Options for Increased Private Sector Participation in Resilience Investment
Acknowledgements
This report is part of an overall effort to identify innovative financing solutions for climate finance. Financial support for this study was provided by the Government of Japan through the Japan-World Bank Program for Mainstreaming DRM in Developing Countries, managed by the World Bank’s DRM Hub in Tokyo. The report was undertaken
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Some people have started realizing that there are large financial groups that dominate the world. Forget the political intrigues, conflicts, revolutions and wars. It is not pure chance. Everything has been planned for a long time.
Some call it “conspiracy theories” or New World Order. Anyway, the key to understanding the current political and economic events is a restricted core of families who have accumulated more wealth and power.
We are speaking of 6, 8 or maybe 12 families who truly dominate the world. Know that it is a mystery difficult to unravel.
We will not be far from the truth by citing Goldman Sachs, Rockefellers, Loebs Kuh and Lehmans in New York, the Rothschilds of Paris and London, the Warburgs of Hamburg, Paris and Lazards Israel Moses Seifs Rome.
Many people have heard of the Bilderberg Group, the Trilateral Commission. But what are the names of the families who run the world and have control of states and international organizations like the UN, NATO or the IMF?
To try to answer this question, we can start with the easiest: inventory, the world’s largest banks, and see who the shareholders are and who make the decisions.
The world’s largest companies are now: Bank of America, JP Morgan, Citigroup, Wells Fargo, Goldman Sachs and Morgan Stanley.Let us now review who their shareholders are.
Bank of America:
State Street Corporation, Vanguard Group, BlackRock, FMR (Fidelity), Paulson, JP Morgan, T. Rowe, Capital World Investors, AXA, Bank of NY, Mellon.
JP Morgan:
State Street Corp., Vanguard Group, FMR, BlackRock, T. Rowe, AXA, Capital World Investor, Capital Research Global Investor, Northern Trust Corp. and Bank of Mellon.
Citigroup:
State Street Corporation, Vanguard Group, BlackRock, Paulson, FMR, Capital World Investor, JP Morgan, Northern Trust Corporation, Fairhome Capital Mgmt and Bank of NY Mellon.
Wells Fargo:
Berkshire Hathaway, FMR, State Street, Vanguard Group, Capital World Investors, BlackRock, Wellington Mgmt, AXA, T. Rowe and Davis Selected Advisers.
We can see that now there appears to be a nucleus present in all banks: State Street Corporation, Vanguard Group, BlackRock and FMR (Fidelity). To avoid repeating them, we will now call them the “big four.”
Goldman Sachs:
“The big four,” Wellington, Capital World Investors, AXA, Massachusetts Financial Service and T. Rowe.
Morgan Stanley:
“The big four,” Mitsubishi UFJ, Franklin Resources, AXA, T. Rowe, Bank of NY Mellon e Jennison Associates. Rowe, Bank of NY Mellon and Jennison Associates.
We can just about always verify the names of major shareholders. To go further, we can now try to find out the shareholders of these companies and shareholders of major banks worldwide.
Bank of NY Mellon:
Davis Selected, Massachusetts Financial Services, Capital Research Global Investor, Dodge, Cox, Southeatern Asset Mgmt. and … “The big four.”
State Street Corporation (one of the “big four”):
Massachusetts Financial Services, Capital Research Global Investor, Barrow Hanley, GE, Putnam Investment and … The “big four” (shareholders themselves!).
BlackRock (another of the “big four”):
PNC, Barclays e CIC.
Who is behind the PNC? FMR (Fidelity), BlackRock, State Street, etc.
And behind Barclays? BlackRock.
And we could go on for hours, passing by tax havens in the Cayman Islands, Monaco or the legal domicile of Shell companies in Liechtenstein. A network where companies are always the same, but never a name of a family.
In short: the eight largest U.S. financial companies (JP Morgan, Wells Fargo, Bank of America, Citigroup, Goldman Sachs, U.S. Bancorp, Bank of New York Mellon and Morgan Stanley) are 100% controlled by ten shareholders and we have four companies always present in all decisions: BlackRock, State Street, Vanguard and Fidelity.
In addition, the Federal Reserve is comprised of 12 banks, represented by a board of seven people, which comprises representatives of the “big four,” which in turn are present in all other entities.
