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This is a super-post collating multiple existing answers of mine. It is broken down into:#1. Books#2. Online resources#3. Blogs and websites#4. Youtube Channels#5. Online Courses#6. Movies#1. BooksA. QuantQuantitative Aptitude for Competitive Examination - Abhijit GuhaHow to Prepare for Quantitative Aptitude for CAT - Arun SharmaB. VerbalWord Power Made Easy (The Complete Handbook for Building a Superior Vocabulary) - A wonderfully written book that makes learning new words fun.After (and only after) you are done with it, read All About Words (An Adult Approach to Vocabulary Building)."Competition Success Review" magazineThe editorial sections of major newspapersGood non-fiction books on diverse topics - law, finance, history, politics, philosophy, crime, religion etcVerbal ability for CAT: Arun SharmaHigh School English Grammar & Composition - by Wren and Martin (for grammar)A Communicative Grammar Of English (for grammar)BBC list of Top 100 Books.#2. Online resourcesApart from the basic forums - PagalGuy, TotalGadha, HandakaFunda etc, the below websites will help you prepare comprehensively for the written test as well as for the later parts of the process.A. VerbalA.1. VocabIFTTT - Send yourself a weekly vocabulary list of Wikipedia words of the day: Sit down every Sunday (or any other day you like) and learn 7 new words. All you need is a IFTTT and a Pocket account (both free).ESL Exercises: Test your vocabulary by taking a series of structured quizzes.Visual thesaurus: Understand what words mean, and why. Visualize the origin of words and their interconnectionsDictionary.com Flashcards: When you are on the go, use this flashcard app to learn new words.A.2. Reading SpeedSpritz: Boost your reading speed. Spritz is one of the rare speed-reading websites/app that actually helps.A.3. English languageBBC - Learning English: A great resource to know and understand the various nuances of the English language./r/WritingPrompts: Strangers give you a random (and mostly weird) topic, and you need to write an engaging story around it. Helps build your vocab, grammar and comprehension skills.B. General AwarenessThe best way to stay updated on the various developments is to follow specific sub-reddits./r/worldnews: Be updated on the current events in the world./r/technology/r/science/r/news: Mostly US centric newsC. Soft skillsTake up a few courses:Introduction to Time ManagementGetting started with essay writingReasoningGrammar and PunctuationIntroduction to Public SpeakingD. OthersTenADay: Solve 10 questions everyday from the CAT curriculum. Level up, slowly but steadily#3. Blogs and websitesA. FinanceProf. Jayanth R. Varma's Financial Markets Blog: Prof Jayant Verma is a Professor of Finance (mainly Financial markets) at IIMA. He is one of the most impressive teachers I have ever met. He was one of the first members of SEBI and is on the board of multiple big companies including Infosys and Axis Bank. His blog, which has been up since 2005, is a brilliant resource on understanding the nuances of the financial markets.Dealbook (NYT): Dealbook is the news aggregator section of NYTimes to keep you updated on the current state of affairs of the Fin industry.Mergers & Inquisitions: Everything you need to know about every aspect of the Financial world - from big investment banks to boutique firms, from Private Equity to Hedge Funds and AM/WM firms.Investment Banking Blog: The holy mecca for preparation of i-Banking interviews, the IB Blog offers everything from bootcamps and interview prep courses (paid) to free resources like basic interview questions, overview of the industry etc.Wall Street Oasis: Similar to #2 above, but with more functionality to read the best articles of the month/week/day etc.FT Alphaville: Another news aggregator that will make sure you do not have any time left in your day (courtesy its exhaustive coverage of current affairs)B. EntrepreneurshipEntrepreneur: Your companion on the entrepreneurial journey. The site will keep you updated with the start-up world, help you work on various aspects of your professional self, and also provide the much needed pep-talk when you are feeling down/exhausted/defeated.AVC: The chronicles of Fred Wilson ( a Venture Capitalist for the past 30 years) with some incredible credentials to his name (including investments in Twitter, Tumble, Zynga, Foursuare etc). AVC is probably the most widely-read VC blog in the world.C. MarketingMad Over Marketing: MoM is a fun blog. They capture everything from brand wars on twitter, to collection of some of the best and most important marketing campaigns. The blog is a very easy read and will help you broaden your horizon when it comes to thinking of how you can ante up your marketing/advertising game.Duct Tape Marketing: Duct Tape Marketing focuses on small businesses and startups. They take into account that small businesses do not have the funds that large corporations do. So their marketing tactics need to be tailored to their financial capacity.aimClear: aimClear wants to be the single resource when it comes to your personal as well as company brand by using every possible tool in the marketer's kitty - from social media to SEO, from conclaves to data management using basic tools like Excel.Bufferapp social: Bufferapp is an exhaustive resource to help you manage, grow, and track your social media persona.HubSpot Blog: A collection of 3 secondary blogs - focusing on sales, marketing, and your agency. This trio will help you streamline your sales activity, boost your pre-sales capabilities, help you traverse the maze of sales-killer questions like, "This is too costly", and also help you manage your time and productivity in a better manner.Marketing Land: The Dealbook of marketing, ML is the one-stop solution for your marketing trends news requirement.Startup Marketing | Ryan Gum: Ryan Gum is a growth hacker who helps create marketing plans for startups and small businesses starting from creating your initial pitch, attracting your first customer, and an exhaustive list of Startup Marketing Resources.The SumAll Blog: The SumAll blog is like the child of Buzzfeed and Medium (and not in a negative sense). They post content which is useful and is also written in a fun manner. The articles are often crisp and under a 5-min read.D. EconomicsFreakonomics: The uthors of the best-selling economics-infused-with-pop-culture book have more to say and share than the 2 books. The blog is usually a collection of podcasts that aim to explore the "hidden side of economics" and highlight outliers, which although rare, are extremely critical.Why Nations Fail: On the same line as Freakonomics, the blog by Daren Acemoglu is a follow-up on his book of the same name and explores similar obscure events that shaped the rise and fall of nations and civilizations.Economixcomix: The companion blog for the graphic novel of the same name by Michael Goodwin, Economixcomix explains the basic tenets of Economics in a simple way, along with illustrations to make understanding easier.The Grumpy Economist: The perennial pessimist, the one who finds faults in everything, the dad who bores his kid during dinner with his constant rants and criticisms, John Cochrane provides an unabashed, and hard-hitting critique that exposes the not-so-sunny side of the world economy.Investing and Economics Blog: The Curios Cat blogs is for us. The laymen. The dabblers. It focuses heaving on personal finance, economics, financial literacy, tax planning, credit management et al; stuff that affects the majority of the populace on a regular basis.The Upshot: The NYT economics companion to its financial section, Dealbook, The Upshot is all you need to read to be perfectly updated of what is happening, why it is happening, what would be the consequences, and what could have been done better.Economist's View: A collection of self-posts and the hottest posts from other economics blogs.The Money Illusion: TMI focuses on the money and capital markets and provides wonderful commentary on financial crises, international economics, foreign reserve dynamics, monetary and fiscal policies, labor markets etc.E. LeadershipGuy Kawasaki: Guy is one of the most well known figures in Silicon Valley, and among the first "tech evangelist".All Things Workplace: As the name suggests, this is a blog for managers, bosses, and professionals and aims to cover all aspects of workplace management including effective communication, employee engagement, conflict management, incorporating cultural diversity and differences, various facets of leadership, boosting creativity, and so on.Seth's Blog: Seth is a funny guy. The funniest of all in this list. Although he calls his blog a marketing blog, it's more generic in nature and oft has funny quips and clever observations interspersed with longform articles.Lean In: Everyone knows the book by Sheryl Sandberg, COO of Facebook. The blog aims to continue the story and encourage and empower women to face challenges, voice their opinions, and grow themselves in the workplace.Switch & Shift: S&S aims at helping business transition from the traditional workplace model to the current, more information driven, globally-diverse-yet-connected workplace.Hot Momma's Project: Don't go by the sexist-sounding name, HMP is sort of a companion to LeanIn and strives to help women claim their rightful place in the corporate world.Culture University: In a globally inter-connected world, understanding, accepting, and imbibing cultural diversity is an important trait for organizations to sustain themselves and grow.Big Think: Having Bill Nye, TheScienceGuy, on board is a big achievement for Big Think which aims to be an idea hub, an "Youtube for ideas" as its founders put it.F. OthersBob Sutton: Bob, a Professor of Management Science at Stanford, writes on everything including, but not limited to, workplace culture, book reviews, team management, employee management etc.Harvard Business Review: HBR is the most popular published management magazine that covers almost everything relevant to an MBA degree. If there has to be a starting point for an MBA student/aspirant, this is it.