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The Ludicrous Deviation Between Bond Spreads and Reality

The Ludicrous Deviation Between Bond Spreads and Reality

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The Ludicrous Deviation Between Bond Spreads and Reality

 “The current environment may be more uncertain and riskier than any we have seen in our lifetimes. Yet, spreads say the future has never been more certain.”

We recently wrote that line in The Markets Are Sending Confounding Messages. The article discusses a “metaphorical fog”, induced by central banks. The fog envelops all market signals and, in the process, take away all means of orientation. Investors, unaware of the fog, are pushing the pedal to the metal with little concern.

This article examines the corporate bond fog. In particular, we show how corporate yields are priced for perfection while the economy languishes in what some describe as depression.

Quantifying Warped Perceptions

There are many ways to quantify risk. For this article, we use the Economic Policy Uncertainty Index (EPUI).

EPUI is computed by Economic Policy Uncertainty. The index is comprehensive, as it uses three distinct underlying components to measure the degree of economic uncertainty. Per the organization, their methodology is as follows:

“To measure policy-related economic uncertainty, we construct an index from three types of underlying components. One component quantifies newspaper coverage of policy-related economic uncertainty. A second component reflects the number of federal tax code provisions set to expire in future years. The third component uses disagreement among economic forecasters as a proxy for uncertainty.”

A high index level denotes more uncertainty, and conversely, a lower level reflects more confidence.

The index and its history can be found and downloaded on the St. Louis Federal Reserve’s web site.

Corporate Bond Spreads

The opening quote was from a section of the mentioned article where we discuss the gross mismeasurement of corporate bond risk. Specifically, corporate bond yields versus U.S. Treasuries are at minimal levels, reflecting a high degree of certainty and strength in the economy and financial conditions of corporations.

The fact of the matter is that over 90% of the world’s economies are in a recession. Second-quarter real GDP fell by an annualized rate of 32.9%. The last such decline was during the Great Depression.

While recovery may take hold, there is no guarantee it will last. Recovery has been fully supported by grossly unsustainable fiscal and monetary actions. There are serious questions as to whether these operations can continue.

Needless to say, confidence in the ability of corporations to thrive is misplaced today.  Historically, economic certainty and corporate spreads tend to follow the same path. Today, they are moving in the opposite direction.

To quantify this irrational deviation, we compare the EPUI and BBB-corporate/Treasury yield spreads.

The first graph below compares EPUI to BBB spreads. The higher EPUI, the more uncertainty. Similarly, the higher BBB spreads, the more investor insecurity is priced into bonds.

The second graph divides BBB-rated spreads by the EPUI to provide a comparative ratio. Traditionally, in environments like today, the ratio rises. Conversely, in times of a healthy economy with solid investor confidence, the ratio is low.

The current level of economic uncertainty in EPUI dwarfs prior extremes. BBB spreads are near historic lows. As a result, the ratio of the two rests at the lowest level in 20 years. This reading is untenable.

If the Fed were not rigorously manipulating yields, we would expect the ratio to be at the upper end of the graph. Yields should easily be into the double digits.   

Confirmation

Another powerful way to measure the separation of reality and yield spreads is to equate GDP growth with corporate spreads. During economic slowing or a recession, corporate spreads should widen. When revenues decline, earnings are more dubious, and the ability to service debt therefore, is more difficult. Investors in such environments historically demand more protection in the form of higher yields.

The scatter plot below shows quarterly instances of GDP and BBB-rated corporate spreads dating back to 1997. As shown, the relationship is statistically relevant with an R-squared of .6105. To the human eye, the data also follows a well-correlated path. As GDP declines (y-axis) corporate spreads increase (x-axis) and vice versa. The two orange dots represent the exceptions to the rule, March 31 and June 30, 2020.