In short, the Federal Reserve is controlled by four large private companies: BlackRock, State Street, Vanguard and Fidelity. These companies control U.S. monetary policy (and world) without any control or “democratic” choice.
These companies launched and participated in the current worldwide economic crisis and managed to become even more enriched.
To finish, a look at some of the companies controlled by this “big four” group
Alcoa Inc.
Altria Group Inc.
American International Group Inc.
AT&T Inc.
Boeing Co.
Caterpillar Inc.
Coca-Cola Co.
DuPont & Co.
Exxon Mobil Corp.
General Electric Co.
General Motors Corporation
Hewlett-Packard Co.
Home Depot Inc.
Honeywell International Inc.
Intel Corp.
International Business Machines Corp
Johnson & Johnson
JP Morgan Chase & Co.
McDonald’s Corp.
Merck & Co. Inc.
Microsoft Corp.
3M Co.
Pfizer Inc.
Procter & Gamble Co.
United Technologies Corp.
Verizon Communications Inc.
Wal-Mart Stores Inc.
Time Warner
Walt Disney
Viacom
Rupert Murdoch’s News Corporation.,
CBS Corporation
NBC Universal
The same “big four” control the vast majority of European companies counted on the stock exchange.
In addition, all these people run the large financial institutions, such as the IMF, the European Central Bank or the World Bank, and were “trained” and remain “employees” of the “big four” that formed them.
The names of the families that control the “big four”, never appear.
https://www.defenseone.com/technology/2018/06/russia-too-building-giant-war-cloud/148822/
This article contains numerous lies and propaganda. But yes, the Russian Federation is arming to attain parity with the USA in total defense capability and has already passed it in certain aircraft and electronic warfare systems.. Russia did not annex Crimea, the Crimeans were Russian and voted to join Russia by a vast majority. The Ukraine revolt was run by Vicky Nuland of the US Dept of State (a hard core zio dual citizen traitors) who got 5 Billion dollars to set up a color revolution. Many innocent Crimean women and children on the border were sniped at her direction. She set up Porenchencko as dictator (he is called Porky Pig, a really evil man). Because Israel will be broken apart within the next 8 years according to Heinz Kissinger, the Israelis (Khazarians and non-blood line Hebrews) decided to “liberate the Ukraine so they could move back to their original homeland. This is where Khazaria used to be. This is rest of the story not included in the news.
“Russia is investing in military high-tech development, and especially in domestically produced software and hardware. The data centers working with this cloud are all made with ‘Russian components.’ Such an approach is key to Moscow ensuring that its key components like data are shielded from potential Western interference,” said Sam Bendett, an associate research analyst at CNA and a fellow in Russia studies at the American Foreign Policy Council. “Until recently, many IT components in the military and civilian sectors were Western—that is starting to change.”
The Russian military has determined that big data will be a “significant part in its ongoing modernization drive, with various digital technologies and approaches getting incorporated and used by the Russian forces,” says Bendett. Of course, having a backup internet of sorts would decrease the risks attacking the larger global internet.
Russia is also making moves to bring its trading partners along with it on its journey into Internet exile.
Last fall, Russia said that it was creating an independent directory naming system, or DNS — in essence the massive database that connects your browser to a web server across the world — for use by Russia, Brazil, India, South Africa, and China — the BRIC countries. Russian Foreign Minister Sergey Lavrov recently said that Russia was pursuing an information security agreement with its BRIC counterparts for formally adoption at their July summit in Johannesburg.
Oria Adamo, 72 years old and the mayor of a small town in Central African Republic shows his ID card in the village of Ndu, Bas Uele province, Democratic Republic of the Congo where thousands fled after fleeing a surge in violence that began in May 2017. © Simon Lubuku/UNHCRFardowsa, a 20-year old Somali refugee in Uganda, knows the vital importance of identity documents to refugees. She and her family were forced to flee her homeland in 2001 without any official documentation. The refugee ID card she was issued by the Government of Uganda not only provides her with protection and access to humanitarian assistance, but it has also given her the opportunity to study at university and open a mobile money account. With this foundation, Fardowsa is planning to start her own business to further improve her and her family’s new life. In the process, she will also be contributing to Uganda’s economy while realizing her potential as a young female refugee.