#4. Youtube ChannelsTakshzila shikshak: A very well structure and exhaustive resource that replicates the offline classroom model. They cover the entire range of topics for CAT and other MBA entrance exams in India - quantitative ability, vocabulary, logic, reasoning, reading comprehension, grammar, data sufficiency and data interpretation.Other similar resources include:handakafundaCareer Launcher2IIM CAT PreparationByju'sEndeavor Careers Pvt. Ltd.Harvard Business Review: Touching on the nuances of business - strategy formulation and execution, role of a CEO, disruption, stress management, and overall professional development as a manager or an entrepreneur.MBAbullshitDotCom: Topic-wise video lectures on the various basics of Finance - stock and bond markets, valuations, Corporate Finance, Accounting et al.Minute MBA by OnlineMBA.com: Illustrated lessons primarily on entrepreneurship, people management, and innovation.ehowfinance: Another great resource, but focuses more on personal finance, budgeting, accounting, insurance, taxation etc.#1. You also can watch the Economics playlists on CrashCourse. It is one of the best channels on Youtube for learning any subject starting from a blank slate.#2. Marketing Management#3. Corporate Finance#4. Understanding Financial Markets (Yale classes by the Nobel Laureate in Economics, Professor Roberyt Schiller)#5. Augment your vocabulary (primarily meant for GRE aspirants, however is applicable for most MBA entrance exams)#6. Data InterpretationA few other videos you might find useful.#1. Understanding how the Stock Exchange works#2: Money and credit#5. Online CoursesA. Business and management (mostly beginner courses)Basics of supply chain management (SCM)Basics of MarketingBasics of OperationsBasics of digital marketingB. Economics and financeFinancial markets: A must take. The course is being taught by the renowned Nobel-laureate and Yale Prof Robert Shiller and will cover a lot of concepts of Financial markets and their machinations. Apart from the basics, it will also cover certain aspects of behavioral finance and financial crises and the role of regulations.Microeconomics: Will cover the basics of Microeconomics from supply-demand, market efficiency, types of competitions, market power and public goods and externalities.Introduction to finance: Basics - time value of money and valuationsC. Statistics and data analysisRegression models: The course looks at the various regression models and special cases like ANOVA. All of which is taught in the 1st year.Data analysis and statistical inference: Estimation, confidence intervals, decision making based on data analysis etc.Data visualization: Will be helpful both during and after the MBA. How to present the data in the most impactful manner, use software to make complex designs etc.Other useful courses:Social EntrepreneurshipIntroduction to Probability#6. Movies12 Angry Men (1957): A wonderful movie that was part of my MBA curriculum, 12 Angry Men is probably the best thing you can watch on the art of negotiation and persuasion.To Kill a Mockingbird (1962): I love the book and I make no effort to hide it. The 1962 adaptation by Robert Mulligan does complete justice to the book. It's a life lesson everyone should learn. It teaches you kindness, courage, and unflinching devotion to the pursuit of justice even in the face of overwhelming odds.More about the book and what makes it great: Deepak Mehta (दीपक मेहता)'s answer to Why do you like the book 'To Kill a Mockingbird,' and why should I read it?Up in the Air (2009): As a manager (post your MBA), one of the hardest aspects of your job would be to fire people. In this movie, George Clooney will teach you how to do it.The Pursuit of Happyness (2006): On why persistence is important.Wall Street (1987): A lesson, and a warning, on the lengths to which brokers and financial analysts went to in order to achieve success and fame.The Social Network (2010): For the rabble-rousers. The ones who don't respond well to authority. The dreamers. The entrepreneurs.Too Big To Fail (2011): A documentary on the Financial Crisis of 2008.Margin Call (2011): Chronicles the initial stages of the 2008 crisis. And how corporate greed condemned the world to a period of financial upheaval and meltdown.Inside Job (2010): The final movie on the 2008 crisis. And the best.The Wolf Of Wall Street (2013): Based on the life of Jordan Belfort, a broker/trader, and another victim of the Wall Street Lust.

Yes - they are, and it will accelerate from here.Reshoring Is on the Rise: What It Means for the Trade DebateIn 2017 job announcements due to reshoring and FDI grew at the fastest rate in history. The cumulative return of over half a million jobs since 2010 equals over 50% of the total increase in U.S. manufacturing jobs during that period.In 2017 the combined reshoring and related foreign direct investment (FDI ) announcements surged, adding over 171,000 jobs in 2017, with an additional 67,000 in revisions to the years 2010 through 2016. This brings the total number of manufacturing jobs brought to the U.S. from offshore to over 576,000 since the manufacturing employment low of 2010. The 171,000 reshoring and FDI job announcements equal 90% of the 189,000 total manufacturing jobs added in 2017.In 2017 announcements of combined Reshoring and FDI jobs were up 122% compared to unrevised 2016 totals and 52% compared to revised 2016 totals. We believe the huge increases were largely based on anticipation of greater U.S. competitiveness due to expected corporate tax and regulatory cuts following the 2016 election. Similar to the previous few years, FDI continued to exceed reshoring in terms of total jobs added, but reshoring has closed most of the gap since 2015.This report contains data on trends in U.S. reshoring announcements by U.S. headquartered companies and FDI by foreign companies that have shifted production or sourcing from offshore to the U.S. The data is cumulative 2010 through 2017 and is for the U.S. only, unless otherwise noted.We observe from our 2017 data on reshoring, combined with other Reshoring Initiative reports, that:• It is now clear that U.S. manufacturing, including foreign-owned plants, can be started up or grown to support a substantial flow of work back to the U.S.• U.S. and foreign companies increasingly recognize that it is in their interest to supply more of the U.S. market by local production and sourcing.• Based on timing of announcements, much of the surge was due to the anticipation of lower taxes and regulations and higher tariffs. To bring back more than about 10% of the five million offshored jobs will require more U.S. competitiveness, more leveling of the playing field—including some combination of lower USD, stronger skilled workforce training, still lower corporate tax rates, and a VAT (Value Added Tax).• Bringing so many jobs from offshore disproves the weak claim that only 4 to 13% of the decline in manufacturing jobs has been due to offshoring, with the rest to automation. If so few had been lost to offshoring, so many could not be recovered in one year.See also BCG report on US manufacturing renaissance from 2011. Also the update here. And the book on US manufacturing renaissance is very well worth reading.Reshoring of Manufacturing to the US Gains MomentumBCG Report: USA To Experience Manufacturing RenaissanceHere's the Boston Consulting Company's press release in full:Within the next five years, the United States is expected to experience a manufacturing renaissance as the wage gap with China shrinks and certain U.S. states become some of the cheapest locations for manufacturing in the developed world, according to a new analysis by The Boston Consulting Group (BCG).With Chinese wages rising at about 17 percent per year and the value of the yuan continuing to increase, the gap between U.S. and Chinese wages is narrowing rapidly. Meanwhile, flexible work rules and a host of government incentives are making many states—including Mississippi, South Carolina, and Alabama—increasingly competitive as low-cost bases for supplying the U.S. market."All over China, wages are climbing at 15 to 20 percent a year because of the supply-and-demand imbalance for skilled labor," said Harold L. Sirkin, a BCG senior partner. "We expect net labor costs for manufacturing in China and the U.S. to converge by around 2015. As a result of the changing economics, you're going to see a lot more products 'Made in the USA' in the next five years."After adjustments are made to account for American workers' relatively higher productivity, wage rates in Chinese cities such as Shanghai and Tianjin are expected to be about only 30 percent cheaper than rates in low-cost U.S. states. And since wage rates account for 20 to 30 percent of a product's total cost, manufacturing in China will be only 10 to 15 percent cheaper than in the U.S.—even before inventory and shipping costs are considered. After those costs are factored in, the total cost advantage will drop to single digits or be erased entirely, Sirkin said.Products that require less labor and are churned out in modest volumes, such as household appliances and construction equipment, are most likely to shift to U.S. production. Goods that are labor-intensive and produced in high volumes, such as textiles, apparel, and TVs, will likely continue to be made overseas."Executives who are planning a new factory in China to make exports for sale in the U.S. should take a hard look at the total costs. They're increasingly likely to get a good wage deal and substantial incentives in the U.S., so the cost advantage of China might not be large enough to bother—and that's before taking into account the added expense, time, and complexity of logistics," said Sirkin, whose most recent book, GLOBALITY: Competing with Everyone from Everywhere for Everything, deals with globalization and emerging markets.Indeed, a number of companies, especially U.S.-based ones, are already rethinking their production locations and supply chains for goods destined to be sold in the U.S. For some, the economics have already reached a tipping point.Caterpillar Inc., for example, announced last year the expansion of its U.S. operations with the construction of a new 600,000-square-foot hydraulic excavator manufacturing facility in Victoria, Texas. Once fully operational, the plant is expected to employ more than 500 people and will triple the company's U.S.