To estimate where yield spreads should be, we can draw a horizontal line to the right from the orange dots to their intersection with the dotted line. The point of juncture is off the charts, literally.  While Q2 was an anomaly, it is not an anomaly to assume a growth rate for 2020 of minus 10%. Based on the data above, at such a level, BBB spreads should be 11.65%.

A second way to assess meaning to the graph is to draw a line vertically from the orange dots to the dotted line. By doing this, you arrive at the historical economic growth rate associated with the spreads. This optimistic approach says current spreads are commensurate with GDP growth of 3-5%.

Economic Caution Ahead

In times like these it is near impossible to be certain in your economic outlook. More concerning than the current situation, we believe investors are overestimating what economic growth will look like in the next expansion.

In The Decade Long Path Ahead to Economic Recovery – Part 1 Debt, we showed the graph below. The clear takeaway is that the economic growth rate of each successive expansion was less than the one before it.

Given the massive Federal debt supporting the economy, this trend will undoubtedly continue in the future.

Our analysis leads us to conclude the real future economic growth rate will be just above 1%. As such, we state in the article: “Based on this analysis, the economy will not regain pre-COVID economic levels this decade.” 

Real Measures of Corporate Credit

We present more evidence below to help further highlight the gross mispricing of bond spreads.




From Mike Larson at Weiss Ratings:

“Fifty-four companies defaulted on their debts in the second quarter of 2020. That was the most for any three-month period since 2009 in the wake of the Great Recession.

It gets worse. The default wave isn’t anywhere close to cresting.

Moody’s predicts defaults will get worse through 2021. Why? More debt than ever before was ALREADY low-rated and lousy even before the COVID-19 outbreak struck.

And this credit crisis is much more broad-based than anything we’ve ever seen. Retailers and consumer services firms, for instance, are dropping like flies due to plunging in-store sales and crushing debt levels.

Knowing all that, what do you think high-yield “junk” bonds should be doing?

Plunging in price, right?

And investors owning this kind of lousy paper — or mutual funds and ETFs stuffed to the gills with it — would be losing money hand over first, correct?

That’s not what’s happening at all!

In fact, junk bonds just had their best month since October 2011.”


Lastly, the following quote from a recent New York Federal Reserve white paper- Implications of the COVID-19 Disruption for Corporate Leverage

“Looking ahead, we find that a sizable share of U.S. corporations have interest expense greater than cash flow, raising concerns about the ability of those corporations to endure further liquidity shocks.”


No one knows with certainty what the future holds. We do, however, know what the present holds. The graphs and commentary shown above do not depict an environment in which investors should accept a bare minimum return for taking risk.

Summary

The yield on BBB-rated bonds is now in many cases below the yields of Treasury Bills from 2019. Just think about the irrationality of that one fact.

Corporate bond investors no longer have a voice. The Fed now dictates market levels through direct manipulation and suggestions for future action. Investors must accept yields that bear no resemblance to reality or receive a negative real return on their money.

The Fed is encouraging investors to pick up their speed despite extremely hazardous conditions. While many appear to trust the Fed, the Fed cannot eliminate risk.

We leave you with a quote from David Rosenberg– “The Fed is distorting risk markets on a scale never before seen. They are making a mockery of capitalism and bailing out bad actors. The system is broken.”

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The War Between Knowledge And Stupidity

The War Between Knowledge And Stupidity

Authored by Bert Olivier via The Brownstone Institute,

Bernard Stiegler was, until his premature…

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The War Between Knowledge And Stupidity

Authored by Bert Olivier via The Brownstone Institute,

Bernard Stiegler was, until his premature death, probably the most important philosopher of technology of the present. His work on technology has shown us that, far from being exclusively a danger to human existence, it is a pharmakon – a poison as well as a cure – and that, as long as we approach technology as a means to ‘critical intensification,’ it could assist us in promoting the causes of enlightenment and freedom.