Identification is also crucial for internally displaced persons (IDPs), who have been forced to flee their homes to other areas within their own country. During a recent participatory assessment conducted by the UN Refugee Agency (UNHCR) in Diffa, Niger, Mohammed, an internally displaced man, emphasized: “having an identification document makes life more dignified. The community respects you and knows you are somebody”. His ID helps him pass through security checkpoints in the conflict-affected area where he lives, allowing him to continue in his business. Having an ID also facilitates social participation for many IDPs and can contribute to addressing gender-based issues and other risks of marginalization.
Advances in digital technology and the introduction of ID systems by governments around the world are resulting in new approaches to providing IDs to forcibly displaced persons.
In past situations of mass influxes, receiving governments would often request UNHCR to undertake refugee registration and documentation on their behalf. But host countries are now taking an increased role even during the first phases of a crisis, often in partnership with UNHCR, using shared identity management tools and registration processes. In some countries, refugees are now being included in the host country’s national population registry or ID system, which means they are issued a Unique Identity Number (UIN) and their life events are being recorded in the civil registry – something that used to be accessible only to citizens.
UNHCR staff member Winnie Mugisa is hard at work verifying Congolese refugees using the biometric equipment at Oruchinga settlement in Uganda. © Michele Sibiloni/UNHCRKey drivers of this trend include the commitment by all countries, as part of the Sustainable Development Goals (SDGs), to “provide legal identity for all, including birth registration” by 2030 (target 16.9) and the 2016 New York Declaration for Refugees and Migrants. Regional civil registration and vital statistics (CRVS) initiatives in Africa and in Asia and the Pacific have also shone a light on the importance of host States registering the births of refugees, IDPs and stateless persons, to protect child rights.
Past research by the World Bank has shown the potentially transformative impacts of proper identification for the inclusion of refugees in local communities and economies. The use of digitally-enabled IDs that are interoperable across different aid agencies can greatly enhance the efficiency of humanitarian assistance delivery. Importantly, the provision of IDs that are officially recognized will facilitate the financial inclusion of refugees by, for example, allowing them to register SIM cards in their own name and to open mobile money or bank accounts. Host communities will also benefit from the extension of coverage of ID systems across the whole country, including hard-to-reach and border areas.
But there are also risks that need to be managed. The collection and use of personal data is a great responsibility. It must be done in such a way that protects against misuse or unauthorized disclosure, and ensures that the individual’s right to privacy is respected. UNHCR’s data protection policy recognizes that the stakes are even higher for refugees, requiring additional considerations. To address these risks, governments should adopt and implement strong legal and regulatory frameworks for data protection, ensure that they are collecting and using personal data with the informed consent of the data subjects, and capture and process only the minimum data needed for the purposes of an ID system.
UNHCR and the World Bank share the goal of ensuring that the voices and needs of the forcibly displaced and host communities are considered in the design and implementation of robust, inclusive, and responsive ID systems. This is a central feature of the 10 Principles on ID for Sustainable Development that both organizations have endorsed, along with over 20 other international, philanthropic, academic, and private sector organizations.
To implement UNHCR’s Digital Identity and Inclusion Strategy, consultations are being held with forcibly displaced persons and host communities to understand how to develop digital ID systems that best meet their needs. This work is based on UNHCR’s existing participatory approaches and also supports efforts to issue documentation to refugee men and women on an equal basis.
Girl students using tablets pre-loaded with educational software at their Instant Network Schools (INS) classroom in Juba primary school, Dadaab. © Assadullah Nasrullah/UNHCRSimilarly, the World Bank is working to ensure that projects to support ID systems in client countries reflect the experiences and needs of the population, and that they leave no one behind—particularly the poorest and most vulnerable groups such as refugees and IDPs. To make this happen, it is critical to keep local stakeholders engaged throughout the process, and to create channels for people to actively provide feedback on their experiences getting and using IDs, including through grievance redress mechanisms.
As part of their wider partnership, UNHCR and the World Bank will work together to develop practical tools that a wide range of stakeholders can use to consult with refugees, IDPs, people at risk of statelessness, and host communities in the design and implementation of ID systems.Listening to their voices is crucial to ensuring that their ID needs are met and their protection enhanced. This will complement other collaboration such as joint work in countries where governments are seeking to include refugees and IDPs in ID systems, guidance on key privacy and data protection safeguards for refugees in ID systems, as well as an upcoming report on existing and emerging models across the world for providing digital IDs to refugees.