-based excavator capacity. "Victoria's proximity to our supply base, access to ports and other transportation, as well as the positive business climate in Texas made this the ideal site for this project," said Gary Stampanato, a Caterpillar vice president.NCR Corp. announced in late 2009 that it was bringing back production of its ATMs to Columbus, Georgia, in order to decrease the time to market, increase internal collaboration, and lower operating costs. And toy manufacturer Wham-O Inc. last year returned 50 percent of its Frisbee production and its Hula Hoop production from China and Mexico to the U.S."Workers and unions are more willing to accept concessions to bring jobs back to the U.S.," noted Michael Zinser, a BCG partner who leads the firm's manufacturing work in the Americas. "Support from state and local governments can tip the balance."Zinser noted that executives should not make the mistake of comparing the average labor costs for production workers in China and the U.S. when making investment decisions. The costs of Chinese workers are still much cheaper, on average, than comparable U.S. workers, and some managers may assume that China is a better location. But averages can be deceiving."If you're just comparing average wages in China against those in the United States, you're looking at the problem in the wrong way," Zinser cautioned. "Average wages don't reflect the real decisions that companies have to make. Averages are historical and based on the country as a whole, not on where you would go today.""In the U.S., we have highly skilled workers in many of our lower-cost states. By contrast, in the lower-cost regions in China it's actually very hard to find the skilled workers you need to run an effective plant," added Doug Hohner, another BCG partner who focuses on manufacturing.Even as companies reduce their investment in China to make goods for sale in the U.S., it is clear that China will remain a large and important manufacturing location. First, investments to supply the huge domestic market in that nation will continue. Second, in the absence of trade barriers that prevent offshoring, Western Europe will continue to rely on China's relatively lower labor rates since the region lacks the flexibility in wages and benefits that the U.S. enjoys.Third, even though other low-cost countries—such as Vietnam, Thailand, and Indonesia—will benefit from companies seeking wage rates that are lower than China's, only a portion of the demand for manufacturing will shift from China. Smaller low-cost countries simply lack the supply chain, infrastructure, and labor skills to absorb all of it, Hohner noted.Here is the book:https://www.bcg.com/documents/file84471.pdfI’m not just talking about this after it happened either. It was a core theme of my macro fund (now defunct) back in July 2012. Most entertaining to visit investors and counterparties in New York and tell them “America is a great country”, because for most of my life before that the situation was reversed. Now I was the bull on the US and the people who lived there had lost all confidence.It’s not because of Trump exactly, but at the same time it’s not got nothing to do with him either.What happened is the following.I’ve personally been very negative on the US since I first visited as a teenager paying my own way in 1989. It was a society that got some very basic things completely wrong, and seemed to have broken the normal feedback loops (everyone has problems, but what matters is what you do once you encounter problems) because of the dominance of the socially-constructed world over reality.Simple example of this. My father - an immigrant to Britain without any special financial resources or contacts - took us off sugar in 1979/1980ish for essentially the same reasons that would motivate people to do that today (against strong medical advice to the contrary). Ken Griffin sent out an email to Citadel people around about 2004/2005 pointing out the massive flaws with the standard dietary advice. And it’s only post 2008 that this really started to gain traction in the broader media. Something is broken with a society that takes thirty years to close a loop like that!I’ve been becoming more positive on the US since about 2011. The US quietly started on a path to becoming very competitive from 2009 onwards and started fixing its problems. Anatole Kaletsky said before the crisis in a debate with Marc Faber that ‘a problem deferred is a problem solved’. What a contemptible attitude! I believe that a problem recognised is on its way to being solved.Thus the media cascade of negative information about the US should not be cause for gloom but for rejoicing! Finally - people start to wake up to all those things that have been broken forever.Is the US dollar bottoming?So BCG wrote this report in 2011 saying that within five years there would be a US manufacturing renaissance. The US started to become very competitive in some areas but was seriously held back in others.I believe - as does John Taylor, creator of the Taylor Rule in monetary policy - that the US economy is a caged lion. Take off the muzzle and the economy will roar! And indeed that’s what’s happening now.Take Off the Muzzle and the Economy Will RoarCan We Restart This Recovery All Over Again?I have argued for some time that a change in policy could transform the not-so-great recovery into a great one of the kind experienced following earlier financials crises. But many now say it’s too late: if you missed the fast growth of a V-shaped recovery at the start, you’re not going to get it now. In several respects, however, the current position of the economy is like the bottom of a recession. The labor force participation is lower than at the bottom of the recession and productivity growth is down. From this position a change in policy could generate a post-recession-like boom for several years and a higher steady state growth rate thereafter, just as in the graphs. At the least it is an issue for debate, and it looks like I’ll have a good one at the upcoming session on this topic at the AEA meetings in January with Blanchard, Feldstein, Fischer and Stiglitz.Donald Trump is not my cup of tea as the sort of person who should lead a great nation. (Neither were Hillary Clinton and Bernie Sanders). But the sort of person I think should be a leader simply could not be elected in the current year, and so it’s an exercise in futility to will the world to be something other than what it is right now. (Longer term dreaming plus action can change everything of course).As a philosophical anarcho-capitalist with some sympathy for monarchy, I’m much more concerned about understanding reality than cheering for a political side. Thus the question isn’t whether I like the guy, but what are likely to be the consequences of policy? We’re in the domain of positive, value-free, economics (given current and likely future policy, what is likely to happen), not in the domain of assessing policy from an ethical perspective. The latter is an interesting question, but it has nothing to do with what will happen - people ought to be able to separate the two ways of looking at the world, but it’s very difficult.Back in the 1990s people like Bill Clinton used to talk about national competitiveness - one State of the Union address was even devoted to that topic. Well, I think competitiveness is the wrong framing, but for the present purpose it will do.Clinton was a more graceful speechwriter than Trump, and the problems he faced were not the same and nor were his solutions. But what’s similar is quite interesting. Clinton actually cut spending, by the way. I wonder if that might still be possible today.Bill Clinton's First State of the Union AddressFor too long we have drifted without a strong sense of purpose or responsibility or community.And our political system so often has seemed paralyzed by special interest groups, by partisan bickering, and by the sheer complexity of our problems. I believe we can do better because we remain the greatest nation on Earth, the world's strongest economy, the world's only military superpower. If we have the vision, the will, and the heart to make the changes we must, we can still enter the 21st century with possibilities our parents could not even have imagined and enter it having secured the American dream for ourselves and for future generations.I well remember 12 years ago President Reagan stood at this very podium and told you and the American people that if our national debt were stacked in thousand-dollar bills, the stack would reach 67 miles into space. Well, today that stack would reach 267 miles. I tell you this not to assign blame for this problem. There is plenty of blame to go around in both branches of the Government and both parties. The time has come for the blame to end. I did not seek this office to place blame. I come here tonight to accept responsibility, and I want you to accept responsibility with me. And if we do right by this country, I do not care who gets the credit for it.…Tonight I want to talk with you about what Government can do because I believe Government must do more. But let me say first that the real engine of economic growth in this country is the private sector, and second, that each of us must be an engine of growth and change. The truth is that as Government creates more opportunity in this new and different time, we must also demand more responsibility in turn.Our immediate priority must be to create jobs, create jobs now. Some people say, "Well, we're in a recovery, and we don't have to do that." Well, we all hope we're in a recovery, but we're sure not creating new jobs. And there's no recovery worth its salt that doesn't put the American people back to work.…Second, our plan looks beyond today's business cycle because our aspirations extend into the next century. The heart of this plan deals with the long term. It is an investment program designed to increase public and private investment in areas critical to our economic future.…Over the long run, all this will bring us a higher rate of economic growth, improved productivity, more high-quality jobs, and an improved economic competitive position in the world.