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It’s time for a wellness check at CVS Health.

Shares of the company are down more than 20% this year as it grapples with higher-than-expected medical costs in its insurance unit and pharmacy reimbursement pressure, among other issues.

As it seeks to claw back faith with Wall Street, the company is considering breaking itself up.

CVS has engaged advisors in a strategic review of its business, CNBC reported Monday. One option being weighed is splitting up its retail pharmacy and insurance units. It would be a stunning reversal for the company, which has spent tens of billions of dollars on acquisitions over the last two decades to turn itself into a one-stop health destination for patients.

Some analysts contend that a breakup of CVS would be challenging and unlikely. 

CVS risks losing customers and revenue if it splits up its vertically integrated business segments, which includes health insurer Aetna and the major pharmacy benefits manager Caremark. That could translate to more lost profits for a health-care giant that has slashed its full-year 2024 earnings guidance for three consecutive quarters. 

“There really is no perfect option for a split,” said eMarketer senior analyst Rajiv Leventhal, who believes a breakup is still a possibility. “If that does happen, one side of the split becomes really successful and prosperous, and the other would significantly struggle.”

Notably, CVS executives on Monday met with major shareholder Glenview Capital to discuss how to fix the flailing business and recover its stock, CNBC previously reported. But Glenview on Tuesday denied rumors that it is pushing to break up the company.

If CVS stays intact, CEO Karen Lynch and the rest of the management team will have to execute major changes to address what industry experts say are glaring issues battering its bottom line and stock price.

The company has already undertaken a $2 billion cost-cutting plan, announced in August, to help shore up profits. CVS on Monday said that plan involves laying off nearly 3,000 employees.

Some analysts said the health-care giant must prioritize recovering the margins in its insurance business, which they believe is the main issue weighing on its stock price and financial guidance for the year. That pressure drove a leadership change earlier this year, with Lynch assuming direct oversight of the company’s insurance unit in August, displacing then-President Brian Kane.

CVS’ management team and board of directors “are continually exploring ways to create shareholder value,” a company spokesperson told CNBC, declining to comment on the rumors of a breakup. 

“We remain focused on driving performance and delivering high quality healthcare products and services enabled by our unmatched scale and integrated model,” the spokesperson said in a statement. 

Investors may get more clarity on the path forward for the company during its upcoming earnings call in November.

Some analysts said the likelihood of CVS separating its retail pharmacy and insurance segments is low given the synergies between the three combined businesses. Separating them could come with risks, they added. 

“The strategy itself is still vertical integration,” Jefferies analyst Brian Tanquilut told CNBC. “The execution might not have been the greatest, but I think it’s a little too early to really conclude that it’s a broken strategy.”

Many of CVS’ clients contract with the company across its three business units, according to Elizabeth Anderson, analyst at Evercore ISI. Anderson said “carving out and pulling apart a whole contract” in the event of a breakup might be “quite difficult operationally” and lead to lost customers and revenue. 

Pharmacy benefits managers like CVS’ Caremark sit at the center of the drug supply chain in the U.S., negotiating drug rebates with manufacturers on behalf of insurers, creating lists of preferred medications covered by health plans and reimbursing pharmacies for prescriptions. 

That means Caremark also sits at the intersection of CVS’ retail pharmacy operation and its Aetna insurer, boosting the competitive advantage of both of the businesses. In the event of a breakup, it’s not clear where Caremark would fall.

Separating Caremark from Aetna would put the insurance business at a competitive disadvantage since all of its largest rivals, including UnitedHealth Group, Cigna and Humana, also have their own PBMs, said eMarketer’s Leventhal. 

But Caremark, in some cases, also funnels drug prescriptions to CVS retail pharmacies, he said. That has helped the company’s drugstores gain meaningful prescription market share over its chief rival, Walgreens, which has been struggling to operate as a largely stand-alone pharmacy business. 

CVS is the top U.S. pharmacy in terms of prescription drug revenue, holding more than 25% of the market share in 2023, according to Statista data released in March. Walgreens trailed behind with nearly 15% of that share last year. 

Now, CVS drugstores must maintain an edge over competitors at a time when the broader retail pharmacy industry faces profitability issues, largely due to falling reimbursement rates for prescription drugs. Increased competition from Amazon and other retailers, inflation, and softer consumer spending are making it more difficult to turn a profit at the front of the store. Meanwhile, burnout among pharmacy staff is also putting pressure on the industry. 

CVS’ operating margin for its pharmacy and consumer wellness business was 4.6% last year, up from 3.3% in 2022 but down from 8.5% in 2019 and 9.9% in 2015.

CVS and Walgreens have both pivoted from years of endless retail drugstore store expansions to shuttering hundreds of locations across the U.S. CVS is wrapping up a three-year plan to close 900 of its stores, with 851 locations shuttered as of August.

