Harris started ‘like a rocket’ in Michigan. Now she’s slipping
Marcie Paul is nervous.
A Democratic activist, Ms Paul has been knocking on hundreds of strangers’ doors, making phone calls and sending out flyers, all in an effort to woo people here to vote for Kamala Harris.
When Harris replaced President Joe Biden as the Democratic candidate in July, Ms Paul was hopeful, as she saw the vice-president go “off like a rocket” in Michigan.
The state is one of three “blue wall” states – along with Pennsylvania and Wisconsin – that went Democrat in 2020, and if won again, would help clinch a presidential victory for Harris.
But with less than a month to go before election day, Harris’s honeymoon period in Michigan could be ending, leaving her pathway to victory less certain. A Quinnipiac poll last week indicated Donald Trump is leading in the swing state by three points.
“To keep that pace for the whole race – even though it’s seriously abbreviated – would be really unrealistic for anyone,” said Ms Paul, a resident of West Bloomfield, Michigan and co-founder of the liberal advocacy group Fems for Dems. “But I thought that we’d be a little more comfortable.”
Ms Paul is among several Democratic organisers and lawmakers in Michigan who say the presidential race here is tighter than expected, even as the Harris campaign appears to be heeding lessons from 2016. Critics say then-Democratic presidential
Up north, immigration and economy take centre stage
Although the state is far from the southern border, Democratic organisers keep hearing that immigration is a top concern for Michigan voters.
“I don’t understand why,” said Ms Paul, the Fems for Dems leader. “It’s just really not relevant for us.”
But the issue has resonated with many of the voters the BBC spoke to, including Mary Beierschmitt of Novi, Michigan.
“It’s a big issue,” she said, adding that she thought Harris had not handled the situation well as vice-president, when Harris was tasked with finding solutions to tackle the source of migration.
Illegal border crossing reached a record high last year. After the Biden administration enacted asylum restrictions, they fell to their lowest in four years.
Trump has made attacks on Harris’s immigration record a central part of his campaign. His focus has not just been at the southern border, but in midwestern states as well, including Michigan’s neighbour Ohio, where the former president has falsely claimed Haitian immigrants are settling illegally in the town of Springfield and eating residents’ pets.
Voters tend to blame the party in power for their frustrations with national issues like the economy and immigration, even if the Biden administration isn’t solely responsible for the border crisis and the rising cost of living, said Jonathon Hanson, a lecturer at University of Michigan’s Ford School of Public Policy.
“The downside for Harris and Biden is, although they’ve done a lot of things to help the economy recover from a major downturn, it’s a more difficult story to tell politically,” he said.
Trump also may have the upper hand among some swing voters in Michigan because he is more well known than Harris after four years in office and years in the public eye, said Mr Hanson.
Tim and Janet of Novi, Michigan, say they know Trump’s personality well – and they don’t like it. But the independent voters already cast their ballots for Trump because they believe he is better at articulating his policies than Harris.
“I can’t vote for somebody just because it’s a feel-good time,” said Tim, a 75-year-old who declined to share his last name for privacy reasons. “They need to be doing things and have policy initiatives that are going to be beneficial.”
But in the Detroit suburb of Warren, Harris’s new economic policies are swaying independent voter Darrell Sumpter.
The vice-president has laid out a number of economic proposals during her campaign, including a plan to offer first-time home buyers an average of $25,000, and an expansion of the child tax credit.
“I’ve never been able to even afford a house. I’ve been waiting for years,” said Mr Sumpter, 52, who voted for Trump in 2020 and is leaning toward Harris this year.
“I don’t want the country to regress right back to the same state it was with Trump,” he added.
Darrell Sumpter is excited by the possibilities of Harris’s economic proposals
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The placentas fuelling hospital kitchens in Nepal
The burning of medical waste poses a serious health and environmental danger. Hospitals in Nepal have started turning this hazardous waste into cooking gas.
Hospital staff close to the incinerator complained of persistent coughs, breathing difficulties, headaches, sore eyes and rashes. The black, noxious smoke that poured out of its chimney wafted in through the windows of Tribhuvan University Teaching Hospital (TUTH) in Nepal’s capital Kathmandu. Staff reluctantly closed them to protect their vulnerable patients: children and babies in paediatric and neonatal intensive care, and adults with respiratory illnesses.
“Keeping the windows shut caused the rooms to overheat and added to the discomfort,” recalls Deepak Mahara, former TUTH executive director who has now retired. “When the incinerator was operational, smoke frequently drifted into these sensitive areas, causing significant distress. The foul smell made the work environment uncomfortable.”