It is no exaggeration to say that making believable information and credible analysis available to citizens at present is probably indispensable for resisting the behemoth of lies and betrayal confronting us. This has never been more necessary than it is today, given that we face what is probably the greatest crisis in the history of humanity, with nothing less than our freedom, let alone our lives, at stake. 

To be able to secure this freedom against the inhuman forces threatening to shackle it today, one could do no better than to take heed of what Stiegler argues in States of Shock: Stupidity and Knowledge in the 21st Century (2015). Considering what he writes here it is hard to believe that it was not written today (p. 15): 

The impression that humanity has fallen under the domination of unreason or madness [déraison] overwhelms our spirit, confronted as we are with systemic collapses, major technological accidents, medical or pharmaceutical scandals, shocking revelations, the unleashing of the drives, and acts of madness of every kind and in every social milieu – not to mention the extreme misery and poverty that now afflict citizens and neighbours both near and far.

While these words are certainly as applicable to our current situation as it was almost 10 years ago, Stiegler was in fact engaged in an interpretive analysis of the role of banks and other institutions – aided and abetted by certain academics – in the establishment of what he terms a ‘literally suicidal financial system’ (p. 1). (Anyone who doubts this can merely view the award-winning documentary film of 2010, Inside Job, by Charles Ferguson, which Stiegler also mentions on p.1.) He explains further as follows (p. 2): 

Western universities are in the grip of a deep malaise, and a number of them have found themselves, through some of their faculty, giving consent to – and sometimes considerably compromised by – the implementation of a financial system that, with the establishment of hyper-consumerist, drive-based and ‘addictogenic’ society, leads to economic and political ruin on a global scale. If this has occurred, it is because their goals, their organizations and their means have been put entirely at the service of the destruction of sovereignty. That is, they have been placed in the service of the destruction of sovereignty as conceived by the philosophers of what we call the Enlightenment…

In short, Stiegler was writing about the way in which the world was being prepared, across the board – including the highest levels of education – for what has become far more conspicuous since the advent of the so-called ‘pandemic’ in 2020, namely an all-out attempt to cause the collapse of civilisation as we knew it, at all levels, with the thinly disguised goal in mind of installing a neo-fascist, technocratic, global regime which would exercise power through AI-controlled regimes of obedience. The latter would centre on ubiquitous facial recognition technology, digital identification, and CBDCs (which would replace money in the usual sense). 

Given the fact that all of this is happening around us, albeit in a disguised fashion, it is astonishing that relatively few people are conscious of the unfolding catastrophe, let alone being critically engaged in disclosing it to others who still inhabit the land where ignorance is bliss. Not that this is easy. Some of my relatives are still resistant to the idea that the ‘democratic carpet’ is about to be pulled from under their feet. Is this merely a matter of ‘stupidity?’ Stiegler writes about stupidity (p.33):

…knowledge cannot be separated from stupidity. But in my view: (1) this is a pharmacological situation; (2) stupidity is the law of the pharmakon; and (3) the pharmakon is the law of knowledge, and hence a pharmacology for our age must think the pharmakon that I am also calling, today, the shadow. 

In my previous post I wrote about the media as pharmaka (plural of pharmakon), showing how, on the one hand, there are (mainstream) media which function as ‘poison,’ while on the other there are (alternative) media that play the role of ‘cure.’ Here, by linking the pharmakon with stupidity, Stiegler alerts one to the (metaphorically speaking) ‘pharmacological’ situation, that knowledge is inseparable from stupidity: where there is knowledge, the possibility of stupidity always asserts itself, and vice versa. Or in terms of what he calls ‘the shadow,’ knowledge always casts a shadow, that of stupidity. 

Anyone who doubts this may only cast their glance at those ‘stupid’ people who still believe that the Covid ‘vaccines’ are ‘safe and effective,’ or that wearing a mask would protect them against infection by ‘the virus.’ Or, more currently, think of those – the vast majority in America – who routinely fall for the Biden administration’s (lack of an) explanation of its reasons for allowing thousands of people to cross the southern – and more recently also the northern – border. Several alternative sources of news and analysis have lifted the veil on this, revealing that the influx is not only a way of destabilising the fabric of society, but possibly a preparation for civil war in the United States. 