…Because small business has created such a high percentage of all the new jobs in our Nation over the last 10 or 15 years, our plan includes the boldest targeted incentives for small business in history. We propose a permanent investment tax credit for the smallest firms in this country, with revenues of under $5 million. That's about 90 percent of the firms in America, employing about 40 percent of the work force but creating a big majority of the net new jobs for more than a decade. And we propose new rewards for entrepreneurs who take new risks. We propose to give small business access to all the new technologies of our time.Trump Policies Pushed U.S. Back Into No. 1 On Competitiveness RankingEconomy: Have Donald Trump's policies had a big impact on the U.S. economy and its competitiveness? The answer, we think, is an obvious yes. Now comes a new report, based mainly on "hard" data, that confirms that.The report comes from the IMD Competitiveness Center in Switzerland. Each year it ranks countries by 256 different variables to come up with its global competitiveness rankings.For 2018, there was a surprise: The U.S. leapt three places to take over the top spot in global competitiveness — just ahead of Hong Kong, Singapore, the Netherlands and Switzerland. That jump was based on its "strength in economic performance and infrastructure," ranking first in both areas.That this is so shouldn't shock anyone with any knowledge of what's going on in the economy.Meanwhile, Trump continues to slash away at the thicket of regulations that strangles the U.S. economy, costing us collectively nearly $2 trillion a year. All of this has helped to fuel an economic renaissance of sorts. U.S. households are $7.1 trillion richer since Trump entered office, thanks to rising share prices and strong real estate markets.Just to be clear, we're not citing this one report as a be-all and end-all for competitiveness or even for the fate of the economy. Nor are we in the forecasting business.But others are, and among them have been some of Trump's fiercest critics. To read what they wrote and said, the U.S. returning to No. 1 in competitiveness wouldn't just be unlikely — it would be impossible.Just last November, for instance, a blog post on the Economic Policy Institute's website informed us that "Republican tax plan will reduce American competitiveness." That was, to be kind, wide of the mark.Similarly, the liberal Brookings Institution opined in March of last year that "Trump's 'America First' budget will leave the economy running behind." Didn't happen.…"We are probably looking at a global recession, with no end in sight," said New York Times columnist and Nobelist Paul Krugman, just one day after Trump won the election."Under Trump, I would expect a protracted recession to begin within 18 months. The damage would be felt far beyond the United States," said Larry Summers, the former top economist for Presidents Bill Clinton and Barack Obama, speaking in the summer of 2016."If the unlikely event happens and Trump wins you will see a market crash of historic proportions," agreed MSNBC's Steve Rattner, a former Obama administration official, speaking in October of 2016.The US has been held back by bad courts and bad policy. This is not a matter about which any opinion can be arbitrarily held because there is a burgeoning literature on economic policy uncertainty, and policy uncertainty after 2009 was unusually elevated. See Economic Policy Uncertainty Index as one place to start.Measuring Economic Policy UncertaintyWe develop a new index of economic policy uncertainty (EPU) based on newspaper coverage frequency. Several types of evidence – including human readings of 12,000 newspaper articles – indicate that our index proxies for movements in policy-related economic uncertainty. Our US index spikes near tight presidential elections, Gulf Wars I and II, the 9/11 attacks, the failure of Lehman Brothers, the 2011 debt-ceiling dispute and other major battles over fiscal policy. Using firm-level data, we find that policy uncertainty raises stock price volatility and reduces investment and employment in policy-sensitive sectors like defense, healthcare, and infrastructure construction. At the macro level, policy uncertainty innovations foreshadow declines in investment, output, and employment in the United States and, in a panel VAR setting, for 12 major economies. Extending our US index back to 1900, EPU rose dramatically in the 1930s (from late 1931) and has drifted upwards since the 1960s.This is not even a new insight - it certainly precedes the notorious alt-right thinker Lord Keynes who wrote in the General Theory:John Maynard KeynesEven apart from the instability due to speculation, there is the instability due to the characteristic of human nature that a large proportion of our positive activities depend on spontaneous optimism rather than on a mathematical expectation, whether moral or hedonistic or economic. Most, probably, of our decisions to do something positive, the full consequences of which will be drawn out over many days to come, can only be taken as a result of animal spirits — of a spontaneous urge to action rather than inaction, and not as the outcome of a weighted average of quantitative benefits multiplied by quantitative probabilities. Enterprise only pretends to itself to be mainly actuated by the statements in its own prospectus, however candid and sincere. Only a little more than an expedition to the South Pole, is it based on an exact calculation of benefits to come. Thus if the animal spirits are dimmed and the spontaneous optimism falters, leaving us to depend on nothing but a mathematical expectation, enterprise will fade and die; — though fears of loss may have a basis no more reasonable than hopes of profit had before.It is safe to say that enterprise which depends on hopes stretching into the future benefits the community as a whole. But individual initiative will only be adequate when reasonable calculation is supplemented and supported by animal spirits, so that the thought of ultimate loss which often overtakes pioneers, as experience undoubtedly tells us and them, is put aside as a healthy man puts aside the expectation of death.This means, unfortunately, not only that slumps and depressions are exaggerated in degree, but that economic prosperity is excessively dependent on a political and social atmosphere which is congenial to the average business man. If the fear of a Labour Government or a New Deal depresses enterprise, this need not be the result either of a reasonable calculation or of a plot with political intent; — it is the mere consequence of upsetting the delicate balance of spontaneous optimism. In estimating the prospects of investment, we must have regard, therefore, to the nerves and hysteria and even the digestions and reactions to the weather of those upon whose spontaneous activity it largely depends.Since the midterm elections in 2014, and most notably since the presidential elections of 2016 there has Updatebeen a drop in average policy uncertainty and a stunning revival in animal spirits - particularly that of small businesses. Small businesses create more than 100% of all the jobs.You can see that policy uncertainty in the US has been unusually elevated for a prolonged period of time since 2009. The highest spike was actually higher than after 9/11! That kind of environment, as Lord Keynes observed, is the sort of thing that will depress enterprise.It’s not a partisan thing either.So it’s not that surprising that as policy uncertainty has diminished, optimism has sky-rocketed.You can see that after 2009 regulation became the single biggest problem for small business and that since 2014 it started to become much less important.Problem today is that you just can’t get the staff.Small Businesses Hiring or Trying to Hire Hits Nineteen Year High in NFIB June Jobs ReportA vibrant democracy depends on a strong, free, private sector. The Administration and Congress have implemented important policy changes that strengthen the private sector. The new tax code is returning money to the private sector where history makes clear it will be better invested than by a government bureaucracy. Regulatory costs, as significant as taxes, are being reduced.The private sector must not be deprived of its right to manage its economic affairs. History has proven that governments cannot deliver the success that a free economy can. There is much more work to be done. Rising healthcare costs have not been addressed and tax code complexity continues to burden small business owners, but we are on the right path.These “big picture” developments are supporting a Main Street economy that is on fire. Hiring is proceeding as fast as labor supply issues allow, compensation is at record high levels, and capital spending the strongest in decades as owners feel it is once again a good time to expand their firms.Sales are historically strong and positive profit trends at the best level in the survey’s history. Accounting for about half of the economy, Main Street is definitely driving economic growth and employment to higher levels.Did Trump really deregulate? Let’s see what the conservative Heritage Foundation had to say.Trump Administration Embraces Heritage Foundation Policy RecommendationsOne year after taking office, President Donald Trump and his administration have embraced nearly two-thirds of the policy recommendations from The Heritage Foundation’s “Mandate for Leadership.”The “Mandate for Leadership” series includes five individual publications, totaling approximately 334 unique policy recommendations. Analysis completed by Heritage determined that 64 percent of the policy prescriptions were included in Trump’s budget, implemented through regulatory guidance, or under consideration for action in accordance with The Heritage Foundation’s original proposals.Heritage Foundation research analysts began developing the policy recommendations in 2016 during the presidential campaign with the following principles in mind: free enterprise, limited government, individual freedom, traditional American values, and a strong national defense.With approximately 70 former Heritage employees working for the Trump transition team or as part of the administration, the policy recommendations have served as guidelines for reducing the size and scope of the federal government through specific and detailed actions.The first “Mandate for Leadership” was released in January 1981, containing policy proposals of reform that would make government more efficient and effective. President Ronald Reagan distributed Heritage’s book at his first Cabinet meeting.“As President Reagan did in the 1980s,” Binion said, “President Trump has embraced the comprehensive recommendations made in the ‘Mandate for Leadership.’ These achievements have led to economic growth, a stronger national defense, and a restoration of the rule of law.”So the US was held back by high corporate taxes, an unfriendly attitude towards free markets and business (visible in the chart above of regulation being the single biggest problem) and to some extent bad courts. Corporate taxes are now very very favourable for expansion at home. The new administration has done a copy paste of proposals written by the Heritage Foundation as regards regulation, and behold above the results. We will also have a business-friendly Supreme Court for decades and that has similarly had a supportive impact on animal spirits.One interesting question remains. At Cambridge my first year Director of Studies was Lord Eatwell, Labour spokesman in the House of Lords. Now and then he would still be on the phone to Gordon Brown at the beginning of our supervision. He was known for his book “Whatever Happened to Britain”, which in 1979 advocated erecting a tariff walk around the UK to revive manufacturing. That would have been a terrible idea. But I do wonder if he might not have been somewhat right about the importance of Kaldor-Verdoon's Law.Verdoorn's law - WikipediaVerdoorn's law differs from “the usual hypothesis … that the growth of productivity is mainly to be explained by the progress of knowledge in science and technology”,[4] as it typically is in neoclassical models of growth (e.g. the Solow model). Verdoorn's law is usually associated with cumulative causation models of growth, in which demand rather than supply determine the pace of accumulation.Nicholas Kaldor and Anthony Thirlwall developed models of export-led growth based on Verdoorn's law. For a given country an expansion of the export sector may cause specialisation in the production of export products, which increase the productivity level, and increase the level of skills in the export sector. This may then lead to a reallocation of resources from the less efficient non-trade sector to the more productive export sector, lower prices for traded goods and higher competitiveness. This productivity change may then lead expanded exports and to output growth.If you read the Trump plan the motivation for policy is clearly spelled out. Reading it took me back to Cambridge days because many of the manufacturing points fell out of fashion in subsequent years. But it might be that the Keynesians had a point on this one thing. The other points are not Keynesian at all but rather post neoclassical endogenous growth theory (what we used to call common sense).https://www.google.co.uk/url?sa=t&source=web&rct=j&url=https://assets.donaldjtrump.com/Trump_Economic_Plan.pdf&ved=2ahUKEwjJuI7D9pDcAhXJNcAKHXaRAgkQFjAAegQIABAB&usg=AOvVaw33ktw0PJlUcuckEzHHleyBMarc Faber has been talking for years (like the late Kurt Richebacher) about how due to monetary inflation the productive economy was depressed versus money shuffling, leisure, education, healthcare and government. Okay - and I agree. But what does the productive sector look like? It's not just manufacturing, but quite a lot of it is that plus primary industries like extraction and agriculture.The share of manufacturing in output appeared stable for decades. Employment collapsed implying it was productivity gains and so the jobs won't come back. But I don't believe it, some Fed researchers don't believe it, and the administration doesn't believe it. There were serious measurement problems and I think in fact output wasn't stable as a share of GDP.Trump is a funny kind of conservative if he is one at all. This emphasis on manufacturing is something I haven't seen since Cambridge. (You have to understand that Cambridge is a place where not that many years before Joan Robinson lectured in a Maoist uniform - it's a far left kind of place, on the whole). And the corporate tax cuts and deregulation bit since I worked for a while at the Cato Institute (a free market think tank in Washington DC).Back to the main track.The basic point - thank you for taking off (half of) the muzzle; now the economy is roaring. This time around that will accompany a likely acceleration in reshoring. If the old socialists were right then perhaps some productivity growth too.I guess a few million jobs could come back to manufacturing and businesses servicing manufacturing in some years - maybe by the end of a second term. That would be a brave call, but I don't see why it's not possible. BCG spoke about two to three million jobs, and thought that a conservative number.Manufacturers say every dollar of manufacturing creates another $3.60 of value added elsewhere. Could be.New Study Shows Manufacturing Footprint Much Larger Than PerceivedThis answer is quite long. It's not a simple topic. But you should also read GE (especially the work of Marco Annunziata) and Siemens on the impact of the industrial internet of things and associated technologies. They tend also to encourage the relocalisation of production.Manufacturing final demand is booming. A revival of US production won't come at the expense of others.It's a new Industrial Revolution ahead!

Obesity is often seen as the main contributor to an increasing prevalence of diabetes [8–10] but other factors such as ageing, ethnicity, lifestyle (i.e., physical inactivity and energy dense diet), socioeconomic status, education, and urbanization have also been identified as potentially important factors [11–14].Diabetology & Metabolic SyndromeOpen AccessPublished: 09 November 2016Factors that could explain the increasing prevalence of type 2 diabetes among adults in a Canadian province: a critical review and analysisVéronique Thibault, Mathieu Bélanger, […]Michelina MancusoDiabetology & Metabolic Syndrome volume 8, Article number: 71 (2016) Cite this article15k Accesses16 Citations7 AltmetricMetricsdetailsAbstractBackgroundThe prevalence of diabetes has increased since the last decade in New Brunswick. Identifying factors contributing to the increase in diabetes prevalence will help inform an action plan to manage the condition. The objective was to describe factors that could explain the increasing prevalence of type 2 diabetes in New Brunswick since 2001.MethodsA critical literature review was conducted to identify factors potentially responsible for an increase in prevalence of diabetes. Data from various sources were obtained to draw a repeated cross-sectional (2001–2014) description of these factors concurrently with changes in the prevalence of type 2 diabetes in New Brunswick. Linear regressions, Poisson regressions and Cochran Armitage analysis were used to describe relationships between these factors and time.ResultsFactors identified in the review were summarized in five categories: individual-level risk factors, environmental risk factors, evolution of the disease, detection effect and global changes. The prevalence of type 2 diabetes has increased by 120% between 2001 and 2014. The prevalence of obesity, hypertension, prediabetes, alcohol consumption, immigration and urbanization increased during the study period and the consumption of fruits and vegetables decreased which could represent potential factors of the increasing prevalence of type 2 diabetes. Physical activity, smoking, socioeconomic status and education did not present trends that could explain the increasing prevalence of type 2 diabetes. During the study period, the mortality rate and the conversion rate from prediabetes to diabetes decreased and the incidence rate increased. Suggestion of a detection effect was also present as the number of people tested increased while the HbA1c and the age at detection decreased. Period and birth cohort effect were also noted through a rise in the prevalence of type 2 diabetes across all age groups, but greater increases were observed among the younger cohorts.ConclusionsThis study presents a comprehensive overview of factors potentially responsible for population level changes in prevalence of type 2 diabetes. Recent increases in type 2 diabetes in New Brunswick may be attributable to a combination of some individual-level and environmental risk factors, the detection effect, the evolution of the disease and global changes.BackgroundWith 382 million people living with diabetes in 2013 [1], the World Health Organization declared the condition as being epidemic [2]. It is estimated that diabetes will affect 3.7 million Canadians in 2018, making it the principal health challenge of the country [3]. Diabetes is associated with many health complications. Comparing the population with and without diabetes, those with diabetes have a 300% increased risk of being hospitalized [3]. Annual per capita healthcare costs for people with diabetes are three to four times greater than for individuals without diabetes [3]. New Brunswick is one of the provinces in Canada where the prevalence of diabetes is the highest [3]. The prevalence of diabetes is estimated to have increased by 86% in this province between 2000 and 2010 [4].A population-level increase in prevalence of diabetes may be attributable to a wide range of potential factors [5–7]. Obesity is often seen as the main contributor to an increasing prevalence of diabetes [8–10] but other factors such as ageing, ethnicity, lifestyle (i.e., physical inactivity and energy dense diet), socioeconomic status, education, and urbanization have also been identified as potentially important factors [11–14]. Further findings also suggest that increasing incidence rates of diabetes [15–18] and global changes are other potential explanatory factors (e.g. environmental pollution, obesogenic environment and rapid socioeconomic development) that could affect the entire population [19, 20]. In addition to changes in the prevalence of risk factors, other elements, including increases in screening [10], changes in diagnostic criteria [21], and decreasing mortality rates among individuals with diabetes [15–18, 22–32] could contribute to the rise in prevalence of this condition.Perhaps due to the wide variety of factors potentially responsible for an increase in prevalence of diabetes, no studies have attempted to present a comprehensive list of factors which could be responsible for population-level changes in prevalence of diabetes. A comprehensive list of factors that contribute to the growing prevalence of diabetes would provide a foundation for population health planning in developing successful strategies