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How the hidden epidemic of violence against nurses affects health care

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theconversation.com – Jason Blomquist, Assistant Professor of Nursing, Boise State University – 2025-03-04 07:09:00

Nurses in the United States face a high rate of burnout.
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Jason Blomquist, Boise State University

“Violence is just part of the job. Every nurse and health care worker experiences it at some point.”

Sentiments like this echo across American hospitals and health care facilities, capturing a disturbing and growing reality. Though Americans think of nursing as the most trusted profession, we often fail to see that it’s also one of the most dangerous.

An alarming 8 in 10 nurses face violence at work. As a result, health care workers are more than four times as likely to be injured by workplace violence than workers in all other industries combined.

Despite these staggering numbers, the full extent of this epidemic may not be fully understood because nurses and other health care workers chronically underreport violent encounters. The American Nurses Association estimates that only 20% to 60% of incidents are accounted for. Additionally, there is no agreed-upon definition for workplace violence or clear way of tracking it on a national level.

As a practicing bedside nurse, I have experienced my fair share of workplace violence. As a professor of nursing, my research shows that violence has become a normalized but underreported part of working in health care and that it affects the care patients receive in pervasive ways.

What really counts as workplace violence in health care?

When people think about workplace violence, they often imagine dramatic physical assaults. Assaults do happen, but violence directed at workers can take many other forms, including verbal threats, intimidation, sexual aggression and bullying.

What makes defining and measuring workplace violence especially difficult in health care settings is the range of people involved. Violence may stem from patients, their families, co-workers or even disgruntled members of the public.

Nurses and health care staff work with people during incredibly stressful moments in their lives. Sometimes patients are experiencing medical conditions that may cause them to act out or be confused, such as dementia, delirium, psychosis or even postoperative reactions to anesthesia.

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Too often, nurses who are threatened or hurt at work do not report the event.

Some health care organizations use vague definitions, such as “workplace violence is any violent act or threat of violence,” while nursing organizations advocate for tiered definitions delineating between perpetrator and intent.

Although not all employees can recite their organization’s official definition of workplace violence, ask a nurse whether they have ever experienced a threatening situation at work and they will likely have stories at the ready. In my 14 years of nursing practice, nurses shared many different types of threatening encounters. They reported being screamed at by distraught visitors and having their hair and wrists grabbed by patients who are trying to bite or spit at them. I have personally experienced having objects thrown at me from across the room and being threatened with retribution by patients’ family members.

Nurses also shared more extreme experiences in which they or their co-workers were injured in the course of trying to simply deliver care. Many described the emotional impact of watching a co-worker hurt badly enough to require medical attention.

From my observations, it’s not just the major incidents but the countless small threats or insensitive behaviors that add up over a nurse’s career. These seemingly less-threatening events are much harder to document, and many nurses shrug them off, but the small infractions take a toll when they happen repeatedly.

Breaking the culture of silence

A culture of silence makes such incidents hard to track.

The medical-surgical nursing unit at the hospital where I conducted my research has a healthy and supportive culture. Yet in my ongoing doctoral work, which will be published in May, of the 74% percent of staff that acknowledged experiencing workplace violence in the past year, only 30% reported the event.

When nurses stay silent, whether from fear, futility or institutional pressure, violence becomes an accepted part of the job. Without accurate data, health care facilities don’t understand the true extent of the problem, can’t implement effective safety measures, and struggle to support their workers in meaningful ways.

There are common themes as to why nurses underreport violence. Some nurses think reporting does not make a difference. Others find the lack of clarity in defining workplace violence or reporting policies demotivating and confusing.

Nurses also report a lack of support from management, a fear of reprisal or a sense of shame when reporting. Commonly, many nurses simply find reporting tools to be too difficult and time-consuming to use.

Nurse listening to heartbeat of a senior woman during medical consultation
Nurses are the largest segment of the health care workforce in the U.S.
Frazao Studio Latino via Getty Images

The hidden costs to health care

For health care workers, the consequences extend far beyond physical injuries.

Workplace violence in all its forms contributes to anxiety, depression or PTSD, as well as job dissatisfaction. Dangerous workplace violence trends are a contributing factor in 55% of health care workers feeling burned out and 18% of newly licensed registered nurses leaving the profession within the first year.