There is a different way of explaining this widespread ‘stupidity,’ of course – one that I have used before to explain why most philosophers have failed humanity miserably, by failing to notice the unfolding attempt at a global coup d’etat, or at least, assuming that they did notice it, to speak up against it. These ‘philosophers’ include all the other members of the philosophy department where I work, with the honourable exception of the departmental assistant, who is, to her credit, wide awake to what has been occurring in the world. They also include someone who used to be among my philosophical heroes, to wit, Slavoj Žižek, who fell for the hoax hook, line, and sinker.

In brief, this explanation of philosophers’ stupidity – and by extension that of other people – is twofold. First there is ‘repression’ in the psychoanalytic sense of the term (explained at length in both the papers linked in the previous paragraph), and secondly there is something I did not elaborate on in those papers, namely what is known as ‘cognitive dissonance.’ The latter phenomenon manifests itself in the unease that people exhibit when they are confronted by information and arguments that are not commensurate, or conflict, with what they believe, or which explicitly challenge those beliefs. The usual response is to find standard, or mainstream-approved responses to this disruptive information, brush it under the carpet, and life goes on as usual.

‘Cognitive dissonance’ is actually related to something more fundamental, which is not mentioned in the usual psychological accounts of this unsettling experience. Not many psychologists deign to adduce repression in their explanation of disruptive psychological conditions or problems encountered by their clients these days, and yet it is as relevant as when Freud first employed the concept to account for phenomena such as hysteria or neurosis, recognising, however, that it plays a role in normal psychology too. What is repression? 

In The Language of Psychoanalysis (p. 390), Jean Laplanche and Jean-Bertrand Pontalis describe ‘repression’ as follows: 

Strictly speaking, an operation whereby the subject attempts to repel, or to confine to the unconscious, representations (thoughts, images, memories) which are bound to an instinct. Repression occurs when to satisfy an instinct – though likely to be pleasurable in itself – would incur the risk of provoking unpleasure because of other requirements. 

 …It may be looked upon as a universal mental process to so far as it lies at the root of the constitution of the unconscious as a domain separate from the rest of the psyche. 

In the case of the majority of philosophers, referred to earlier, who have studiously avoided engaging critically with others on the subject of the (non-)‘pandemic’ and related matters, it is more than likely that repression occurred to satisfy the instinct of self-preservation, regarded by Freud as being equally fundamental as the sexual instinct. Here, the representations (linked to self-preservation) that are confined to the unconscious through repression are those of death and suffering associated with the coronavirus that supposedly causes Covid-19, which are repressed because of being intolerable. The repression of (the satisfaction of) an instinct, mentioned in the second sentence of the first quoted paragraph, above, obviously applies to the sexual instinct, which is subject to certain societal prohibitions. Cognitive dissonance is therefore symptomatic of repression, which is primary. 

Returning to Stiegler’s thesis concerning stupidity, it is noteworthy that the manifestations of such inanity are not merely noticeable among the upper echelons of society; worse – there seems to be, by and large, a correlation between those in the upper classes, with college degrees, and stupidity.

In other words, it is not related to intelligence per se. This is apparent, not only in light of the initially surprising phenomenon pertaining to philosophers’ failure to speak up in the face of the evidence, that humanity is under attack, discussed above in terms of repression. 

Dr Reiner Fuellmich, one of the first individuals to realise that this was the case, and subsequently brought together a large group of international lawyers and scientists to testify in the ‘court of public opinion’ (see 29 min. 30 sec. into the video) on various aspects of the currently perpetrated ‘crime against humanity,’ has drawn attention to the difference between the taxi drivers he talks to about the globalists’ brazen attempt to enslave humanity, and his learned legal colleagues as far as awareness of this ongoing attempt is concerned. In contrast with the former, who are wide awake in this respect, the latter – ostensibly more intellectually qualified and ‘informed’ – individuals are blissfully unaware that their freedom is slipping away by the day, probably because of cognitive dissonance, and behind that, repression of this scarcely digestible truth.