to address this epidemic of diabetes. As such, the objectives of this study were (1) to develop a comprehensive list of factors to consider when trying to identify causes of change in prevalence of diabetes in a population and (2) to use this list to describe factors that may be responsible for the recent increase in prevalence of type 2 diabetes in New Brunswick.MethodsStep 1: critical review procedureA critical review of the literature was conducted to identify all factors potentially involved in explaining changes in the prevalence of diabetes. A critical review includes an extensive research of the literature and an evaluation of its quality without a systematic research approach [33]. This type of review includes a description of identified articles, synthesizes and analyzes the information to develop an hypothesis or a model for further study [33]. The first step of the critical review was to identify studies that aimed to document a wide range of factors explaining changes in the prevalence of diabetes. The following term was used in the PubMed database to identify only review articles: “Review[ptyp]”. Additional terms were also entered at this step to identify any review articles on the topic of diabetes prevalence, trends, or epidemiology: “prevalence” [title/abstract] AND “diabetes/prevention and control “[majr] OR (“Diabetes” [title/abstract] AND “trends” [title/abstract] OR “diabetes/epidemiology “[majr]). The second step of the critical review searched studies that described other factors without restricting to only review articles. At this point, we used this research procedure “prevalence” [title/abstract] AND (“diabetes/prevention and control “[majr]) OR (“Diabetes” [title/abstract] AND “trends” [title/abstract]). From the 3215 articles of the first research procedure and 1907 of the second, 446 were duplicates. Of the 4676 unique articles, we retained six review articles that presented multiple potential determinants of diabetes prevalence. All other articles were scanned to retain any articles (n = 71) which presented other factors not considered in the review articles identified and to provide additional empirical support to the factors identified in the reviews. In total, 77 articles were included in this critical review.Step 2: description of potential determinants of diabetes prevalenceData sources and study populationThe changes in factors potentially involved in explaining an increase in a population’s prevalence of diabetes identified in the critical review were studied using a descriptive repeated cross sectional analysis approach. De-identified registries of all individuals with diabetes and all individuals with prediabetes were created from New Brunswick Department of Health administrative datasets and were stored in a secured office within the New Brunswick Health Council. Those administrative datasets included the list of all New Brunswickers with provincial healthcare coverage (all Canadian residing in New Brunswick) and a repository of all HbA1c tests conducted between 2001 and 2014. Individuals were identified as having diabetes the first time they had a HbA1c test ≥6.5% (48 mmol/mol) and were excluded from prevalence estimates after they died based on their date of death. Similarly, individuals were identified as having prediabetes the first time they had a HbA1c test between 6.0 (42 mmol/mol) and 6.4% (47 mmol/mol) and were removed from the prediabetes registry if they developed diabetes, or if they had a normal HbA1c test (<6.0%) (<42 mmol/mol), or if they died. Because only type 2 diabetes population was of interest for this study and because it was not possible to differentiate the type of diabetes in the diabetes registry, only those ≥30 years of age at detection were included in the analysis, with no maximum age limit. This approach is used by the New Brunswick Department of Health for their provincial reports and has been used by other authors [6] since diabetes cases diagnosed before this age are more often type 1 diabetes [34]. Other data were obtained from the Canadian Census of Population, the Canadian Community Health Survey, the National Household Survey, the Labour Force Survey and the Income Statistics Division from Statistics Canada. The New Brunswick databases used for this study were completely anonymized and the study was approved by the Institutional Review Board of the Centre hospitalier universitaire de l’Université de Sherbrooke.VariablesPrevalence of diabetes and prediabetes were measured annually as the proportion of individuals with diabetes and the proportion of individuals with prediabetes divided by their respective populations at risk during the fiscal year, defined as April 1st to March 31st. The population at risk was determined based on the number of New Brunswickers aged 30 or older recorded from the annual estimates of the population from Statistics Canada. The denominator for incidence rates corresponded to the at-risk population described above minus the prevalent cases and incident cases during the year. Mortality rate corresponded to the number of people with diabetes who died during the fiscal year. The denominator included all people living with diabetes, including the time alive among those who died within the given year. The conversion rate from prediabetes to diabetes was calculated as the number of individuals with prediabetes who developed diabetes during the fiscal year over the number of individuals with prediabetes. Number of people with HbA1c testing was defined annually as the number of people with at least one HbA1c test during the fiscal year. Age at detection was derived from the date at which the first test attained the diagnostic threshold and the documented birth date of the individuals. HbA1c at detection was obtained by averaging the HbA1c value at detection of all incident cases for each fiscal year. The breakdown of the population by age groups was obtained from 2001 to 2014 from annual estimates of the entire New Brunswick population from Statistics Canada. The prevalence of select risk factors was determined from self-reported information available for the New Brunswick population from the Canadian Community Health Survey in 2003, 2005 and annually from 2007 to 2014 for people aged 35 years old and greater. These risk factors included obesity (body mass index ≥30, calculated from self-reported height and weight data), hypertension (self-reported diagnosis received from a healthcare professional), consumption of fruits and vegetables (eating fruits and vegetables usually more than five times per day), physical activity (categorized as active or inactive based on the average daily physical activity reported for the 3 previous months), alcohol consumption (having drunk more than five glasses of alcohol at one occasion, at least once a month during the last year—note that because of changes in definitions in 2013, only data up to 2012 were considered herein) and smoking (smoking cigarettes every day). Level of education (number of people who completed high school; number with a university degree) was obtained from the Labour Force Survey from 2001 to 2014. Socioeconomic status (percentage of people having low income before taxes) was available from 2001 to 2011 from the Income Statistics Division of Statistics Canada and urbanization (people living in a rural area, defined as any territory situated outside population centers which contain a population of at least 1000 person and a density of 400 or more person by square kilometer) was obtained from Census data for 2001, 2006 and 2011. Ethnicity (percentage of immigration used as a proxy for ethnicity herein) was also obtained from Census data for 2001 and 2006 and from the National Household Survey for 2011.Statistical analysisCochran–armitage analyses of trend were used to assess the association between time (fiscal year) and variables represented as yearly prevalence. Poisson regressions were used to assess associations between time and mortality rate and between time and conversion rate from prediabetes to diabetes. Linear regressions were used to assess time trends in number of people who undergone HbA1c testing, the average value of HbA1c and the average age at detection. Assessing the presence of a period effect was done by calculating the prevalence of diabetes across 10 year age groups (30–39, …, 90+) for each fiscal year. Assessing for the presence of a birth cohort effect was also done by calculating the prevalence of diabetes among decade-of-birth-based cohorts (1910–1920, …, 1961–1970) for each fiscal year.ResultsFrom 101,519 individuals identified with diabetes in the registry between 2001 and 2014, 97,865 individuals were included because they were diagnosed at 30 years old or older. The prevalence of type 2 diabetes increased by an average of 6.4% per year over this time period, which represents an overall increase of 120% (Table 1). The critical literature review identified several factors that could potentially explain such a change in the prevalence of diabetes at a population level. The factors have been grouped in five categories (Table 2) which are defined below. A description of these factors from 2001 to 2014 in New Brunswick is also presented to better understand how they could have contributed to the rise in prevalence of diabetes in this region. In Table 2, factors for which we found information and which we included in the analyses are presented in italics.Table 1 Description of factors related to the prevalence of type 2 diabetesFull size tableTable 2 Factors potentially involved in explaining changes in a population’s prevalence of diabetesFull size tableIndividual-level risk factorsAccording to the literature review, the rise in a population’s prevalence of diabetes could be attributed to increases in that population’s prevalence of individual-level risk factors for the condition. Concurrently, we noted a marked increase in the prevalence of prediabetes from 2001 to 2014 (Table 1). Increases were also noted in the prevalence of obesity, hypertension, alcohol consumption, and immigration over the same period of time. During the study period, we also found the population was aging and that the prevalence of consumption of fruits and vegetables decreased.However, the proportion of people reporting a physically active lifestyle, sedentary behaviours, tobacco smoking, having completed high school and university