Despite this, no one realised their symptoms were connected to the incinerator’s emissions until 2014, when a local non-profit, the Health Environment and Climate Action Foundation (HECAF360), approached hospital managers to suggest replacing the offensive furnace with an underground biodigester. Staff not only faced long-term health conditions if they continued to be exposed to the poisoned air, but the hospital was also causing broader public health and environmental dangers, HECAF360 warned. Low-quality incineration of health care waste releases dioxins and furans into the atmosphere – chemicals both classified as human carcinogens. While medical waste that is dumped outside of hospital grounds poses risks to anyone who may come into contact with it, such as waste pickers on dump sites.
“We were unaware of the negative impact of the mismanagement of healthcare waste,” says Mahara. Realising the issue was serious, he agreed to take action. “It needed to be addressed immediately to comply with hospital’s mission to ‘do no harm’,” he says.
Alamy
About 5.2 million people die each year from waste-related diseases around the world (Credit: Alamy)
The situation at TUTH is common. Hospitals worldwide use incinerators to eradicate rubbish. It is the method most commonly used in developing countries to dispose of infectious waste, according to a UN Human Rights Council report. The report highlights that if medical facilities have small-scale incinerators, or manage them incorrectly, this can lead to dioxins emissions that are 40,000 times higher than emission limits set forth in the Stockholm Convention on Persistent Organic Pollutants.
In Nepal, hospitals and healthcare centres generate between 1 and 1.7kg (2.2 and 3.7lb) of healthcare waste per bed each day, according to Health Care Without Harm (HCWH), a global non-profit working to reduce healthcare services’ negative impacts on the environment and people. One study estimates low-income countries produce up to 6kg (13.3lb) of hazardous waste per bed per day, which rises to 11kg (24.3lb) in high-income nations.
The safe approach to medical waste management is to separate and treat wastes differently. According to the World Health Organization (WHO), 15% of healthcare waste is hazardous material that may be infectious, toxic or radioactive. Waste must all be segregated before disposal, but just one-third of healthcare facilities do this. This has a detrimental impact on people and the planet. About 5.2 million people, including four million children, die each year from waste-related diseases around the world.
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Pre-eclampsia: The deadly mystery scientists can’t solve
The condition causes more than 70,000 maternal deaths every year – but its causes continue to elude scientists.
After a glittering track and field career which saw her rack up seven Olympic gold medals and 14 world championship golds, Allyson Felix assumed that pregnancy would be as smooth as her trademark running style.
“All my life, I’ve taken care of my body, my body has been my tool, and it has never really failed me,” says Felix. “I’ve trained and I’ve put demands on my body, and it’s always performed. [So] I was thinking [of having] like a beautiful natural birth, I’d gone to hypnobirthing, and all these things,” she says.
But when Felix attended a routine check-up at 32 weeks, she was shocked to be told that she had severe pre-eclampsia, a pregnancy complication that causes dangerously high blood pressure levels and organ damage, and that she required immediate hospitalisation. The following day, doctors performed an emergency C-section, and her daughter Camryn was born two months early, subsequently spending the first month of her life in the neonatal intensive care unit.
Until then, there had been few signs that anything was amiss for Felix and her unborn baby, other than some swelling in her feet. “I wasn’t too alarmed by that, but I found out I was spilling protein and all these things about my blood pressure. It was terrifying. But our family got to go home,” she says.
While Camryn is now a healthy five year old, Felix is all too keenly aware of similar stories which have resulted in a far more tragic ending. In April 2023, her long-time team-mate Tori Bowie, a former world 100m champion and relay gold medallist at the Rio 2016 Olympics, died in childbirth from complications linked to pre-eclampsia. She was just 32.
“We were on numerous relay teams together, we competed against each other, with each other, and that was extremely shocking,” says Felix. “Someone that I’ve spent so much time with, it was really devastating.”
Unravelling a deadly enigma
Worldwide, pre-eclampsia is thought to be responsible for more than 70,000 maternal deaths and 500,000 foetal deaths every year, with many fatalities resulting from stroke or prolonged fitting as a result of the elevated blood pressure. It can occur without warning at any time during pregnancy, with some women developing early-onset pre-eclampsia before 34 weeks, and others experiencing late-onset forms of the condition. Women can even suffer from postpartum pre-eclampsia in the six weeks after giving birth.
Getty Images
Rates of pre-eclampsia are up to 60% higher in black women – though no one knows why (Credit: Getty Images)
Scientists have uncovered a few clues as to why this happens. Excessive inflammation, beginning in the uterus, disrupts the delicate communication patterns taking place between the mother’s body and the foetus. In particular, it impacts the reshaping of blood vessels within the uterus to form the placenta, the organ created to provide the foetus with the nutrients and oxygen it needs.