This is stupidity, or the ‘shadow’ of knowledge, which is recognisable in the sustained effort by those afflicted with it, when confronted with the shocking truth of what is occurring worldwide, to ‘rationalise’ their denial by repeating spurious assurances issued by agencies such as the CDC, that the Covid ‘vaccines’ are ‘safe and effective,’ and that this is backed up by ‘the science.’ 

Here a lesson from discourse theory is called for. Whether one refers to natural science or to social science in the context of some particular scientific claim – for example, Einstein’s familiar theory of special relativity (e=mc2) under the umbrella of the former, or David Riesman’s sociological theory of ‘inner-’ as opposed to ‘other-directedness’ in social science – one never talks about ‘the science,’ and for good reason. Science is science. The moment one appeals to ‘the science,’ a discourse theorist would smell the proverbial rat.

Why? Because the definite article, ‘the,’ singles out a specific, probably dubious, version of science compared to science as such, which does not need being elevated to special status. In fact, when this is done through the use of ‘the,’ you can bet your bottom dollar it is no longer science in the humble, hard-working, ‘belonging-to-every-person’ sense. If one’s sceptical antennae do not immediately start buzzing when one of the commissars of the CDC starts pontificating about ‘the science,’ one is probably similarly smitten by the stupidity that’s in the air. 

Earlier I mentioned the sociologist David Riesman and his distinction between ‘inner-directed’ and ‘other-directed’ people. It takes no genius to realise that, to navigate one’s course through life relatively unscathed by peddlers of corruption, it is preferable to take one’s bearings from ‘inner direction’ by a set of values which promotes honesty and eschews mendacity, than from the ‘direction by others.’ Under present circumstances such other-directedness applies to the maze of lies and misinformation emanating from various government agencies as well as from certain peer groups, which today mostly comprise the vociferously self-righteous purveyors of the mainstream version of events. Inner-directness in the above sense, when constantly renewed, could be an effective guardian against stupidity. 

Recall that Stiegler warned against the ‘deep malaise’ at contemporary universities in the context of what he called an ‘addictogenic’ society – that is, a society that engenders addictions of various kinds. Judging by the popularity of the video platform TikTok at schools and colleges, its use had already reached addiction levels by 2019, which raises the question, whether it should be appropriated by teachers as a ‘teaching tool,’ or whether it should, as some people think, be outlawed completely in the classroom.

Recall that, as an instance of video technology, TikTok is an exemplary embodiment of the pharmakon, and that, as Stiegler has emphasised, stupidity is the law of the pharmakon, which is, in turn, the law of knowledge. This is a somewhat confusing way of saying that knowledge and stupidity cannot be separated; where knowledge is encountered, its other, stupidity, lurks in the shadows. 

Reflecting on the last sentence, above, it is not difficult to realise that, parallel to Freud’s insight concerning Eros and Thanatos, it is humanly impossible for knowledge to overcome stupidity once and for all. At certain times the one will appear to be dominant, while on different occasions the reverse will apply. Judging by the fight between knowledge and stupidity today, the latter ostensibly still has the upper hand, but as more people are awakening to the titanic struggle between the two, knowledge is in the ascendant. It is up to us to tip the scales in its favour – as long as we realise that it is a never-ending battle. 

Tyler Durden Fri, 03/15/2024 - 23:00

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Government

“I Can’t Even Save”: Americans Are Getting Absolutely Crushed Under Enormous Debt Load

"I Can’t Even Save": Americans Are Getting Absolutely Crushed Under Enormous Debt Load

While Joe Biden insists that Americans are doing great…

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"I Can't Even Save": Americans Are Getting Absolutely Crushed Under Enormous Debt Load

While Joe Biden insists that Americans are doing great - suggesting in his State of the Union Address last week that "our economy is the envy of the world," Americans are being absolutely crushed by inflation (which the Biden admin blames on 'shrinkflation' and 'corporate greed'), and of course - crippling debt.