education, and being of low income evolved in directions that were opposite to the direction expected to be considered as a factor contributing to the increasing prevalence of diabetes.Environmental risk factorsThe literature review has shown that some environmental risk factors such as the presence of environmental pollutants (such as nitrogen dioxide (NO2), particulate matter (PM), organic persistent pollutants and non-persistent pesticides), urbanization and rapid socioeconomic development could explain part of the increase in the prevalence of diabetes. In this study, the only factor that was possible to measure was the urbanization based on the proportion of people living in a rural area. This proportion decreased during the study period and evolved in a direction supporting that it may have influenced the increase in prevalence of diabetes in New Brunswick (Table 1).Evolution of the diseaseSome factors characterizing the evolution of the disease, including survival time among individuals with diabetes, number of new cases of diabetes and conversion to diabetes from prediabetes population, could explain the increase in the prevalence of diabetes. In this study, we found that only two of these factors evolved in the direction expected if these factors were to explain the increase in prevalence of diabetes. The incidence rate increased from 2001 to 2014 and a higher increase in the incidence rate was seen around 2002 and 2005 (Table 1). The mortality rate of the population with diabetes decreased in the same period. In contrast, the conversion rate from prediabetes to diabetes could not explain the increase in prevalence of diabetes because it decreased during this period.Detection effectThe literature review also suggested that a change in prevalence of disease could be attributed to changes in how the condition is identified. The detection effect could be related to an increase in the number of people being screened or diagnosed, an earlier detection of the disease and changes in diagnostic criteria. Accordingly we found that the number of people tested for HbA1c increased from 2001 to 2014 and showed a higher increase around 2003 and 2010 (Fig. 1). Concurrently, the mean HbA1c at detection decreased between 2001 and 2014 suggesting that people are being diagnosed earlier in the evolution of the disease (Table 1). It was also noted that the percentage of individuals with diabetes previously identified with prediabetes increased from 2001 to 2014, also suggesting that people are being detected at an earlier stage of their disease. The average age at detection also supports the presence of a detection effect since data suggest that people are being diagnosed at a younger age.Fig. 1figure1Number of individuals who received at least one HbA1c test by fiscal yearFull size imageGlobal changesChanges in any or a combination of factors above may affect all of the population regardless of people’s age (period effect). Changes in factors could also be more pronounced in segments of the population, based on the year of birth (birth cohort effect). In this study, the presence of a period effect was supported by an increase in the prevalence of type 2 diabetes from 2001 and 2014 in each age group, with the 40–49 year old age group displaying a greater increase (Fig. 2a). The presence of a birth cohort effect was also suggested since the increase in prevalence of type 2 diabetes was considerably greater among the youngest birth cohort compared to the oldest birth cohorts (Fig. 2b).Fig. 2figure2a Relative percentage of change in prevalence of type 2 diabetes by age groups (2001–2014). b Relative percentage of change in prevalence of type 2 diabetes by birth cohort group (2001–2014)Full size imageDiscussionThe prevalence of type 2 diabetes has more than doubled in the past 15 years in New Brunswick. Although this prevalence change is relatively greater than changes noted elsewhere, this is consistent with the increase in prevalence in diabetes observed in recent years in other provinces and countries around the world [69, 72]. To help identify factors responsible for this increase, our literature review led to the identification of five categories of factors which together represent a comprehensive overview of factors that could explain a change in prevalence of diabetes. Our review included considerably more potential factors than what had been reported in other literature reviews [5–7, 35, 57, 73]. Guided by this inventory, we assessed the changes in nearly all factors suggested to potentially influence the prevalence of diabetes in New Brunswick. Through this work, we identified that changes in prevalence of diabetes in New Brunswick are likely attributed to a combination of numerous factors.Among individual-level risk factors identified in the critical review, our analysis suggests that the presence of other conditions, such as the aging population, obesity, hypertension and prediabetes could contribute to explain the increase in prevalence of type 2 diabetes in New Brunswick. Furthermore, although immigration increased in NB, it is difficult to conclude that ethnicity might have an effect on the prevalence of type 2 diabetes in NB since no information is available on ethnic origin of immigrants in the databases used.An increase in prevalence of obesity or body mass index has been linked to increases in the prevalence of diabetes in many other studies [8, 37–39, 68] and authors suggested it is the most important contributor to increases in prevalence of diabetes [8–10]. Consistent with changes in body composition of the population, we also noted that diet quality decreased over the study period. However, our data suggest that New Brunswickers became more physically active in the past 15 years, which does not concord with trends for obesity and diabetes. It has been suggested that this discrepancy may be attributable to measurement error associated with the use of self-reported measures [74]. Self-reported measures, such as physical activity levels, are suspected to have been influenced by an increase in social desirability possibly creating higher estimates over the years [74]. However, our results are consistent with the apparent increase in prevalence of a physically active lifestyle in the United States from 2001 and 2009, which seems to have had minimal impact on reducing the burden of obesity [75]. Among the potential for environmental risk factors to have influenced diabetes, we only had access to data relating to urbanization and these suggested that the transition from a predominantly rural to an urban population accompanied the increase in prevalence of diabetes in New Brunswick. This transition may mean that a greater proportion of the population may be exposed to obesogenic environments such as more sedentary work, higher use of car and public transport, television viewing and in short, lower levels of physical activity [6]. Although environmental pollution can be present in rural regions, it is also possible that urbanization has led to more exposure to pollutants. A meta-analysis has shown that the prolonged exposition to nitrogen dioxide (NO2), particulate matter less than 2.5 mm (PM2.5), and particulate matter less than 10 micrometers (PM10) was associated to type 2 diabetes incidence in cohort studies [55].Changes in how diabetes evolves may also contribute to explaining a change in how the prevalence of disease increased in New Brunswick. Most particularly, we noted a decline in mortality rates of people with diabetes from 2001 to 2014, which is consistent with results from other studies [18, 22, 23, 26–28, 31]. The 40% decrease in mortality rates observed in our study over 14 years is similar to the 37.2% decrease in mortality witnessed in Ontario between 1996 and 2009 [29]. A longer survival period in the population with diabetes, likely explained by better treatment and control of the disease [48], therefore contributed to the increase in prevalence. An increase in the conversion rate from prediabetes to diabetes could also have explained an increase in diabetes prevalence [65]. However, this study shows a decrease in the conversion rate from prediabetes to diabetes, therefore suggesting either better prevention efforts in this population at risk or a relatively higher proportion of people identified with prediabetes through more screening.As our data indicated, it is highly probable that part of the increase in prevalence of diabetes can be attributed to a detection effect whereby the number of people tested with HbA1c rose markedly during the study period. Although the increase in testing was observed every year, sharper increases appeared to coincide with milestones such as the publication of the 2003 and 2008 guidelines encouraging type 2 diabetes screening [76, 77] and the identification of HbA1c as a recognised diagnostic tool by the American Diabetes Association in 2010 [78]. The possibility of earlier detection of the disease is also supported by a decrease in HbA1c levels and age at detection during the study period. The increase in testing and an early detection may also partly be explained by the study period corresponding with the introduction of financial incentives for physicians to offer recommended care to their patients with diabetes (2010), the implementation of an HbA1c tracking tool created to improve adherence to guidelines (2009) [79] and the Physician Practice profiles implemented in 2010 to aid physicians to identify at risk patients in New Brunswick. It should also be mentioned that although our analysis did not allow for the assessment of the relative contribution of each factor, another study suggested that improvements in detection of diabetes could explain as much as 25% of the increase in the prevalence of diabetes diagnosed since 1970 [10].The fact that an increase in the prevalence of type 2 diabetes was observed in all age groups over the 15 years of study supports the presence of a period effect. The percentage of change in the prevalence of diabetes was nevertheless higher among the 40–49 years old, as it is possible that this group benefited from a higher detection effect than other age groups. The period effect could be attributed to a combination of any of the other factors identified in this study, including urbanization, increases in immigration and an increase in the detection. Other factors not measured, such as rapid