That is a huge problem, considering that the United States is projected to have 193,100 nursing job openings per year until 2032, yet will produce only roughly 177,400 new nurses in that time frame. This also has vast repercussions for patient care.

During my nursing career, I observed my peers developing complex strategies to protect themselves while trying to provide compassionate care. Like me, they tended to carefully position themselves near doorways, maintained constant awareness of their surroundings and silently assessed each new interaction for potential risks.

These invisible precautions reflect the far-reaching effects of health care violence. When nurses are hypervigilant about their safety, they have less emotional energy for patient care. When they’re rushing between rooms due to short staffing caused by violence-related turnover, they have less time for each patient. When they are worried about what the next patient encounter may bring, they are increasing their anxiety, fear and stress rather than focusing on delivering quality care.

Creating safer health care together

Each health care visit is a chance for patients and their families to improve nursing care for everyone.

When you visit a hospital or clinic, try to understand the stress that health care workers are under and express your needs and concerns calmly. You never know what your nurse is dealing with in their interactions with other patients. They try to compartmentalize and give you their full attention, but they might also be experiencing a difficult and traumatic situation right next door.

It also helps to share information that might be relevant to caring for your family member, such as whether their medical condition is causing them to act differently than normal. And you should speak up if you witness any forms of aggressive behavior. These actions might seem small, but they support health care staff and help prevent violence in health care settings.

Nurses are trained to keep information private, to be problem-solvers and to bear the burden of the job, so they don’t always seek support. If you have a nurse or health care worker in your family or circle of friends, let them know you care. Supporting their safety validates their work and leads to better care for everyone.The Conversation

Jason Blomquist, Assistant Professor of Nursing, Boise State University

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How Trump’s tariffs could mean rising costs for families, strain for states

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theconversation.com – Bedassa Tadesse, Professor of Economics, University of Minnesota Duluth – 2025-03-04 16:12:00

A potential $110B economic hit: How Trump’s tariffs could mean rising costs for families, strain for states

A worker at a steel company in Monterrey, Nuevo Leon, Mexico, on Feb. 11, 2025.
Julio Cesar Aguilar/AFP via Getty Images

Bedassa Tadesse, University of Minnesota Duluth

Get ready to pay more for avocados, maple syrup and – well – almost everything.

The U.S. officially imposed new 25% tariffs on Canada and Mexico on March 4, 2025, following through on a long-delayed pledge from President Donald Trump. American consumers and businesses are now bracing for higher costs and potential supply disruptions.

Although tariffs, or taxes on imports, are a pillar of Trump’s economic policy, the move still surprised many observers, since Mexico and Canada are among the U.S.’s traditional allies and top trading partners. The administration further rattled global supply chains by doubling existing tariffs on Chinese goods to 20%.

As an economist who studies global trade, I wanted to know how the 25% import duties on Canada and Mexico would affect different parts of the country. So I conducted a state-by-state impact analysis.

What I found is alarming: The U.S. economy could face an annual loss of US$109.23 billion. This shortfall would mean rising costs of everyday goods for American families and would disproportionately affect certain states. My analysis focused exclusively on the effects of U.S. tariffs, so it didn’t take retaliation from Canada or Mexico into account. If it did, the losses would be even greater.

Unequal burdens for states, higher prices for families

Imagine your grocery bill surging by 17.5% to 25%, car parts costing hundreds of dollars more, and your favorite local restaurant raising prices as imported ingredients become unaffordable. Because tariffs drive up consumer prices, these scenarios, or others like them, will soon become reality across the U.S.

But not all Americans will be affected equally, I found. States that are deeply connected to North American supply chains will suffer the biggest economic blows. Texas, with its strong trade ties to Mexico and key role in energy, would lose $15.3 billion. California’s diverse economy would take a $10.2 billion hit. Michigan, heavily reliant on auto manufacturing, would face a $6.2 billion blow – over 1% of its gross domestic product.

The biggest losers from the policy on a per-capita basis would be smaller, trade-dependent states that lack the flexibility to absorb such a shock. New Mexico, Kentucky and Indiana would be among the hardest hit, with projected GDP losses ranging from 1.12% to 1.48%. These states rely heavily on manufacturing and specialized industries, making them particularly vulnerable to rising costs and supply chain disruptions.

Take New Mexico. While it may not experience the largest total economic loss, it would bear the highest per-person burden. That $1.73 billion hit to its economy would translate to $822 for every resident – a devastating blow in a state where incomes are already below the national average.