The signs are obvious. Last week we noted that banks' charge-offs are accelerating, and are now above pre-pandemic levels.

...and leading this increase are credit card loans - with delinquencies that haven't been this high since Q3 2011.

On top of that, while credit cards and nonfarm, nonresidential commercial real estate loans drove the quarterly increase in the noncurrent rate, residential mortgages drove the quarterly increase in the share of loans 30-89 days past due.

And while Biden and crew can spin all they want, an average of polls from RealClear Politics shows that just 40% of people approve of Biden's handling of the economy.

Crushed

On Friday, Bloomberg dug deeper into the effects of Biden's "envious" economy on Americans - specifically, how massive debt loads (credit cards and auto loans especially) are absolutely crushing people.

Two years after the Federal Reserve began hiking interest rates to tame prices, delinquency rates on credit cards and auto loans are the highest in more than a decade. For the first time on record, interest payments on those and other non-mortgage debts are as big a financial burden for US households as mortgage interest payments.

According to the report, this presents a difficult reality for millions of consumers who drive the US economy - "The era of high borrowing costs — however necessary to slow price increases — has a sting of its own that many families may feel for years to come, especially the ones that haven’t locked in cheap home loans."

The Fed, meanwhile, doesn't appear poised to cut rates until later this year.

According to a February paper from IMF and Harvard, the recent high cost of borrowing - something which isn't reflected in inflation figures, is at the heart of lackluster consumer sentiment despite inflation having moderated and a job market which has recovered (thanks to job gains almost entirely enjoyed by immigrants).

In short, the debt burden has made life under President Biden a constant struggle throughout America.

"I’m making the most money I've ever made, and I’m still living paycheck to paycheck," 40-year-old Denver resident Nikki Cimino told Bloomberg. Cimino is carrying a monthly mortgage of $1,650, and has $4,000 in credit card debt following a 2020 divorce.

Nikki CiminoPhotographer: Rachel Woolf/Bloomberg

"There's this wild disconnect between what people are experiencing and what economists are experiencing."

What's more, according to Wells Fargo, families have taken on debt at a comparatively fast rate - no doubt to sustain the same lifestyle as low rates and pandemic-era stimmies provided. In fact, it only took four years for households to set a record new debt level after paying down borrowings in 2021 when interest rates were near zero. 

Meanwhile, that increased debt load is exacerbated by credit card interest rates that have climbed to a record 22%, according to the Fed.

[P]art of the reason some Americans were able to take on a substantial load of non-mortgage debt is because they’d locked in home loans at ultra-low rates, leaving room on their balance sheets for other types of borrowing. The effective rate of interest on US mortgage debt was just 3.8% at the end of last year.

Yet the loans and interest payments can be a significant strain that shapes families’ spending choices. -Bloomberg

And of course, the highest-interest debt (credit cards) is hurting lower-income households the most, as tends to be the case.

The lowest earners also understandably had the biggest increase in credit card delinquencies.

"Many consumers are levered to the hilt — maxed out on debt and barely keeping their heads above water," Allan Schweitzer, a portfolio manager at credit-focused investment firm Beach Point Capital Management told Bloomberg. "They can dog paddle, if you will, but any uptick in unemployment or worsening of the economy could drive a pretty significant spike in defaults."

"We had more money when Trump was president," said Denise Nierzwicki, 69. She and her 72-year-old husband Paul have around $20,000 in debt spread across multiple cards - all of which have interest rates above 20%.