The rocky outlook for retail pharmacies could make it difficult for CVS to find a buyer for its drugstores in the event of a split, according to Tanquilut. He said a spinoff of CVS’ retail pharmacies would be more likely.

“There’s a reason they’re cutting down stores. Why break it up when the relationship between Caremark and CVS retail is what keeps it outperforming the rest of the pharmacy peer group?” Tanquilut said. 

CVS has other assets that would need to be distributed in the event of a breakup. 

That includes two recent acquisitions: fast-growing primary care clinic operator Oak Street Health, which the company purchased for $10.6 billion last year, and Signify Health, an in-home health-care company that CVS bought for about $8 billion in 2022. Those deals aimed to build on CVS’ major push into health care — a strategy that Walgreens and other retailers have also pursued over the last few years. 

Oak Street Health could theoretically be spun out with Aetna in the case of a split, Mizuho managing director Ann Hynes wrote in a research note Tuesday. 

The primary care clinic operator complements Aetna’s Medicare business because it takes care of older adults, offering routine health screenings and diagnoses, among other services. CVS also sells Aetna health plans that offer discounts when patients use the company’s medical care providers. 

But CVS has also started to integrate Oak Street Health with its retail pharmacies. The company has opened those primary care clinics side by side with some drugstore locations in Texas and Illinois, with plans to introduce around two dozen more in the U.S. by the end of the year. 

Several companies, including Amazon, Walmart, CVS and Walgreens, are feeling the pain from bets on primary care. That’s because building clinics requires a lot of capital, and the locations typically lose money for several years before becoming profitable, according to Tanquilut. 

Walgreens could potentially exit that market altogether. The company said in a securities filing in August it is considering a sale of its primary care provider VillageMD.

But Tanquilut said it may not make sense for CVS to sell Oak Street Health or Signify Health because “they’re actually hitting their numbers.” 

Signify saw 27% year-over-year revenue growth in the second quarter, while Oak Street sales grew roughly 32% compared with the same period last year, reflecting strong patient membership, CVS executives said in an earnings call in August.

Oak Street ended the quarter with 207 centers, an increase of 30 from last year, executives added. 

“Why get rid of them when they’re still strategic in nature?” Tanquilut told CNBC, adding that it would be difficult to find a buyer for Oak Street given the challenging market for primary care centers.

Improving the insurance unit

If CVS doesn’t undergo a breakup, the “single best value-creating opportunity” for the company is addressing the ongoing issues on the insurance side of the business, according to Leerink Partners analyst Michael Cherny. 

He said the segment’s performance has fallen short of expectations this year due to higher-than-expected medical costs — by far the biggest hit to the company’s financial 2024 guidance and stock performance, he said. Cherny said he is confident the issue is “fixable,” but it will depend on whether CVS can execute the steps it has already outlined to improve margins in its insurance unit next year. 

Aetna includes plans for the Affordable Care Act, Medicare Advantage and Medicaid, as well as dental and vision. Medical costs from Medicare Advantage patients have jumped over the last year for insurers as more seniors return to hospitals to undergo procedures they had delayed during the Covid-19 pandemic, such as hip and joint replacements. 

Medicare Advantage, a privately run health insurance plan contracted by Medicare, has long been a key source of growth and profits for the broader insurance industry. More than half of Medicare beneficiaries are enrolled in those plans as of 2024, enticed by lower monthly premiums and extra benefits not covered by traditional Medicare, according to health policy research organization KFF. 

But investors are now concerned about the skyrocketing costs from Medicare Advantage plans, which insurers warn may not come down anytime soon. 


A general view shows a sign of CVS Health Customer Support Center in CVS headquarters of CVS Health Corp in Woonsocket, Rhode Island, U.S. October 30, 2023. 

Faith Ninivaggi | Reuters

Cherny said CVS faced a “double whammy” in Medicare Advantage this year, grappling with excess membership growth at a time when many seniors are using more benefits. 

In August, CVS also said its lowered full-year outlook reflected a decline in the company’s Medicare Advantage star ratings for the 2024 payment year. 

Those crucial ratings help patients compare the quality of Medicare health and drug plans and determine how much an insurer receives in bonus payments from the Centers for Medicare & Medicaid Services. Plans that receive four stars or above get a 5% bonus for the following year and have their benchmark increased, giving them a competitive advantage in their markets.

Last year, CVS projected it would lose up to $1 billion in 2024 due to lower star ratings, the company disclosed in a securities filing. 

But things may start to look up in 2025. 

For example, one of the company’s large Medicare Advantage contracts regained its four-star rating, which will “create an incremental tailwind” in 2025, CVS executives said in August. 

“We’re giving them the benefit of the doubt because we know that the stars rating bonus payments will come back in 2025,” Tanquilut said. 