Today, many forcibly displaced persons are among the approximately 1 billion people around the world who lack any form of government recognized ID. Our collective hope is that in closing the identity gap every forcibly displaced person, like Fardowsa and Mohammed, can have access to a digital ID and to the rights, protection, and opportunities that come with it.
http://www.worldbank.org/en/news/feature/2017/12/15/year-in-review-2017-in-12-charts
© World Bank
How to sum up 2017? The global economy improved but there were plenty of unsettling and upsetting events and trends. Catastrophic storms and flooding wrecked homes and livelihoods from South Asia to the Caribbean. Education quality in many countries fell short even as much of the world raced into the digital age. Yet extreme poverty continues to decline. Innovation and technology are enhancing the quality of life. And human capital is now the biggest driver of wealth in the world today. Here’s what 2017 looked like in 12 charts.
Across 45 countries, an estimated 83 million people required emergency food assistance in 2017 — over 70% more than in 2015. Yemen is home to the largest food-insecure population — 17 million Yemenis don’t reliably have enough to eat, and over 3 million children, and pregnant and nursing women, are acutely malnourished. A complex mix of ongoing fragility and conflict, large-scale displacement, climate-change and natural resource degradation continues to intensify food insecurity for millions of people around the world. Food demand is projected to rise by at least 20 percent globally over the next 15 years.
Heads of state and other leaders affirmed their commitments to fight climate change at the One Planet Summit in Paris on December 12, on the two-year anniversary of the Paris Agreement. Their calls for concrete action came as concentrations of the greenhouse gas carbon dioxide reached their highest level in 800,000 years. CO2 emissions rose 60% between 1990 and 2014. In the last three years, global emissions had leveled off, but they recently began to rise again.
Record-breaking hurricanes, torrential monsoon rains, and historic flooding claimed lives and destroyed property in the Caribbean, South Asia, and the United States. In Sierra Leone and Colombia, hundreds died in mudslides after heavy rains. There are around 4-times as many natural disasters (when 10+ people are killed or 100+ affected) today than there were in the 1960s.
But disasters affect people differently — poorer people suffer only a fraction of economic losses caused by disasters, but they bear the brunt of their consequences. The “Unbreakable” report argues that investing in people’s socioeconomic resilience is critical to breaking the cycle of disaster-induced poverty.
Wealth is the assets base that enables countries to generate income (GDP) and grow. Investing in people leads to greater wealth and faster economic growth. Human capital – the skills, experience and effort of a population, is the world’s greatest asset. It accounts for about 65% of global wealth. However, in low-income countries, only 41% of wealth is human capital. As countries grow, the share of human capital becomes more important. Among other challenges, accelerations in technology require countries to urgently invest in their people if they hope to compete in the economy of the future. The forthcoming book “The Changing Wealth of Nations 2018: Building a Sustainable Future”, released in January 2018, explores these issues.
Education is one of the greatest investments a society can make in its children — and in its human capital. But there’s a crisis in learning. The 2018 World Development Reportfinds that the quality and quantity of education vary widely within and across countries. In the poorest countries, fewer than 1 in 5 primary school kids are proficient in math and reading. Hundreds of millions of children around the world are growing up without even the most basic life skills. A forthcoming study will look at the effects of education on economic mobility between generations. For example, about 12% of adults born in the 1980s in some low-income or fragile economies of Sub-Saharan Africa have more education than their parents, compared to more than 80% of the same generation in parts of East Asia.
Before a child’s 6th birthday, the brain matures more rapidly than at any other time in life. Poor nutrition can have a profound, lifelong impact on a child’s learning, health and adult earnings. The number of children who are stunted has generally declined since 1990, but the number of stunted children increased in Sub-Saharan Africa from nearly 45 million in 1990 to 57 million in 2015. Unless the trend is reversed, the region will not meet the global target of reducing stunting by 40% by 2025. And with the jobs of the future expected to demand new and more sophisticated skills, it’s becoming more critical to invest early in people.
