic status based on their address.

They compared this information to that of individuals without IIH.Overall, the risk of developing IIH was higher in those who were obese.Economic cheap renova status only affected women's risk, and this finding was independent of their weight, according to the study. Obese women of child-bearing age were at highest risk of IIH.People with IIH were also more likely to require emergency hospital admissions than their counterparts without these headaches, with 9% requiring brain surgery to prevent blindness, the study found.Pickrell did say there could be explanations other than obesity for the surge in IIH."The increase may also be attributable to increased IIH diagnosis rates due to raised awareness of the condition and greater use of [digital] technology at routine optometry appointments," he said. Eye doctors often diagnose IIH during routine exams that look at the back of the eye.The biggest concern with these headaches is the potential for vision loss, which likely explains the increased rates of emergency hospital admissions seen cheap renova in the new study among people with IIH.More informationLearn more about IHH and how it is diagnosed and treated at the National Eye Institute.SOURCES. William Owen Pickrell, PhD, MRCP, consultant neurologist, honorary clinical associate professor, Swansea University, Wales.

Brian Grosberg, MD, director, Hartford HealthCare Headache Center, and cheap renova professor, Neurology, University of Connecticut School of Medicine, Hartford. Neurology, Jan. 20, 2021Copyright cheap renova © 2020 HealthDay. All rights reserved.

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An 18-year-old teen was found cheap renova shot dead lying in a Hudson Valley roadway.The shooting took place around 9:50 p.m., Monday, May 31, in Rockland County.A Spring Valley Police officer was on patrol on Crispus Attucks Road and heard multiple gunshots in the area, Detective Matthew Galli said.Responding officers found a male lying in the roadway on Rose Avenue where he was pronounced dead, Galli said.The teen suffered from multiple gunshot wounds. Police from numerous agencies were called in to help due to a large crowd in the area at the time cheap renova of the shooting, he added.Anyone with information is asked to contact the Spring Valley Police Department at 845-356-7400 or email tips@villagespringvalley.org.The following agencies assisted at the scene. Clarkstown Police Department, Ramapo Police Department, New York State Police, Rockland County Sheriff’s Office, Orangetown Police Department, Westchester County Police Department, Spring Hill EMS Services, Spring Valley Fire Department, Rockland County Paramedics, Rockland cheap renova County District Attorney’s Office, FBI Safe Streets, Chaverim of Rockland. This is a developing cheap renova story. Check back to Daily Voice for cheap renova updates.

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