During a conference In May, CVS said it would pursue a “margin over membership” strategy: CVS CFO Tom Cowhey said the company is prepared to lose up to 10% of its existing Medicare members next year in an effort to get its margins “back on track.” 

The company will make significant changes to its Medicare Advantage plans for 2025, such as increasing copays and premiums and cutting back certain health benefits. That will eliminate the expenses tied to those benefits and drive away patients who need or want to use them. 

Those actions will help the company achieve its target of 100- to 200-basis-points margin improvement in its Medicare Advantage business, CVS executives said in August. 

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More than a dozen tigers were incinerated after the animals contracted bird flu at a zoo in southern Vietnam, officials said.

State media VNExpress cited a caretaker at Vuon Xoai zoo in Bien Hoa city saying the animals were fed with raw chicken bought from nearby farms. The panther and 20 tigers, including several cubs, weighed between 10 and 120 kilograms (20 and 265 pounds) when they died. The bodies were incinerated and buried on the premises.

“The tigers died so fast. They looked weak, refused to eat and died after two days of falling sick,” said zoo manager Nguyen Ba Phuc.

Samples taken from the tigers tested positive for H5N1, the virus that causes bird flu.

The virus was first identified in 1959 and grew into a widespread and highly lethal menace to migratory birds and domesticated poultry. It has since evolved, and in recent years H5N1 was detected in a growing number of animals ranging from dogs and cats to sea lions and polar bears.

In cats, scientists have found the virus attacking the brain, damaging and clotting blood vessels and causing seizures and death.

More than 20 other tigers were isolated for monitoring. The zoo houses some 3,000 other animals including lions, bears, rhinos, hippos and giraffes.

The 30 staff members who were taking care of the tigers tested negative for bird flu and were in normal health condition, VNExpress reported. Another outbreak also occurred at a zoo in nearby Long An province, where 27 tigers and 3 lions died within a week in September, the newspaper said.

Unusual flu strains that come from animals are occasionally found in people. Health officials in the United States said Thursday that two dairy workers in California were infected — making 16 total cases detected in the country in 2024.

“The deaths of 47 tigers, three lions, and a panther at My Quynh Safari and Vuon Xoai Zoo amid Vietnam’s bird flu outbreak are tragic and highlight the risks of keeping wild animals in captivity,” PETA Senior Vice President Jason Baker said in a statement sent to The Associated Press.

“The exploitation of wild animals also puts global human health at risk by increasing the likelihood of another pandemic,” Baker said.

Bird flu has caused hundreds of deaths around the world, the vast majority of them involving direct contact between people and infected birds.

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A 21-year-old Yazidi woman has been rescued from Gaza where she had been held captive by Hamas for years after being trafficked by ISIS.

The Israel Defense Forces (IDF) said Thursday that Fawzia Amin Sido was freed this week in an operation coordinated between Israel, the United States and other international actors.

She said that she was initially kidnapped by ISIS as a child in August 2014 when the group captured the city of Sinjar in the Nineveh Governorate of northern Iraq, executing Yazidi men and boys and committing acts of sexual violence and rape against women and girls, among other crimes.

Over the next few years, Fawzia was trafficked to different locations across several countries.

“We ended up in Al-Hol camp (in Syria) before we were smuggled to Idlib in 2019, and from there, we went to Turkey. In 2020, they arranged a passport for me in Turkey so I could fly from Istanbul to Hurghada, Egypt, and then to Gaza,” she said.

“Hamas constantly harassed me due to my Yazidi background and contact with my family, even going so far as to format my phone [erase its contents] during their investigations. After a year, they moved me to a guest house.”

When the Israel-Hamas war broke out in 2023, she was again moved around frequently – until October 1, when she said an NGO rescued her.

The IDF said that her captor was killed, “presumably during IDF strikes” in Gaza, allowing her to flee to a hideout, from where she was rescued and taken to the Kerem Shalom border crossing.

“From there, American officials took me and helped return me to Baghdad,” she said.

Israel released a video showing her reuniting with her family members, who were overcome with emotion as they embraced her.

Iraq’s Ministry of Foreign Affairs said she was freed after over four months of efforts from Iraqi government agencies working with American and Jordanian authorities.

US State Department spokesman Matthew Miller confirmed that the US helped evacuate Fawzia from Gaza. He echoed Israel’s account, saying that “the recent death of her captor in Gaza allowed her to escape.”

“We were contacted by the Iraqi government, who was made aware of the fact that she escaped, that she was alive, and that she wanted to come home to her family. And the government of Iraq asked us to do whatever we could to get her out of Gaza and get her home. So over the past few weeks, we worked with a number of our partners in the region to get her out of Gaza,” Miller said at a press briefing on Thursday.