Each day, 41,000 girls marry before they are 18 years old – that’s 15 million girls every year. A new report finds that marriage deeply affects child brides, their children, their family and even their countries. Girls married young are in turn: less likely to complete secondary school, more likely to give birth before they’re 18, have reduced future earnings, and are at greater risk of domestic violence. If child marriage were ended by 2030, the report finds that the gains in well-being for populations could reach more than $500 billion annually.
Jobs are a pathway out of poverty, but 60% of young people ages 15–24 worldwide are jobless. In South Asia and Sub-Saharan Africa the number of people ages 15–24 has been steadily rising, to 525 million in 2015 — almost half the global youth population. Jobs for young people are important for the social, economic, and political inclusion of individuals and new research finds that people are aspiring to earn higher incomes than before, as access to the internet increases. In Africa alone, home to 1.2 billion people, 226 million smartphones were connected to the internet at the end of 2015.
Globally, over a billion people rely on forests for their livelihoods, and forests are valued at over $600 billion per year. Animal, plant and marine biodiversity comprise the “natural capital” that keeps our ecosystems functional and economies productive. But the world is experiencing a dramatic loss of biodiversity. Climate change, poaching, overfishing, and pollution come together with the degradation of forests, landscapes, and ecosystems to make habitats much more vulnerable. While 2017 did see the discovery of new species such as the Tapanuli Orangutan in Indonesia, according to the IUCN, nearly one-quarter of the world’s mammal species are known to be globally threatened or extinct.
The majority of the world’s countries are governed by democratic regimes. Elections are one of the most well-established mechanisms available to citizens to strengthen accountability and responsiveness to their demands. The 2017 World Development Report on Governance finds that although they have become the most common mechanism to elect authorities around the world, elections are increasingly perceived as unfair. Since the 1940s, voter turnout has been declining worldwide. According to the report, ordinary citizens and marginalized groups sometimes find political parties unwilling to represent and articulate their demands. Globally, political parties rank as the least trusted political institution.
Over the last 15 years, the amount of time it takes to start a business has been cut in half.A vibrant private sector leads to job creation which can transform countries and communities. The Doing Business project has recorded nearly 3,200 reforms in the business environment of 186 economies around the world. The area that’s seen the greatest number of reforms is starting a business. Today, the time taken to start a new small or medium business averages 20 days worldwide, compared with 52 in 2003.
Renewable power is transforming the global electricity system, with new capacity and investment values consistently outstripping performance in the fossil-fuel sector. In 2016, more than 160 gigawatts of solar, wind, hydropower, geothermal, and biomass capacity was built around the world — an investment of almost $297 billion. Around one fifth of the world’s energy comes from renewables. Last year they made up more than half of new additions to power generation capacity glob
Written and Compiled by Martin L. Pall, PhD
Professor Emeritus of Biochemistry and Basic Medical Sciences
Washington State University
Address: 638 NE 41st Ave., Portland OR 97232 USA
martin_pall@wsu.edu 503-232-3883 May 17, 2018
Summary:
We know that there is a massive literature, providing a high level of scientific certainty, for each
of eight pathophysiological effects caused by non-thermal microwave frequency EMF exposures.
This is shown in from 12 to 35 reviews on each specific effect, with each review listed in Chapter
1, providing a substantial body of evidence on the existence of each effect. Such EMFs:
1. Attack our nervous systems including our brains leading to widespread
neurological/neuropsychiatric effects and possibly many other effects. This nervous
system attack is of great concern.
2. Attack our endocrine (that is hormonal) systems. In this context, the main things that
make us functionally different from single celled creatures are our nervous system and
our endocrine systems – even a simple planaria worm needs both of these. Thus the
consequences of the disruption of these
FULL INFO IN LINK ABOVE
Circular Economy is a global platform bringing together leaders, companies, emerging innovators and regions to accelerate the goals of the International Bankers, the Rothschild’s and the Rockefeller’s . . .