Denise and Paul Nierzwicki blame Biden for what they see as a gloomy economy and plan to vote for the Republican candidate in November.
Photographer: Jon Cherry/Bloomberg

During the pandemic, Denise lost her job and a business deal for a bar they owned in their hometown of Lexington, Kentucky. While they applied for Social Security to ease the pain, Denise is now working 50 hours a week at a restaurant. Despite this, they're barely scraping enough money together to service their debt.

The couple blames Biden for what they see as a gloomy economy and plans to vote for the Republican candidate in November. Denise routinely voted for Democrats up until about 2010, when she grew dissatisfied with Barack Obama’s economic stances, she said. Now, she supports Donald Trump because he lowered taxes and because of his policies on immigration. -Bloomberg

Meanwhile there's student loans - which are not able to be discharged in bankruptcy.

"I can't even save, I don't have a savings account," said 29-year-old in Columbus, Ohio resident Brittany Walling - who has around $80,000 in federal student loans, $20,000 in private debt from her undergraduate and graduate degrees, and $6,000 in credit card debt she accumulated over a six-month stretch in 2022 while she was unemployed.

"I just know that a lot of people are struggling, and things need to change," she told the outlet.

The only silver lining of note, according to Bloomberg, is that broad wage gains resulting in large paychecks has made it easier for people to throw money at credit card bills.

Yet, according to Wells Fargo economist Shannon Grein, "As rates rose in 2023, we avoided a slowdown due to spending that was very much tied to easy access to credit ... Now, credit has become harder to come by and more expensive."

According to Grein, the change has posed "a significant headwind to consumption."

Then there's the election

"Maybe the Fed is done hiking, but as long as rates stay on hold, you still have a passive tightening effect flowing down to the consumer and being exerted on the economy," she continued. "Those household dynamics are going to be a factor in the election this year."

Meanwhile, swing-state voters in a February Bloomberg/Morning Consult poll said they trust Trump more than Biden on interest rates and personal debt.

Reverberations

These 'headwinds' have M3 Partners' Moshin Meghji concerned.

"Any tightening there immediately hits the top line of companies," he said, noting that for heavily indebted companies that took on debt during years of easy borrowing, "there's no easy fix."

Tyler Durden Fri, 03/15/2024 - 18:00

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Spread & Containment

Sylvester researchers, collaborators call for greater investment in bereavement care

MIAMI, FLORIDA (March 15, 2024) – The public health toll from bereavement is well-documented in the medical literature, with bereaved persons at greater…

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MIAMI, FLORIDA (March 15, 2024) – The public health toll from bereavement is well-documented in the medical literature, with bereaved persons at greater risk for many adverse outcomes, including mental health challenges, decreased quality of life, health care neglect, cancer, heart disease, suicide, and death. Now, in a paper published in The Lancet Public Health, researchers sound a clarion call for greater investment, at both the community and institutional level, in establishing support for grief-related suffering.

Credit: Photo courtesy of Memorial Sloan Kettering Comprehensive Cancer Center

MIAMI, FLORIDA (March 15, 2024) – The public health toll from bereavement is well-documented in the medical literature, with bereaved persons at greater risk for many adverse outcomes, including mental health challenges, decreased quality of life, health care neglect, cancer, heart disease, suicide, and death. Now, in a paper published in The Lancet Public Health, researchers sound a clarion call for greater investment, at both the community and institutional level, in establishing support for grief-related suffering.

The authors emphasized that increased mortality worldwide caused by the COVID-19 pandemic, suicide, drug overdose, homicide, armed conflict, and terrorism have accelerated the urgency for national- and global-level frameworks to strengthen the provision of sustainable and accessible bereavement care. Unfortunately, current national and global investment in bereavement support services is woefully inadequate to address this growing public health crisis, said researchers with Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine and collaborating organizations.  

They proposed a model for transitional care that involves firmly establishing bereavement support services within healthcare organizations to ensure continuity of family-centered care while bolstering community-based support through development of “compassionate communities” and a grief-informed workforce. The model highlights the responsibility of the health system to build bridges to the community that can help grievers feel held as they transition.   