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The fate of a possible successor to Hezbollah leader Hassan Nasrallah is unclear following an Israeli airstrike on Beirut.

Safieddine is a maternal cousin of Nasrallah – the two studied in Iran together in the early 1980s. Just like Nasrallah, Safieddine is a staunch critic of Israel and the West, with deep alliances with the Iranian leadership.

Safieddine served as head of Hezbollah’s executive council and, until his predecessor’s death, was seen as one of the most likely heirs to the organization’s highest-ranking seat. The group has yet to name a successor to Nasrallah.

The executive council is one of five bodies that make up the Shura Council, which is the organization’s decision-making body. The executive council oversees political matters, as opposed to the Jihad Council which is the group’s military body, which Safieddine is a member of.

Safieddine has previously spoken of the “strong relationship” between Hezbollah and Iran’s Revolutionary Guard Corps (IRGC), and especially Iranian general Qasem Soleimani, who was killed in US airstrike at Baghdad airport in 2020. Safieddine’s son is married to Soleimani’s daughter.

The Shiite cleric was born in 1964 in the southern Lebanese village of Deir Qanoun En Nahr. Like the late Hezbollah leader, he wears the black turban signaling that he is a “Sayyid,” a Shiite honorific title denoting descent from Prophet Mohammed.

The 60-year-old cleric has had a visible presence across Hezbollah’s political stage, especially over the past year. Throughout the Gaza war, Safieddine would make statements denouncing Israel’s actions in the enclave and on his country’s southern border.

Nasrallah “started tailoring positions for him within a variety of different councils within Lebanese Hezbollah. Some of them were more opaque than others. They’ve had him come, go out and speak,” Phillip Smyth, an expert who studies Iran-backed Shiite militias, told Reuters.

Speaking at the funeral ceremony of one of the slain Hezbollah members in May, Safieddine boasted that his group is nonetheless strong and resilient, prioritizing – along with their Iranian allies – the Palestinian cause and the need to liberate the Palestinian people.

Following the back-to-back explosions that targeted Hezbollah pagers and walkie-talkies, Safieddine said that his organization “will not back down until the end.”

Saffiedine has long been a hawkish critic of US policy, which he sees as aiding and abetting Israel’s actions in Gaza and southern Lebanon.

In 2021, he accused Washington of “interfering” in Lebanese domestic politics, saying that “American tyranny” is “sabotaging” the region’s nations, citing Iraq and Afghanistan among examples.

The United States designated Hezbollah a foreign terrorist organization in 1997, and in 2017 designated Safieddine a foreign terrorist.

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Yair Pinhas grew up hiking in the hills around Kiryat Shmona, his hometown in northern Israel, near the border with Lebanon.

“We always thought that the October 7 (attack) would happen here, we always talked about it,” he said, rolling a cigarette outside a hotel on the shore of the Sea of Galilee, about 40 miles from Kiryat Shmona.

Pinhas’ parents and his elderly grandmother have been living in this hotel for almost a year, ever since they were evacuated from Kiryat Shmona following the October 7 terror attacks. Pinhas spent months couch-surfing with friends in Tel Aviv before renting an apartment there; he comes regularly to see his family.

Kiryat Shmona, which sits in a pocket of Israeli land surrounded by Lebanon, just a couple of miles to the south and east from the border, sits on the opposite side of Israel to where the Hamas-led attacks took place last year. But its proximity to Lebanon makes it vulnerable to Hezbollah, the Iran-backed militant group that has been attacking Israel on a regular basis over the past year, in support of Hamas.

Israel has responded with cross-border attacks and the two sides have been engaged in a tit-for-tat escalation since October 8. Hezbollah has said it will not stop striking Israel until a ceasefire is reached in Gaza.

The city was hit multiple times in recent months, most recently by a barrage of rockets that caused heavy damage and several fires on Friday morning, according to Israeli police.

“When I was growing up, it wasn’t just sirens like now… it was someone blaring from a car, ‘everybody get to shelters! Everybody get to shelters!’ And in school, when the alarm went off, nobody was freaking out because we were used to it,” he said.

“Everybody goes into the shelter, you hear the bombs and then wait for somebody to tell you it’s safe to leave,” he explained, adding that while the locals have gotten used to attacks from the skies, there has always been the worry that Hezbollah could try to storm them from the ground.

“There was a warning some months before October 7, saying you need to know that the next war won’t be just rockets. They will come here. There are a lot of tunnels, and we need to prepare ourselves… and we didn’t. People are stupid. Until something happens, you don’t really act,” he said.

But then came the shock of the terror attacks, when Hamas and other militant groups killed more than 1,200 people in southern Israel and kidnapped some 250 more into Gaza.