socioeconomic development and increase in environmental pollution, could also be at play [19]. The data also presented evidence of a birth cohort effect as we observed higher increases in the prevalence of type 2 diabetes in the younger cohort groups. This could be explained by exposure early in life to some environmental factors related to an increase in obesity, as suggested by Soon et al. [19]. These results are consistent with others who demonstrated that steeper increases in the prevalence of diabetes in the youngest cohort parallel increases in the prevalence of obesity in the younger generations [19, 20]. The development of more obesogenic environment may affect younger people to a greater extent than other age groups since it represents a great proportion of their relative environmental exposure [19]. Further, another study reported that weight gain between 25 and 40 years old was associated with a higher risk of diabetes than a weight gain after 40 years old [80].The present study has some limitations that need to be acknowledged. First, because of the descriptive design of the study, it was not possible to quantify and contrast the relative contribution of each factor. Second, the prevalence of diabetes and prediabetes could be underestimated due to the use of only one diagnostic method (HbA1c test) in determining presence of disease and because HbA1c was only endorsed as a diagnostic method after 2010. However, because the HbA1c test had been in significant use prior to 2010 for the management of the disease [81], we hypothesise that most of the time a diagnosis of diabetes was followed by a HbA1c test a short period after. In the same way, the detection effect measured in part by the number of people tested with a HbA1c could be overestimated by the fact that the HbA1c values for prediabetes or diabetes screening had not been identified before 2010 and we did not consider other screening tests such as fasting glucose and oral glucose tolerance test which were often used before 2010. However, HbA1c test has different sensitivity, specificity and utility than other diagnostic tests such as OGTT and fasting glucose [35] and because of that, it is advisable to use the same diagnostic test over time. Also, even though the HbA1c test is not universally accepted as a diagnostic tool [82] and may be affected by some individual conditions [83], it represents less individual variability than other tests and provides a better reflection of the glucose homeostasis in the long term [84]. Third, because it was not possible to distinguish the type of diabetes in the diabetes registry, it was not possible to exclude gestational diabetes cases and type 1 diabetes was excluded only on the basis of age. However, the 4% exclusion of potential type 1 diabetes individuals is close to the proportion of type 1 diabetes which is estimated to represent about 5-10% of cases of diabetes [85]. Fourth, it was not possible to measure some risk factors because of lack of data available, including gestational diabetes, intra uterin environnment, nutritional transition status, family diabetes history, environmental pollution, rapid socioeconomic development and high triglycerides. Fifth, our description of risk factors was performed concurrently to the change in prevalence of diabetes we were attempting to explain. Since diabetes has a long latency period, it may be appropriate to start describing those factors before 2001. This study also has strengths that need to be highlighted. This is the first study that describes an overview of factors that could explain the increase in prevalence of type 2 diabetes and used a population based analysis to measure almost all of those factors. The majority of analysis was done on the entire New Brunswick population and almost all the data was available for the 15 year period.ConclusionsIn conclusion, this study presents a comprehensive overview of potential factors that could explain the change in the prevalence of type 2 diabetes. This study shows that for the past 15 years, the prevalence of diabetes in New Brunswick has increased considerably and this increase could be explained by many factors including some individual-level and environmental risk factors, the detection effect, the evolution of the disease and global changes. However, the increasing prevalence of diabetes observed may not be as impressive as it appears due to the significant influence of the detection effect and the dramatic decrease in mortality. A better understanding of factors potentially responsible for the increase in type 2 diabetes can assist in making informed decisions about diabetes programs and policies. This study may be used as a template for other countries or provinces to identify factors that could explain the increase in the prevalence of diabetes in their respective jurisdictions. More research is needed to measure the relative contribution of each factor on the increase in prevalence of diabetes by measuring each factor directly at the individual level and to evaluate the change in risk factors earlier in the evolution of the disease.References1.International diabetes federation. Diabetes Atlas 6th edition. 2013 http://www.idf.org/sites/default/files/EN_6E_Atlas_Full_0.pdf. Accessed 15 May 2016.2.World Health Organisation. Diabetes. 2016. Diabetes. Accessed 15 May 2016.3.Public Health Agency Diabetes in Canada: facts and figures from a public health perspective. 2011. Diabetes in Canada: Facts and figures from a public health perspective. Accessed 15 May 2016.4.Canadian diabetes association. The cost of diabetes in New Brunswick. 2009.5.Li H, Oldenburg B, Chamberlain C, et al. 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LB helped with the interpretation of the results. SH helped with the interpretation of the results. BG contributed to the acquisition of the data and interpretation of the results. MM helped with acquisition of the data and the interpretation of the results. VT wrote the first version of the article and MB, EL, LB, MA, SH, BG and MM critically revised the manuscript. All authors approved the final version of the article.AcknowledgementsThe authors would like to thank Michel Arsenault from the New Brunswick Health Council for his previous experience and expertise with these datasets and for facilitating access to the data, and to members of the New Brunswick Department of Health who supported the extraction and transfer of the data.Competing interestsThe authors declare that they have no competing interests.Availability of data and materialThe population-level data used for this study are readily available through open access from Statistics Canada. The individual-level data analyzed remain the intellectual property of the New Brunswick Department of Health. Through a data sharing agreement, the authors are licensed users of the data, and under the licensing agreement are not permitted to share or distribute the data. Researchers wishing to access those data may contact the Maritime Strategy for Patient Oriented Research Support Unit to obtain more information on how to do so: Maritime SPOR SUPPORT Unit.Ethics approval and consent to participateThe databases used for this study were completely anonymized. The study was approved by the Institutional Review Board of the Centre hospitalier universitaire de l’Université de Sherbrooke.FundingVT was funded to do this work through scholarships from the Canadian Institutes of Health Research (CIHR), Diabète Québec, the Centre de Recherche Médicale de l’ Université de Sherbrooke (CRMUS) and the Maritime SPOR support unit (MSSU) which is funded through the CIHR and the New Brunswick Health Research Foundation. EL was also funded through CRMUS and MSSU.Author informationAffiliationsFaculty of Medicine and Health Sciences, Université de Sherbrooke, 2500 boul. de l’Université, Sherbrooke, QC, J1K 2R1, CanadaVéronique Thibault, Mathieu Bélanger, Emilie LeBlanc & Lise BabinCentre de formation médicale du Nouveau-Brunswick, 100 Des Aboiteaux St, Moncton, NB, E1A 7R1, CanadaVéronique Thibault, Mathieu Bélanger, Emilie LeBlanc & Lise BabinVitalité Health Network, 275 Main Street Suite 600, Bathurst, NB, E2A 1A9, CanadaMathieu Bélanger & Lise BabinNew Brunswick Department of Health, 520 King Street, Fredericton, NB, E3B 6G3, CanadaStuart Halpine & Beverly GreeneNew Brunswick Health Council, 100 des Aboiteaux Street, Suite 2200, Moncton, NB, E1A 7R1, CanadaMichelina Mancuso100 rue des Aboiteaux, Pavillon J.-Raymond Frenette, Moncton, NB, E1A 3E9, CanadaMathieu BélangerCorresponding authorCorrespondence to Mathieu Bélanger.Rights and permissionsOpen Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (Creative Commons - Attribution 4.0 International - CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (Creative Commons - CC0 1.0 Universal) applies to the data made available in this article, unless otherwise stated.Reprints and PermissionsAbout this articleVerify currency and authenticity via CrossMarkCite this articleThibault, V., Bélanger, M., LeBlanc, E. et al. Factors that could explain the increasing prevalence of type 2 diabetes among adults in a Canadian province: a critical review and analysis. Diabetol Metab Syndr 8, 71 (2016). Factors that could explain the increasing prevalence of type 2 diabetes among adults in a Canadian province: a critical review and analysisDownload citationReceived01 August 2016Accepted28 October 2016Published09 November 2016DOIFactors that could explain the increasing prevalence of type 2 diabetes among adults in a Canadian province: a critical review and analysisShare this articleAnyone you share the following link with will be able to read this content:Get shareable linkProvided by the Springer Nature SharedIt content-sharing initiativeKeywordsDiabetes mellitusType 2 diabetesEpidemiologyPrevalenceTrendsFactorsDiabetology & Metabolic SyndromeISSN: 1758-5996Contact usSubmission enquiries: Access here and click Contact UsGeneral enquiries: [email protected] more on our blogsReceive BMC newslettersManage article alertsLanguage editing for authorsScientific editing for authorsPoliciesAccessibilityPress centerSupport and ContactLeave feedbackCareersFollow BMCBMC Twitter pageBMC Facebook pageBMC Weibo pageBy using this website, you agree to our Terms and Conditions, California Privacy Statement, Privacy statement and Cookies policy. 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