Circular Economy is a global platform bringing together leaders companies, emerging innovators and regions to accelerate the goals of the International Bankers, the Rothschild’s and the Rockefeller’s . . .Circular Economy is a global platform bringing together leaders companies, emerging innovators and regions to accelerate the goals of the International Bankers, the Rothschild’s and the Rockefeller’s . . .v
Circular Economy 100 | CE100 – Ellen MacArthur Foundation
https://www.ellenmacarthurfoundation.org/ce100Proxy Highlight
The CE100 is a global platform bringing together leading companies, emerging innovators and regions to accelerate the transition to a circular economy.Circular Economy 100 Directory – The Ellen MacArthur Foundation
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Browse the directory of Circular Economy 100 members according to member …The Circular Economy 100 welcomes five new members
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May 8, 2018 … The Circular Economy 100 welcomes five new members.Circular Economy Workshops & Collaboration Projects
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The Circular Economy 100 is a pre- competitive innovation programme …What is the Circular Economy 100? – YouTube
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May 16, 2013 … The Circular Economy 100 is a global platform bringing together leading companies, emerging innovators and regions to accelerate the …Meet Our Partners: Circular Economy 100: The Coca-Cola Company
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Sep 27, 2013 … Earlier this year, the Ellen MacArthur Foundation launched the Circular Economy 100 (CE100), a three year program aimed at bringing …Bridgestone Joins Ellen MacArthur Foundation Circular Economy …
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Bridgestone Joins Ellen MacArthur Foundation Circular Economy 100 Programme. Apr, 27 2018. CE100 logo …Ellen MacArthur Foundation Launches U.S. Circular Economy 100 …
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The Ellen MacArthur Foundation (EMF) officially launched a U.S. branch of its Circular Economy 100 (CE100) program, according to Sustainable Brands.Dow Joins Circular Economy 100
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May 18, 2016 … Dow is the latest global company to join the Circular Economy 100 (CE100), the Ellen MacArthur Foundation’s pre-competitive innovation …
http://www.pressdemocrat.com/news/8438909-181/north-bay-fires-effects-on
Researchers at UC Davis’ Environmental Health Sciences Center are looking for new mothers and pregnant women who experienced the North Bay fires to serve as subjects for a new study on the potential effects of exposure to toxic smoke and ash on expectant mothers and their infants.
Participants in the Bio-Specimen Assessment of Fire Effects Study, or B-SAFE, must have lived or worked in areas affected by the October 2017 fires — including Sonoma, Mendocino, Lake, Napa, Solano, Nevada or Yuba counties.
They also must be willing to provide test samples of their blood, hair and breast milk, their babies’ saliva and the placenta and umbilical cord blood of women who have not yet given birth. Scientists from Davis will make home visits to collect the samples and will compensate participants for their time.
The study, one of several post-fire research projects underway at the health sciences center, seeks to yield information about the implications of wildfires for the health of expectant mothers and their babies, but particularly where the fires burn in developed areas, destroying thousands of homes and everything in them: solvents, glues, metals, formaldehydes and halogens used in construction, as well as cleaning supplies, electronics, paints, insecticides and other substances stored inside.
“Very little is known about how wildfires impact the health of women and their babies who were exposed during pregnancy,” said principal investigator Rebecca J. Schmidt, assistant professor of public health sciences at UC Davis. “Our goal is to gather mothers with fire- affected pregnancies who want to help us understand what they were exposed to and the biological effects of those exposures on them and their children.”
Researchers are primarily trying to examine exposure levels and will disclose any concerning results to participants for follow-up with their own health care providers, said Karen Finney, a campus spokeswoman.
But the scientists hope to obtain additional funding to study health outcomes in children, if appropriate. Children whose mothers are involved in this study may be eligible, Finney said.
Researchers at the environmental health center also are studying health effects from the fires, ash contents and smoke.
Participants in the B-SAFE study must either be currently pregnant and due to deliver no later than Oct. 31 of this year, or be a new mom who was pregnant during October’s fires.
They also must be 18 and able to understand and respond to written questions in English, though the study is to be expanded to include Spanish speakers.
The B-SAFE study is being funded by the National Institute of Environmental Health Sciences.
https://www.cdc.gov/mmwr/volumes/67/wr/mm6722a1.htm?s_cid=mm6722a1_w
The most recent overall suicide rates (representing 2014–2016) varied fourfold, from 6.9 (District of Columbia) to 29.2 (Montana) per 100,000 persons per year (Supplementary Table; https://stacks.cdc.gov/view/cdc/53785). Across the study period, rates increased in all states except Nevada (where the rate was consistently high throughout the study period), with absolute increases ranging from 0.8 per 100,000 (Delaware) to 8.1 (Wyoming). Percentage increases in rates ranged from 5.9% (Delaware) to 57.6% (North Dakota), with increases >30% observed in 25 states (Supplementary Table; https://stacks.cdc.gov/view/cdc/53785) (Figure).