The Center for the Advancement of Bereavement Care at Sylvester is advocating for precisely this model of transitional care. Wendy G. Lichtenthal, PhD, FT, FAPOS, who is Founding Director of the new Center and associate professor of public health sciences at the Miller School, noted, “We need a paradigm shift in how healthcare professionals, institutions, and systems view bereavement care. Sylvester is leading the way by investing in the establishment of this Center, which is the first to focus on bringing the transitional bereavement care model to life.”

What further distinguishes the Center is its roots in bereavement science, advancing care approaches that are both grounded in research and community-engaged.  

The authors focused on palliative care, which strives to provide a holistic approach to minimize suffering for seriously ill patients and their families, as one area where improvements are critically needed. They referenced groundbreaking reports of the Lancet Commissions on the value of global access to palliative care and pain relief that highlighted the “undeniable need for improved bereavement care delivery infrastructure.” One of those reports acknowledged that bereavement has been overlooked and called for reprioritizing social determinants of death, dying, and grief.

“Palliative care should culminate with bereavement care, both in theory and in practice,” explained Lichtenthal, who is the article’s corresponding author. “Yet, bereavement care often is under-resourced and beset with access inequities.”

Transitional bereavement care model

So, how do health systems and communities prioritize bereavement services to ensure that no bereaved individual goes without needed support? The transitional bereavement care model offers a roadmap.

“We must reposition bereavement care from an afterthought to a public health priority. Transitional bereavement care is necessary to bridge the gap in offerings between healthcare organizations and community-based bereavement services,” Lichtenthal said. “Our model calls for health systems to shore up the quality and availability of their offerings, but also recognizes that resources for bereavement care within a given healthcare institution are finite, emphasizing the need to help build communities’ capacity to support grievers.”

Key to the model, she added, is the bolstering of community-based support through development of “compassionate communities” and “upskilling” of professional services to assist those with more substantial bereavement-support needs.

The model contains these pillars:

  • Preventive bereavement care –healthcare teams engage in bereavement-conscious practices, and compassionate communities are mindful of the emotional and practical needs of dying patients’ families.
  • Ownership of bereavement care – institutions provide bereavement education for staff, risk screenings for families, outreach and counseling or grief support. Communities establish bereavement centers and “champions” to provide bereavement care at workplaces, schools, places of worship or care facilities.
  • Resource allocation for bereavement care – dedicated personnel offer universal outreach, and bereaved stakeholders provide input to identify community barriers and needed resources.
  • Upskilling of support providers – Bereavement education is integrated into training programs for health professionals, and institutions offer dedicated grief specialists. Communities have trained, accessible bereavement specialists who provide support and are educated in how to best support bereaved individuals, increasing their grief literacy.
  • Evidence-based care – bereavement care is evidence-based and features effective grief assessments, interventions, and training programs. Compassionate communities remain mindful of bereavement care needs.

Lichtenthal said the new Center will strive to materialize these pillars and aims to serve as a global model for other health organizations. She hopes the paper’s recommendations “will cultivate a bereavement-conscious and grief-informed workforce as well as grief-literate, compassionate communities and health systems that prioritize bereavement as a vital part of ethical healthcare.”

“This paper is calling for healthcare institutions to respond to their duty to care for the family beyond patients’ deaths. By investing in the creation of the Center for the Advancement of Bereavement Care, Sylvester is answering this call,” Lichtenthal said.

Follow @SylvesterCancer on X for the latest news on Sylvester’s research and care.

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Article Title: Investing in bereavement care as a public health priority

DOI: 10.1016/S2468-2667(24)00030-6

Authors: The complete list of authors is included in the paper.

Funding: The authors received funding from the National Cancer Institute (P30 CA240139 Nimer) and P30 CA008748 Vickers).

Disclosures: The authors declared no competing interests.

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