Indeed, the likely effects of tariffs will be felt especially hard by American families. For example, a family of four in New Mexico would see an estimated $3,288 additional annual costs, equivalent to three months of grocery bills or an entire year’s utility expenses. Families in Kentucky and Indiana would also bear heavy financial burdens, paying an extra $3,120 and $2,836, respectively. Even in wealthier states such as Texas, the added annual costs would reach over $2,000 per household.

For middle- and lower-income families, these aren’t trivial costs. They represent difficult trade-offs, forcing households to cut back on essentials, delay major purchases or dip into savings to make ends meet.

Two flags fly in front of a vehicular bridge.
A truck crosses the Ambassador Bridge, a border crossing between Windsor, Ontario, Canada, and Detroit, Mich., on March 1, 2025.
Geoff Robins/AFP via Getty Images

Where industry will face a tough hit

Perhaps no industry would suffer more than the auto sector, particularly in states such as Michigan, Indiana and Kentucky. These regions rely on a highly integrated North American supply chain, where components cross borders multiple times before a final product reaches consumers. Tariffs would disrupt this delicate balance, leading to price increases, reduced production and job losses.

My conservative estimate shows that such disruptions could cost the industry approximately $28.2 billion, putting around 680,000 jobs at risk across manufacturing, parts production and sales operations. And the ripple effects would extend beyond automakers to suppliers, dealerships and local economies.

But the pain wouldn’t stop there. Manufacturing, which plays a critical role in 17 of the top 20 states most affected by tariffs, would also face rising costs and shrinking profit margins. The agricultural sector – vital in at least 10 states – would endure higher input costs and potential retaliatory tariffs from Mexico and Canada. Past trade disputes have shown that American farmers often bear the brunt of such policies, with lost export markets and declining revenues.

During the U.S.-China trade war of 2018-2019, for example, American farmers suffered over $27 billion in losses, with soybean exports dropping by 71% and states such as Iowa, Illinois and Kansas losing billions in GDP. The federal government paid affected farmers more than $23 billion to offset these losses. Similar – and possibly worse – challenges loom now.

Retaliation from Mexico and Canada could deal a heavy blow to agricultural exports – including corn, beef and dairy – that anchor local economies, especially in Iowa, Nebraska and Wisconsin. Both countries have threatened countermeasures targeting key U.S. exports, raising concerns among farmers and agribusinesses. Retaliatory tariffs could shrink profit margins, further disrupt supply chains, and create uncertainty for producers relying on these markets.

Looking at the bigger picture

The new Trump tariff regime represents a fundamental shift in how the U.S. engages with its closest economic partners. While ostensibly meant to strengthen American industry, the tariffs on offer have serious side effects that will likely cause widespread disruptions for businesses, consumers and entire state economies.

Trade isn’t just about numbers on a spreadsheet. It’s about real people, real businesses and the intricate economic fabric that connects the nation. Changes to this system can come at a high price. Safeguarding American jobs and ensuring economic stability entails recognizing the realities of global trade and considering the trade-offs of instituting new policies.

While tariffs are one method of disrupting the status quo, they are far from the only way. Indeed, reform is also possible through targeted policies – including negotiated trade agreements, investment incentives and workforce development programs – that address trade concerns without altering deeply integrated supply chains.The Conversation

Bedassa Tadesse, Professor of Economics, University of Minnesota Duluth

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Extreme heat silently accelerates aging on a molecular level − new research

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theconversation.com – Eunyoung Choi, Postdoctoral Associate in Gerontology, University of Southern California – 2025-03-04 13:44:00

Extreme heat increases the risk of a number of diseases, including kidney and heart conditions.
Spencer Platt/Getty Images

Eunyoung Choi, University of Southern California

What if extreme heat not only leaves you feeling exhausted but actually makes you age faster?

Scientists already know that extreme heat increases the risk of heat stroke, cardiovascular disease, kidney dysfunction and even death. I see these effects often in my work as a researcher studying how environmental stressors influence the aging process. But until now, little research has explored how heat affects biological aging: the gradual deterioration of cells and tissues that increases the risk of age-related diseases.

New research my team and I published in the journal Science Advances suggests that long-term exposure to extreme heat may speed up biological aging at the molecular level, raising concerns about the long-term health risks posed by a warming climate.