“Everything has changed then,” Pinhas said. “We thought our army was strong and prepared and suddenly you see this, shooting everywhere. I had three friends who were at the Nova festival, one of them died, two were saved,” he said.

‘There will be a lot of deaths’

The Israeli government said the fate of people like Pinhas is among the reasons why it needs to act forcefully against Hezbollah in Lebanon.

Speaking at the United Nations General Assembly meeting last week, Israeli Prime Minister Benjamin Netanyahu said Hezbollah had fired more than 8,000 rockets at Israel since October 8, forcing some 60,000 people to flee their homes along the border.

“Israel has been tolerating this intolerable situation for nearly a year. Well, I’ve come here today to say enough is enough. We won’t rest until our citizens can return safely to their homes,” he said.

Shortly after Netanyahu spoke at the UN, the Israel Defense Forces (IDF) launched a deadly strike on the Lebanese capital Beirut, targeting and killing Hezbollah’s long term leader Hassan Nasrallah.

Three days later, the IDF said it was launching a “limited and localized” ground operation in Lebanon. The IDF’s top spokesperson, Rear Adm. Daniel Hagari, said the move was designed to prevent an October-7 style attack by Hezbollah and “to enable all 60,000 Israelis to safely return back to their homes in northern Israel.”

But at least some of the people whose fates Netanyahu invoked during his speech are questioning the decision.

“I think that it’s very dangerous for the army to go to Lebanon, because there are many, many traps… I think that we can protect the border by plane. Or go (in) and come back… But not stay (in Lebanon), it’s too dangerous,” she said.

Hatan, whose house overlooks the Lebanese border, has lived in Shtula her whole life. She said that she’s worried current warfare is much more deadly than it was in 2006, the last time Israel invaded Lebanon.

Pinhas, too, is conflicted about Israel’s decision to cross the border.

“It’s very hard. On (the) one hand, I can say, yes, you’re right, because we need to go back home and we need to bring peace to our town. So my first thought is we need to do something about it, because their (Hezbollah’s) main purpose is to kill us,” he said.

“But the other thing that I’m feeling, and everybody’s feeling that, is that this is very dangerous, and there will be a lot of deaths. Hezbollah, they know very well their territory there, this is their playground. This is not like in 2006, this is not a small group, we gave them a lot of time to prepare themselves and get a lot of ammunition,” he added, referencing the 2006 Israeli invasion into Lebanon which lasted 34 days and ended in a stalemate after killing some 1,100 people on the Lebanese side and about 170 Israelis.

The Israeli offensive is among the most intense in decades, surpassed only by its bombing of Gaza.

Standing on a hilltop in Kiryat Shmona, the scale of the bombardment becomes apparent as a steady stream of loud bangs reverberates throughout the valley. A loud boom when the artillery round gets fired, followed by a whizz overhead. A while later, a deep thud of the impact somewhere behind the border.

A city of some 22,000, Kiryat Shmona has turned into a ghost town over the past year. Signs of destruction are clearly visible throughout its streets – shrapnel holes in facades, damage caused by falling debris, destruction caused by direct hits by rockets.

On Thursday, marking the Jewish new year, the Pinhas family snuck back into Kiryat Shmona for a brief visit.

“To water the plants and feed the cats. There are many street cats in Kiryat Shmona and they need feeding,” Pinhas said.

Several rockets were fired at the city from Lebanon on Thursday but were intercepted by the Iron Dome air defense systems, the bright light of interceptor missiles popping up in the skies and chasing away the threat.

A black and white cat, meanwhile, continued to rummage through the pile of debris lying in front of a family home destroyed in an earlier rocket attack.

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Israel has pummeled Lebanon with an unprecedented airstrike campaign in less than three weeks, killing over 1,400 people, injuring nearly 7,500 others and displacing more than one million people from their homes, according to the Lebanese health ministry.

The bombardment, which Israel says is targeting Hezbollah strongholds in the country, marks the world’s “most intense aerial campaign” outside of Gaza in the last two decades, according to the conflict monitoring group Airwars.

Over the course of two days, on September 24 and September 25, the Israel military said it used 2,000 munitions and carried out 3,000 strikes.

“This isn’t normal,” Tripp said of both the scale and size of Israel’s strikes on Lebanon.  While Israel’s air campaign is extremely “unusual,” Tripp said its assault on Gaza over the last year – where nearly 60% of buildings are estimated to have been damaged from Israeli strikes – have normalized such mass assaults.

Israel says it takes steps to minimize civilian harm, like making phone calls and sending text messages to residents in buildings designated for attack. Human rights groups like Amnesty International say such warnings do not absolve Israel of responsibilities under international humanitarian law to limit civilian harm.

As a result, the death toll in Lebanon continues to rise, with a fifth of its population now displaced.