Because the flow of blood through the placenta is abnormal, it ultimately interferes with how the mother’s body controls blood pressure, gradually leading to hypertension and ultimately pre-eclampsia.
“When a woman becomes pregnant, her heart’s got to pump extra for the baby and the placenta,” says Ian Wilkinson, clinical pharmacologist and professor of therapeutics at the University of Cambridge, who is leading a UK-based population study of pre-eclampsia called Poppy. “The amount of blood she’s pumping each minute goes up one-and-a-half to two times [in normal pregnancy].”
Women with existing autoimmune disorders, those aged over 40 and women with a larger body mass index are known to be at greater risk, perhaps because they are unable to adapt as well to the physical toll that pregnancy places on a woman’s body.
But there are still many mysteries about why certain women develop pre-eclampsia, often without warning, and why others do not. In particular, rates are as much as 60% higher in black women, who are also more likely to experience severe forms of the condition.
Some researchers believe that the latter could be linked to poorer access to good nutrition and health insurance. “There’s structural racism, where certain patients and communities don’t have the same access to early interventions, detection screening, primarily because of where they get their healthcare,” says Garima Sharma, director of cardio-obstetrics and cardiovascular women’s health at the healthcare company Inova Health System in Fairfax, Virginia.
At the same time, Sharma says that this does not explain exactly why the condition begins in the first place. While doctors still rely heavily on clinical risk factors such as age, ethnicity and medical history to assess who might develop pre-eclampsia, the accuracy of predictions based on these factors is notoriously poor. “The sensitivity of clinical risk factors on their own is low,” says Sharma.
But with newer and improved diagnostics beginning to emerge, scientists may soon be able to shed more light on who is at risk and why.
Predicting pre-eclampsia
While specialists treating other diseases such as cancer or chronic infections can often take a biopsy of a patient’s internal tissues for further analysis, there is no easy way of studying the changes taking place in a pregnant woman’s uterus.
“We can’t just routinely go in and collect a sample of placenta [from a pregnant woman], because that can really increase the risk of miscarriage,” says Lana McClements, associate professor at the University of Technology Sydney. “And animals actually don’t develop pre-eclampsia, so rodent models, for example, are very difficult to create.”
Top 10 car brands in Southeast Asia
Malaysia’s largest car manufacturer Perodua pipped other global favourites like Toyota, BMW and Tesla to become Southeast Asia’s top car brand in 2024. Dive into the insights from Campaign’s exclusive research with Milieu Insight. Malaysia’s largest national car manufacturer Perodua has finished first in our list of Southeast Asia’s top 10 car brands. Founded in 1993, Perodua is known for producing some of Malaysia’s most iconic car models, including Kancil, Myvi and Bezza. With a reputation for affordable, reliable vehicles, Perodua continues to be one of the most popular carmakers in the country with a sizeable 46.3% market share in 2023. Perodua received an overall score of 58.3%, achieving more than a one point lead over its nearest competitor, Toyota, which scored 57.01%. It’s ranking in first position was largely due to a high brand awareness score in its domestic market along with top scores for buying experience and customer service. Perodua didn’t make the top 10 of any other market outside Malaysia. The ranking is based on Campaign’s authoritative list of Southeast Asia’s top 50 brands, created in partnership with research firm Milieu Insight. We have published reports on the top 10 brands from the surveyed markets (Indonesia, Thailand, Philippines, Malaysia, Vietnam, Singapore) across 10 sectors. The brands were evaluated using attributes such as awareness, purchase, quality, buying experience, customer service, trustworthiness, innovation, brand touchpoints (ease of use across all digital and offline interactions), and advocacy (degree of recommendation). Over the next few weeks, Campaign Asia-Pacific will provide a comprehensive analysis of the top brands by sector in Southeast Asia. This is the fifth in a 10-part series covering sectors such as food, electronics, travel, apparel & accessories, financial services, beauty, telcos & streaming, ecommerce, transport & delivery, automotive, and food delivery. The chart below shows the scores of the top overall car brands in Southeast Asia. Following the chart, you’ll find the top 10 automotive brands in individual markets, along with a brief analysis of the top 10 performers across the region. Overall, the top car brands in SEA is dominated by legacy and multinational brands such as Toyota, Honda and BMW, all of which made the top five. However, local manufacturers have also performed well with Malaysia’s national car manufacturers Perodua and Proton finishing in first position and seventh place respectively. China’s Geely made third ranking overall, while electric vehicle producer Tesla finished in eight position. Above all, the automotive brands with a reputation for being reliable and affordable performed the best. Brands like Perodua, Toyota and Geely are priced competitively, making them accessible to a wide range of consumers. In charts: Car brands breakdown by market Let’s have a closer look at the top 10 SEA performers 1. Perodua Founded in 1993, Perodua has risen to become Malaysia’s largest national car manufacturer with 46.3% of the domestic market share in 2023. Known for their affordable, reliable and fuel-efficient cars, they have produced some of Malaysia’s best-selling car models over the years, including Kancil, Myvi and Bezza. Perodua achieved a high brand awareness score in Malaysia of 83%. It also picked up some of the highest scores among Malaysian consumers for buying experience and customer service, which is testament to the company’s reputation for providing excellent after-sales service to its customers. 