Person wearing a shirt reading 'EXCESSIVE HEAT ALERT' handing water bottle to older adult sitting outside
Extreme heat is a public health issue.
AP Photo/Lynne Sladky

Extreme heat’s hidden toll on the body

My colleagues and I examined blood samples from over 3,600 older adults across the United States. We measured their biological age using epigenetic clocks, which capture DNA modification patterns – methylation – that change with age.

DNA methylation refers to chemical modifications to DNA that act like switches to turn genes on and off. Environmental factors can influence these switches and change how genes function, affecting aging and disease risk over time. Measuring these changes through epigenetic clocks can strongly predict age-related disease risk and lifespan.

Research in animal models has shown that extreme heat can trigger what’s known as a maladaptive epigenetic memory, or lasting changes in DNA methylation patterns. Studies indicate that a single episode of extreme heat stress can cause long-term shifts in DNA methylation across different tissue types in mice. To test the effects of heat stress on people, we linked epigenetic clock data to climate records to assess whether people living in hotter environments exhibited faster biological aging.

Two people sitting with their backs against the corner of a blue building,
Certain populations are more vulnerable to extreme heat.
Angela Weiss/AFP via Getty Images

We found that older adults residing in areas with frequent very hot days showed significantly faster epigenetic aging compared with those living in cooler regions. For example, participants living in locations with at least 140 extreme heat days per year – classified as days when the heat index exceeded 90 degrees Fahrenheit (32.33 degrees Celcius) – experienced up to 14 months of additional biological aging compared with those in areas with fewer than 10 such days annually.

This link between biological age and extreme heat remained even after accounting for a wide range of individual and community factors such as physical activity levels and socioeconomic status. This means that even among people with similar lifestyles, those living in hotter environments may still be aging faster at the biological level.

Even more surprising was the magnitude of the effect – extreme heat has a comparable impact on speeding up aging as smoking and heavy alcohol consumption. This suggests that heat exposure may be silently accelerating aging, at a level on par with other major known environmental and lifestyle stressors.

Long-term public health consequences

While our study sheds light on the connection between heat and biological aging, many unanswered questions remain. It’s important to clarify that our findings don’t mean every additional year in extreme heat translates directly to 14 extra months of biological aging. Instead, our research reflects population-level differences between groups based on their local heat exposure. In other words, we took a snapshot of whole populations at a moment in time; it wasn’t designed to look at effects on individual people.

Our study also doesn’t fully capture all the ways people might protect themselves from extreme heat. Factors such as access to air conditioning, time spent outdoors and occupational exposure all play a role in shaping personal heat exposure and its effects. Some individuals may be more resilient, while others may face greater risks due to preexisting health conditions or socioeconomic barriers. This is an area where more research is needed.

What is clear, however, is that extreme heat is more than just an immediate health hazard – it may be silently accelerating the aging process, with long-term consequences for public health.

U.S. map showing extreme caution level or higher heat days, with the greatest number of total heat days in the South
Large swaths of the U.S. population are experiencing long stretches of extreme heat, as this map of cumulative heat days from 2010 to 2016 shows.
Eunyoung Choi, CC BY-ND

Older adults are especially vulnerable because aging reduces the body’s ability to regulate temperature effectively. Many older individuals also take medications such as beta-blockers and diuretics that can impair their heat tolerance, making it even harder for their bodies to cope with high temperatures. So even moderately hot days, such as those reaching 80 degrees Fahrenheit (26.67 degrees Celcius), can pose health risks for older adults.

As the U.S. population rapidly ages and climate change intensifies heat waves worldwide, I believe simply telling people to move to cooler regions isn’t realistic. Developing age-appropriate solutions that allow older adults to safely remain in their communities and protect the most vulnerable populations could help address the hidden yet significant effects of extreme heat.The Conversation

Eunyoung Choi, Postdoctoral Associate in Gerontology, University of Southern California

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Gifts from top 50 US philanthropists rebounded to $16B in 2024 − Mike Bloomberg; Reed Hastings and Patty Quillin; and Michael and Susan Dell lead the list of biggest givers

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theconversation.com – David Campbell, Professor of Public Administration, Binghamton University, State University of New York – 2025-03-04 09:05:00

Mike Bloomberg speaks at the Global Renewables Summit in September 2024.
Bryan Bedder/Getty Images for Bloomberg Philanthropies

David Campbell, Binghamton University, State University of New York; Lindsey McDougle, Rutgers University – Newark, and Susan Appe, University at Albany, State University of New York

The 50 American individuals and couples who gave or pledged the most to charity in 2024 committed US$16.2 billion to foundations, universities, hospitals and more. That total was 33% above an inflation-adjusted $12.2 billion in 2023, according to the Chronicle of Philanthropy’s latest annual tally of these donations. Media mogul and former New York City Mayor Mike Bloomberg led the list, followed by Netflix co-founder and chairman Reed Hastings, along with his wife, Patty Quillin. Businessman Michael Dell and his wife, Susan Dell, pledged the third most in 2024.