Hezbollah and Israel have consistently been exchanging fire since October 8, the day after the Hamas-led attack on Israel, in which more than 1,200 people were killed and 250 taken hostage. Hezbollah, an Iran-backed militant group, has said that it will not stop striking Israel until a ceasefire in Gaza – where the Israeli bombardment has killed more than 41,000 people in the past year, according to the ministry of health in the territory – is reached.

The majority of the fire exchanged between Israel and Hezbollah since the start of the war has come from Israeli strikes, drones, shelling and missiles on Lebanese territory, according to data from ACLED (Armed Conflict Location and Event Data), an organization that collects data on violent conflict.

Israel has launched nearly 9,000 attacks into Lebanon since October 8; Hezbollah launched 1,500 attacks in that same time frame, according to the ACLED data.

On September 25, Israel further escalated its air campaign with an intense barrage of strikes across swathes of Lebanon, marking the deadliest day for Lebanon since the 2006 Israel-Hezbollah war – and a turning point in the current conflict.

While most of Israel’s airstrikes over the past year have targeted southern Lebanon, Israel has also ramped up its attacks on Lebanon’s capital in recent weeks, with multiple airstrikes in southern Beirut flattening residential buildings and heavily populated civilian areas.

A rapid succession of strikes has killed at least seven high-ranking Hezbollah commanders and officials in recent weeks, dealing the most significant blow to the group since its formation in the early 1980s.

Those strikes have mostly been concentrated in the city’s southern Dahiyeh neighborhood, a densely packed residential area and Hezbollah stronghold. It was there that Israel assassinated the militant group’s leader in an air raid on his underground bunker on September 27.

But as Israel’s campaign to disarm Hezbollah continues, civilians are paying the highest price, including 127 children who have been killed in less than three weeks, according to the health ministry.

On September 23 alone, at least 558 people – including 50 children and 94 women – were killed.

Women and girls are also particularly affected by the displacement caused by the airstrikes, according to Lebanon’s country director at the humanitarian agency CARE International. Nearly half of the people in Lebanon’s emergency shelters for displaced people are children, and the facilities are operating beyond capacity, Michael Adams said.

Now, Israel is targeting central Beirut  – not its suburbs – with airstrikes for the first time in nearly 20 years.

Meanwhile, a quarter of Lebanese territory is now under Israeli military evacuation orders​ as Israel intensifies its ground operation in the south, with its inhabitants pushed more than 30 miles north of their homes.

More than 100 villages in southern Lebanon have now been issued the evacuation notices, stoking fears of an expanded ground invasion.

Residents have no idea when they might be able to return – or what they might find remaining.

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Using fluoride in drinking water to improve dental health may be less effective now than it was in the past, according to a new major review.

Ten per cent of people in England have fluoride added to their drinking water by the council and the government is considering expanding the reach of fluoridation projects.

But a new study found the benefits of fluoridating water seem to have declined since fluoride toothpaste became widely available in the 1970s.

Academics at Manchester, Dundee and Aberdeen universities compared 157 studies looking at the effect of fluoridation on the dental health of communities.

When the government began adding fluoride to drinking water, it reduced the number of decayed, missing or filled teeth by two whole teeth on average among children with their baby teeth, researchers said.

However, once fluoride toothpaste became widely available, that number declined.

Now, it is equivalent to a reduction of a “quarter of a tooth” that is decayed, missing or filled, on average.

Fluoride is still added to water mainly in the West Midlands and the North East.

The government is currently deciding whether to extend that to cover Darlington, Durham, Gateshead, Hartlepool, Middlesbrough, Newcastle, Northumberland, North Tyneside, Redcar and Cleveland, South Tyneside, Stockton and Sunderland.

“Water fluoridation is only having a modest benefit on dental caries, and those benefits may take years to be realised,” said University of Manchester’s Professor Anne-Marie Glenny, who co-authored the paper.

Professor Glenny said water fluoridation should be part of a “comprehensive programme of public health interventions, including those that reduce sugar consumption or other preventative measures”.

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The UK needs a strategy to meet growing demand for data centres or risk losing its advantage in the race to develop artificial intelligence (AI), one of the sector’s largest players has told Sky News.

Data centres – warehouses housing processors that power cloud computing – are central to the digital economy. They provide the power, connections and security required for the vast amount of processing power on which everything from personal device browsing to AI learning relies.

The UK is currently Europe’s largest data hub, with more than 500 data centres, the majority in the South East.

Slough in west London is the industry’s historic base, largely because of its proximity to both transatlantic connectors and the City of London, whose financial services and banks were initially the biggest customers for computation power.

Last month the government classified data centres as ‘critical national infrastructure’, putting them on a par with power stations and railways but the industry says a broader strategy is required as it moves to meet the growing demand driven by power-hungry AI chips.