2. Toyota The Japanese car major made the top five in every market that we surveyed, including first ranking in Thailand and the Philippines. Its Toyota Hilux model is the top selling car in the region and has been for some years. Toyota achieved among the highest scores overall for brand awareness, buying experience and customer service in all markets. If it hadn’t been for Perodua’s strong support in Malaysia, Toyota may have well taken the crown. 3. Honda Founded in 1946 in Japan, Honda is the world’s top motorcycle manufacturer, with Asia accounting for most of its sales. Honda ranked in the top five of all six markets in Southeast Asia, and achieved top ranking in both Vietnam and Indonesia. Consumers in Vietnam scored Honda the highest of all brands in the buying experience (91%) and customer service categories (86%). This tallies with the fact that Honda motorcycles are best-sellers in Vietnam and are also ubiquitous in Indonesia, known and preferred for their reliability and affordability. 4. Geely Founded in 1997, Geely is one of China’s leading auto groups. The company has gained popularity in China due to its affordable pricing and relatively good quality. Acquisitions like Volvo Cars in 2010 and Proton in 2017 have propelled its international reach, while partnerships like Baidu for software development and Daimler for engine technology have solidified its technological edge. It’s also been a best-seller in the electric vehicles sector. It’s fourth place ranking is largely due to its high scores in Vietnam where it achieved 96% for customer service and 91% for buying experience. 5. BMW Leading German automaker BMW ranked in the top five of every market in SEA, including taking the top spot in Singapore. BMW and MINI saw record-breaking sales across Southeast Asia in 2023, with Vietnam and Indonesia achieving 50% and 38% growth in BMW sales year-on-year respectively. In Singapore, BMW and MINI combined is the city-state’s number-one choice across all car brands. This tallies with our survey results where Singapore consumers scored BMW the highest of all brands for both buying experience and customer service. 6. Mercedes-Benz The German car giant made the top 10 in the car brands sector for all markets in SEA. It achieved its highest ranking in Vietnam where it finished second behind Honda with a best brand score of 62.45%. In Vietnam, Mercedes has dominated the luxury car market with as much as 60% share of the market in the last four years. Consumers in Vietnam scored Mercedes the highest of all brands in the buying experience category (94%) and customer service (86%) and quality (74%). The German car manufacturer first opened a factory in Ho Chi Minh City in 1995, and the company has become a treasured part of the Vietnamese landscape. 7. Proton The second largest of Malaysia’s national car manufacturers, Proton, has ranked in seventh position overall in SEA’s top car brands largely owing to its popularity and legacy in its domestic market. Proton was established in 1983 as the national car brand of Malaysia at the behest of former Prime Minister Mahathir Mohamed. Since then, its reliable and affordable lineup of cars have been a hit, and in recent years its SUV models, including the Proton X50, X70 and X90 have been best sellers. The Chinese automaker Geely purchased a 49.9% stake in Proton Cars in 2017. The joint venture brought Proton X70 based on Geely Boyue as its first model. 8. Tesla The US electric carmaker co-founded by Elon Musk is widely regarded as the leader in the EV market. Its Model Y SUV was the best-selling car model in 2023, topping 1.15 million sales, making it the first ever pure electric vehicle to lead the global market. Tesla made the top five in both Malaysia and Singapore, where the EV giant achieved high scores for customer service and buying experience. 9. Audi The German luxury automaker is a branch of Volkswagen and sells a range of sedans, SUVs, convertibles, coupes, electric and hybrids. Known for producing sporty vehicles, with high quality and progressive design, Audi is a popular choice across Asia, particularly in Singapore where Audi was ranked in third position with high scores across quality, buying experience and customer service. Audi also made the top 10 in Malaysia, Vietnam and Indonesia. 10. Ford Known for iconic vehicles such as the Ford Mustang, Ford Fiesta, and Ford F-150, the company’s founder Henry Ford stayed true to his vision to make owning a car both practical and affordable as The Ford Motor Company has been a top manufacturer of motor vehicles for more than a century now. Ford made the top five in both Thailand and the Philippines, benefitting from high brand awareness, buying experience and quality scores.