Neither MacKenzie Scott nor Elon Musk, both of whom announced donations large enough to land them on this list, provided enough information for the Chronicle to include them. Musk didn’t name the nonprofits to which he gave stock, and Scott declined to confirm how much money she put into the donor-advised funds through which she gives. Known as DAFs, these funds are savings accounts reserved for charitable giving.

The Conversation U.S. asked David Campbell, Lindsey McDougle and Susan Appe, three philanthropy scholars, to assess the significance of these gifts and to consider what they indicate about the state of charitable giving in the United States.

What trends stand out overall?

Appe: I think it’s good to see that eBay founder Pierre Omidyar, an Iranian-American entrepreneur born in France, with his wife Pam, are among the top 12 donors. Omidyar is the only foreign-born philanthropist on this list who reported giving to democracy promotion in the U.S. through his Democracy Fund. The Omidyars also funded the AI Collaborative, a group that promotes artificial intelligence governance based on democratic values, and their Omidyar Network, an organization promoting responsible technology.

Given concerns about democratic backsliding around the world, which could arguably include President Donald Trump’s efforts to expand the executive branch’s power, I’m surprised not to see more top donors clearly funding democracy promotion.

I study philanthropy by U.S. immigrants. They either give more or at the same rate as people born in the United States.

Omidyar is one of seven immigrants among 2024’s top U.S. donors. The others are Herta Amir, who was born in what was then Czechoslovakia; Sergey Brin, a Russian immigrant; the Pagidipati family, which came from India; K. Lisa Yang, who was born in Singapore; Michele Kang, who immigrated from South Korea; and Joe Wen, a Taiwanese immigrant.

In 2024, as in most years, many of these wealthy donors supported prestigious universities and large hospitals and stowed millions in their own foundations and donor-advised funds. Although it’s impossible to predict exactly what their foundations and DAFs will support in the future, history suggests that they’re unlikely to focus on addressing systemic issues such as economic inequality.

McDougle: It doesn’t appear that any of these top 50 donors are Black or Latino. This lack of representation is undoubtedly a reflection of broader societal disparities and may influence how individuals from these groups perceive their own potential as philanthropists.

Philanthropic capacity often correlates with wealth accumulation, and significant gaps in wealth between racial groups are likely to have a direct influence on who we see in the Philanthropy 50. Black families, for instance, possess just 15% of the wealth of white families, while Hispanic families have only about 22%. These wealth disparities likely prevent many Black and Latino Americans from having the wealth necessary to engage in large-scale philanthropy.

This reality highlights the need for the nation’s leading philanthropists to fund initiatives that focus on addressing systemic barriers to economic equality. MacKenzie Scott has been doing this through the millions of dollars she has donated to support racial equity and economic mobility.

Addressing these disparities also involves changing the narrative around who is considered a philanthropist. As I have argued before, underrepresented groups may not always see themselves as philanthropists, partly due to limited resources and the historical portrayal of philanthropy as the domain of the wealthy. But by redefining philanthropy to include a broader spectrum of giving, philanthropy can play a pivotal role in leveling the playing field and creating more opportunities for all.

What surprises you about the biggest donors?

Appe: The absence of Oracle co-founder Larry Ellison, Google co-founder Larry Page and former Microsoft CEO Steve Ballmer also stands out due to the presence of many other tech billionaires, including Mark Zuckerberg and Bill Gates, on this list.

Campbell: In addition to Elon Musk, a South African immigrant, not making this list for the second year in a row – even though he is the richest person in the world – Jeff Bezos isn’t listed either. Few private citizens have sought to change American society more than they have – Musk most recently through his role in the so-called Department of Government Efficiency and Bezos through actions he takes as the owner of The Washington Post and the founder of Amazon, among other initiatives.