High land prices, competition for grid connections and the resistance of local residents have put a premium on further expansion in the southeast, leading some companies to look beyond the industry’s traditional base.

Kao Data, which has an expanding campus in Harlow, Essex, is among those looking to beyond the South East, and broke ground this week on a £350m development at Stockport in Greater Manchester.

Spencer Lamb, Kao’s chief commercial officer, said the UK industry is at a turning point.

“We are under pressure to be able to provide capacity and create data centre buildings to fuel the demand from AI, that’s the challenge. Whether we as a country provide the environment for it is the big question mark,” he said.

“If we want to be part of the global AI opportunity we need to deploy these resources in locations that are suitable, sustainable and have the opportunity for growth. We didn’t really have a plan 10 years ago when cloud computing started, and by accident we’ve ended up where we are today which is in effect consuming all the power into the west of London.

“Now is the time to come up with a UK-wide data centre strategy and start deploying these facilities in other parts of the country, distributing them fairly.”

Kao’s expansion in Manchester exploits an existing industrial site – it will replace a concrete factory – and the availability of a grid connection, fundamental in a notoriously power-hungry industry in which a facility’s size is measured in megawatts not square feet. A 100MW data centre consumes the same amount of electricity as 100,000 homes, a town roughly the size of Ipswich.

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Mr Lamb said it is a model the government should heed. “A realistic opportunity would be to allocate two or three locations across the UK which have access to power as data centre planning zones, where the local authorities understand what a data centre is, are welcoming and we can develop these buildings simply and swiftly and remove a lot of the bureaucracy that exists.”

The Stockport site also has the backing of the mayor of Greater Manchester, Andy Burnham, who sees data as part of the jigsaw of infrastructure required to boost economic development in the North West.

“This is now critical national infrastructure as designated by the new government, and it makes sense that all of that capacity is not just clustered in one part of the country. We now need to see the emergence of a large-scale data centre industry in the north of England,” Mr Lamb said.

The challenge of further expansion in the South East is evident on the outskirts of the expanding village of Abbotts Langley in Hertfordshire, where a patch of green belt has become a frontline in the debate over data centres and the new government’s commitment to growth.

The 31-hectare plot, once grazed by cows that produced milk for the nearby Ovaltine factory, has been bought by property developer Greystoke Land and earmarked for a data centre.

The local planning authority, Three Rivers Council, rejected it because of the loss of green belt, but on her first day in office, Angela Rayner, the housing minister, “called in” the application, beginning a process expected to end with her over-ruling the local authority.

Labour promised to back development in government but that does not make it popular. As well as concerns over the environmental impact of a data centre, residents believe the development will remove the only buffer between the village and the motorway.

Stephen Giles-Medhurst, Liberal Democrat leader of Three Rivers Council, 76% of which is made up of green belt, told Sky News communities need something in return.

“I’m not a total nimby, I can see which way the wind is blowing, but we will make the best case possible to say no to this development because it is an inappropriate site, which causes very high harm to the green belt.

“Ironically we do have some brownfield sites that landowners won’t release, and we can’t compulsory purchase, let’s do something about that and bring them back into public ownership.

“But if at the end of the day we’re overruled then we will be demanding the infrastructure that’s for Abbots Langley and Three Rivers.”

A Ministry for Housing, Communities and Local Government spokesperson said: “Our reforms to the planning system will make it easier to build the key infrastructure this country needs – such as data centres – securing our economic future and giving businesses the confidence to invest.

“Development on the green belt will only be allowed where there is a real need and will not come at the expense of the environment.”

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Melania Trump is not the only first lady to express pro-choice views. She joins several former Republican first ladies who have shared similar perspectives, often in their memoirs, despite this stance historically contrasting with the GOP platform.

Other spouses of Republican presidents, such as Pat Nixon, Betty Ford, Nancy Reagan, Barbara Bush and Laura Bush, have been recorded either during or after their husbands’ tenure in office expressing pro-choice views.

‘I feel very strongly that it was the best thing in the world when the Supreme Court voted to legalize abortion and, in my words, bring it out of the backwoods and put it in the hospital where it belongs,’ Betty Ford said in a CBS News’ ’60 Minutes’ interview in 1975, two years after Roe v. Wade was handed down.

Following Ford’s comments on premarital sex, marijuana and abortion during the CBS interview, then-President Gerald Ford reportedly joked that she had cost him votes.

As a more conservative first lady, Nancy Reagan avoided taking a public stance against abortion that would put her at odds with former President Ronald Reagan. However, she later revealed her personal position on the issue.

‘I’m against abortion, I don’t believe in abortion,’ Reagan said at George Washington University in 1994, five years after her husband left the Oval Office. ‘On the other hand, I believe in a woman’s choice. So, it puts me somewhere in the middle, but I don’t know what you’d call that.’