Modeled suicide rate trends indicated significant increases in 44 states, among males (34 states) and females (43 states), as well as for the United States overall (Supplementary Table; https://stacks.cdc.gov/view/cdc/53785). Nationally, the model-estimated average annual percentage change for the overall suicide rate was an increase of 1.5%. By sex, estimated national rate trends further indicated significant average annual percentage change increases for males (1.1%) and females (2.6%) (Supplementary Table; https://stacks.cdc.gov/view/cdc/53785).
Suicide decedents without known mental health conditions (11,039; 54.0%) were compared with those with known mental health conditions (9,407; 46.0%) for 27 states. Whereas decedents were predominantly male (76.8%) (Table 1) and non-Hispanic white (83.6%), those without known mental health conditions, relative to those with mental health conditions, were more likely to be male (83.6% versus 68.8%; odds ratio [OR] = 2.3, 95% CI = 2.2–2.5) and belong to a racial/ethnic minority (OR range = 1.2–2.0). Suicide decedents without known mental health conditions also had significantly higher odds of perpetrating homicide followed by suicide (aOR = 2.9, 95% CI = 2.2–3.8). Among decedents aged ≥18 years, 20.1% of those without known mental health conditions and 15.3% of those with mental health conditions had previously served in the U.S. military or were serving at the time of death.
Whereas firearms were the most common method of suicide overall (48.5%), decedents without known mental health conditions were more likely to die by firearm (55.3%) and less likely to die by hanging/strangulation/suffocation (26.9%) or poisoning (10.4%) than were those with known mental health conditions (40.6%, 31.3%, and 19.8%, respectively). These differences remained significant in the adjusted models.
Toxicology testing was less likely to be performed for decedents without known mental health conditions. Among those with toxicology results, decedents without known mental health conditions were less likely to test positive for any substance overall (aOR = 0.8, 95% CI = 0.7–0.8), including opioids (aOR = 0.90, 95% CI = 0.81–0.99), but were more likely to test positive for alcohol (aOR = 1.2, 95%, CI = 1.1–1.3).
Information on circumstances surrounding suicide were available for all decedents with mental health conditions (9,407) and approximately 85% of those without known mental health conditions (9,357) in 27 states (Table 2). Persons without known mental health conditions were less likely to have any problematic substance use (aOR = 0.7, 95% CI = 0.7–0.8) than were persons with known mental health conditions. Whereas two thirds of decedents with known mental health conditions had a history of mental health or substance use treatment (67.2%), just over half (54.0%) were in treatment at the time of death.
Decedents without known mental health conditions had a significantly higher likelihood of any relationship problem/loss (45.1%) than did those with known mental health conditions (39.6%), specifically intimate partner problems (30.2% versus 24.1%), arguments/conflicts (17.5% versus 13.6%), and perpetrating interpersonal violence in the past month (3.0% versus 1.4%). Decedents without known mental health conditions were also more likely than were those with known mental health conditions to have experienced any life stressors (50.5% versus 47.2%) such as recent criminal legal problems (10.7% versus 6.2%) or eviction/loss of home (4.3% versus 3.4%) and were more likely to have had a recent or impending (within the preceding or upcoming 2 weeks, respectively) crisis (a current or acute event thought to contribute to the suicide) (32.9% versus 26.0%). All of these differences remained significant in the adjusted models. Physical health problems and job/financial problems were commonly contributing stressors among both persons without mental health conditions (23.2% and 15.6%, respectively) and those with mental health conditions (21.4% and 16.8%, respectively). Similarly, among all persons with recent crises, intimate partner problems were the most common types and did not differ by group.
Decedents without known mental health conditions had significantly lower odds of recent release from any institution (aOR = 0.5, 95% CI = 0.4–0.5). Among those recently released, decedents without known mental health conditions were significantly more likely than decedents with mental health conditions to have been released from a correctional facility (25.7% versus 8.7%), hospital (43.7% versus 33.0%), or other facility, such as an alcohol/substance use treatment facility (24.2% versus 11.6%). Among decedents with known mental health conditions who were recently released from an institution, 46.7% were released from psychiatric facilities.