I believe that it is worth asking why neither of these men, who rank among the wealthiest Americans, made the list this year. While Musk gave too little information to make the list, his previous giving choices raise questions about his commitment to philanthropy as a way to advance the public good. In 2022 and 2023, for example, his foundation gave away less money than required by law and supported organizations that benefit him and his interests, such as schools attended by his children.

Bezos, by contrast, got a lot of attention in 2022 when he announced he would give away his fortune during his lifetime. Yet his giving has come in fits and starts since 2018, when he began to give away billions of dollars to support people experiencing homelessness, preschools for low-income children and efforts to fight climate change.

Do you have concerns about the big gifts these donors provide?

McDougle: The nonprofits receiving these large donations can end up in a precarious situation if that funding suddenly stops. When nonprofits rely too heavily on a few wealthy donors, they may be forced to make abrupt decisions like cutting crucial programs or laying off staff. Obviously, this underscores a core problem with overdependence on these types of major gifts: They can leave nonprofits in a bind and unable to sustain their operations without continued long-term support.

This is particularly problematic if it affects a nonprofit’s ability to engage in long-term planning. As such, when focusing on the giving of the super rich, it is important to consider not just the immediate benefits of their generosity but also the potential instability it can create for the recipients if their gift is not managed strategically.

Campbell: The total given by America’s top donors in 2024 was the sixth-highest in the past decade, after adjusting for inflation. I’d expected to see a larger amount, given that 2024 was the second straight year of stock market gains of 20% or more.

In 2020, when the COVID-19 pandemic began, the top donors gave nearly twice as much to charity as they did this past year; and they gave close to $8 billion more than that in 2021. Why haven’t the wealthiest Americans sustained that level?

Giant gifts to universities, museums and hospitals are surely making a meaningful difference in America and the world. But I wonder why these donors tend not to focus on the challenges facing those who have the least.

One significant exception is the $1 billion Ruth Gottesman gave the Bronx-based Albert Einstein College of Medicine to allow the school to become tuition-free. Gottesman, a former faculty member at the school, chose to honor and support the many first-generation and low-income students trained there. Bloomberg, upping his commitment to ease the tuition burden at Johns Hopkins University, made a similar gift to the medical school at his alma mater and four medical schools at historically black colleges and universities.

To be sure, some of these philanthropists use the foundations they or their relatives control to help meet the basic needs of Americans struggling to get by and address issues such as poverty, disease prevention and criminal justice reform. Melinda French Gates, Warren Buffett, and John and Laura Arnold all directed much of their giving in 2024 to those kinds of foundations.

What do you expect or hope to see in 2025 and beyond?

Appe: The Trump administration has frozen most U.S. foreign aid, endangering the lives of millions of the world’s poorest people. There are calls for the wealthiest philanthropists to help to fill this void. I hope some big donors respond with large gifts to UNICEF, the United Nations agency for children, and the WHO Foundation, which supports the World Health Organization.

Top philanthropists have been slow to react so far. However, the MacArthur Foundation just announced plans to increase its giving over the next two years. MacArthur president John Palfrey said this is a response to what he called a “major crisis” brought on by the Trump administration’s spending cuts. I will observe whether other foundations or some of the wealthiest Americans follow suit.

Still, philanthropy cannot fill all these gaps. The $60 billion in foreign aid cuts represent a sliver of the trillions the Trump administration wants to slice from the federal budget. If it succeeds, donors will have countless other priorities.

Campbell: Events that took place during the first Trump administration, like the murder of George Floyd, the erosion of democratic norms and the separation of immigrant families, led philanthropists to embrace giving that addressed these issues, notably diversity, equity and inclusion initiatives. In the early days of the second Trump administration, prominent donors like Mark Zuckerberg have enthusiastically backtracked on their own DEI policies. I am now watching how other donors position themselves relative to the Trump administration’s objectives – as cheerleaders, combatants or something in between.

The Bill & Melinda Gates Foundation and Arnold Ventures have provided funding for The Conversation U.S. in the past. The Gates foundation currently provides funding for The Conversation internationally.The Conversation

David Campbell, Professor of Public Administration, Binghamton University, State University of New York; Lindsey McDougle, Associate Professor of Public Affairs and Administration, Rutgers University – Newark, and Susan Appe, Associate Professor of Public Administration and Policy, University at Albany, State University of New York

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