Barbara Bush, former President George H. W. Bush’s wife, was more reserved in her public statements about abortion and was at odds with her husband’s anti-abortion stance. While she was not as outspoken as Betty Ford, she wrote in her 1994 memoir, ‘I hate abortions, but I just could not make that choice for someone else.’

Former first lady Laura Bush, wife of former President George W. Bush and daughter-in-law to Barbara Bush, also differed with the former Presidents Bush on abortion. 

‘I think it’s important that it remain legal, because I think it’s important for people for medical reasons and other reasons,’ she said in an interview with Larry King Live in 2010. 

Pat Nixon, then-President Richard Nixon’s wife, told reporters during a 1972 press conference – as Roe v. Wade arguments were being considered by the Supreme Court – that she supported the right to choose an abortion, but opposed ‘wholesale abortion on demand.’

Trump, wife of Republican presidential candidate and former President Donald Trump, wrote the memoir entitled ‘Melania’ that is scheduled to come out on Oct. 8, per the Amazon release date. In the book, according to a preview by The Guardian, she expresses a viewpoint closely aligned with that of former first ladies before her.

‘It is imperative to guarantee that women have autonomy in deciding their preference of having children, based on their own convictions, free from any intervention or pressure from the government,’ Trump reportedly wrote.

‘Why should anyone other than the woman herself have the power to determine what she does with her own body? A woman’s fundamental right of individual liberty, to her own life, grants her the authority to terminate her pregnancy if she wishes.

‘Restricting a woman’s right to choose whether to terminate an unwanted pregnancy is the same as denying her control over her own body. I have carried this belief with me throughout my entire adult life.’

The former first lady drew criticism from pro-life advocates on social media after the excerpts were published just a month away from Election Day. This year, the Republican Party’s official platform also softened its language on abortion, as former President Trump also said he would not support a federal abortion ban.

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Newly revealed emails show senior military officials raised concerns with the White House within days of Israel commencing its operation in Gaza. 

Reuters obtained and examined emails between senior State Department and Pentagon officials between Oct. 11-14 that showed concern and alarm as Israel started hitting the Gaza Strip with missile strikes. 

The emails specifically focused on the mass evacuation of Palestinians as a potential legal issue. Dana Stroul, the deputy assistant secretary of defense for the Middle East at the time, wrote to senior Biden aides Oct. 13 and warned that Israel could face war crime charges for its actions. 

The emails also include pressure to include messages of sympathy for the Palestinian people and to allow more aid into Gaza while seeking to remain in solidarity with Israel. 

Israel’s invasion of Gaza has proven polarizing and painful for the Democrats. The progressive wing and younger voters are trying to hold the Biden administration to account for its support of Israel as tens of thousands of Palestinians die. 

The invasion also made it difficult — if not impossible — for aid groups to help the displaced residents of Gaza who fled their homes to avoid getting caught up in Israel’s operations. 

Stroul outright alleged that Israel could be ‘close to committing war crimes’ after the Israeli Defense Forces (IDF) dropped leaflets over northern Gaza urging residents to flee their homes ahead of the military rolling into the territory as part of the early ‘targeted incursions.’ 

‘Their main line is that it is impossible for one million civilians to move this fast,’ Stroul wrote. One official said that such an operation was not possible without creating a ‘humanitarian catastrophe.’ 

Three senior U.S. officials argued the White House was slow to address these problems, with Biden’s team at one point arguing that the U.S. was ‘leading international efforts to get humanitarian aid into Gaza,’ which would remain a ‘top priority.’ 

Bill Russo, at the time an assistant secretary of state in the Bureau of Global Public Affairs, attempted to drive home the long-term impact of the U.S.’s ‘lack of response on the humanitarian conditions’ in Gaza, calling it ‘ineffective and counterproductive’ while also harming relations with Arab nations. 

‘If this course is not quickly reversed by not only messaging, but action, it risks damaging our stance in the region for years to come,’ Russo wrote in one email, according to Reuters. A colleague forwarded his emails to White House officials and warned that ‘otherwise would-be stalwart’ Arab partners might think twice about relations with the U.S. 

Russo eventually resigned from his post in March 2024, citing personal reasons for his decision.

Far-left voters have placed the fate of Gaza front and center of their concerns approaching November’s election. The voters of Michigan started an ‘uncommitted’ protest vote during the Democratic primary as a means of venting frustration at the Biden administration’s handling of the crisis. 

Those same voters shredded Harris for her DNC speech in August, calling it ‘horrible’ and accusing Harris of ‘downplaying’ U.S. complicity in the Gaza invasion by providing Israel funding and weapons. 

Neither the White House, the State Department nor the Pentagon responded to Fox News Digital’s requests for comment. 

Reuters contributed to this report. 

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