Decedents without known mental health conditions were significantly less likely to have a history of suicidal ideation (23.0%) or prior suicide attempts (10.3%) compared with those with known mental health conditions (40.8% and 29.4%, respectively). Suicide intent was disclosed by 22.4% and 24.5% of persons without and with known mental health conditions, respectively.
During 1999–2016, suicide rates increased significantly in 44 states, and 25 states experienced increases >30%. Rates increased significantly among males in 34 states, and females in 43 states. Additional research into the specific causes of these trends is needed. Data from the 27 states participating in NVDRS provide important insight into circumstances surrounding suicide and can help states identify prevention priorities.
Suicidologists regularly state that suicide is not caused by a single factor (5); however, suicide prevention is often oriented toward mental health conditions alone with regard to downstream identification of suicidal persons, treatment of mental health conditions, and prevention of reattempts. This study found that approximately half of suicide decedents in NVDRS did not have a known mental health condition, indicating that additional focus on nonmental health factors further upstream could provide important information for a public health approach (10). Those without a known mental health condition suffered more from relationship problems and other life stressors such as criminal/legal matters, eviction/loss of home, and recent or impending crises.
Similarly, persons with mental health conditions also often experienced other circumstances such as relationship problems and job/financial or physical health problems that contributed to their suicide. These findings point to the need to both prevent the circumstances associated with the onset of mental health conditions and support persons with known mental health conditions to decrease their risk for poor outcomes (11). Two thirds of suicide decedents with mental health conditions had a history of treatment for mental health or substance use disorders, with approximately half in treatment when they died. This finding suggests the need for additional safety supports, including broader implementation of affordable and effective treatment modalities, such as doctor-patient collaborative care models and proven cognitive-behavioral therapies. In addition, increased access to behavioral health providers in underserved areas is needed, as is expansion of health care systems that integrate physical and behavioral health, with a priority on suicide prevention and patient safety, especially through care transitions (12).
Comprehensive statewide suicide prevention activities are needed to address the full range of factors contributing to suicide. Prevention strategies include strengthening economic supports (e.g., housing stabilization policies, household financial support); teaching coping and problem-solving skills to manage everyday stressors and prevent future relationship problems, especially early in life; promoting social connectedness to increase a sense of belonging and access to informational, tangible, emotional, and social support; and identifying and better supporting persons at risk (e.g., military veterans, persons with physical/mental health conditions) (12). Other strategies include creating protective environments (e.g., reducing access to lethal means among persons at risk for suicide, creating organizational and workplace policies to promote help-seeking, easing transitions into and out of work for persons with mental health conditions and other life challenges), strengthening access to and delivery of care, supporting family and friends after a suicide, and encouraging the media to follow safe reporting recommendations (12). Some states, such as Colorado, are planning to implement such a comprehensive approach to suicide prevention (10).
The findings in this report are subject to at least three limitations. First, in the state-level analysis, rankings for four states (Maryland, Massachusetts, Rhode Island, and Utah) might have been affected by large proportions of injury deaths of undetermined intent (potentially biasing reported suicide rates downward) or decreased percentages of such deaths over time (potentially biasing estimated rate trends upward). Second, NVDRS is not yet nationally representative; the 27 states included represent 49.6% of the population (https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml). Finally, abstractors of NVDRS data are limited to information contained in investigative reports. Therefore, the extent of informant knowledge can affect data completeness and accuracy. Studies that include more in-depth interviews with next-of-kin often identify greater attributions to mental health disorders (13); however, many methodological variations across studies exist (14). It is likely that some persons without known mental health conditions in the current study were experiencing mental health challenges that were unknown, undiagnosed, or not reported by key informants. Nonetheless, the high prevalence of diverse contributing circumstances among those with and without known mental health conditions suggests the importance of addressing the broad range of factors that contribute to suicide.
Suicide is a growing public health problem. Effective approaches to prevent the many suicide risk factors are available. States and communities can use data from NVDRS and resources such as CDC’s Preventing Suicide: A Technical Package of Policy, Programs, and Practices (12) to better understand suicide in their populations, prioritize evidence-based comprehensive suicide prevention, and save lives.
